Content, quality, and reliability of spinal tuberculosis-related videos on Bilibili, TikTok, and Xiaohongshu: a cross-sectional analysis

<title>Abstract</title> <p>Background: Short-video platforms have become common sources of health information, yet the educational value of disease-specific content remains uncertain. For spinal tuberculosis, delayed recognition and poor adherence to prolonged multidrug treatment can lead to deformity and neurological disability, making accurate and actionable communication particularly important. Methods: On July 17, 2026, the first 100 results returned for the Chinese term “脊柱结核” (spinal tuberculosis) were screened on Bilibili, TikTok (Douyin), and Xiaohongshu. Eligible videos were categorized by uploader, presentation format, and medical content. Quality was evaluated using the Global Quality Score (GQS), modified DISCERN (mDISCERN), Journal of the American Medical Association (JAMA) benchmark criteria, and the Patient Education Materials Assessment Tool for audiovisual materials (PEMAT-A/V). Platform and subgroup differences were examined using nonparametric tests, and associations were assessed using Spearman correlations. Results: Of 300 screened videos, 214 were included (Bilibili, n = 53; TikTok, n = 100; Xiaohongshu, n = 61). Professional physicians produced 80.8% of videos, and scientific popularization was the predominant format (79.4%). The median GQS, mDISCERN, JAMA, PEMAT understandability, and PEMAT actionability scores were 3.00, 3.00, 2.00, 73.00%, and 25.00%, respectively. TikTok generated the greatest engagement. Bilibili videos were longer, had lower JAMA scores, and were less often adequately understandable. Xiaohongshu resembled TikTok in its predominance of physician-produced scientific-popularization videos but generated substantially less engagement than TikTok. Videos uploaded by independent users and those based on personal experience consistently received lower quality scores than professionally produced or structured educational content. Video duration and content breadth correlated with quality, whereas time-standardized engagement showed little or no association with GQS. Conclusion: Spinal tuberculosis videos across the three platforms were generally understandable and of moderate overall quality, but few translated information into clear actions for viewers. Popularity metrics did not reliably identify better information. Greater professional participation, transparent sourcing, and platform-specific quality safeguards are needed to improve digital education on spinal tuberculosis.</p>