Consistency and Completeness of YouTube Condom Use Instructions Compared to Health Organisation Guidelines

Correct condom use is essential for preventing sexually transmitted infections (STIs), human immunodeficiency virus (HIV), and unintended pregnancies, yet significant knowledge gaps persist, especially among young people in India. YouTube is widely used for sexual-health information, but its engagement-driven algorithm often promotes videos with high views rather than high accuracy, increasing the risk of misinformation. Limited evidence exists on the accuracy and completeness of condom-use instructions available to Indian audiences.

To analyze condom-use steps presented in popular YouTube videos in English, Hindi, and Tamil, and compare them with the National Health Mission (NHM) condom-use guidelines.

A cross-sectional content analysis was conducted on 30 YouTube videos (15 in English, eight in Hindi, seven in Tamil) identified through predefined multilingual keywords in incognito search. Videos were evaluated using a 16-point Total Score (T Score) and an 8-point Vital Score (V Score), both developed by the authors based on the NHM condom-use guidelines. Descriptive statistics were used to assess completeness, accuracy, and presentation patterns.

Major instructional gaps were observed across all four steps of condom use. On average, videos mentioned 2.6 of five instructions (52%) for Step 1 (opening), 2.5 of three instructions (83.3%) for Step 2 (application), 0.5 of three instructions (16.7%) for Step 3 (during sex), and 1.7 of five instructions (34%) for Step 4 (disposal). English-language videos performed best (mean V Score: 4.7/8), followed by Hindi (4.4/8) and Tamil (3.0/8). Videos with >10 million views, those published by channels with 10,000-100,000 subscribers, and videos with >500 comments were significantly associated with higher instructional quality. No video demonstrated all eight essential steps.

The analyzed YouTube videos did not consistently follow the step-by-step NHM Condom Use Guidelines, with lower frequencies of instruction during the "during sex" and disposal stages and incomplete coverage even within more frequently mentioned steps. These instructional gaps mirror documented user errors, suggesting that suboptimal online content may indirectly contribute to improper condom-use practices. Improving the completeness and stage-wise consistency of videos - preferably through professional review and alignment with freely available NHM guidelines - may enhance the reliability of YouTube as a sexual-health education resource.