Quality and content evaluation of anal fistula information on TikTok and Bilibili: A cross-sectional study

Short-video platforms are widely used for medical information, but the quality of anal fistula content remains uncertain. We evaluated anal fistula-related videos on TikTok and Bilibili and compared platforms and uploader categories. The top 200 videos under each platform's default comprehensive ranking were screened. Eligible videos were assessed using the Global Quality Score (GQS), modified DISCERN (mDISCERN), Journal of the American Medical Association benchmark criteria (JAMA), and 7-indicator completeness score (7-ICS). Platform and uploader differences were evaluated using nonparametric tests. Spearman correlations examined relationships between engagement and quality, and multivariable ordinal logistic regression identified factors associated with higher scores. Of 400 screened videos, 333 were included (TikTok, 167; Bilibili, 166). Median GQS, mDISCERN, JAMA, and 7-ICS scores were each 2.00. Treatment (71.4%) and clinical manifestations (63.9%) were the most frequently covered domains, whereas epidemiology (7.2%) and prevention (12.6%) were least covered. TikTok videos were shorter and received greater engagement than Bilibili videos (all P < .001). Bilibili had higher unadjusted 7-ICS scores and JAMA score distributions, while GQS and mDISCERN did not differ. After adjustment, TikTok was associated with higher GQS (OR, 2.26; 95% CI: 1.27-4.02) and lower 7-ICS (OR, 0.26; 95% CI: 0.13-0.50), but not with JAMA or mDISCERN. Specialist-physician uploader status and longer video duration were associated with higher scores for all 4 outcomes. Engagement metrics were strongly intercorrelated but were generally unrelated to quality measures. Anal fistula-related videos on both platforms were generally incomplete and of suboptimal quality. Platform differences were mixed rather than uniformly favoring TikTok or Bilibili. Specialist-physician authorship and longer duration were consistently associated with better scores. These cross-sectional findings represent associations, not causal effects.