BiliBili, Douyin and Xiaohongshu as health information platforms for stroke: evaluating information quality and content

Stroke remains a significant global health concern. Despite numerous stroke-related videos on social media, research evaluating their information quality across platforms remains limited. This study compares information quality and content of stroke-related videos on BiliBili, Douyin and Xiaohongshu. This study analyzed 227 stroke-related videos across three platforms (58 from BiliBili, 88 from Douyin and 81 from Xiaohongshu). Information quality was assessed using adapted HONCode and PEMAT-A/V standards. Content analysis examined stroke aspects (definition, symptoms, etiology, assessment, treatment, outcome, complications, risk factors and prevention). Statistical analyses included Mann-Whitney U, Kruskal-Wallis and Spearman correlation analysis. Overall, videos showed moderate information quality (72.7% achieving medium HONCode levels). Compliance rates were 4.0% for Principle 4 (source reference) and 2.2% for Principle 5 (evidence for claims). Videos showed higher understandability (median 0.73; IQR 0.2) but suboptimal actionability (median 0.67; IQR 1.0). Content completeness was low (median 2.00, IQR 3.0), with treatment (63.0%) and symptoms (55.1%) mentioned most frequently and assessment (15.4%) and complications (15.0%) less frequently. Spearman's correlation analysis indicated that there were mostly no correlations between video information quality and user engagement (Likes, Collections, Comments, Shares) on the three platforms. Specifically, among the three platforms, Douyin had significantly higher information quality (P < 0.001), while Xiaohongshu showed lower understandability (P = 0.032) and content completeness (P < 0.001). Stroke videos' information quality on BiliBili, Douyin and Xiaohongshu was generally moderate, but commonly lacked evidence support, actionability and content completeness. Among these platforms, Douyin demonstrated relatively better performance, while Xiaohongshu showed poorer understandability and completeness. This study recommends that video publishers focus on enhancing evidence support and actionability, particularly regarding stroke assessment and complications, to help the public access more accurate and complete stroke information. For BiliBili and Xiaohongshu, increasing medical professional participation is recommended to improve information quality. Xiaohongshu needs to improve content understandability by using simpler and clearer language to explain stroke-related knowledge.