YouTube Optimization to Disseminate Palliative Care Education to Chinese Americans

Social media has the potential to deliver specific information to target populations and thus be the bridge to cross cultural barriers for ethnic minorities. Initiating timely discussions regarding Advance Care Planning (ACP) and palliative care plays a crucial role in health care. Elderly Chinese American immigrants often suffer from limited knowledge and engagement in ACP due to low acculturation [1-3]. Hence, understanding how to initiate and deliver timely discussions regarding ACP and palliative care is essential. A previous study suggested that YouTube as a platform was able to adapt to improve on delivering dementia education to the elderly [4]. Our study explored the role of YouTube in optimizing the delivery of Chinese-spoken palliative care education to Chinese Americans across various platforms and devices.

A board-certified psychiatrist was invited onto a North American Chinese radio broadcast station for an educational talk show in Cantonese, discussing the nature, purpose, and benefits of palliative care. The real-time recording was then uploaded to YouTube, as a singular 46.91-minute video (https://youtu.be/2kAsTvAY8_Y). Data was captured in the first 60 months period, between January 2014 and January 2019. Using YouTube Analytics, the data extrapolated included parameters such as type of device used; age of viewers; number of views; Average View Duration (AVD); and number of times the video was shared, further categorized by each social media platform. The data were dichotomized into two 30-month periods (January 2014-July 2016 and July 2016-January 2019) and then analyzed using descriptive statistics.

YouTube Analytics recorded 1594 views by people ≥55 years old, with a total viewing time of 7,416 minutes. There were similar views in 30-month periods (796 views in the initial, 798 views in the latter). There was an increase in total viewing time, from 3,102 minutes in the initial 30-month period to 4,314 minutes in the latter. The Average View Duration (AVD) in the initial and latter period was 3.9 and 5.4 minutes, respectively. In the latter period, there was increased mobile phone usage, from 267 views to 398 views, which is a jump from 33.5% to 49.9% of views. When examining traffic source, which is the method of how individuals found this particular video, data in the initial period indicates that suggested videos and YouTube search dominated 81.7% of the traffic source (428 and 222, respectively). In the latter period, data reveals decreased traffic from suggested videos and YouTube search (375 and 196, respectively), which accounts for 71.6% of the traffic source, but there was a marked increase in the use of browse features (16 initial to 99 latter), which is an increase from 2.0% to 12.4%. Almost double the individuals shared the video in the latter period (7 shares in initial, to 12 shares in latter). The additional shares all came from use of WhatsApp and Text-message.

The shifts seen, especially in the type of traffic source and AVD, continues to support previous studies that YouTube’s algorithm can adapt and improve on delivering information to targeted populations [4]. An important shift to be noted is the increased traffic to browse features, which is traffic coming from individuals clicking on this video that was recommended from their home screen, subscription feed, watch later, and trending/explore. Suggested videos remain the top traffic source, as it is traffic coming from individuals clicking on this video that was immediately suggested to them after they finished watching another video. To our knowledge, there are no reports investigating the optimization potential of YouTube to disseminate palliative care education to Chinese Americans. Previous studies have demonstrated the YouTube is capable to disseminating general health information to the Chinese-speaking general public [5]. A recent study showed significant increase of ACP knowledge and advance directive signing after patients in Taiwanese geriatric wards were shown Mandarin educational videos [6]. The current study adds that mobile phones may be the method of choice to disseminate information across various social media platforms as shown by the marked increase of mobile phone viewers in the latter period and the additional video sharing from WhatsApp and text message, both of which are used in mobile phones.

This study further supports that YouTube is a useful tool that can optimize the dissemination of language- and culturally appropriate palliative care education to Chinese Americans. Based on this study, future research should explore how to use YouTube’s dissemination optimization to further increase reach and visibility of similar videos on social media platforms on mobile phones.

1. Gao X, Sun F, Ko E, Kwak J, Shen HW (2015) Knowledge of advance directive and perceptions of end-of-life care in Chinese American elders: The role of acculturation. Palliat Support Care 13(6): 1677-1684.
2. Cho JY, Cote S, Enguidanos S (2016) Knowledge About and perceptions of advance care planning and communication of Chinese American older adults. J Am Geriatr Soc 64(9):1884-1889.
3. Dhingra L, Cheung W, Breuer B, Huang P, Lamet K, et al. (2020) Attitudes and beliefs toward advance care planning among underserved Chinese American immigrants. J Pain Symptom Manage 60(3): 588-594.
4. Lam NHT, Woo BKP (2018) Exploring the role of YouTube in delivering dementia education to older Chinese. Asian J Psychiatr 31: 25-26.
5. Shu S, Woo BKP (2020) Digital media as a proponent for healthy aging in the older Chinese American population: Longitudinal analysis. JMIR Aging 3(1): e20321.
6. Lin LH, Cheng HC, Chen YC, Chien LY (2021) Effectiveness of a video-based advance care planning intervention in hospitalized elderly patients: A randomized controlled trial. Geriatr Gerontol Int 21(6): 478-484.