As more people turn to the internet for health advice, healthcare professionals are increasingly leveraging online platforms to reach broader audiences, share their expertise, and connect with patients and communities in new and meaningful ways. However, with this shift comes the challenge of ensuring that accurate, evidence-based information rises above the noise.

This webinar will explore the rapidly changing landscape of online clinical information, focusing on the pivotal role content creators play in shaping public understanding. We'll also explore how you can effectively use online platforms to share expert advice and provide reliable information directly to your patients and the wider community.

Experts:

• Helen Surana, Deputy Editor, BMJ Innovations
• Vishaal Virani, Strategic Partner Manager, Health Partnerships, YouTube Health
• Aziza Sesay, GP educator and content creator, Talks with Dr. Sesay
• Joe Freeman, Deputy Head of Social, NHS

Transcription:

Welcome everyone and welcome to those of us who are joining, those of you who are joining at the moment. My name is Helen Serrano. I'm one of the clinical editors at BMJ, work across a range of journals and products. And the one that we're working on the moment is BMJ Future Health of the, of which this is one of the, maybe it's the, 10th or 11th webinar in our series that we're working up to our event in November.

So this event is this webinar is called. What is the place of the clinical content creator? And how can we increase the quality of health information online? And I suppose the subject is those things are created. There is a lot of clinical content online and how do we make sure it's. Good stuff from good people.

But I'm delighted to welcome our panel today. And I think we've got a slide with people's names and faces so you can familiarize yourself quickly with them. We've got Vishal Virani, who is the strategic partner manager at healthcare. of Health Partnerships at YouTube Health. And Joe Freeman, who is Deputy Head of Social for the NHS.

Joining us later is going to be Aziza Sesay who is a content creator, clinical content creator and we'll get her views when she joins us. But I suppose it's down to me to, I think, really, it'd be great Vishal and Jo, if you could each take sort of five minutes to set out your stall.

What do you do? What's your day job? And why do you think clinical content online is A, important and  how do we get it right? Vishal, over to you to start and then over to you, Jay.  

Thank you, Helen, and thank you everybody for joining and tuning in. Very nice to meet all of you. I am a clinician by background and then did my F1, F2 training and then jumped out and did various other things in health consultancy digital health.

I've been in this role for the last three and a half years. And so we set up the YouTube Health Initiative just before the pandemic. And So the the basic premise is to make it easier for viewers to access authoritative health information online. So we could see that there was growing demand amongst viewers for accessing health information, but we didn't necessarily have a very structured or rigorous approach to delivering or serving up high quality content from expert sources on the platform.

And so we introduced a product feature, which means, and if you. Search for any health topic on YouTube at the top of the search results you see a shell labelled from health sources that contains videos specifically coming from authoritative sources and There is then a label against those videos that says from a licensed doctor from a licensed nurse from a UK accredited healthcare provider  Depending on the the context of the of the expert expertise of that source  and so we put those product that product feature in place.

And we've been working very closely with NHS organizations, health charities, individual clinicians to encourage them to create content on various different health topics, make that content as engaging as possible, collaborate with each other. And so it's really great to have Joe. Here we've been working with very closely on how do what role can the NHS play in this?

And I think there's multiple different pieces to this puzzle. So we need to get that high quality content from the traditionally kind of authoritative and expert sources, such as the NHS national channels, such as the NHS trust. So we've been working very closely with the Great Ormond Street with the University College London Hospital and various other trusts.

But what we've also done is nurtured a community of clinician creators, and that's where that's where Aziza comes in, it's a really good reflection of the of that clinician creator community. And so we've been trying to give them the skills and encouragement to create content online.

It's a very nice creative outlet for them and and they have got different areas of expertise, which allows us to cover a variety of different topic areas. And what we're seeing is massive growth in terms of viewership. So in 2022, there were 3 billion views of health videos from UK sources in the UK alone.

In 2023, there were 4. 5 billion views. So it's a big number, but it's also a 50 percent year on year increase.  There's millions of videos available. From from health sources from UK health sources on the platform. So there's a massive,  there's a massive been growing massive demand and supply, and we're gaining legitimacy for this kind of world of content creation, clinician creators within the industry as well.

And and yeah, it's a very exciting time. And I think that ultimately, this is all about helping to educate and empower patients to look after themselves to better understand the conditions that they are dealing with the chronic conditions they're dealing with. To help them with preventative healthcare and and, various other things as they go through their care journey.

So yeah, that's a little bit about YouTube health and what we've been up to.  

Brilliant. Thanks so much, Vishaal. That's lots for me to, lots for me to come back and ask you more about.  Joe, perhaps you could do a similar sort of introduction to your role at NHS England. 

Yeah, sure. Thanks, Helen. Thanks, Vishaal.

I've heard some of that before, but it's always really interesting to hear what you're all doing. Hi, everyone. Thanks for having me. I am the deputy head of social media for NHS England. So I run the team who basically oversee all the social media channels that come out of the National  Health Service.

So that is across the channels that you would expect social media to use, so Facebook, Instagram, And YouTube as the kind of main channels, as well as LinkedIn that we utilize on a day to day basis and then oversee a suite of other channels that kind of secondary their primary use for payments and paid activity.

 In terms of the content that we share, my role is very much focused on kind of 2 tranches of content really. So there's the What we'll call the kind of the corporate NHS stuff. So the channels that talk about the NHS as an organization and what we do and what we think about certain things. And then there's a set of channels that we also run that is purely for health information.

So we keep these 2 things very separate. We've got 2 distinct groups of audiences across those channels and they're obviously both really important for us. So the health information which I think it probably makes more sense to focus on here is We have north of about.

Just under 2 million followers across those sets of channels. We've got a good understanding of what content they like, what works and what we need to be sharing. We have this balance of what are the NHS priorities, what are the government's priorities, and what are our priorities based on the users and what people want to know.

And how do we kind of balance that kind of. Structure content across our channels to make sure it's interesting, timely and relevant  in amongst all of that. Obviously, the kind of clinical element for us is really important. We have very strict kind of clinical sign off processes for all of our content.

Everything that goes out the door is vetted and it's been through some form of process, which I think is really helpful.  We need to really make sure that the content we put out is obviously accurate to be a particularly authoritative voice in this space.  And if we get it wrong, it's problematic.

In touchwood, we've been fine so far. Our processes are good. The people we work with across directorates and clinicians in those teams  really get and understand the role of social media. So we're not always able to move as quickly as I'd like sometimes, which I think is understandable, but we can represent.

The content based on what matters and for us and our audiences as well as we can. 1 thing that I've worked on across YouTube is the introduction of a standard for health content that NHS England produced. So that kind of sets out a level of. Appropriateness, for health information that people are sharing, be that online or elsewhere which I think is really important.

And so one thing that I'm really passionate about is why I'm and why I'm so keen to join conversations like this is to share what we do and work in the open. And if I think it's quite important that as a large national organization that we can support other people to increase the quality of content they produce online.

Feedback.  around the messaging they share or accessibility or the approach to content, because we can work at a scale that not a huge amount of other organizations can. And if we can share that and and leverage other people's channels as well to share, have the same objectives and reach the same outcomes in terms of ultimately improving the health of people who want to find this content, then I'm all for that.

So it's really great to have this opportunity to go share what we've done. YouTube, Vishal talked about kind of the number of views of health content over recent years into the billions across YouTube. It's huge.  And I think the ambition to raise and surface better quality content for people is an ambition that we share.

Also,  through our kind of discovery work around how we would approach YouTube, it became very apparent that the NHS website itself is very well used. Millions of people use that every month. You're probably all familiar with it, but it's only used by a certain group of people. So it's skews towards a 45, 50 plus demographic.

But we know that obviously people under that age have health concerns. So where are they going for their information? And it became quite apparent that YouTube is one of those places they're looking for content. So that presented an opportunity for us to get this trusted information in a space that people are already using.

And I had this kind of lofty ambition to make sure that our content for the NHS was the first thing that someone watched on YouTube. If they were searching for something on a health. On a health topic that was a bit ambitious. It's quite hard to get content out the door. It takes a while.

It's got to go through the processes and involve all the right people, but I think we can get there. But what has become quite apparent as well with people like Aziza and the incredible work that she does is there are lots of other people who are creating great content. And if we can help amplify their efforts and increase the overall quality of content on the platform, I think we will do 

really good job.

There we go, that is me. Thanks, Joe. Thanks so much. And yeah, just someone's noted, Joe is in an open plan office. Obviously, there might be a bit of background noise when he's talking, but other than that someone has already. So don't be shy. Please put your questions in the chat or in the Q& A as we go along.

And I'm delighted to welcome Aziza to join us, Dr. Sesay.  We're just doing general. Introduce yourselves and say maybe a little potted career history would be interesting for the people online and what you do now and why you do it would be really great just in five minutes.  

Of course.

Hello everyone so sorry about the delay. I am really I'm so excited to be here. So great to see Joe and Vishaal. I'm on brand YouTube health,  but basically I'm Dr. Aziza Sesay. I'm a GP. I'm also an educator, health content creator. I'm honorary senior clinical lecturer, and I run a platform called Talks with Dr. Sesay, which is all about health education, empowerment, advocacy, and I have a particular interest in women's health. But I also talk about cancer awareness and health inequity. So my journey started because of COVID and lockdown and just a plethora of misinformation that was out there. And actually it was, it started after having a conversation with one of my aunts who explained to me that she was really ecstatic. Her blood pressure is finally normal. So she stopped her blood pressure tablets and I was just like, okay, unfortunately, there's that lack of knowledge and health literacy is a determinant of health. So I decided to start doing zoom talks. Because obviously I couldn't do my face to face community talks.

And then through zoom, we had different decisions and then I thought, let me go into, different social media platforms and put the recordings onto, for instance, YouTube. But then I couldn't do that anymore because I got pregnant during the pandemic. And instead I started creating short form content, which was a lot easier.

So I've created content on cervical screening and encouraged quite a lot of people to finally go for their cervical screening test. And a lot of whom actually came back saying, oh, we've never known what it entailed. We didn't understand that it was that important, and so on and so forth.

And I have one of the most powerful stories for me is someone who said that they had delayed their screening for so long but they finally saw my video, they went for screening, and actually they were found to have abnormal cells, and they've had the treatment, and now they're fine. But, if they didn't go for screening, we know that it could have ultimately gone to something else.

And what's been really great is just the Capacity and the ability to work with such big organizations like obviously YouTube health, which I'm like such a big advocate for.  I'm sure visuals already said this number because I asked him the other day 4. 8 billion views on health conditions just on YouTube alone in 1 year in 2023.

That is a lot. So it is a source of health information. And so we definitely. Need to leverage this and ensure that we have the correct safe evidence based scientific information out there because unfortunately there, there is, like I said, a plethora of misinformation, which is dangerous and there are loads of vulnerable individuals who are being fed the wrong information.

This is why I'm really passionate about and I've been very fortunate to work with other charities and also work with NHS England and Joe to create content. And as he says, the process through doing it with NHS is different because it's all. You have to go through a script. It's quite rigid, but obviously, as an independent health content creator myself I have a bit more free will than what I can say and what I can do, but obviously, it has to remain within that remit of ensuring that it's scientific evidence based information.

And there are platforms like PIFTIC, for instance which gives the Either the organization or the creator that tick to say, look, they're using evidence based scientific information. Also, there's the Academy of Royal College of Medicine. They've all come up with some guidelines that we have to follow as well.

And then obviously being doctors and healthcare professionals, we have are the councils that again, set guidelines that we have to follow as health Creators who are clinicians as well. So it's not just giving information really nearly and doing whatever we want is ensuring that what we're sharing is evidence based scientific and correct.

And really quickly. I always show this. So if I didn't show this, I'm not as easy.  But I always use props similar to this. This is a vulva. If anybody watching is thinking, Oh my god, she's throwing a vulva on screen. I am really passionate about destigmatizing women's health and removing all the hypersexualization because unfortunately it's why a lot of women are either suffering in silence or being diagnosed late and unfortunately losing their life.

And I also use props that are brown. This is a boob, my boob prop because representation matters and we don't usually see different representation. And unfortunately, again, that's why that can feed into why the stats and the disparities exist in  a certain marginalized community. So yeah, sorry, I spoke too much.

That's me. 

Not at all. That was a really helpful introduction. And I think I'll come back to you just to follow on a little bit. I think the first topic I'd like to dig into a bit is your audience and who is your audience? And so you say, so your first audience was your auntie and then it became community work and Zoom calls and.

I presume, I'm afraid I haven't looked you up, but I presume your audience is a bit bigger now and they select, they choose to come to you, but how much do you know about them? And how much are you aware of exactly who you're talking to and who you're hoping to talk to? And it's an individual content creator and Joe, I'll be coming to you to ask about the NHS audience next. 

I think what's really great about social media is that literally your audience could be anybody. Okay. And what we want is we want health information to be accessible to everybody. So if you have the internet, you get the access to information. Mine really varies. I do have a larger female audience population within mine, but there are some males who are coming on board as well because women's health.

It's about everybody's health. It determines everyone's health as well. But yeah, no, some of my videos reach millions, have millions of views and reach millions of individuals, which again means that you're impacting people that you'll never meet and you'll never know, but you positively potentially changing their lives, potentially saving their lives.

We get loads of comments and DMs from people saying, Oh, because of you, I've done this, or because of you, I know this. So that's the impact of social media. It's bigger than people realize, and this is the future. We're literally going to continue to head into this direction.

People are using social media as a means of health information. It's not the same as before. Some people's attention spans have definitely lowered. Nobody's really reading leaflets as much. We used to send loads of leaflets before. Now, I literally share videos with my patients, because it's just, Quick, easier.

What I love about YouTube is anybody can access it whether or not you have an account and also you have the option of speeding up the video if you don't have that much time. But I think that's really great. With regards to do I know who they are? Not really. But I do get questions. The audience from individuals who share their stories.

It can be challenging sometimes because obviously some people want to give once you to get personal medical advice, which we're not allowed to, but it's just signposting them to the relevant pages like NHS website or so on are telling them to access their healthcare professional. And like I say, This is such a privilege for me that I can actually impact my patients directly in front of me, one to one, but I can also, impact millions of people through my videos.

Yeah, it's amazing. I love it.  

Great. Thank you. And Joe, can you get, dig a bit deeper into the audiences you serve? You talked a little bit about about that, but Jill McClain's asked Why you have the separate channels for health information and general information. I presume that's because they're different audiences.

And is there any other way you think about the audience on your social channels? 

Yes.  It's a good question about why we have separate channels. The. The real reason at the moment is because we were from two different organizations. So we had my, I came from NHS digital and my responsibility was purely around the health information channels.

And then NHS digital ceased to exist and became part of NHS England and NHS England social media team did the kind of. We are the kind of corporate stuff. So we inherited that structure at the moment. And now, whether that is it's right for the future. I think there are probably, you could probably pick that apart a bit.

And there's pros and cons of both. From the analysis that we have done, there are quite distinct audiences. There's very little crossover where we've been able to have a look where we've got different channels. Also is a presence. 2 different presences on 1 channel, there is relatively little crossover.

So we're not too worried about cannibalizing the audiences with our content,  but that isn't to say, I think we could make some efficiencies and be better in terms of how that works.  So that is something that we will look at. So we're broadly aware of who the audiences are from.

The health information kind of angle we've got over a million people on our Facebook page, for example, that is predominantly female. So it's 70, 65 percent female, I think and when you actually look at who engages with that content is even more a greater percentage of female. So it's very much a female led engagement, which I guess in some. 

Is not hugely surprising. I think we often see females engaging more with their health than men. That's stereotypically. So I think what we can do is we can look at that and we can leverage those channels based on the audiences we want to reach. In an ideal world, we would have a different kind of content strategy for what we put on Facebook compared to what we put on.

Twitter on X or on Instagram. And how we're able to do that is dependent on resource at the moment, but ideally we would have a different content strategy per channel where we can maybe talk about the same thing, but in a different way, depending on what we were trying to do at any given time.

But the YouTube one is quite interesting. So the analytics that YouTube provides really interesting. You can, if you are that way minded, you can get lost in the data and the detail, which is fascinating. And you can really start to glean a lot of information from who is watching your content and where there might be some kind of gaps.

We've had some support from Bashar in terms of kind of understanding audiences and demographics.  But as I said earlier, we, it's been, it's very clear thinking about where people are searching for their information online, where they're getting it. And so this kind of 18 to 34 ish audience who we are primarily catering for on our YouTube channel NHS website to any great extent.

So we were able to, that kind of really helps us justify the effort and the resource that we put into creating content on YouTube. 

Thanks, Joe. And Vishal,  you've been mentioned as someone who's got access to all sorts of fascinating data. Can you dig a bit, tell us a little bit about what you can tell about the audiences and who's watching what and and how creators might, or how you might, how different people with different audiences might want, might use YouTube to, to speak to them. 

Yes. So the data is rich at the channel level when they're The video level and predominantly the point of the data is to help our creators and partners understand  Which types of videos are most successful? For which types of audiences and so you can then  You know in an ideal world you create video and then you have some type of a hypothesis About the audience that you're trying that you're targeting with that video in terms of age group  So there are some things that the data can tell you so You know, for example, what we don't have is socioeconomic classes, we don't have ethnicity.

So there are certain metrics that people might like to see to understand how diverse the population is that they're targeting, but we don't actually have just because we don't capture that  information from users. So it's more about kind of age groups, it's gender, it's their geography. It's and actually in terms of geography, it's interesting.

To see the different countries start tuning into a video and so you'll get lots of viewership from the US and from India in particular for English language videos. So that's at the channel level. And then you can also see where they're watching the video, how they're accessing the video. So is that because actually of searching on YouTube? 

Or is it because they found it on a third party website? And so we found with certain NHS videos that have been embedded into GP clinic websites, that traffic source has that source has driven a large amount of traffic that video. And so you get understand where your video is being embedded across the ecosystem, which can be helpful. 

At the individual video level, you can then see how much of the video someone has watched. You can look at the retention graphs and see, exactly where they're dropping off or where the peaks of interest are in a video. And so that can be very helpful if you're thinking about doing a short form video based on a long form video that you already put out.

Say, oh, there was a peak of interest around this particular question. Let's do a short on that. Particular question. And ultimately the analytics are there to serve the partners to better focus their future content. And so that is the big thing for us. It's just get started on YouTube.

Just get started with creating something, put it out there. And then see what happens. Look at the data, refine and iterate and make every video maybe 1 percent better than the previous video. And so yeah, that's why we're very excited about this kind of world of clinician creators. We're seeing more and more people getting involved and getting started and then using that data to try and refine their approach over time. 

Brilliant. Thank you. I just wonder, we've got a question, which I think is directly relating to being a clinical content creator from  Hayley Johnson. And it's a sort of one, I think that's something that puts make a lot of people think twice. And so thanks for asking the question, Hayley.

And I won't read it all, but How can you be sure to protect yourself as a clinical creator from an indemnity declaration of interest perspective in line with clinical good practice with the GMC regulations and all those sorts of things. I guess that's something. You've had to think about a lot to encourage people to go get on, on, on YouTube, Vishaal, and Aziza, you would know personally you, you've mentioned a few of the guidelines that exist, but  can you be sure you're doing the right thing? 

Or saying the right thing?  

I can jump in briefly, but then I will defer to Aziza because I think she will have, A lot more insight into this topic, but the reality is that we don't get involved on that side of things on the identity side of things with YouTube. So what we will do is make sure that any content that is on the platform is not misinformation.

So we have various different processes and policies and approaches  that leverage algorithms, leverage some of the medical doctors we have in our team and leverage our community guidelines around what's allowed, what isn't allowed to then remove content. That is misinformation that is helping us information as quickly as possible, ideally before it's had in views so that we see is very much our responsibility.

Our other responsibility is around creating,  allowing really high quality content to shine on the platform. And so we have got these guardrails around what is what, which types of channels can be included in the health shelves, for example. So we do try to push that high quality content, but in terms of what the GMC say, there are individual creators who've got policies with with various different medical insurance companies that will cover the content that they create online.

And that's third party. So we don't tend to advise on that or suggest one thing or another. We just are very focused on making sure the misinformation is removed from the platform. But I don't know, Aziza will probably have some personal insights about how she thinks about this. 

Yeah so it's a tough one because this is still pretty new. It's still in its infancy. So things are still being put into place. So a lot of the guidelines are pretty new in regards to, for instance, the Academy of Royal College of Mets, and it was only last year, I believe, that they created something with YouTube.

Sort of guidelines that we can follow as  clinicians. And then the GMC, again, they update things based on what's changing and what's been happening. So there's a bit of guidance. Sorry, 2 seconds. I'm so sorry. 

I am so sorry. Can you give me 2 just 2 minutes? I'll come back just 2 seconds. So sorry.  

It's all right. Maybe we can get head over to you, Joe. And say how you use.  Can you hear me?  

I can. Yes. 

Oh, good. Sorry. I got the muted side. I'm sure I'm not. How you make sure that your clinicians are  behaving.

Saying the right things and doing the right things. Is there a, is there an extra role for the NHS in doing that?  

Yes, it's obviously really important and something we take exceptionally seriously. So we have a clinical review process for all of our content that goes on YouTube. And that was born out of the same sort of review process that exists for content on NHS UK as the NHS website. Primarily worked with that same group of clinicians. And actually a lot of the content that. Is on the NHS YouTube channel is derived from content on the NHS website as a kind of a rule. So that's generally our starting point. And we know that content on the website has been designed by a very talented group of content designers and been through levels of user research and  policy and clinical development.

Steers and approvals before it goes anywhere. So we're of the base from which we work. We start from with our kind of YouTube content has already been through a very strict and well assured and the best process  and then.  We repeat that to some extent, we're not as I said, not starting from scratch, but.

Sometimes it's necessary to make content YouTube specific and relevant for that platform. We have to make some changes. We might tweak some of the language or the structure of of the content a bit so that it becomes more relevant to the audience, but we always make sure that and throughout that process.

That the right people who were in the policy around particular kind of health topics are involved as well as various conditions  at those appropriate stages. From the scripting stage through to storyboarding through to 1st edits through to publication, there are checks at all of those stages.

And then we have a very complicated. Looking process to diarize and review all of that content every 3 years. So we're quite aware that is really important. Social media changes really quickly. We have, there have been instances where we've had to outside of that 3 year cycle, go back and make changes to content should advice and guidance change.

And so we were able to then go in and update that content so that we can be confident that everything that is on our channel represents the best current and accurate clinical advice. We.  Throughout some user research we did before we embarked on this journey, we spoke to quite a few people who do search and look for health content on YouTube,  because we had this  consideration that they people wanted to see an NHS clinician on camera.

And whilst there's huge value to that for us. Because we've got the leverage, the weight of the NHS brand behind our content. People didn't think that was actually necessary. So if you look at our YouTube channel, which you can like and subscribe. So you go to YouTube to say you could, you'll see that a lot of that stuff is motion graphics or animated.

And that was a very conscious decision because we understand that people will still trust that content because it's coming from a verified channel as the NHS and it's nicely branded. But also what that means is it's Much easier for us to edit that content. Should we need to change the advice?

We don't have to find the clinician again. We don't have to find a place to shoot and agree a time and do all of that stuff. We can literally just do a voiceover and edit some animation files. And I'm my creative team would be would kill me for sim over simplifying that that process, but the principle of it is that it then becomes quicker for us to update that content.

So we can react very quickly. But that kind of trusted content thing and the clinical assurance is obviously as the NHS incredibly important for us.  

Thanks. We've got a couple of questions about regulation. And I think we could probably talk for a long time about it, but Vishal, I'd just quite like to get your take.

And obviously, again, I think it's a question you get asked a lot is,  do you think  the regulation, what regulation should be in place that aren't in place and what regulations in this particular area, obviously are there, and are they, and that we've got a question here from Hitesh Jandiani, asking if, What's in place globally in terms of regulation for social media. 

Yes, so I personally think that at least as far as YouTube goes, then we're in a good place from a kind of governance and regulation point of view, as far as  the objective of high quality health information access to high quality health information. Yes, if you think about any regulation what is the purpose of it?

In this context I would think the purpose is that we want to create a safe,  first and foremost, a safe experience for viewers accessing health information on the platform, and I think that safe means an absence of Misleading or misinformation. I think that in an ideal world, you then want to regulate to create high quality environment as well.

And so that's where the health shelves that I described come into play and the work that we do with Joe in the NHS and Aziza and various other clinical creators. So I would look at it. I would look at regulation both of those realms. So I think that we've got, you may not want to call it regulation per se, but governance around misinformation, removing that from the platform, which is the processes that I described.

And we've got medical misinformation policies covering a range of different health topics.  And then we've got the work that we're doing to raise up the high quality information and so one of the things that Joe mentioned is the standards for creating high quality health content online, which we worked with the Academy of Medical Royal Colleges, NHS England, various other stakeholders on, and that is a set of guidelines that is now available on both the NHS website in the digital service manual, and then also on the Academy of Medical Royal Colleges website.

And those are standards that every one of our channels. Has to adhere to if they want to be part of the health shelves that I described. And as a result, I think we create a safe and high quality environment. Now, in terms of individual doctors getting pulled out, pulled up on promoting products that they shouldn't, then there are different processes in place for that.

For example, the Advertising Standards Authority will pull you out, will call you out, sorry, if you are promoting a product without making that clear. And we have processes within our platform. Form that allow you to declare that you have been paid to create this particular video. It actually, those videos that one has been paid to create by a brand are not eligible for inclusion in the health shelves I described.

So I think that on the kind of defensive regulatory governance side, I think that there's a few things that we have in place and then obviously a lot of the work that we're doing is on the offensive side to say like, how do we, if we've created the safe. type of environment, how do we then make that as high quality and, valuable for viewers as possible, which is probably more the work that we are focused on YouTube health team now. 

Brilliant, thanks. And just while you're there just, I've got a great question here, which I'm going to leave out the first bit of and get hit to the second bit, because I think the first bit might hint at the solution you're after. Someone who's on our web. Thank you. I work in.  Commonly with older people, and we'd be keen to know how many people in this cohort might self serve with info in a digital format. 

And they're suggesting something that could happen on a YouTube platform to make that easier for them. But Vishal, have you, where would you start if you want to create digital content for example, people who are frail by definition, medical definition? How would you?

Find out if you're getting to the right people. 

In terms of the analytics that we're talking about before, you can at least see the age group of people that are accessing your content. And so there is there are age groups every 10 in 10 year intervals and then 65 plus and, for a lot of channels, especially in the health domain, depending on the topic, you can get up to 20, 25 percent of all viewers being 65 plus or something along those lines, or at least around 10 to 15 percent for some videos. And so there is absolutely traction amongst that older population. I think the biggest blockers are actually digital access and that's not necessarily a kind of a function of your age, but it could be more a function of your socioeconomic or something along those lines.

I think that the older people are engaging with the content. And then I think it's a question of trying to tap into the topics that are of interest to that population. And they may want a slightly different approach. So it may not be that kind of really fast cuts from one scene to the next scene with loads of visual overlays and text.

pop ups that you're starting to see that Gen Z are very excited by. It might be a slightly different approach. It might be much more calm and focus just on a particular topic and being very clear about that topic. But but yeah, I think that's what I would say. I'm not sure if I did answer that question, if I fully understood it.

I think that, I was paraphrasing, and I think the question really comes into that, that, that difficulty of the social, so knowing whether you're reaching the right socioeconomic groups and diversity in all its forms whether racial or disability or all those sort of things, which you can't really capture YouTube is that. 

A short survey was, I,  is suggested of more, is there a way of capturing more data through YouTube videos?  

We wouldn't, we don't tend to be the ones capturing the data. I think the close the loop is where the GP clinics or the secondary care settings come in, where they will share the information with their patients and then close the loop and trying to understand if those patients found that information valuable.

You could, there's lots of comments on the videos from which you can see what people think about it. Particular video, which I think can be quite  instructive and insightful as well. We are merely the facilitators. And so the extent to which that we can tap into a diverse audience is very much a function of.

The content that is available and whether that tailors to that diverse audience or not, I would say it's a relatively diverse audience that it's at least accessing the platform, given we've got 96 percent of the online UK population using YouTube on a monthly basis. So we're basically accessing.

Everyone who has got access to the internet now, there's a whole separate conversation about the people who don't have access to internet and how we address that issue etc, which,  not just something for us to think about as YouTube, it's for society at large to think about.

But for those who access who are online, We are tapping into a pretty diverse population, but the question is, are they satisfied with the health content that they see on the platform? And I think that's very much dependent on the type of content our creators are putting out there. And, I'm sure there's more work that could be done there all the time. 

And speaking of creators Aziz What have you got views on this topic? 

Yeah, no, this is why I'm really passionate about the whole using the right colour, different representation different coloured props to, again serve a vast majority of the population. So the reason I often talk about using, brown props or brown to Tools is because I have seen myself where I've had people who either say to me, oh, I paid attention to this because, either you look like me or, the props that you've used look similar to me.

So this is, it's really important. I think from a commons perspective that we are ensuring that we're covering. Every aspect when we're doing any campaigns that we are being inclusive and not labelling certain communities as hard to reach when really it's more like they're hardly reached or they're, they've been easily ignored for so long.

I, and I think that's where having a diverse group of clinician creators in this space and NHS do really well with that. I'm recruiting a lot of us from different backgrounds and ethnicity. It does help. In the consumption of the information and again, if you can't see it, you won't be it.

Yeah, that I don't necessarily have, robust data on how many, how much of my content is consumed by a specific ethnicity, but I have gotten loads of either comments or. Videos and it's just a simple thing of having a prop that is a different colour when I created a content on how to check your Volvo and I use the line diagram of a brown Volvo.

I went on Google to look for 1 and they didn't have it. There was nothing in that colour. So representation matters. And I'm really quickly because I was interrupted when I was talking about the accreditation or just ensuring that your content is, safe and you're following the guidelines, they've already mentioned the, but also is another 1 where they have, you have to meet 10 criteria  in order to get your to ensure that you're the information that you're sharing is accurate, scientific and evidence based.

If you have that with your content, that's helpful as an individual, because I know Joe was talking as an NHS.  I do go back and look at my content. And either sometimes I either remove the content if it has like old information or I put something in the caption and, bold or in brackets to say the most updated information is this, so we, we do have that responsibility as people.

Creators to ensure that everything that we're putting is the most up to date and it's also helpful and this is one of the criteria with the health shelf on YouTube, which is good because it forces you to ensure that you're putting the information to sources where you're getting the information from reputable websites  like the NHS UK websites and so on.

And if you are going to work with brands, which is going to happen, a lot of it would have to do with your. Your ethos and your beliefs and whether or not you are in line with what the brand is representing and you need to be very careful and how you who you're associating yourself with and how you're associating yourself with them.

And if, for instance, it's a supplement brand, and it's saying that it cures a certain condition, and, that's not true. And as a clinician creator, if you're an influencer, that's something else, you could say what you want, but as a doctor, you have that additional, hats and certification and the trust is there.

So you have to be very careful in how you relay certain information in the brands that you work with. Again, are they ethically aligned with you  and your Purpose and again, like Michelle said, if you're paid for it, you have to ensure that's part of the advertising regulation that you put ad or paid partnership to show that you have had some sort of, monetary gain through affiliation with them.

Yeah, that's what I would say.  Be careful how you're working with brands and indemnification. If you are indemnified for your GP work, you can contact whichever indemnity you're with just to ask if they cover you for social media. There aren't many. I actually, I don't know. I think there's one but  just find out and ultimately, if you're following the guidelines, and if you're ensuring that the information that you're sharing is evidence based and scientific, you should be fine.

Just keep checking on it.  

Thanks, that's really helpful. I guess actually in response to a couple of those questions, there's within the medical community, there's a strong urge to not do anything until you've got the data in line to tell you exactly what the right thing to do is, because that's how we practice medicine and evidence based medicine.

But actually when it comes to creating content, sometimes the Creation comes first, and then you collect data, and then you can adjust and  change. I think just remember that what you think is basic knowledge is not basic knowledge for everyone, and it could be the simplest thing. The example I gave was my aunt thought that because her blood pressure was normal, she stopped her blood pressure tablet.

You don't necessarily need to go and look at data for that. The fact is, if your blood pressure is normal on the blood pressure tablet, Take the blood pressure tablet. So it doesn't have to be that complex. And I think a lot of the times, but as we're  perfectionists, we think we need to have the best equipment.

We have to have all of the information. It should be the most expertly executed. But actually you learn on the go. Your first video is going to you might be lucky in the first video might be amazing like mine. I'm joking. It wasn't  and then and you just build as you go along and you get better and working with different organizations.

You learn so much like working with NHS for me has been really helpful in regards to the accessibility how I'm sharing things with my patients. So I do share some content where it's just music in the background and I don't and I have captions. But there's no, there's nothing that's coming out in words, and Joe's, he's pulled me up on this before, he's it's not fair, what about for people who are visually impaired? They just hear music. They don't know what the content is about. So it's just those little tiny tweaks that we learn about together. And in writing scripts together,  you just get better and better. 

Yeah, thank you. Vishal, I've got, I know you're going to have to hop off fairly soon, so I just want to ask you this one, which is very much for you. From Anna Seward, who is, got a question about the advertising on YouTube and how, if a UK audience is looking for health information. They may get served with information from for example, the US or something that's not, or advertising that's  not necessarily advertising, but just algorithmically, they might get served with stuff from other countries.

It. Is there is that part of your work to make sure that content reaches the right audience at the right time, the right quality? 

Yeah so the ads, there's a lot of sophistication around the ads that are served up to viewers. And so they will be very much tailored to the geography. So you will not see ads for US focused products or whatever it would be.

It would be relevant to the UK audience, that advert. The ads are.  Are then also reviewed in the same way that all of our video videos are reviewed. And so we have misinformation  policies and guidelines around that for ads as well, which our medical teams are involved in reviewing in the same way we have the videos themselves.

So there is a lot of rigor around the ads that appear on a particular video, so they will be relevant to that geography. And they will also be appropriate ads which are not having missing misinformation, etc.  

And that's part of how YouTube is wired that happens generally automatically, is that right? Yeah, absolutely. 

Yeah. 

Okay. I'm just scrolling back. Oh, yes, Joe, I've got a question for you, which is similar to the one I asked you before we started the webinar, which is Dylan Mugendra asks, I'd be keen to learn more about any updated content strategies being considered for X, given the changes that have been taking place and do tweets include links away from X, and X as in Twitter, as we would  commonly have known it. 

reach less than posts with it.  Do tweets that include links away from Twitter have less reach than posts that keep the user within the platform? I guess that's quite an inside baseball question for people who work on content is whether you're keeping people on your platform or whether you're referring them out, but with particular reference to  Twitter.

Yes. So We always signpost off to content on mostly NHS UK for health information stuff. I, we have seen a decline in the reach of our content but we consistently include links. I'm not, I guess I'm not sure if it is the inclusion of links that has has decreased that given the recent changes obviously. 

The X has changed a lot, not only his name, his ownership,  the role of content and the impact it has on the wider society. There is obviously  a topic of hot debate  for us as NHS England.  X still plays a really important role in kind of our communications channels. We've got sizable audiences. It's good for  kind of the immediacy of content and seeing what's happening and we still reach good numbers of people through it.

It's still important part of that mix for us. I guess I think there's probably some testing to do with that kind of linking out to other content, but through our social media content, generally, including stuff on YouTube, we. We always signpost off to additional information because obviously within a tweet or a post on X, you can only have a certain amount of information.

So we can give the key bit of content and what we want someone to take away or learn. But we, it's really helpful for us to give that signposting for people to find out more and dig into a topic a little bit more and read a bit more detail if something is of particular relevance to them.

So I think if it, if we did find that the links.  in our content did decrease the reach. I think it's still important that we do it anyway. And we'd need to think about how appropriate that is to can continue. But that content on the website where we link to does give additional context to people, which I think is really important. 

Great. Thank you. Just, we've probably got time for a couple more questions. So do please type them in. Put them in the box, if you've got them but just while we're waiting for any more questions, and we are going to have to finish soon is I wondered if we could have a little bit of a think about  the role is in of clinicians in health information, generally, And if that's a different thing when it's online and on YouTube, or if it's the same as in all the other ways in which we've traditionally done health education, I think, Aziza, you talked a little bit about not giving out leaflets anymore, but  where do we think this health literacy in the population comes from?

Does it just come from clinicians, or is there a wider  question? 

Yeah, it's a good question. I don't know it's asking the whole population, but generally, what I am finding, honestly, is that a lot of people are accessing their health information online, and this could be either through TikTok, Instagram, YouTube, the various social media platforms.

It's just, I think it's quicker and again easily accessible if you have the Internet. So this is where it's important again for us as clinicians to be involved in this space. It's not unprofessional because I think for a while it was seen as unprofessional if you're in this space. You don't have to dance to create social media videos, but it's more impactful and also safer.

You get them accurate evidence based scientific information, and then you help to tackle the misinformation that's going around. Because as I say, it's just, there's just excessive misinformation and the most, the people who are affected the most are the most vulnerable. For me, what I have found really helpful about this, apart from obviously the most rewarding aspect is.

Changing, impacting and positively saving additional lives, like millions of lives, hopefully it's the fact that when you create these videos, It's almost like you have to do all this research, right? So I am staying up to date just through content creation. It's not even like nobody, nobody's forcing me to learn it.

I'm having to do it. It's not part of my ePortfolio,  so I'm having to learn the information, but I'm also having to learn how to explain it in simple terms to my patient. I feel like it makes me a better. communicator in general, but it makes me a better communicator to my patients as well because you want to make sure that you're disseminating information that is understandable for everybody, anyone, the average Joe.

So yeah, this is where I feel it's really helpful as a clinician.  Great for CPD. Yep. 

Yeah. Joe.  

So I think content creators are here to stay. They're not going anywhere. I think it's been evidenced by Vishal that A lot of people are looking for health information on platforms like YouTube.

It's similar in, we're seeing there is a growth in search intent across all sorts of topics on TikTok, for example, it's not just the for you feed. People are looking for this stuff. So I think as as we have done with the NHS with YouTube, it is about being present and having a presence with trusted, authentic information in a space that people are already using.

Almost like going to the places where people are already looking for stuff. And I guess that's easier for the NHS to do. But are. Content on YouTube is very, the strategy and thinking behind is very much around search and what are people looking for? So when we pick our topics that we're going, we create content on, we dive into that to look at.

Okay, we're going to make a period of a video about periods or a video about endometriosis. But what are people asking about those conditions? And we really dive into the search data and the intent of what people want to create content that meets those needs of the users so that we know that we're going to have content there.

That people are actually looking for. So that kind of search for us is really important. And that's where the majority of our views have come from. We've seen the views from search on YouTube and Google go up from something like 30 percent to 60 plus nearly 70 percent over the last sort of three or four years.

So this evidencing the fact that our approach there is working and we're not going to get a million views in a week. That's fine. I. Made by piece of that, but we will get to that level over 3 or 4 years. So it's very much kind of evergreen, longer term view with our content. But beside kind of organizations and creators like Aziza, there's people with lived experiences and people who have health conditions, I think, play a really important role here.

And so that's not necessarily. As much on the kind of discovery, or I've got a symptom and I want to know what it is, or I've just been diagnosed. I need more information, but it's about I think the representation of what it's like to live with a particular condition. And that's really important because it brings together a sense of community for people,  a feeling that they're not alone, or a feeling of, again, discovery on how to live with something.

So there's a really great chap called Misha,  who's known as Mr. Crohn's and colitis, who has a stoma and, creates really great content. He's just brilliant guy who's built this great following on YouTube and Instagram and he's united people around his condition and brings that kind of community together to for help and advice and information and support, which I think is really interesting.

The NHS aren't necessarily going down the supply chain. All tangle with their content. And I don't think I think it's fair to say that it's easier and other kind of medic creators aren't doing the same, but there is this kind of additional space  to bring people together in a community around a particular condition where they can learn and share experiences and feel like they're not alone or they can mentally or from a well being perspective, cope or deal with their condition.

So I think that's another angle where there's. Not a responsibility for people, but another area that is really valuable in terms of that kind of discovery and use of health content online as well.  

Thanks. And Vishal, just before we finish one of the things is that, like, how long has YouTube been really interested in this and realize that  YouTube is?

being used for health information and obviously your role has been instrumental in reacting to that.  

I think we've probably been aware about it for a very long time, because there's been like, there's been, there's a video, for example, that is now 10 years old on the UCLH NHS Trust channel about how to use your inhaler.

Which has got  close to a million views and it's been getting hundreds of thousands of views since it was published 10 years ago. 

Yeah. 

And so that just gives you a sense of the fact that this is nothing new. But it's probably just the fact that, We decided to put some specific rigor and approach around, around this topic around four years ago, but I think it's been a thing on the platform ever since it really started, to be honest, because if you think that how to videos are a big part of YouTube and there's a lot of how tos in terms of how to lose weight, how to stay fit, how to prevent cancer, how to stop smoking, that, all those types of  things that people have been searching for a long time.

And just one other thing I will say for anyone who wants to maybe take a little bit of action if they're already creating. So if you're not yet creating health content, but you would like to be check out the health. youtube the YouTube health website on health. youtube. There's a section on best practices where we've got interviews, for example, with Joe about the NHS channel and various other materials.

to help you get started on your journey. If you already do have a YouTube channel or know someone that does, you could join our health creator community and I will put the link into this chat so that you guys can. 

Yes. Brilliant. Thank you. The virtual sessions.  

Great. And I think that really is. Pretty much all we've got time for if we're going to let people get to their two o'clock meetings, which I'm sure a lot of us have.

But thank you so much. All of our panel, Joe and Vishal and Aziza. I'm sure you're accessible people who can be sought out. But just in case If anyone is interested or in hearing more from this group, they will be at the future health event in November. So we hope to see as many of you there as possible in central London.

It's going to be a great event. Looking at all sorts of aspects of health online and with like with this with a particular focus on getting frontline clinicians and people who are involved in health care who might not be  involved in health tech in a big way yet, giving them the tools they need to get started and get interested.

You can definitely meet Vishal and his team there, and there'll be a number of other really great talks. So I'd encourage you to look at that. The registration link is on the screen now, so please take it, grab that QR code while you can, or visit futurehealth. bmj. com. But that is all we've got time for, and I'd just like to thank the panel very much, and everyone online for joining, and we'll see you at the next webinar.

Thank you.