The reach-rigor paradox in health communication: a comparative analysis of congenital heart disease content quality and engagement on TikTok and Bilibili.

BACKGROUND

Congenital heart disease (CHD) is the most common birth defect and a major contributor to childhood morbidity and mortality. Short-video platforms-particularly TikTok and Bilibili-have become prominent sources of public health information. However, the quality and reliability of CHD-related educational content on these platforms remain insufficiently characterized.

METHODS

We conducted a cross-sectional analysis in October 2025 by retrieving the top 100 CHD-related videos from TikTok and Bilibili (n = 200). Two independent reviewers assessed each video using the Global Quality Scale (GQS) and a modified DISCERN instrument. Video characteristics, uploader type, and user engagement indicators were extracted. Analyses included descriptive statistics, nonparametric group comparisons, and Spearman correlation tests.

RESULTS

Overall video quality was moderate to high, with a median GQS score of 4 (IQR 3-4), while reliability was moderate, with a median modified DISCERN score of 3 (IQR 3-4). Medical professionals were the most common uploaders (49%). A notable tension between reach and scientific rigor was observed: TikTok videos achieved substantially higher engagement (median likes 733 vs 60; p < 0.001) yet exhibited lower average GQS scores than Bilibili. Narrative/storytelling formats generated the highest interaction (median likes 3,248 on TikTok) but received the lowest quality and reliability ratings, whereas expert explanations and animation/diagram-based videos showed superior credibility. Engagement indicators displayed weak to negligible negative correlations with GQS and modified DISCERN scores. After 2023, uploader profiles shifted toward professionalization (medical professional uploaders increased from 26.3% to 62.9%), but this change was not associated with statistically significant improvements in quality metrics.

CONCLUSION

Although CHD-related short videos on major platforms demonstrate generally acceptable quality, content popularity remains poorly aligned with scientific reliability. These findings highlight the need to balance engagement with accuracy in digital health communication. Future efforts should strengthen science communication training for professional creators and implement platform-level quality assurance mechanisms to enhance the public health value of short-video content.