Diabetic retinopathy on Douyin and Bilibili: how reliable is public health information in the digital era?

Diabetic retinopathy is a major cause of preventable vision loss, and patients increasingly seek health information through online video platforms. Douyin and Bilibili have become influential channels for Chinese-language health communication, but the quality, reliability, and actionability of diabetic retinopathy-related videos on these platforms remain insufficiently characterized. On February 8, 2026, we collected the top 100 highly visible Chinese-language diabetic retinopathy videos from each platform using newly registered accounts. Video characteristics, uploader type, content category, presentation format, and engagement metrics were recorded. Quality and reliability were assessed using the Global Quality Score (GQS), modified DISCERN, JAMA benchmark criteria, and the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). Platform and subgroup differences were evaluated using nonparametric tests with Benjamini-Hochberg false discovery rate correction. Determinants of quality were reanalyzed using the original scores, including a proportional-odds ordinal logistic model for GQS and linear regression with heteroskedasticity-consistent (HC3) standard errors for PEMAT actionability. Threshold-based ROC and logistic analyses were retained only as sensitivity analyses. A total of 200 videos were analyzed. Douyin videos showed higher user engagement, whereas Bilibili videos were longer and had higher GQS and PEMAT scores. Overall quality was limited: only 6 videos (3.0%) achieved a GQS of 4, and only 16 videos (8.0%) reached the 67-100% range for PEMAT actionability. Exploratory subgroup analyses after multiple-testing correction identified several differences in quality and reliability by uploader source, content category, and presentation format; however, because some categories were sparsely populated, these patterns should be viewed as descriptive and hypothesis-generating, pending confirmation in larger studies. In models using the original scores and the same core covariates, longer video duration was independently associated with higher GQS (OR=1.64, 95%CI: 1.32-2.04, P <0.001). Compared with professional-individual uploaders, professional-institution uploaders had higher GQS (OR=2.73, 95% CI: 1.25-5.96, P =0.011) and higher PEMAT actionability scores (β=12.04, 95% CI: 2.73-21.35, P =0.011). Highly visible diabetic retinopathy-related videos on Douyin and Bilibili provide widely accessed but uneven educational information, with particularly limited actionability. Within this limited sample, professional involvement, structured presentation, and content that translates knowledge into concrete screening, follow-up, and management actions were associated with more favorable educational-score patterns; these exploratory observations require confirmation in larger studies. Because the findings reflect a single-day, algorithm-mediated sample of highly visible search results, broader longitudinal and multi-keyword studies are needed.