YouTube and Men's Health: A Review of the Current Literature

Quality and reliability analysis of videos about ThuLEP on Youtube

OBJECTIVES

To assess the reliability and quality analyses of ThuLEP videos on YouTube, as a source of public information.

MATERIALS AND METHODS

In this study, a YouTube search with the keyword "ThuLEP" was performed on November 15, 2022 and 142 videos were listed according to relevance. Video features and source of upload were recorded. The quality of videos was evaluated by using both the Journal of American Medical Association (JAMA) score and the Global Quality Score(GQS); the reliability of videos was evaluated by using 5-point modified DISCERN tool,respectively. The correlation analysis was performed by using Spearman test between video features and these three scores.

RESULTS

77 videos were analysed after exclusion and the most common source of upload were urologists (54.5%) and the videos containing only ThuLEP surgery (74%) were the majority of the videos. The median JAMA score, 5-point modified DISCERN score, and GQS were 2, 1, 1, respectively. There were no statistical differences in these three scores according to the source of the upload. All three scores were analysed separately by language and no significant statistical difference was found.There was a positive correlation between the video power index and as well as JAMA, GQS and m. DISCERN scores.

CONCLUSIONS

Despite abundant videos on ThuLEP on YouTube, most of these videos are not targeted to public and information provided may not be as useful for patients. Information presented in these videos may be inaccurate and not reliable.

Youtube is an unreliable source of information about delayed ejaculation treatment

BACKGROUND

Social platforms such as YouTube have become sources of information about diseases as they can be easily and rapidly accessed. However, this also has the risk of ill-intentioned content and misleading information.

OBJECTIVE

To evaluate the reliability of YouTube video content about delayed ejaculation treatment.

MATERIAL AND METHODS

YouTube videos were searched using the terms "delayed ejaculation," "retarded ejaculation," "inhibited ejaculation," and "anejaculation." Videos were excluded if they were not in English, were not related to the subject, or did not have audio and visual content. In accordance with the scientifically proven accurate information, the videos were separated as reliable (Group 2, n: 112) and unreliable videos (Group 1, n: 94). The groups were compared in respect of the video characteristics, and the scores obtained in the DISCERN-5, Global Quality Scale, the Patient Education Materials Assessment Tool Audiovisual, and the Journal of the American Medical Association scales. Intraclass correlation test was used to evaluate the level of agreement between the two investigators.

RESULTS

Of the 1200 videos, 994 were excluded. No significant difference was determined between the Group 1 and Group 2 in respect of the median number of views [1672 (4555) vs 1547 (28,559), p = 0.63] and likes [10 (42) vs 17 (255), p = 0.07]. There was a greater number of videos in the Group 2 (54.4%) and the points obtained on the scoring scales were significantly higher than the Group 1 (p < 0.001). The videos originating from universities/professional organizations/non-profit physician/physician group were comprised the majority of the reliable videos (55.3%) and the unreliable videos had more content related to treatment (71.4%) (p < 0.001).

CONCLUSION

Although there was a greater number of reliable videos related to the problem of delayed ejaculation, the content could be misleading and should be avoided by patients seeking treatment without consulting a physician.

Assessment of the Quality and Reliability of Content Available on YouTube About Palpitations

Palpitations refer to the sensation of rapid, fluttering, or pounding heartbeats in the chest, the determinants of which may range from hormonal changes to anxiety or arrhythmias. YouTube is one of the most prevailing and accepted web-based platforms people trust to help them understand more about their health conditions. Thus, this study aims to assess whether the quality of content about palpitations on this platform is reliable and sufficient. Seventy-one YouTube videos were analyzed using criteria such as date and time of upload, type of uploader, and type of content. The Global Quality Score (GQS) and modified DISCERN score were used to analyze the quality and reliability of the information provided. Microsoft Excel (Microsoft Corporation, Redmond, WA, US) was used for data analysis, and StataCorp's 2023 Stata Statistical Software (College Station, TX, US) was used for statistical analysis and visualization. Of the 71 videos analyzed, 90.14% were uploaded more than a year ago, 80.28% described the symptomatology in detail, and 81.69% accurately described the etiological factors. Hospitals and doctors were the most common uploaders, constituting 23% and 19% of the uploaded videos, respectively, and had high GQSs (Median GQS = 4). The highest scores also belonged to videos uploaded by patients suffering from the disease (Median GQS = 5). Hospitals and news channels ranked highest on the reliability score (Median DISCERN = 4, respectively). It was determined that despite varied sources, the nature of content provided by the platform contains promotional material and content gaps; YouTube should, therefore, be used critically and as per professional sources.

The quality and content analysis of YouTube videos about chemotherapy for children

PURPOSE

This study undertook a systematic examination of YouTube videos about chemotherapy for pediatric patients, with a primary focus on assessing the videos' quality, content, and reliability.

METHOD

The research was conducted by searching YouTube using the keywords "chemotherapy for children" and "chemotherapy for pediatric," employing filters for "worldwide" and "all categories." The top 100 videos, based on popularity, were selected for evaluation according to the power analysis calculation. Two independent experts in pediatric oncology reviewed these videos. Video characteristics were recorded: length, view count, likes, dislikes, view ratio, and video-like ratio. The Video Power Index was calculated to measure video popularity. The modified DISCERN and Global Quality Scale (GQS) assessed the videos for quality and reliability.

RESULTS

The 100 videos were analyzed. Official health institutions uploaded 54%, while independent users contributed 46%. Independent user uploads garnered significantly more views than official health institutions (p = .006). The number of likes, view ratio, and Video Power Index of independent users' videos were significantly higher than official health institutions' videos (respectively, p = .007, .007, and .008). On the other hand, the modified DISCERN score and GQS were significantly higher in YouTube videos of official health institutions than in independent users (p < .001). A strong correlation was observed between the modified DISCERN score and GQS (r = .879, p < .001).

CONCLUSION

This study provides valuable insights into the YouTube videos on pediatric chemotherapy, emphasizing the need to improve the quality and reliability of online health information for this vulnerable population.

The reliability and quality of YouTube videos as a source of breath holding spell

BACKGROUND

Breath holding spells (BHS) are an important non-epileptic condition that is common in childhood and causes concern to families. YouTube is a powerful social media tool for accessing diseases and information such as BHS in child health. The aim of the study was to measure of the quality and reliability levels of the videos published in English on BHS uploaded on YouTube.

METHODS

The key words "infant", "cry", "breath holding spells", holding spells" and "breath spells" were searched on the YouTube on November 14, 2022, in this study. Along with the general features of the videos, their quality and reliability were evaluated according to the global quality score (GQS), mDISCERN score.

RESULTS

Fifty-five videos were evaluated. The mDISCERN and GQS scores of the videos in the useful group were higher than those in the misleading group (p < 0.001, p < 0.001). In the useful group, 87.5% of academic institutions and 93.3% of medical doctors (MDs) uploaded high-score GQS videos, while this rate was 16.7% in independent users (p = 0.005). The positive correlation was found between mDISCERN and GQS scores (p < 0.001).

CONCLUSION

The majority of YouTube videos on BHS contained useful information with sufficient quality. Professional associations such as universities and academic institutes need to produce better quality videos to provide families/users with more accurate and up-to-date information about BHS. We emphasize that YouTube should analyse videos published in the field of health, especially in the field of pediatrics, such as BHS, with committees consisting of expert health professionals, and publish them after evaluation. YouTube should consider collaborating with professional pediatrics health organizations such as American Academy of Pediatrics (AAP), academic institutes and universities in the field of BHS to produce high-quality videos.

Exercises for fibromyalgia syndrome: what YouTube tells us as a source of information for patient and physician education

OBJECTIVE

YouTube, a popular worldwide source to access health information online, may have an impact in enhancing exercise therapy for fibromyalgia patients. This study is aimed to investigate the quality and reliability of exercise videos prepared for fibromyalgia syndrome on YouTube.

METHODS

A thorough search on YouTube using six search terms related to fibromyalgia treatment and exercise was conducted. The videos with content on exercises for fibromyalgia, acceptable audio-video quality, and are in English language were included, whereas duplicates were excluded from the analysis. Quality was determined using the Global Quality Scale (GQS) and JAMA system, and reliability using the mDISCERN criteria.

RESULTS

Out of a total of 600 videos, 70 videos that met the inclusion criteria were included in the analysis. Physicians were found to produce content mostly in high and medium quality (%70.2), other medical professionals mostly in low and medium quality (93.8%), while non-medical users mostly in low quality (86.7%). Ninety percent of the videos targeted patients, while 10% targeted healthcare professionals as an audience, and the majority (93.7%) of videos targeting patients were of low and medium quality, as most (85.7%) of the videos targeting healthcare professionals were of high quality.

CONCLUSION

YouTube can be used as a tool to increase exercise adherence in fibromyalgia patients, as it offers a wide range of content that is easily accessible and useful at times. To implement this tool, physicians need to upload more content online as they stand for pioneers of high-quality information dissemination on the internet. KeyPoints • This research emphasizes the need for high-quality online healthcare information which is accessed by a vast number of individuals and the implementations that effectively address and prevent the spread of misinformation. • Additionally, it presents suggestions for the future regarding the uploading of such content on the internet. • Physicians hold the key responsibility in ensuring the availability of high-quality online health content, thereby carrying significant implications for its overall impact.

Assessing the scientific quality and reliability of YouTube videos about chemotherapy

No studies have evaluated the interaction, quality, and reliability of chemotherapy-related videos published on YouTube. The aim was to evaluate the content of YouTube videos about chemotherapy using 5 different scoring tools. In this cross-sectional register-based study, popular videos on YouTube about the following keywords were examined; "chemotherapy," "what is chemotherapy," "types of chemotherapy," "chemotherapy side effects" and "chemotherapy treatments." Quality and reliability of video content were measured using the modified DISCERN (mDISCERN), the Journal of the American Medical Association (JAMA), the Global Quality Score (GQS), the Video Information Quality Index (VIQI), and Health on the Net code (HONcode) scores. A total of 108 videos were analyzed in the study. The median duration was 200 (30-2020) seconds and the median total number of views was 17500 (61-8615000). Among the video publishers, private hospitals were the most (n = 36, 33%). The most (n = 71, 66%) populer category of videos were patient education videos. Half (n = 55, 51%) of the narrators in the videos were only oncology professionals. Mean DISCERN, JAMA, GQS, VIQI, and HONcode scores were 2.73 ± 1.18, 1.97 ± 1.05, 2.94 ± 1.08, 14.03 ± 3.73, and 4.68 ± 2.46, respectively. A positive correlation was found between the 5 scoring points (P < .001 for all pairwise comparisons). There was a significant difference between video quality scores according to video categories and video publishers (P < .001 for both). Although most YouTube videos about chemotherapy were helpful to patients, content quality and reliability were moderate-low. Cancer patients looking for information on chemotherapy may find YouTube videos beneficial, but clinicians must be cautious to clear up any misunderstandings.

Assessment of the reliability of YouTube™ videos about zirconia crowns in pediatric dentistry

PURPOSE

To evaluate the reliability of YouTube™ videos on zirconia crowns in pediatric dentistry.

METHODS

On January 4, 2022, a search was performed using the term "pediatric zirconia crown". The first 100 videos on the subject were included. Non-English videos, duplicates, and off-topic videos were excluded. For each video, an examiner recorded the number of views, likes, comments, channel followers, upload date, duration, and category rating. Two examiners assessed the reliability of the information presented in the videos using DISCERN, a brief questionnaire and scale score used to assess in a valid and reliable way the quality of information on treatment choices for health problems. Descriptive and inferential analyses were performed (p < 0.05).

RESULTS

Of the initial 100 videos, 72 were excluded because of language, duplication, and subject matter. The 28 remaining videos had an average of 3.5 comments, 8,896.18 channel followers, 5,614.00 views, 19.14 likes, and a duration of 840.32 s. The average view rate was 7.54 per day ± 10,206.81. There was a statistically significant difference between the number of views and comments (p < 0.001), likes and comments (p < 0.001), and likes and views (p = 0.006). According to the DISCERN, none of the videos received the maximum grade to be considered very good. Two were considered good, nine fair, fourteen poor, and three very poor.

CONCLUSION

Given that the majority of YouTube™ videos currently available on zirconia crowns in pediatric dentistry were deemed unreliable according to the DISCERN questionnaire, caution should be exercised when using the information presented.

YouTube Videos on Nutrition and Dental Caries: Content Analysis

BACKGROUND

Dental caries is the most common health condition worldwide, and nutrition and dental caries have a strong interconnected relationship. Foods and eating behaviors can be both harmful (eg, sugar) and healthful (eg, meal spacing) for dental caries. YouTube is a popular source for the public to access information. To date, there is no information available on the nutrition and dental caries content of easily accessible YouTube videos.

OBJECTIVE

This study aimed to analyze the content of YouTube videos on nutrition and dental caries.

METHODS

In total, 6 YouTube searches were conducted using keywords related to nutrition and dental caries. The first 20 videos were selected from each search. Video content was scored (17 possible points; higher scores were associated with more topics covered) by 2 individuals based on the inclusion of information regarding various foods and eating behaviors that impact dental caries risk. For each video, information on video characteristics (ie, view count, length, number of likes, number of dislikes, and video age) was captured. Videos were divided into 2 groups by view rate (views/day); differences in scores and types of nutrition messages between groups were determined using nonparametric statistics.

RESULTS

In total, 42 videos were included. Most videos were posted by or featured oral health professionals (24/42, 57%). The mean score was 4.9 (SD 3.4) out of 17 points. Videos with >30 views/day (high view rate; 20/42, 48% videos) had a trend toward a lower score (mean 4.0, SD 3.7) than videos with ≤30 views/day (low view rate; 22/42, 52%; mean 5.8, SD 3.0; P=.06), but this result was not statistically significant. Sugar was the most consistently mentioned topic in the videos (31/42, 74%). No other topics were mentioned in more than 50% of videos. Low-view rate videos were more likely to mention messaging on acidic foods and beverages (P=.04), water (P=.09), and frequency of sugar intake (P=.047) than high-view rate videos.

CONCLUSIONS

Overall, the analyzed videos had low scores for nutritional and dental caries content. This study provides insights into the messaging available on nutrition and dental caries for the public and guidance on how to make improvements in this area.

Quality and Reliability of YouTube Videos on Myocardial Infarction: A Cross-Sectional Study

INTRODUCTION

This study aims to assess the quality and reliability of the disease information available on YouTube (www.youtube.com) about "heart attacks" or myocardial infarctions, using a Global Quality Score (GQS) for quality, a DISCERN score for reliability, and a Video Power Index (VPI) for popularity.

METHODOLOGY

In this cross-sectional observational study, the YouTube videos were analyzed in terms of the type of uploader, content, and other factors. The GQS, DISCERN score, and Video Power Index (VPI) were utilized to assess the quality, reliability, and popularity of the information, respectively.

RESULTS

The majority of the videos (78.44%) were uploaded over a year ago. Only 33.34% and 7.84% were uploaded by doctors and healthcare organizations, respectively. Around 72.55% of the videos contained information about symptoms, 66.67% discussed the causes, 52.94% covered treatment, and 47.06% focused on prevention. Additionally, 41.18% provided details on investigations, while only 19.61% touched upon mortality. Patient-created videos accounted for 19.61% of the content, and 15.69% of the videos included promotional material.

CONCLUSION

The main outcome of our study indicates that the YouTube videos examined regarding myocardial infarctions exhibit high-quality content, as supported by a higher average GQS score. The consistent quality of information discovered in our study suggests that YouTube can serve as an additional platform for sharing knowledge and educating individuals about this important health condition. By raising awareness and delivering accurate information, these videos can help in early detection, prevention, and better outcomes for individuals who are at risk of experiencing a myocardial infarction.

Is Arabic Information on YouTube About Erectile Dysfunction Based on Scientific Evidence?

Background

Online medical education is critical for public health literacy and physician efficacy, but it must be trustworthy. Although it has the potential to be a useful resource for medical education, users must be able to identify reliable content.

Objective

To assess the scientific quality of Arabic-language video content related to erectile dysfunction that is available on YouTube to learn what information our patients can handle online.

Materials and Methods

A comprehensive search of the YouTube database was carried out to identify videos related to erectile dysfunction published in Arabic. The search was conducted using the following keywords: "Erectile dysfunction", "Sexual dysfunction" and "Impotence". Without a time, limit, the search was carried out until January 1, 2023. The quality assessment of the videos was done using the Kappa score.

Results

The videos in our sample had up to one million views (average 2,627,485.6), and the kappa index was 0.86 (p <0.001). Of these videos, 16% were considered scientific evidence-based (SEB), and 84% were considered not scientific evidence-based (NSEB) (p <0.001). The NSEB group addressed details concerning natural remedies, the Psychosocial sphere, and lifestyle, whereas the SEB group tended to be more concerned with physiopathology, etiology, endothelial dysfunction, diagnosis, psychosocial treatment, oral treatment, injections, or prosthesis.

Conclusion

On social media, misleading or incorrect information about erectile dysfunction is widely disseminated. This research may support urological and technical oversight and emphasizes guiding patients to the best men's health options.

Use of YouTube by academic medical centres during the COVID-19 pandemic: an observational study in Taiwan

OBJECTIVES

YouTube has been of immense importance in conveying essential information on COVID-19 and promoting the latest healthcare policies during the outbreak. However, there have been few studies that have focused on how healthcare organisations have used YouTube to communicate with the public and increase their awareness during the pandemic, as well as its effectiveness.

DESIGN

A nationwide observational study.

SETTINGS

We analysed all YouTube video posts culled from the official accounts of all medical centres in Taiwan from December 2019 to August 2021.

PARTICIPANTS

All YouTube videos were categorised as either COVID-19 or non-COVID-19 related. The COVID-19-related videos were divided into five categories, and detailed metrics for each video were recorded. For comparison, we also surveyed all YouTube video posts placed by the Ministry of Health and Welfare and the Taiwan Centers for Disease Control (TCDC).

RESULTS

We analysed official YouTube channels from 17 academic medical centres, involving a total of 943 videos. We found a relationship between the quantity of YouTube videos uploaded by the TCDC and the trend of confirmed cases (Pearson's correlation coefficient was 0.25, p=0.02). Data from private hospitals revealed that they posted more COVID-19 videos (103 vs 56) when compared with public hospitals. In addition, multivariate linear regression showed that more 'likes' (estimate 41.1, 95% CI 38.8 to 43.5) and longer lengths (estimate 10 800, 95% CI 6968.0 to 14 632.0) of COVID-19-related videos correlated significantly with an increased number of 'views'.

CONCLUSIONS

This nationwide observational study, performed in Taiwan, demonstrates well the trend and effectiveness of academic medical centres in promoting sound healthcare advice regarding COVID-19 through YouTube due to the channel's easy accessibility and usability.

Guideline-Nonconformant Investigational Treatments for Erectile Dysfunction: What are Patients Learning?

OBJECTIVE

To evaluate the validity of YouTube content on shockwave, platelet-rich plasma, and stem cell therapies for erectile dysfunction (ED). The consumerization of men's health is particularly notable among regenerative ED treatments, and the popularity of these treatments has been amplified by social media sites such as YouTube.

METHODS

We searched YouTube utilizing the following terms: "shockwave therapy-," "platelet-rich plasma- and "stem cell therapy-" "-for erectile dysfunction." The first 50 resulting videos per query were screened (inclusion criteria: relevant title/content, English language, >100 views) and judged by 2 independent graders using the validated DISCERN instrument for consumer health information. Regression analysis assessed association of video characteristics with DISCERN score.

RESULTS

Seventy-one unique videos met criteria. More content featured non-physicians (37%) or non-urologist physicians (35%) than urologists (28%). Mean DISCERN score was low at 42.8 of 80. DISCERN score significantly differed by video category and characteristics. Educational and urologist-featuring videos were associated with higher score. News reports were associated with lower score. Only 3 videos mentioned investigational/experimental status of the therapies. Only 2 cited society guidelines.

CONCLUSION

Most YouTube videos on regenerative ED therapies are unreliable and from non-urologists. The misrepresentation of proven efficacy may be encouraging patients to seek these still investigational treatments at high fiscal costs to the patient. Videos with urologists were more likely to be higher quality and guideline based. The urological and academic communities should continue to leverage the power of social media to provide evidence-backed consumer health information in this space.

The quality and reliability analysis of YouTube videos about insulin resistance

AIM

There is an increasing trend in the use of internet as a search tool for health-related informations. Insulin resistance is one of the most searched subjects online and some of the videos about insulin resistance have been watched by millions of YouTube users. This study aims to determine the quality and reliability of the most popular videos about insulin resistance on YouTube.

METHODS

On March 1, 2022, the term "insulin resistance" was searched on YouTube. The videos' popularity was assessed with Video Power Index (VPI). The quality and reliability were assessed with DISCERN score, modified DISCERN score and global quality score (GQS).

RESULTS

A total of 100 most popular videos were evaluated after applying the exclusion criteria. Fifty-four percent of the videos were very poor-poor, 35 % moderate, and 11 % good-excellent quality. Although few in number, the videos with relatively higher quality and more reliable had higher numbers of views, likes and comments (p < 0.01). There was a positive correlation between DISCERN score and VPI, duration, view, like, dislike, comment numbers of the videos (p < 0.01). Healthcare providers uploaded 58 % of the videos, while independent users uploaded 42 %. Video like ratio (VLR) at healthcare providers' videos was significantly higher than independent users' videos (p = 0.001).

CONCLUSIONS

Despite the high viewing rates of YouTube videos about insulin resistance, the overall quality and reliability were found to be very low. However, when high quality content regarding popular medical topics is produced, more people can be informed correctly.

An investigation of the reliability of YouTube videos on undescended testis

INTRODUCTION AND OBJECTIVE

There are thousands of patient information videos published on YouTube, the most watched video sharing platform; however, most of these videos contain incomplete or incorrect information. Interestingly, some videos with incomplete or incorrect information have a higher view rate. This study aimed to evaluate the quality of patient information videos on 'undescended testis' published on YouTube.

MATERIAL AND METHOD

A search was conducted on YouTube using the keywords 'undescended testis' and 'cryptorchidism', and a total of 373 videos were found. Among these, 122 patient information videos presented in the English language were examined. Four different scoring systems were used to evaluate the quality of the videos: Patient Education Materials Assessment Tool for Audiovisual Materials, Global Quality Score, Journal of American Medical Association score, and modified DISCERN scoring system. Whether the videos contained accurate and sufficient information was evaluated using a scoring system developed based on the patient information booklet prepared by the European Association of Urology (EAU) on undescended testis.

RESULTS

The median duration (sec), number of views and number of likes of the videos were 269 (11-2484), 589 (6-1.563561) and 7 (0-4.200), respectively. According to the EAU-patient information scoring (EAU-PIS), while 32 (26.2%) of the total 122 videos contained a good level of informativeness (score: 8-10), the view rate of these videos was only 4.1% among all videos. When the top 10 most watched videos were evaluated, their mean EAU-PIS was 5.9 ± 2.81, and these videos contained a moderate level of informativeness. On the positive side, 90% of all the videos recommended surgery as a treatment option.

DISCUSSION

Although YouTube is a widely used video-sharing platform, it is also a website where people or institutions can easily upload non-standardized videos due to the absence of regulations. Therefore, although it is an easily accessible source of information, it has many gaps in terms of reliability. As shown in our study, the rate of videos with accurate information was very low. It would be beneficial for viewers to be aware of this and accept YouTube as a source where they can have a general idea about a subject in which they are interested rather than using it as a reference information site. In future, YouTube can become a reference source in the medical field, especially with the standardization of medical videos through the collaboration of various organizations.

Does YouTube Provide Qualified Patient Education Videos About Atrial Fibrillation?

Objective

Patients utilize the internet as a pathway to acquire knowledge of specific diseases. However, there are limited oversight and review mechanisms to ensure the authenticity of online information. This study aimed to evaluate the quality of video-based resources used to obtain information about atrial fibrillation (AF).

Methods

Multiple AF-specific keywords were used to perform a systematic search of YouTube. Two independent reviewers reviewed the top 50 results of each keyword search. To record data, the Journal of the American Medical Association (JAMA) score, modified DISCERN score, AF-specific score (AFSS), and essential score (Escore) were used. The Kruskal-Wallis test was used for intergroup comparisons.

Results

A total of 74 videos that met the inclusion criteria were included in the analysis. In terms of video quality, 68% were poor, 19% were moderate, and 13% were exceptional. Videos submitted by publishers with a medical background were much less popular (p < 0.05) than those submitted by publishers without a medical background. The video quality did not differ among those included in this study.

Conclusions

Some videos on YouTube that are of real value are not as popular as those with low-quality content submitted by news agencies/media publishers. Furthermore, videos submitted by those with a medical background do not receive as much attention as others. It is important to acknowledge that video platforms should establish content and quality auditing mechanisms for videos. Furthermore, publishers should ensure that viewers receive accurate and complete knowledge and use more concise and accessible images or animations that are tailored to the audience.