A total of 400 videos were screened, with a total of 264 videos retained for analysis. This followed the removal of duplicates (n = 72), and other videos which did not meet the inclusion criteria. This included content which were a news or opinion item on the use of face masks (n = 31), did not have DIY as the primary content (n = 8), were on an unrelated topic, such as cosmetic face masks (n = 23), and content that was not in the English language (n = 2).
The majority of videos (n = 242, 91.7%) were categorised as ‘non-useful’ using the author designed checklist, with only 8.3% (n = 22) categorised as ‘useful’. However, useful videos had a higher median duration compared to non-useful videos (7:28 minutes vs. 3:42 minutes), with this a significant difference. Useful videos also had higher median number of likes, dislikes and viewership per day, compared with non-useful videos, but these results were not statistically significance (Table 1).
Individuals were the primary content contributors (n = 239, 90.5%), followed by news and media outlets (n = 13, 4.9%), and organisations including commercial entities (n = 12, 4.5%). 90% of useful and non-useful videos were created by individuals. Organisations had the highest median number of subscribers at 169000.0 (37750.0–283750.0), followed by news and media outlets at 110000.0 (37650.0–1855000.0), and individuals at 36500.0 (8380.0–180000.0). The majority of the videos were produced in North America, namely the United States (n = 175, 66.3%), followed by Asia (n = 45, 17.0%), Europe (n = 12, 4.5%), Africa (n = 2, 0.8%), and Oceania (n = 4, 1.5%). 9.8% (n = 26) of videos did not have a location listed in their YouTube channel description.
Content evaluation
Overall, the YouTube videos categorised as useful had higher mean scores compared to non-useful videos across all assessed content evaluation categories (Table 2). Across both useful and non-useful videos, manufacturing instructions had the highest mean score compared to all other categories, with the difference not statistically significant (4.2 ± 1.0 vs 2.6 ± 1.0, p = 0.45).
Table 2
Summary of total content evaluation score results grouped by categories of useful (n = 22) and non-useful (n = 242)
| Content evaluation category | Useful (n = 22) | Non-useful (n = 242) | P-value |
| Reason and caveats for use (out of 3) | 2.0 ± 0.6 | 0.8 ± 0.8 | 0.00 |
| Manufacturing instructions (out of 6) | 4.2 ± 1.0 | 2.6 ± 1.0 | 0.45 |
| Instructions for use (out of 5) | 2.5 ± 1.1 | 0.8 ± 0.7 | 0.00 |
| Re-use instructions (out of 3) | 1.0 ± 0.8 | 0.1 ± 0.3 | 0.00 |
| Cleaning instructions (out of 1) | 0.8 ± 0.4 | 0.1 ± 0.3 | 0.32 |
| Values are mean ± SD or as otherwise indicated |
Reasons and caveats for use
Videos categorised as useful had higher overall percentage scores against all assessed criteria relating to the presence of reasons and caveats for use of face masks compared to non-useful videos (Table 3). The inclusion of a reason for using cloth face masks was present in more than half the videos across both categories, with identification of population groups in which face masks should not be used referenced the least.
The reasons promoted for the use of face masks were broadly associated with the themes of individual protection and as a response to PPE shortages. From an individual perspective, face masks were described in some videos as a means for protecting individuals from “spreading droplets to others”, and for some, as a means for “helping me stop touching my face”. Most videos across both categories, particularly those originating from the United States, also referenced the CDC’s recommendations to wear cloth face masks when going outside as a key reason. PPE shortages saw masks being referenced as an alternative to purchasing medical masks, either because of known shortages, but largely, to preserve medical masks for use by HCWs. Some videos originating from the United States, also accompanied this reasoning with an appeal for viewers to create DIY masks for donation to hospitals. HCWs were described in some videos as using cloth face masks as an additional covering over medical masks, to prolong the use of a medical mask underneath.
Disclaimers on the effectiveness of the DIY mask being promoted in the video were a feature of most videos, with many encouraging their audience to “do their own research”.
Manufacturing instructions
Manufacturing instructions were the main content features across all videos analysed (Table 2). The most common DIY instructions were for stitched masks (both hand- and machine-sewn) compared to assembled masks. A minority of videos included DIY instructions for both stitched and assembled masks within the same content (Table 3).
Table 3
Frequency of adherence against content evaluation checklist criteria, grouped by categories of useful (n = 22) and non-useful (n = 242)
| Category | Item # | Item Description | Useful (n = 22) | Non-useful (n = 242) |
| Reason and caveats for use | 1 | The video includes a reason for using cloth face masks | 21 (95.5) | 126 (52.1) |
| 2 | The video notes that cloth face coverings are not surgical masks or N-95 respirators, or the equivalent of | 19 (86.4) | 67 (27.7) |
| 3 | The video notes population groups that cloth face masks should not be used on (i.e. children under 2 years, or on individuals who have breathing difficulties, unconscious or incapacitated and would need assistance to remove the cover) | 4 (18.2) | 3 (1.2) |
| Manufacturing instructions | 1 | The viewer is recommended to use 100% cotton or cotton blend fabrics | 21 (95.5) | 78 (32.3) |
| 2 | The video provides instructions on creating a stitched mask or assembled (i.e. piece of cloth and two bands) | Stitched – 15 (68.2); Assembled – 5 (22.7); Both – 2 (9.1) | Stitched – 162 (66.9); Assembled – 77 (31.8); Both – 3 (1.2) |
| 3 | The viewer is recommended to use filters within the mask | 14 (63.6) | 98 (40.5) |
| 4 | The video includes directions around the size and shape of the mask (e.g. template) and highlights the importance of producing a product of the correct size | 19 (86.4) | 173 (71.5) |
| 5 | The video notes that the cloth face mask should be breathable | 6 (27.3) | 11 (4.5) |
| 6 | The video includes guidance on manufacturing conditions (i.e. sterilising material prior to use, all individuals involved in making face masks should be symptom-free, wash hands thoroughly and sanitise workstations with disinfectant (if sewing)) | 10 (45.5) | 14 (5.8) |
| Instructions for use | 1 | The video notes that only new or properly disinfected masks should be used | 11 (50.0) | 8 (3.3) |
| 2 | The video contains instructions to wash hands with soap and water or alcohol-based sanitiser before and after touching mask | 6 (27.3) | 1 (0.4) |
| 3 | The video demonstrates fitting of the masks around the mouth, nose and chin (verbal or visual demonstration) | 21 (95.5) | 141 (58.3) |
| 4 | The video notes that the masks should be picked up and removed by touching ear loops or ties only (including visual demonstration) | 13 (59.1) | 19 (7.9) |
| 5 | The video references that face masks should be used in combination with proper handwashing and physical distancing hygiene practices. | 4 (18.2) | 15 (6.2) |
| Re-use instructions | 1 | The video includes reference to duration of use for cloth face masks | 5 (22.7) | 2 (0.8) |
| 2 | The video includes instructions on when to re-use the mask (e.g. washing after each use) | 11 (50.0) | 14 (5.8) |
| 3 | The video includes storage instructions | 5 (22.7) | 0 (0.0) |
| Cleaning instructions | 1 | The video includes instructions on how to effectively wash the mask | 18 (81.8) | 34 (14.0) |
| Values are the number of videos in compliance with the criterion (% of sample) |
Nearly all useful videos (n = 21, 95.5%) included a recommendation to use 100% or cotton blend fabrics to create the DIY masks. This was an explicit reference to the use of cotton, with some videos suggesting bandanas or t-shirts as a potential source. This contrasts with the non-useful videos, where only 32.3% (n = 78) included a recommendation on the use of cotton in creating DIY face masks. While bandanas and t-shirts also featured as recommendations for source material, the type of fabric to be used in creating DIY masks was frequently non-specified. Other materials suggested for use included denim, leather, sanitary pads, filter material (e.g. HEPA), paper towels and tissues.
Filters were recommended for use in both useful and non-useful videos (63.6% vs. 40.5%, respectively). Materials recommended for use included paper towels, coffee filters, HEPA grade filter material (either purchased or obtained from repurposing vacuum bags), and air-conditioning filter material. For some videos, user concerns on the safety of HEPA filters, due to concerns on filters containing fibreglass or being contrary to manufacturers’ instructions, often resulted in updates to the video content. As an example, some videos which recommended the use of HEPA filters often had updates or added disclaimers discouraging the use of this material following the upload the video. However, these updates were commonly added into the description section of the video, with the audio-visual content not edited to reflect any of the updated or additional information.
Guidance on the dimensions for the face masks were included in more than half of all videos analysed, with this described in the audio-visual content, and often supplemented with a template for user download. Ensuring breathability and description of manufacturing conditions were the least described content features across both useful and non-useful videos.
Instructions for use
YouTube videos categorised as useful had a higher overall mean score for criteria relating to instructions for use compared to non-useful videos (2.5 ± 1.1 vs 0.8 ± 0.7, p = 0.00).
Demonstrations on the fitting of the mask around the mouth, nose and chin were the predominant instructions for use which were highlighted in both useful (n = 21, 95.5%) and non-useful (n = 141, 58.3%) videos. These demonstrations also appeared to allow for content creators to showcase the results of their DIY efforts.
Information relating to the handling of new and used face masks was present in a greater percentage of useful videos compared to non-useful videos (Table 3). Recommendations on the use of new or properly disinfected face masks, and correct handling of the removal of face masks using the ear loops or ties only was present in more than half of the videos categorised as useful (≥ 50%). This contrasts with the non-useful videos, where only 3.3% (n = 8) of videos noted the use of new or properly disinfected masks, and 7.9% (n = 19) outlined correct handling for removal (either though verbal recommendations or visual demonstrations).
Encouraging appropriate hand hygiene as part of the handling of face masks was present in less than half of the videos across both categories. References to the use of face masks as an additional personal protective measure in complement to other measures such as appropriate hand hygiene and physical distancing was also present in less than half the useful and non-useful videos, being 18.2% (n = 4) and 6.2% (n = 15), respectively.
Re-use and cleaning instructions
Similarly, to other categories, useful videos had higher percentage scores across all criteria relating to the re-use and cleaning of face masks compared to non-useful videos (Table 3). However, of all the criteria assessed, information on when to re-use face masks, such as washing after each use was present in only 11 videos (50%) categorised as useful; with all other criteria present in less than half the videos across both categories. Some videos which included instructions on re-using face masks, linked these to the cleaning instructions, where it was noted that only washed masks should be re-used.
Of the useful videos, 22.7% (n = 5) included references to the duration of use for cloth face masks, and storage instructions. As an example, some videos recommended using zip-lock bags to store face masks. In contrast, 2 videos (0.8%) of non-useful videos included references to recommended duration of use, with no videos providing guidance on how to store cloth face masks.
Instructions to clean the cloth face mask were present in 81.8% (n = 18) of useful and 14.0% (n = 34) of non-useful videos. Methods that were recommended to clean cloth face masks included machine wash on a hot cycle, and then left to air dry. Handwashing was also recommended in some videos, using soap in hot or warm water, and left to air dry. Many videos also included references to the cloth face mask being washable but did not include specific washing instructions.
[INSERT[ Table 3 Frequency of adherence against content evaluation checklist criteria, grouped by categories of useful (n = 22) and non-useful (n = 242)