Quality and Reliability of Adolescent Sexuality Education on Chinese Video Platforms: Sentiment-Topic Analysis and Cross-Sectional Study.

Background: Adolescence is a critical period for lifelong health, which makes access to accurate and comprehensive sexuality education essential. As video platforms become a primary source of information for adolescents, the quality of their content significantly impacts their physical and mental health.

Objective: This study aimed to evaluate the quality, reliability, understandability, and actionability of adolescent sexuality education videos on major Chinese platforms (Bilibili, TikTok or Douyin, and Kwai), analyze associated user comment sentiment and topics, identify predictors of quality and reliability, and provide recommendations.

Methods: A cross-sectional analysis was conducted (April 2025) on the top 100 comprehensively ranked comprehensive sexuality education videos (N=300 total) retrieved from each platform using the keyword ("adolescent sexuality education"). Videos were assessed using the Global Quality Score, modified DISCERN, and Patient Education Materials Assessment Tool (PEMAT-U/A), with interrater reliability assessed via Cohen κ. A corpus of over 49,000 user comments underwent sentiment analysis (fine-tuned RoBERTa) and topic modeling (BERTopic, yielding 29 topics grouped into 6 themes). Statistical analyses included Kruskal-Wallis H tests, Spearman correlations, and stepwise linear regressions (SPSS [version 27.0]; P<.05).

Results: Video quality and reliability were moderate on Bilibili and TikTok but generally poor on Kwai. Content from verified sources (physicians, educators, and institutional media) demonstrated superior quality and stability compared to highly variable content from individual media (the predominant source type, especially on Kwai; 87/100, 87%). Paradoxically, Kwai exhibited the highest user engagement despite the lowest quality scores. Understandability (PEMAT-U) was consistently the strongest positive predictor for both quality (Global Quality Score, final model adjusted R=0.383, β=0.485) and reliability (modified DISCERN, final model adjusted R=0.209, β=0.319). Actionability (PEMAT-A) and video duration were also significant positive predictors. Understandability scores (PEMAT-U) were generally high (approximately 69%), while actionability scores (PEMAT-A) were moderate to low (33%-50%). Sentiment analysis revealed that comments were predominantly neutral (35,372/49,680, 71.2%), with negative comments (9141/49,680, 18.4%) significantly outweighing positive ones (5167/49,680, 10.4%). Key discussion themes identified included sources of knowledge acquisition, sexual safety and prevention, physiology, and sexual health and practices.

Conclusions: While online video platforms offer accessible channels for adolescent sexuality education in China, the current content is often of moderate-to-poor quality, with questionable reliability and limited actionability. Understandability is paramount, but high engagement does not necessarily correlate with high quality or reliability, potentially amplifying misinformation. To effectively empower youth, critical steps include enhancing content quality by adhering to evidence-based frameworks like the International Technical Guidance on Sexuality Education; strengthening platform accountability through improved verification and algorithms; and promoting user media literacy. These measures aim to foster a healthier and more equitable future for Chinese adolescents, helping to achieve goals related to sexually transmitted infections and pregnancy prevention and promoting more open societal attitudes toward sexuality.