Evaluating online cannabis health information for Thai breast cancer survivors using the Quality Evaluation Scoring Tool (QUEST)

Thanarpan Peerawong (Lead / Corresponding author), Tharin Phenwan (Contributing member), Sojirat Supanitwatthana (Contributing member), Panupong Puttarak (Contributing member), Pitchaya Thongkhao (Contributing member), Nat Boonsasonsub (Contributing member), Porraphan Wannakul (Contributing member), Naowanit Siammai (Contributing member), Prakaidao Sunthorn (Contributing member)

Research output: Contribution to journalConference articlepeer-review


Purpose: This study evaluated the quality of cannabis-related content on social media platforms accessed by Thai breast cancer survivors post its legalization in 2019.

Materials and Methods: A cross-sectional study was conducted at a Southern Thailand tertiary hospital from November 2020 to May 2022 A breast cancer survivors support group was involved as a part of the patient and public involvement process throughout. The group identified contents related to medical cannabis via various social media platforms which were then categorized by the research team based on the content creators, platforms used, content category and upload date. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess the quality of the content, with scores ranging from 0 to 28. The contents were classified as ‘good’ or ‘bad’ based on expert ratings (1 to 5) The inter-observer reliability of QUEST was analyzed. Youden index was used as the cut point of QUEST. Statistical analysis was performed with the p value < 0.05 deemed as statistically significant.

Results: 64 cannabis-related contents from 2019 onwards were evaluated. They were categorized as news channels (33.9%), governmental sources (25.8%), contents created by healthcare providers (19.4%), and contents created by alternative medicine providers (19.4%). Most (48.4%) were uploaded on YouTube and websites (29.7%). Most of the contents created were news (36.5%) and generic cannabis advertisements (27%). Few (12%) of the contents created had no identifiable dates and came primarily from alternative medicine providers.

The inter-observer correlation of QUEST scores was 0.86 (p<0.05). The mean QUEST score was 12.1±7.6. The content was considered ‘good’ when the expert’s rating was over 3. With the QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating good and bad content quality were 81.2% and 97.5% respectively. The creator of the content was the only significantly distinguishable factors between ‘good’ and ‘bad’ quality contents. Bad contents were primarily from alternative medicine providers and news channels. They focused on the indications of cannabis use, instructions for use and promotion of medical cannabis, with limited coverage regarding the contraindications and side effects of cannabis.

Conclusions: This study underscores the varying quality of medical cannabis information shared on social media amongst Thai breast cancer survivors. Given that content creators are the sole predictive factor for good content quality, future research should focus on benchmarking and validating educational content related to cannabis for healthcare providers and end users.
Original languageEnglish
Article numberP-089
Pages (from-to)405
Number of pages1
JournalRadiation Oncology Journal
Issue numberSupplement 2
Publication statusPublished - Oct 2023
EventThe Federation of Asian Organizations for Radiation Oncology (FARO) conference 2023 - The-K Hotel, Seoul, Korea, Republic of
Duration: 11 Oct 202313 Oct 2023


  • content analysis
  • medical cannabis
  • breast cancer
  • social network


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