Short-form video exposure characteristics and respiratory symptom severity among patients with chronic obstructive pulmonary disease: a cross-sectional study

Background Short-form video platforms have become a dominant health information source for COPD patients, yet the relationship between content characteristics of exposure and respiratory symptom severity remains unexplored. Given China's 1.02 billion short-form video users with daily viewing exceeding 150 min, understanding differential health impacts of various content types is critical, particularly for older adults vulnerable to algorithmic misinformation. Objective This study investigated associations between multidimensional short-form video exposure characteristics—content type (health preservation, illness prevention, daily exercise), viewing duration, and user acceptance—and respiratory symptom severity measured by the BCSS among outpatients with COPD. Methods A multi-center cross-sectional study enrolled 207 GOLD-confirmed COPD patients (mean age 63.0 ± 12.9 years; 55.1% male) from January to July 2025. Short-form video exposure was assessed using a validated self-designed questionnaire (Cronbach‘s α =0.78, CVI=0.85). Respiratory symptoms were measured using the BCSS. Analyses included t-tests, ANOVA, and hierarchical multiple linear regression, with established clinical confounders forced into multivariable models per STROBE guidelines. Multicollinearity and model assumptions were verified. Results Mean BCSS was 7.86 ± 2.24, indicating moderate-to-severe symptom burden. Health preservation content exposure was independently associated with higher BCSS (B = 1.163, β =0.227, P = 0.003), while daily exercise content showed an inverse association (B = −0.876, β =−0.196, P = 0.007). Daily viewing duration was not independently associated with BCSS (B = 0.059, P = 0.377). Acceptance showed a significant non-linear pattern suggestive of an inverted U-shaped relationship with BCSS (P for non-linearity=0.025), warranting cautious interpretation. Content and acceptance variables improved model fit beyond clinical covariates and duration ( Δ R 2 = 0.108, P = 0.001), whereas duration alone did not ( Δ R 2 = 0.009, P = 0.155). The final model explained 22.0% of BCSS variance. Conclusion Content type—not duration alone—was significantly associated with respiratory symptom severity in COPD patients. Health preservation content (often non-evidence-based) was linked to worse symptoms, while daily exercise content showed protective associations. The non-linear acceptance-symptom relationship suggests that the association between content acceptance and symptom severity is complex and not simply monotonic; the underlying mechanisms merit further investigation. These findings support content-aware digital health literacy interventions and integration of social media exposure assessment into nursing-led COPD management.