Non-evidence-based preconception information on Xiaohongshu and delayed assisted reproductive care attendance: an observational study with propensity score matching

Imagine your brain is a busy train station, and every day, thousands of trains (ideas, facts, and stories) arrive on different tracks. Some trains are built by engineers with blueprints and safety checks; these are evidence-based facts, like the medical advice doctors give you. Other trains are built by people who just feel like they know the way, often using old stories or "folk remedies" without any blueprints; these are non-evidence-based rumors.

For a long time, scientists have worried that when people are trying to solve a big problem—like having a baby—they might hop on the wrong train. In the world of Assisted Reproductive Technology (ART), which is the fancy medical term for treatments like IVF that help people conceive, timing is everything. If you wait too long to get on the right track, the journey gets much harder. But here's the tricky part: we live in an era where everyone is glued to their phones, scrolling through apps to find answers. One of the most popular apps in China is called Xiaohongshu (often called "Little Red Book"). It's a place where people share photos and stories about life, including how they got pregnant. The big question researchers wanted to answer was: If someone reads a story on this app that sounds like a miracle cure but isn't backed by science, does it actually make them wait longer to see a real doctor?

This study is like a detective story that tries to figure out if reading the wrong kind of travel guide on social media causes people to miss their train station. The researchers didn't just guess; they used a clever statistical trick called Propensity Score Matching. Think of this as a magic mirror that finds two people who are almost identical in every way—same age, same anxiety levels, same location, same how-long-they've-been-trying-to-conceive—but one of them read the "miracle cure" stories, and the other read the "medical facts" stories. By comparing these twins, the researchers could see if the stories themselves were the reason one person waited longer than the other.

Here is what the detectives found. They looked at 470 posts on Xiaohongshu and matched them up into 130 pairs of "twins." The results were pretty clear: the people who were exposed to the non-evidence-based, "folk remedy" type of posts were significantly more likely to delay seeing a specialist. In fact, 30.77% of the people who read the unproven stories waited at least 6 months to seek formal medical help, compared to only 7.69% of those who read the evidence-based posts.

The math behind this is strong. The study calculated that if you are exposed to these non-evidence-based preconception stories, your odds of delaying your doctor's visit are 5.33 times higher than if you stick to the evidence-based content. That's a huge jump! The researchers also checked the "quality score" of the posts using a tool called the Brief DISCERN scale. The "miracle cure" posts scored a median of 9, while the medical advice posts scored a median of 15. The lower the quality score, the more likely the reader was to wait.

The study also looked at different groups to make sure the result wasn't a fluke. Whether the person was under 35 or over 35, or had been trying to conceive for less than 3 years or more, the pattern held true. The "miracle cure" stories seemed to act like a fog, making people feel like they didn't need to rush to the doctor because they could just try a diet or a herbal tea first. The researchers suggest this happens because these stories make the problem feel less scary (lowering the sense of urgency) and make the "alternative" solutions seem more effective than they really are.

However, the authors are careful to tell us this isn't a magic spell that proves the stories caused the delay. It's a snapshot in time (a cross-sectional study), so we can't say for 100% certain that the story made them wait, only that the two things are strongly linked. It's possible that people who already prefer natural remedies are just more likely to read those stories and also more likely to wait. But even with that uncertainty, the connection is loud and clear: on this popular app, the more you read the unproven, "folk" advice, the more likely you are to put off getting the medical help you might need. The study suggests that if we want to help people get pregnant sooner, we need to make sure the "trains" on these apps are built with better blueprints.