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ORIGINAL RESEARCH
Correspondence to C. Cook:
e-mail: c.m.cook@massey.ac.nz
Catherine Cook PhD RN
Lecturer
School of Health and Social Services,
Massey University, Auckland, New Zealand
Abstract
Aims. This paper describes online recruitment and the email interviewing data
collection method with women diagnosed with a viral sexually transmitted infection. The paper highlights the advantages of the method to researchers and participants when conducting research where face-to-face participation may difficult.
Background. Online recruitment and in-depth email interviewing have been used by
only a small number of nurses internationally. The method enables inclusion of
people who might otherwise be excluded from research, for reasons such as geographical distance, incompatible time frames, clinicians gate-keeping and participants desire for anonymity for physical or emotional reasons.
Methods. In-depth email interviews were conducted with 26 women in New
Zealand, United States of America, Canada and England who had a diagnosis of
either human papilloma virus or genital herpes simplex virus. Data were collected
during 20072008 and analysed using a poststructuralist, feminist thematic analysis.
Results. Participant retention was high. Women emphasized satisfaction with the
process. Asynchronous interviews allowed for additional reflexivity in the
researchers responses and rich data generation.
Conclusion. This method has the potential to enable nurses to include vulnerable
and relatively inaccessible participants in sensitive research. In-depth email interviews may generate rich data through a process participants deem to be of personal
value.
Keywords: email interviewing, internet, methodology, nursing research, qualitative
research
Introduction
This article discusses the use of in-depth email interviewing to
explore womens experiences after the diagnoses of either
genital herpes simplex virus (HSV) or the human papilloma
virus (HPV). The study examined what sexual health clinicians taught women about these sexually transmitted infections (STIs), and what women learnt from clinicians, and
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Background
The internet has been harnessed to conduct health research
for a number of years (Mann & Stewart 2000). Liamputtong
(2007) argued that online research methods make research
user-friendly to vulnerable populations by increasing their
comfort and control. Examples of online health-related
interview methods include quantitative surveys (Cantrell &
Lupinacci 2007), synchronous one-off online interviews in
chat rooms (Davis et al. 2004), asynchronous one-to-one
in-depth email interviews (McKeown et al. 2010) and online
discussion groups (Kralik 2005, Guise et al. 2007).
Although online research methods may advantage vulnerable populations participation, it is important for researchers
to determine whether potential participants are able to access
the internet. The concept, digital divide, is used to critique
potential obstacles to internet use and unequal access to
research participation opportunities (Lewis et al. 2005).
Access disparities may include socio-economic, ethnic, generational and gendered aspects. Lewis et al. contended that
2011 Blackwell Publishing Ltd
C. Cook
The study
Aims
This paper is the report of online recruitment and the data
collection method of email interviewing with women who
had a diagnosis of a viral STI. The paper highlights the
advantages of the email interviewing method to nurses where
FTF research may be difficult for participants.
Design
A feminist, poststructuralist approach was used to explore
what the diagnosis of a viral STI meant to womens lives,
including the impact on healthcare experiences and their
social and sexual lives. This approach was used because I
wanted to understand the ways that these meanings or
discourses affected womens sense of agency, both in
interactions with clinicians and with sexual partners. Burr
described discourse as:
a set of meanings, metaphors, representations, images, stories,
statements and so on that in some way together produce a version of
events (Burr 1995, p. 48).
Participants
A majority were from New Zealand with a small number
from USA, Canada and England. I sought women with a
medical diagnosis of either infection to explore the clinical
and personal experiences associated with being diagnosed.
The recruitment process involved the following:
An email advertisement was prepared with a link to the
university webpage detailing the study.
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Data collection
Research questions
Sixteen interview questions were developed to ask women
with HSV/HPV. Preparing these set questions meant that
women knew how far through the interview they were so
they could anticipate the ending. The following are examples
of the questions:
How similar or different is the consultation process compared with experiences consulting health professionals
about other conditions?
What questions, if any, are difficult to ask health professionals? Why? Are there any topics you would find it
helpful for a health professional to initiate in a conversation
related to HSV that would ease the way for you?
Based on your experiences, what is the prescription you
would like to give health professionals about an ideal
consultation process in relation to women with HSV or
HPV?
2011 Blackwell Publishing Ltd
Data management
A trouble-free interview process was enhanced with attention
to practicalities. A new email was begun when replying to
participants rather than using the reply facility on the email.
This step was a security decision so that if a woman ever left
an email accessible to another person the whole interview
would not be revealed in one email.
An organized system was developed to keep track of where
participants were in the process. For rapport-building, notes
were made about personal aspects participants raised: sexual
abuse, recent hospitalization, death in the family, colposcopy
appointments, a holiday.
Ethical considerations
Approval for the study was obtained from the ethics committee of the university through which the research was
undertaken. The participant information sheet alerted participants to possible psychological discomfort they might
experience. Local and international referral plans were in
place through collegial networks, should additional support
be necessary. The information sheet advised women it
might be preferable not to participate if they were dealing
with co-existing mental health difficulties or a current life
crisis.
Given the prevalence of sexual abuse, assault and intimate
partner violence in womens lives (Kramer et al. 2004,
Bonomi et al. 2009), the researcher was mindful that some
participants may disclose these experiences as part of
discussing aspects of their sexuality and experiences of
clinical consultations. The researchers clinical familiarity
with such disclosures meant that disclosures were responded
to empathically, issues of current safety were checked and
women were made aware of support and referral networks.
Data analysis
Data were analysed thematically (Braun & Clarke 2006).
Interviews were initially coded for the micro-themes. A system
of manual coding was used with attention to absences in the
data and the presence of descriptions. For example, the coding, the absent genital area was used as many participants
referred only indirectly to the genital area. The approach to
analysis of email conversation is similar to analysis of verbatim interview text. Given that the email interview data are
already a text document, the method bypasses the many
transcribing decisions required when translating voice to text.
Minor grammatical errors were corrected where the meaning
was clear, to aid readability. When sentence structure made
comprehension confusing, women were asked to clarify
before using that portion of data. The transcripts had very few
typographical errors; some women commented on the
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C. Cook
Internet familiarity
Most women reported the internet was a resource with their
diagnosis and they readily found the research advertisement.
Although the email interview experience was new to participants, internet use was commonplace to access STI information:
When I used the internet I didnt have to worry about anyone seeing
me as I have a laptop at home. To start with I just typed in the word,
herpes. Then I narrowed it down to herpes support, which then gave
me lots of sites to look at. There is a website where you can ask
questions or chat to people. I think online talking is very good as you
can speak to people in the same situation who are having the same
problems etc., as not everyone can get to a local support group or to
their doctors/health clinic to talk to anyone if they have a problem or
a question (Maddy, 24 years old)
Results
Twenty-six women with an HSV or a HPV diagnosis
participated in the interviews. Participants ages ranged from
22 to 71 years of age. Seventeen resided in New Zealand and
of these 16 were of European descent and one identified as
Maori/European. Five participants were from USA. Of these,
four described themselves as Caucasian and one as Latin/
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Clarification
Receiving womens emails meant there were no time delays
with transcription and participants comments were clarified
in the researchers next reply:
2011 Blackwell Publishing Ltd
you think your doctor had any idea of the effect of the word, herpes,
upon you - did you appear upset or did you keep the upset hidden?
Participants reply:
Researcher response to partner-abuse disclosure: It must have taken a
She didnt have any idea of the impact on me and I kept my tears until
outside
Staying on-track
To build rapport with participants, each woman was
acknowledged as an individual. The comments below were
made to assure women that individual attention was given:
Researcher:
Im glad the exam is over and fingers crossed for the results! Your
email makes me recall that in the 1980s and early 90s womens
lot of strength and courage to leave your previous relationship.Teasing you about HSV sounds incredibly cruel.
Researcher response to a womans difficulties with her general
practitioners limited knowledge about HSV: I have been really
struckhow on your own you have been, and how little support,
advice and education you have received from the doctors you have
consulted.I am impressed with the advocacy work you have
undertaken on your own behalf
groups had hot and cold files on doctors the latter being doctors
to be avoided. Your GP sounds like she should be warmly
recommended!
Researcher:
It sounds like youre a very busy mother, with a little one. I know that
feeling of grabbing time while a child sleeps.
Sensitive topics
The research questions elicited numerous sensitive disclosures. Women told of past traumas including sexual abuse,
2011 Blackwell Publishing Ltd
C. Cook
no one could see meI think we have developed a relationship
despite the lack of visual feedback so I think it is a valid practice
(Dianne, 33 years old).
Dianne raised points that contradict the purported advantages of FTF interviews. She instead commented about the
intrusiveness of body language and the potential disruptiveness of the interviewer to her train of thought. She considered
that the opportunity to edit her writing enhanced her
contribution.
I think the interview online is better than a face-to-face one.Just my
personal opinion, but a face to face interview would in a sense give
less information. I think I would be just smiling and nodding my head
to any questions you hadQuite simply, I would be discussing my
private parts with a stranger, and perhaps that has never really been
done for more than just clinical analysis (Rachel, 28 years old).
Discussion
Email interviewing had limitations as a research method.
Women were not offered alternative interview methods and
due to this, some may have chosen not to participate. The
study included only a small number of women with enough
computer ability and English literacy to participate. The
participants were not ethnically diverse even though there was
international participation. Participants were unlikely to
represent the breadth of experiences of women with viral
STIs. For example, women for whom the diagnosis is of
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Conclusion
The internet is a tool of everyday life for millions of people
and a common adjunct to women acquiring health infor 2011 Blackwell Publishing Ltd
Acknowledgements
I thank all the women who participated in this research for
their generosity and enthusiasm for the study. I thank
Professor Alison Jones and Associate Professor Louisa Allen
from The University of Auckland for the clarity, precision
and goodwill with which they supervised my PhD thesis, on
which this paper is based. Special thanks to the numerous
academics internationally who assisted me with the design of
the research method. I appreciate the useful revisions
suggested by Dr Barbara Staniforth and the anonymous
reviewer.
Funding
The University of Auckland Doctoral Scholarship.
Conflict of interest
No conflict of interest has been declared by the author.
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