Data Sources and Data Collection Methods

In order to answer my four research questions, I used two sources to collect data: newsgroup threads and semi-structured interviews. The following sections outline the approach I used when collecting and analyzing my data. Specifically, I:

collected and analyzed appropriate threads and messages from three online newsgroups;

conducted semi-structured interviews which entailed transcribing, coding, and then analyzing the interview data with ten participants or until saturation was reached.

4.3.1 Pilot Study

I conducted a pilot study in which I analyzed the threads found on a depression support group. I examined the range of information behaviour found on the online newsgroup using Wilson‘s cognitive authority theory and Savolainen‘s ELIS (everyday life information-seeking) model. This study examined the information behaviour on the newsgroup as users considered, or incorporated, CAM to help regulate depression. The data came from the discussion threads and messages posted to the newsgroup and they were analyzed using discourse analytic techniques as outlined by Wetherell, Taylor, and Yates (2001). Specifically, I answered the following questions:

(1) How is discussion about CAM therapies was discursively presented, framed, and responded to on the newsgroup;

(2) How do individuals used experiential and expert knowledge to construct authoritative accounts justifying CAM use or non-use;

(3) What information sources were called on in creating authoritative accounts?

I selected this particular newsgroup for my pilot study because it has been active and archived since 1995, making it the longest running and largest newsgroup on

depression in terms of number of postings and number of members. It is not necessary to subscribe to the newsgroup in order to read the threads, users can post anonymously, and users occasionally e-mailed each other off-list which afforded them privacy if they chose.

I read and selectively analyzed various threads on the newsgroup that covered the years from January 1995–December 2005. The search strings I used in this pilot study were:

Table 1. Number of Records Retrieved for Search Strings

Search String

Number of Records Retrieved

“Alternative and medicine” 645

“Alternative and treatment” 615

“Natural medicine” 336

“Alternative medicine” 330

“Complementary and medicine” 13

I scanned all of the threads retrieved by my search strings to ensure that they met a number of criteria for inclusion in the study. First, I removed duplicate records and false drops from the study. Second, to be included in the study, the discussion thread had to include more than one posting. Third, spam (which was identified by the newsgroup users) was not included unless it provoked a relevant discussion among the newsgroup members. In total, I read and selectively analyzed 2,491 publicly available messages contained in 176 discussion threads.

A number of themes and findings emerged from the study. First, how newsgroup users constructed their depression affected their perceptions of the effectiveness of CAM and conventional medication. For example, those who constructed their depression as a chronic illness viewed allopathic medication as the most appropriate treatment and biomedical information sources as the most authoritative. Those who discussed their depression as a spiritual crisis considered both CAM and conventional medication to be effective treatments. How users introduced and framed CAM or allopathic treatment was based upon their conception of depression, which, in turn, influenced the information sources users drew upon when creating authoritative accounts. This finding is explored in greater depth in the current study. Second, expert and / or experiential knowledge was invoked by newsgroup posters as evidence to support claims. In the current study, I have expanded my analysis by examining the information sources and knowledge resources invoked by people, and by examining how people use discursive strategies and information to make and justify claims.

A final significant finding was the interesting two-fold properties of messages posted to the newsgroup in which the user directly asked for information. While asking for information from others, users would divulge their own stories, discuss the medication and treatments they were currently using to treat their depression, and provide disclosures of some kind. Information was presented via personal narratives, stories about others‘

experiences, or by posting newspaper articles, journal articles, or book titles or summaries. While information-seeking, these users were also sharing information. This hybrid activity supports the idea of treating depression as a life project or information project whereby information-seeking and sharing forms a part of the daily management of disease. In the current study, I expand upon this finding by analyzing newsgroup participants‘ and interviewees‘ information practices.

The main limitation in the pilot study was that the population of online users do not adequately represent all people living with depression. For example, in Canada women are treated one and a half times more often for depression than men are and they are diagnosed with depression four times as often as men (Health Canada, 2002), yet newsgroup

postings, when gender was evident, had far more male authors than female authors. As a rough estimate, at least 60% of messages were written by men. Furthermore, the age range of users on this newsgroup was not representative of the general population. When age was stated or approximated (roughly 10% of messages), the eldest participant was 65 years old and the youngest was 17. Often depression occurs in the elderly—a group who are often overlooked and who may not use newsgroups as frequently as their younger counterparts. Also, depression typically first appears in late adolescence and young adulthood and younger people tend to use the Internet more often than older people do ergo, the number of younger users on the newsgroup may be overrepresented as having depression. These same limitations are applicable to the current study.

However, the study based on analyzing newsgroup postings offered the following advantages: I was able to learn more about what medication and CAM therapies people with depression might use; the postings and threads were archived since the group‘s inception; newsgroups grant immediate and ready access to people with depression and those who support them; the messages assisted in formulating pertinent research questions and provided additional avenues of inquiry for interviews. Most importantly, because the

newsgroup is a naturally-occurring data set, I can be confident that newsgroup users were not tailoring their posts to accommodate my reading of them for research.

4.3.2 Newsgroups

Arguably, Usenet has diminished in importance with the increased use of blogs, wikis, and portals; however, I selected newsgroups as my electronic data source for several reasons. Although there are a number of blogs and portals that deal with depression or complementary and alternative medicine, they do not generate enough traffic and discussion to adequately answer my research questions. Additionally, postings to blogs can be sporadic and the postings themselves often consist of small blurbs. While the same small-blurb style of writing can occur on a newsgroup as well, a newsgroup offers space to accommodate detailed arguments, opinions, and other types of writing. Also, the

newsgroups selected for inclusion in this study have extensive archives dating back to at least the year 1996—no blog, wiki, or portal has been active for this length of time.

The postings are derived from personal participation in the support group—they are voluntary, spontaneous, and non-restrictive—and consequently, the postings are not

affected by the presence of the researcher. Supplementing and complementing in-person interviews with data collected online provided a robust means to answer my research questions because I was able to take advantage of two different mediums—face-to-face communication and online interactions.

Two phases of data collection were undertaken for the current research project— analyzing newsgroup messages and conducting semi-structured interviews. For Phase I, I expanded on my pilot study to include analysis of pertinent threads from two more

newsgroups in addition to the depression support newsgroup. I used the data from three newsgroups—a depression support newsgroup, a newsgroup devoted to discussing alternative health, and a biomedical newsgroup focused on discussing the practices of biomedicine. Each of these newsgroups covers an important aspect of this research project—depression, complementary and alternative medicine, and lay perspectives of biomedicine. The depression support group focuses specifically on ―depression and mood disorders,‖ the alternative health group‘s focus is on discussion about ―alternative,

discussion about ―medicine and its related products and regulations.‖ All three of these newsgroups can be found online and each group was selected based upon the large number of subscribers to the newsgroup, the longevity of the newsgroup, and the amount of

activity on the newsgroup. I examined messages and threads from these three online newsgroups that were posted between the years 2002-2007.

While other search engine portals or gateways also offer access to Web groups, the newsgroups relevant to this research project (i.e., the groups where participants discuss depression, complementary and alternative medicine, and biomedicine) have far more activity than the other newsgroup hosting services. A preliminary search in the alternative health newsgroup using the search string ―depression and treatment‖ retrieved 2,120 messages for example. Similarly, a search in the biomedical newsgroup retrieved 1,350 results using the search string ―depression and treatment.‖ A search in the depression support group retrieves 2,310 messages using this search string. All three groups have been ranked as having high activity and a large number of subscribers—the biomedical group has 986 subscribers, the health group has 1,398 subscribers, and the depression support group has 2,265 subscribers. Throughout my findings and discussion, I have not identified what specific newsgroup the message being analyzed was derived from as the messages from each newsgroup were not sufficiently different from each other to influence my findings and warrant revealing this information.

4.3.3 Newsgroup data

The following table lists the search terms I used in the three newsgroups to retrieve relevant messages.

Table 2. Search Terms for Newsgroup Threads

Search Terms Number of hits Number of hits Number of hits

depression group alternative health biomedical group

alternative (and depression) 8,070 10,500 599

alternative and medicine

(and depression) 550 3,780 324

complementary 182 238 (depression)* 59 (depression)

complementary and

medicine 17 220 (depression) 32 (depression)

exercise 12,000 837 (depression) 303 (depression)

herb or herbal 1,230 730 (depression) 102 (depression)

holistic 447 319 (depression) 48 (depression)

homeopathy 190 4 (depression) 45 (depression)

meditation 2,620 204 (depression) 66 (depression)

nutrition 1,920 583 (depression) 274 (depression)

omega 1,520 378 (depression) 36 (depression)

supplements 1,210 1,120 (depression) 143 (depression)

Wort (St. John‘s) also ―wart‖ due to common misspelling

5,630 694 (depression) 46 (depression)

vitamins 1,770 918 (depression) 158 (depression)

yoga 1,440 129 (depression) 40 (depression)

* In addition to searching for the singular terms listed, the search term ―depression‖ was Boolean ―and‖ed in the two newsgroups that did not specifically focus on depression. My search terms were deliberately biased toward high recall rather than precision. My goal was to retrieve as many hits as possible so that my searching would be comprehensive rather than precise; ergo, I used simple search terms. I used the same criteria for message inclusion as I did for my pilot study—I removed duplicate records, false drops, and spam (unless it provoked a relevant discussion) and the thread had to contain more than one message to be included. Ten thousand pages of newsgroup messages were whittled down to 1,941 relevant pages.

Table 3 outlines the number of relevant messages and threads retrieved from the newsgroups. In total 7,984 messages from three newsgroups in 394 threads were analyzed.

Table 3. Number of Relevant Messages and Threads from Newsgroups

depression group

Number of threads Number of messages

2002—14 2002—94 2003—9 2003—134 2004—9 2004—159 2005—80 2005—1,328 2006—70 2006—999 Total: 182 Total: 2,714

alternative health group

Number of threads Number of messages

2002—27 2002—484 2003—33 2003—561 2004—34 2004—714 2005—29 2005—943 2006—54 2006—1,320 Total: 177 Total: 4,022 biomedical group

Number of threads Number of messages

2002—3 2002—264 2003—3 2003—47 2004—11 2004—147 2005—11 2005—557 2006—7 2006—233 Total: 35 Total: 1,248

4.3.4 Interviewing

I conducted ten in-depth interviews with individuals who were currently suffering from depression or who had experienced depression in the past. These semi-structured interviews provided opportunities for follow up and probing (Bates, 2004; Johnson, 2002; Lofland, 1971). The interviews ranged from 40 to 90 minutes. Six out of the ten

interviews took place in the interviewee‘s home. Four of the interviews were conducted at restaurants chosen by the participants. All of the interviews took place face-to-face and were recorded.

Because qualitative research is inductive, a number of themes and questions used to guide my interviews were developed using the results from the newsgroup study.

Additional questions were incorporated into the interview schedule based on my first interviews. (Please see Appendix A for a list of interview questions). I used a process of recording, transcribing, and open coding as recommended by Glaser and Strauss (1970) to code my interviews. I used the qualitative software Ethnograph 5.0 to analyze my

newsgroup and interview data.

On a practical level, I began each interview by introducing myself, providing a written summary of the project (while giving the respondent enough time to read it) and ensuring that the participant fully understood the project prior to conducting the interview. I followed certain suggestions from Fielding (1993) about guided conversation—a method which emphasizes probing and the facilitation of conversation rather than using a more restrictive question and answer type interview. Fielding suggests that the aim of probing is to allow a participant to talk about an event or their story without directing them to any particular conclusions. The interview questions were designed according to the principles advocated by Berg (2009): they were open-ended, clear, and couched in the language levels and preferences of participants.

The process of data analysis went hand in hand with data collection. Broom (2005) suggests that analyzing data as the research progresses shapes the ongoing data collection and produces high quality data. By analyzing the data as I conducted the interviews I was able to refine my research questions, pursue emerging themes, and generate more in-depth queries for other interviews. For example, after my second interview I realized that asking participants how they deal with stress was an important question that I had omitted from

my initial interview schedule. Researchers suggest that when data collection and analysis begin at the same time and proceed concurrently the likelihood of missing significant themes is greatly reduced (Broom, 2005; Bryman & Teevan, 2005; Glaser, 1992; Lincoln & Guba, 1985; Miles & Huberman, 1994).

I read through both the interview transcripts and the newsgroup threads several times, noting ideas and emergent themes. I used open coding as described by Ezzy (2002), and Strauss and Corbin (2008). I ensured that atypical cases and conflicts with the data were noted. Following this initial analysis, I re-read the interviews looking for themes. Labelled by some as ―axial coding‖ (Ezzy, 2002; Strauss & Corbin, 2008) this is the process of moving beyond reading and writing notes to sorting one‘s observations. Within this process, once a theme was identified, I searched through the interviews for other related comments, employing ―constant comparison‖ (Glaser & Strauss, 1970) to further develop or complicate these themes. From here, I continued to refine and develop my themes while paying attention to the nuances in the data such as the atypical cases (e.g., the sole poster who questioned the scientific method as the gold standard for creating

knowledge or generating evidence). Themes were developed that specifically answered my research questions about participants‘ conceptualizations of depression, CAM, and biomedicine. Additional themes were uncovered through coding related to information practices such as the act of prescribing. Developing themes and using constant comparison allowed me to organize my data and to then analyze pertinent messages and threads using discourse analysis.