Main Study

The main study involved individual interviews with men focusing on how they constructed their ‘personal communities’, and exploring the importance of people within these in offering support for, and shaping how men think about, safer sex. The following section of this chapter provides further detail about the interviews conducted. I now discuss decisions that informed the sampling and recruitment strategies, and the process of data collection, before outlining how the data were analysed.

3.3.2.1 Ethics

Ethical approval for the project was granted by The College of Social Science Ethics Committee at the University of Glasgow.

3.3.2.2 Sampling and Recruitment for the Main Study

A purposive sampling strategy was developed (Marshall and Rossman, 1999;

Ritchie et al., 2003a). As highlighted in the literature review, less research has been conducted with young gay and bisexual men around their understandings of safer sex and the social context of their understandings of HIV risk. Analysis of data from the Gay Men’s Sexual Health Survey conducted in Scotland between 1996 and 2008 found that overall, men aged 25 years and under were

significantly more likely to report two or more unprotected partners in the previous 12 months, suggesting that they were at higher risk than other age groups (Knussen et al., 2011). Other Scottish data, now published as part of a local Needs Assessment, indicated that there had been an increase in the number of men diagnosed with HIV in the 24-34 age group (Coia et al., 2014).

These patterns of increased risk also appeared to fit with Arnett’s (2000; 2001) conceptions of ‘emerging’ and ‘young’ adulthood as encompassing the ages 18-29. Based on these rationales, key inclusion criterion were that the men were

aged between the ages of 18 and 29, identified as gay, bisexual, or as a man who has sex with other men.

Given the discussion of the scene as a ‘visible’ dimension of ‘gay community’, as outlined in the literature review, I aimed to include both men who frequented the main urban gay centres (scene-based), and those who did not (non-scene).

The table below outlines the proposed sampling frame for the study, with actual numbers recruited highlighted in the final three columns.

Table 3-1 Sampling Frame for Main Study Age Group

My experiences during my MSc study (Boydell-Wright, 2011) and the exploratory phase of the PhD research (Boydell et al., 2014) reflected some of the practical difficulties and methodological issues relating to sampling and recruitment that have been highlighted in previous research with gay men and lesbian women (Browne, 2005; Filiault and Drummond, 2009; Morris, 2006; Sullivan and Losberg, 2003). Filiault and Drummond (2009) note that gay men can be difficult to

recruit to qualitative studies, as few men actively volunteer as participants. Gay and bisexual men have at times been termed a ‘hard to reach’ group (Van

Eeden-Moorefield et al., 2008) and various recruitment strategies have been suggested, such as online recruitment, the use of adverts on internet sites and in

the gay press, access through gay men’s support organisations and community groups, and snowballing (Browne, 2005; Filiault and Drummond, 2009; Morris, 2006; Sullivan and Losberg, 2003).

Early on in my MSc studies, one of my supervisors assisted me in making contact with Gay Men’s Health, a Scottish charity for gay men, and I arranged a meeting with the Chief Executive. He emphasised the important of gaining trust among individuals and organisations working with gay men in Scotland and made it clear that it would take time to gain ‘visibility’ and build trust and credibility within this particular ‘community’. My experiences reflected this, and building links with organisational gatekeepers and developing trust with individuals proved to be a lengthy process. Thus, although recruitment for the main study took place between September 2012 and June 2013, much of the ‘work’ of recruitment had been ongoing for many months prior to this.

The recruitment strategies I chose to use were based on a those used in previous qualitative studies with gay and bisexual men, advice from practitioners working in HIV prevention in Scotland, and reflection on my own experiences during my MSc and exploratory research. The table below provides a summary of the recruitment strategies used, with the sections that follow providing more detail about each.

Table 3-2 Recruitment Strategies for Main Study

Strategies for Recruiting Young Gay and Bisexual men

Recruitment at GAYCON 2012 with individuals and organisations

Recruitment through gay men’s organisations and support groups for young gay men (e.g. Gay Men’s Health, LGBT Youth Scotland, Terrence Higgins Trust etc.)

Recruitment using Get Rubbered! database through Terrence Higgins Trust Recruitment through personal and professional networks, and snowballing Recruitment using social media such as Twitter and Facebook

3.3.2.4 Recruitment at GAYCON 2012

In October 2012 I attended GAYCON, a national conference on the sexual health of gay and bisexual men (primarily in Scotland) held in Glasgow. The conference

was aimed at workers with a role in improving the sexual health of gay and bisexual men. Before the conference I sought permission from the chair of the conference organising committee to use the conference as an opportunity for recruitment. The sexual health team from the MRC/CSO SPHSU had a stand at the conference in order to facilitate knowledge transfer and provide a forum for consultation with professionals working in the field. Copies of my study advert (Appendix 7) and information sheet (Appendix 8) were available from the SPHSU stand. As one of the staff manning the stand I had the opportunity to meet with men attending the conference, as well as practitioners working in the field of gay men’s sexual health. In addition, I presented at the conference, outlining some the key findings from my exploratory focus groups. This enabled me to get feedback from practitioners and academics.

Although I had developed a good working relationship with staff at both Gay Men’s Health, and Terrence Higgins Trust, my intention was to make contact with other relevant community-based organisations and groups, specifically youth groups associated with other LGB charities, and LGBT support groups linked to universities in Scotland. In an attempt to facilitate this, I had already contacted a number of organisations and individuals (by email and phone) to provide details of my project and request the chance to meet with them.

Despite repeated contact, up to this point I had had limited success. The conference proved to be a ‘turning point’, as I was able to meet with key

representatives of many organisations face-to-face and have informal discussions about the possibility of them becoming involved in promoting the project.

Indeed, after presenting at the conference, a number of individuals from organisations I had not previously liaised with approached me with offers to assist in promoting the project. I was able to follow this interest up after the conference, subsequently developing good working relationships with staff within a number of other community-based organisations, including Waverley Care, HIV Scotland, and LGBT Youth Scotland.

The conference also enabled me to make direct contact with men who had chosen to attend out of personal (and professional) interest. The first two study participants enrolled into the study were men I met during the conference.

3.3.2.5 Recruitment Through Gay Men’s Organisations and Support Groups for Young LGB People

Where organisations agreed to promote the study I provided copies (both electronic and hard copies) of the advertisements and information sheets outlining the aims of the research, enabling organisations to forward these to potential participants who were then free to contact me. Many of the

organisations placed an alternative version of the advert (Appendix 9) on their static websites, as well as promoting the study using social media such as Facebook and Twitter. Other organisations passed information to project

workers involved in community outreach, who then spoke directly to men about the study as part of their outreach work. A number of organisations invited me to attend pre-existing groups to talk to young men about the research. I found this very useful as it gave the men the chance to meet me informally, ask

questions about the research, and find out more about what was involved in the interview process. Fifteen of the participants who took part in the study were recruited through community-based organisations.

In addition to visiting pre-existing social support groups, along with another colleague from the MRC SPHSU (who was also seeking to recruit gay and bisexual men for a qualitative sexual health study) I was invited to a number of events held on the ‘gay scene’ in Glasgow and Fife. On these occasions, I accompanied health promotion workers who were undertaking outreach work, delivering sexual health prevention and HIV prevention information within these settings. I was able to take along study information sheets and advertisements, and speak directly to men who approached the stand where information leaflets, condoms and lubricant were provided. Again, I found it beneficial to be able to speak to potential participants in an informal setting, and although not all men were keen to take part, many showed interest in discussing the research and the work of the MRC SPHSU. Five men I spoke to in these settings provided me with contact details and showed interest in participating, however only one of these men took part in an interview.

3.3.2.6 Recruitment Using THT’s Get Rubbered! Database

Staff at THT assisted with recruitment using their database of men who obtain condoms by post (Get Rubbered!). The database covers three predominantly

rural areas in Scotland (Lanarkshire, Ayrshire, and Fife) and contains the details of over 500 men who have subscribed to the service. According to data collected and provided by THT, most of these men are not regular scene-goers.

Approximately 80% of these men (n=400) had previously agreed to receive information by post and e-mail relating to future research and consultation work. I provided electronic copies of my advert (Appendix 9) and information sheet and these were incorporated into a newsletter developed by THT staff.

This was distributed to all men on the database who had previously agreed to be contacted. Men interested in participating were then free to contact me. This method of recruitment was not successful, and no men came forward via this route.

3.3.2.7 Recruitment Through Personal and Professional Networks, and Snowballing

During my MSc research project, snowball sampling proved to be the most effective method of recruitment (Boydell-Wright, 2011). Similar to Browne (2005) I found that recruitment using professional and personal networks worked well, as recommendations from friends and colleagues seemed to offer

participants confidence that I was a trustworthy researcher and individual.

During the main project, this again proved to be the case and was one of the most successful strategies. A number of colleagues within the MRC SPHSU

contacted gay male friends, passing on copies of the information sheet to them.

Two men contacted me directly and agreed to participate in the research. One of these men passed details of the study to his friends and colleagues, and another six men took part in an interview as a result of this.

As highlighted earlier, within the Sexual Health team at the MRC SPHSU, recruitment for another qualitative sexual health study with gay men ran

concurrently. We had initially been concerned that this could lead to difficulties in recruitment for both projects, however, as the projects were exploring

different topics, and the targeted age range differed, this was less problematic than initially anticipated. My colleague was able to pass details of my research to men whom she met, and a further two men who she discussed the project with took part in an interview.

In total ten men were recruited through networks and snowballing.

3.3.2.8 Recruitment using social media such as Twitter and Facebook As noted previously, a number of organisations placed the study advert on their static websites, as well as promoting the study using social media such as

Facebook and Twitter. I was able to supplement this by tweeting and retweeting the advert using the Sexual Health Team’s Twitter account, as well as my

personal account. Other organisations and groups, such as University LGBT groups, picked up on Tweets and posts on individuals’ Facebook pages and these were then retweeted and ‘liked’ within Facebook. In total, two participants were recruited in this way.

3.3.2.9 Development of the Interview Topic Guide

I developed a topic guide for the interviews guided by my reading of the

empirical literature, and the study research questions. Kvale (2007) notes that

“an interview guide is a script that structures the course of the interview more or less tightly. The guide may merely contain some topics to be covered, or it can be a detailed sequence carefully worded questions.” (p. 56-57). In line with Kvale, the topic guide I developed aimed to allow me to systematically explore key themes throughout the interview, while retaining flexibility to enable me to follow up issues emerging from participants’ answers. Rubin and Rubin (2012) provide advice on the ordering of main questions during an interview, making clear that “early questions [should] not restrict what the interviewees feel they can say later. In general, present broad orientating questions first and more detailed, specific questions afterward.” (p. 136). They note that where broad question are asked, participants may anticipate questions that will be asked later, thereby answering more than one question at once. This highlights the need for flexibility in the interview/topic guide, and the need to be a

‘responsive’ interviewer. In developing the topic guide I followed this guidance, structuring the topic guide by initially exploring general issues around the men’s

‘personal communities’, before moving on to more specific questions about people within them, and finally to discussion of sex, sexual practice, and HIV.

Structuring the interview in this way meant I was able to ask more sensitive

questions later in the interview, having already built up rapport with participants (Kvale, 2007; Rubin and Rubin, 2012).

3.3.2.10 Constructing the Men’s ‘Personal Communities’

Following Spencer and Pahl’s (2006) method of exploring personal communities’, I sent a letter to participants in advance of the interview (Appendix 10) asking them to think about “people who are important to you now” (p. 214) as a way of establishing members of their ‘personal communities’. Participants were asked to bring along a list of these people to the interview. The majority of

participants came with a list prepared, and some even had written notes to explain why they had chosen to include specific people. Even where they had not brought a written list, they often described their thought processes when considering who was ‘important to [them] now’. During the first part of the interview I encouraged participants to place the individuals they had listed on to an “affective map” (Spencer and Pahl, 2006, p. 216) consisting of concentric circles relating to, and intending to represent, their relative importance

(Appendix 11). I asked that they think about themselves as being at the centre of the map, and to place the individuals (and for a minority, groups) in the circles, using the innermost circles for those with whom they had the closest relationships, and the other circles for those for with whom they had a close (but not as close) relationship with, and to. In this way men constructed a diagram/schematic of their ‘personal community’, which was then used during the interview to facilitate discussion around the meaning of relationships.

It is important to note that I did not use the term ‘personal community/ies’

when talking with participants. Although I referred to the ‘affective map’ as a

‘map’ or a way of mapping people ‘important to them now’, I at no point referred to the resultant diagram/schematic as their ‘personal community’.

Thus, when I refer to men’s ‘personal communities’, I am referring to the

analytical or conceptual logic which I have applied to exploring and interrogating the ‘affective maps’ that the men developed, and the discussion of these that followed during the interview. Nevertheless, some of the men did spontaneously talk about the ‘map’ they had constructed as representing ‘my community’. For example when talking about the people on his map, Kane (23) described how he

had tried to “create my own little community”, which included his close family and friends.

Some participants found the mapping process easier than others, however, most described the map as being useful, and found having a visual representation beneficial during the interview. Only one participant said they disliked the

‘mapping process’ as they felt it was similar to ‘mind mapping’.

3.3.2.11 Piloting the Interview Schedule

Between October 2012 and December 2012, I conducted six interviews that served as a pilot. As Kvale (2007) notes,

“...the problems of an interview project tend to surface in the analysis stage, more often than they originate in the earlier stages. The solution is to improve the quality of the original interviews. Thus, clarifying the meanings of statements during an interview will make the later analysis easier and more well founded...” (p. 43).

On this basis, Kvale suggests that where possible, work that is assumed to be post-interview should be pushed forward to earlier stages. Thus, my supervisors suggested that I should read, reflect and begin analysis on the first six interviews conducted. This enabled me to identify gaps and issues that required further exploration and interrogation, as well as considering if, and how the data answered my original research questions. It became clear that my initial interviews, although providing data that answered the research questions, lacked some of the depth required for deeper and more nuanced interpretation.

Reflecting on the first six interviews enabled me to rethink areas of the topic guide requiring revision. Some topics, such as ‘coming out’ were dropped from the interview, as men often raised issues around this spontaneously when asked about their relationships with people within their ‘personal communities’. The finalised topic guide can be found in Appendix 12. The lack of explicit discussion of personal sexual practice by some of the participants prompted me to think how to ‘delve deeper’ and I concluded that using ‘prompt cards’, detailing different sexual practices, could be useful in furthering discussion with men who seemed reticent to discuss the specificities of their own sexual practice. Prompt

cards were developed by returning to the literature and examining how previous studies had explored sexual practice (Appendix 13). Having developed the

prompt cards, I reviewed the wording/terminology with a Senior Health Promotion worker working in HIV prevention with gay men. A similar set of prompts cards were developed in relation to support, based on findings from Wilkinson, Holt and colleagues (2012) analysis of men’s ‘personal

communities’(Appendix 14).

3.3.2.12 Conducting the Main Fieldwork

All of the interviews took place between October 2012 and July 2013. Where men showed interest in the research, I made telephone or email contact to arrange a convenient date and time for the interview. Interviews took place in a number of locations throughout Scotland. Given the sensitive nature of some of the questions, a priority when agreeing a location for the interviews was that they should take place somewhere the participant would be unconcerned about being overheard. When making arrangements to meet, I discussed with each participant which setting would be most comfortable to meet, although there were some constraints on ‘suitable’ spaces, especially in more rural areas. The majority of interviews (n=25) took place in space provided by organisations who had assisted in recruitment. Men who had become aware of the research through such community-based organisations were often familiar and relatively

All of the interviews took place between October 2012 and July 2013. Where men showed interest in the research, I made telephone or email contact to arrange a convenient date and time for the interview. Interviews took place in a number of locations throughout Scotland. Given the sensitive nature of some of the questions, a priority when agreeing a location for the interviews was that they should take place somewhere the participant would be unconcerned about being overheard. When making arrangements to meet, I discussed with each participant which setting would be most comfortable to meet, although there were some constraints on ‘suitable’ spaces, especially in more rural areas. The majority of interviews (n=25) took place in space provided by organisations who had assisted in recruitment. Men who had become aware of the research through such community-based organisations were often familiar and relatively