Within the literature of participation in online support groups, two distinct type of user engagement has been consistently identified. There are the presence of members who actively participate by both reading and posting messages on the wall, which are more commonly known as 'posters' and there are also members who do not post but may read the messages posted which are known as ‘lurkers’ (Nonnecke & Preece, 2000). Nonnecke, Preece & Andrews (2004) did find that lurkers tend to perceive that they receive less than the expected benefits compared to posters due to their behaviour. Mo & Coulson (2010) in their study of posters and lurkers living with HIV however did not find any significant differences between them in terms of self-care efficacy, loneliness, depression or optimism. Nevertheless, very little could be implied from such minimal research.
Relating the literature to the dental anxiety or phobia context, very little research has been done except from the work of Buchanan & Coulson (2007) where they appear to have found some individuals who feel empowered to tackle their dental anxiety or phobia and Coulson & Buchanan (2008) where they found individuals with reduced dental anxiety since joining an OSG. Thus, this warrants further research in the field of dental anxiety.
Research Question:
Is there a difference between dental anxiety patients in terms of their online experience upon joining an online support group?
How do members perceive that their online experience has improved their management of their anxiety?
Do people who post more also benefit more than those who just lurk?
Study Design
The study will use a mixed methodology of both qualitative and quantitative, within-subjects retrospective design. The presence of the two different types of participants within dental anxiety online support groups will act as the independent variables and the dependent variables will be their online experience. The independent variables will be lurkers and posters within the online support group communities and the dependent variables will be their overall experience, improvements in anxiety management and empowerment effects. The constructs will be measured through a combination of both open-ended and close-ended online questionnaires.
Practical Considerations (Participants)
The participants that will be needed in this study will consist of participating members from dental anxiety online support groups on the Internet. Thus, dental anxiety support groups will first have to be identified through popular and recognized search engines such as Google.
As with accessing online support groups, where privacy and confidentiality remains an important criterion, permission from gatekeepers or admins of the online support groups would be needed to carry out the study. Thus, the objectives and aims of the study will be explained and presented to the gatekeepers and admins of the respective groups and approval in carrying out the study will be obtained before any information or study materials are distributed to the members of the groups in order to recruit participants.
In ensuring that a currently functioning dental anxiety online support group is identified and to maximize recruitment of participants, inclusion criteria of dental anxiety support groups will be defined as done by Mo & Coulson (2010) in their study. A currently functioning online support group will be defined such that the group must consists of at least 50 members, have at least a current post on the online support group bulletin board or forum that has existed no longer than one month. Groups were also excluded if their aim was just to purely provide information.
Also as identified from the literature, lurkers tend to participate less in support groups and may tend not to participate in any other additional activities happening within the group. This might cause underrepresentation of the lurkers within the group and thus affect the outcomes of the results. In addition, less could be known about individuals who do not respond to the questionnaires posted and thus could not provide a full representation of the members of the group. Personal messages would be sent to each and every respective member to promote participation as well as providing the average time needed to complete the questionnaire could maybe promote participation amongst the members, as time is an important factor in this modern world.
Besides that, due to online support groups being internationally accessible, a wide variety of individuals from different backgrounds would be included. Although English language is the now the most globalized language across the world (Sharifian, 2013), there are still individuals who may speak a different language and have only a minimal knowledge of the English language. Due to the study being conducted mainly in English, there would be a problem in understanding the questions posed. In order to prevent this from occurring, an exclusion criterion, in which individuals who do not speak or understand English will be implemented by providing an explicit statement together with the information that would be distributed about the current study prior to participation.
Practical Considerations (Data Collection)
As the study involves collecting participant’s responses through online questionnaires, there are a number of data collection logistics that needs to be attended to before the start of the experiment.
Data collection is a very time intensive process. It is very important to allow the right amount of time between sending out invitations to participate in a study and analyzing the responses so that the right amount of data is obtained for the study. Thus, schedules will have to be set up in advance for data collection and will be strictly adhered to. In unforeseen circumstances, there might not be enough time to collect enough data to present and make an effective study. A backup plan should also be made so that if data collection is not successful within the planned schedule, it could be implemented to collect the data that is required. A timeline of the period of data collection and a backup period of data collection will be proposed before initiation of data collection. Progress will be reviewed every week to ensure that data collection is in accordance to the schedule.
Besides that, it is particularly important that the data collected through the online questionnaires is stored in a reliable database so that no responses or data is lost or damaged. Recollection of data would be required if data is lost and would cost an insurmountable amount of time to finish the study. Therefore it is particularly important that a safe and secure site and database is used. A few reliable online survey or questionnaire sites that has been identified to be reliable and secure such as surveymonkey.com and psychdata.com will be used to prevent any mishaps of data lost.
As online questionnaires does not provide the privilege of researchers being able to monitor the progress of participants as well as responding to questions from the participants, there is a possibility that participants may not fully understand particular questions within the questionnaire and thus leave it unanswered which causes the occurrence of missing data. These missing data could further impact the results of the study. Therefore, participants will be reminded to answer to the best of their ability and should not leave any questions unanswered so that there is no missing data.
Ethical Considerations
In conducting a research within the field of psychology, there are various factors within the design and nature of the study that could affect participants either directly through accidents or indirectly through psychosocial effects. Thus, it is particularly important that researchers follow a code of conduct that is defined by the respective recognized ethical boards before proceeding with carrying out a study. The British Psychological Society (BPS) has compiled a Code of Human Research Ethics (2011) which outlines the various principles that researchers should follow before carrying out a study to ensure that the study or experiment’s benefits are maximized and harm is minimized. As this current piece of research would involve the Internet as a research medium, there are a number of particular challenges in adhering to ethical principles, which could be of main concern to the ethics principles (BPS, 2013). The main ethical issues that pertain to this particular study would focus primarily on informed consent, anonymity or confidentiality and the right to withdraw from the study.
In regards to valid consent, it is important that participants should be provided with details that are sufficient regarding the nature, aspects and risks associated with their participation (BPS, 2013). Thus, before consenting to participate in this particular study, full information regarding the aims of the study, the methods in which participants would be assessed and their right to withdraw at any time during or after the study, would be given to the participants. This will be implemented by presenting the information to the members of the group through a private message together with their invitation to participate in the experiment.
Within the Internet-mediated research context, confirming that participants have properly engaged with valid consent procedures are not always as simple, particularly with online anonymized questionnaires (BPS, 2013). Individuals would not fully read the consent details and participate in the study without fully understanding the impact and extent of their participation. It is recommended as good practice to include check boxes in response to explicit consent statements (BPS, 2013). The use of these boxes is an effective strategy in showing that participants have read the key constructs of the consent information and thus agree to participate in the study (BPS, 2013). After participants are provided with the information of the study and agree to participate, they would be presented with a list of check boxes informing them explicitly of their consent to participate, anonymity and right to withdraw. It would be compulsory to answer the check boxes coupled with explicit statements of consent before progressing to fully participate in the study.
As the current research would involve collecting data through online questionnaires there is one particular risk, which is of concern in most Internet-mediated research and this is the researcher’s control over the confidentiality of data. To protect the privacy and confidentiality of the participants who responded to the questionnaire, only their age and gender is requested and reported for demographic purposes. No other information will be asked of participants. The BPS (2013) has stated that researchers need to be aware that maintaining absolute confidentiality of participant’s responses is not always possible. Thus, participants should always be informed in advanced. For instance, participants may decide to withdraw their participation and this would require a need for tracing their responses. To maximize confidentiality, the researcher will inform the use of ID codes following the rules of the Data Protection Act before the study is initiated, in which it will allow the identification of the correct data to be withdrawn.
In the case in which participants would wish to withdraw their participation, withdrawal procedures should be made as clear as possible to the participants (BPS, 2013). Participants may decide to withdraw themselves during the course of pursuing the questionnaire and simply exiting the browser may not necessarily mean that they are withdrawing their responses (BPS, 2013). Thus, clear signs of exit and withdrawal should be implemented in the material used. In this case, due to the use of online survey software solutions in the current study which may not assimilate ‘exit’ or ‘withdraw’ buttons within the online questionnaires (BPS, 2013), the researcher would inform participants by stating at the beginning of the study that withdrawal of their responses could be made on the last page by ticking a check box which could be done regardless of whether they have fully answered the online questionnaire. Withdrawal of data after completion will also be considered. Instruction and contact information of the researcher will be provided at the beginning and at the end of the study for participants who intend to request for their withdrawal of their data. Participants would also be given a time period of 1 month of participation to withdraw their data before it is analyzed in which the data could not be withdrawn.
Another possible ethical consideration in which it could affect the research project is the extent of its ‘quality, integrity and contribution’ as emphasized by the Code of Human Research Ethics (BPS, 2013). The lack of control due to the Internet’s greater variability and reach of participants across the Internet may affect the data that is collected. For instance, an individual could make repeat submissions over and over again. These repeat submissions may seriously affect the validity of a study (BPS, 2013). Ensuring that it does not happen could bring upon better scientific value to the study. The researcher will identify online survey platforms, which assimilate data forensic checks that prevents multiple submissions from a same individual and utilize one of them as the main platform for preparing the online questionnaires.
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