Valoración del “Material de estudio complementario para el curso Estadística Aplicada

The third element of the study was undertaken in March and April 2012, following analysis of data from observations and interviews. This section of the chapter deals with issues around data collection via the Internet, and describes the process undertaken.

Internet mediated research poses a number of dilemmas. These can be summarised neatly:

 What constitutes ‘privacy’ in an online environment?

 How easy is it to gain informed consent from participants, and what does informed consent actually mean in such a context?

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 How is a researcher to ascertain the ‘real’ identity of participants?

These four issues were of central concern during this phase of the study, and are addressed here, as I outline the way in which the internet research was undertaken.

Ethical concerns have long troubled researchers working with data gained through online interaction (Ess, 2002), part of the problem relating to the fact that different online methods will produce different research relationships. Therefore, ethics may vary with methodology and context (Bailey, 2001). In my case, being a novice in the world of internet research, I decided to try to apply the same ethical principles that had guided the ‘real’ world part of the study. Namely, ensuring an honest and transparent approach, and including attention to the principles of informed consent, anonymity, and right to withdraw. As the British Psychological Society suggest in their internet research guidelines, such work

“…requires the application of the same controls, checks and balances that apply to good research in traditional settings. It should also involve the same ethical considerations being given to people who are taking part in the research, whether they are simply being observed or are invited to actively engage in experimental tasks or activities” (BPS, 2007:1).

The issue of privacy has been suggested as the most important ethical issue for internet researchers (Thurlow et al, 2004), for the simple reason that there is a lack of clarity as to what entails public or private space on the worldwide web. According to Hewson et al (2003), data that have been made voluntarily and deliberately available in this domain should be accessible to researchers, as long as anonymity is ensured. However, even this view has been challenged, with suggestions that an individual’s understanding of privacy

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might be determined by who they believe sees the work, and what purpose they attach to it.

On The Midwifery Sanctuary site, basic access is public, given that all posts (other than those within the ‘members only’ area) are visible without any need to register or log in. The search facility is also public. I began my work by searching through the site for information about whether I would be able to use my findings in a thesis, and what permissions might be needed to do so. I could find nothing relating to privacy issues within any of the various forums, including the ‘welcome’ board and the ‘frequently asked questions’ thread. I later posted a question relating to use of findings, but there appeared no clear policy or guidance in place. In the meantime, several of the respondents individually noted their consent for me to use comments they made, and nobody at the forum suggested that it might not be appropriate to do so.

I was keen to begin by searching the site for the terms ‘managers’ and ‘management’, in order to get an idea of whether such topics came up in discussions or debates, and so needed to make a decision as to whether to become a registered user of the site. This raised the issue of whether ‘lurking’ is an acceptable part of internet mediated research. In their guidelines, the British Psychological Society suggest ‘lurking’ as the most likely instance of deception in internet research (BPS, 2007:4). However, Chen et al (2004) have suggested that such activity might help the researcher to gain an understanding of important topics or the culture of a group, although these authors found lurking was generally disapproved of as a data collection method. Similarly, Eysenbach & Till (2001) write that there is a risk of individuals ‘lurking’ in online communities being perceived as intruders.

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Based on these findings, and knowing that I was likely to want to post questions on message boards as part of the work, I decided to register with the site prior to undertaking any further study. Having completed the relevant online form, I then had to wait for a moderator to approve my registration, which took about a week. Once registered, I was able to log in, and also gained access to the ‘members only’ area of the site.

Having spent some time looking through various areas of the Sanctuary, and getting a feel for what kinds of conversations and interactions were going on, I decided to do two things. Firstly, I posted a message introducing myself, to include information about why I might be asking questions. I used informal language:

“Hello, this is exciting! I’m a former midwife, but I left practice two years ago to do

a funded, full-time, three year PhD. Yes, I know – I feel very, very lucky! My thesis

is about midwifery leadership – how clinical leaders got there, and how we might

narrow the chasm that sometimes appears between clinicians and

leaders/managers. And most importantly, how we can encourage more midwives

to be helped appropriately into future leadership positions. I’m a bit passionate on

this subject, and I’m keen to see whether my ideas resonate with midwives out

there, so I’d like to ask questions periodically that I can hopefully use in the thesis”.

Within this post, I was attempting to address the issue of consent, which is another area of concern in internet mediated research, and closely linked to that of private/public space. Once again, there appears to be no consensus on the subject, with guidelines generally considering an approach close to that used in ‘real’ world research to be the most appropriate. Obviously, with over 3000 potential participants reading this post and going on to view any questions I would pose, this was a matter for some thought, and gaining written consent would be impossible. I was guided by the idea that I should be as open and honest as possible, and the introductory post was designed to fulfil this aim. I considered

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who might respond to my posts, based on what I had already seen on the site. There was a sense of a lively community here, and I gained the impression that people felt safe to post on a vast range of subjects, both within and beyond midwifery.

One thing that I noticed was that some members obviously knew others, apparent in some of their exchanges and conversations, and despite pseudonyms being applied throughout the site (I became ‘30fairy’). This brings me to the subject of anonymity, which has been identified as the third consideration in this mode of research.

Questions of pseudonyms are complex in internet research, with the BPS guidelines (2007:4) suggesting the importance of treating individuals posting to forums with the same ethical consideration as for ‘real life’ research. This relates to the fact that when quoting responses, participants might be traceable through internet search engines. However, the other side of this argument comes back to the idea of public space, and to what degree online posters understand their comments and conversations to be taking place in a public arena. The Midwifery Sanctuary allows users to give as much or as little information about their identity as they wish. Table 4.2, below, gives details of how I identified myself at the online forum, using the registration form:

Table 4.2 Online identification

My details Notes

Username 30fairy Pseudonyms used across the site Rank Weeing on a stick A midwifery joke by the site, relates to

how many posts you have written Occupation

Doctoral student, 3rd year, scared of writing up

Often left blank, sometimes professional occupation given, e.g. midwife, student midwife

Location I left this blank Often left blank, sometimes general geographical location given

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Groups Registered users Can also include e.g. moderator, administrator

Status Always learning Often left blank, sometimes ‘midwife’, sometimes personal

Most site users appeared to give very little information, and often the only identifying elements were their username and rank. While this appeared to answer my concerns about identifiability of participants at the point of posting, the issue of whether to add a second layer of disguise (beyond their site pseudonym) was one that required much thought. Based on the BPS guidance, I eventually presented findings without any direct identification, instead referring to which question the comment related.

By now, I was clearly not ‘lurking’, and I decided that my second action would comprise two parts. First, I undertook a search of the site, using the terms ‘managers’ and ‘management’. Both these searches returned a large number of results, and I decided to limit the search to one year back. A further complication was in the use of the word ‘management’, as in midwifery this relates to various clinical elements, such as management of the 3rd stage of labour, or management of induction. However, I sorted through the results to identify those relating to the type of management I referred to. Having undertaken the search, and having gained an idea of the kinds of references midwives on the site made to managers and management, I commenced the second part of my data collection, which involved asking specific questions via one of the subject areas. I based my questions in the ‘midwifery’ part of the site, on the basis that it seemed an appropriate place in which to pose such questions, and also because this area is particularly well populated and new threads seem to generate a good amount of discussion and feedback.

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Questions were based on four elements of the study that had been explored already:

 Observation of midwifery leadership development programmes;

 The midwifery matrons/heads of midwifery/educationalist interview findings;

 The wider literature around NHS management and leadership;

 The results of the Midwifery Sanctuary searches of ‘managers’ and ‘management’. In total, I asked four questions on the subject of midwifery leadership and management, over a period of five weeks, which are detailed in table 4.3 below.

Table 4.3 Questions asked via the Midwifery Sanctuary

Date Question

10th March:

Midwifery Managers

Hi, I have a question that I need help with… I’m a PhD student and former midwife, looking at midwifery leadership, and I’d love to hear fellow midwives’ thoughts on this: Can you call yourself a midwife if you don’t work clinically?

21st March:

Hands up, Midwives!

Hands up if you aspire to become a midwifery manager. For example, are you aiming for a ward manager post, or would you like to become a matron or even a head of midwifery one day? And if not, why not?

30th March:

Matrons: what are they?

So, in my PhD thesis, I’ve been talking to matrons, who have very clear ideas about what their identity is. But I’d like to know what you think: when I say ‘matron’, is your first response ‘midwife’, ‘manager’, or ‘leader’? Or maybe a combination of all three? A thousand thanks for all the responses so far to my other questions – your opinions are super valuable!

16th April:

Matrons (again, sorry!). Later, changed to Beautiful Midwifery Leadership!

So, as I’m sure you know by now, if you’ve seen my other questions, I’m looking at midwifery leadership for my PhD. The responses I’ve had have been great, and as a former midwife myself, I can relate to much of what is being said. I have one more question, and as

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ever, I’ll be hugely appreciative of your responses: What can midwifery managers (at all levels of the service) do to earn the respect of midwives? Can you think of anything that would make their role seem more attractive for your own career path? I know, that was two questions – my apologies!

Again, I was careful to pose the questions using language and style that I felt was appropriate for the site, and I was particularly mindful of the potential impact of an engaging title. Table 4.4 below shows the response rate for the four main questions, as well as for the introductory post, as of April 18th, 2012. By this date, I was seeing no new responses to the questions I had posted, and so decided to end this element of the data collection.

Table 4.4 responses to questions on the Midwifery Sanctuary

Views Responses Site area Date of question Question 1:

Midwifery Managers

698 22 Midwifery 10/3/12

Question 2:

Hands up, midwives

691 25 Midwifery 21/3/12

Question 3:

Matrons: what are they?

393 11 Midwifery 30/3/12 Question 4: Beautiful Midwifery Leadership 260 9 Midwifery 16/4/12 Introduction 196 5 Welcome to the forum 10/3/12

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4.7 Data Analysis