JAN JOURNAL OF ADVANCED NURSING

ORIGINAL RESEARCH

Email interviewing: generating data with a vulnerable population

Catherine Cook

Accepted for publication 3 September 2011

Correspondence to C. Cook: C O O K C . ( 2 0 1 2 ) Email interviewing: generating data with a vulnerable

e-mail: c.m.cook@massey.ac.nz
Catherine Cook PhD RN
Lecturer
School of Health and Social Services,
Massey University, Auckland, New Zealand
population. Journal of Advanced Nursing 68(6), 13301339. doi: 10.1111/j.1365-
2648.2011.05843.x
Abstract
Aims. This paper describes online recruitment and the email interviewing data
collection method with women diagnosed with a viral sexually transmitted infec-
tion. The paper highlights the advantages of the method to researchers and par-
ticipants 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 geo-
graphical distance, incompatible time frames, clinicians gate-keeping and partic-
ipants 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 inter-
views may generate rich data through a process participants deem to be of personal
value.

Keywords: email interviewing, internet, methodology, nursing research, qualitative

research

their personal lives. These infections are endemic globally

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 clini-
cians taught women about these sexually transmitted infec-
tions (STIs), and what women learnt from clinicians, and
(Trottier & Franco 2006, Looker et al. 2008) and therefore
are common for specialist sexual health clinicians, but are
experienced as extraordinary and potentially socially dis-
crediting for the person with the condition (Newton &
McCabe 2008, Oster & Cheek 2008). The central question of
the study was how clinicians might contribute to womens
quality of life after a viral STI diagnosis, given that the

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diagnosis may have multiple meanings, diagnostically and
personally.
Prior to commencing the study, the author had more than a
decade as a nurse and counsellor in the sexual health field in
New Zealand and anticipated recruiting women for face-
to-face (FTF) interviews. A literature review led to a change
in research method. Reports of in-depth email interviewing
used by nurses (Kralik 2000, Adler & Zarchin 2002, Tatano
Beck 2005) and others within the social science field
(Illingworth 2001, McCoyd & Kerson 2006) highlighted
the benefits of this method when interviewing people who are
vulnerable and marginalized by a variety of health-related
conditions. These researchers emphasized both suitability to
participants of email over FTF interviews and the generation
of rich data.
The author had relevant skills for email interviewing, as an
email nurse-counsellor for two sexual health organizations.
In part, the decision to use email interviewing came from
considerable experience as an email nurse counsellor, thereby
learning that it is common for people with health problems to
use the internet for information, support and activism. There
is a familiarity with internet and email that often precedes the
decision to participate in online research.
The study also used email interviewing with clinicians, but,
in these instances, the method was used for geographical
access and clinicians control over timetabling. This paper
addresses interviews with women with HSV/HPV as the
method was used with these participants primarily to
optimize discussion with potentially vulnerable participants.
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 vulner-
able 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, gen-
erational and gendered aspects. Lewis et al. contended that
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Generating data with a vulnerable population
people who are conventionally marginalized economically,
racially, because of sexual orientation, geographic isolation,
illness or disabilities are not inevitably excluded from internet
technology.
The digital divide metaphor was contested in three studies
conducted in the United States of America (USA) by Mehra
et al. (2004). They concluded that the digital divide had
limited significance as the internet contributes to social equity
and empowerment. The studies addressed access of low income
families, sexual minorities and African-American women.
Internet use in conjunction with a medical consultation is a
routine part of many peoples lives (e.g. Hay et al. 2008).
Participants in online research are often recruited from a
variety of online resources. People who experience stigma
with a condition turn more readily to the internet than those
who do not experience stigma. A USA survey (Berger et al.
2005) of 7014 people with a stigmatized condition demon-
strated that this group was much more likely to use the
internet than those with a non-stigmatizing health condition.
Internet use involved information retrieval and contacting
clinicians. Participation in ehealth online communities
and social networks are part of the everyday experiences
(Hamilton & Bowers 2006). These groups are readily
accessible to people with minimal internet searching skills.
The internet is not the domain of youth. In a USA study of
2104 participants, Ybarra and Suman (2008) noted equal
numbers of adolescents and people 60 years and older using
the internet to seek health information.
Women predominate in the area of seeking health infor-
mation online. An international online survey by Lagan et al.
(2010) concluded that it is commonplace for pregnant
women to use the internet an adjunct to health care. Two
USA studies (Dickerson 2003, Pandey et al. 2003) indicated
that womens traditional responsibility for family health was
linked to internet use. The internet was an ally, with women
going online as part of family health management.
Researchers may turn to online recruitment when access is
blocked by clinicians. In their North American study of
women who had terminated pregnancies subsequent to the
diagnosis of a foetal abnormality, McCoyd and Kerson
(2006) discussed the gate-keeping practices of clinicians
who either did not support the research project or controlled
which women were informed about the research. McCoyd
and Kerson contend that the notion of protecting patients
easily conflated with silencing women. Recruitment rapidly
expanded when research information was accessible to
women through posting an email request for participants
on a relevant website.
Similarly, in a Scottish study about womens use of
reproduction technology, Illingworth (2001) asserted that
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power relations between researchers and clinicians may
impact adversely upon recruitment. She noted that research-
ers dependence on clinicians for initial participant recruit-
ment may thwart researchers access to interviewing women
FTF. She encountered clinicians gate-keeping, which led to
her decision to interview women by email.
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).
A discursive analysis was used to show how the meanings of
viral STIs in contemporary western society are formed in
contradictory ways; a clinician might understand the infec-
tion as an epidemiological inevitability and a woman might
see the same condition as a punishment for casual sex, or
vice versa. A discursive approach rules out arguments for or
against the true meanings of an STI and focuses on why it can
be a confounding task to teach about apparently simple
health topics.
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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The recruitment advertisement was linked to the Home
pages of two websites of a government funded organization
that provides information about HSV and HPV for clini-
cians and lay people in New Zealand. The websites have
considerable local and international traffic.
A webpage provided people with information about the
research and links to PDF documents of the participant
information and consent forms.
The webpage was posted on the website of the university
where the research was undertaken. This link was impor-
tant to establish credibility.
The advertisement with the webpage link was emailed to
academics and colleagues with a request to forward the
email to their collegial and womens networks. A request
for participants was circulated on the emailing list of uni-
versity students.
Data reached saturation before other recruitment options
were needed. When data saturation was achieved, the links
were removed from the relevant websites and recruitment
ended.
Email security: a designated email address for interviews
only was used and measures for internet security were
reviewed. The participant information form gave partici-
pants step-by-step information about the researchers
management of data security and recommendations for
their own management of the email correspondence to
protect their privacy. The details of these steps are available
elsewhere (Cook, 2009). The aim was to enable women
with minimal computer literacy to participate and have
acceptable data security.
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 com-
pared with experiences consulting health professionals
about other conditions?
What questions, if any, are difficult to ask health profes-
sionals? 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?
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In terms of talking to a partner about sexuality and sexual
health, has anything changed since the diagnosis?
Has the meaning of your sexuality altered at all since you
became aware of having a viral STI? (I use the term, sex-
uality, broadly to mean feelings of desire and desirability).
After establishing that the prerequisite participant infor-
mation and consent form had been read, women were asked
to respond to the initial group of questions plus demo-
graphic information. Approximately four questions were
emailed at a time. The following quote is from an email sent
to one of the participants and is an example of the
researchers aim to convey that there was no right or wrong
answer:
thanks so much for reading through the preliminary documents
participating in research can be quite a time commitment and I
appreciate you considering that my research may be worth the effort.
I have a series of questions about experiences with health profes-
sionals and later a series of questions about other aspects of living
with HSV. You are welcome to answer the questions in any way that
feels right for you and you are also welcome to digress and make
comments that are not related specifically to the questions the
questions are really like stepping stones to get a process started and to
provide me with a bit of a framework.
Women responded to the first group of questions and in
reply, the researcher made brief comments, sometimes asking
further questions about points raised. In addition, the next
group of questions were posed.
Clarification
Clarification was enhanced through the immediate avail-
ability of the interview text. Ongoing email exchanges
enabled the researcher to check any data where meaning was
unclear so that quotes were congruent with participants
intentions.
Completion
The interview ending was clear to ensure respectful com-
pletion. Interviews ended after the 16 formal questions
were completed with agreement that the researcher would
email 3 months after the interview ending for participants
to add to (or delete) aspects of their narratives and to
evaluate the online process. As negotiated, contact was
made again when the study was completed and each
woman was provided online access to the research. Kralik
et al. (2000) described the importance of attention to
interview closure. Illingworth (2001) reported that because
she had not negotiated an ending to interviews, intermittent
contact with some participants continued and closure
became difficult.
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Generating data with a vulnerable population
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 com-
mittee of the university through which the research was
undertaken. The participant information sheet alerted par-
ticipants 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 cod-
ing, 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 verba-
tim 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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enjoyment and care they took checking their replies and
re-reading their comments prior to submission.
Rigour
Rigour was established using Liamputtongs (2009) guide-
lines for evaluating qualitative research. Liamputtong iden-
tified two key strategies: (i) design and method decisions, (ii)
the participants, peer researchers and outsiders. Email inter-
views were selected to enable participation from those
women who might consider it impossible to participate FTF.
Womens quotes were clarified before analysis. The
researcher engaged in a reflexive process throughout the
interviewing process (Davidson & Tolich 2003). Reflexivity
entailed journaling emotional and intellectual responses to
the interviews. Discussions with clinical colleagues and aca-
demic supervisors included analysing themes in the data and
addressing ethical obligations and potential conflicts in my
intersecting roles as researcher, nurse and counsellor (Long &
Eagle 2009).
The question of participant authenticity is an important
aspect of data validity, which includes the extent to which
online and FTF data differ. The absence of non-verbal cues
and participants opportunities to edit responses is arguably
problematic (Mann & Stewart 2000). The researchers
inability to read emotional cues is contested as a problem
in online research. Seymour (2001), whose participants lived
with disabilities, asserted that FTF interviewing was a
qualitative convention rather than a superior method that
disqualified online research. McCoyd and Kerson (2006),
whose participants chose either email, telephone or FTF
interviews, noted that email participants preferred that the
interviewer could not see emotional cues because they were
spared additional vulnerability.
Authenticity is also about whether people are who they say
they are, for example, in terms of gender, age and life
experiences. Mann and Stewart (2000) asserted that partic-
ipants insider-knowledge is a possible test of authenticity.
Womens insider knowledge in this study appeared sustained
over the interviewing time-frame enabling the researcher to
have confidence over the probable genuineness of womens
claims about their diagnoses.
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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Cuban. The English participant was Caucasian, as were the
two Canadian participants. All women corresponded in
English. Time since diagnosis ranged from 1 week to
20 years. In analysing the interviewing method, the following
themes were identified: internet familiarity, clarification,
staying on-track, sensitive topics, and disembodiment and
rapport building.
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 partic-
ipants, internet use was commonplace to access STI infor-
mation:
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)
Most participants ranked the internet a more valuable source
of information than health professionals they consulted:
The internet has been my most used resource about HSV. Its
available 24 hours a day to answer any questions I have. Its provided
most of the answers Ive needed about the virus (Miranda, 48 years
old)
The internet was appealing in terms of its affordability:
Actually I found the herpes website to be most informative as the
doctor is too expensive just to go to for a chat (Claire, 29 years old)
Women typically believed they were able to evaluate online
material for their benefit:
it has been through my own research on the internet, some good,
some bad that I have been able to get a handle on what the diagnosis
means for meto decipher the research that is out there and filter out
the propaganda and fear-based support groups (Victoria, 37 years
old)
Clarification
Receiving womens emails meant there were no time delays
with transcription and participants comments were clarified
in the researchers next reply:
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Researchers comment/question:
Your comments about your GP stood out to me - that once you
received this diagnosis you realised that there were limitations to the
relationship that you hadnt experienced previously. When you said,
I was too devastated to think that [the diagnosis] was correct, do
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:
She didnt have any idea of the impact on me and I kept my tears until
outside
The availability of the transcript and the time to reflect
between emails enabled the researcher to identify significant
themes in womens everyday accounts. For example,
womens practices of saving-face, as in the above example,
was commonplace and led to the analysis of the importance
of clinicians anticipating possible distress and initiating
questions.
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
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.
Careful crafting of emails was part of the researchers
commitment to an ethical, respectful process. Care in word
choice was important because of the absence of voice tone
and non-verbal cues. To ensure a reflexive response, the
researcher waited at least 24 hours from initially reading to
responding. Women indicated that they too took time to
recall and represent their experiences in an unhurried
manner.
Sensitive topics
The research questions elicited numerous sensitive disclo-
sures. Women told of past traumas including sexual abuse,
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Generating data with a vulnerable population
rape, abusive ex-partners and problematic encounters with
clinicians that compounded feelings of loss of control. What
follows are examples of the beginnings of researcher
responses:
Researcher response to date-rape disclosure: Im sorry you had what
sounds like a shockingly awful time to be attacked sexually by
someone you know is an experience that women tell me is
overwhelming in so many ways.
Researcher response to partner-abuse disclosure: It must have taken a
lot of strength and courage to leave your previous relation-
ship.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
Email interviews were not a short-cut interviewing method.
Although the method spared time in transcribing interviews,
interviews with each woman took me approximately
68 hours to complete, plus extra time for data management.
Disembodiment and rapport building
The time-frame of email interviewing assisted rapport build-
ing. Participants reported the preference for dialogue without
FTF contact:
To write answers instead of speaking them has probably been easier
for me, because that helps in the reflective process. I feel I have given
as accurate an account as I could have, in fact more accurate because
had this been a structured interview, face-to-face, I think I would
have had to deal with a variety of emotions as each question was
asked, which may have affected my responses considerably. I wasnt
left unsettled [by the email interview], which again I think I would
have been had this been face-to-face.I think you communicated a
good amount of compassion through your replies to my responses,
and I felt safe throughout the entire process (Sophia, 51 years old).
Sophia raised an important point about the writing enabling
a reflective process that aids accuracy in terms of what she
wanted to convey, without having to manage emotions.
what I like is the anonymity so you can be perhaps a bit more
forthright/honest than face to face. I didnt have body language
interfering like it can sometimesor have anyone interrupting me
(also can be quite disruptive). I can reworkmy words so that they
best reflect what I am trying to say.Also, I felt I could cry and not
be embarrassed about it (like I am in face-to face-situations) because
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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 advanta-
ges of FTF interviews. She instead commented about the
intrusiveness of body language and the potential disruptive-
ness 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).
Rachels point about imagining smiling and nodding at the
interviewer highlight that there is nothing intrinsically
superior about interviewers subjective impressions of inter-
viewees. The absence of FTF contact spared women poten-
tially stressful parts of the interview process and enhanced
contributions. Women commented on helpful and at times
transforming aspects of participation:
The research process, and corresponding with you, was very cathartic
for me. It helped me organise my thoughts in a coherent manner and
address issues that were bothering me. It also helped me, through a
process of self-discovery, to put HPV in context (Ann, 36 years old).
There has been great value for me in doing the research. You have
responded to what I have written in a helpful and healing way. I at
last feel I have a voice and have been heard.I was certainly more
forthcoming with the specialist due to being involved with your
research and I am more confident to speak my truth (Jane, 71 years
old).
As a nurse with many years of FTF and online counselling
experience, the researcher assessed that data were not
compromised through the collection method.
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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limited significance were less likely to be reading designated
HSV/HPV websites and would not come across the research
(Hunt & McHale 2007). Women with more distress about the
diagnosis were likely to invest time and effort in the inter-
views. Although participants reported valuing the method, it
is possible that significant data were missed through the
absence of non-verbal cues (Hamilton & Bowers 2006).
The findings show that email interviews may be a valuable
data collection tool to interview people who are marginal-
ized. The concept of sensitive research (Liamputtong 2007)
shaped the interview process. Sensitive research includes any
research where the participants disclosures involve real or
potential risk of harm, physically, emotionally or legally.
Women with HSV/HPV are part of a socially diverse hidden
population. Interviewing women who have contracted a viral
STI involves asking women about aspects of their health,
sexuality and relationships that are deemed private. Womens
disclosures about sexuality and sexual health are potentially
discrediting, given the stigma associated with viral STIs
(Bickford et al. 2007, Waller et al. 2007). Additional com-
munication skills and cognisance of ethical complexities are
required by researchers when engaging in sensitive research
(Dickson-Swift et al. 2008).
In this study, womens enthusiasm for email compared with
FTF interviews reflects other research findings. In an Austra-
lian study, Seymour (2001) argued internet-based interviewing
enabled more egalitarian research practices with people with
disabilities who were more able to speak their experiences
through email rather than in FTF interviews. There were fewer
hurdles as participants controlled contact and interview
location. Similarly, in an Australian study using email inter-
views with people who had a traumatic brain injury, partic-
ipants preferred email rather than FTF interviews (Egan et al.
2006). Cognitive-linguistic impairments were less intrusive for
participants, who preferred the open time-frame, comfort of a
familiar environment and keeping track of the interview
without relying on memory. Egan et al.s findings illustrate
that FTF interviews may disadvantage participants and impact
adversely on data quality. In Kraliks (2000) Australian-based
study of women with long-term illnesses, email interviews
enabled inclusion of women who would otherwise have been
excluded due to rural isolation or illness. Email interviews
provide inclusiveness not possible in the flesh.
Women emphasized the ease with which they disclosed
personal information in their emails. This aspect of email
interviewing is not unproblematic for participants and
researchers. Mann and Stewart (2000) and Liamputtong
(2009) have alerted researchers to the potential risks of
participants over-disclosure online; communicating in a far
less guarded manner with a stranger than they might FTF.
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What is already known about this topic
In-depth email interviewing generates rich data with
participants of interest to nurses.
Email interviewing enables nurses to research
traditionally hard-to-reach participants.
Participants may find the email interview process
preferable to face-to-face interviews, especially for
sensitive topics.
What this paper adds
The study adds further methodological data to the
limited literature on nurses use of email interviewing.
Email interviewing is not inevitably more ethically
complex than face-to-face interviewing and may
instead address ethical hurdles, particularly in relation
to participants wellbeing.
Implications for practice and/or policy
Nurses need to consider whether the use of in-depth
email interviewing may be more beneficial for
participants and for data generation compared with
face-to-face interview methods.
Given the absence of non-verbal cues, nurses may need
additional training in communication skills to
effectively facilitate online rapport-building and
responses to participants disclosures.
For this reason, each participant was advised that they could
withdraw any aspects of the interview from the research, as
well as the researcher using discretion to withhold potentially
identifying material from publication. Participants were also
welcome to make comments and to ask questions off the
record.
The risk of over-disclosure applies to researchers and
participants. Mindful of possible online over-disclosure the
researcher took care with replies, because they were essen-
tially public documents potentially instantly available to any
audience as the women had no reciprocal ethical obligation
to protect researcher privacy. This area of altered researcher
disclosure in online interviews compared to FTF warrants
further research. The researcher is potentially more vulner-
able than in FTF situations.
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
Generating data with a vulnerable population
mation and support. Despite the ordinariness of online
health information and communication, few nurses have
harnessed the email interviewing method for in-depth
explorations of health-related issues. The method is low-
cost and transcends numerous traditional barriers to
interviewing and could readily be used for international
collaborative research. The method may more readily enable
the participation of groups who are geographically isolated,
marginalized and/or vulnerable. Empathic communication
skills are essential for the ethical care of participants and for
rich data generation. The merits of the method warrant
nurses further consideration.
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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