IntroductIonA survey of access to the internet in the UK conducted in 2008 revealed that the internet is used by 79% of men and 75% of women of all ages including 72% of people aged 55-64 years and 32% of people aged ≥65 years.1 Internet data that is freely and publicly accessible are now being used for research purposes. 2,3 Internet communities offer an increasingly important source of information expressed openly by individuals. In particular, the internet offers access to hard-to-reach groups who are often excluded (or exclude themselves) from traditional research studies.
dIscourse AnAlysIsDiscourse analysis (DA), an approach to analysing naturally occurring language, is a technique that is particularly suited to examining internet data. 4,5 DA is pertinent to health care for it has the potential to reveal the dimensions of health beliefs, the doctorpatient relationships and the dissemination of health information. The focus of DA is on communicative behaviour. 6 Within internet forums communicative behaviour is the manner in which individuals communicate through written text.At a basic level, interrogation with linguistic analysis software reveals word frequency. Frequency is a simple way to identify problems and issues. We can look at how patterns of words colocate together and uncover associations between words (that is, concordances) that may provide insights into people, groups, and ideas. With the development of computers, linguistics has become involved using concordancing where keywords from a body of text, often termed a corpus, are highlighted in their surrounding context. Search engines like Google and Yahoo are, at heart, simple concordancers in their browsing functions. They offer the casual user the opportunity to search a very large database for examples of a single word or phrase (one's own name, for instance). Linguistic concordancing offers the opportunity for more sophisticated language-based analyses. The techniques are very widely-used in language studies; for example, in forensic linguistics (assessing whether a document has been forged or to examine witness statements). The approach has been applied to healthcare studies since the 1990s, though not yet with great frequency.
7-11bIAses of trAdItIonAl reseArch ApproAches versus Internet forum-bAsed dIscourse AnAlysIs The assessment of patients' behaviour for research purposes is fraught with difficulties (Box 1). 12 One of the problems of measuring behaviours is that the act of measurement can itself influence behaviour. The measurement of behaviour is vulnerable to reactivity and self-presentational bias on the part of the patient. Reactivity is the tendency of attention from others to influence behaviour. If patients are aware that their behaviour is being monitored, this might stimulate a specific behaviour simply by drawing attention to it. This is because of self-presentational bias. Patients may perceive that a certain behaviour, for example, adherence to treatment, is one of the duties expected of the 'good patient' and may be re...