Objective: The purpose of this study is, through hermeneutical interpretation, to discover the practical knowledge embedded in the experiences of implantable cardioverter defibrillator (ICD) recipients who seek help through Internet communication, to discover what matters to them. This knowledge will assist health care providers in planning patient education and support, to know what works and what does not work in use of Internet supports especially for individuals who live in isolated rural areas. Individuals at risk for recurring sudden cardiac death are protected by the life saving technology of ICD but experience anxiety, anger and depression. These individuals seek others with similar experiences on the Internet as support.
Design: The study was an exploratory, descriptive design using the methods of Heideggerian Hermeneutics. Data were collected through an Internet-like computer mediated group interview and email communications that are both structured to elicit stories. The computer- mediated group interview created a natural communicative context for telling stories that allowed the peers to talk to one another, clarify and contrast and address similarities in their stories. Participants of an ICD focused web site were invited to engage in an online virtual focus discussion of their online experiences. They were asked to tell a story of how they used the Internet. Subsequent individual email interviews were conducted to clarify and expand narratives. Transcripts from focus group and individual email interviews provided the data for hermeneutic analysis.
Sample: Those who participate in an existing Internet site for individuals with ICD were contacted, with permission of the web site's owner, through a posting from the researcher describing the study and inviting them to join the study and describe their experiences and how Internet communications help. The study population of ICD recipients who use Internet communications were computer literate, had resources to access a computer system, and had motivation to seek out the Internet sites. Virtual focus group memberships of 24 individuals comprised the informants.
Setting: The Internet provided the site for the study. The virtual focus group occurred at the researchers web site in a discussion forum that consisted of a collection of the participants responses to general open ended questions about their experience, followed by additional probing questions that reflected issues discussed. The group format was asynchronous (not real time but over time) because potential informants may not have had access to synchronous facilities (for live chats). This allowed individuals to respond to the group at any time of day at their convenience. A period of four weeks was given to allow the participants time to react to the others comments at their leisure.
Concept: Meaning of computer mediated communications via the Internet by persons with an ICD.
Method: Heideggerian Hermeneutics, a form of interpretive phenomenology, was used to collect and interpret texts for common themes and constitutive patterns.
Findings: Seven related themes and one constitutive pattern emerged. The related themes included: 1.) Receiving an ICD invokes need for knowledge and support; 2). Getting past the fear of living with uncertainty; 3.) Internet as a window to the future; 4.) Internet as access to people with similar experience; 5.) Internet as mountain of information and goldmine of knowledge about ICD; 6.) Internet as social interaction; 7.) Becoming informed consumers of health care. The constitutive pattern is: Gaining a context for healthy life with an ICD.
Conclusions: Through hermeneutic study of these narrative stories an understanding of individuals perceptions are revealed. Role of Internet technology can be fundamental for patient education and support in gaining a context for understanding living with an ICD. As the patients become informed consumers they learn the need for critical evaluation of information on the web.
Implications: Within the stories lies the possibility of understanding the concerns, practical knowledge, forms of engagement and reasoning in action used by the participants when communicating on the Internet. This understanding of the importance of Internet communication will compliment knowledge of how and why the Internet is important and useful to patients especially in remote rural areas. This knowledge will be used by health care providers in identifying the possibilities of integrating the Internet into a patients self-management. Not all individuals with ICD have access to this resource, therefore, efforts must be made to bridge this "digital divide."
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