Open question data were analyzed according to the principles of content analysis, as Gillham (2000) suggests. Qualitative content analysis is data driven, which means that the codes generated come from the data itself during the course of the study. Following his method the first step in this analysis consisted of reading the answers to determine an initial understanding of the different meanings contained in the answers. The text was then re-read and any sentences, phrases or words describing the specified content were marked and condensed into categories. The researcher immersed herself in the data and let “ad hoc” categories develop spontaneously from her consideration of the data. This method enables a more objective evaluation of the data than by comparing content based on the impressions of the researcher. While listing all the responses received there are tentative categories forming in mind. For each question, these categories are listed and then each statement is checked against these categories. The final categories and frequency of occurrence are entered in an analysis grid shown below in Table 4.4-4.7. The answers are ordered from high to low frequency so that the most frequent answers are at the top of the table. Most of the open questions are actually half-open questions as there was the option given to explain the answer given in the closed questions. Most of the possible answers were already given through the close questions and therefore there were only a few people filling in the open questions as it was not compulsory in continuing with the questionnaire. The statements made in these open questions are very helpful and explorative. Even if the analysis of open questions is sometimes a bit hard it was very useful for our purpose to include these extra questions to gain some additional information. The full answers to all open questions can be found in Appendix G and H.
The stated reasons for signing up for the online-treatment in general were mostly the wish to reduce the overall alcohol consumption, or to come back to a normal alcohol intake level in order to win back control over behavior. One person said that her driving force would be the wish to be a good role-model for her son.
In order to find out the Motivation for people to sign up for the anonymous variant and not for the non-anonymous one, there was a question designed to investigate the importance of different reasons given. There was the option to add personal reasons which were not covered in the given ones. Participants indicated that the desire to remain anonymous while being treated was an important point for them without explaining the reason for this desire. Also named was a feeling of shame in relation to the general practitioner, health insurance and social environment. One person said that this way was the easiest solution without having to worry about anything.
When it came to indicating the Intention to sign up for the non-anonymous variant after being informed about the handling of identification information, most participants indicated a low Intention to sign up for the treatment. The reason most frequently stated was that they didn’t want their general practitioner to be informed about their alcohol problems followed by the items regarding the health insurance, uncertainties concerning privacy and the fear of wrong conclusions being drawn from the alcohol-problem background with regard to future health problems. Three people indicated that they didn’t want their social environment to know about the alcohol problems and that they are afraid of being stigmatized or labeled by people. Another named reason was that people are afraid that their employer or colleagues might learn about their problems. Some people stated that their relationship to their general practitioner was too bad and that they didn’t want to inform him about their alcohol problems. Furthermore, people were often unsure about the costs of the treatment being covered by the insurance and therefore rather signed up for the anonymous treatment where they wouldn’t have to worry about this. Only one person reports to be living abroad and therefore being unable to undergo the non-anonymous treatment. For another person this treatment is an additional treatment to an insurance covered face-to-face. The person wants to follow this second treatment to stay alert and isn’t sure about here health insurance covering the costs a second time. One participant with a high intention to sign up for the anonymous variant stated as a reason that the waiting time of 5 months is too long and that she would rather publish her details and start the treatment immediately than waiting such a long time.
The open question asking about suggestions to stimulate people’s Intention to sign up for the non-anonymous variant brought some useful points forward. Three participants suggested that all the insurance companies and the government be included in this project and that they pay for the treatment. In this way the non-anonymous variant can be replaced with the anonymous variant and the possibility of more treatment places in that variant. Some people indicated that they don’t really know what to answer because they were not familiar with the system and how everything comes together. Participants said it might be helpful to indicate the shorter waiting time of the non-anonymous variant more clearly and that also the necessity of a referral letter from the general practitioner should be taken out. As also stated in the closed questions above, people find it very important that all the personal details are eliminated after finishing the treatment or that there are no personal information necessary at all. It was also suggested to indicate more clearly that the non-anonymous treatment will be paid by the insurance and that remaining anonymous in front of the health insurance might ease the entering of the non-anonymous treatment. The complete answers to this question can be found in Appendix H.
The aim of this study was to examine the reasons and motives for people to choose against the non-anonymous treatment option when entering the online therapy for alcohol problems. This was done by identifying the demographic factors, social cognitive and psychological variables which are associated with the enrolment behavior of participants.
The study yielded that respondents have different reasons for preferring the anonymous treatment towards the non-anonymous one. Despite the fear of stigma, most respondents were afraid that they don’t have any control over where and how their identification information are stored and who has access to them. There were other factors such as Perceived Self-efficacy, Subjective Norm, Motivation to undergo the anonymous variant and Outcome Beliefs, that altogether might have influenced the Intention to sign up for the non-anonymous treatment.
Results show relations between the specified constructs and the qualitative responses bring in some additional points to think about such as the often stated fear of abuse of privacy when giving up identification information. Conclusions from these results will be drawn and developed into concrete recommendations for Tactus.