Sensitive research topics: netnography revisited

Roy Langer (Department of Communication, Journalism and Computer Science, Roskilde University, Roskilde, Denmark)
Suzanne C. Beckman (Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark)

Qualitative Market Research

ISSN: 1352-2752

Article publication date: 1 June 2005

17995

Abstract

Purpose

This paper discusses how netnography can be applied in order to conduct covert research on sensitive research topics. An analysis of a Danish internet message board on cosmetic surgery illustrates suggestions concerning modifications of netnography guidelines.

Design/methodology/approach

Owing to the relevance of studying sensitive research topics – in particular when access to informants is difficult – netnography has been applied in an analysis of cross consumer online‐communication about cosmetic surgery on a Danish internet message board. Methodological stages and procedures including entreé, data collection, analysis and interpretation have been followed. In terms of research ethics and member checks, however, the suggested guidelines have been modified.

Findings

Empirical findings verify that consumers use internet message boards in order to exchange information and advice about cosmetic surgery. Especially the opportunity to masquerade and to cover their identities allows them to express attitudes, opinions, and experiences freely – and hence to study these in order gain deeper insights into consumption motives, concerns, and experiences.

Originality/value

The paper suggests that netnography is a suitable methodology for the study of sensitive research topics, enabling the researcher in an unobtrusive and covert way to gain deeper insights into consumers' opinions, motives, and concerns. Based on a discussion of netnography's position in between discourse analysis, content analysis and ethnography, it is argued for the legitimacy of covert research, including a revision of existing guidelines for research ethics with regard to informed consent when conducting netnography.

Keywords

Citation

Langer, R. and Beckman, S.C. (2005), "Sensitive research topics: netnography revisited", Qualitative Market Research, Vol. 8 No. 2, pp. 189-203. https://doi.org/10.1108/13522750510592454

Publisher

:

Emerald Group Publishing Limited

Copyright © 2005, Emerald Group Publishing Limited


The pictures showed “before” and “after”. Or rather stuffed and sucked. Like porn they were deliberately not glamorous, but then also like porn this was flesh without personality. For lipo read hippo. The most common view was of the buttocks and the upper thighs, circus‐lady rolls of flesh above or below the hips (Dunant, 1995, pp. 75‐6).

Introduction

New medical and technological opportunities as well as increasing wealth enable consumers in the western world to define and realize themselves on the growing “Who am I” – market, including designing their own bodies. The growing number of clinics offering cosmetic surgery mirrors an increasing number of consumers who have decided to change their physical appearance. Cosmetic surgery is here defined as a surgical intervention on the physically healthy body that concerns the “enhancement” of physical aspects without medical indication or prescription (Ensel, 1996).

Various American and European entertainment TV‐channels have recently launched reality broadcast surgery – shows titled “Extreme Makeover” (ABC), “The Swan” (Fox), “Beauty Clinic” (RTL) or “I want a famous face” (MTV). These reality shows have in common that they picture consumers before, under and after cosmetic surgeries. Despite of such public (media) attention, cosmetic surgery is still a sensitive topic. A sensitive topic is one “that potentially poses for those involved a substantial threat, the emergence of which renders problematic for the researcher and/or the researched the collection, holding, and/or dissemination of research data” (Lee and Renzetti, 1993, p. 5).

Consumers who consider cosmetic surgery rarely talk about it in public. Though TV‐shows might increase attention to cosmetic surgery, and, ultimately, legitimize consumption of cosmetic surgeries, they are primarily based on a mixture of bizarre disgust, sincere horror and embarrassed bluntness. Cosmetic surgery fits beautifully into such broadcast concepts, as disgust and embarrassment simply reflect the sensitivity of the topic.

From a different perspective and for different reasons, market research and consumption studies have to address such sensitive topics. The relevance of such research not only derives from the growth in consumption of cosmetic surgery as such. As Sieber (1993) makes clear, sensitive topics raise wider issues to the ethical, political and legal aspects of research. Moreover, sensitive topics frequently address “some of society's most pressing social issues and policy questions” (Sieber and Stanley, 1988, p. 55). And Lee (1993, p. 2) adds: “Sensitive research is important too precisely because it illuminates the darker corners of society”.

Increased consumption in darker corners of society raises important questions with regard to motivations and drivers such as: Why do more and more people accept liposuction, breast augmentation, nose reshaping or penis enlargement, including the risk of serious health damages as a result? Where and how do these people gain information about the products offered and about their suppliers, in particular as the cosmetic surgery business is – at least in most European countries and though growing – an under‐regulated market? And how do consumers deal with sensitive aspects attached to cosmetic surgery?

In order to find answers to these questions, market researchers cannot just apply traditional market research methods such as questionnaire surveys, qualitative depth interviews and ethnographic observation. A recent study based on face‐to‐face depth interviews with women who had a cosmetic surgery (Askegaard et al., 2002), disclosed difficulties to establish contact to former or potential consumers of cosmetic surgery, who were willing to inform researchers about their motivations, information seeking processes, and experiences. The same study also revealed particular recruitment problems related to the gender of the researcher/interviewer and potential informants: since most consumers of cosmetic surgery are females and since the topic is sensitive, informant recruitment is even more difficult, when the researcher/interviewer is a male. How can a researcher then gain a deeper understanding of a sensitive research topic such as the consumption of cosmetic surgery?

If potential informants are not willing to meet the researcher personally, the second best solution is to “meet” informants where they already are. Based on statistical accounts showing that the third most common reason for people to go on line is to search for health information (next after weather and sports and just ahead of pornography, cf. Macias et al., 2004), it appears to be logical to engage in media ethnography. Like other groups of consumers, such as boycotters (Kozinets and Handelman, 1998), consumers of television shows (Kozinets, 1999), Apple‐computers, Ford or Saab cars (Muniz and O'Guinn, 2001) or coffee (Kozinets, 2002), consumers of cosmetic surgery take advantage of cross consumer online communication about products and services. Macias et al. (2004) state: “While several years ago most of the women relied on doctors and pharmacists or their mothers as their sources for health information, the have now turned to the web … ”. This appears to be particularly true for communication about cosmetic surgery where consumers seem to rely heavily on word‐of‐mouth information (Nowak and Washburn, 1998, p. 52).

In particular, Kozinets (1998, 1999, 2002) has to be credited for his efforts to conceptualise how online communities' discourses can be investigated for market and consumer research purposes. His netnographic approach seems to be a compelling method to study consumers' needs and desires, opinions and attitudes, experiences, and interaction.

Based on the illustrative example of an analysis of consumer communication on an internet message board (IMB) about cosmetic surgery consumption, this paper aims at presenting the advantages and disadvantages of netnography as a method for studying such a sensitive topic. Although not offering an entirely new methodology, the paper critically discusses issues with regard to the general characteristics of netnography as a method, especially with regard to research ethics as presented by Kozinets (2002).

Research on cosmetic surgery

Cosmetic surgery has received impressive attention in various social sciences such as social philosophy, cultural studies, social history, (medical) sociology, and juridical science (Foucault, 1979; Webster and Driskell, 1983; Turner, 1985; Featherstone et al., 1991; Morgan, 1991; Paglia, 1991; Bordo, 1992; Cordas, 1994; Bermudez et al., 1995; Haiken, 1997, 2001; Sheldon and Wilkinson, 1998; Wijsbek, 2001).

Previous research regards the body mainly as a cultural text where cultural values and ideals are symbolically inscribed (Douglas, 1982; Lees and Shape, 1992), and/or an object of social control. In pre‐modernity the body was an object of external power, in modernity, however, it becomes disciplined by internal self‐control (Foucault, 1979). Bourdieu (1977) labels this observation “body regimes”, claiming that the body has become an asset in social relations.

Hence, a consumption perspective has been suggested where the body is increasingly seen as a commodity (Richins, 1991; Gimlin, 2000). According to Firat and Dholakia (1998, p. 84), the practice of customizing oneself as a situation‐specific marketable entity can be interpreted as a mode of asserting oneself in the world through consumption: “(t)he market is a cornucopia of products s/he can acquire to craft the images s/he wants or needs to represent”. Consequently, the body is most generously exploited in the world of marketing practice: “Procedures such as the face lift, liposuction, hair transplantation, and varicose vein reduction are no longer procedures demanded only by the rich and famous, but are now aggressively advertised by providers and demanded by mainstream American consumers” (Nowak and Washburn, 1998, p. 46). Consumer research has, however, only generated few empirical studies so far (e.g. Schouten, 1991; Thompson and Hirschman, 1995; Schroeder and Borgerson, 1998; Sayre, 1999; Askegaard et al., 2002).

One of the main reasons for this relates to difficulties in accessing and recruiting informants willing to expose their bodies and minds. Gaining access to individuals or groups concerning sensitive topics is acknowledged as one of the major obstacles and difficulties for researchers (Ayella, 1993). According to Noelle‐Neuman's theory of the spiral of silence (Noelle‐Neuman, 1984) individuals, who fear social isolation, refrain from expressing opinions out of step with the general climate of opinion. Remaining silent “reinforces the impression of unanimity which, in turn, increases pressure on those holding minority views” (Lee, 1993, p. 36).

“Thick descriptions” and netnography

Goulding (2003) stresses the need for a greater emphasis on rich and varied forms of data collection in consumer and marketing research in order to get a deeper understanding of consumer society. Referring to Geertz (1973, p. 10), Elliott and Jankel‐Elliot (2003, p. 215) suggest correspondingly ethnographic and quasi‐etnographic research methods that are able to develop “a ‘thick description’ of the lived experience of consumers”.

This quest for “thick descriptions” is not new at all. In fact, it was part of the motivation behind the interpretive turn in market and consumer research. Simultaneously, the comparatively new internet medium has been widely discussed as a tool for data collection in marketing and consumer research (December, 1996; Gordon, 2000; Abbott, 2001; Evans et al., 2001; Furrer and Sudharshan, 2001; James, 2002). “The speed, ease, cost and, perhaps, novelty of research using the internet explain its appeal to clients for both quantitative and qualitative research (…)” (Nancarrow et al., 2001, p. 137). Moreover, the internet offers “new opportunities for quantitative and qualitative research techniques” (Solomon, 1996, p. 9).

Online communication between consumers has been studied by using netnography (Kozinets, 2002) for understanding their attitudes, perceptions, imagery, and feelings. As Kozinets (1998, 1999) points out, the internet offers increased opportunities for social group participation, where consumers form virtual communities of consumption in order to assert social power, to unite, and to claim symbols and ways of life that are meaningful to them and the communities they build. Hence, netnographic studies seem to be able to offer those “thick descriptions” of the life worlds of consumers, Goulding, Elliott and Jankell‐Elliott and others look for. Moreover, netnography makes particularly sense for attempts to analyse communities where access based on conventional methods is difficult (Langer, 2003a; Pires et al., 2003).

According to Kozinets (1998, 1999, 2002), netnography is “a new qualitative research methodology that adapts ethnographic research techniques to study cultures and communities that are emerging through computer‐mediated communications” (Kozinets, 2002, p. 62). Compared with other methods, it is less time consuming, potentially less obtrusive, and less costly. Referring to common ethnographic procedures, Kozinets (2002, p. 63) recommends the following methodological stages and procedures for netnographic studies:

  1. 1.

    Entrée: formulation of research questions and identification of appropriate online fora for study.

  2. 2.

    Data collection: Direct copy from the computer‐mediated communications of online community members and observations of the community and its members, interactions and meanings.

  3. 3.

    Analysis and interpretation: classification, coding analysis and contextualization of communicative acts.

  4. 4.

    Research ethics: “(1) The researcher should fully disclose his or her presence, affiliations, and intentions to online community members during any research; (2) the researchers should ensure confidentiality and anonymity of informants; and (3) the researchers should seek and incorporate feedback from members of the online community being researched… (4) The researcher should take a cautious position on the private‐versus‐public medium issue. This procedure requires the researcher to contact community members and to obtain their permission (inform consent) to use any specific postings that are to be directly quoted in the research” (Kozinets, 2002, p. 65; Kozinets and Handelman, 1998).

  5. 5.

    Member checks: Presentations of some or all final research report's findings to the people who have been studied in order to solicit their comments.

Kozinets (1999, p. 254) recommends to distinguish between tourists, minglers, devotees and insiders when analysing messages from online community members: Tourists lack strong social ties to the group, and maintain a superficial or passing interest in the consumption activity. Minglers maintain strong social ties, but are only perfunctorily interested in the central consumption activity. Devotees maintain a strong interest in the consumption activity, but have few social attachments to the group. Finally, insiders have strong social ties to the group and maintain a strong interest in the central consumption activity. Kozinets (2002, p. 64) highlights devotees and insiders – i.e. the most enthusiastic, actively involved and sophisticated users – as the most important data sources.

As Kozinets notes, nethnography is “based primarily on the observation of textual discourse” (Kozinets, 2002, p. 64) and states that content analysis is used to expedite the coding and analysis of data. Hence, any trained communication scholar who is familiar with the rich tradition of methods for the analysis of textual discourse might wonder why the study of textual discourse on the internet should be classified as a (quasi‐) ethnographic method. Without denying its ethnographic relevance, it appears even more legitimate to classify or position content analysis of online communication in between discourse analysis, content analysis, and ethnography. Content analysis itself is already a well‐established method in communication and media studies in its own right with a more than 70 years old tradition. Originally applied to traditional mass media texts (such as texts and shows in newspapers, on radio or TV), there is no reason not to apply it to the internet as well.

Quantitative and qualitative media content analysis

The birth of content analysis can be dated back to the 18th century in Sweden, but its break through came first with Berelson's (1952/1971) seminal article “Quantitative content analysis in communication research”. To him, this method enables the analyst to describe content systematically and objectively by examining the statistic occurrence of defined units (such as arguments or phrases). Therefore the first step in quantitative content analysis is to break down a text into countable units, and then to produce statistical computations in relation to categories that are defined by the analyst (see Krippendorf (1980), for a comprehensive overview of relevant techniques).

Quantitative content analysis has been criticised for its rooting in the positivist and behaviourist paradigm of science – in particular by researchers in the tradition of hermeneutics and critical theory (Bucher and Fritz, 1989, pp. 145‐9). According to its critics, quantitative content analysis tries to escape from subjectivity, which is immanent in textual interpretation. Internal relations between the units and the textual whole are excluded from analysis. Therefore quantitative content analysis runs the risk to neglect what might be important aspects of the textual meaning (Fühlau, 1982, p. 92.). Qualitative aspects, such as the ways of expressions in a text, the co‐ and context of the text, power relations in a text or different perspectives in a text are not subject for discussion. However, it deserves mentioning that content analysis software is increasingly making progress in avoiding the pitfalls of non‐computer assisted analysis.

Grounded in the critique of quantitative content analysis, many media and communication researchers subscribe to qualitative content analysis, beginning with the so‐called “humanistic trend” in communication research in the early 1970s. Much of the work focused on power relations expressed and established in and by media texts, and moved towards qualitative analytical designs, often derived from the advances made in general and textual semiotics (Mayring, 1983). Instruments in the analytical process are semiotic terms, pragmatic theory of meaning, and rules for interpretation from textual analysis, including the basic principles of summarising, explaining and structuring of the material (Mayring, 1983, p. 53).

In recent years, qualitative content analysis has increasingly incorporated discourse analysis as a method for study of textual discourse (Elliott, 1996; Langer, 1998; Hackley, 2000). Media and communication scholars have also applied both quantitative and qualitative content analysis in their studies of internet communication (McMillan, 2000, for a further discussion).

Implications and limitations

There are, admittedly, a few differences between content analysis of conventional mass media such as newspaper articles or TV‐programmes on the one hand and online media communication on the other (Stempel and Stewart, 2000). One difference is the fact that mass media are by definition public media. On the internet, however, it has to be decided from case to case (i.e. from IMB to IM, from webpage to webpage, from list to list, from dungeon to dungeon) whether we deal with (semi‐) private communication or public communication. The key to this decision is the access criteria for observation of and/or participation in such communication: if access is restricted (e.g. by use of passwords) and thus reserved for members only, we can talk about a (semi‐) private communication within the community and should apply those guidelines and procedures, Kozinets recommends. If access is not restricted, i.e. if anybody can participate in the communication without any restrictions, this can be defined as public communication.

Clearly, differences between an ethnographic perspective on research ethics and communication studies with regard to informed consent should not be neglected. However, even from an ethnographic perspective covert research might be an appropriate methodology, in particular when studying sensitive research topics. Lee (1993, p. 143) distinguishes between an absolutist, a pragmatic and a sceptical position of ethics in covert research. Whereas the absolutist position holds that covert research is fatally compromised, the sceptical position accepts a positive justification for covert study. The third position, the pragmatic perspective, recognizes potential difficulties associated with covert research. It acknowledges the need to protect the rights of research participants and the obligation not to harm them, but still accepts covert studies, in particular if there is no other way for the necessary data to be obtained (Lee, 1993, p. 144).

Another difference is the honesty and trustworthiness of online communicators compared to other media communicators. “Cyberspace appears to be a dark hallway filled with fugitive egos seeking to entrap the vulnerable neophyte” (Solomon, 1996, p. 11). This can, however, also be an advantage: “From behind their screen identities, respondents are more apt to talk freely about issues that could create inhibitions in a traditional face‐to‐face group, particularly when discussing sensitive topics” (Solomon, 1996). Thus, devotees and insiders are not necessarily – as Kozinets claims – the most important data sources. Tourists and minglers might be as valuable, in particular when analysing sensitive topics, because they feel free to speak without necessarily being forced to reveal their true identities.

The here suggested repositioning and reclassification of content studies on the internet (i.e. netnography) is more than just a terminological classification exercise, since it includes several implications for the methodological procedures and guidelines suggested by Kozinets. These implications do not object these procedures in general. They only suggest less rigorous guidelines and procedures and a more moderate and open‐ended form of inquiry, contingent upon the specific research questions raised as well as on the specific context of and set up for a particular study.

First, there is no obvious reason to neglect the rich tradition of content studies in media and communication research. Despite of a few differences, communication content on the internet is comparable to communication content in any other mass media.

Second, since there already exist both quantitative and qualitative content analysis procedures in media and communication studies, it would be too rigorous to claim that content analysis of online communication necessarily is limited to be a qualitative quasi‐ethnographic method. Instead, the specific research questions to be answered must be decisive for whether researchers conduct quantitative or qualitative content analysis of online communication.

Third, the ethical guidelines for the study of online communication recommended by Kozinets should be revised. These guidelines make sense in restricted (semi‐) private online communication and when taking departure in traditional ethnography. But they are far too rigorous – and basically also endanger the unobtrusiveness of online communication studies, as we will argue later – when serving as general guidelines for the study of all online communication. Instead – and with a few exceptions due to the specific context of an online communication depending on whether there is free public access to the IMB or not – we suggest to rely on the research ethics for content analysis developed in media and communication research.

Consumers' online discourses about cosmetic surgery

One of the primary meeting places enabling to social group participation are IMBs (Kozinets, 2002, p. 63). An IMB is depending on whether a user has to offer money or something else (e.g. photos) in exchange for the permission to get access to the board – a public or semipublic communication channel where users offer information about specific topics (Parks, 1996, p. 80). Taking departure in Kozinets' guidelines for conducting netnographic studies (Kozinets, 2002), this study addresses consumers' online communication about cosmetic surgery in order to illustrate why and to which extent particular guidelines recommended by Kozinets had to be modified.

Entrée

The purpose of the study was to understand how IMB users make sense of cosmetic surgery by providing each other information and discussing various cosmetic surgery related topics. Research questions covered issues such as: What type of information are consumers looking for? Which experiences, feelings, attitudes and opinions about cosmetic surgeries do they express? How do those consumers, who have had or consider cosmetic surgery, motivate their decisions?

The study was informed by experiences from a previous face‐to‐face depth interview study with females who had a cosmetic surgery (Askegaard et al., 2002) and by extensive literature and media archive research. With regard to choice of IMB, two Danish IMBs with public access were identified:

  1. 1.

    IMBs on a popular health information web site (www.netdoktor.dk), with both male and female users; and

  2. 2.

    IMBs on a popular womens' web site (www.oestrogen.dk) with predominantly female users.

Owing to the fact that females still are the primary consumers of cosmetic surgery, this second web site was chosen for further analysis. It is a prize awarded web site and owned by one of Denmark's leading publishing houses. As all IMBs on this web site are accessible without any restrictions, they can be characterized as public communication. In sum, the cultural entrée to this IMB corresponds with Kozinets' recommendations.

Data collection

The largest IMB on the web site, headlined “Plastic Surgery”, was chosen for further analysis. The data collection period lasted from January 2001 to end of May 2002. During this period a total of 896 contributions could be identified, filling 164 printed pages and having an average length of 34 words per posting. All contributions have been printed, coded and categorized by an experienced coder before further analysis and interpretation. All 896 contributions received a classification number (from C 001 to C 896).

Hence – and in contrast to the procedures suggested by Kozinets (2002) – this analysis was based on the complete set of contributions in order to find representative answers in addition to thick qualitative descriptions of social life, proposing that quantitative and qualitative results of content analysis are not mutually exclusive, but can supplement each other.

Analysis and interpretation

The body of the entire text was read through several times. Emergent conceptualisations were altered on successive readings. The material was structured, coded and summarized, then explained and interpreted. Multiple coding of the topical focus of the postings was supplemented with frequency coding for a variety of aspects, such as positive/negative/neutral attitude to or experience with cosmetic surgery and identity information about the contributor. Disconfirming evident was sought within the data set and in searches on other web pages. Thus, the analysis and interpretation of data corresponds with Kozinets' recommendations, except for the fact that quantitative frequency analysis has been conducted as a supplement to qualitative textual analysis.

Ethics and member check

Based on the experience of the total lack of responses in recruitment attempts on IMBs in the previously mentioned study and based on the fact that the IMB is regarded as a public communication media, it was decided not to inform contributors to this IMB about the identity of the analyst. No member checks were made, as participation in the IMB does not require formal membership. Nor have authors of entries quoted in the study been informed or asked for permission to use direct quotations. In fact, many of the names that contributors used (often pseudonyms, such as “Sad(ie)”, “The fat role”, “The dissatisfied” or “Angry Woman”), have been displayed in this study, as they provide further information about the users. In the final study, however, eventual information about email‐addresses, phone numbers, etc. in postings, were made anonymous.

Hence, the largest difference in the procedures of this study compared to Kozinets' recommendations is related to ethics and member checks. As it would have been difficult to obtain similar data in another way, data collection occurred based on the before mentioned pragmatic position towards covert research. However, and as argued above, we claim that the chosen procedures fully satisfy ethical standards for content analysis of public media texts. A comparable example could be an analysis of readers' letters in newspapers. Here – and due to the fact that these are intentionally public postings by the authors – it would be absolutely unusual to seek permission to use direct quotations. Moreover, the disclosure of the researchers' presence or contacting community members to obtain their permission to use any specific postings, as suggested by Kozinets (2002, p. 65), would weaken one of the major advantages and strengths of content analysis, namely its unobtrusiveness. It would potentially endanger the whole research project if participants in IMB's oppose to the research. Moreover, some hesitant users might engage in “the spiral of silence” mentioned above by not producing postings. This would ultimately result in misrepresentations of consumers' accounts of a given topic, where only the most articulate users of an IMB and those, who feel less affected by the sensitivity of the topic, are included in the analysis.

Findings

This section reports and exemplifies major findings of the study in order to illustrate, which types of results can be conducted by applying content analysis in the study of online communication. Since the purpose of this section is to exclusively focus on methodological aspects, the findings are discussed in more details and extension elsewhere (Langer, 2003b).

Information seeking behaviour

One of the purposes of the study was to identify the type of information provided and requested by the users of the IMB. A representative frequency analysis of the subtopical focus in the content of all contributions revealed that the IMB was primarily used in order to discuss three sub‐topics. The two largest ones (each of them mentioned in 24 per cent of all entries) concerned asking or offering general advice and discussing breast augmentations. The third largest sub‐topic were users' personal experiences with surgeons and/or cosmetic surgery performed on them (17 per cent of all entries). Discussions about the pros and cons of cosmetic surgery, the price of particular surgeries, liposuction techniques and other types of cosmetic surgery, such as facelifts, breast reductions and nose reshapes, were identified as smaller sub‐topics.

Masquerading

An identification of all signed entries confirmed, that 81 per cent of all entries were signed with names of females, 17 per cent were anonymous and only 2 per cent were signed with male names. Among those contributors signing their message with a name, 64 users could be identified as multiple contributors. One woman signed for 28 of the 896 messages and was therefore even recommended by another discussant as an insider expert. Forty three users could be identified who offered their personal mail address or even their phone number for further contact via a less public communication channel. Fourteen of these users were later contacted by e‐mail asking for further information. In line with previous attempts, none of these contacts was successful.

Attitudes and opinions

Only 5 per cent of all contributions discussed the general pros and cons of cosmetic surgery, indicating that most users already had made up their minds. However, there was some debating about gender differences and how men perceive and sometimes even forces women into cosmetic surgery, as the following excerpt shows:

I am curious to know what guys are thinking about silicone implants. Usually they really like all those big bosomed girls on TV and in magazines. But how do they react if it is their own girl friend? (C 336, Mini).

My boy friend does not even want to touch my breasts as they are now. So, I cannot really see that this would make a big difference to him (C 337, anonymous).

Men have double standards of morality in regard to this issue. I have discussed the topic with several guys. They said, it was nice to look at but uncomfortable to touch (C 338, Sonja S.).

Yeah, men have really double standards. My partner enjoys looking at other girls' silicone breasts but does not want me to get some. That's really irritating! (C 339, anonymous).

You have a marvellous boy friend – just imagine how much confirmation it is to have a boy friend who does not want you to get your breasts done!!! (C 340, Amanda).

He does not love my breasts. That's the problem. He is my problem – if I have one… (C 341, anonymous).

One of the largest debates with no less than 29 postings was headlined “Plastic boobies do not give you the self‐esteem you lack!”. An anonymous user suggested that women who look out for a cosmetic surgery should rather see psychologist. Half of the responses were in favour of cosmetic surgery and the other half opposed it. Among this group, several users emphasized in their reply that getting a cosmetic surgery does not necessarily have to do with lack of self‐esteem: “I do not lack self‐esteem, but I cannot even fit into children underwear. I feel this is a fair problem” (C 37).

Seeking and giving advice

Many of the discussions about clinics and surgeons were initiated by women looking for general advice such as where to perform a cosmetic surgery, or by women who had already undergone a cosmetic surgery in a particular clinic. The first type typically had headlines such as “Good plastic surgeons?” (C 417), “I need an advice” (C 282), “Breast augmentation nearby Aalborg?” (a Danish province town, C 542), or just “Help me!!!!” (C 417). Sometimes, as in the last example, these contributions reflected sincere desperation. The second type of contributions often started with headlines such as “Where is the best place?” (C 114), “Do you know them?” (C 211), “H.C. Andersen clinic – can anyone give recommendations?” (C 277) confirming the word‐of‐mouth character of this IMB.

Personal experiences

Eighty seven per cent of all postings reporting personal experiences with cosmetic surgery were positive, only 2 per cent were neutral or discuss both post‐surgery advantages and disadvantages, and 11 per cent reported negative experiences and results. Louise's contribution was a typical report of positive experiences:

I am a 24 years old girl. Last year I had a liposuction…this is the best thing that happened to me ever. I just want to tell those women, who consider it and who are afraid of the pain that it does not hurt at all. It itches a little, when you get the anaesthetization – that's it! After the surgery I was in bed for the rest of the day, because I was tired. Next day I got up and had no pain. Two days later I went to work and there was no problem… So, there is something, you can look forward to!!!! (C 144, Louise).

However, a posting from Mai Britt illustrates negative experiences. She had won a breast augmentation among listeners of a Danish radio station. A few years later she reflected about her breast augmentation:

“Here is my story about the ZZZ clinic. I won my breast augmentation in Radio Voice in 1998. It was not my big dream to get larger boobies – but, well, now I had won this surgery and I nevertheless then looked forward to it… My nipples are now almost five times as large as before, and I have the worst and ugliest Frankenstein‐scars, you've ever seen – about 2 centimeters all the way around … ” (C 457, Mai Britt).

Disembodied online communication about (problems with) the body

The IMB is a medium where consumers can discuss cosmetic surgery with others not tabooing the topic. Potential anonymity in the discussion forum is face saving and participants do not risk condemnation and denunciation. Consumers minimize their fear of – in this case even literary speaking – looking foolish in a non‐directive counselling process (Rogers, 1961) where they perceive unconditional positive attention. But this also includes narcissistic self‐expression and new problems for consumers engaging in the surgical treatment of a healthy body. One of these are the financial implications:

“My situation is actually quite funny. I have taken a loan in the bank for my new breasts. I have to pay for ten years and then I will probably have to have a new loan, as the implants will have to be replaced. It's the vicious circle … ” (C 351. “That's it!”)

One user described the situation on the market of cosmetic surgery as: “This is a jungle!” The users of the IMB explore things they cannot or dare not do/say in other fora. Here, consumers are trying on identities for size, calculating the costs, learning about opportunities and risks of cosmetic surgery, and imagining future selves through comparisons with other past and present selves in online communication. Though this sometimes also includes tensions between (self) images, representations and reality, it mirrors a reflexive discussion of the topic and an analogous use of the medium:

“To all of you opponents who believe that we are just subordinated men, that we have the responsibility for anorexia and crazy beauty ideals – come on! Be fair! Get‐ting a surgery is not just something you do. A lot of pain, money and thoughts are involved. If you are mentally healthy, you will not be very influenced by models and men. Eating disorders usually pop up when young girls are afraid of becoming grown ups and get detached from their parents” (C 45, anonymous).

Conclusion

This study has demonstrated that netnography is a suitable methodology for a sensitive research topic such as consumption of cosmetic surgery, where consumers are difficult to recruit as informants for research purposes. Netnography enables the researcher in an unobtrusive and covert way to gain deeper insights into consumers' opinions, motives, worries and concerns.

It is argued here that the covert study of public online communication about sensitive research topics is both legitimate and ethical. With regard to guidelines for and procedures of such studies, these should not be too rigorous. Content studies of online communication can have an ethnographic focus, but should first and foremost be regarded as – potentially both quantitative and qualitative‐content analysis, as it is conducted in communication and media studies. Hence, well‐established ethical guidelines from these fields of research should be applied to the study of all publicly accessible communication. This is in particular relevant for the application of netnography by commercial market researchers, as it legitimates already established practices and makes such research even less costly, than when information consent of informants has to be requested. Market and consumer research should, however, in any case carefully adapt research procedures to the specific context and research questions of the study and be constantly aware of privacy rights of their “units of analysis”.

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