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1 Knee Arthroplasty: Shared Experience in a Virtual KNEE ARTHROPLASTY: SHARED EXPERIENCE IN A VIRTUAL COMMUNITY By MICHAEL D. BROOKSHIRE A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2011 1 © 2011 Michael D. Brookshire 2 ACKNOWLEDGMENTS First, I would like to thank Burlingame Industries of Rialto, California for its financial support during the time it took to complete this doctoral degree. I will forever be grateful to Robert C. Burlingame, not only for his encouragement, but also for allowing me to work an abbreviated schedule throughout coursework and the writing of this dissertation, creating a working environment that helped alleviate many of the day-to- day pressures graduate students experience in pursuit of a doctorate. I would like to thank my committee, Chair Dr. David H. Ostroff, members Dr. Cory Armstrong and Dr. Amy Jo Coffey, and outside member Dr. Kenneth Sassaman. My committee made this a rigorous process, and I am the better for that. And a special nod to Dr. Sassaman for offering advice and support beyond this dissertation during a particularly difficult time in the process. A heartfelt thanks also goes out to Associate Dean Dr. Debbie Treise, who provided unwavering support; academic when needed, emotional when the demons of doubt slipped their leash, threatening to render impotent the entire endeavor. Thank yous are in order for Craig Lee, without whom the survey component of this paper would never have seen the light of day; Christina Locke, whose formatting skills helped shaped the final product; Paul Kirk, whose help in locating sources proved invaluable to this research, while his humorously intelligent jabs at my theoretical musings slapped me back into reality when I took the process too seriously; Kim Holloway, whose help with, and advice on, all things financial in my time at Florida were immeasurable; and Jody Hedge, to whom I will be eternally grateful for guiding me through matriculation and registration … every … single … semester. 3 A very special thanks to Patrick Reakes, Chair of the Humanities and Social Sciences Library at Library West, whose skillful advice in helping me to find even the most obscure information in support of this research was incalculable. Just as important, he and his family were friends to me as well. Thanks to Richard Warner, Jeremy Reither, and Jim Lawrence of BoneSmart®, who trusted this research and provided me access to the BoneSmart community. And I owe a very special thanks to Josephine Fox, whose knowledge of and insight into all things BoneSmart® made this research a reality—without her this paper would not have been possible. And lastly, I thank my daughter Alicia O‘Brien, her husband Christopher, granddaughters Mackenzie and Megan, and grandson Sean, for keeping me grounded in reality and connected to my roots, and, when I needed it most, providing safe haven 3,000 miles away from the rigors of academia. And … for just being alive. 4 TABLE OF CONTENTS page ACKNOWLEDGMENTS .................................................................................................. 3 LIST OF TABLES ............................................................................................................ 8 LIST OF FIGURES .......................................................................................................... 9 ABSTRACT ................................................................................................................... 10 CHAPTER 1 INTRODUCTION .................................................................................................... 12 Purpose of Study .................................................................................................... 16 Theoretical Perspectives ......................................................................................... 17 Methodology ........................................................................................................... 18 Need for Study ........................................................................................................ 19 Contributions to Research ...................................................................................... 20 Background ............................................................................................................. 21 The Internet and Information Seeking .............................................................. 21 Seeking Health Information Online ................................................................... 25 Joint Replacement ............................................................................................ 30 BoneSmart.org ................................................................................................. 33 Further Chapters ..................................................................................................... 35 2 REVIEW OF THE LITERATURE ............................................................................ 37 Strength of Weak Ties ............................................................................................ 37 Virtual Community................................................................................................... 42 Community ....................................................................................................... 43 Commonality .................................................................................................... 45 Identity .............................................................................................................. 47 Space and Place .............................................................................................. 49 Social Support .................................................................................................. 54 Online Health Community................................................................................. 55 Opinion Leadership ................................................................................................. 56 The Primary Group ........................................................................................... 59 Social Power .................................................................................................... 61 Defining Opinion Leadership ............................................................................ 62 Opinion Leadership in a New Age .................................................................... 64 Social Network Analysis ................................................................................... 68 Social Network Analysis in Mass Communication ............................................ 72 Two-Step to Multi-Step ..................................................................................... 76 Antecedents of Effective Communication ............................................................... 79 Trust ................................................................................................................. 80 5 Credibility .......................................................................................................... 89 Homophily ........................................................................................................ 93 Gaps in Research ................................................................................................... 96 The Nature of Inquiry .............................................................................................. 97 Research Questions ............................................................................................... 99 3 METHODOLOGY.................................................................................................. 102 Mixed Methods ..................................................................................................... 102 Case Study ........................................................................................................... 103 Social Network Analysis as Method ...................................................................... 104 Online Surveys ..................................................................................................... 110 Online Interviews .................................................................................................. 113 Phenomenology .................................................................................................... 117 Textual Analysis .................................................................................................... 117 Reliability and Validity ........................................................................................... 118 Definitions ............................................................................................................. 120 Nominal Definitions ........................................................................................ 121 Operational Definitions ................................................................................... 121 Sampling and Recruitment .................................................................................... 122 Procedures ........................................................................................................... 124 SNA Observation ............................................................................................ 124 Online Questionnaire ...................................................................................... 128
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