Rural clinicians in small communities face the pressure of always being ‘on-duty’1, and the ethical challenges of overlapping relationships and role duality2 while working within settings with active gossip networks3 and increased social proximity3. Conducting insider research within small rural communities poses similar challenges and pressures.
This commentary describes perspectives of insider research using the participatory action research method, focusing on improving outcomes relating to youth sexual health services in a small rural community4. Insider research is used to describe research where the researcher has a direct involvement or connection with the research setting5. There are varying degrees of ‘insider’, and the concept should be viewed as a continuum rather than a dichotomy6 or binary opposites7-9. The lead author of this article has experience as an insider researcher, living as a long-term resident and conducting research within their own small rural community4, and has navigated the ethical challenges and community pressures of conducting participatory action research within an interconnected network.
It is generally presumed that access to study participants is easily granted for the insider researcher10 and data collection is therefore less time consuming6. The author has found some participants very willing to assist the project based on previous personal or professional relationships, while others required extended periods of deliberation before participating, or refusing. The literature suggests there are no overwhelming advantages to being an insider or outsider researcher4,6,11-13 and, while insider research is not problematic in itself14, in the authors’ experience the research team must maintain a safe research environment for both participants and the researcher.
The positionality of the insider researcher allows advantages relating to a greater understanding of a community’s undocumented historical context12, access to research participants10 and an intimacy or familiarity that promotes sharing15 and trust1. This was an advantage for this research, which enabled the researcher to become embedded within the critical paradigm.
The interconnected nature of rural communities
There is literature examining the phenomena of insider research within the context of workplaces1,16, professional settings9, education6,17, subculture12 and community18, and literature examining management of clinical work within small rural communities1-3,16,18-20. There is, however, to the author’s knowledge, limited literature examining the experience of insider research as conducted in a place of personal belonging or everyday life for the researcher12.
Rural towns are interconnected in nature, individuals live with close social contact3 and professionals rarely maintain singular roles20. Insiders within these communities manage the ethics of dual roles and interconnected relationships as professionals2,16,20 or researchers10,21. It has been highlighted in workplace research that insider researchers face challenges maintaining clear boundaries with colleagues and peers9. In the small-town setting, this is combined with the rural workforce aspect of seeming always available1.
Insider researchers manage the benefits of interconnected communities, such as increased approachability16 and greater access to research participants or interviews10, while ensuring confidentiality22 or informed consent10 are not compromised by pre-established professional or peer relationships6, or local networks3. The insider researcher explicitly acknowledged the interconnectedness of rural towns in ethics submissions, participant information and consent forms, explaining that maintaining confidentiality through anonymity may not be guaranteed in the setting4. This disclosure allowed participants to provide clear informed consent with an understanding of the setting. The researcher provided full disclosure of research aims and intent to all participants.
Mitigating difficulties maintaining anonymity can be achieved through having the whole research team review cases, or by forming an advisory group to give guidance and recommendations around decisions on de-identification and exclusion of data. It may be appropriate to avoid controversial lines of enquiry6,23, or consider withholding information from publication or discussion that could be identifying11.
A rural insider researcher can leverage relationships that are already formed. This may include advantages relating to a greater understanding of setting, established relationships and key stakeholders12. Some participants may feel obliged to participate due to pre-existing relationships10,24. Coercion is addressed through the manner in which an insider researcher approaches, contacts, obtains consent from and explains research participation to a potential participant24-26.
Ensuring that participants know they can withdraw at any stage of the research process, and that refusing to participate will not be detrimental to existing small town networks and opportunities, is critical in maintaining the ethical integrity of the research27. In the present research, efforts were made to ensure young people did not feel coerced into participating due to their relationship with the researcher, and they were provided with opportunities and an explanation of how to withdraw from the study at any stage.
Ensuring neutrality during the interview process is important in minimising a participant’s feeling that they should confirm or conform to the researcher’s own opinions, particularly within the context of ongoing interaction6, and researchers may decide to use a third party to interview some participants. Within this research, some participants had preconceptions of possible outcomes the researcher may have wanted to achieve based on previous professional work within the community around sexual health, youth health and sporting clubs. The insider researcher actively sought participants from beyond immediate professional networks and sought out stakeholders who were known to hold opposing or contrary views to other participants. The researcher chose to mitigate researcher bias through recording existing and strained relationships when reviewing participant recruitment.
Insider researchers should disclose the aims and intent of their research12, while ensuring participants feel they are engaged in a process that promotes sharing15 and trust1, and that informed consent is not compromised10. To eliminate potential awkwardness after a data collection episode, the researcher explicitly stated to participants how important it was to have diversity of viewpoints.
The research team took care to minimise participants being too focused on preconceived ideas of the researcher’s work18, or feelings of coercion to express views they believed match those of the wider community28. For example, they took care how they portrayed their views in local and social media.
When interviewing known participants, there can be occasions where shared prior experiences may not be fully explained, and further questioning may be required to clarify a known phenomenon for data collection6,29. This should be done carefully to avoid guiding the participant while acknowledging that this pre-existing knowledge may exist24 and may feel contrived. In the present research, the research team checked manuscripts to reduce bias and ensured probing questions were full and complete to enhance confirmability. The insider researcher negotiates a fine balance between participant and researcher assumptions, pre-existing knowledge and the researcher’s desire for data18,24. Regular discussion with the research team was an important aspect of this research.
Workplace insider research may lead to a continued interaction post-research9,13. Small communities see increased role duality, where clinicians are on the same sporting teams as patients, or the teacher of a child20. This directly applies to research, with the interconnected nature of small communities leading to a greater chance of continued contact beyond the researcher–participant relationship and research project12,24.
At school drop-off times, sporting clubs, the aisle of the local supermarket – all became settings for continued researcher–participant interaction, where the author was met with queries on project progress. While this is not entirely problematic, maintaining a participant’s right to anonymous and confidential participation22, and ethical researcher–participant boundaries can be difficult6,8 within the socially proximate rural setting3.
The researcher found participants generally curious about study progress, others that were consulted, and if the peer they referred participated. Informing participants at the time of data collection of the research process and how important it is for participants not to discuss the research in informal settings until the data are fully analysed and reported can help manage continuing interactions, as can limiting the window of data collection. A scripted response that the research team is continuing to speak with participants, and that data are being analysed with results available by a set time, can allow researchers to manage relationships by providing credible information and updates while maintaining confidentiality and anonymity27.
Insider researchers can feel a significant burden in trying to maintain confidentiality24 and, in the case of preparing for publication, can be pressured by the knowledge that participants may read published results and recognise themselves or others despite efforts to de-identify data18. The authors have chosen to withhold quotes and identifying data such as job positions in presenting data that may identify participants from this small rural setting in publication.
Insider researchers have an important role in generating research from within the rural area and, while not overwhelmingly advantaged or disadvantaged11, they occupy a position of privilege and trust. Prior to collecting data, insider researchers should take measures to negotiate ongoing relationships and the researcher’s place within a community, including managing how views are portrayed in social and local media; manage bias by approaching participants beyond obvious networks and recording existing relationships; and explicitly acknowledge the interconnected nature of rural towns in ethics submissions and participant information. With appropriate measures and planning in place, insider research can be conducted rigorously.