Exploiting a virtual research environment as an innovative approach to vignette construction and presentation in a Factorial Survey Design study (FSD).

Background: In 2013, 36 million adults (73%) in the UK accessed the Internet daily with over 245 million (78.1%) daily users in the USA. Increased use of the internet is reflected in the growing trend of Internet Mediated Research (IMR) for survey and intervention studies. This trend presents an opportunity for FSD to develop as a methodology. Aim: to construct and present a FSD study within an IMR laboratory.Method: The study employed a virtual research environment managed by Project Implicit®. FSD methods were utilised to identify predictor variables and construct the vignette stem. Assignment of the predictor variables and generation of the vignettes was achieved offline using customised algorithms. Validated patient photographs were integrated with vignettes enhancing realism. The online presentation of the vignettes was programmed using JavaScript. Multiple gatekeepers in 2 health trusts and 2 universities emailed invitations to participants containing the study hyperlink through which participants self-administered the survey. This deployment method guaranteed anonymity a necessity with a sensitive topic.Results: The technology constructed and presented realistic clinical vignettes adhering to FSD criteria. Orthogonality was achieved as Spearman rank correlations among predictor variables were all <0.1. N=427 participants completed 3,416 vignettes, no technical difficulties were experienced.Conclusion: This study created an environment conducive for exploring sensitive issues with decision-making, enhanced recruitment via its originality and contributed to the development of FSD as a methodology.