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Grounded theory research: A design framework for novice researchers

Ylona chun tie.

1 Nursing and Midwifery, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia

Melanie Birks

Karen francis.

2 College of Health and Medicine, University of Tasmania, Australia, Hobart, TAS, Australia

Background:

Grounded theory is a well-known methodology employed in many research studies. Qualitative and quantitative data generation techniques can be used in a grounded theory study. Grounded theory sets out to discover or construct theory from data, systematically obtained and analysed using comparative analysis. While grounded theory is inherently flexible, it is a complex methodology. Thus, novice researchers strive to understand the discourse and the practical application of grounded theory concepts and processes.

The aim of this article is to provide a contemporary research framework suitable to inform a grounded theory study.

This article provides an overview of grounded theory illustrated through a graphic representation of the processes and methods employed in conducting research using this methodology. The framework is presented as a diagrammatic representation of a research design and acts as a visual guide for the novice grounded theory researcher.

Discussion:

As grounded theory is not a linear process, the framework illustrates the interplay between the essential grounded theory methods and iterative and comparative actions involved. Each of the essential methods and processes that underpin grounded theory are defined in this article.

Conclusion:

Rather than an engagement in philosophical discussion or a debate of the different genres that can be used in grounded theory, this article illustrates how a framework for a research study design can be used to guide and inform the novice nurse researcher undertaking a study using grounded theory. Research findings and recommendations can contribute to policy or knowledge development, service provision and can reform thinking to initiate change in the substantive area of inquiry.

Introduction

The aim of all research is to advance, refine and expand a body of knowledge, establish facts and/or reach new conclusions using systematic inquiry and disciplined methods. 1 The research design is the plan or strategy researchers use to answer the research question, which is underpinned by philosophy, methodology and methods. 2 Birks 3 defines philosophy as ‘a view of the world encompassing the questions and mechanisms for finding answers that inform that view’ (p. 18). Researchers reflect their philosophical beliefs and interpretations of the world prior to commencing research. Methodology is the research design that shapes the selection of, and use of, particular data generation and analysis methods to answer the research question. 4 While a distinction between positivist research and interpretivist research occurs at the paradigm level, each methodology has explicit criteria for the collection, analysis and interpretation of data. 2 Grounded theory (GT) is a structured, yet flexible methodology. This methodology is appropriate when little is known about a phenomenon; the aim being to produce or construct an explanatory theory that uncovers a process inherent to the substantive area of inquiry. 5 – 7 One of the defining characteristics of GT is that it aims to generate theory that is grounded in the data. The following section provides an overview of GT – the history, main genres and essential methods and processes employed in the conduct of a GT study. This summary provides a foundation for a framework to demonstrate the interplay between the methods and processes inherent in a GT study as presented in the sections that follow.

Glaser and Strauss are recognised as the founders of grounded theory. Strauss was conversant in symbolic interactionism and Glaser in descriptive statistics. 8 – 10 Glaser and Strauss originally worked together in a study examining the experience of terminally ill patients who had differing knowledge of their health status. Some of these suspected they were dying and tried to confirm or disconfirm their suspicions. Others tried to understand by interpreting treatment by care providers and family members. Glaser and Strauss examined how the patients dealt with the knowledge they were dying and the reactions of healthcare staff caring for these patients. Throughout this collaboration, Glaser and Strauss questioned the appropriateness of using a scientific method of verification for this study. During this investigation, they developed the constant comparative method, a key element of grounded theory, while generating a theory of dying first described in Awareness of Dying (1965). The constant comparative method is deemed an original way of organising and analysing qualitative data.

Glaser and Strauss subsequently went on to write The Discovery of Grounded Theory: Strategies for Qualitative Research (1967). This seminal work explained how theory could be generated from data inductively. This process challenged the traditional method of testing or refining theory through deductive testing. Grounded theory provided an outlook that questioned the view of the time that quantitative methodology is the only valid, unbiased way to determine truths about the world. 11 Glaser and Strauss 5 challenged the belief that qualitative research lacked rigour and detailed the method of comparative analysis that enables the generation of theory. After publishing The Discovery of Grounded Theory , Strauss and Glaser went on to write independently, expressing divergent viewpoints in the application of grounded theory methods.

Glaser produced his book Theoretical Sensitivity (1978) and Strauss went on to publish Qualitative Analysis for Social Scientists (1987). Strauss and Corbin’s 12 publication Basics of Qualitative Research: Grounded Theory Procedures and Techniques resulted in a rebuttal by Glaser 13 over their application of grounded theory methods. However, philosophical perspectives have changed since Glaser’s positivist version and Strauss and Corbin’s post-positivism stance. 14 Grounded theory has since seen the emergence of additional philosophical perspectives that have influenced a change in methodological development over time. 15

Subsequent generations of grounded theorists have positioned themselves along a philosophical continuum, from Strauss and Corbin’s 12 theoretical perspective of symbolic interactionism, through to Charmaz’s 16 constructivist perspective. However, understanding how to position oneself philosophically can challenge novice researchers. Birks and Mills 6 provide a contemporary understanding of GT in their book Grounded theory: A Practical Guide. These Australian researchers have written in a way that appeals to the novice researcher. It is the contemporary writing, the way Birks and Mills present a non-partisan approach to GT that support the novice researcher to understand the philosophical and methodological concepts integral in conducting research. The development of GT is important to understand prior to selecting an approach that aligns with the researcher’s philosophical position and the purpose of the research study. As the research progresses, seminal texts are referred back to time and again as understanding of concepts increases, much like the iterative processes inherent in the conduct of a GT study.

Genres: traditional, evolved and constructivist grounded theory

Grounded theory has several distinct methodological genres: traditional GT associated with Glaser; evolved GT associated with Strauss, Corbin and Clarke; and constructivist GT associated with Charmaz. 6 , 17 Each variant is an extension and development of the original GT by Glaser and Strauss. The first of these genres is known as traditional or classic GT. Glaser 18 acknowledged that the goal of traditional GT is to generate a conceptual theory that accounts for a pattern of behaviour that is relevant and problematic for those involved. The second genre, evolved GT, is founded on symbolic interactionism and stems from work associated with Strauss, Corbin and Clarke. Symbolic interactionism is a sociological perspective that relies on the symbolic meaning people ascribe to the processes of social interaction. Symbolic interactionism addresses the subjective meaning people place on objects, behaviours or events based on what they believe is true. 19 , 20 Constructivist GT, the third genre developed and explicated by Charmaz, a symbolic interactionist, has its roots in constructivism. 8 , 16 Constructivist GT’s methodological underpinnings focus on how participants’ construct meaning in relation to the area of inquiry. 16 A constructivist co-constructs experience and meanings with participants. 21 While there are commonalities across all genres of GT, there are factors that distinguish differences between the approaches including the philosophical position of the researcher; the use of literature; and the approach to coding, analysis and theory development. Following on from Glaser and Strauss, several versions of GT have ensued.

Grounded theory represents both a method of inquiry and a resultant product of that inquiry. 7 , 22 Glaser and Holton 23 define GT as ‘a set of integrated conceptual hypotheses systematically generated to produce an inductive theory about a substantive area’ (p. 43). Strauss and Corbin 24 define GT as ‘theory that was derived from data, systematically gathered and analysed through the research process’ (p. 12). The researcher ‘begins with an area of study and allows the theory to emerge from the data’ (p. 12). Charmaz 16 defines GT as ‘a method of conducting qualitative research that focuses on creating conceptual frameworks or theories through building inductive analysis from the data’ (p. 187). However, Birks and Mills 6 refer to GT as a process by which theory is generated from the analysis of data. Theory is not discovered; rather, theory is constructed by the researcher who views the world through their own particular lens.

Research process

Before commencing any research study, the researcher must have a solid understanding of the research process. A well-developed outline of the study and an understanding of the important considerations in designing and undertaking a GT study are essential if the goals of the research are to be achieved. While it is important to have an understanding of how a methodology has developed, in order to move forward with research, a novice can align with a grounded theorist and follow an approach to GT. Using a framework to inform a research design can be a useful modus operandi.

The following section provides insight into the process of undertaking a GT research study. Figure 1 is a framework that summarises the interplay and movement between methods and processes that underpin the generation of a GT. As can be seen from this framework, and as detailed in the discussion that follows, the process of doing a GT research study is not linear, rather it is iterative and recursive.

Research design framework: summary of the interplay between the essential grounded theory methods and processes.

Grounded theory research involves the meticulous application of specific methods and processes. Methods are ‘systematic modes, procedures or tools used for collection and analysis of data’. 25 While GT studies can commence with a variety of sampling techniques, many commence with purposive sampling, followed by concurrent data generation and/or collection and data analysis, through various stages of coding, undertaken in conjunction with constant comparative analysis, theoretical sampling and memoing. Theoretical sampling is employed until theoretical saturation is reached. These methods and processes create an unfolding, iterative system of actions and interactions inherent in GT. 6 , 16 The methods interconnect and inform the recurrent elements in the research process as shown by the directional flow of the arrows and the encompassing brackets in Figure 1 . The framework denotes the process is both iterative and dynamic and is not one directional. Grounded theory methods are discussed in the following section.

Purposive sampling

As presented in Figure 1 , initial purposive sampling directs the collection and/or generation of data. Researchers purposively select participants and/or data sources that can answer the research question. 5 , 7 , 16 , 21 Concurrent data generation and/or data collection and analysis is fundamental to GT research design. 6 The researcher collects, codes and analyses this initial data before further data collection/generation is undertaken. Purposeful sampling provides the initial data that the researcher analyses. As will be discussed, theoretical sampling then commences from the codes and categories developed from the first data set. Theoretical sampling is used to identify and follow clues from the analysis, fill gaps, clarify uncertainties, check hunches and test interpretations as the study progresses.

Constant comparative analysis

Constant comparative analysis is an analytical process used in GT for coding and category development. This process commences with the first data generated or collected and pervades the research process as presented in Figure 1 . Incidents are identified in the data and coded. 6 The initial stage of analysis compares incident to incident in each code. Initial codes are then compared to other codes. Codes are then collapsed into categories. This process means the researcher will compare incidents in a category with previous incidents, in both the same and different categories. 5 Future codes are compared and categories are compared with other categories. New data is then compared with data obtained earlier during the analysis phases. This iterative process involves inductive and deductive thinking. 16 Inductive, deductive and abductive reasoning can also be used in data analysis. 26

Constant comparative analysis generates increasingly more abstract concepts and theories through inductive processes. 16 In addition, abduction, defined as ‘a form of reasoning that begins with an examination of the data and the formation of a number of hypotheses that are then proved or disproved during the process of analysis … aids inductive conceptualization’. 6 Theoretical sampling coupled with constant comparative analysis raises the conceptual levels of data analysis and directs ongoing data collection or generation. 6

The constant comparative technique is used to find consistencies and differences, with the aim of continually refining concepts and theoretically relevant categories. This continual comparative iterative process that encompasses GT research sets it apart from a purely descriptive analysis. 8

Memo writing is an analytic process considered essential ‘in ensuring quality in grounded theory’. 6 Stern 27 offers the analogy that if data are the building blocks of the developing theory, then memos are the ‘mortar’ (p. 119). Memos are the storehouse of ideas generated and documented through interacting with data. 28 Thus, memos are reflective interpretive pieces that build a historic audit trail to document ideas, events and the thought processes inherent in the research process and developing thinking of the analyst. 6 Memos provide detailed records of the researchers’ thoughts, feelings and intuitive contemplations. 6

Lempert 29 considers memo writing crucial as memos prompt researchers to analyse and code data and develop codes into categories early in the coding process. Memos detail why and how decisions made related to sampling, coding, collapsing of codes, making of new codes, separating codes, producing a category and identifying relationships abstracted to a higher level of analysis. 6 Thus, memos are informal analytic notes about the data and the theoretical connections between categories. 23 Memoing is an ongoing activity that builds intellectual assets, fosters analytic momentum and informs the GT findings. 6 , 10

Generating/collecting data

A hallmark of GT is concurrent data generation/collection and analysis. In GT, researchers may utilise both qualitative and quantitative data as espoused by Glaser’s dictum; ‘all is data’. 30 While interviews are a common method of generating data, data sources can include focus groups, questionnaires, surveys, transcripts, letters, government reports, documents, grey literature, music, artefacts, videos, blogs and memos. 9 Elicited data are produced by participants in response to, or directed by, the researcher whereas extant data includes data that is already available such as documents and published literature. 6 , 31 While this is one interpretation of how elicited data are generated, other approaches to grounded theory recognise the agency of participants in the co-construction of data with the researcher. The relationship the researcher has with the data, how it is generated and collected, will determine the value it contributes to the development of the final GT. 6 The significance of this relationship extends into data analysis conducted by the researcher through the various stages of coding.

Coding is an analytical process used to identify concepts, similarities and conceptual reoccurrences in data. Coding is the pivotal link between collecting or generating data and developing a theory that explains the data. Charmaz 10 posits,

codes rely on interaction between researchers and their data. Codes consist of short labels that we construct as we interact with the data. Something kinaesthetic occurs when we are coding; we are mentally and physically active in the process. (p. 5)

In GT, coding can be categorised into iterative phases. Traditional, evolved and constructivist GT genres use different terminology to explain each coding phase ( Table 1 ).

Comparison of coding terminology in traditional, evolved and constructivist grounded theory.

Adapted from Birks and Mills. 6

Coding terminology in evolved GT refers to open (a procedure for developing categories of information), axial (an advanced procedure for interconnecting the categories) and selective coding (procedure for building a storyline from core codes that connects the categories), producing a discursive set of theoretical propositions. 6 , 12 , 32 Constructivist grounded theorists refer to initial, focused and theoretical coding. 9 Birks and Mills 6 use the terms initial, intermediate and advanced coding that link to low, medium and high-level conceptual analysis and development. The coding terms devised by Birks and Mills 6 were used for Figure 1 ; however, these can be altered to reflect the coding terminology used in the respective GT genres selected by the researcher.

Initial coding

Initial coding of data is the preliminary step in GT data analysis. 6 , 9 The purpose of initial coding is to start the process of fracturing the data to compare incident to incident and to look for similarities and differences in beginning patterns in the data. In initial coding, the researcher inductively generates as many codes as possible from early data. 16 Important words or groups of words are identified and labelled. In GT, codes identify social and psychological processes and actions as opposed to themes. Charmaz 16 emphasises keeping codes as similar to the data as possible and advocates embedding actions in the codes in an iterative coding process. Saldaña 33 agrees that codes that denote action, which he calls process codes, can be used interchangeably with gerunds (verbs ending in ing ). In vivo codes are often verbatim quotes from the participants’ words and are often used as the labels to capture the participant’s words as representative of a broader concept or process in the data. 6 Table 1 reflects variation in the terminology of codes used by grounded theorists.

Initial coding categorises and assigns meaning to the data, comparing incident-to-incident, labelling beginning patterns and beginning to look for comparisons between the codes. During initial coding, it is important to ask ‘what is this data a study of’. 18 What does the data assume, ‘suggest’ or ‘pronounce’ and ‘from whose point of view’ does this data come, whom does it represent or whose thoughts are they?. 16 What collectively might it represent? The process of documenting reactions, emotions and related actions enables researchers to explore, challenge and intensify their sensitivity to the data. 34 Early coding assists the researcher to identify the direction for further data gathering. After initial analysis, theoretical sampling is employed to direct collection of additional data that will inform the ‘developing theory’. 9 Initial coding advances into intermediate coding once categories begin to develop.

Theoretical sampling

The purpose of theoretical sampling is to allow the researcher to follow leads in the data by sampling new participants or material that provides relevant information. As depicted in Figure 1 , theoretical sampling is central to GT design, aids the evolving theory 5 , 7 , 16 and ensures the final developed theory is grounded in the data. 9 Theoretical sampling in GT is for the development of a theoretical category, as opposed to sampling for population representation. 10 Novice researchers need to acknowledge this difference if they are to achieve congruence within the methodology. Birks and Mills 6 define theoretical sampling as ‘the process of identifying and pursuing clues that arise during analysis in a grounded theory study’ (p. 68). During this process, additional information is sought to saturate categories under development. The analysis identifies relationships, highlights gaps in the existing data set and may reveal insight into what is not yet known. The exemplars in Box 1 highlight how theoretical sampling led to the inclusion of further data.

Examples of theoretical sampling.

Thus, theoretical sampling is used to focus and generate data to feed the iterative process of continual comparative analysis of the data. 6

Intermediate coding

Intermediate coding, identifying a core category, theoretical data saturation, constant comparative analysis, theoretical sensitivity and memoing occur in the next phase of the GT process. 6 Intermediate coding builds on the initial coding phase. Where initial coding fractures the data, intermediate coding begins to transform basic data into more abstract concepts allowing the theory to emerge from the data. During this analytic stage, a process of reviewing categories and identifying which ones, if any, can be subsumed beneath other categories occurs and the properties or dimension of the developed categories are refined. Properties refer to the characteristics that are common to all the concepts in the category and dimensions are the variations of a property. 37

At this stage, a core category starts to become evident as developed categories form around a core concept; relationships are identified between categories and the analysis is refined. Birks and Mills 6 affirm that diagramming can aid analysis in the intermediate coding phase. Grounded theorists interact closely with the data during this phase, continually reassessing meaning to ascertain ‘what is really going on’ in the data. 30 Theoretical saturation ensues when new data analysis does not provide additional material to existing theoretical categories, and the categories are sufficiently explained. 6

Advanced coding

Birks and Mills 6 described advanced coding as the ‘techniques used to facilitate integration of the final grounded theory’ (p. 177). These authors promote storyline technique (described in the following section) and theoretical coding as strategies for advancing analysis and theoretical integration. Advanced coding is essential to produce a theory that is grounded in the data and has explanatory power. 6 During the advanced coding phase, concepts that reach the stage of categories will be abstract, representing stories of many, reduced into highly conceptual terms. The findings are presented as a set of interrelated concepts as opposed to presenting themes. 28 Explanatory statements detail the relationships between categories and the central core category. 28

Storyline is a tool that can be used for theoretical integration. Birks and Mills 6 define storyline as ‘a strategy for facilitating integration, construction, formulation, and presentation of research findings through the production of a coherent grounded theory’ (p. 180). Storyline technique is first proposed with limited attention in Basics of Qualitative Research by Strauss and Corbin 12 and further developed by Birks et al. 38 as a tool for theoretical integration. The storyline is the conceptualisation of the core category. 6 This procedure builds a story that connects the categories and produces a discursive set of theoretical propositions. 24 Birks and Mills 6 contend that storyline can be ‘used to produce a comprehensive rendering of your grounded theory’ (p. 118). Birks et al. 38 had earlier concluded, ‘storyline enhances the development, presentation and comprehension of the outcomes of grounded theory research’ (p. 405). Once the storyline is developed, the GT is finalised using theoretical codes that ‘provide a framework for enhancing the explanatory power of the storyline and its potential as theory’. 6 Thus, storyline is the explication of the theory.

Theoretical coding occurs as the final culminating stage towards achieving a GT. 39 , 40 The purpose of theoretical coding is to integrate the substantive theory. 41 Saldaña 40 states, ‘theoretical coding integrates and synthesises the categories derived from coding and analysis to now create a theory’ (p. 224). Initial coding fractures the data while theoretical codes ‘weave the fractured story back together again into an organized whole theory’. 18 Advanced coding that integrates extant theory adds further explanatory power to the findings. 6 The examples in Box 2 describe the use of storyline as a technique.

Writing the storyline.

Theoretical sensitivity

As presented in Figure 1 , theoretical sensitivity encompasses the entire research process. Glaser and Strauss 5 initially described the term theoretical sensitivity in The Discovery of Grounded Theory. Theoretical sensitivity is the ability to know when you identify a data segment that is important to your theory. While Strauss and Corbin 12 describe theoretical sensitivity as the insight into what is meaningful and of significance in the data for theory development, Birks and Mills 6 define theoretical sensitivity as ‘the ability to recognise and extract from the data elements that have relevance for the emerging theory’ (p. 181). Conducting GT research requires a balance between keeping an open mind and the ability to identify elements of theoretical significance during data generation and/or collection and data analysis. 6

Several analytic tools and techniques can be used to enhance theoretical sensitivity and increase the grounded theorist’s sensitivity to theoretical constructs in the data. 28 Birks and Mills 6 state, ‘as a grounded theorist becomes immersed in the data, their level of theoretical sensitivity to analytic possibilities will increase’ (p. 12). Developing sensitivity as a grounded theorist and the application of theoretical sensitivity throughout the research process allows the analytical focus to be directed towards theory development and ultimately result in an integrated and abstract GT. 6 The example in Box 3 highlights how analytic tools are employed to increase theoretical sensitivity.

Theoretical sensitivity.

The grounded theory

The meticulous application of essential GT methods refines the analysis resulting in the generation of an integrated, comprehensive GT that explains a process relating to a particular phenomenon. 6 The results of a GT study are communicated as a set of concepts, related to each other in an interrelated whole, and expressed in the production of a substantive theory. 5 , 7 , 16 A substantive theory is a theoretical interpretation or explanation of a studied phenomenon 6 , 17 Thus, the hallmark of grounded theory is the generation of theory ‘abstracted from, or grounded in, data generated and collected by the researcher’. 6 However, to ensure quality in research requires the application of rigour throughout the research process.

Quality and rigour

The quality of a grounded theory can be related to three distinct areas underpinned by (1) the researcher’s expertise, knowledge and research skills; (2) methodological congruence with the research question; and (3) procedural precision in the use of methods. 6 Methodological congruence is substantiated when the philosophical position of the researcher is congruent with the research question and the methodological approach selected. 6 Data collection or generation and analytical conceptualisation need to be rigorous throughout the research process to secure excellence in the final grounded theory. 44

Procedural precision requires careful attention to maintaining a detailed audit trail, data management strategies and demonstrable procedural logic recorded using memos. 6 Organisation and management of research data, memos and literature can be assisted using software programs such as NVivo. An audit trail of decision-making, changes in the direction of the research and the rationale for decisions made are essential to ensure rigour in the final grounded theory. 6

This article offers a framework to assist novice researchers visualise the iterative processes that underpin a GT study. The fundamental process and methods used to generate an integrated grounded theory have been described. Novice researchers can adapt the framework presented to inform and guide the design of a GT study. This framework provides a useful guide to visualise the interplay between the methods and processes inherent in conducting GT. Research conducted ethically and with meticulous attention to process will ensure quality research outcomes that have relevance at the practice level.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Grounded Theory In Qualitative Research: A Practical Guide

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Grounded theory is a useful approach when you want to develop a new theory based on real-world data Instead of starting with a pre-existing theory, grounded theory lets the data guide the development of your theory.

What Is Grounded Theory?

Grounded theory is a qualitative method specifically designed to inductively generate theory from data. It was developed by Glaser and Strauss in 1967.

• Data shapes the theory:  Instead of trying to prove an existing theory, you let the data guide your findings.
• No guessing games:  You don’t start with assumptions or try to confirm your own biases.
• Data collection and analysis happen together:  You analyze information as you gather it, which helps you decide what data to collect next.

It is important to note that grounded theory is an inductive approach where a theory is developed from collected real-world data rather than trying to prove or disprove a hypothesis like in a deductive scientific approach

You gather information, look for patterns, and use those patterns to develop an explanation.

It is a way to understand why people do things and how those actions create patterns. Imagine you’re trying to figure out why your friends love a certain video game.

Instead of asking an adult, you observe your friends while they’re playing, listen to them talk about it, and maybe even play a little yourself. By studying their actions and words, you’re using grounded theory to build an understanding of their behavior.

This qualitative method of research focuses on real-life experiences and observations, letting theories emerge naturally from the data collected, like piecing together a puzzle without knowing the final image.

When should you use grounded theory? 

Grounded theory research is useful for beginning researchers, particularly graduate students, because it offers a clear and flexible framework for conducting a study on a new topic.

Grounded theory works best when existing theories are either insufficient or nonexistent for the topic at hand.

Since grounded theory is a continuously evolving process, researchers collect and analyze data until theoretical saturation is reached or no new insights can be gained.

What is the final product of a GT study?

The final product of a grounded theory (GT) study is an integrated and comprehensive grounded theory that explains a process or scheme associated with a phenomenon.

The quality of a GT study is judged on whether it produces this middle-range theory

Middle-range theories are sort of like explanations that focus on a specific part of society or a particular event. They don’t try to explain everything in the world. Instead, they zero in on things happening in certain groups, cultures, or situations.

Think of it like this: a grand theory is like trying to understand all of weather at once, but a middle-range theory is like focusing on how hurricanes form.

Here are a few examples of what middle-range theories might try to explain:

• How people deal with feeling anxious in social situations.
• How people act and interact at work.
• How teachers handle students who are misbehaving in class.

Core Components of Grounded Theory

This terminology reflects the iterative, inductive, and comparative nature of grounded theory, which distinguishes it from other research approaches.

• Theoretical Sampling: The researcher uses theoretical sampling to choose new participants or data sources based on the emerging findings of their study. The goal is to gather data that will help to further develop and refine the emerging categories and theoretical concepts.
• Theoretical Sensitivity:  Researchers need to be aware of their preconceptions going into a study and understand how those preconceptions could influence the research. However, it is not possible to completely separate a researcher’s history and experience from the construction of a theory.
• Coding: Coding is the process of analyzing  qualitative data  (usually text) by assigning labels (codes) to chunks of data that capture their essence or meaning. It allows you to condense, organize and interpret your data.
• Core Category:  The core category encapsulates and explains the grounded theory as a whole. Researchers identify a core category to focus on during the later stages of their research.
• Memos: Researchers use memos to record their thoughts and ideas about the data, explore relationships between codes and categories, and document the development of the emerging grounded theory. Memos support the development of theory by tracking emerging themes and patterns.
• Theoretical Saturation:  This term refers to the point in a grounded theory study when collecting additional data does not yield any new theoretical insights. The researcher continues the process of collecting and analyzing data until theoretical saturation is reached.
• Constant Comparative Analysis:  This method involves the systematic comparison of data points, codes, and categories as they emerge from the research process. Researchers use constant comparison to identify patterns and connections in their data.

Barney Glaser and Anselm Strauss first introduced grounded theory in 1967 in their book, The Discovery of Grounded Theory .

Their aim was to create a research method that prioritized real-world data to understand social behavior.

However, their approaches diverged over time, leading to two distinct versions: Glaserian and Straussian grounded theory.

The different versions of grounded theory diverge in their approaches to  coding , theory construction, and the use of literature.

All versions of grounded theory share the goal of generating a  middle-range theory  that explains a social process or phenomenon.

They also emphasize the importance of  theoretical sampling ,  constant comparative analysis , and  theoretical saturation  in developing a robust theory

Glaserian Grounded Theory

Glaserian grounded theory emphasizes the  emergence of theory from data  and discourages the use of pre-existing literature.

Glaser believed that adopting a specific philosophical or disciplinary perspective reduces the broader potential of grounded theory.

For Glaser, prior understandings should be based on the general problem area and reading very wide to alert or sensitize one to a wide range of possibilities.

It prioritizes  parsimony ,  scope , and  modifiability  in the resulting theory

Straussian Grounded Theory

Strauss and Corbin (1990) focused on developing the analytic techniques and providing guidance to novice researchers.

Straussian grounded theory utilizes a more structured approach to coding and analysis and acknowledges the role of the literature in shaping research.

It acknowledges the role of  deduction  and  validation  in addition to induction.

Strauss and Corbin also emphasize the use of  unstructured interview questions  to encourage participants to speak freely

Critics of this approach believe it produced a rigidity never intended for grounded theory.

Constructivist Grounded Theory

This version, primarily associated with Charmaz, recognizes that knowledge is situated, partial, provisional, and socially constructed. It emphasizes abstract and conceptual understandings rather than explanations.

Kathy Charmaz expanded on original versions of GT, emphasizing the researcher’s role in interpreting findings

Constructivist grounded theory acknowledges the researcher’s influence on the research process and the co-creation of knowledge with participants

Situational Analysis

Developed by Clarke, this version builds upon Straussian and Constructivist grounded theory and incorporates  postmodern ,  poststructuralist , and  posthumanist  perspectives.

Situational analysis incorporates postmodern perspectives and considers the role of nonhuman actors

It introduces the method of  mapping  to analyze complex situations and emphasizes both  human and nonhuman elements .

• Discover New Insights:  Grounded theory lets you uncover new theories based on what your data reveals, not just on pre-existing ideas.
• Data-Driven Results:  Your conclusions are firmly rooted in the data you’ve gathered, ensuring they reflect reality. This close relationship between data and findings is a key factor in establishing trustworthiness.
• Avoids Bias:  Because gathering data and analyzing it are closely intertwined, researchers are truly observing what emerges from data, and are less likely to let their preconceptions color the findings.
• Streamlined data gathering and analysis:  Analyzing and collecting data go hand in hand. Data is collected, analyzed, and as you gain insight from analysis, you continue gathering more data.
• Synthesize Findings : By applying grounded theory to a qualitative metasynthesis , researchers can move beyond a simple aggregation of findings and generate a higher-level understanding of the phenomena being studied.

Limitations

• Time-Consuming:  Analyzing qualitative data can be like searching for a needle in a haystack; it requires careful examination and can be quite time-consuming, especially without software assistance6.
• Potential for Bias:  Despite safeguards, researchers may unintentionally influence their analysis due to personal experiences.
• Data Quality:  The success of grounded theory hinges on complete and accurate data; poor quality can lead to faulty conclusions.

Practical Steps

Grounded theory can be conducted by individual researchers or research teams. If working in a team, it’s important to communicate regularly and ensure everyone is using the same coding system.

Grounded theory research is typically an iterative process. This means that researchers may move back and forth between these steps as they collect and analyze data.

Instead of doing everything in order, you repeat the steps over and over.

This cycle keeps going, which is why grounded theory is called a circular process.

Continue to gather and analyze data until no new insights or properties related to your categories emerge. This saturation point signals that the theory is comprehensive and well-substantiated by the data.

Theoretical sampling, collecting sufficient and rich data, and theoretical saturation help the grounded theorist to avoid a lack of “groundedness,” incomplete findings, and “premature closure.

1. Planning and Philosophical Considerations

Begin by considering the phenomenon you want to study and assess the current knowledge surrounding it.

However, refrain from detailing the specific aspects you seek to uncover about the phenomenon to prevent pre-existing assumptions from skewing the research.

• Discern a personal philosophical position.  Before beginning a research study, it is important to consider your philosophical stance and how you view the world, including the nature of reality and the relationship between the researcher and the participant. This will inform the methodological choices made throughout the study.
• Investigate methodological possibilities.  Explore different research methods that align with both the philosophical stance and research goals of the study.
• Plan the study.  Determine the research question, how to collect data, and from whom to collect data.
• Conduct a literature review.  The literature review is an ongoing process throughout the study. It is important to avoid duplicating existing research and to consider previous studies, concepts, and interpretations that relate to the emerging codes and categories in the developing grounded theory.

2. Recruit participants using theoretical sampling

Initially, select participants who are readily available ( convenience sampling ) or those recommended by existing participants ( snowball sampling ).

As the analysis progresses, transition to  theoretical sampling , involving the deliberate selection of participants and data sources to refine your emerging theory.

This method is used to refine and develop a grounded theory. The researcher uses theoretical sampling to choose new participants or data sources based on the emerging findings of their study.

This could mean recruiting participants who can shed light on gaps in your understanding uncovered during the initial data analysis.

Theoretical sampling guides further data collection by identifying participants or data sources that can provide insights into gaps in the emerging theory

The goal is to gather data that will help to further develop and refine the emerging categories and theoretical concepts.

Theoretical sampling starts early in a GT study and generally requires the researcher to make amendments to their ethics approvals to accommodate new participant groups.

3. Collect Data

The researcher might use interviews, focus groups, observations, or a combination of methods to collect qualitative data.

• Observations : Watching and recording phenomena as they occur. Can be participant (researcher actively involved) or non-participant (researcher tries not to influence behaviors), and covert (participants unaware) or overt (participants aware).
• Interviews : One-on-one conversations to understand participants’ experiences. Can be structured (predetermined questions), informal (casual conversations), or semi-structured (flexible structure to explore emerging issues).
• Focus groups : Dynamic discussions with 4-10 participants sharing characteristics, moderated by the researcher using a topic guide.
• Ethnography : Studying a group’s behaviors and social interactions in their environment through observations, field notes, and interviews. Researchers immerse themselves in the community or organization for an in-depth understanding.

4. Begin open coding as soon as data collection starts

Open coding   is the first stage of coding in grounded theory, where you carefully examine and label segments of your data to identify initial concepts and ideas.

This process involves scrutinizing the data and creating codes grounded in the data itself.

The initial codes stay close to the data, aiming to capture and summarize critically and analytically what is happening in the data

To begin open coding, read through your data, such as interview transcripts, to gain a comprehensive understanding of what is being conveyed.

As you encounter segments of data that represent a distinct idea, concept, or action, you assign a code to that segment. These codes act as descriptive labels summarizing the meaning of the data segment.

For instance, if you were analyzing interview data about experiences with a new medication, a segment of data might describe a participant’s difficulty sleeping after taking the medication. This segment could be labeled with the code “trouble sleeping”

Open coding is a crucial step in grounded theory because it allows you to break down the data into manageable units and begin to see patterns and themes emerge.

As you continue coding, you constantly compare different segments of data to refine your understanding of existing codes and identify new ones.

For instance, excerpts describing difficulties with sleep might be grouped under the code “trouble sleeping”.

This iterative process of comparing data and refining codes helps ensure the codes accurately reflect the data.

Open coding is about staying close to the data, using in vivo terms or gerunds to maintain a sense of action and process

5. Reflect on thoughts and contradictions by writing grounded theory memos during analysis

During open coding, it’s crucial to engage in memo writing. Memos serve as your “notes to self”, allowing you to reflect on the coding process, note emerging patterns, and ask analytical questions about the data.

Document your thoughts, questions, and insights in memos throughout the research process.

These memos serve multiple purposes: tracing your thought process, promoting reflexivity (self-reflection), facilitating collaboration if working in a team, and supporting theory development.

Early memos tend to be shorter and less conceptual, often serving as “preparatory” notes. Later memos become more analytical and conceptual as the research progresses.

Memo Writing

• Reflexivity and Recognizing Assumptions:  Researchers should acknowledge the influence of their own experiences and assumptions on the research process. Articulating these assumptions, perhaps through memos, can enhance the transparency and trustworthiness of the study.
• Write memos throughout the research process.  Memo writing should occur throughout the entire research process, beginning with initial coding.67 Memos help make sense of the data and transition between coding phases.8
• Ask analytic questions in early memos.  Memos should include questions, reflections, and notes to explore in subsequent data collection and analysis.8
• Refine memos throughout the process.  Early memos will be shorter and less conceptual, but will become longer and more developed in later stages of the research process.7 Later memos should begin to develop provisional categories.

6. Group codes into categories using axial coding

Axial coding is the process of identifying connections between codes, grouping them together into categories to reveal relationships within the data.

Axial coding seeks to find the axes that connect various codes together.

For example, in research on school bullying, focused codes such as “Doubting oneself, getting low self-confidence, starting to agree with bullies” and “Getting lower self-confidence; blaming oneself” could be grouped together into a broader category representing the impact of bullying on self-perception.

Similarly, codes such as “Being left by friends” and “Avoiding school; feeling lonely and isolated” could be grouped into a category related to the social consequences of bullying.

These categories then become part of the emerging grounded theory, explaining the multifaceted aspects of the phenomenon.

Qualitative data analysis software often represents these categories as nested codes, visually demonstrating the hierarchy and interconnectedness of the concepts.

This hierarchical structure helps researchers organize their data, identify patterns, and develop a more nuanced understanding of the relationships between different aspects of the phenomenon being studied.

This process of axial coding is crucial for moving beyond descriptive accounts of the data towards a more theoretically rich and explanatory grounded theory.

7. Define the core category using selective coding

During  selective coding , the final development stage of grounded theory analysis, a researcher focuses on developing a detailed and integrated theory by selecting a  core category  and connecting it to other categories developed during earlier coding stages.

The core category is the central concept that links together the various categories and subcategories identified in the data and forms the foundation of the emergent grounded theory.

This core category will encapsulate the main theme of your grounded theory, that encompasses and elucidates the overarching process or phenomenon under investigation.

This phase involves a concentrated effort to refine and integrate categories, ensuring they align with the core category and contribute to the overall explanatory power of the theory.

The theory should comprehensively describe the process or scheme related to the phenomenon being studied.

For example, in a study on school bullying, if the core category is “victimization journey,” the researcher would selectively code data related to different stages of this journey, the factors contributing to each stage, and the consequences of experiencing these stages.

This might involve analyzing how victims initially attribute blame, their coping mechanisms, and the long-term impact of bullying on their self-perception.

Continue collecting data and analyzing until you reach theoretical saturation

Selective coding focuses on developing and saturating this core category, leading to a cohesive and integrated theory.

Through selective coding, researchers aim to achieve theoretical saturation, meaning no new properties or insights emerge from further data analysis.

This signifies that the core category and its related categories are well-defined, and the connections between them are thoroughly explored.

This rigorous process strengthens the trustworthiness of the findings by ensuring the theory is comprehensive and grounded in a rich dataset.

It’s important to note that while a grounded theory seeks to provide a comprehensive explanation, it remains grounded in the data.

The theory’s scope is limited to the specific phenomenon and context studied, and the researcher acknowledges that new data or perspectives might lead to modifications or refinements of the theory

• Constant Comparative Analysis:  This method involves the systematic comparison of data points, codes, and categories as they emerge from the research process. Researchers use constant comparison to identify patterns and connections in their data. There are different methods for comparing excerpts from interviews, for example, a researcher can compare excerpts from the same person, or excerpts from different people. This process is ongoing and iterative, and it continues until the researcher has developed a comprehensive and well-supported grounded theory.
• Continue until reaching theoretical saturation : Continue to gather and analyze data until no new insights or properties related to your categories. This saturation point signals that the theory is comprehensive and well-substantiated by the data.

8. Theoretical coding and model development

Theoretical coding is a process in grounded theory where researchers use advanced abstractions, often from existing theories, to explain the relationships found in their data. 

Theoretical coding often occurs later in the research process and involves using existing theories to explain the connections between codes and categories.

This process helps to strengthen the explanatory power of the grounded theory. Theoretical coding should not be confused with simply describing the data; instead, it aims to explain the phenomenon being studied, distinguishing grounded theory from purely descriptive research.

Using the developed codes, categories, and core category, create a model illustrating the process or phenomenon.

Here is some advice for novice researchers on how to apply theoretical coding:

• Begin with data analysis:  Don’t start with a pre-determined theory. Instead, allow the theory to emerge from your data through careful analysis and coding.
• Use existing theories as a guide:  While the theory should primarily emerge from your data, you can use existing theories from any discipline to help explain the connections you are seeing between your categories. This demonstrates how your research builds on established knowledge.
• Use Glaser’s coding families:  Consider applying Glaser’s (1978) coding families in the later stages of analysis as a simple way to begin theoretical coding. Remember that your analysis should guide which theoretical codes are most appropriate.
• Keep it simple:  Theoretical coding doesn’t need to be overly complex.   Focus on finding an existing theory that effectively explains the relationships you have identified in your data.
• Be transparent:  Clearly articulate the existing theory you are using and how it explains the connections between your categories.
• Theoretical coding is an iterative process : Remain open to revising your chosen theoretical codes as your analysis deepens and your grounded theory evolves.

9. Write your grounded theory

Present your findings in a clear and accessible manner, ensuring the theory is rooted in the data and explains the relationships between the identified concepts and categories.

The end product of this process is a well-defined, integrated grounded theory that explains a process or scheme related to the phenomenon studied.

• Develop a dissemination plan : Determine how to share the research findings with others.
• Evaluate and implement : Reflect on the research process and quality of findings, then share findings with relevant audiences in service of making a difference in the world

Reading List

Grounded Theory Review : This is an international journal that publishes articles on grounded theory.

• Birks, M., & Mills, J. (2015).  Grounded theory: A practical guide . Sage.
• Corbin, J., & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13, 3-21.
• Charmaz, K. (2006). Constructing Grounded Theory: A practical guide through Qualitative Analysis. Thousand Oaks, California: Sage.
• Clarke, A. E. (2003). Situational analyses: Grounded theory mapping after the postmodern turn .  Symbolic interaction ,  26 (4), 553-576.
• Glaser, B. G. (1978).  Theoretical sensitivity . University of California.
• Glaser, B. G. (2005).  The grounded theory perspective III: Theoretical coding . Sociology Press.
• Glaser, B. G., & Holton, J. (2004, May). Remodeling grounded theory. In  Forum qualitative sozialforschung/forum: qualitative social research  (Vol. 5, No. 2).
• Charmaz, K. (2012). The power and potential of grounded theory.  Medical sociology online ,  6 (3), 2-15.
• Glaser, B., & Strauss, A. (1965). Awareness of dying. New Brunswick. NJ: Aldine. This was the first published grounded theory study
• Glaser, B., & Strauss, A. (2017).  Discovery of grounded theory: Strategies for qualitative research . Routledge.
• Pidgeon, N., & Henwood, K. (1997). Using grounded theory in psychological research. In N. Hayes (Ed.), Doing qualitative analysis in psychology Press/Erlbaum (UK) Taylor & Francis.

• Correspondence
• Open access
• Published: 09 September 2011

How to do a grounded theory study: a worked example of a study of dental practices

• Alexandra Sbaraini 1 , 2 ,
• Stacy M Carter 1 ,
• R Wendell Evans 2 &
• Anthony Blinkhorn 1 , 2  

BMC Medical Research Methodology volume  11 , Article number:  128 ( 2011 ) Cite this article

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Qualitative methodologies are increasingly popular in medical research. Grounded theory is the methodology most-often cited by authors of qualitative studies in medicine, but it has been suggested that many 'grounded theory' studies are not concordant with the methodology. In this paper we provide a worked example of a grounded theory project. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature.

We documented a worked example of using grounded theory methodology in practice.

We describe our sampling, data collection, data analysis and interpretation. We explain how these steps were consistent with grounded theory methodology, and show how they related to one another. Grounded theory methodology assisted us to develop a detailed model of the process of adapting preventive protocols into dental practice, and to analyse variation in this process in different dental practices.

Conclusions

By employing grounded theory methodology rigorously, medical researchers can better design and justify their methods, and produce high-quality findings that will be more useful to patients, professionals and the research community.

Peer Review reports

Qualitative research is increasingly popular in health and medicine. In recent decades, qualitative researchers in health and medicine have founded specialist journals, such as Qualitative Health Research , established 1991, and specialist conferences such as the Qualitative Health Research conference of the International Institute for Qualitative Methodology, established 1994, and the Global Congress for Qualitative Health Research, established 2011 [ 1 – 3 ]. Journals such as the British Medical Journal have published series about qualitative methodology (1995 and 2008) [ 4 , 5 ]. Bodies overseeing human research ethics, such as the Canadian Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, and the Australian National Statement on Ethical Conduct in Human Research [ 6 , 7 ], have included chapters or sections on the ethics of qualitative research. The increasing popularity of qualitative methodologies for medical research has led to an increasing awareness of formal qualitative methodologies. This is particularly so for grounded theory, one of the most-cited qualitative methodologies in medical research [[ 8 ], p47].

Grounded theory has a chequered history [ 9 ]. Many authors label their work 'grounded theory' but do not follow the basics of the methodology [ 10 , 11 ]. This may be in part because there are few practical examples of grounded theory in use in the literature. To address this problem, we will provide a brief outline of the history and diversity of grounded theory methodology, and a worked example of the methodology in practice. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature.

The history, diversity and basic components of 'grounded theory' methodology and method

Founded on the seminal 1967 book 'The Discovery of Grounded Theory' [ 12 ], the grounded theory tradition is now diverse and somewhat fractured, existing in four main types, with a fifth emerging. Types one and two are the work of the original authors: Barney Glaser's 'Classic Grounded Theory' [ 13 ] and Anselm Strauss and Juliet Corbin's 'Basics of Qualitative Research' [ 14 ]. Types three and four are Kathy Charmaz's 'Constructivist Grounded Theory' [ 15 ] and Adele Clarke's postmodern Situational Analysis [ 16 ]: Charmaz and Clarke were both students of Anselm Strauss. The fifth, emerging variant is 'Dimensional Analysis' [ 17 ] which is being developed from the work of Leonard Schaztman, who was a colleague of Strauss and Glaser in the 1960s and 1970s.

There has been some discussion in the literature about what characteristics a grounded theory study must have to be legitimately referred to as 'grounded theory' [ 18 ]. The fundamental components of a grounded theory study are set out in Table 1 . These components may appear in different combinations in other qualitative studies; a grounded theory study should have all of these. As noted, there are few examples of 'how to do' grounded theory in the literature [ 18 , 19 ]. Those that do exist have focused on Strauss and Corbin's methods [ 20 – 25 ]. An exception is Charmaz's own description of her study of chronic illness [ 26 ]; we applied this same variant in our study. In the remainder of this paper, we will show how each of the characteristics of grounded theory methodology worked in our study of dental practices.

Study background

We used grounded theory methodology to investigate social processes in private dental practices in New South Wales (NSW), Australia. This grounded theory study builds on a previous Australian Randomized Controlled Trial (RCT) called the Monitor Dental Practice Program (MPP) [ 27 ]. We know that preventive techniques can arrest early tooth decay and thus reduce the need for fillings [ 28 – 32 ]. Unfortunately, most dentists worldwide who encounter early tooth decay continue to drill it out and fill the tooth [ 33 – 37 ]. The MPP tested whether dentists could increase their use of preventive techniques. In the intervention arm, dentists were provided with a set of evidence-based preventive protocols to apply [ 38 ]; control practices provided usual care. The MPP protocols used in the RCT guided dentists to systematically apply preventive techniques to prevent new tooth decay and to arrest early stages of tooth decay in their patients, therefore reducing the need for drilling and filling. The protocols focused on (1) primary prevention of new tooth decay (tooth brushing with high concentration fluoride toothpaste and dietary advice) and (2) intensive secondary prevention through professional treatment to arrest tooth decay progress (application of fluoride varnish, supervised monitoring of dental plaque control and clinical outcomes)[ 38 ].

As the RCT unfolded, it was discovered that practices in the intervention arm were not implementing the preventive protocols uniformly. Why had the outcomes of these systematically implemented protocols been so different? This question was the starting point for our grounded theory study. We aimed to understand how the protocols had been implemented, including the conditions and consequences of variation in the process. We hoped that such understanding would help us to see how the norms of Australian private dental practice as regards to tooth decay could be moved away from drilling and filling and towards evidence-based preventive care.

Designing this grounded theory study

Figure 1 illustrates the steps taken during the project that will be described below from points A to F.

Study design . file containing a figure illustrating the study design.

A. An open beginning and research questions

Grounded theory studies are generally focused on social processes or actions: they ask about what happens and how people interact . This shows the influence of symbolic interactionism, a social psychological approach focused on the meaning of human actions [ 39 ]. Grounded theory studies begin with open questions, and researchers presume that they may know little about the meanings that drive the actions of their participants. Accordingly, we sought to learn from participants how the MPP process worked and how they made sense of it. We wanted to answer a practical social problem: how do dentists persist in drilling and filling early stages of tooth decay, when they could be applying preventive care?

We asked research questions that were open, and focused on social processes. Our initial research questions were:

What was the process of implementing (or not-implementing) the protocols (from the perspective of dentists, practice staff, and patients)?

How did this process vary?

B. Ethics approval and ethical issues

In our experience, medical researchers are often concerned about the ethics oversight process for such a flexible, unpredictable study design. We managed this process as follows. Initial ethics approval was obtained from the Human Research Ethics Committee at the University of Sydney. In our application, we explained grounded theory procedures, in particular the fact that they evolve. In our initial application we provided a long list of possible recruitment strategies and interview questions, as suggested by Charmaz [ 15 ]. We indicated that we would make future applications to modify our protocols. We did this as the study progressed - detailed below. Each time we reminded the committee that our study design was intended to evolve with ongoing modifications. Each modification was approved without difficulty. As in any ethical study, we ensured that participation was voluntary, that participants could withdraw at any time, and that confidentiality was protected. All responses were anonymised before analysis, and we took particular care not to reveal potentially identifying details of places, practices or clinicians.

C. Initial, Purposive Sampling (before theoretical sampling was possible)

Grounded theory studies are characterised by theoretical sampling, but this requires some data to be collected and analysed. Sampling must thus begin purposively, as in any qualitative study. Participants in the previous MPP study provided our population [ 27 ]. The MPP included 22 private dental practices in NSW, randomly allocated to either the intervention or control group. With permission of the ethics committee; we sent letters to the participants in the MPP, inviting them to participate in a further qualitative study. From those who agreed, we used the quantitative data from the MPP to select an initial sample.

Then, we selected the practice in which the most dramatic results had been achieved in the MPP study (Dental Practice 1). This was a purposive sampling strategy, to give us the best possible access to the process of successfully implementing the protocols. We interviewed all consenting staff who had been involved in the MPP (one dentist, five dental assistants). We then recruited 12 patients who had been enrolled in the MPP, based on their clinically measured risk of developing tooth decay: we selected some patients whose risk status had gotten better, some whose risk had worsened and some whose risk had stayed the same. This purposive sample was designed to provide maximum variation in patients' adoption of preventive dental care.

Initial Interviews

One hour in-depth interviews were conducted. The researcher/interviewer (AS) travelled to a rural town in NSW where interviews took place. The initial 18 participants (one dentist, five dental assistants and 12 patients) from Dental Practice 1 were interviewed in places convenient to them such as the dental practice, community centres or the participant's home.

Two initial interview schedules were designed for each group of participants: 1) dentists and dental practice staff and 2) dental patients. Interviews were semi-structured and based loosely on the research questions. The initial questions for dentists and practice staff are in Additional file 1 . Interviews were digitally recorded and professionally transcribed. The research location was remote from the researcher's office, thus data collection was divided into two episodes to allow for intermittent data analysis. Dentist and practice staff interviews were done in one week. The researcher wrote memos throughout this week. The researcher then took a month for data analysis in which coding and memo-writing occurred. Then during a return visit, patient interviews were completed, again with memo-writing during the data-collection period.

D. Data Analysis

Coding and the constant comparative method.

Coding is essential to the development of a grounded theory [ 15 ]. According to Charmaz [[ 15 ], p46], 'coding is the pivotal link between collecting data and developing an emergent theory to explain these data. Through coding, you define what is happening in the data and begin to grapple with what it means'. Coding occurs in stages. In initial coding, the researcher generates as many ideas as possible inductively from early data. In focused coding, the researcher pursues a selected set of central codes throughout the entire dataset and the study. This requires decisions about which initial codes are most prevalent or important, and which contribute most to the analysis. In theoretical coding, the researcher refines the final categories in their theory and relates them to one another. Charmaz's method, like Glaser's method [ 13 ], captures actions or processes by using gerunds as codes (verbs ending in 'ing'); Charmaz also emphasises coding quickly, and keeping the codes as similar to the data as possible.

We developed our coding systems individually and through team meetings and discussions.

We have provided a worked example of coding in Table 2 . Gerunds emphasise actions and processes. Initial coding identifies many different processes. After the first few interviews, we had a large amount of data and many initial codes. This included a group of codes that captured how dentists sought out evidence when they were exposed to a complex clinical case, a new product or technique. Because this process seemed central to their practice, and because it was talked about often, we decided that seeking out evidence should become a focused code. By comparing codes against codes and data against data, we distinguished the category of "seeking out evidence" from other focused codes, such as "gathering and comparing peers' evidence to reach a conclusion", and we understood the relationships between them. Using this constant comparative method (see Table 1 ), we produced a theoretical code: "making sense of evidence and constructing knowledge". This code captured the social process that dentists went through when faced with new information or a practice challenge. This theoretical code will be the focus of a future paper.

Memo-writing

Throughout the study, we wrote extensive case-based memos and conceptual memos. After each interview, the interviewer/researcher (AS) wrote a case-based memo reflecting on what she learned from that interview. They contained the interviewer's impressions about the participants' experiences, and the interviewer's reactions; they were also used to systematically question some of our pre-existing ideas in relation to what had been said in the interview. Table 3 illustrates one of those memos. After a few interviews, the interviewer/researcher also began making and recording comparisons among these memos.

We also wrote conceptual memos about the initial codes and focused codes being developed, as described by Charmaz [ 15 ]. We used these memos to record our thinking about the meaning of codes and to record our thinking about how and when processes occurred, how they changed, and what their consequences were. In these memos, we made comparisons between data, cases and codes in order to find similarities and differences, and raised questions to be answered in continuing interviews. Table 4 illustrates a conceptual memo.

At the end of our data collection and analysis from Dental Practice 1, we had developed a tentative model of the process of implementing the protocols, from the perspective of dentists, dental practice staff and patients. This was expressed in both diagrams and memos, was built around a core set of focused codes, and illustrated relationships between them.

E. Theoretical sampling, ongoing data analysis and alteration of interview route

We have already described our initial purposive sampling. After our initial data collection and analysis, we used theoretical sampling (see Table 1 ) to determine who to sample next and what questions to ask during interviews. We submitted Ethics Modification applications for changes in our question routes, and had no difficulty with approval. We will describe how the interview questions for dentists and dental practice staff evolved, and how we selected new participants to allow development of our substantive theory. The patients' interview schedule and theoretical sampling followed similar procedures.

Evolution of theoretical sampling and interview questions

We now had a detailed provisional model of the successful process implemented in Dental Practice 1. Important core focused codes were identified, including practical/financial, historical and philosophical dimensions of the process. However, we did not yet understand how the process might vary or go wrong, as implementation in the first practice we studied had been described as seamless and beneficial for everyone. Because our aim was to understand the process of implementing the protocols, including the conditions and consequences of variation in the process, we needed to understand how implementation might fail. For this reason, we theoretically sampled participants from Dental Practice 2, where uptake of the MPP protocols had been very limited according to data from the RCT trial.

We also changed our interview questions based on the analysis we had already done (see Additional file 2 ). In our analysis of data from Dental Practice 1, we had learned that "effectiveness" of treatments and "evidence" both had a range of meanings. We also learned that new technologies - in particular digital x-rays and intra-oral cameras - had been unexpectedly important to the process of implementing the protocols. For this reason, we added new questions for the interviews in Dental Practice 2 to directly investigate "effectiveness", "evidence" and how dentists took up new technologies in their practice.

Then, in Dental Practice 2 we learned more about the barriers dentists and practice staff encountered during the process of implementing the MPP protocols. We confirmed and enriched our understanding of dentists' processes for adopting technology and producing knowledge, dealing with complex cases and we further clarified the concept of evidence. However there was a new, important, unexpected finding in Dental Practice 2. Dentists talked about "unreliable" patients - that is, patients who were too unreliable to have preventive dental care offered to them. This seemed to be a potentially important explanation for non-implementation of the protocols. We modified our interview schedule again to include questions about this concept (see Additional file 3 ) leading to another round of ethics approvals. We also returned to Practice 1 to ask participants about the idea of an "unreliable" patient.

Dentists' construction of the "unreliable" patient during interviews also prompted us to theoretically sample for "unreliable" and "reliable" patients in the following round of patients' interviews. The patient question route was also modified by the analysis of the dentists' and practice staff data. We wanted to compare dentists' perspectives with the perspectives of the patients themselves. Dentists were asked to select "reliable" and "unreliable" patients to be interviewed. Patients were asked questions about what kind of services dentists should provide and what patients valued when coming to the dentist. We found that these patients (10 reliable and 7 unreliable) talked in very similar ways about dental care. This finding suggested to us that some deeply-held assumptions within the dental profession may not be shared by dental patients.

At this point, we decided to theoretically sample dental practices from the non-intervention arm of the MPP study. This is an example of the 'openness' of a grounded theory study potentially subtly shifting the focus of the study. Our analysis had shifted our focus: rather than simply studying the process of implementing the evidence-based preventive protocols, we were studying the process of doing prevention in private dental practice. All participants seemed to be revealing deeply held perspectives shared in the dental profession, whether or not they were providing dental care as outlined in the MPP protocols. So, by sampling dentists from both intervention and control group from the previous MPP study, we aimed to confirm or disconfirm the broader reach of our emerging theory and to complete inductive development of key concepts. Theoretical sampling added 12 face to face interviews and 10 telephone interviews to the data. A total of 40 participants between the ages of 18 and 65 were recruited. Telephone interviews were of comparable length, content and quality to face to face interviews, as reported elsewhere in the literature [ 40 ].

F. Mapping concepts, theoretical memo writing and further refining of concepts

After theoretical sampling, we could begin coding theoretically. We fleshed out each major focused code, examining the situations in which they appeared, when they changed and the relationship among them. At time of writing, we have reached theoretical saturation (see Table 1 ). We have been able to determine this in several ways. As we have become increasingly certain about our central focused codes, we have re-examined the data to find all available insights regarding those codes. We have drawn diagrams and written memos. We have looked rigorously for events or accounts not explained by the emerging theory so as to develop it further to explain all of the data. Our theory, which is expressed as a set of concepts that are related to one another in a cohesive way, now accounts adequately for all the data we have collected. We have presented the developing theory to specialist dental audiences and to the participants, and have found that it was accepted by and resonated with these audiences.

We have used these procedures to construct a detailed, multi-faceted model of the process of incorporating prevention into private general dental practice. This model includes relationships among concepts, consequences of the process, and variations in the process. A concrete example of one of our final key concepts is the process of "adapting to" prevention. More commonly in the literature writers speak of adopting, implementing or translating evidence-based preventive protocols into practice. Through our analysis, we concluded that what was required was 'adapting to' those protocols in practice. Some dental practices underwent a slow process of adapting evidence-based guidance to their existing practice logistics. Successful adaptation was contingent upon whether (1) the dentist-in-charge brought the whole dental team together - including other dentists - and got everyone interested and actively participating during preventive activities; (2) whether the physical environment of the practice was re-organised around preventive activities, (3) whether the dental team was able to devise new and efficient routines to accommodate preventive activities, and (4) whether the fee schedule was amended to cover the delivery of preventive services, which hitherto was considered as "unproductive time".

Adaptation occurred over time and involved practical, historical and philosophical aspects of dental care. Participants transitioned from their initial state - selling restorative care - through an intermediary stage - learning by doing and educating patients about the importance of preventive care - and finally to a stage where they were offering patients more than just restorative care. These are examples of ways in which participants did not simply adopt protocols in a simple way, but needed to adapt the protocols and their own routines as they moved toward more preventive practice.

The quality of this grounded theory study

There are a number of important assurances of quality in keeping with grounded theory procedures and general principles of qualitative research. The following points describe what was crucial for this study to achieve quality.

During data collection

1. All interviews were digitally recorded, professionally transcribed in detail and the transcripts checked against the recordings.

2. We analysed the interview transcripts as soon as possible after each round of interviews in each dental practice sampled as shown on Figure 1 . This allowed the process of theoretical sampling to occur.

3. Writing case-based memos right after each interview while being in the field allowed the researcher/interviewer to capture initial ideas and make comparisons between participants' accounts. These memos assisted the researcher to make comparison among her reflections, which enriched data analysis and guided further data collection.

4. Having the opportunity to contact participants after interviews to clarify concepts and to interview some participants more than once contributed to the refinement of theoretical concepts, thus forming part of theoretical sampling.

5. The decision to include phone interviews due to participants' preference worked very well in this study. Phone interviews had similar length and depth compared to the face to face interviews, but allowed for a greater range of participation.

During data analysis

1. Detailed analysis records were kept; which made it possible to write this explanatory paper.

2. The use of the constant comparative method enabled the analysis to produce not just a description but a model, in which more abstract concepts were related and a social process was explained.

3. All researchers supported analysis activities; a regular meeting of the research team was convened to discuss and contextualize emerging interpretations, introducing a wide range of disciplinary perspectives.

Answering our research questions

We developed a detailed model of the process of adapting preventive protocols into dental practice, and analysed the variation in this process in different dental practices. Transferring evidence-based preventive protocols into these dental practices entailed a slow process of adapting the evidence to the existing practices logistics. Important practical, philosophical and historical elements as well as barriers and facilitators were present during a complex adaptation process. Time was needed to allow dentists and practice staff to go through this process of slowly adapting their practices to this new way of working. Patients also needed time to incorporate home care activities and more frequent visits to dentists into their daily routines. Despite being able to adapt or not, all dentists trusted the concrete clinical evidence that they have produced, that is, seeing results in their patients mouths made them believe in a specific treatment approach.

Concluding remarks

This paper provides a detailed explanation of how a study evolved using grounded theory methodology (GTM), one of the most commonly used methodologies in qualitative health and medical research [[ 8 ], p47]. In 2007, Bryant and Charmaz argued:

'Use of GTM, at least as much as any other research method, only develops with experience. Hence the failure of all those attempts to provide clear, mechanistic rules for GTM: there is no 'GTM for dummies'. GTM is based around heuristics and guidelines rather than rules and prescriptions. Moreover, researchers need to be familiar with GTM, in all its major forms, in order to be able to understand how they might adapt it in use or revise it into new forms and variations.' [[ 8 ], p17].

Our detailed explanation of our experience in this grounded theory study is intended to provide, vicariously, the kind of 'experience' that might help other qualitative researchers in medicine and health to apply and benefit from grounded theory methodology in their studies. We hope that our explanation will assist others to avoid using grounded theory as an 'approving bumper sticker' [ 10 ], and instead use it as a resource that can greatly improve the quality and outcome of a qualitative study.

Abbreviations

grounded theory methods

Monitor Dental Practice Program

New South Wales

Randomized Controlled Trial.

Qualitative Health Research Journal: website accessed on 10 June 2011, [ http://qhr.sagepub.com/ ]

Qualitative Health Research conference of The International Institute for Qualitative Methodology: website accessed on 10 June 2011, [ http://www.iiqm.ualberta.ca/en/Conferences/QualitativeHealthResearch.aspx ]

The Global Congress for Qualitative Health Research: website accessed on 10 June 2011, [ http://www.gcqhr.com/ ]

Mays N, Pope C: Qualitative research: observational methods in health care settings. BMJ. 1995, 311: 182-

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kuper A, Reeves S, Levinson W: Qualitative research: an introduction to reading and appraising qualitative research. BMJ. 2008, 337: a288-10.1136/bmj.a288.

Article   PubMed   Google Scholar  

Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada, Tri-Council Policy Statemen: Ethical Conduct for Research Involving Humans . 1998, website accessed on 13 September 2011, [ http://www.pre.ethics.gc.ca/english/policystatement/introduction.cfm ]

Google Scholar  

The Australian National Statement on Ethical Conduct in Human Research: website accessed on 10 June 2011, [ http://www.nhmrc.gov.au/publications/synopses/e35syn.htm ]

Bryant A, Charmaz K, (eds.): Handbook of Grounded Theory. 2007, London: Sage

Walker D, Myrick F: Grounded theory: an exploration of process and procedure. Qual Health Res. 2006, 16: 547-559. 10.1177/1049732305285972.

Barbour R: Checklists for improving rigour in qualitative research: A case of the tail wagging the dog?. BMJ. 2001, 322: 1115-1117. 10.1136/bmj.322.7294.1115.

Dixon-Woods M, Booth A, Sutton AJ: Synthesizing qualitative research: a review of published reports. Qual Res. 2007, 7 (3): 375-422. 10.1177/1468794107078517.

Article   Google Scholar  

Glaser BG, Strauss AL: The Discovery of Grounded Theory: Strategies for Qualitative Research. 1967, Chicago: Aldine

Glaser BG: Basics of Grounded Theory Analysis. Emergence vs Forcing. 1992, Mill Valley CA, USA: Sociology Press

Corbin J, Strauss AL: Basics of qualitative research. 2008, Thousand Oaks, CA: Sage, 3

Charmaz K: Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. 2006, London: Sage

Clarke AE: Situational Analysis. Grounded Theory after the Postmodern Turn. 2005, Thousand Oaks, CA: Sage

Bowers B, Schatzman L: Dimensional Analysis. Developing Grounded Theory: The Second Generation. Edited by: Morse JM, Stern PN, Corbin J, Bowers B, Charmaz K, Clarke AE. 2009, Walnut Creek, CA, USA: Left Coast Press, 86-125.

Morse JM, Stern PN, Corbin J, Bowers B, Charmaz K, Clarke AE, (eds.): Developing Grounded Theory: The Second Generation. 2009, Walnut Creek, CA, USA: Left Coast Press

Carter SM: Enacting Internal Coherence as a Path to Quality in Qualitative Inquiry. Researching Practice: A Discourse on Qualitative Methodologies. Edited by: Higgs J, Cherry N, Macklin R, Ajjawi R. 2010, Practice, Education, Work and Society Series. Rotterdam: Sense Publishers, 2: 143-152.

Wasserman JA, Clair JM, Wilson KL: Problematics of grounded theory: innovations for developing an increasingly rigorous qualitative method. Qual Res. 2009, 9: 355-381. 10.1177/1468794109106605.

Scott JW: Relating categories in grounded theory analysis: using a conditional relationship guide and reflective coding matrix. The Qualitative Report. 2004, 9 (1): 113-126.

Sarker S, Lau F, Sahay S: Using an adapted grounded theory approach for inductive theory about virtual team development. Data Base Adv Inf Sy. 2001, 32 (1): 38-56.

LaRossa R: Grounded theory methods and qualitative family research. J Marriage Fam. 2005, 67 (4): 837-857. 10.1111/j.1741-3737.2005.00179.x.

Kendall J: Axial coding and the grounded theory controversy. WJNR. 1999, 21 (6): 743-757.

CAS   PubMed   Google Scholar  

Dickson-Swift V, James EL, Kippen S, Liamputtong P: Doing sensitive research: what challenges do qualitative researchers face?. Qual Res. 2007, 7 (3): 327-353. 10.1177/1468794107078515.

Charmaz K: Discovering chronic illness - using grounded theory. Soc Sci Med. 1990, 30,11: 1161-1172.

Curtis B, Evans RW, Sbaraini A, Schwarz E: The Monitor Practice Programme: is non-surgical management of tooth decay in private practice effective?. Aust Dent J. 2008, 53: 306-313. 10.1111/j.1834-7819.2008.00071.x.

Article   CAS   PubMed   Google Scholar  

Featherstone JDB: The caries balance: The basis for caries management by risk assessment. Oral Health Prev Dent. 2004, 2 (S1): 259-264.

PubMed   Google Scholar  

Axelsson P, Nyström B, Lindhe J: The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. J Clin Periodontol. 2004, 31: 749-757. 10.1111/j.1600-051X.2004.00563.x.

Sbaraini A, Evans RW: Caries risk reduction in patients attending a caries management clinic. Aust Dent J. 2008, 53: 340-348. 10.1111/j.1834-7819.2008.00076.x.

Pitts NB: Monitoring of caries progression in permanent and primary posterior approximal enamel by bitewing radiography: A review. Community Dent Oral Epidemiol. 1983, 11: 228-235. 10.1111/j.1600-0528.1983.tb01883.x.

Pitts NB: The use of bitewing radiographs in the management of dental caries: scientific and practical considerations. DentoMaxilloFac Rad. 1996, 25: 5-16.

Article   CAS   Google Scholar  

Pitts NB: Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice?. Caries Res. 2004, 38: 294-304. 10.1159/000077769.

Tan PL, Evans RW, Morgan MV: Caries, bitewings, and treatment decisions. Aust Dent J. 2002, 47: 138-141. 10.1111/j.1834-7819.2002.tb00317.x.

Riordan P, Espelid I, Tveit A: Radiographic interpretation and treatment decisions among dental therapists and dentists in Western Australia. Community Dent Oral Epidemiol. 1991, 19: 268-271. 10.1111/j.1600-0528.1991.tb00165.x.

Espelid I, Tveit A, Haugejorden O, Riordan P: Variation in radiographic interpretation and restorative treatment decisions on approximal caries among dentists in Norway. Community Dent Oral Epidemiol. 1985, 13: 26-29. 10.1111/j.1600-0528.1985.tb00414.x.

Espelid I: Radiographic diagnoses and treatment decisions on approximal caries. Community Dent Oral Epidemiol. 1986, 14: 265-270. 10.1111/j.1600-0528.1986.tb01069.x.

Evans RW, Pakdaman A, Dennison P, Howe E: The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for adults. Aust Dent J. 2008, 53: 83-92. 10.1111/j.1834-7819.2007.00004.x.

Blumer H: Symbolic interactionism: perspective and method. 1969, Berkley: University of California Press

Sturges JE, Hanrahan KJ: Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res. 2004, 4 (1): 107-18. 10.1177/1468794104041110.

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Acknowledgements

We thank dentists, dental practice staff and patients for their invaluable contributions to the study. We thank Emeritus Professor Miles Little for his time and wise comments during the project.

The authors received financial support for the research from the following funding agencies: University of Sydney Postgraduate Award 2009; The Oral Health Foundation, University of Sydney; Dental Board New South Wales; Australian Dental Research Foundation; National Health and Medical Research Council Project Grant 632715.

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Authors' contributions

All authors have made substantial contributions to conception and design of this study. AS carried out data collection, analysis, and interpretation of data. SMC made substantial contribution during data collection, analysis and data interpretation. AS, SMC, RWE, and AB have been involved in drafting the manuscript and revising it critically for important intellectual content. All authors read and approved the final manuscript.

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Additional file 1: Initial interview schedule for dentists and dental practice staff. file containing initial interview schedule for dentists and dental practice staff. (DOC 30 KB)

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Additional file 2: Questions added to the initial interview schedule for dentists and dental practice staff. file containing questions added to the initial interview schedule (DOC 26 KB)

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Sbaraini, A., Carter, S.M., Evans, R.W. et al. How to do a grounded theory study: a worked example of a study of dental practices. BMC Med Res Methodol 11 , 128 (2011). https://doi.org/10.1186/1471-2288-11-128

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Grounded theory may perhaps be one of the most widely known methodologies used to conduct qualitative research in the social sciences and beyond. Introduced by sociologists Barney Glaser and Anselm Strauss (Glaser & Strauss, 1967), grounded theory suggests that procedures once thought to be unacceptable with regards to traditional qualitative research have become perfectly acceptable, if not desirable and required. The methodology also provides justification for regarding qualitative research as a legitimate and rigorous form of inquiry (DePoy & Gitlin, 2016).

GT is multivariate. It happens sequentially, subsequently, simultaneously, serendipitously, and scheduled. Barney Glaser ( 1998 )

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Aldiabat, K., & Le Navenec, C.-L. (2011a). Phiosophical roots of classical grounded theory: Its foundations in symbolic interactionism. The Qualitative Report, 16 (4), 1063–1080.

Google Scholar  

Aldiabat, K., & Le Navenec, C.-L. (2011b). Clarification of the blurred boundaries between grounded theory and ethnography: Differences and similarities. Turkish Online Journal of Qualitative Inquiry, 2 (3) Retrieved May 15, 2019, from: https://files.eric.ed.gov/fulltext/ED537796.pdf

Allan, G. (2003). A critique of using grounded theory as a research method. Electronic Journal of Business Research Methods, 2 (1), 1–10.

Bernard, H. R. (2000). Social research methods: Qualitative and quantitative approaches . Sage.

Bernard, H. R., & Ryan, G. W. (2010). Analyzing qualitative data: Systematic approaches . Sage.

Bhaskar, R. (1998). Philosophy and scientific realism. In M. Archer, R. Bhaskar, A. Collier, T. Lawson & A, Norrie (Eds.), Critical realism: Essential readings, (pp. 16-47). : Routledge.

Campbell, J. (2011, January 2). Grounded theory video 34. Introduction to methods of qualitative research . Nova Southeastern University. Retrieved November 1, 2011, from: http://www.youtube.com/watch?v=fZYlXMStdlo

Capper, C. A. (1993). Educational administration in a pluralistic society: A multiparadigm approach. In C. Capper (Ed.), Educational administration in a pluralistic society (pp. 7–35). SUNY Press.

Charmaz, K. (1990). Discovering chronic illness: Using grounded theory. Social Science & Medicine, 30 (11), 1161–1172.

Article   Google Scholar  

Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 509–535). Sage.

Charmaz, K. (2004). Grounded theory. In M. S. Lewis-Beck, A. Bryman, & T. Futing Liao (Eds.), The Sage encyclopedia of social science research methods (pp. 440–444). Sage.

Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis . Sage.

DePoy, E., & Gitlin, L. N. (2016). Introduction to research (5th ed.). Elsevier.

Dey, I. (1999). Grounding grounded theory: Guidelines for qualitative inquiry . Emerald Group.

Fletcher-Watson, B. (2013). Toward a grounded dramaturgy: Using grounded theory to interrogate performance practices in theatre for early years. Youth Theatre Journal, 27 (2), 130–138.

Gibbs, G. (2010a, June 11). Core elements part 1. Grounded theory . University of Huddersfield. Retrieved November 4, 2011, from: https://www.youtube.com/watch?v=4SZDTp3_New

Gibbs, G. (2010b, June 19). Core elements part 2. Grounded theory . University of Huddersfield. Retrieved May 22, 2019, from.: https://www.youtube.com/watch?v=dbntk_xeLHA

Glaser, B. G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory . The Sociology Press.

Glaser, B. G. (1992). Basics of grounded theory analysis: Emergence vs. forcing . The Sociology Press.

Glaser, B. G. (1998). Doing Grounded theory: Issues & Discussion . The Sociology Press.

Glaser, B. G. (2001). The grounded theory perspective: Conceptualization contrasted with description . The Sociology Press.

Glaser, B. G. (2007). All is data. Grounded Theory Review: An International Journal, 2 (6) Retrieved May 21, 2019, from: http://groundedtheoryreview.com/2007/03/30/1194/

Glaser, B. G. & Strauss, A. L. (1965/2005). Awareness of dying. Routledge.

Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research . Routledge.

Goldthorpe, J. H. (1997). A response to the commentaries. Comparative Social Research, 16 , 121–132.

Haig, B. D. (2010). Abductive research methods. In P. Peterson, R. Tierney, E. Baker, & B. McGaw (Eds.), International encyclopedia of education (3rd ed., pp. 77–82). Elsevier.

Chapter   Google Scholar  

Hernandez Blanco, H. J. & Alas-as, T. C. (n.d.). Grounded research methods . Retrieved May 21, 2019, from.: https://www.scribd.com/presentation/362248809/Grounded-theory-ppt

Holton, G. (2004). Robert K. Merton. Proceedings of the American Philosophical Society, 148 (4), 505–517.

Holton, J. A. (2010). The coding process and its challenges. Grounded Theory Review: An International Journal, 1 (9) Retrieved May 21, 2019, from: http://groundedtheoryreview.com/2010/04/02/the-coding-process-and-its-challenges/

James, P. (2006). Globalism, nationalism, tribalism: Bringing theory back in . Sage.

Book   Google Scholar  

Kelle, U. (2005). “Emergence” vs. “forcing” of empirical data? A crucial problem of “grounded theory” reconsidered. Forum: Qualitative Social Research, 6 (2), Art 27. Retrieved, May 21, 2019, from: https://cdn.uclouvain.be/public/Exports%20reddot/spri/documents/FQS_2005_A_Crucial_Problem_of_Grounded_Theory_Reconsidered.pdf

Kempster, S., & Parry, K. W. (2011). Grounded theory and leadership research: A critical realist perspective. The Leadership Quarterly., 22 ( 1 ), 106–120.

Martin, P. Y., & Turner, B. A. (1986). Grounded theory and organizational research. The Journal of Applied Behavioral Science, 22 (2), 141–157.

Merton, R. K. (1936). The unanticipated consequences of purposive social action. American Sociological Review, 1 (6), 894–904.

Merton, R. K. (1968). Social theory and social structure . The Free Press.

Merton, R. K., & Barber, E. (2004). The travels and adventures of serendipity: A study in sociological semantics and the sociology of science . Princeton University Press.

Mesly, O. (2015). Creating models in psychological research . Springer.

Mjøset, L. (2005). Can grounded theory solve the problems of its critics? Sosiologisk Tidsskrift, 13 , 379–408. Retrieved May 23, 2019, from: https://ieri.org.za/sites/default/files/Text_-_Building_Social_Science_on_case_studies_lessons_for_BRICS.pdf

Morse, J. M., & Niehaus, L. (2009). Mixed method design: Principles and procedures . Left Coast Press.

Parker, L. D., & Roffey, B. H. (1997). Methodological themes: Back to the drawing board: Revisiting grounded theory and the everyday accountant’s and manager’s reality. Accounting, Auditing & Accountability Journal, 10 (2), 212–247.

Peirce, C. S. (2011). Philosophical writings of Peirce . Dover.

Pidgeon, N., & Henwood, K. (2009). Grounded theory . In M. Hardy & A. Bryman (Eds.), Handbook of data analysis (pp. 625–648). Sage.

Popper, K. R. (1979). Objective knowledge . Oxford University Press.

Potter, J. A. (1998). Qualitative and discourse analysis. In A. S. Bellack & M. Hersen (Eds.), Comprehensive clinical psychology (Vol. 3, pp. 117–144). Pergamon.

Ralph, N., Birks, M., & Chapman, Y. (2014). Contextual positioning: Using documents as extant data in grounded theory research. Sage Open, 4 (3). https://doi.org/10.1177/2158244014552425

Ralph, N., Birks, M., & Chapman, Y. (2015). The methodological dynamism of grounded theory. International Journal of Qualitative Methods , 1–6. https://doi.org/10.1177/1609406915611576

Savin-Baden, M., & Major, C. (2013). Qualitative research: The essential guide to theory and practice . Routledge.

Scott, H. (2009). What is grounded theory? Grounded theory online. Retrieved May 20, 2019, from: http://www.groundedtheoryonline.com/what-is-grounded-theory/

Stanley, L., & Wise, S. (2002). Breaking out again: Feminist ontology and epistemology . Routledge.

Strauss, A. L. (1987). Qualitative analysis for social scientists . Cambridge University Press.

Strauss, A. L., & Corbin, J. M. (1990). Basics of qualitative research: Grounded theory procedures and techniques (2nd ed.). Sage.

Strauss, A. L., & Corbin, J. M. (1994). Grounded theory methodology: An overview. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (1st ed., pp. 273–284). Sage.

Thomas, G., & James, D. (2006). Reinventing grounded theory: Some questions about theory, ground and discovery. British Education Research Journal, 32 (6), 767–795.

Tolhurst, E. (2012). Grounded theory method: Sociology’s quest for exclusive items of inquiry. Forum: Qualitative Social Research, 13 (3), Art. 26. Retrieved May 23, 2019, from: http://www.qualitative-research.net/index.php/fqs/article/view/1860/3432

Willig, C. (2013). Introducing qualitative research in psychology . Open University Press.

Willis, J. W. (2007). Foundations of qualitative research: Interpretive and critical approaches . Sage.

Download references

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Negotiating emotional order: a grounded theory of breast cancer survivors

Jennifer A. Klimek Yingling

Klimek Yingling, J. A. (2018). Negotiating emotional order: A grounded theory of breast cancer survivors. Grounded Theory Review: An International Journal 17 (1), 12-27.

In this article, classic grounded theory captures the processes of 12 women who had completed initial treatment for breast cancer. The qualitative data analysis reveals the basic social process of negotiating emotional order that describe how breast cancer survivors perceive their illness and decide to take action. From the data, five stages of the process of negotiating emotional order emerge: 1) Losing Life Order, 2) Assisted Life Order, 3) Transforming 4) Accepting, and 5) Creating Emotional Order. This study may help healthcare providers who care for breast cancer survivors understand the depth of perpetual emotional impact that breast cancer survivors endure. This study will potentially serve as a path for future research and aid in the understanding of the psychological impact that breast cancer has upon survivors.

Keywords : breast cancer, survivor, chemotherapy, emotional order

What Sparked This Research

I cared for a patient who I had gotten to know as her child often visited the emergency department due to hemophilia. She was a pleasure to work with, strong, level headed, and upbeat. On this particular day she was the patient. Her complaint was simple: a cough and she clearly wasn’t herself emotionally. I was surprised to discover, when I took her past medical history, that she was a breast cancer survivor. After I discussed her chest x-ray results I sensed she was still upset and filled with uncertainty. Then the lightbulb went on. I asked her directly if she was concerned if the cancer was recurring. She said yes and her tears flowed. I do believe if I had not dug a little deeper into her emotional state she would have left the emergency department with much of the same emotional duress that she initially had. This interaction sparked my research as it was clear that breast cancer survivors endure a process after treatment ends. For these survivors the treatment is over but the emotional aspect of breast cancer is not. It also became evident to me that health care providers need to know more about this process on order to be able to treat patients holistically.

Negotiating Emotional Order: A Grounded Theory of Breast Cancer Survivors

Breast cancer is the most prevalent cancer found in women worldwide (American Cancer Society [ACS], 2016; Ferlay et al., 2104). In the United States, it is estimated that 3.5 million women have been diagnosed with breast cancer; 245,000 will be newly diagnosed; and, approximately 40,000 women will succumb to breast cancer annually (ACS, 2016; Breastcancer.org, 2016). Early detection and improved treatment is credited to the rising population of women who are breast cancer survivors (Howlader et al., 2015; McCloskey, Lee, & Steinburg, 2011). Concerns about the psychosocial ramifications of chronic illness have a long history. The Institute of Medicine (2009), American Cancer Society (2015), and the American Society of Clinical Oncology (2015) resonate concern about psychosocial hindrances regarding cancer patients, citing them as a critical area needing improvement within the nation’s health care system.

The literature suggests breast cancer survivors endure psychological stressors after the completion of treatment including the following: loneliness (Marroquin, Czamanski-Cohen, Weihs, & Stanton, 2016; Rosedale, 2009), anxiety and depression (Walker, Szanton, & Wenzel, 2015), uncertainty (Dawson, Madsen, & Dains, 2016; Mishel et al., 2005), and fear of recurrence (McGinty, Small, Laronga, & Jacobsen, 2016). The phenomenon of breast cancer survivorship has been identified with qualitative methods, yet is lacking explanatory theory (Allen, Savadatti & Levy, 2009; Pelusi, 1997). Qualitative analysis uses inductive rather than deductive investigation of a clinical phenomenon for capturing themes and patterns within subjective perceptions to generate an interpretive account to inform clinical understanding. Inductive methods are used by the researchers to discover and generate theory (Artinian, Giske, & Cone, 2009; Glaser, 2008). Therefore, grounded theory was chosen to study the process of survivorship in women who have completed treatment for breast cancer.

A Glaserian grounded theory design was chosen to explore the process of transition survivorship in women who have completed treatment for breast cancer. Grounded theory allows the researcher to explore a phenomenon and build theory from concepts going through processes and transitions (Glaser & Strauss, 1967; Glaser, 2008). The ACS defines cancer survivor as “anyone with a history of cancer, from the time of diagnosis through the remainder of their life” (ACS, 2016, p. 3). This definition was used for inclusion criteria for this project. Prior to commencement of the research, approval from the university’s institutional review board was secured. A purposive sample was sought and participants were self-identified breast cancer survivors in a suburban community in Northeast United States. A presentation was made at a local breast cancer survivorship group. Flyers were posted in community centers, libraries, and public places including areas that reach numerous individuals. Based on these recruitment efforts, 12 women were interviewed during a four-month period.

Data Collection

All participants received written and verbal information about the study and gave informed consent. Data were collected by completing the following: a demographic data form, approximately one-hour individual in-depth interviews, observational notes, and field notes. All of the data was handled in a confidential manner. Each interview session lasted approximately one hour in length. Broad open-ended questions were used to stimulate discussion of thoughts and feelings about extended survivorship. Focused questions and prompts were used to elicit more specific information from participants about their actions to attain and maintain psychosocial health after the completion of breast cancer treatment. The focus questions also elicited information about processes used to modify and maneuver through adversities after completion of treatment. Each participant was asked to describe situations when she knew something had changed in her health and psychosocial status after the completion of treatment for breast cancer. Participants were asked to answer the questions until they felt they had no information to add to the topic.

Data Analysis

Data analysis took a Glaserian approach in which data collection, analysis, and memoing were ongoing and concurrent throughout the research. Each interview was digitally taped and transcribed. Atlas.ti software was used as a depository to code, store, and memo during analysis. Data was coded line by line to fracture the data into nouns formed from a verb or gerund. The interviews were re-coded on three different occasions. After the initial interview was coded, the second interview was coded in a similar fashion and the data were examined for common constructs that were clustered. Subsequent interviews were open-coded and compared with ideas and relationships described in the researcher’s memos. As the categories unfolded, some categories were re-coded or combined with other categories. At the conclusion of the last interview, all codes were sorted to certify fit. Once a core variable or category was identified, coding became selective. The researcher continued the interviews and coding until saturation of the core variable was achieved. On saturation, theoretical coding was used to intersect categories within the data. Exploration of the literature for substantive codes that were significant was conducted each day. Extensive memo taking was used via manual notes and also as freehand drawn visuals created by the researcher to capture the researcher’s mind set.

Trustworthiness

For the purpose of this paper, a conglomerate of trustworthiness criteria grounded from the recommendations of Glaser (1978, 1998, 2001) was employed. The researcher who conducted this study had scant exposure to extended breast cancer survivors in her personal and professional realm. Techniques to establish credibility included prolonged engagement and peer debriefing. Theoretical sampling and constant comparison took place when data, analytic categories, interpretations, and conclusions were discussed and tested with study participants throughout the interview process. Prolonged engagement developed rapport and participant trust. To address transferability, the following groups of data were included in an audit trail: 1) raw data, 2) data reduction and analysis notes, data reconstruction and synthesis products, 3) process notes, 4) materials related to intentions and dispositions, and 5) preliminary development information. The researcher kept a reflexive journal to record methodological decisions and the rationale for the decisions, the planning and management of the study, and reflection upon the researcher’s own principles, feelings, and interests. Lastly, external audits were conducted by several researchers not involved with the research process on several occasions.

The Theory of Negotiating Emotional Order

The main concern of the women is the struggle for emotional order. The meaning inherent in the basic social process of Negotiating Emotional Order is that women who have been diagnosed with breast cancer strive for emotional order by negotiating control of the negative feeling of threats to their mortality and to live their daily lives. The process described in the theory of Negotiating Emotional Order changes as the situation of the breast cancer survivors changes. As time passes, the women move from discovering an abnormality to a time after treatment ends. This process is dynamic and perpetual in nature because the threat of cancer recurrence remains until the end of the breast cancer survivor’s life. For some women, negotiating emotional order is achieved even when the cancer recurs or metastasizes.

The participants’ actions and decisions illuminate the perpetual struggle to negotiate emotional order. For some, order is compartmentalizing negative thoughts and emotions that they could not control. For others, they accept the fact that they cannot control cancer but project order onto other aspects of their lives. The struggle for emotional order is present from the time the survivor found the abnormality into long-term survivorship and at times is cyclic. Five stages of the process of negotiating emotional order emerges from the data: 1) Losing Life Order, 2) Assisted Life Order, 3) Transforming, 4) Accepting, and 5) Creating Emotional Order.

Losing Life Order

During this time period, the realization of the threat of breast cancer disrupts emotional order with intense fear and uncertainty of the future. The breast cancer survivor often makes decisions and acts on her instincts to placate the immediacy that she feels prior to starting treatment, often seeks information from the Internet, popular literature, media and from others who have experienced breast cancer. Unfortunately, their need for immediacy is often not met by the health care community, so they take matters into their own hands and act.

Many of the participants voice that this time period is difficult, as they have multifaceted family roles as wives, mothers, and children of parents of their own causing additional emotional turmoil. The participants continue or attempt to continue with their family roles by working, caring for children, and maintaining their households. The breast cancer survivors voice that they don’t have time to let cancer get in the way emotionally as they are too busy with family and work responsibilities. The participants speak of emotional duress when they see their families react to their illness and chose to protect their families by concealing their emotions. One participant talked about why she concealed her emotions: “The emotional impact it had on my family was horrible . . . I felt like I had to be strong for them . . . I would not show any emotions about being sick.”

Losing order encompasses two properties of disorder: losing emotional order and losing physical order. Upon discovering an abnormality, and then confirming breast cancer, the breast cancer survivors report loss of control of their bodies, which causes emotional duress. This stage marked the survivors’ first sense that cancer cannot be controlled. Loss of emotional order is represented by feelings of sadness, anger, immediacy, loneliness, fear, and uncertainty. This stage is hallmarked by emotional chaos and decision making. Approaches the women use in this stage are: taking matters into own hands and concealing to maintain family order.

Assisted Life Order

Surprisingly, although treatment is a physically draining endeavor, the breast cancer survivors voice that it is a time of respite when they focus on physical well-being rather than the emotional disruption that is occurring. During this phase, the women are often consumed with treatments of surgery, chemotherapy, and/or radiation. The participants state they feel proactive and protected while under the frequent care of health care providers. This participant’s narrative exemplifies the feeling of being assisted emotionally and physically by health care providers: “While you’re getting chemotherapy, you think you’re doing something to kill off any additional cancer that the surgery didn’t get. You have certain protection.”

The breast cancer survivors verbalize feeling lonely, despite having much social and family support, and purposely seek out other women who endured breast cancer for emotional support. Breast cancer survivors seek emotional support from formal and informal support persons. The participants also discuss a phenomenon where other breast cancer survivors would approach them after hearing about their diagnosis and come to their assistance to provide support. The importance of this camaraderie is evident in this narrative: “I didn’t know people that have been through this…people came out of the woodwork. People that I had known that I didn’t know that had cancer who shared their stories with me.” Some of the breast cancer survivors express the need to have a connection with someone who has experienced breast cancer. Some women seek formal support groups for this need and continue to use them after treatment is completed.

The second stage of negotiating emotional order is assisted life order that occurs when the breast cancer survivor enters treatment and focuses all of her energy into physical well-being. At the same time, survivors entrust their life order into the hands of health care providers and rely on social support to carry them through the time that they are in treatment. During this time, the breast cancer survivor keeps physically and emotionally occupied with the routine of appointments and treatment. During this time, the women feel treatment is a sanctuary and they express that during this time they feel lonely in their current experience. During the second period, they engage with others with formal training or personal experience with breast cancer to establish emotional order.

Transforming

At this stage of the process, the breast cancer survivors report a cutting point or a crossroads and make a change in thought process. They are autonomously responsible for their physical and emotional well-being. This autonomy is a sharp contrast to their behavior while in treatment, where they live day to day and do not think about the future. Once treatments end, survivors must take the wheel and navigate into their life and the future. It does appear that this cutting point is an emotionally charged timeframe: the temporary sanctuary of treatment ends and many survivors feel the need to take subjective responsibility of their emotional order. The survivors speak about the need to reach inward to claim emotional order to live their lives beyond breast cancer.

During this stage, the threat changes from the fear of the diagnosis of cancer to the fear of cancer. The fear of cancer can be recurrence of breast cancer, occurrence of a new cancer, and/or cancer metastasis. The process of beginning to move on from the emotional effects of the diagnosis of breast cancer begins shortly after the end of treatment. Fear is initially intense then becomes manageable over time for many. Several women note the recurrent fear abates somewhat after the first year and even more after five years. The fear of recurrence also can return many years after the completion of treatment. This dread is especially true if the breast cancer survivor discovers new symptoms or abnormalities that lead her to believe the cancer has returned. Often waiting for the results of diagnostics causes extreme anxiety and fear of recurrence.

The interviewed participants ranged from three months to twenty-four years post treatment. Despite the variation of time since the ending of treatment, all of the participants discussed levels of fear of recurrence. Often, the fear of recurrence affects their daily lives initially until they set cancer apart from living their present life. Several of the participants state it is not so much an inherent process rather than an active decision to take control of their feelings of fear and move onward. In this stage, the turning point is the active decision to leave breast cancer in the past and focus on the present and future. Another participant, who is thirteen years post treatment, discussed this decision: “I told myself, I have to make a move here. You can curl up in a ball and die or I can move on. I started moving on.”

When the breast cancer survivors leave treatment, they are at a crossroad in which feelings of loss and confusion are produced. After adjuvant treatment ends, the breast cancer survivors must remap their lives and begin to strive for a new normalcy in their lives. The threat at this stage changes from the diagnosis of cancer and is replaced with the fear of recurrence. The breast cancer survivors often revisit their own mortality during this time and these feelings can cause loss of emotional order. During this time the breast cancer survivor transforms, remapping their life course and also moving on from fear.

Uncertainty of the future also causes emotional distress for breast cancer survivors. The reality that none can control their own mortality, or cancer, is an aspect of the emotional trajectory that the breast cancer survivors struggle with initially. Once breast cancer survivors make this realization, they can then subjectively gain order of their emotions. This action is autonomous as no one else but the breast cancer survivor can complete this task. One participant spoke about this decision: “There are things that I can change and there are things that I am powerless over. It’s distinguishing and I do have control over what I’m thinking.”

Although the breast cancer survivor attempts to control her emotions, she often will come to the realization that she can keep her emotions in order rather than control them so that she can move on in her life and get serenity with the past diagnosis of breast cancer. Several of the participants state the turning point occurs when they realize they cannot control cancer or their feelings, and thus accept order versus control. As the threat of recurrence is no longer an issue, they accept their mortality and are living in the present day. A participant reflection on this concept: “We’ll all go some day. It’s just my time might come sooner than expected. A part of life.”

Feelings of emotional loss of control can be triggered by reminders after treatment ends. Reminders include physical reminders, body image reminders, diagnostics, and society cancer awareness. Although gaining realization of their own mortality, living with reminders forces the breast cancer survivors to cope on a daily basis with the fear of recurrence as they are reminded by physical and cognitive aftermath of breast cancer. Additionally, diagnostics and health care visits can elicit feelings of fear. Breast cancer survivors also voice that breast cancer or cancer awareness activities in the community and media also trigger feelings of fear. The impact of reminders is showcased by one participant’s remarks: “I worry about it all the time. Every ache and pain I have. When my bones hurt I wonder if it is bone cancer. Every time I have to have a mammogram, I pray it’s not there.”

Creating Emotional Order

Inherently, human beings have emotions. One of these emotions is fear in response to a threat. As the threat of cancer recurrence has a perpetual quality in women who have been diagnosed with breast cancer, the emotional aspect of cancer recurrence is long-standing. Since she cannot fully control her emotions, the breast cancer survivor will compartmentalize negative feelings of uncertainty and fear to achieve emotional order. To protect themselves emotionally, several of the participants speak about triaging these emotions to the back of their heads and putting these feelings away. One participant illustrates this behavior: “It’s probably because I pushed it to the back of my head because I don’t want to deal with those emotions.”

Once the breast cancer survivor accepts the fact that there are aspects of her life she can control and there are aspects over which she has no power, she will begin to create emotional order. Having control over actions and or parts of her life allows the breast cancer survivor to have emotional order. During times of emotional distress, they also increase their attempts to distract themselves from their emotions. This increase in activity temporarily increases with times of stress. Often, after the breast cancer survivor feels well, she redefines the actions in which she participates. Survivors express themselves by participating in activities that they enjoy or want to experience but did not have the courage to do so prior to diagnosis. Breast cancer survivors also talk about controlling their family roles and home environment. The breast cancer survivor might demonstrate control by creating a household routine or enumerating familial activities. Distracting self with other aspects of life also is a way that breast cancer survivors create emotional order. By immersing themselves back into their daily routines of work, marital, household, and family roles, survivors limit the amount of time they have available to think about the fear of recurrence, which is similar to using activity to occupy time during the assisted life order stage.

Social comparison through self-evaluations is another way that these participants achieve emotional order. Breast cancer survivors use social comparison as a method to create emotional order by viewing their experience as better than others who experienced poor outcomes. As a defense mechanism, if the breast cancer survivor views her experience as positive then she reaffirms she is a survivor. Social comparison is evident almost unanimously in the data. Participants speak often of reflecting on the experience they endured and feel lucky. While exploring this code the researcher asked the participants what they meant by luck or being lucky. Consistently the participants talk about luck as comparing outcomes as better or worse. For example, when asked what she meant by having better luck, a participant replied: “Well I was thinking someone maybe had the same surgery as me, did better than me.” Here is an example of a breast cancer survivor socially comparing her experience as worse than another person’s experience.

In addition to evaluating the actual treatment outcomes and evaluating the way that they physically dealt with treatment, the breast cancer survivors also evaluate the entire experience of breast cancer by reflection. The ability to reflect onto the past experience to find benefits and assign positive outcomes related to the cancer allow the survivor to make sense of the experience and create emotional order. In many ways, the survivors feel everything that they endured was worth what they became. Many reflect back and feel they gained knowledge of self-meaning knowing their bodies and emotions and realized they have abilities to endure adversity that they did not know before the experience of breast cancer. The breast cancer survivors reflect back in awe of the emotional stamina that they had during adversity and were proud of their accomplishments. One participant states: “It is amazing. Yeah if someone had told me I could write a book, become a massage therapist and learn the body the way I have. I would have said no way.”

“I feel like I know these people. You have been through what they have been through.” This participant’s narrative sums up the transparent common bond the participants feel with other cancer survivors. To create emotional order, the breast cancer survivors help others as a way to help themselves emotionally. Planned helpfulness allows the breast cancer survivor to create emotional order by gaining satisfaction through assisting others. Often breast cancer survivors employ ambiguousness until they are ready to disclose their survivorship status. This opacity allows them to experience empowerment and also allows them life choice—a common theme throughout the interviews. Breast cancer survivors plan and decide how they would help others; many are grateful for the acquaintance disclosure and guidance they receive early in their disease trajectory and want to pay forward some type of comfort to others who are enduring cancer.

Once survivors accept the fact that they cannot control their mortality and cancer, the breast cancer survivor creates social order to protect herself emotionally. Breast cancer survivors are acutely aware that their actions do not guarantee that cancer will not return, but in this stage they want to maintain a status of being physically and emotionally healthy. One participant communicates: “What work do I need to do. I am a survivor and want to be a survivor for a long time.” Although reminders often trigger fear, the survivors often use methods to create emotional order, to find balance and not allow feelings of fear to overcome them. Breast cancer survivors protect themselves by controlling their actions, compartmentalizing negative feelings, using social comparison and/or engaging in planned helpfulness.

Creating Emotional Order allows breast cancer survivors to transcend the fear of recurrence by controlling their actions, compartmentalizing negative feelings, and using social comparison and planned helpfulness. Although they cannot control their emotions or control cancer, they can control the way they react to emotions and take control of their life actions. Many of the participants shelve their negative emotions in order not to let the psychological aspect of breast cancer interfere in their daily lives. The participants show evidence that the survivors can regress between stages of this theory, but after their initial passage through the stages progress forward quickly and resiliently.

Limitations

There are several limitations in this research. First, the researcher attempted to recruit a variety of participants from diverse social and demographic backgrounds through flyers posted in public places. Despite this attempt to obtain a diverse population, all the participants are White and hold high school education or equivalency and most of the sample had three or more years of college education. Most of the participants are married or partnered. Economic and insurance status information is not included in the demographic data. Expanding the demographic sample might have allowed modifiability of the theory to explore additional relationships between these variables and the process of survivorship.

Finally, grounded theory analyses are population specific. This research represents the primary step in theory development. The aim of grounded theory construction is to hone and develop a theory in the attempt to produce formal theory. Testing the applicability of this theory may be appropriate in other populations who face severe illnesses, for example individuals as they face the aging process, individuals who are facing a terminal illness, veterans returning from war diagnosed with post-traumatic stress disorder, men facing prostate cancer, and/or women facing infertility.

The aim of this study is to contribute to the knowledge of breast cancer survivorship. This research contributes to the literature as a lack of holistic research exists on the process of extended survivorship that involves the fragments of the process of survivorship. Breast cancer is a significant and prominent healthcare challenge for many women in the United States. Negotiating emotional order is identified as the core category allowing women to survive emotionally after completing treatment for breast cancer. Five stages were identified including the following: Losing Life Order, Assisted Life Order, Transforming, Accepting, and Creating Emotional Order. The grounded theory of negotiating order integrates and highlights the importance of recognizing emotional health in breast cancer survivors.

This research challenges a staple in cancer survivorship literature that is reported by Mullan (1985) in several ways. First, in the current study, breast cancer survivors described the process of survivorship beginning before diagnosis with the discovery of an abnormality. This variation in the genesis of process of survivorship is different from Mullan’s (1985) model in which the process of survivorship is said to begin with diagnosis. Second, a new stage that represented transitional survivorship or Stage III: Transforming is described in the current study as the period immediately following the completion of treatment. Third, Mullan (1985) described extended survivorship as ending once the survivor enters remission. Although most breast cancer survivors interviewed for this study entered remission, several experienced recurrences or metastatic breast cancer so Mullan’s model excluded the process that these individuals endured.

Lastly, in this study extended survivorship appeared to be a continuous state rather than a conduit to permanent survivorship as Mullan (1985) described in his model. Mullan (1985) stated permanent cancer survivorship begins once the person is considered cancer free and can successfully return to their normal physical and emotional abilities prior to the cancer diagnosis. The survivors in this study describe extended survivorship to have a perpetual nature rather than being permanently cured physically or emotionally. They also challenge the fact they would return to “normal.” One of the participants states, “It was a rough road. Trying to figure out who I was, where I belong. Because they say your life goes back to normal, there is no normalcy. I don’t feel I am normal today.” This idea is significant as many breast cancer survivors may feel the need to feel “normal” due to the extensive publication of Mullan’s (1985) model. The use of Mullan’s (1985) model by many credible cancer authorities may prove to be confusing and frustrating to breast cancer survivors who lack the feeling of normalcy after treatment is completed and into extended survivorship.

The theory of Negotiating Emotional Order supports several existing theories that describe how individuals handle severe illnesses beyond cancer. This work complements several authors who described survivorship beyond the biomedical model that psychosocial and environmental factors influence (Collins, 1995; Festinger, 1954; Folkman & Greer, 2000; Taylor, 1983; Walker, Jackson, & Littlejohn, 2004).

The construct of control can be found in the literature in multiple patient populations including breast cancer (Warren, 2010), cardiac disease (Svansdotti et al., 2012), patients with obsessive compulsive disorder (Kang, Namkoong, Yoo, Jhung, & Kim, 2012), diabetes (Hughes, Berg, & Wiebe, 2012), and sexual assault (Frazier, Morlensen, & Steward, 2005). In this study, loss of emotional control is important, as it serves as a catalyst shaping the decisions and actions of the participants. Additionally, controlling actions were used later by the participants as a means to cope, thus creating emotional order. This theme is analogous with Folkman’s (1984) description of control as a dynamic coping mechanism with shifting appraisal as result of a stressful encounter or environment.

Benefit finding and planned helpfulness that are reported are consistent with Taylor’s (1983) proposed theory of cognitive adaptation in response to threatening events as both are displays of a search for meaning in the experience and attempts of mastery to restore self-esteem. It may also be noted that Taylor (1983) linked an individual’s sense of control to positive cognitive adaptation. Lastly, social comparison is evident in this group. This observation echoes Festinger’s (1954) work hypothesizing that social comparison is done to promote self-normalcy. Social comparison in this population is a mechanism to negotiate emotional order by improving the survivors’ positive perception of their situation and is consistent with the work Collins (1995) reported.

Implications for Practice

This research affords a glimpse into the experience of survivorship from the perspective of women who have completed treatment for breast cancer and how they survived emotionally from the detection of an abnormality into extended survivorship. This work aids in the development of a broad understanding of the processes that individuals endure when faced with a serious health status alteration. This information might aid health care providers to understand the immediacy that breast cancer survivors experience during the disease trajectory and the concept that the fear of recurrence can last perpetually and be an issue that is important to survivors until the end of their lives.

A lesson that can be taken away from this work is that women are continuously attempting to create emotional order and this clearly indicates they need support to continue well after treatment ends. In terms of theory, the identification of the process used by breast cancer survivors to negotiate emotional order may be helpful for health care providers who care for, educate, and design nursing interventions for this population. This study of survivorship after breast cancer establishes the beginning process of generating a formal grounded theory on survivorship that could, through further theoretical sampling, be extended beyond this patient population. Building on existing theory, this qualitative data analysis may help explain the mechanisms used by populations who have experienced a life-threatening illness personally or while supporting a loved one.

Acknowledgements

I would like to thank the breast cancer survivors who shared their personal survivorship journey for this research. I also thank Dr. Elise Lev, Dr. Karen D’Alonzo, Dr. Claudia Beckman, Dr. Louise Dean Kelly and Naomi Tobes for their encouragement and invaluable contributions to this work.

Declaration of Conflicting Interests

The author declares no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

This research is supported by the Rita C. Koph Memorial Research Award generously given by the Foundation of New York State Nurses, Cathryne A. Welch Center for Nursing Research

Allen, J., Savadatti, S., & Levy, A. (2009). Transition from breast cancer patient to survivor. Psycho-Oncology, 18 , 71-78.

American Cancer Society 1 (2016). Cancer Treatment & Survivorship Facts & Figures 2016- 2017 . Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2015-2016.pdf

Artinian, B., Giske, T., & Cone, P. (2009). Glaserian grounded theory in nursing research: Trusting emergence. New York, NY: Springer Publishing Company.

Blumer, M. (1969). Symbolic interactionism. Englewood Cliffs, NJ: Prentice Hall. Breastcancer.org (2016). U.S. Breast Cancer Statistics. Retrieved from http://www.breastcancer.org/symptoms/understand_bc/statistics

Collins, R. (1995). For better or worse: the impact of upward social comparison on self-evaluations. Psychological Bulletin, 1 , 51-69.

Dawson, G., Madsen, L., & Dains, J. (2016). Interventions to manage uncertainty and fear of recurrence in female breast cancer survivors: A review of the literature. Clinical Journal of Oncology Nursing, 20 (6), E155-E161.

Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7 (2), 117- 140.

Folkman, S. (1984). Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and Social Psychology, 46 (4), 839-852.

Folkman, S., & Greer, S. (2000). Promoting psychological well-being in the face of serious illness: When theory, research and practice inform each other. Psycho-oncology, 9 , 11- 19.

Frazier, P., Morlensen, H., & Steward, J. (2005). Coping strategies as mediators of the relations among perceived control and distress in sexual assault survivors. Journal of Counseling Psychology, 52 (3), 267-278.

Glaser, B. (1978) Theoretical sensitivity: Advances in the methodology of grounded theory. Mill Valley, CA: Sociology Press.

Glaser, B. (1998) Doing grounded theory: Issues and discussions. Mill Valley, CA: Sociology Press.

Glaser, B. (2001) The Grounded Theory Perspective: Conceptualization Contrasted with Description, Mill Valley, CA: Sociology Press.

Glaser, B. (2008). Doing grounded theory. Mill Valley, CA: Sociology Press.

Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Hawthorne, NY: Aldine de Gruyter.

Howlader, N., Noone, A., Krapcho, M., Garshell, J., Miller, D., Altekruse, S., . . . Cronin, K. (2015, April). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Retrieved from http://seer.cancer.gov/csr/1975_2012/

Hughes, A., Berg, C., & Wiebe, D. (2012). Emotional processing and self-control in adolescents with type 1 diabetes. Journal of Pediatric Psychology, 37 (8), 925-934.

Kang, J., Namkoong, K., Yoo, S., Jhung, K., & Kim, S. (2012). Abnormalities of emotional awareness and perception in patients with obsessive-compulsive disorder. Journal of Affective Disorders, 141 (23), 286-293.

Marroquin, B., Czamanski-Cohen, J., Weihs, K., & Stanton, A. (2016). Implicit loneliness, emotion regulation and depressive symptoms in breast cancer. Journal of Behavioral Medicine, 39 (5), 832-844.

Mayer, D., Nasso, S., & Earp, J. (2017). Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA. The Lancet Oncology, 18 (1), 11- 18.

McCloskey, S., Lee, S., & Steinberg, M. (2011). Roles and types of radiation in breast cancer treatment: early breast cancer, loco-regionally advanced, and metastatic disease. Current Opinion in Obstetrics & Gynecology, 23 (1), 51-57.

McGinty, H., Small, B., Laronga, C., & Jacobsen, P. (2016). Predictors and patterns of fear of cancer recurrence in breast cancer survivors. Health Psychology, 35 (1), 1-9.

Mishel, M., Germino, B., Belyea, M., Lanely, I., Stewart, J., & Clayton, M. (2005). Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psychooncology, 14 (11), 962-978.

Mullan, F. (1985). Seasons of survival: Reflections of a physician with cancer. New England Journal of Medicine, 313 , 270-273.

Pelusi, J. (1997). Lived experience of surviving breast cancer. Oncology Nursing Forum, 24 (8), 1343-1353.

Rosedale, M. (2009). Survivor loneliness of women following breast cancer. Oncology Nursing Forum, 36 (2), 175-183

Svansdottir, E., Karlsson, H., Gudnason, T., Olason, D., Thorgilsson, H., Sigtryggsdottir, U., . . . Denollet, J. (2012). Validity of Type D personality in Iceland: with disease severity and risk markers in cardiac patients. Journal of Behavioral Medicine, 35 (2), 155- 166.

Taylor, S. (1983). Adjustment to threatening events: A theory of cognitive adaption. American Psychologist, 1181-1172.

Trusson, D., & Pilnik, A. (2016). Between stigma and pink positivity: Women’s perceptions of social interactions during and after breast cancer treatment. Sociology of Health and Illness, 39 (3), 458-473.

Walker, J., Jackson, H., & Littlejohn, G. (2004). Models of adjustment to chronic illness: Using the example of rheumatoid arthritis. Clinical Psychology Review, 24 (4), 461-488.

Walker, R., Szanton, S., & Wenzel, J. (2015). Working toward normalcy post-treatment: A qualitative study of older breast and prostate survivors. Oncology Nursing Forum, 42 (6), E358-E367.

Warren, M. (2010). Uncertainty, lack of control and emotional functioning in women with metastatic breast cancer: A review and secondary analysis of the literature using the critical appraisal technique. European Journal of Cancer Care, 19 , 564-574.

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White, R.E., Cooper, K. (2022). Grounded Theory. In: Qualitative Research in the Post-Modern Era. Springer, Cham. https://doi.org/10.1007/978-3-030-85124-8_9

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Home » Grounded Theory – Methods, Examples and Guide

Grounded Theory – Methods, Examples and Guide

Table of Contents

Grounded Theory

Definition:

Grounded Theory is a qualitative research methodology that aims to generate theories based on data that are grounded in the empirical reality of the research context. The method involves a systematic process of data collection, coding, categorization, and analysis to identify patterns and relationships in the data.

The ultimate goal is to develop a theory that explains the phenomenon being studied, which is based on the data collected and analyzed rather than on preconceived notions or hypotheses. The resulting theory should be able to explain the phenomenon in a way that is consistent with the data and also accounts for variations and discrepancies in the data. Grounded Theory is widely used in sociology, psychology, management, and other social sciences to study a wide range of phenomena, such as organizational behavior, social interaction, and health care.

History of Grounded Theory

Grounded Theory was first introduced by sociologists Barney Glaser and Anselm Strauss in the 1960s as a response to the limitations of traditional positivist approaches to social research. The approach was initially developed to study dying patients and their families in hospitals, but it was soon applied to other areas of sociology and beyond.

Glaser and Strauss published their seminal book “The Discovery of Grounded Theory” in 1967, in which they presented their approach to developing theory from empirical data. They argued that existing social theories often did not account for the complexity and diversity of social phenomena, and that the development of theory should be grounded in empirical data.

Since then, Grounded Theory has become a widely used methodology in the social sciences, and has been applied to a wide range of topics, including healthcare, education, business, and psychology. The approach has also evolved over time, with variations such as constructivist grounded theory and feminist grounded theory being developed to address specific criticisms and limitations of the original approach.

Types of Grounded Theory

There are two main types of Grounded Theory: Classic Grounded Theory and Constructivist Grounded Theory.

Classic Grounded Theory

This approach is based on the work of Glaser and Strauss, and emphasizes the discovery of a theory that is grounded in data. The focus is on generating a theory that explains the phenomenon being studied, without being influenced by preconceived notions or existing theories. The process involves a continuous cycle of data collection, coding, and analysis, with the aim of developing categories and subcategories that are grounded in the data. The categories and subcategories are then compared and synthesized to generate a theory that explains the phenomenon.

Constructivist Grounded Theory

This approach is based on the work of Charmaz, and emphasizes the role of the researcher in the process of theory development. The focus is on understanding how individuals construct meaning and interpret their experiences, rather than on discovering an objective truth. The process involves a reflexive and iterative approach to data collection, coding, and analysis, with the aim of developing categories that are grounded in the data and the researcher’s interpretations of the data. The categories are then compared and synthesized to generate a theory that accounts for the multiple perspectives and interpretations of the phenomenon being studied.

Grounded Theory Conducting Guide

Here are some general guidelines for conducting a Grounded Theory study:

• Choose a research question: Start by selecting a research question that is open-ended and focuses on a specific social phenomenon or problem.
• Select participants and collect data: Identify a diverse group of participants who have experienced the phenomenon being studied. Use a variety of data collection methods such as interviews, observations, and document analysis to collect rich and diverse data.
• Analyze the data: Begin the process of analyzing the data using constant comparison. This involves comparing the data to each other and to existing categories and codes, in order to identify patterns and relationships. Use open coding to identify concepts and categories, and then use axial coding to organize them into a theoretical framework.
• Generate categories and codes: Generate categories and codes that describe the phenomenon being studied. Make sure that they are grounded in the data and that they accurately reflect the experiences of the participants.
• Refine and develop the theory: Use theoretical sampling to identify new data sources that are relevant to the developing theory. Use memoing to reflect on insights and ideas that emerge during the analysis process. Continue to refine and develop the theory until it provides a comprehensive explanation of the phenomenon.
• Validate the theory: Finally, seek to validate the theory by testing it against new data and seeking feedback from peers and other researchers. This process helps to refine and improve the theory, and to ensure that it is grounded in the data.
• Write up and disseminate the findings: Once the theory is fully developed and validated, write up the findings and disseminate them through academic publications and presentations. Make sure to acknowledge the contributions of the participants and to provide a detailed account of the research methods used.

Data Collection Methods

Grounded Theory Data Collection Methods are as follows:

• Interviews : One of the most common data collection methods in Grounded Theory is the use of in-depth interviews. Interviews allow researchers to gather rich and detailed data about the experiences, perspectives, and attitudes of participants. Interviews can be conducted one-on-one or in a group setting.
• Observation : Observation is another data collection method used in Grounded Theory. Researchers may observe participants in their natural settings, such as in a workplace or community setting. This method can provide insights into the social interactions and behaviors of participants.
• Document analysis: Grounded Theory researchers also use document analysis as a data collection method. This involves analyzing existing documents such as reports, policies, or historical records that are relevant to the phenomenon being studied.
• Focus groups : Focus groups involve bringing together a group of participants to discuss a specific topic or issue. This method can provide insights into group dynamics and social interactions.
• Fieldwork : Fieldwork involves immersing oneself in the research setting and participating in the activities of the participants. This method can provide an in-depth understanding of the culture and social dynamics of the research setting.
• Multimedia data: Grounded Theory researchers may also use multimedia data such as photographs, videos, or audio recordings to capture the experiences and perspectives of participants.

Data Analysis Methods

Grounded Theory Data Analysis Methods are as follows:

• Open coding: Open coding is the process of identifying concepts and categories in the data. Researchers use open coding to assign codes to different pieces of data, and to identify similarities and differences between them.
• Axial coding: Axial coding is the process of organizing the codes into broader categories and subcategories. Researchers use axial coding to develop a theoretical framework that explains the phenomenon being studied.
• Constant comparison: Grounded Theory involves a process of constant comparison, in which data is compared to each other and to existing categories and codes in order to identify patterns and relationships.
• Theoretical sampling: Theoretical sampling involves selecting new data sources based on the emerging theory. Researchers use theoretical sampling to collect data that will help refine and validate the theory.
• Memoing : Memoing involves writing down reflections, insights, and ideas as the analysis progresses. This helps researchers to organize their thoughts and develop a deeper understanding of the data.
• Peer debriefing: Peer debriefing involves seeking feedback from peers and other researchers on the developing theory. This process helps to validate the theory and ensure that it is grounded in the data.
• Member checking: Member checking involves sharing the emerging theory with the participants in the study and seeking their feedback. This process helps to ensure that the theory accurately reflects the experiences and perspectives of the participants.
• Triangulation: Triangulation involves using multiple sources of data to validate the emerging theory. Researchers may use different data collection methods, different data sources, or different analysts to ensure that the theory is grounded in the data.

Applications of Grounded Theory

Here are some of the key applications of Grounded Theory:

• Social sciences : Grounded Theory is widely used in social science research, particularly in fields such as sociology, psychology, and anthropology. It can be used to explore a wide range of social phenomena, such as social interactions, power dynamics, and cultural practices.
• Healthcare : Grounded Theory can be used in healthcare research to explore patient experiences, healthcare practices, and healthcare systems. It can provide insights into the factors that influence healthcare outcomes, and can inform the development of interventions and policies.
• Education : Grounded Theory can be used in education research to explore teaching and learning processes, student experiences, and educational policies. It can provide insights into the factors that influence educational outcomes, and can inform the development of educational interventions and policies.
• Business : Grounded Theory can be used in business research to explore organizational processes, management practices, and consumer behavior. It can provide insights into the factors that influence business outcomes, and can inform the development of business strategies and policies.
• Technology : Grounded Theory can be used in technology research to explore user experiences, technology adoption, and technology design. It can provide insights into the factors that influence technology outcomes, and can inform the development of technology interventions and policies.

Examples of Grounded Theory

Examples of Grounded Theory in different case studies are as follows:

• Glaser and Strauss (1965): This study, which is considered one of the foundational works of Grounded Theory, explored the experiences of dying patients in a hospital. The researchers used Grounded Theory to develop a theoretical framework that explained the social processes of dying, and that was grounded in the data.
• Charmaz (1983): This study explored the experiences of chronic illness among young adults. The researcher used Grounded Theory to develop a theoretical framework that explained how individuals with chronic illness managed their illness, and how their illness impacted their sense of self.
• Strauss and Corbin (1990): This study explored the experiences of individuals with chronic pain. The researchers used Grounded Theory to develop a theoretical framework that explained the different strategies that individuals used to manage their pain, and that was grounded in the data.
• Glaser and Strauss (1967): This study explored the experiences of individuals who were undergoing a process of becoming disabled. The researchers used Grounded Theory to develop a theoretical framework that explained the social processes of becoming disabled, and that was grounded in the data.
• Clarke (2005): This study explored the experiences of patients with cancer who were receiving chemotherapy. The researcher used Grounded Theory to develop a theoretical framework that explained the factors that influenced patient adherence to chemotherapy, and that was grounded in the data.

Grounded Theory Research Example

A Grounded Theory Research Example Would be:

Research question : What is the experience of first-generation college students in navigating the college admission process?

Data collection : The researcher conducted interviews with first-generation college students who had recently gone through the college admission process. The interviews were audio-recorded and transcribed verbatim.

Data analysis: The researcher used a constant comparative method to analyze the data. This involved coding the data, comparing codes, and constantly revising the codes to identify common themes and patterns. The researcher also used memoing, which involved writing notes and reflections on the data and analysis.

Findings : Through the analysis of the data, the researcher identified several themes related to the experience of first-generation college students in navigating the college admission process, such as feeling overwhelmed by the complexity of the process, lacking knowledge about the process, and facing financial barriers.

Theory development: Based on the findings, the researcher developed a theory about the experience of first-generation college students in navigating the college admission process. The theory suggested that first-generation college students faced unique challenges in the college admission process due to their lack of knowledge and resources, and that these challenges could be addressed through targeted support programs and resources.

In summary, grounded theory research involves collecting data, analyzing it through constant comparison and memoing, and developing a theory grounded in the data. The resulting theory can help to explain the phenomenon being studied and guide future research and interventions.

Purpose of Grounded Theory

The purpose of Grounded Theory is to develop a theoretical framework that explains a social phenomenon, process, or interaction. This theoretical framework is developed through a rigorous process of data collection, coding, and analysis, and is grounded in the data.

Grounded Theory aims to uncover the social processes and patterns that underlie social phenomena, and to develop a theoretical framework that explains these processes and patterns. It is a flexible method that can be used to explore a wide range of research questions and settings, and is particularly well-suited to exploring complex social phenomena that have not been well-studied.

The ultimate goal of Grounded Theory is to generate a theoretical framework that is grounded in the data, and that can be used to explain and predict social phenomena. This theoretical framework can then be used to inform policy and practice, and to guide future research in the field.

When to use Grounded Theory

Following are some situations in which Grounded Theory may be particularly useful:

• Exploring new areas of research: Grounded Theory is particularly useful when exploring new areas of research that have not been well-studied. By collecting and analyzing data, researchers can develop a theoretical framework that explains the social processes and patterns underlying the phenomenon of interest.
• Studying complex social phenomena: Grounded Theory is well-suited to exploring complex social phenomena that involve multiple social processes and interactions. By using an iterative process of data collection and analysis, researchers can develop a theoretical framework that explains the complexity of the social phenomenon.
• Generating hypotheses: Grounded Theory can be used to generate hypotheses about social processes and interactions that can be tested in future research. By developing a theoretical framework that explains a social phenomenon, researchers can identify areas for further research and hypothesis testing.
• Informing policy and practice : Grounded Theory can provide insights into the factors that influence social phenomena, and can inform policy and practice in a variety of fields. By developing a theoretical framework that explains a social phenomenon, researchers can identify areas for intervention and policy development.

Characteristics of Grounded Theory

Grounded Theory is a qualitative research method that is characterized by several key features, including:

• Emergence : Grounded Theory emphasizes the emergence of theoretical categories and concepts from the data, rather than preconceived theoretical ideas. This means that the researcher does not start with a preconceived theory or hypothesis, but instead allows the theory to emerge from the data.
• Iteration : Grounded Theory is an iterative process that involves constant comparison of data and analysis, with each round of data collection and analysis refining the theoretical framework.
• Inductive : Grounded Theory is an inductive method of analysis, which means that it derives meaning from the data. The researcher starts with the raw data and systematically codes and categorizes it to identify patterns and themes, and to develop a theoretical framework that explains these patterns.
• Reflexive : Grounded Theory requires the researcher to be reflexive and self-aware throughout the research process. The researcher’s personal biases and assumptions must be acknowledged and addressed in the analysis process.
• Holistic : Grounded Theory takes a holistic approach to data analysis, looking at the entire data set rather than focusing on individual data points. This allows the researcher to identify patterns and themes that may not be apparent when looking at individual data points.
• Contextual : Grounded Theory emphasizes the importance of understanding the context in which social phenomena occur. This means that the researcher must consider the social, cultural, and historical factors that may influence the phenomenon of interest.

Advantages of Grounded Theory

Advantages of Grounded Theory are as follows:

• Flexibility : Grounded Theory is a flexible method that can be used to explore a wide range of research questions and settings. It is particularly well-suited to exploring complex social phenomena that have not been well-studied.
• Validity : Grounded Theory aims to develop a theoretical framework that is grounded in the data, which enhances the validity and reliability of the research findings. The iterative process of data collection and analysis also helps to ensure that the research findings are reliable and robust.
• Originality : Grounded Theory can generate new and original insights into social phenomena, as it is not constrained by preconceived theoretical ideas or hypotheses. This allows researchers to explore new areas of research and generate new theoretical frameworks.
• Real-world relevance: Grounded Theory can inform policy and practice, as it provides insights into the factors that influence social phenomena. The theoretical frameworks developed through Grounded Theory can be used to inform policy development and intervention strategies.
• Ethical : Grounded Theory is an ethical research method, as it allows participants to have a voice in the research process. Participants’ perspectives are central to the data collection and analysis process, which ensures that their views are taken into account.
• Replication : Grounded Theory is a replicable method of research, as the theoretical frameworks developed through Grounded Theory can be tested and validated in future research.

Limitations of Grounded Theory

Limitations of Grounded Theory are as follows:

• Time-consuming: Grounded Theory can be a time-consuming method, as the iterative process of data collection and analysis requires significant time and effort. This can make it difficult to conduct research in a timely and cost-effective manner.
• Subjectivity : Grounded Theory is a subjective method, as the researcher’s personal biases and assumptions can influence the data analysis process. This can lead to potential issues with reliability and validity of the research findings.
• Generalizability : Grounded Theory is a context-specific method, which means that the theoretical frameworks developed through Grounded Theory may not be generalizable to other contexts or populations. This can limit the applicability of the research findings.
• Lack of structure : Grounded Theory is an exploratory method, which means that it lacks the structure of other research methods, such as surveys or experiments. This can make it difficult to compare findings across different studies.
• Data overload: Grounded Theory can generate a large amount of data, which can be overwhelming for researchers. This can make it difficult to manage and analyze the data effectively.
• Difficulty in publication: Grounded Theory can be challenging to publish in some academic journals, as some reviewers and editors may view it as less rigorous than other research methods.

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Article Contents

Introduction, distinguishing features of grounded theory, the role and timing of the literature review.

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Grounded theory: what makes a grounded theory study?

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Carley Turner, Felicity Astin, Grounded theory: what makes a grounded theory study?, European Journal of Cardiovascular Nursing , Volume 20, Issue 3, March 2021, Pages 285–289, https://doi.org/10.1093/eurjcn/zvaa034

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Grounded theory (GT) is both a research method and a research methodology. There are several different ways of doing GT which reflect the different viewpoints of the originators. For those who are new to this approach to conducting qualitative research, this can be confusing. In this article, we outline the key characteristics of GT and describe the role of the literature review in three common GT approaches, illustrated using exemplar studies.

Describing the key characteristics of a Grounded theory (GT) study.

Considering the role and timing of the literature review in different GT approaches.

Qualitative research is a cornerstone in cardiovascular research. It gives insights in why particular phenomena occur or what underlying mechanisms are. 1 Over the past 2 years, the European Journal of Cardiovascular Nursing published 20 qualitative studies. 2–21 These studies used methods such as content analysis, ethnography, or phenomenology. Grounded theory (GT) has been used to a lesser extent.

Grounded theory is both a methodology and a method used in qualitative research ( Table 1 ). It is a research approach used to gain an emic insight into a phenomenon. In simple terms, this means understanding the perspective, or point of view, of an ‘insider’, those who have experience of the phenomenon. 22 Grounded theory is a research approach that originated from the social sciences but has been used in education and health research. The focus of GT is to generate theory that is grounded in data and shaped by the views of participants, thereby moving beyond description and towards theoretical explanation of a process or phenomenon. 23

Grounded theory as a method and methodology

One of the key issues with using GT, particularly for novices, is understanding the different approaches that have evolved as each specific GT approach is slightly different.

The tradition of GT began with the seminal text about classic GT written by Glaser and Strauss, 24 but since then GT has evolved into several different types. The approach to GT chosen by the researcher depends upon an understanding of the epistemological underpinnings of the different approaches, the match with the topic under investigation and the researcher’s own stance. Whilst GT is frequently used in applied health research, very few studies detail which GT approach has been used, how and why. Sometimes published studies claim to use GT methodology but the approaches that form the foundation of GT are not reported. This may be due to the word limit in academic journals or because legitimate GT approaches have not been followed. Either way, there is a lack of clarity about the practical application of GT. The purpose of this article is to outline the distinguishing characteristics of GT and outline practical considerations for the novice researcher regarding the place of the literature review in GT.

There are several distinguishing features of GT, as outlined by Sbaraini et al. 25 The first is that GT research is conducted through an inductive process. This means that the researcher is developing theory rather than testing it and must therefore remain ‘open’ throughout the study. In essence, this means that the researcher has no preconceived ideas about the findings. Taking an inductive approach means that the focus of the research may evolve over time as the researchers understand what is important to their participants through the data collection and analysis process.

With regards to data analysis, the use of coding is initially used to break down data into smaller components and labelling them to capture the essence of the data. The codes are compared to one another to understand and explain any variation in the data before they are combined to form more abstract categories. Memos are used to record and develop the researcher’s analysis of the data, including the detail behind the comparisons made between categories. Memos can stimulate the researcher’s thinking, as well as capturing the researcher’s ideas during data collection and analysis.

A further feature for data analysis in a GT study is the simultaneous data analysis and sampling to facilitate theoretical sampling. This means that as data analysis progresses participants are purposefully selected who may have characteristics or experiences that have arisen as being of interest from data collection and analysis so far. Questions in the topic guide may also be modified to follow a specific line of inquiry, test ideas and interpretations, or fill gaps in the analysis to build an emerging substantive theory. This evolving and non-linear methodology is to allow the evolution of the study as indicated by data, rather than analysing at the end of data collection. This approach to data analysis supports the researcher to take an inductive approach as discussed above.

Theoretical sampling facilitates the construction of theory until theoretical saturation is reached. Theoretical saturation is when all the concepts that form the theory being developed are well understood and grounded in data. Finally, the results are expressed as a theory where a set of concepts are related to one another and provide a framework for making predictions. 26 These key features of GT are summarized in Table 2 .

Distinguishing features of a GT study (adapted from Sbaraini et al. 25 )

The identification of a gap in the published literature is typically a requirement of successful doctoral studies and grant applications. However, in GT research there are different views about the role and timing of the literature review.

For researchers using classic Glaserian GT, the recommended approach is that the published literature should not be reviewed until data collection, analysis and theory development has been completed. 24 The rationale for the delay of the literature review is to enable the researcher to remain ‘open’ to discover theory emerging from data and free from contamination by avoiding forcing data into pre-conceived concepts derived from other studies. Furthermore, because the researcher is ‘open’ to whichever direction the data takes they cannot know in advance which aspects of the literature will be relevant to their study. 27

In Glaserian GT, the emerging concepts and theory from data analysis inform the scope of the literature review which is conducted after theory development. 24 This approach to the literature review aligns with the rather positivist stance of Glaser in which the researcher aims to remain free of assumptions so that the theory that emerges from the data is not influenced by the researcher. Reviewing the literature prior to data analysis would risk theory being imposed on the data. Perhaps counterintuitively, Glaser does recommend reading literature in unrelated fields to understand as many theoretical codes as possible. 28 However, it is unclear how this is different to reading literature directly related to the topic and could potentially still lead to the contamination of the theory arising from data that delaying the literature review is intended to avoid. It is also problematic regarding the governance processes around research, whereby funders and ethics committees would expect at least an overview of the existing literature as part of the justification for the study.

A study by Bergman et al. 29 used a classic Glaserian GT approach to examine and identify the motive of power in myocardial infarction patients’ rehabilitation process. Whilst the key characteristics of GT were evident in the way the study was conducted, there was no discussion about how the literature review contributed to the final theory. This may have been due to the word limit but illustrates the challenges that novice researchers may have in understanding where the literature review fits in studies using GT approaches.

In Straussian GT, a more pragmatic approach to the literature view is adopted. Strauss and Corbin 30 recognized that the researcher has prior knowledge, including that of the literature, before starting their research. They did not recommend dissociation from the literature, but rather that the literature be used across the various stages of the research. Published literature could identify important areas that could contribute to theory development, support useful comparisons in the data and stimulate further questions during the analytical process. According to Strauss and Corbin, researchers should be mindful about how published work could influence theory development. Whilst visiting the literature prior to data collection was believed to enhance data analysis, it was not thought necessary to review all the literature beforehand, but rather revisit the literature at later stages in the research process. 30

A study published by Salminen-Tuomaala et al. 31 used a Straussian GT approach to explore factors that influenced the way patients coped with hospitalization for acute myocardial infarction. The authors described a reflexive process in which the researcher noted down their preconceived ideas about the topic as part of the data analysis process. The literature review was conducted after data analysis.

The most recent step in the evolution of GT is the move towards a constructivist epistemological stance advocated by Charmaz. 32 In simple terms, this means that the underlying approach reflects the belief that theories cannot be discovered but are instead constructed by the researcher and their interactions with the participants and data. As the researcher plays a central role in the construction of the GT, their background, personal views, and culture will influence this process and the way data are analysed. For this reason, it is important to be explicit about these preconceptions and aim to maintain an open mind through reflexivity. 32 Therefore, engaging in a preliminary literature review and using this information to compare and contrast with findings from the research undertaken is desirable, alongside completing a comprehensive literature review after data analysis with a specific aim to present the GT.

A study published by Odell et al. 33 used the modified GT approach recommended by Charmaz 32 to study patients’ experiences of restenosis after Percutaneous Coronary Intervention. The authors described the different GT approaches and key features of GT methodology which clearly informed the conduct of the study. However, there was no detail about how the literature review was used to shape the data analysis process and findings.

A solution: be clear on the approach taken to the literature review and why

Despite the clear differences in the approach to the literature review in GT, there appears to be a lack of precise guidance for novice researchers regarding how in depth or exhaustive a preliminary literature review should be. This lack of guidance can lead to a variety of different approaches as evidenced in the GT studies we have cited as examples, which is a challenge for the novice researcher. This uncertainty is further compounded by the concurrent approach to data collection and analysis which allows for the research focus to evolve as the study progresses. The complexity of the research process and the role and timing of the literature review is summarized in Figure 1 .

Literature review in Grounded Theory.

Taking a pragmatic approach, researchers will need to familiarize themselves with the literature to receive funding and approval for their study. This preliminary literature review can be followed up after data analysis by a more comprehensive review of the literature to help support the theory that was developed from the data. The key is to ensure transparency in reporting how the literature review has been used to develop the theory. The preliminary literature review can be used to set the scene for the research as part of the introduction, and the more extensive literature review can then be used during the discussion section to compare the theory developed from the data with existing literature, as per Probyn et al. 34

Whilst this pragmatic approach aligns with Straussian GT and Charmaz’s constructivist GT, it is at odds with Glaserian GT. Therefore, if Glaserian GT is chosen, the researcher should be explicit about deviation and provide a rationale.

Word count for journal articles is often a limiting factor in how much detail is included in why certain methodologies are used. Submitting detail about the methodology and rationale behind it can be presented as online supplementary material, thereby allowing interested readers to access further information about how and why the research was executed.

The use of GT as a methodology and method can shed light on areas where little knowledge is already known, generating theory directly from data. The traditional format of a published article does not always reflect the iterative approach to the literature review and data collection and analysis in GT. This can generate tension between how the research is presented in relation to how it was conducted. However, one simple way to ensure clarity in reporting is to be transparent in how the literature review is used.

The authors received no financial support for the research, authorship or publication of this article.

Conflict of interest : The authors declare that there are no conflicts of interest.

Greenhalgh T , Taylor R. Papers that go beyond numbers (qualitative research) . Br Med J 1997 ; 315 : 740 – 743 .

Google Scholar

Wilson RE , Rush KL , Reid RC , et al.  The symptom experience of early and late treatment seekers before an atrial fibrillation diagnosis . Eur J Cardiovasc Nurs 2021 ; 20 :231--242.

Lauck SB , Achtem L , Borregaard B , et al.  Can you see frailty? An exploratory study of the use of a patient photograph in the transcatheter aortic valve implantation programme . Eur J Cardiovasc Nurs 2021 ; 20 :252--260.

Sundelin R , Bergsten C , Tornvall P , Lyngå, P. et al.  Self-rated stress and experience in patients with Takotsubo syndrome: a mixed methods study . Eur J Cardiovasc Nurs 2020 ; doi: 10.1177/1474515120919387.

Janssen DJ , Ament SM , Boyne J , et al.  Characteristics for a tool for timely identification of palliative needs in heart failure: the views of Dutch patients, their families and healthcare professionals . Eur J Cardiovasc Nurs 2020 ; doi: 10.1177/1474515120918962.

Steffen EM , Timotijevic L , Coyle A. A qualitative analysis of psychosocial needs and support impacts in families affected by young sudden cardiac death: the role of community and peer support . Eur J Cardiovasc Nurs 2020 ; doi: 10.1177/1474515120922347.

Molzahn AE , Sheilds L , Bruce A , Schick-Makaroff K , Antonio M , Clark AM. Life and priorities before death: a narrative inquiry of uncertainty and end of life in people with heart failure and their family members . Eur J Cardiovasc Nurs 2020 ; 19 : 629 – 637 .

Wistrand C , Nilsson U , Sundqvist A-S. Patient experience of preheated and room temperature skin disinfection prior to cardiac device implantation: a randomised controlled trial . Eur J Cardiovasc Nurs 2020 ; 19 : 529 – 536 .

Widell C , Andréen S , Albertsson P , Axelsson ÅB. Octogenarian preferences and expectations for acute coronary syndrome treatment . Eur J Cardiovasc Nurs 2020 ; 19 : 521 – 528 .

Ferguson C , George A , Villarosa AR , Kong AC , Bhole S , Ajwani S. Exploring nursing and allied health perspectives of quality oral care after stroke: a qualitative study . Eur J Cardiovasc Nurs 2020 ; 19 : 505 – 512 .

Sutantri S , Cuthill F , Holloway A. ‘ A bridge to normal’: a qualitative study of Indonesian women’s attendance in a phase two cardiac rehabilitation programme . Eur J Cardiovasc Nurs 2019 ; 18 , doi: 10.1177/1474515119864208.

Liu X-L , Willis K , Fulbrook P , Wu C-J(J) , Shi Y , Johnson M. Factors influencing self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus . Eur J Cardiovasc Nurs 2019 ; 18 : 700 – 710 .

Wingham J , Frost J , Britten N , Greaves C , Abraham C , Warren FC , Jolly K , Miles J , Paul K , Doherty PJ , Singh S , Davies R , Noonan M , Dalal H , Taylor RS. Caregiver outcomes of the REACH-HF multicentre randomized controlled trial of home-based rehabilitation for heart failure with reduced ejection fraction . Eur J Cardiovasc Nurs 2019 ; 18 : 611 – 620 .

Olsson K , Näslund U , Nilsson J , Hörnsten Å. Hope and despair: patients’ experiences of being ineligible for transcatheter aortic valve implantation . Eur J Cardiovasc Nurs 2019 ; 18 : 593 – 600 .

Heery S , Gibson I , Dunne D , Flaherty G. The role of public health nurses in risk factor modification within a high-risk cardiovascular disease population in Ireland – a qualitative analysis . Eur J Cardiovasc Nurs 2019 ; 18 : 584 – 592 .

Brännström M , Fischer Grönlund C , Zingmark K , Söderberg A. Meeting in a ‘free-zone’: clinical ethical support in integrated heart-failure and palliative care . Eur J Cardiovasc Nurs 2019 ; 18 : 577 – 583 .

Haydon G , van der Riet P , Inder K. Long-term survivors of cardiac arrest: a narrative inquiry . Eur J Cardiovasc Nurs 2019 ; 18 : 458 – 464 .

Freysdóttir GR , Björnsdóttir K , Svavarsdóttir MH. Nurses’ Use of Monitors in Patient Surveillance: An Ethnographic Study on a Coronary Care Unit . London, England : SAGE Publications ; 2019 . p 272 – 279 .

Google Preview

Pokorney SD , Bloom D , Granger CB , Thomas KL , Al-Khatib SM , Roettig ML , Anderson J , Heflin MT , Granger BB. Exploring patient–provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: results of the INFORM-AF study . Eur J Cardiovasc Nurs 2019 ; 18 : 280 – 288 .

Instenes I , Fridlund B , Amofah HA , Ranhoff AH , Eide LS , Norekvål TM. ‘ I hope you get normal again’: an explorative study on how delirious octogenarian patients experience their interactions with healthcare professionals and relatives after aortic valve therapy . Eur J Cardiovasc Nurs 2019 ; 18 : 224 – 233 .

Palmar-Santos AM , Pedraz-Marcos A , Zarco-Colón J , Ramasco-Gutiérrez M , García-Perea E , Pulido-Fuentes M. The life and death construct in heart transplant patients . Eur J Cardiovasc Nurs 2019 ; 18 : 48 – 56 .

De Chesnay M , Banner D. Nursing Research Using Grounded Theory: Qualitative Designs and Methods . New York, NY : Springer Publishing Company ; 2015 .

Corbin J , Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory . 3rd ed. California : SAGE ; 2007 .

Glaser BG , Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research . New York : Aldine ; 1967 .

Sbaraini A , Carter SM , Evans RW , Blinkhorn A. How to do a grounded theory study: a worked example of a study of dental practices . BMC Med Res Methodol 2011 ; 11 : 128 – 128 .

Charmaz K. ‘ Discovering’ chronic illness: using grounded theory . Soc Sci Med 1990 ; 30 : 1161 – 1172 .

Thornberg R , Dunne C. Literature review in grounded theory. In Bryant A , Charmaz K , eds. The SAGE Handbook of Current Developments in Grounded Theory . London : SAGE Publications ; 2019 .

Glaser BG. Doing Grounded Theory: Issues and Discussions . California : Sociology Press ; 1998 .

Bergman E , Berterö C. ‘ Grasp Life Again’. A qualitative study of the motive power in myocardial infarction patients . Eur J Cardiovasc Nurs 2003 ; 2 : 303 – 310 .

Strauss A , Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques . 2nd ed. California : Sage ; 1998 .

Salminen-Tuomaala M , Åstedt-Kurki P , Rekiaro M , Paavilainen E. Coping—seeking lost control . Eur J Cardiovasc Nurs 2012 ; 11 : 289 – 296 .

Charmaz K. Constructing Grounded Theory . 2nd ed. Los Angeles : SAGE ; 2014 .

Odell A , Grip L , Hallberg LRM. Restenosis after percutaneous coronary intervention (PCI): experiences from the patients' perspective . Eur J Cardiovasc Nurs 2006 ; 5 : 150 – 157 .

Probyn J , Greenhalgh J , Holt J , Conway D , Astin F. Percutaneous coronary intervention patients’ and cardiologists’ experiences of the informed consent process in Northern England: a qualitative study . BMJ Open 2017 ; 7 : e015127 .

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10 Grounded Theory Examples (Qualitative Research Method)

Chris Drew (PhD)

Dr. Chris Drew is the founder of the Helpful Professor. He holds a PhD in education and has published over 20 articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education. [Image Descriptor: Photo of Chris]

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Grounded theory is a qualitative research method that involves the construction of theory from data rather than testing theories through data (Birks & Mills, 2015).

In other words, a grounded theory analysis doesn’t start with a hypothesis or theoretical framework, but instead generates a theory during the data analysis process .

This method has garnered a notable amount of attention since its inception in the 1960s by Barney Glaser and Anselm Strauss (Corbin & Strauss, 2015). 

Grounded Theory Definition and Overview

A central feature of grounded theory is the continuous interplay between data collection and analysis (Bringer, Johnston, & Brackenridge, 2016).

Grounded theorists start with the data, coding and considering each piece of collected information (for instance, behaviors collected during a psychological study).

As more information is collected, the researcher can reflect upon the data in an ongoing cycle where data informs an ever-growing and evolving theory (Mills, Bonner & Francis, 2017).

As such, the researcher isn’t tied to testing a hypothesis, but instead, can allow surprising and intriguing insights to emerge from the data itself.

Applications of grounded theory are widespread within the field of social sciences . The method has been utilized to provide insight into complex social phenomena such as nursing, education, and business management (Atkinson, 2015).

Grounded theory offers a sound methodology to unearth the complexities of social phenomena that aren’t well-understood in existing theories (McGhee, Marland & Atkinson, 2017).

While the methods of grounded theory can be labor-intensive and time-consuming, the rich, robust theories this approach produces make it a valuable tool in many researchers’ repertoires.

Real-Life Grounded Theory Examples

Title: A grounded theory analysis of older adults and information technology

Citation: Weatherall, J. W. A. (2000). A grounded theory analysis of older adults and information technology. Educational Gerontology , 26 (4), 371-386.

Description: This study employed a grounded theory approach to investigate older adults’ use of information technology (IT). Six participants from a senior senior were interviewed about their experiences and opinions regarding computer technology. Consistent with a grounded theory angle, there was no hypothesis to be tested. Rather, themes emerged out of the analysis process. From this, the findings revealed that the participants recognized the importance of IT in modern life, which motivated them to explore its potential. Positive attitudes towards IT were developed and reinforced through direct experience and personal ownership of technology.

Title: A taxonomy of dignity: a grounded theory study

Citation: Jacobson, N. (2009). A taxonomy of dignity: a grounded theory study. BMC International health and human rights , 9 (1), 1-9.

Description: This study aims to develop a taxonomy of dignity by letting the data create the taxonomic categories, rather than imposing the categories upon the analysis. The theory emerged from the textual and thematic analysis of 64 interviews conducted with individuals marginalized by health or social status , as well as those providing services to such populations and professionals working in health and human rights. This approach identified two main forms of dignity that emerged out of the data: “ human dignity ” and “social dignity”.

Title: A grounded theory of the development of noble youth purpose

Citation: Bronk, K. C. (2012). A grounded theory of the development of noble youth purpose. Journal of Adolescent Research , 27 (1), 78-109.

Description: This study explores the development of noble youth purpose over time using a grounded theory approach. Something notable about this study was that it returned to collect additional data two additional times, demonstrating how grounded theory can be an interactive process. The researchers conducted three waves of interviews with nine adolescents who demonstrated strong commitments to various noble purposes. The findings revealed that commitments grew slowly but steadily in response to positive feedback, with mentors and like-minded peers playing a crucial role in supporting noble purposes.

Title: A grounded theory of the flow experiences of Web users

Citation: Pace, S. (2004). A grounded theory of the flow experiences of Web users. International journal of human-computer studies , 60 (3), 327-363.

Description: This study attempted to understand the flow experiences of web users engaged in information-seeking activities, systematically gathering and analyzing data from semi-structured in-depth interviews with web users. By avoiding preconceptions and reviewing the literature only after the theory had emerged, the study aimed to develop a theory based on the data rather than testing preconceived ideas. The study identified key elements of flow experiences, such as the balance between challenges and skills, clear goals and feedback, concentration, a sense of control, a distorted sense of time, and the autotelic experience.

Title: Victimising of school bullying: a grounded theory

Citation: Thornberg, R., Halldin, K., Bolmsjö, N., & Petersson, A. (2013). Victimising of school bullying: A grounded theory. Research Papers in Education , 28 (3), 309-329.

Description: This study aimed to investigate the experiences of individuals who had been victims of school bullying and understand the effects of these experiences, using a grounded theory approach. Through iterative coding of interviews, the researchers identify themes from the data without a pre-conceived idea or hypothesis that they aim to test. The open-minded coding of the data led to the identification of a four-phase process in victimizing: initial attacks, double victimizing, bullying exit, and after-effects of bullying. The study highlighted the social processes involved in victimizing, including external victimizing through stigmatization and social exclusion, as well as internal victimizing through self-isolation, self-doubt, and lingering psychosocial issues.

Hypothetical Grounded Theory Examples

Suggested Title: “Understanding Interprofessional Collaboration in Emergency Medical Services”

Suggested Data Analysis Method: Coding and constant comparative analysis

How to Do It: This hypothetical study might begin with conducting in-depth interviews and field observations within several emergency medical teams to collect detailed narratives and behaviors. Multiple rounds of coding and categorizing would be carried out on this raw data, consistently comparing new information with existing categories. As the categories saturate, relationships among them would be identified, with these relationships forming the basis of a new theory bettering our understanding of collaboration in emergency settings. This iterative process of data collection, analysis, and theory development, continually refined based on fresh insights, upholds the essence of a grounded theory approach.

Suggested Title: “The Role of Social Media in Political Engagement Among Young Adults”

Suggested Data Analysis Method: Open, axial, and selective coding

Explanation: The study would start by collecting interaction data on various social media platforms, focusing on political discussions engaged in by young adults. Through open, axial, and selective coding, the data would be broken down, compared, and conceptualized. New insights and patterns would gradually form the basis of a theory explaining the role of social media in shaping political engagement, with continuous refinement informed by the gathered data. This process embodies the recursive essence of the grounded theory approach.

Suggested Title: “Transforming Workplace Cultures: An Exploration of Remote Work Trends”

Suggested Data Analysis Method: Constant comparative analysis

Explanation: The theoretical study could leverage survey data and in-depth interviews of employees and bosses engaging in remote work to understand the shifts in workplace culture. Coding and constant comparative analysis would enable the identification of core categories and relationships among them. Sustainability and resilience through remote ways of working would be emergent themes. This constant back-and-forth interplay between data collection, analysis, and theory formation aligns strongly with a grounded theory approach.

Suggested Title: “Persistence Amidst Challenges: A Grounded Theory Approach to Understanding Resilience in Urban Educators”

Suggested Data Analysis Method: Iterative Coding

How to Do It: This study would involve collecting data via interviews from educators in urban school systems. Through iterative coding, data would be constantly analyzed, compared, and categorized to derive meaningful theories about resilience. The researcher would constantly return to the data, refining the developing theory with every successive interaction. This procedure organically incorporates the grounded theory approach’s characteristic iterative nature.

Suggested Title: “Coping Strategies of Patients with Chronic Pain: A Grounded Theory Study”

Suggested Data Analysis Method: Line-by-line inductive coding

How to Do It: The study might initiate with in-depth interviews of patients who’ve experienced chronic pain. Line-by-line coding, followed by memoing, helps to immerse oneself in the data, utilizing a grounded theory approach to map out the relationships between categories and their properties. New rounds of interviews would supplement and refine the emergent theory further. The subsequent theory would then be a detailed, data-grounded exploration of how patients cope with chronic pain.

Grounded theory is an innovative way to gather qualitative data that can help introduce new thoughts, theories, and ideas into academic literature. While it has its strength in allowing the “data to do the talking”, it also has some key limitations – namely, often, it leads to results that have already been found in the academic literature. Studies that try to build upon current knowledge by testing new hypotheses are, in general, more laser-focused on ensuring we push current knowledge forward. Nevertheless, a grounded theory approach is very useful in many circumstances, revealing important new information that may not be generated through other approaches. So, overall, this methodology has great value for qualitative researchers, and can be extremely useful, especially when exploring specific case study projects . I also find it to synthesize well with action research projects .

Atkinson, P. (2015). Grounded theory and the constant comparative method: Valid qualitative research strategies for educators. Journal of Emerging Trends in Educational Research and Policy Studies, 6 (1), 83-86.

Birks, M., & Mills, J. (2015). Grounded theory: A practical guide . London: Sage.

Bringer, J. D., Johnston, L. H., & Brackenridge, C. H. (2016). Using computer-assisted qualitative data analysis software to develop a grounded theory project. Field Methods, 18 (3), 245-266.

Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory . Sage publications.

McGhee, G., Marland, G. R., & Atkinson, J. (2017). Grounded theory research: Literature reviewing and reflexivity. Journal of Advanced Nursing, 29 (3), 654-663.

Mills, J., Bonner, A., & Francis, K. (2017). Adopting a Constructivist Approach to Grounded Theory: Implications for Research Design. International Journal of Nursing Practice, 13 (2), 81-89.

• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd-2/ 10 Reasons you’re Perpetually Single
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• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd-2/ 101 Hidden Talents Examples

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Grounded theory and the PhD – notes for novice researchers

Journal of Humanities and Applied Social Sciences

ISSN : 2632-279X

Article publication date: 26 October 2020

Issue publication date: 19 November 2020

This paper aims to consider the realities and problematics of applying a grounded theory (GT) approach to research, as a novice, within a mixed methods study during post graduate research. Its intention is to provide the novice user with a framework of considerations and greater awareness of the issues that GT can expose during research activity.

Design/methodology/approach

Using empirical evidence and a comparative approach, the paper compares the efficacy of both the classic Glaserian and Straussian models. It observes the effects of a positivist academic environment upon the choice of approach and its application. This study was specific to design education; however, its reliance upon a social science epistemology results in findings beneficial to research novices across broader disciplines.

GT presents the novice researcher with several potential pitfalls. Most problematic were the immutable, positivist institutional requirements, researcher a priori knowledge, the reliance upon literature for the research proposal and structure of the proposal itself. These include suspension of the notion that the purist use of either model can be applied in the current academic environment, the need for a close relationship with the data and toleration of a non-linear process with unexpected results.

Originality/value

The practicalities of GT research are often reflected upon by the academy, but use by novice researchers is little considered. The findings from this study provide a novel set of guidelines for use by those embarking on GT research and particularly where the requirements of formal education may cause a conflict.

• Grounded theory
• Social science research
• Novice researcher
• Glaserian grounded theory
• Post graduate research
• Straussian grounded theory
• Mixed methods research

Thurlow, L. (2020), "Grounded theory and the PhD – notes for novice researchers", Journal of Humanities and Applied Social Sciences , Vol. 2 No. 4, pp. 257-270. https://doi.org/10.1108/JHASS-05-2020-0079

Emerald Publishing Limited

Copyright © 2020, Lisa Thurlow.

Published in Journal of Humanities and Applied Social Sciences . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence maybe seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

This paper considers the practicalities and problematics of applying grounded theory (GT) as a novice researcher during a mixed methods research project. Presented as a critical review of GT via a case study, it observes postgraduate (PhD) investigation into the nature of sketch inhibition among undergraduates within design higher education. The aim of the study was to build an effective theory of sketch inhibition as along with a set of pedagogic tools for its management in higher education – sketch inhibition is defined as a phenomenon whereby the suffer feels or demonstrates a reluctance or inability to engage with the mark-making aspect of design ideation and development ( Author, 2019 ). This type of problem-solving and conceptual activity is also evident in broader environments including the social sciences, sciences and business. Although often criticised for its lack of formal epistemology ( Doherty, 2015 ; Downs, 2017 ), the design disciplines have historically borrowed heavily from the social sciences, and an unintended consequence of this study offers methodological insight, not only to design research but also to other disciplines.

The following considers GT as a research approach and methodological framework (deleted phrase) alongside the personality of post graduate research. Its characteristics (both Glaserian and Straussian) are considered by the literature, together with a critical evaluation of their relationship. The benefits and problematics of GT applied within the mainly positivist environment of independent post graduate study are considered – from initial proposal, data gathering and analysis; thesis-writing; and identifying points along the research process where method particular attention or method slurring ( Baker et al. , 1992 ) were required. By way of conclusion, the findings from this have been developed into a set of considerations for prospective users of the method, intended as a decision-making tool for novices to GT research.

The personality of grounded theory research – comparison of the schools during project proposal development

Suddaby (2006) and Muratovski (2016) believe GT is the best used to observe a phenomenon where little extant theory is available: it “relies on the absence of an existing theory and its purpose is to set up a new theory,” ( Muratovski, 2016 , p. 99). Such lack of theory relating to the phenomenon of sketch inhibition drew the research towards an inductive process, and paradigmatically, GT. A constructivist approach was identified as the most appropriate – sketch inhibition being phenomenological and perceived at both the macro-level across discipline and by individual sufferers. GT, ( Glaser and Strauss, 1967 ; Strauss and Corbin, 1990 ), offering both method and result ( Bohm, 2004 ) in providing understanding ( Furniss, 2011 ) of sketch inhibition was the most appropriate approach for observing the phenomenon.

Based on this initial understanding of GT research, and its apparent suitability for the study, further review of evaluation method was conducted. Being data-driven, GT study demands identification of an area of interest or research question to be investigated but no explicit methodology at the outset – this was perplexing; the antithesis of the requirement for post graduate study. GT and phenomenology paradigms occupying a close relationship within the social sciences, method slurring is often an unavoidable consequence of its use ( Baker et al. , 1992 ). The close relationship between research activity and data and the recursive nature of their method were noted by Glaser and Strauss (1967 , p. 6): “most hypotheses and concepts not only come from the data, but are systematically worked out in relation to the data during the course of the research.” A notable trait of GT research is the requirement for analysis of data as it is collected, rather than as afterwards – this in contrast to previous activity, the body of data sought in their entirety before analysis begins. Identification and saturation of categories is data-driven ( Muratovski, 2016 ) using an emergent approach to classification: pre-defined categories unnecessary and potentially harmful to the process. Both Glaserian and Straussian approaches to GT use constant comparison – the evaluation of new data against existing categories and development of new categories should these emerge during the process. Locke (1996) observing this recursive process necessary for subsequent growth of the research: “the materializing theory drives ongoing data collection” ( Locke, 1996 , p. 240).

Both approaches use theoretical sampling – the identification of further sources of data to be evaluated, these reliant upon the development of theory emerging from existing data ( Suddaby, 2006 ). Via the process of constant comparison and purposive sampling, identification of clear categories and the relationships between them emerge from the data:

Categories or codes […] are the basic building blocks of a grounded theory. As they are developed, the same recursive, theory driven, comparative processes are used to surface the links and relationships among the categories to construct a complete theoretical framework ( Locke, 1996 , p. 241)

This would allow the data to drive the research and obviate the need for a preformulated methodology.

GT’s separation into two individual schools, to include Straussian in 1990 offered the research a choice: that of emergence versus forcing of data. The Glaserian model of emergence relied upon allowing the data to simply appear during analysis characterized by the separateness between researcher and the external world that incorporates their subject matter ( Howell, 2013 ). Locke (1996 , p. 241) considered the benefit of this, the Glaserian model favouring a passive, neutral approach, thereby avoiding contamination of pre-conception, providing a “one-way mirror” on the data: “categories emerge upon comparison and properties emerge upon more comparison. And that is all there is to it” ( Glaser, 1992 , p. 43). Locke (1996 , p. 239) suggested the Glaserian model enabled researchers “to use their intellectual imagination and creativity to develop theories related to the areas of enquiry” through the gathering of naturalistic data. Borgatti (2020) suggested theory developed from such activity (deleted phrase) aims to “focus on making implicit belief systems explicit”.

The Straussian model’s ( Strauss and Corbin, 1990 ) requirement of questioning the data to develop theory provides the researcher with a world view through a Constructivist lens, ( Guba and Lincoln, 2005 ). Strauss and Corbin (1990) suggested both induction, whereby data is used to build a picture of a reality, and deduction based upon hypothesis testing, (deleted phrase) were intrinsic to such research and the act of conceptualization by the researcher would by default, involve deduction, suggesting interaction between the two was necessary for theory-building. With a dearth of knowledge around sketch inhibition, the methodological purity of the Glaserian model was attractive, and further considered.

Coding, according to Walker and Myrick (2006 , p. 549), “transports researchers and their data from transcript to theory,” observing that both models use the same basic functions: “gather data, code, compare, categorize, theoretically sample, develop a core category, and generate a theory” (p. 550). Glaser’s (1978) approach involves two separate processes – substantive coding (fracturing the gathered data into categories based upon its properties), followed by selective, or theoretical coding; grouping into codes at the conceptual level and allowing the theory to develop as a result ( Walker and Myrick, 2006 ). Strauss and Corbin (1990) , coding is more complex, involving open, axial and selective coding, although individual stages are subject to blurring and can be used both sequentially and concurrently ( Walker and Myrick, 2006 ).

Initial, open coding allows reduction of data into concise manageable themes that accurately reflect the phenomenon. Axial coding allows for interpretation of categories to be identified. Muratovski (2016) refers to Leedy and Ormrod’s (2010) questioning (provoking) of data to facilitate this. They ask, “What are the conditions that have given rise to this process? What is the context in which this process is embedded? […] What are the consequences of these strategies?” ( Leedy and Ormrod, 2010 , p. 143).

The final, selective coding stage involves the bringing together of categories and connections, their development into a storyline to describe the mechanics of the issue. According to Muratovski (2016) , this is the point where theory can be developed. This more constructivist approach to coding was criticised by Glaser for being too aggressive, negatively affecting the research outcome. “Strauss’ sampling is controlled by the evolving relevant concepts, and relevance comes from testing out what is looked for, not what is emerging” ( Glaser, 1992 , p. 103). He believed this caused contamination of the analysis and favoured anticipation over emergence – that it could “force conceptual descriptions” as opposed to enabling the natural emergence of “grand theories,” ( Glaser, 1992 , p. 8). Borgatti (2020) , however, endorsed the Straussian model for consisting of “a set of steps whose careful execution is thought to guarantee a good theory as the outcome”. At this point, the purity of the Galserian model was still considered the most appropriate for the study, enabling a natural emergence of knowledge about sketch inhibition, and an almost effortless development of theory.

The contentious nature of the researcher’s a priori experience illustrated how the Glaserian approach could be problematic to the study. Glaser’s (1992 , p. 50) belief that previous knowledge was detrimental to effective theorizing – the researcher should, “just not know as he approaches the data,” was problematic, Suddaby (2006 , p. 634) suggesting the negation of researcher experience, agenda and the literature impossible: “the researcher is a blank sheet devoid of experience or knowledge” being unattainable within any research scenario.

The Straussian paradigm allowed for, and even endorsed for their insight, the benefit of the researcher’s a priori experience and exposure to the issues under scrutiny – this including engagement with relevant literature. Potter (2006) believed unintentional researcher influence unavoidable, subsequent knowledge considered to be of a Constructivist epistemology. Baker et al. (1992) believed that fully understanding the realities of social or psycho-social situations within a GT study could only happen through observation, listening, inferring from the literature and reflecting upon one’s own experiences – effectively, everything could be considered data within a GT study – this, via the lens of the researcher. This more structured approach was potentially more manageable than a classic Glaserian style and appeared to provide a robust and justifiable route towards growth of theory ( Wacker, 2008 ). Despite the unease between the two schools, Suddaby (2006 , p. 635) maintains that GT offers, “a practical middle ground between a theory-laden view of the world and an unfettered empiricism”.

Using grounded theory to research sketch inhibition

The essentialist concept of measurability being vital to success in education – the award of academic qualifications impossible without it – creates an immutable environment for within which post graduate researchers must function. Such need for measurability requires, by default, a set of criteria to measure against, the research proposal being central to this. With most influence on the study was the requirement for a formal, developed proposal: this was completely at odds with GT and effectively precluded its use purest form – methodological concessions were already being made.

A review of the literature was necessary to frame the scope of the research and with so little literature referring directly to sketch inhibition, a wider search allowed context to be established. This continued for over a year, almost exclusively, to build a research framework robust enough to carry the primary research through to completion of the study. If the Glaserian model were to be observed, the use of the literature review together with empirical data would deem the data already contaminated. The Straussian model, by default, had become the approach to the study.

According to the institutional requirement, the research proposal was submitted. The initial aim was:

An investigation into the reasons for design students and early career designers avoiding manual drawing tools during design development and the proposal of a pedagogical framework to address this.

The stages of design development where drawing is used and an investigation into its purpose within creative development.

Current practice of designers across a range of disciplines regarding their use of drawing techniques during design development.

Reasons for students choosing not to use drawing as a tool for development and presentation – explicit reasoning.

An investigation into the use of drawing as a tool for design development within HE – tactic reasoning.

The position and value of drawing within current frameworks for design education – tacit reasoning ( Author, 2015 ).

This proposal was problematic on several levels. As a statement of intent, it was far too complex. In contradiction to GT it made assumptions about the nature and extent of sketch inhibition and presupposed that it was indeed an issue. In addition to this, and in further contradiction to GT, the proposal required submission of a literature review and proposed methodology for data collection and analysis. The methodology was also submitted for ethical approval: pre-empting methods and samples was required despite there being little data upon which to base their need. Regardless of this, without such approval, the research could not have been conducted.

The formal review

At this point, a full literature review together with the developed methodology for data collection and analysis was required. The standard PhD model demanded the literature review prior to primary research. This again was in conflict with a GT approach. Based upon institutional requirements, the methodology presented for review was as follows:

Semi-structured interviews: Divided into two groups, with those who observed sketch inhibition, i.e. industry and education specialists; and with those who suffered sketch inhibition, i.e. undergraduates of design. The semi-structured approach was considered the most appropriate mode and accordingly, a standard operating procedure had to be developed and a set of questions designed.

Protocol analysis experiment and observation: to identify the symptoms of sketch inhibition among sufferers, a sample of inhibited students would complete an ideation task to be observed and coded. This was based upon similar methodologies of Suwa et al. (1998) , Bilda and Gero (2005) and Kim et al. (2010) identified from the literature used to investigate designers’ processes. It was intended that data would be analysed using a coding system based on precedents set by Suwa et al. (1998) and Tang et al. (2011) .

NASA TLX questionnaire: to be applied post-protocol analysis experiment to establish participants’ emotional response to the activity to provide data about the soft issues of sufferers.

Questionnaire and Delphi study: once a proposal for sketch inhibition management had been developed, this would be submitted for feedback to interview subjects from Group 1. In addition to this, the Delphi study ( Hsu and Sandford, 2007 ) was intended to produce a normalised set of moderated pedagogic tools for use by educators ( Author, 2016 ).

Getting it wrong

Based upon this proposal, the formal review was passed and progression to a PhD was approved. However, as a piece of GT research, the project was already failing: the methodology up to this point had been driven entirely by institutional requirements and not by the data. The remit of the study was the development of a theory of sketch inhibition and pedagogic framework; however, the proposed tools would not facilitate the constant comparative and purposive sampling essential to achieve this. In fact, the research process had developed into a series of box-ticking exercises to fulfil the requirements of the institution and understanding sketch inhibition had become subordinate to the research proposal. This was completely at odds with the aim and approach of the study and a watershed moment – the GT literature was revisited, the protocol experiment, NASA TLX questionnaire and questionnaire and Delphi study duly scrapped and restructuring of the project undertaken.

Getting it right

Based solely upon the emergence of issues from data, the interview method alone was kept, albeit in a form more reflective of true GT. The semi-structured approach was scrapped, instead, identifying issues to be discussed with subjects based, simply, upon the question, “what do I need to know about sketch inhibition?” This would be applied to the same two groups, i.e.; observers and sufferers of sketch inhibition. From this, further interviews were conducted, data coded immediately after each one, and emergent themes used to inform the next interview, i.e.; adding to the body of issues to be discussed.

The interviews provided both data for the study, and insight into the problematics of conducting GT research. Digression was a common issue, particularly among industry subjects and often difficult to manage: if everything was considered as data within a GT study, to what extent could digression be allowed in case it offered up some new and unexpected insight? This was difficult to resolve – it also resulted in lengthy transcriptions and data extraction that were the most time-consuming part of the study.

Lack of structure during the interviews with students was particularly problematic. It was assumed the unstructured approach favoured in GT studies would elicit breadth and depth of data, but this was not the case: students were simply unaware of what they didn’t know. Lack of maturity and experience may have affected the way subjects responded, and it was evident their understanding of sketching and the design process was somewhat poor. The frustration of trying to tease out responses from some subjects created a tendency to ask leading questions – this had to be carefully monitored to avoid corrupted the data. Data from educators was very high and proved most valuable to the study. Constant comparison and theoretical sampling led to an interview with one subject whose data approved pivotal to the whole study: without using GT, this subject not have been identified.

Always a conundrum for qualitative research, interview sample size was surprisingly simple to establish. Where the literature offered a plethora of notions about this, GT made it simpler: the interviews continued until no further new issues emerged from the data. Instead of an arbitrarily-set sample, constant comparison enabled identification of the point of saturation.

Data management

Depth and breadth of data during GT research is difficult to predict, Fassinger (2005) noting the complexity of data handling as potentially problematic. NVivo software was used throughout the study for storage, management, coding and analysis, thereby mitigating some of the complexity observed by Charmaz (2000) . NVivo’s graphic tools enabled visual macro-analysis of the data – this, essential for interrogating the quantity of data generated by the study. Charmaz (2000 , p. 520) suggested that such software had a tendency to “unintentionally foster an illusion that interpretive work can be reduced to a set of procedures”. This did not, however, appear problematic: emergent themes rather than software parameters were the driver of data handling.

Data analysis

The coding process, “identifying patterns and discovering theoretical properties in the data,” ( Bowen, 2008 , p. 144), adhered to the Straussian method, initially developing open coding. Individual nodes were created as they emerged from the data, observing Borgatti's (2020) “nouns and verbs of a conceptual world.” Boyatzis’ (1998 , p. 161) definition of a theme was observed as closely as possible; “a pattern in the information that at minimum describes and organises the possible observations and at maximum interprets aspects of the phenomenon” – (process illustrated in Figure 1 ).

A hierarchy of themes emerged as coding progressed. Meta-themes became structured into parent nodes, for example, “cognitive issues” and “definitions of sketching.” As new interview data were analysed, additional themes emerged and iterative (constant comparison) process of revisiting already coded data to code for new themes was conducted. And so, the number of parent nodes increased, as did child nodes within these. Braun and Clarke’s (2006) method was also observed: to reduce loss of context during coding some of the surrounding data was kept: whole sentences and sometimes paragraphs relevant to the theme were coded to maintain clarity of meaning. Multiple coding also formed part of the constant comparison process – coding data as many times as necessary to ensure it was coded into all nodes it related to. Throughout the coding process, axial coding, using mind mapping techniques, identified further issues within and between themes, according to Walker and Myrick (2006 , p. 553), to “understand categories in relationship to other categories and their subcategories” ( Figure 2 ).

Selective coding, “the process of selecting the central or core category, systematically relating it to other categories, validating those relationships and filling in categories that need further refinement and development,” ( Strauss and Corbin, 1990 , p. 116), began towards the end of the data gathering process. This underpinned the structure of findings and their presentation as a narrative of sketch inhibition ( Figure 3 ).

Theoretical sampling

Where theoretical sampling offered efficiency to the study, the lack of time to research new methodologies was problematic. During coding, the potential benefit of a learning style survey emerged. Responses from the interviews with sufferers of sketch inhibition suggested that there may be a link between inhibition and learning preference or learning difference. As such, a new data gathering methodology was applied. Similarly, the interview data suggested a possible issue among sufferers of inhibition and their employability – the benefit of a longitudinal study emerged.

The findings from the learning preference study were valuable to the study; however, the longitudinal study failed to gather any purposeful data: the GT approach of developing methodology according to emerging need was proving problematic. The fixed timeframe of the study prevented the development of an effective methodology and its application in an effective way. Instead, a rushed study with limited sample, based upon revisiting interview subjects via email was applied, very unsuccessfully.

Thesis structure

The thesis, in traditional PhD study, requires a linear set of content to be presented for examination. A product of the positivist tradition, such structure tends to favour the sciences. This is endorsed by the institution’s Code of Practice for Research Degree Students ( De Montfort University, 2018 , p. 52), which describes the structure of “a conventional dissertation”. Additionally, the mandatory training modules provided by the doctoral training programme, specifically, Structuring and Completing Your Thesis ( De Montfort University, 2020 ), further validate this, describing the required format for thesis presentation ( Figure 4 ).

Despite pouring through many theses during the course of the study in search of non-traditional formats, these requirements appear to have never been challenged. It was tempting to present the study in a non-linear format truly reflective of Grounded Theory, but too much was at stake and thus a version of the traditional structure was submitted.

Positivist issues for grounded theory research

A typical PhD taking between three and seven years to complete, timeframe is an immutable factor and certainly impinged upon this study. Without the limits of time, a truer reflection of the possibilities of GT research would have been achieved. The study would have continued as long as was necessary, the data and findings growing far beyond those presented in the thesis. Time restrictions were a constant issue – the joy of observing the emergence of a new issue to research, coupled with the lack of available time to investigate a potential methodology was problematic. This was particularly apparent during the learning style questionnaire and longitudinal study. Despite this, it was also an essential mechanism for the study – an ensuing deadline guaranteed to sharpen the mind. Although positivism could be criticised for placing restrictions upon the study it would have looked very different without it – and not necessarily for the better. PhD requirements actually lent a beneficial framework to the research, structure providing helpful boundaries to work within.

Henwood and Pidgeon (2003) believe, “The excitement and challenge of GT is finding a way out of its maze, but there is no one legitimate way out of the maze,” and GT research is certainly nothing if not complex. Fernández and Lehmann (2005) considered creativity an important part of GT research coupled with the need to conceptualise to develop theory from the data. They also believed the researcher should be able to tolerate confusion, and sporadic regression of the research process. These factors were certainly reflective of the study, challenging traditional linear approaches to previous projects.

GT appears to relate closely to Complexity Theory, ( Kuhn, 2008 ; Wang, 2010 ). Although in its infancy, this could provide a paradigm for the future of design education, and potentially benefit research into creative issues – both approaches able to accommodate complex, creative, non-linear systems and emergence of unexpected data. Despite the methodological and epistemological benefits that could accompany this, such a reality is probably distant, and the shoe-horning of non-positivist endeavours into positivist structure would have to continue.

Novice use of GT can be fraught with complexity and initially perceived as in-compatible with traditional post graduate research. However, a version of such an approach within a finite research structure is possible and very rewarding. The Glaserian model suffers most as a result of institutional requirements. Its purity is compromised from the outset by researcher prior knowledge and the use of literature during the proposal development stage (deleted phrase). The Straussian version is more accepting of the realities of constructivism – and more forgiving of research structure. Despite this, the research proposal and ethical requirements of contemporary research projects have a huge impact upon such a study.

The dual approach of constant comparison and theoretical sampling of both models are invaluable. They enable close observation of the study, both in terms of the data analysis and as a tool for the management of processes. They also support the researcher in dealing with novel and unexpected findings – the greatest joy of conducting research.

Based upon the observations of the case study, a set of considerations is offered for the novice researcher:

Understand what GT is about before you start. Make sure you fully understand its purpose and nature before you embark on research of this type: its remit is theory-building within an area of lack. It may be easier and less stressful to embrace other paradigms with more structured methodologies. The question is how hard do you want to make it for yourself?

It is almost impossible to apply GT in its purest form during post graduate research; identification of an issue to investigate is not enough for many institutions, (or funding bodies). They require certainty, a developed proposal with clear objectives and a methodology early on in the process, this being essential for ethical approval. This will require considerable reference to literature, understanding of GT and possible negotiation over the proposal before starting. At this point, theoretically, your research is no longer GT, but becomes a hybridized, institutionally acceptable form of the approach. Live with this, as there is little you can do.

Know the research will grow – it is not linear. GT research, being data driven, relies on the last piece of data to inform the next activity, (constant comparison and theoretical sampling). This implies a degree of flying by the seat of one’s pants, and allowing yourself to be taken wherever the data dictates. Where other types of research can be planned, GT is different and may lead to heated discussion with supervisors over matters of project management.

Allow the data to drive you at all times. This is almost a mantra when conducting such a project. The urge to lean towards a highly structured proposal is huge, especially during times of isolation and hopelessness that characterize PG research. Keep in mind that theory while covering unchartered territory is never going to be easy.

Being data driven, rather than relying on prescribed samples, data saturation can be easily identified using GT. Theoretical sampling is also efficient for focussing effort where it is required. The close relationship between research data and research activity allows this – and why coding data at the point of collection is so important.

Time will be problematic. Researching entire new methods of data gathering and applying these effectively may be problematic. It is somewhat of a Catch 22 for the researcher: such methods cannot be fully investigated and piloted prior to a GT study, as the data has not guided you there. However, during a GT study, getting to grips with unfamiliar and unexpected methodologies takes time. This can result potentially, in poor application and results of little benefit to the research.

It is not tidy. If you prefer a clear, highly managed approach to research, GT may not be your bag. The snowball effect of research and data growing in different and unexpected directions at the same time can be overwhelming. A pragmatic disposition is required in this situation – the ability to detach necessary to maintain control of the process.

Positivist factors should be embraced – timeframes, deadlines and structure are the antithesis of GT, but without them the novice handler will struggle to maintain focus and momentum.

GT research offers a steep learning curve and the balancing between immersion in the data and maintaining objectivity. If all these factors do not deter the novice researcher, such projects can be creative, exciting and hugely rewarding.

Emergence of initial themes from the data according to Strauss’ method of open coding

Model of axial coding using mind mapping techniques

Selective coding to build the narrative of sketch inhibition

Required thesis structure

Author ( 2015 ), PhD Proposal, [Unpublished Document] , De Montfort University , Leicester .

Author ( 2016 ), Formal Review Document [Unpublished Document] , De Montfort University , Leicester .

Author ( 2019 ), “ Designers who don’t draw: an investigation into sketch inhibition among undergraduate designers ”, PhD thesis, De Montfort University , Leicester .

Baker , C. , Wuest , J. and Stern , P.N. ( 1992 ), “ Method slurring: the grounded theory/phenomenology example ”, Journal of Advanced Nursing , Vol. 17 No. 11 , pp. 1355 - 1360 , doi: 10.1111/j.1365-2648.1992.tb01859.x .

Bilda , Z. and Gero , J.S.J. ( 2005 ), “ Does sketching off-load visuo-spatial working memory? ”, Studying Designers , Vol. 5 No. 2005 , pp. 145 - 160 .

Bohm , A. ( 2004 ), “ Theoretical coding: Text analysis in grounded theory ”, in Flick , U. , von Kardoff , E. and Steinke , I. (Eds), A Companion to Qualitative Research , Sage , pp. 270 - 275 .

Borgatti , S. ( 2020 ), “ Introduction to grounded theory ”, available at: www.analytictech.com/mb870/introtogt.htm ( accessed 30 January 2018 ).

Bowen , G.A. ( 2008 ), “ Naturalistic inquiry and the saturation concept: a research note ”, Qualitative Research , Vol. 8 No. 1 , pp. 137 - 152 , doi: 10.1177/1468794107085301 .

Boyatzis , R. ( 1998 ), Transforming Qualitative Information: Thematic Analysis and Code Development , Sage .

Braun , V. and Clarke , V. ( 2006 ), “ Using thematic analysis in psychology ”, Qualitative Research in Psychology , Vol. 3 No. 2 , doi: 10.1191/1478088706qp063oa .

Charmaz , K. ( 2000 ), “ Constructivist and objectivist grounded theory ”, Handbook of Qualitative Research , pp. 509 - 535 .

De Montfort University ( 2018 ), Code of Practice for Research Degree Students , De Montfort University .

De Montfort University ( 2020 ), “ REST7301 structuring and completing your thesis ”, [online teaching resource] Doctoral College, De Montfort University , Leicester .

Doherty , M. ( 2015 ), [Interview] Lecturer, Department of Design , University of Suffolk , Ipswich .

Downs , S. ( 2017 ), [Interview] Senior Lecturer, School of the Arts , English and Drama, Loughborough University .

Fassinger , R.E. ( 2005 ), “ Paradigms, praxis, problems and promise: grounded theory in counseling paradigms ”, Journal of Counseling Psychology , Vol. 52 No. 2 , pp. 156 - 166 , doi: 10.1037/0022-0167.52.2.156 .

Fernández , W.D. and Lehmann , H. ( 2005 ), “ Achieving rigour and relevance in information systems studies: Using grounded theory to investigate organizational cases ”, The Grounded Theory Review , Vol. 5 No. 1 , pp. 79 - 107 .

Furniss , D. , Blandford , A. and Curzon , P. ( 2011 ), “ Confessions from a grounded theory PhD: experiences and lessons learnt ”, Proceedings of the SIGCHI Conference on Human Factors in Computing Systems , pp. 113 - 122 .

Glaser , B. ( 1978 ), Theoretical Sensitivity , Sociology Press .

Glaser , B.G. ( 1992 ), Emergence vs Forcing: Basics of Grounded Theory Analysis , Sociology Press .

Glaser , B.G. and Strauss , A.L. ( 1967 ), The Discovery of Grounded Theory: Strategies for Qualitative Research , Aldine .

Guba , E.G. and Lincoln , Y.S. ( 2005 ), “ Paradigmatic controversies, contradictions and emerging influences ”, in Lincoln , N.D. (Ed.), The Sage Handbook of Qualitative Research , Sage pp. 191 - 216 .

Henwood , K. and Pidgeon , N. ( 2003 ), “ Grounded theory in psychological research ”, in Camic , P. , Rhodes , J. and Yardley , L. (Eds), Qualitative Research in Psychology: Expanding Perspectives in Methodology and Design , APA .

Howell , K. ( 2013 ), An Introduction to the Philosophy of Methodology , Sage .

Hsu , C.-C. and Sandford , B.A. ( 2007 ), “ The Delphi technique: making sense of consensus, practical assessment ”, Research and Evaluation , Vol. 12 No. 10 , pp. 1 - 8 .

Kim , J.E. , Bouchard , C. , Omhover , J.F. and Aoussat , A. ( 2010 ), “ Towards a model of how designers mentally categorise design information ”, CIRP Journal of Manufacturing Science and Technology , Vol. 3 No. 3 , pp. 218 - 226 , doi: 10.1016/j.cirpj.2010.11.004 .

Kuhn , L. ( 2008 ), “ Complexity theory and educational research ”, Educational Philosophy and Theory , Vol. 40 No. 1 , pp. 177 - 189 .

Leedy , P. and Ormrod , J. ( 2010 ), Practical Research: planning and Design , Pearson .

Locke , K. ( 1996 ), “ Rewriting the discovery of grounded theory after 25 years? ”, Journal of Management Inquiry , Vol. 5 No. 3 , pp. 239 - 245 , doi: 10.1177/07399863870092005 .

Muratovski , G. ( 2016 ), Research for Designers , Sage .

Potter , S. ( 2006 ), Doing Postgraduate Research , Sage .

Strauss , A. and Corbin , J.M. ( 1990 ), Basics of Qualitative Research: Grounded Theory Procedures and Techniques , Sage Publications .

Suddaby , R. ( 2006 ), “ What grounded theory is not ”, Academy of Management Journal , Vol. 49 No. 4 , pp. 633 - 642 .

Suwa , M. , Purcell , T. and Gero , J. ( 1998 ), “ Macroscopic analysis of design processes based on a scheme for coding designers’ cognitive actions ”, Design Studies , Vol. 19 No. 4 , pp. 455 - 483 , doi: 10.1016/S0142-694X(98)00016-7 .

Tang , H. , Lee , Y. and Gero , J. ( 2011 ), “ Comparing collaborative co-located and distributed design processes in digital and traditional sketching environments: a protocol study using the function–behaviour–structure coding scheme ”, Design Studies , Elsevier , Vol. 32 No. 1 , pp. 1 - 29 , doi: http://dx.doi.org.proxy.library.dmu.ac.uk/10.1016/j.destud.2010.06.004 .

Wacker , J.G. ( 2008 ), “ A conceptual understanding of requirements for theory-building ”, Journal of Supply Chain Management , Vol. 44 No. 3 , pp. 5 - 15 .

Walker , D. and Myrick , F. ( 2006 ), “ Grounded theory an exploration of process and procedure ”, Qualitative Health Research , Vol. 16 No. 4 , pp. 547 - 559 .

Wang , T. ( 2010 ), “ A new paradigm for design studio education ”, International Journal of Art and Design Education , Vol. 29 No. 2 , pp. 173 - 183 , doi: 10.1111/j.1476-8070.2010.01647.x .

Corresponding author

About the author.

Lisa Thurlow is a Lecturer within the School of Design, researcher and writer. Her teaching crosses multiple disciplines including interior design, fashion and textiles, footwear, design management, research methodologies and design cultures. Her PhD (2019) used Grounded Theory to consider the cause, symptoms and management of sketch inhibition among under-graduate designers across multiple disciplines. Her interests include design cognition and visual learning pedagogies, developing tools for students with learning differences and international students for whom such approaches are beneficial. She runs workshops in design process sketching and inhibition management and is currently working on various related publications.

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Home > ETD > Doctoral > 5973

Doctoral Dissertations and Projects

Examining influences of academic resilience among minority adolescent students.

Sylvia Alice Okpon , Liberty University Follow

School of Behavioral Sciences

Doctor of Education in Community Care and Counseling (EdD)

Tracy N. Baker

Academic resilience, racial minority, minority middle school students, adolescents, academic success

Disciplines

Recommended citation.

Okpon, Sylvia Alice, "Examining Influences of Academic Resilience Among Minority Adolescent Students" (2024). Doctoral Dissertations and Projects . 5973. https://digitalcommons.liberty.edu/doctoral/5973

This quantitative and correlational study aimed to investigate which variables of minority adolescent students promote academic resilience and focus on African American and Hispanic students within a public charter school located in Southeast Texas. Grounded on resilience theory, the research investigated the cognitive and emotional regulation of students and student–teacher connections in the process of academic resilience. A purposive sample composed of more than 100 students was used to collect data using the Cognitive Emotional Regulation Questionnaire, the Inventory of the Student–Teacher Relationship, and the Academic Resilience Scale for an online survey. Data analysis indicated that cognitive and emotional resilience mitigating coping skills demonstrate significant or greater adaptation to academic hardships. Furthermore, the correlations of the strong teacher–student ties on academic resilience emphasized the mediation effect on the repercussions of emotional regulation. This research highlights the importance of identifying and cultivating factors that give academic success among vulnerable groups of students. In this case longitudinal aspects of the influence of resilience strategies and broader demographic factors emerged as an important direction of further investigation. This research study sought to deliver valuable recommendations to educators who are not only learning specialists but also psychologists and policymakers striving to improve the academic achievements of minority students who are studying in disadvantaged environments.

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