- 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
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.
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.
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.
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.
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.
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.
grounded theory methods
Monitor Dental Practice Program
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The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2288/11/128/prepub
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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Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia
Alexandra Sbaraini, Stacy M Carter & Anthony Blinkhorn
Population Oral Health, Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
Alexandra Sbaraini, R Wendell Evans & Anthony Blinkhorn
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Correspondence to Alexandra Sbaraini .
The authors declare that they have no competing interests.
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.
Electronic supplementary material
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)
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)
Additional file 3: Questions added to the modified interview schedule for dentists and dental practice staff. file containing questions added to the modified 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
Received : 17 June 2011
Accepted : 09 September 2011
Published : 09 September 2011
DOI : https://doi.org/10.1186/1471-2288-11-128
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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.
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.
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.
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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.
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.
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 ).
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.
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
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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 .
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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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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
2 College of Health and Medicine, University of Tasmania, Australia, Hobart, TAS, Australia
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.
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.
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.
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.
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.
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
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 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.
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, 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
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.
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.
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.