Knowledge generated solely through quantitative hypothetical-deductive research approaches, while extremely valuable in clinical practice, appears insufficient in family medicine; the meanings that patients and professionals give to health issues, as well as the context of health care delivery, play a vital role in enhancing care. Qualitative research in primary care is growing; it is attempting to clarify how people think and the meanings they give to health, disease, and life events. The most common methodology of qualitative research in medicine is grounded theory methodology (GTM). Grounded theory emphasizes using steps and procedures to connect induction and deduction through constant comparison of the data to generate new and valid sociologic theories from empiric material. However, not all studies in medical sciences that use methods for analyzing qualitative data developed by grounded theorists develop a new theory. Family physicians need to have an understanding of GTM to interpret and hopefully engage in qualitative research to resolve some of the elusive issues in health care. This article briefly describes the evolution of GTM and highlights the similarities and differences among the 2 main streams: Glaserian and Straussian grounded theories. It also discusses constructivist grounded theory, which is a modified Straussian grounded theory by Charmaz and Clarke that uses situational analysis in GTMs to incorporate real-world messiness into qualitative research.
Evolution of GTMs
Grounded theory methodology, an approach originally developed by Glaser and Strauss in the 1960s, paved the way for a different form of research that was hypothesis generating as opposed to the accepted norm and the practice of hypothesis-driven theory verification research.1 Over the years the original GTM evolved into 2 main approaches: that of Glaser,2,3 rooted in critical-rationalistic thinking, and that of Strauss and Corbin,4 inspired by pragmatist and interactionist thinkers. In traditional or Glaserian grounded theory, the methodology aims to discover a theory that might be subsequently verified by further research. Strauss, on the other hand, advocates that there are multiple truths and that the external world is a symbolic representation.4 Currently, both approaches to GTM and their variations are used as theoretical frameworks in qualitative research.
Analysis of original data and previously collected data (ie, secondary data) is deemed acceptable in the original description of grounded theory by Glaser and Strauss.1 One of the fundamental aspects of Straussian grounded theory is the insistence on simultaneous data gathering and analysis. Glaser permits more flexible approaches to data collection and analysis, whereas Strauss and Corbin advocate for elaborate coding and verification methods.5 Although Strauss and Corbin’s approach emphasizes coding frameworks and verification procedures, it acknowledges the researcher’s subjectivities and moves toward a constructivist paradigm in which it is assumed that reality is always interpreted and that reality exists only as multiple mental constructions.5
Constructivist grounded theory
The constructivist grounded theory articulated by Charmaz assumes that analysis is created from shared experiences and relationships between the researchers and the participants.6 It also explores and discovers patterns and connections among categories in the data and assumes emerging multiple realities and indeterminacy.6 Charmaz’s approach allows researchers to explore how participants’ experiences are embedded in a larger context of structural, cultural, temporal, and social situations and relationships. The differences and distinctions between people and hierarchies of power and communication that maintain and perpetuate such differences and distinctions become visible during the analysis.6 Charmaz adds that a researcher’s viewpoint is considered within the theorizing process, and she explains the term theorizing as being both a process and a practice. Theorizing means “stopping, pondering, and rethinking anew ... establishing connections, and asking questions .... When you theorize, you reach down to fundamentals, up to abstractions, and probe into experience,”6 and avoid importing and imposing prepackaged images and ideas onto the data.
Glaser suggests delaying the literature review until data analysis is complete, so themes are developed from the data without the researcher being influenced by the findings of the literature review.5 Charmaz and Strauss and Corbin suggest a preliminary review of relevant literature to obtain conceptual clarity of the problem under investigation.7 However, all grounded theorists emphasize performing a literature review to situate categories and concepts within the existing literature once a theory emerges from the data.
Situational analysis
Another researcher, Clarke, argued that although Strauss’ grounded theory is considered progressive, it maintains a positivist modernist worldview focusing on a pure “basic social process” and does not sufficiently analyze power relations or reflect on materiality.8 Clarke moved grounded theory around the “postmodern turn” with a method assemblage called situational analysis.8,9 Clarke’s approach can include Charmaz-type axial coding, theoretical coding, sampling techniques, memoing, and systematic comparisons, but Clarke argues that grounded theory should be enlarged to represent messiness in social arenas.8 In essence, situational analysis offers more reflexivity, uncertainty, modesty, and representation of contradictions. Clarke’s situational analysis proposes that researchers construct 3 kinds of maps that place emphasis on the range of differences in the data rather than commonalities, as found in the traditional grounded theory approach. The 3 kinds of maps are as follows:
situational maps that lay out the important human, nonhuman, discursive, and material elements in the research situation of concern and provoke analysis of relations among them;
social world and arena maps that lay out the collective actors and their arenas of commitment, framing meso-level interpretations of the situation; and
positional maps that examine the important positions taken (and not taken) in the discourses and the positionality for researchers using critical or deconstructive paradigms.
Situational analysis is offered as an additional tool to help researchers examine conditionality, complexity, and variations, differences, and silences in data.8,10 Clarke emphasizes that the maps can be produced using any or all of the strategies suggested in situational analysis to provide context for the research.8
Conclusion
The theoretical orientation to grounded theory has evolved over time, but rigour and trustworthiness remain important when using GTM. Although, in general, transferability becomes the responsibility of the person who wishes to apply the results to a different context, some of the responsibility to facilitate transferability rests with the researcher.11 There is no single approach to using GTM, and researchers often need to tailor their approach and generate their own version of GTM in the process of conducting research.11,12 Researchers should be encouraged to describe their approach to GTM and their rationale to inform others embarking on similar research.
Notes
Hypothesis is a quarterly series in Canadian Family Physician (CFP), coordinated by the Section of Researchers of the College of Family Physicians of Canada. The goal is to explore clinically relevant research concepts for all CFP readers. Submissions are invited from researchers and nonresearchers. Ideas or submissions can be submitted online at mc.manuscriptcentral.com/cfp or through the CFP website www.cfp.ca under “Authors and Reviewers.”
Footnotes
Competing interests
None declared
- Copyright© the College of Family Physicians of Canada