grounded theory case study method

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Grounded theory research: A design framework for novice researchers

Ylona chun tie.

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

Melanie Birks

Karen francis.

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

Background:

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

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

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

Discussion:

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

Conclusion:

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

Introduction

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

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

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

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

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

Genres: traditional, evolved and constructivist grounded theory

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

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

Research process

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

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

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

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

Purposive sampling

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

Constant comparative analysis

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

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

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

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

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

Generating/collecting data

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

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

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

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

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

Adapted from Birks and Mills. 6

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

Initial coding

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

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

Theoretical sampling

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

Examples of theoretical sampling.

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

Intermediate coding

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

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

Advanced coding

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

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

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

Writing the storyline.

Theoretical sensitivity

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

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

Theoretical sensitivity.

The grounded theory

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

Quality and rigour

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

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

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

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

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

Grounded Theory In Qualitative Research: A Practical Guide

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

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

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

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

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

On This Page:

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

What Is Grounded Theory?

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

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

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

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

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

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

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

When should you use grounded theory? 

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

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

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

What is the final product of a GT study?

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

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

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

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

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

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

Core Components of Grounded Theory

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

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

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

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

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

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

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

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

Glaserian Grounded Theory

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

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

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

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

Straussian Grounded Theory

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

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

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

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

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

Constructivist Grounded Theory

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

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

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

Situational Analysis

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

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

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

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

Limitations

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

Practical Steps

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

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

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

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

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

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

1. Planning and Philosophical Considerations

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

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

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

2. Recruit participants using theoretical sampling

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

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

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

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

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

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

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

3. Collect Data

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

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

4. Begin open coding as soon as data collection starts

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Memo Writing

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

6. Group codes into categories using axial coding

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

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

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

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

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

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

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

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

7. Define the core category using selective coding

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

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

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

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

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

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

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

Continue collecting data and analyzing until you reach theoretical saturation

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

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

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

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

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

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

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

8. Theoretical coding and model development

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

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

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

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

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

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

9. Write your grounded theory

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

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

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

Reading List

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

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

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Home » Grounded Theory – Methods, Examples and Guide

Grounded Theory – Methods, Examples and Guide

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Grounded Theory

Definition:

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

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

History of Grounded Theory

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

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

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

Types of Grounded Theory

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

Classic Grounded Theory

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

Constructivist Grounded Theory

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

Grounded Theory Conducting Guide

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

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

Data Collection Methods

Grounded Theory Data Collection Methods are as follows:

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

Data Analysis Methods

Grounded Theory Data Analysis Methods are as follows:

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

Applications of Grounded Theory

Here are some of the key applications of Grounded Theory:

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

Examples of Grounded Theory

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

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

Grounded Theory Research Example

A Grounded Theory Research Example Would be:

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

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

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

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

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

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

Purpose of Grounded Theory

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

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

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

When to use Grounded Theory

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

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

Characteristics of Grounded Theory

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

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

Advantages of Grounded Theory

Advantages of Grounded Theory are as follows:

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

Limitations of Grounded Theory

Limitations of Grounded Theory are as follows:

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

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Grounded Theory Methodology: Principles and Practices

• Reference work entry
• First Online: 13 January 2019
• Cite this reference work entry

• Linda Liska Belgrave 2 &
• Kapriskie Seide 2  

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Since Barney Glaser and Anselm Strauss’ (The discovery of grounded theory: strategies for qualitative research. New York: Adline De Gruyter, 1967) publication of their groundbreaking book, The Discovery of Grounded Theory , grounded theory methodology (GTM) has been an integral part of health social science. GTM allows for the systematic collection and analysis of qualitative data to inductively develop middle-range theories to make sense of people’s actions and experiences in the social world. Since its introduction, grounded theorists working from diverse research paradigms have expanded the methodology and developed alternative approaches to GTM. As a result, GTM permeates multiple disciplines and offers a wide diversity of variants in its application. The availability of many options can, at times, lead to confusion and misconceptions, particularly among novice users of the methodology. Consequently, in this book chapter, we aim to acquaint readers with this qualitative methodology. More specifically, we sort through five major developments in GTM and review key elements, from data collection through writing. Finally, we review published research reflecting these methods, to illustrate their application. We also note the value of GTM for elucidating components of culture that might otherwise remain hidden.

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Belgrave, L.L., Seide, K. (2019). Grounded Theory Methodology: Principles and Practices. In: Liamputtong, P. (eds) Handbook of Research Methods in Health Social Sciences. Springer, Singapore. https://doi.org/10.1007/978-981-10-5251-4_84

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

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

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

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

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

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

Conclusions

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

Peer Review reports

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

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

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

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

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

Study background

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

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

Designing this grounded theory study

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

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

A. An open beginning and research questions

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

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

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

How did this process vary?

B. Ethics approval and ethical issues

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

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

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

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

Initial Interviews

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

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

D. Data Analysis

Coding and the constant comparative method.

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

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

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

Memo-writing

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

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

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

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

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

Evolution of theoretical sampling and interview questions

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

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

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

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

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

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

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

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

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

The quality of this grounded theory study

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

During data collection

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

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

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

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

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

During data analysis

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

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

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

Answering our research questions

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

Concluding remarks

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

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

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

Abbreviations

grounded theory methods

Monitor Dental Practice Program

New South Wales

Randomized Controlled Trial.

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Acknowledgements

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

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

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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 .

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The authors declare that they have no competing interests.

Authors' contributions

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

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

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

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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

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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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