grounded theory methods of qualitative research

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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.

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Home » Grounded Theory – Methods, Examples and Guide

Grounded Theory – Methods, Examples and Guide

Table of Contents

Grounded Theory

Definition:

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

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

History of Grounded Theory

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

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

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

Types of Grounded Theory

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

Classic Grounded Theory

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

Constructivist Grounded Theory

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

Grounded Theory Conducting Guide

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

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

Data Collection Methods

Grounded Theory Data Collection Methods are as follows:

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

Data Analysis Methods

Grounded Theory Data Analysis Methods are as follows:

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

Applications of Grounded Theory

Here are some of the key applications of Grounded Theory:

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

Examples of Grounded Theory

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

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

Grounded Theory Research Example

A Grounded Theory Research Example Would be:

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

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

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

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

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

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

Purpose of Grounded Theory

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

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

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

When to use Grounded Theory

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

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

Characteristics of Grounded Theory

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

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

Advantages of Grounded Theory

Advantages of Grounded Theory are as follows:

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

Limitations of Grounded Theory

Limitations of Grounded Theory are as follows:

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

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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7 The Grounded Theory Method

Antony Bryant, Faculty of Arts, Environment, and Technology, Leeds Metropolitan University

• Published: 02 September 2020
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The term grounded theory was introduced to the research lexicon by Barney Glaser and Anselm Strauss in the 1960s, particularly with the publication of The Discovery of Grounded Theory in 1967. The term itself is somewhat misleading since it does not refer to a theory per se but rather to a method that facilitates the development of new theoretical insights—grounded theories. In this chapter the method is outlined, together with some background to its appearance and subsequent developments. Some key aspects are demonstrated using brief examples and exercises. Later sections describe the main features, procedures, outputs, and evaluation criteria.

The term grounded theory first came to prominence with the publication of The Discovery of Grounded Theory (hereafter Discovery ) by Barney Glaser and Anselm Strauss in 1967. Since that time, the term itself has come to encompass a family of related approaches to research that reaches across many disciplines, including the social sciences, psychology, medicine, healthcare, and many others. Strictly speaking, the term grounded theory refers to the outcome of a research process that has used the grounded theory method, but it is quite common for researchers and others to refer to the method simply as grounded theory, with the context clarifying the meaning. For instance, when Kathy Charmaz and I were compiling and editing a handbook on the topic (Bryant & Charmaz, 2007a/2010), I suggested that the title should be The Sage Handbook of the Grounded Theory Method , a suggestion that was immediately and justifiably rejected by our editor on the grounds that, as far as publishers, librarians, and researchers were concerned, The Sage Handbook of Grounded Theory was far more recognizable and perfectly self-explanatory. For the purposes of what follows, however, the term grounded theory method —hereafter GTM—will be used to refer to the method, with the term grounded theory referring to the outcome.

Prior to the appearance of Discovery , Glaser and Strauss had published several papers and also a book-length study using the GTM, entitled Awareness of Dying (Glaser & Strauss, 1965 ; hereafter Awareness ). This early work developed from deeply personal experiences for both of them, Glaser and Strauss having each recently suffered the loss of a parent. It is crucial to understand that these deeply personal experiences of key life-cycle events were an important facet of the development of the method. Moreover, similar issues continue to form a key feature of a good deal of research using GTM, with the individual researcher or research team being motivated in their work by personal experiences or specific interests in the area. This is evidenced in many papers and accounts centered on GTM-oriented research, and several of the contributors to chapters in the 2007 handbook stress this aspect (e.g., Covan, 2007 ; Star, 2007; Stern, 2007 ).

Glaser and Strauss were joined in their early research by Jeanne Quint (later Jeanne Quint Benoliel), a nursing specialist who transformed the practice of care for the terminally and chronically ill in the course of her professional career, eventually being admitted to the Nursing Academy of Fame (Quint, 1967 ; Quint Benoliel, 1982 , 1996 ). Some of the earliest papers on GTM not only were coauthored by Glaser and Strauss, but also included Quint (Strauss et al., 1964 ). Indeed, the acknowledgments at the beginning of Discovery include reference to a Public Health Service research grant, the funding for which provided the basis for the work leading to publication not only of Awareness and Discovery —and the later book Time for Dying (Glaser & Strauss 1968 )—but also of Quint’s own book, The Nurse and the Dying Patient (1967). Moreover, Quint’s interest in the outcomes of the work would almost certainly have been centered on the ways in which the research on dying—“awareness” and “time”—afforded a basis for more effective practice, something that has always been a central feature and concern of those developing GTM

Apart from their personal experiences of bereavement, the personal trajectories of both Glaser and Strauss are critical in understanding their contributions, joint efforts, and later divergent trajectories with regard to GTM. Anselm Strauss studied at the University of Chicago as a postgraduate and thereafter held posts at various colleges and universities until he returned to Chicago in the 1950s. At this stage, he worked with and was influenced by Howard Becker ( 1963 ) and Erving Goffman ( 1959 ), continuing the ideas of the earlier Chicago luminaries such as Herbert Blumer ( 1969 ) and George Herbert Mead (1934, 1938). Blumer is credited with coining the term symbolic interactionism in the 1930s, although its origins are usually linked to the work of Mead. This basis provided Strauss with a background in social sciences that stressed the importance of naturalistic forms of inquiry, and his writings include standard and influential works on social psychology, many of which went through several revisions and reprints. In 1960, Strauss moved to the University of California, San Francisco (UCSF). There, he was given the responsibility of establishing the teaching of research methods in the new doctoral program in nursing, itself something of a key innovation. By 1968, he had developed his own doctoral program in sociology, with a specific focus on health, illness, and care and with a clear predilection for qualitative research. As explained later, his early background was critical in the initial articulation of GTM and its later developments, but not always in the ways that might have been expected.

Barney Glaser studied at Columbia University, New York, where the key influences and luminaries were Paul Lazarsfeld and Robert K. Merton, Merton being ostensibly the supervisor for Glaser’s Ph.D. The influence of Lazarsfeld was significant, and, to some extent, Glaser might be considered one of the key adherents and developers of Lazarsfeld’s methodological ideas. Glaser himself makes this clear in his book Doing Quantitative GT (2008), in which he clarifies the ways in which Lazarsfeld’s ideas influenced and presaged many key aspects of GTM itself.

In a more recent account of his time at Columbia (Holton, 2011 ), however, Glaser placed far more emphasis on the direct influence of Hans Zetterberg in his intellectual and methodological trajectory. The overall impact of his time at Columbia was to imbue Glaser with an agenda that included confidence in pursuing his own research ideas, a suspicion of grand conceptualizations and the grand conceptualizers, and the importance of publishing one’s work—if necessary, self-publishing. In the development of GTM, the influence of Lazarsfeld was particularly important, as will be explained.

In the early 1960s, Glaser moved from New York to California, and by the mid-1960s, he and Strauss had started to collaborate, producing Awareness in 1965, as well as various earlier papers that can be seen as precursors of GTM. Awareness included a brief appendix entitled “Methods of Collection and Analysis of Data.” This is an important early statement of GTM. It notes that both Strauss and Glaser experienced bereavements in the years prior to their research. Strauss’s experience in the death of his mother led him to understand the importance of people’s expectations of the “certainty and timing of dying” (Strauss & Glaser, 1965, p. 287). He had set up a preliminary study and was later joined in this by Barney Glaser, whose father had recently died. The appendix offers a succinct summary of the approach that was used to produce the foregoing chapters, with mention being made of the importance of developing the confidence to plunge into the fieldwork from the outset, generating hypotheses in subsequent stages as the research progresses, and the “blurring and intertwining of coding, data collection and data analysis” (p. 288). Anyone looking for a starting point in reading about GTM would do well to start with this appendix.

The doctoral program at UCSF, founded in 1968, was very much a proving ground for GTM, although only a limited number of the first intakes used the method in the doctoral dissertations. Those among the first groups undertaking this program were presented with the new research approach, and many of them subsequently became key propagators and developers of the method—notably Kathy Charmaz, Phyllis Stern, Carolyn Wiener, and Adele Clarke. Given the settings and context of Glaser and Strauss’s early research and also that the focus of UCSF was on developing professionals in the areas of medicine, nursing, and what might be termed health support, it was not surprising that much of the work emanating from these GTM pioneers focused on hospital- and health-oriented issues.

Marking the 40th anniversary of the doctoral program in 2008, a member of its first intake made the following comment:

“I like to refer to this program as The Mouse That Roared,” says Virginia Olesen, professor emerita in the Department of Social and Behavioral Sciences at the UCSF School of Nursing. “This has always been a tiny program—never more than six or seven faculty. But, my gosh, the contributions …” (quoted in Schwartz, 2014 )

Strauss can be seen as a pioneer of what would now be termed the sociology of medicine and healthcare. Moreover, this initial anchoring in the healthcare context, combined with the methodological innovations, resulted in a rich and varied series of outputs that have had a significant and continuing influence on social research methods, nursing practices, and palliative care. Schwartz ( 2014 ) did not exaggerate in summarizing the contributions as including

legitimizing the concept of nursing research, establishing today’s most prominent qualitative research methodology, and supplying much of the ammunition informing the most significant public discussions about health and health care over the past half century, from women’s health and health disparities to aging and the impact of science and technology.

With regard to GTM itself, many of the students from these early years of the program went on to develop and enhance the method, including Kathy Charmaz, Juliet Corbin, and Adele Clarke. Since the late 1990s the method has become ever more popular and its application wide-ranging, often in conjunction with other methods and approaches. The chapters in the newly published Handbook of Current Developments in Grounded Theory (Bryant & Charmaz, 2019 ) and The Varieties of Grounded Theory (Bryant, 2019 ) attest to and exemplify this.

Background and Early Development

Although Discovery is commonly regarded as the founding text of GTM, its role was very much one of a manifesto, rather than an instructional overview or manual. In the opening pages of the book, Glaser and Strauss ( 1967 ) argued that the work “is directed toward improving social scientists’ capacities for generating theories” (p. vii). They recognized that not everyone can develop this capacity, but this does not mean that it should be seen as something restricted to a few geniuses. Generating “useful theories” requires “a different perspective on the canons derived from vigorous quantitative verification on such issues as sampling, coding, reliability, validity, indicators, frequency distributions, conceptual formulation, construction of hypotheses, and presentation of evidence. We need to develop canons more suited to the discovery of theory ” (p. viii; emphasis added).

Glaser and Strauss contended that research in the social sciences in the United States in the 1960s was largely centered on the grand theorists and their grand theories. Thus, doctoral students in particular were all too often expected to develop proposals that emanated from one or other well-founded, “grand” theoretical positions, deriving hypotheses and then concomitant procedures and tests for verifying these latter deductions. They saw this as a highly unequal relationship between “theoretical capitalists” and “proletarian testers.” Moreover, this emphasis on verification prevented new and useful theories from being developed. Whether this was quite as widespread as Glaser and Strauss claimed is not clear; indeed, Strauss himself had come from a contending orientation—the Chicago school—that had produced significant work from a fairly wide range of researchers. Indeed, some of these outputs can now be seen as embryonic grounded theories, for example, Boys in White (Becker, Geer, Hughes, & Strauss, 1961 ). But whatever the truth of Glaser and Strauss’s contention, GTM developed as a reaction against a view of research—quantitative and hypothesis oriented—that was prevalent among the social science research community in the United States at the time. It is also important, however, to understand that the method was, from the first, marked far more by its innovative claims and contribution to research practice than it was by its critical position with regard to standard approaches.

Kathy Charmaz ( 2006 , p. 8) pointed to the distinctive features of GTM that challenged many of the core assumptions prevalent among U.S. social science researchers in the 1960s:

the “arbitrary divisions between theory and research”; viewing qualitative studies as preparatory for more rigorous quantitative work; viewing qualitative research as illegitimate and devoid of rigour; viewing qualitative studies as impressionistic and unsystematic; the separation of data collection from its analysis; seeing the only possible outcome of qualitative research as “descriptive case studies rather than theory development.”

It is worth dwelling on these features, since further consideration will be of particular benefit in preparing a GTM-oriented research proposal that often requires engagement with the still-conventional hypothesis-oriented “quantitative canon.” This continues to be an issue for researchers using GTM because the method itself remains contentious and misunderstood by many of those in positions of authority in their respective fields—such as journal editors and reviewers, research examiners, and evaluators. (This matter is addressed at some length in Bryant, 2017 , particularly ch. 18.)

Research versus Theory

What Charmaz termed the “arbitrary division between theory and research” emanates from Glaser and Strauss’s argument that the social sciences in the 1960s in the United States had become “frozen” theoretically. The work of the European founding fathers of social science—Marx, Weber, Durkheim—had been supplemented by the work of homegrown theorists such as Parsons and Merton. This body of work had then come to be seen as a rich basis for further research, particularly for doctoral students and other, relatively inexperienced researchers, who would enhance existing work through the “canon of verification” to which Glaser and Strauss alluded in the opening section of Discovery .

Whatever the merits might have been for this orthodoxy, Glaser and Strauss, each in their own manner, had taken issue with it, both conceptually and as part of their own intellectual trajectories. Strauss had developed ideas in the field of social psychology and was heavily and directly influenced by the work of relatively unconventional social scientists associated with the various generations of the Chicago school, particularly those linked to symbolic interactionism. Glaser, conversely, had direct experience of the ways in which doctoral research could become a process of “proletarian testing” under the guidance of “theoretical capitalists”: Merton was his doctoral supervisor. Holton ( 2011 ) reported on a series of interviews with Glaser, in which he made it clear that although he learned a great deal from Merton and Lazarsfeld, he also consciously trod his own path, with encouragement from Zetterberg, who was only his senior by a few years. Merton’s concept of theories of the middle-range is referred to in Discovery and forms the basis for Glaser and Strauss’s discussion of substantive and formal grounded theories (see Future Directions: What Is a (Grounded) Theory Anyway?).

In their early statements on GTM, such as those in Awareness and Discovery , Glaser and Strauss ( 1965 , 1967 ) wanted not only to demonstrate the power of their method, but also to encourage others to follow their example. In particular, they wanted to encourage early-career researchers to branch out on their own, confident that they could and should aim to contribute new theoretical insights. The grounded theory method, with its emphasis on research founded on directly gathered data, rather than initial hypotheses, offered a route whereby researchers could aim to produce novel theoretical insights in the form of substantive theories—that is, conceptual statements or models that provided deep and practical insights into specific contexts, but that required further work if they were to provide the basis for more general purposes (see later discussion).

Glaser and Strauss were laying the foundation for the preparation of research proposals that can indeed eschew hypothesis testing as the starting point of research and instead specify objectives based on developing new conceptual models, frameworks, or theories. Research carried out on this basis can then be evaluated using Glaser and Strauss’s criteria of fit, grab, work , and modifiability . The view that research is something based on existing theories can be challenged, offering the alternative proposition whereby theories and hypotheses can be the results of a research project. This is not to suggest that the latter viewpoint eclipses the former, but rather that the sequence of “theory then hypotheses then research” can be supplemented or replaced by the sequence “research then theory and hypotheses.”

The Status of Qualitative Research

For many researchers and, perhaps more important, for many disciplinary and research domain gatekeepers, valid research ought to be quantitative. The epigram of Lord Kelvin (Sir William Thompson) is often (mis)quoted in this regard: “If you cannot measure it, you cannot (control) improve it.” A more extended version runs as follows:

In physical science the first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely in your thoughts advanced to the state of Science , whatever the matter may be. [PLA, vol. 1, “Electrical Units of Measurement,” 1883-05-03] available at http://zapatopi.net/kelvin/quotes/ . Accessed July 26, 2012

Kelvin also argued, however, that “radio has no future” and “X-rays will prove to be a hoax,” warned the Niagara Falls Power Company that I “trust you will avoid the gigantic mistake of alternating current,” and stated in his address to the British Association for the Advancement of Science, in 1900, that “There is nothing new to be discovered in physics now, All that remains is more and more precise measurement.” (This last statement is somewhat disputed, since the original source cannot be confirmed.) So much for Lord Kelvin’s prognostications!

All too often, researchers have made the mistake of measuring what can be measured, rather than attending to investigating the key issues—whether or not they are amenable to simple, or not-so-simple, quantification. Glaser and Strauss could have counted the number of patients who died in the various hospital wards they investigated; they could also have looked at the number of days or hours that elapsed between admission to hospital and eventual demise. These might have produced some meaningful outcomes, but the concepts of awareness and time would not have emanated from such studies. Nor would the work of Glaser and Strauss and that of Quint have provided the foundation for significant developments in professional care for the terminally ill.

Kelvin’s longer quote expresses the view that nonquantitative studies are “at best” a preliminary to true knowledge (which must always be quantitative), but the results of the burgeoning of qualitative research that has developed at least since the 1960s indicate something very different. The outcomes of qualitative research can indeed be poor, ill-defined, lacking in rigor, and of little practical use; but so too can the outcomes of quantitative research. Moreover, thanks to the efforts of Glaser and Strauss—as well as many others who have contributed to innovation in research practice in many disciplines—qualitative research can be carried out in accord with clear and coherent criteria, laying a foundation for rigorous claims to knowledge and conceptual and theoretical innovation.

As will be seen in the sections that follow, there is an issue with regard to the distinction between conceptual innovation and impressionistic (re)description, but this is no more problematic for qualitative research than issues around statistical significance and meaningless or ambiguous measurement are for quantitative research. The key point is that Glaser and Strauss’s work in the 1960s and beyond must be recognized as forming a significant contribution to the knowledge claims and practical significance of qualitative research methods and outcomes—many of which are now far more widely accepted if not fully understood and appreciated.

Data Collection and Analysis

One of Glaser’s teachers at Columbia was Paul Lazarsfeld, now considered one of the key influences in the development of investigative and experimental methods in sociology. Many of the existing taken-for-granted methods in applied social research were, in fact, developed by Lazarsfeld and his colleagues, and one of his key concerns was to combine quantitative and qualitative approaches. Before immigrating to the United States, Lazarsfeld lived and worked in Vienna. During this period, he was one of the key researchers and authors of the Marienthal study (Lazarsfeld, Jahoda, & Zeisel, 1933/1971 ), which has since become a classic in the sociological canon. The study was an investigation of one Austrian village—Marienthal—and was pioneering in its in-depth analysis, combining both quantitative and qualitative approaches. In his later work, Lazarsfeld developed the methodological insights gained from this and other studies (1972), publishing several key texts on methods (most notably Lazarsfeld & Rosenberg, 1955 —and many editions thereafter); in these, he warned researchers about the dangers of simple coding and classification techniques, often stressing the need for researchers to analyze their data as it was being collected and categorized.

Much of this resonates with Glaser and Strauss’s characterization of GTM, albeit in a far less amenable and articulated form. Although there are now several variants of the method, one of the key aspects of any truly grounded method study is the way in which the processes of gathering, sorting, and analyzing the data continue simultaneously and iteratively. At later stages of the research, data will be sorted into or compared against categories or codes, but these will themselves be products of the earlier stages of the research, rather than delineations and distinctions preconceived prior to the start of the study itself.

This intertwining might be thought of as a spiral, with foundations in the early data, gathered in a wide and encompassing manner and then moving upward and inward toward a more focused and directed view of some key aspect or aspects of the research domain. As Glaser and Strauss demonstrated in their early studies, and as many have since demonstrated, this approach can result in detailed models or theories that combine conceptual cogency with relevance and utility.

The Results and Value of Qualitative Research

In some cases, qualitative research can produce outcomes that can be criticized as failing to offer more than impressionistic (re)description—that is, simply taking various accounts or observations of some domain of interest and weaving them into a narrative with little or no conceptual depth or practical relevance. As stated earlier, however, an equivalent failing also haunts the world of quantitative methods: results that are based on incorrect or inaccurate use of statistical methods and meaningless or ambiguous hypotheses (see Goldacre’s vivid and readable account of “Bad Science,” 2009; also his blog at http://www.badscience.net/ ). Research is a process fraught with a variety of pitfalls and problems requiring a combination of skill, experience, serendipity, and, sometimes, plain dumb luck. This applies equally to all forms of research, whether predominantly quantitative, qualitative, or a combination of several methods and approaches.

Glaser and Strauss, from the beginning of their work together, stressed that the outcomes of a grounded theory study—that is, the grounded theory itself—had to adhere to some specific criteria, but ones that were distinct from those often held up as necessary for hypothesis-based, deductive research. They termed these criteria grab, fit, work , and modifiability . At first sight, they might appear to be somewhat vague terms, but they are explained in some detail in the latter chapters of Awareness and sections of Discovery .

As I have explained elsewhere (Bryant, 2009 , 2017 , ch. 17), the use of these terms can best be understood in light of the work and ideas of the pragmatists, specifically John Dewey ( 1999 ) and William James ( 1904 ). Dewey, in particular, promoted the idea of theories as tools—to be judged by their usefulness, rather than their truthfulness. This link between pragmatism and GTM was rarely mentioned by Glaser and Strauss in their joint publications in the 1960s, and Glaser never made any reference to it in his later, solo writings. Strauss, for his part, did refer to pragmatism as “a red thread running through my work” (1993, p. 22) in his last book, Continual Permutations of Action , which is not regarded as part of his output on GTM and qualitative methods. Strauss was heavily influenced by pragmatism via his contact with G. H. Mead and others associated with the early Chicago school. In Awareness , Chapter 14 is entitled “The Practical Use of Awareness Theory” (p. 259), and the footnote on that page makes specific reference to Dewey’s concept of a theory as something that is instrumental. But this is perhaps the only indication in Glaser and Strauss’s work—in concert or individually—of any relationship between GTM and pragmatism. Whatever the actual and acknowledged links between pragmatism and GTM might be, situating these four criteria against pragmatist ideas does shed light on each of the terms, enhancing the ways in which they can be understood as guidelines for evaluating the outcomes of research as follows:

Grab : This is a characteristic of a substantive grounded theory. It relates to Dewey’s idea of a theory being judged in terms of its usefulness, rather than on any abstract principle of veracity. If a grounded theory has grab, this might be demonstrated in the way in which the actors from the research setting respond when it is explained to them—they will understand and engage with it, using it in their activities and practices. Jeanne Quint’s development of innovative nursing practices and the ways in which these practices were taken up by colleagues and fellow professionals are prime examples of this feature.

Fit : This term refers to the need for theoretical insights to adhere to the substantive context, rather than to the predilections or biases (conscious or unwitting) of the researcher(s). Glaser offers further thoughts on this issue in Theoretical Sensitivity (1978), stressing that the categories resulting from a GTM study should fit the data. How this is accomplished, and the cogency with which it is demonstrated and argued, will depend on the researcher(s) and the relevant published outputs. It should be thought of as an overarching aim to be striven toward in any GTM-oriented research.

Work : This again builds on the idea of a theory as a tool. Tools are useful within specific contexts or for specific tasks. There are no general-purpose tools suited to all and every situation and job. The anticipated outcome of a GTM-oriented research project ought to be a substantive grounded theory—that is, one that is of use in the context from which it has been drawn and within which it has been grounded. Thus, any such theory ought to be able to offer explanations and insights that perhaps previously were unrecognized or implicit and also provide a basis for consideration of future actions and directions. If such a substantive theory is then enhanced and developed to a wider class of contexts, it can claim formal status. One of the earliest examples of this was Strauss’s work on negotiated orders (Strauss, 1978 ), which extended some of the aspects of the research that led to Glaser and Strauss’s early writings.

Modifiability : One of Glaser and Strauss’s criticisms of hypothesis-based research was that, far too often, by the time a research project had been completed—passing from derivation and proposal, through investigation, to eventual proof or disproof—things had moved on and, as a consequence, the finding and conclusions proved to be of little or no relevance. Furthermore, the process of conceptual discovery is not to be thought of as a once-and-for-all activity, but rather as a continuing and continuous dialogue. Thus, grounded theories must be understood as modifiable, rather than as fixed, definitive statements for all time.

Kathy Charmaz articulated an alternative set of criteria: credibility, resonance, originality, usefulness (see Future Directions: What Is a (Grounded) Theory Anyway?).

Epistemological and Ontological Issues

Practical men, who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist. (John Maynard Keynes, 1964 , p. 383)

The 1960s witnessed various other challenges to academic orthodoxy, although they seem not to have been of any real concern to Glaser or Strauss, since neither author makes extended reference to them in their writings on GTM and associated methodological matters. One of the key challenges emanated from a variety of critiques of what was perceived as the dominant model of social science research and theorizing in the United States at the time, most notably the structural-functionalist approach exemplified in the work of Talcott Parsons ( 1949 , 1951 ). Apart from being seen as inherently conservative in its orientation, this stance was also criticized for placing far more emphasis on social structures and stability at the expense of social actors and agency. Part of the reaction to this view came from the work of the Chicago school of sociology, which stressed the importance of social actors’ views in creating and sustaining social contexts and institutions, including, in the 1950s and early 1960s, the work of Strauss himself, as well as others, such as Erving Goffman and Howard Becker (Becker, 1963 ; Becker et al., 1961 ; Goffman, 1959 ).

With hindsight, one can see the continuity between this facet of the Chicago school and the development of GTM. A significant aspect of the grounded nature of GTM arises from its focus on direct participation in the research context by the researcher(s), often including observation of and interviews with those involved. As will be explained later, the derivation of initial codes that encapsulate key features of the research context can themselves originate with the outcomes of these early interviews, based on the actual words and phrases used by the interviewees.

As has already been argued, GTM was presented by Glaser and Strauss as a challenge to the orthodoxy of research practice at the time. Moreover, it appears reasonable to argue that another aspect of their challenge drew on the ideas Strauss in particular had encountered, and contributed to, during his time in Chicago. Similarly, Glaser had himself taken on, and significantly enhanced, some of the methodological insights on offer from familiarity with Lazarsfeld and colleagues at Columbia. So, there is a case to be made for the influence of these lineages in the development of GTM, although this is in no way to detract from the innovative nature of GTM itself.

What is surprising, however, is the lack of any engagement with a further aspect of the range of challenges to academic orthodoxy at the time, particularly those embodied in the work of Thomas Kuhn. Kuhn’s book The Structure of Scientific Revolutions (1962) created a major stir in the 1960s and is now regarded by many as one of the key philosophical works of the 20th century. Apart from anything else, he challenged widely accepted views of science, scientific research, and the ways in which our knowledge of the world has developed and might be thought of as progressing over time. His use of the term paradigm undermined the view that one could observe the world from a completely neutral position. At around the same time, Peter Berger and Thomas Luckmann encapsulated a similar set of arguments in their book The Social Construction of Reality (1966), and both books contributed to what can be termed a constructivist or interpretivist model of knowledge—that is, that our understanding of reality is apprehended and sustained through social processes and interactions.

This position was articulated specifically to challenge various forms of positivism that, broadly understood, assumes the possibility of some neutral form of observation as a basis for discovery, testing of theories, hypotheses, and other claims to knowledge. The 1960s was marked by a variety of attacks on various forms of “conventional wisdom,” and Glaser and Strauss’s work can be seen as one component of this. What is surprising, however, is that neither Glaser nor Strauss made any extended reference to any of these other, contemporary developments. Kuhn’s argument incorporated what was seen by many as a highly unflattering characterization of science in nonrevolutionary periods—which he termed normal science —as puzzle solving , rather than what might be termed discovery of new knowledge.

This resonates to a large extent with Glaser and Strauss’s criticism of social science research as “proletarian testing” of the grand conceptions of the “theoretical capitalists.” Conversely, one of the main thrusts of Kuhn’s argument was that scientific revolutions amounted to a paradigm shift, which was not simply an enhancement of previous knowledge but rather a completely different way of seeing the world. For instance, the shift from a geocentric view of the universe to a heliocentric one involves studying common aspects of the natural world, but seeing them in completely different ways. Likewise, someone with a grounding in natural sciences from the late 17th or early 18th centuries would, quite literally, see things very differently from someone with a grounding in natural sciences from the late 18th century onward—something illustrated by Kuhn in his description of the work undertaken by Joseph Priestley in the late 18th century. Priestley is now credited with discovering oxygen, but Kuhn argued that Priestley’s own account of his experimental findings indicated that he continued to adhere to accepted wisdom rather than accept what we would now understand as the idea of air and other materials being composed of basic elements such as oxygen. (Priestley argued to his dying days that his observations were of something called dephlogisticated air , whereas Lavoisier, who had heard of and repeated Priestley’s experiments, wrote about his observations and coined the term oxygen , deriving it from two Greek words meaning “acid producer.”)

One of the key consequences of the ideas of Kuhn and others was that there was no such thing as a neutral standpoint from which to observe and explain the world. Taken further, this leads to the argument that the ways in which we describe the world, using language, are not neutral or transparent. Language is not simply a way of describing reality; it is a crucial part of how we constitute and apprehend reality. Taken as a whole, these developments—many of which predate the 20th century in one form or another—culminated in the 1960s in a concerted attack on simple and straightforward ideas about data and observation. But neither Glaser nor Strauss ever took them up in any way. On the contrary, Glaser and Strauss, whether in their collaborative or separate contributions, consistently treated “data” as an uncomplicated concept. Moreover, in using the term emergence in a passive and unembodied sense—as in “the theory emerges from the data”—they could not help but oversimplify the nature of data and the process of “discovery,” seriously obscuring the active role of researchers in shaping the development of codes, categories, and concepts.

By the late 1980s and early 1990s, GTM had grown in popularity, particularly following the publication of Strauss’s solo work, Qualitative Analysis for Social Scientists (Strauss, 1987 ), and his collaborative work with Juliet Corbin, Basics of Qualitative Research (Strauss & Corbin, 1990 , 1998 ). Two further editions have been published more recently (Corbin & Strauss, 2008 , 2015 ). Many doctoral researchers and others more advanced in their academic and research careers were taking up GTM, presenting proposals and findings that drew on Discovery and Basics in particular. Reviewers and research advisers found themselves presented with proposals that did not emanate from clearly formulated research questions or present hypotheses to be tested, but rather outlined generic areas of concern or specific contexts to be explored prior to articulation of clear objectives or issues. Moreover, research papers reported findings in which categories were derived from the intertwining of simultaneous and iterative processes of data gathering and analysis, with the outcomes often presented as having “emerged from the data.”

This presented evaluators, reviewers, and assessors in general with a number of problems and concerns. Some of these concerns emanated from the innovations in the method itself and others from the ways in which researchers reported their findings and the details of the processes they followed.

Innovations

For those used to assessing research proposals in terms of the hypotheses presented or the clarity of the objectives articulated at the outset, GTM-oriented examples were something of a conundrum. Often, such proposals gave only a very generic and ill-defined account of the nature of the planned research, with little, if any, overview of the relevant literature and only the slightest indication of the detailed instruments and methods to be used. This led to GTM proposals being treated as lacking in sufficient detail for any assessments to be made, and the method itself was seen as apparently providing the researchers—particularly doctoral and masters students—with a justification for only a limited amount of preparation prior to embarking on various, often ill-defined, research activities. Thus, the strengths of the method had come to be seen as its inherent weaknesses. In part, this was based on a misunderstanding of GTM by those in positions of authority claiming knowledge of methods, but it was also a result of the ways in which the method was described in various texts and the manner in which it was then taken up by enthusiastic but inexperienced researchers keen to use alternative approaches.

Reporting of Findings

Although there may have been misgivings with regard to use of GTM and, as a consequence, some basis for limiting its growth, in many areas—particularly those associated with the pioneering work that emanated from UCSF in the 1960s and early 1970s—a significant proportion of research publications claimed use of GTM. It rapidly became the most widely claimed of any qualitative method, and in some areas, it eclipsed all other methods—qualitative and quantitative—taken together. Editors and reviewers, however, were often perplexed by some of the GTM-oriented papers that they received. In many cases, these papers seemed to indicate that GTM amounted to nothing much more than stages of data gathering—usually in the form of open-ended interviews—followed by analysis of the data to produce codes or categories, which then mysteriously led to the “emergence” of some end result. This result itself was sometimes termed a grounded theory, but often its conceptual or theoretical claims seemed at best weak and often nonexistent. Moreover, the writers of such accounts often stated that they deliberately ignored any literature that might have shed light on the generic research area and had set off on their research “without any preconceptions” or somehow discounted any potentially relevant experiences, ideas, or preexisting knowledge that might influence their investigations. Terms such as theoretical sensitivity, emergence, theoretical sampling , and theoretical saturation —sometimes accompanied by fleeting references to grab, fit, and work—were perhaps mentioned (often merely in passing) to provide some indicators of rigor and substantiation, but the overall effect on many reviewers and their ilk was one of bewilderment and suspicion.

Constructivist Grounded Theory Method

The overall result of these shortcomings was that GTM came to be regarded as methodologically frivolous or near vacuous. Those with positivist inclinations, particularly if they adhered to Lord Kelvin’s assumptions concerning measurement and quantitative techniques, saw GTM as lacking in any firm foundation (no hypotheses at the outset) and deficient in terms of rigor (no measurement or quantitative verification). Conversely, those with interpretivist predispositions regarded the method as naive and simplistic, given the characterizations offered by its progenitors—and then parroted by users—based on terms such as data, emergence , and induction .

From the 1960s until the mid-1990s, neither Glaser nor Strauss ever engaged with the ways in which the work of Kuhn, Berger and Luckmann, and others of a similar ilk undermined conventional ideas about data, observation, and knowledge claims. Given the central role played by “data,” particularly in Glaser’s writings, this seems somewhat strange; after all, Glaser and Strauss had set out to challenge the research orthodoxy, including those who acted as the gatekeepers and evaluators of theoretical legitimacy and authority. Kuhn’s ideas similarly sought to question the basis on which claims to knowledge were based, a critical enterprise that continues to this day. As I argued elsewhere (Bryant, 2009 ), this omission was particularly perplexing with regard to Strauss, given his background, steeped in the work of G. H. Mead and pragmatism.

Whatever the rationales behind both Glaser’s and Strauss’s specific failures to engage with these issues and ideas, there was no way that GTM could remain remote from or indifferent to them. By the mid-1990s, Kathy Charmaz had begun to articulate what she termed a constructivist form of GTM and, in the second edition of the Handbook of Qualitative Research (Charmaz, 2000 ), she developed her argument, contrasting constructivist GTM with objectivist GTM, as espoused by Glaser.

For Charmaz, GTM had to take account of the active role of the researcher in moving from data collection through analysis to coding, then iterating through further stages of collection and analysis and coding. Thus, codes and categories did not “emerge,” but were the product of deliberate interpretation by the researcher(s). She contrasted this view of GTM with what she termed Glaser’s “objectivist one,” which treats data as something uncovered by the research process, leading to the unearthing of codes and categories and virtually effacing the researcher as an active participant. Thus, in her later book, Charmaz ( 2006 ) used the title Constructing Grounded Theory , rather than Glaser and Strauss’s Discovery . (A new edition was published in 2014, Charmaz, 2014a .)

Soon after this, in the late 1990s and quite independently, I had begun to develop a similar view. I had been presented with several research proposals that alluded to GTM; in many cases, this was no more than a thin veneer, hiding the student’s inability to state any clear ideas regarding specific objectives, lack of familiarity with the literature, or aversion to rigorous methods, particularly quantitative ones—sometimes all three. In most cases, when challenged, the student would agree to revise the proposal, remedying the deficiencies and opting to use some other, more prescriptive method. One student, however, persevered with GTM and was able to respond to the criticisms in a manner that indicated the strengths of the method. My own further examination of texts and sources such as Awareness, Discovery , and Basics indicated that there were indeed valuable and important features of GTM, but that they needed to be separated from the language within which much of the GTM-oriented literature was based—what I termed the GTM mantra .

Writers claiming use of GTM often resort to variations or verbatim quotes of one or more of what might best be termed the mantras of grounded theorists —for example, “entering the research domain with an open mind,” “allowing the theory to emerge from the data,” and “letting the data speak for themselves/itself.” Invocation of any or all of these should not be seen as inevitably leading to inadequate research, although, as has already been pointed out, such statements inevitably lead many reviewers and evaluators to be suspicious of or discount whatever follows.

In the wake of the work undertaken by Charmaz, myself, and others to develop the method in light of the critiques of positivism or objectivism—particularly those emanating from a constructivist or interpretivist position—two issues come to the fore for anyone using or evaluating GTM:

Data now become a problematic concept and cannot simply be incorporated into research without further consideration. Glaser’s admonition against “immaculate conceptualization” is an indispensable part of the researcher’s mindset, but equally essential is an understanding that although the original meaning of “datum” (plural “data”) is something that is “given”—that is, obvious and apparent and ready to hand—our processes of cognition are not as mechanistic and simple as this.

Developing from this is the argument that participants in research settings will encompass multiple standpoints and conceptions of the specific context. Early statements of GTM clearly incorporate this to some extent; for instance, the work on awareness describes the ways in which different people develop and communicate their awareness across different settings. But this range of viewpoints must also include the researcher or research team—something that is missing in early GTM writings and was not really attended to in any systematic manner until Charmaz’s work from the late 1990s onward.

In 2006, Kathy Charmaz published an extended statement of constructivist GTM— Constructing Grounded Theory , contrasting this approach with one oriented around “discovery.” Charmaz argued that taking an explicitly constructivist standpoint does impact the research itself, since data collection will necessarily involve researchers taking account of people’s meanings, intentions, actions, and interpretations both in terms of actually engaging with participants—using interviews—and for other forms of data collection, such as observation. Moreover, this leads to a specifically reflective position on the part of the researcher who now must consider his or her own participation and interaction in the research setting. Charmaz updated and revised her book (Charmaz, 2014a ) and further developed her ideas in a number of other publications (see for instance Charmaz, 2014b , 2017a , 2017b ).

Since the 1990s, researchers have been faced with a number of possible forms or variants of GTM. Initially, the fundamental distinctions were those between the initial, joint work of Glaser and Strauss and the later distinct writings of Glaser and Strauss, including the latter’s joint work with Corbin. The distinction between Glaser’s work and that of Strauss and Corbin centers on a number of issues around the process of the method itself, particularly ideas about coding and the use of various frameworks or guidelines for developing concepts. The distinction between Glaser’s orthodox or traditional or objectivist GTM and constructivist GTM relates to the ways in which researchers seek to couch the form of justification for their ideas—constructed or discovered. Although there has been a good deal of debate around this issue, when it comes to carrying out research itself, one’s epistemological stance is often only of passing interest. The most important feature of research is its outcome, and it seems to make little or no difference whether the researcher conducted the research from a positivist/objectivist viewpoint or an interpretivist/constructivist one. Glaser and Strauss were correct to see the criteria of a research outcome—concept, theory, framework, or model—in terms of grab and fit, thereby offering alternative criteria for evaluating research outcomes.

The conclusion with regard to GTM and epistemology is that, although it may be useful for researchers to clarify their own disposition, ultimately, this may not be a factor of any great import.

Grounded Theory Method in Practice

The Grounded Theory Method (GTM) comprises a systematic, inductive, and comparative approach for conducting inquiry for the purpose of constructing theory (Charmaz, 2006 ; Charmaz & Henwood, 2007 ). The method is designed to encourage researchers’ persistent interaction with their data, while remaining constantly involved with their emerging analyses. Data collection and analysis proceed simultaneously and each informs and streamlines the other. The GTM builds empirical checks into the analytic process and leads researchers to examine all possible theoretical explanations for their empirical findings. The iterative process of moving back and forth between empirical data and emerging analysis makes the collected data progressively more focused and the analysis successively more theoretical. GTM is currently the most widely used and popular qualitative research method across a wide range of disciplines and subject areas. Innumerable doctoral students have successfully completed their degrees using GTM. (Bryant & Charmaz, 2007b, p. 1)

Grounded theory method is a method for qualitative research. 1 , 2 It offers an alternative to hypothesis-based research, stipulating that, at the outset, the researcher(s) should not seek to articulate concepts or hypotheses to be tested, but rather that the initial aim should be to gather data as the basis for developing the research project in its initial stages. This can appear perplexing both to researchers and to assessors, since there seems to be little in the way of guidance with regard to the research topic itself. In practice, however, researchers always do have some idea of and familiarity with their topics of interest and should be able to offer some initial characterization of the contexts they are keen to study. This may be a specific location, a set of practices, or specific issues that have engaged the researcher’s interest.

Glaser and Strauss were keen for researchers to approach their study without having formulated ideas about the nature of the “problem” or the specific research question to be asked. In this way, they wanted researchers to be ready to be surprised by their findings, rather than looking for things based on their preconceived ideas. In some cases, researchers have misunderstood this admonition and, on the basis of this misunderstanding, have then made mysterious and frankly laughable claims along the lines of “ignoring” or somehow disconnecting from their own existing knowledge of potentially relevant ideas, concepts, and other materials. (It is this claim, together with the magical invocation of “theory emerging from the data,” that lies at the heart of accusations of GTM being founded on an epistemological fairy tale.) Ian Dey ( 1999 ) provided a pithy corrective to this, which should be remembered by all researchers, whether or not they use GTM: “an open mind is not the same as an empty head.”

Bearing this in mind, a grounded theory study should begin with some characterization of the research context and can then continue with the posing of some open-ended and wide-ranging questions. Glaser and Strauss suggested the following high-level GTM questions:

What is happening here? (Glaser, 1978 )

What is this data a study of? (Glaser, 1978 , p. 57; Glaser & Strauss, 1967 )

What theoretical category does this datum indicate? (Glaser, 1978 ) (“What Is Grounded Theory,” PowerPoint presentation, Kathy Charmaz, 2008 , http://eprints.ncrm.ac.uk/208/1/What_is_Grounded_Theory.ppt )

If researchers are concerned or confused about the term data , Glaser has clearly and consistently affirmed that “all is data.” This means that researchers can and should plunge into their research context and start looking for data. This may be in the form of initial, open-ended interviews, but it can also be in the form of observations, texts, documents, and anything else that might be relevant.

One of the developments emanating from the constructivist account of GTM can be seen in the range of basic questions that a researcher should be prepared to pose at the outset of a research project. This is not to say that, prior to this, GTM researchers failed to consider such issues; rather, the constructivist position necessarily prompts researchers toward such considerations. Thus, Charmaz ( 2006 ) offered several further questions that develop GTM in a more specifically constructivist manner than is evident in Glaser’s and Strauss’s work. She stresses that articulations of answers to the What is happening here? question lead to consideration of “basic social processes” and/or “basic psychological processes,” which Glaser mentions in Theoretical Sensitivity (1978). Unlike Glaser, however, who remains silent on such matters, Charmaz stresses that such consideration depends on the assessments and judgments made by the researcher(s) reflecting on the findings, and such reflection may encompass analysis of the data using further questions, such as:

From whose viewpoint is a given process fundamental?

How do participants’ actions construct [observed social processes]?

Who exerts control over these processes?

What meanings do different participants attribute to the process? (Charmaz, 2006 , p. 20)

Taken together, all of this gives some guidance to researchers who are faced with the inevitable and awkward issue of how and where to start the research. But it provides a very different starting point from more traditional methods, particularly those developing from hypotheses. This latter approach has been described as deductive , since the hypotheses are often derived—deduced—from existing theoretical frameworks or models. This allows researchers to frame a specific research question, which then guides later activities such as the initial engagement with the research context, sampling, method, and analysis. Researchers following GTM eschew this strategy in favor of a far more open-ended one that many have described as inductive , since it relies on gathering data from which more generic patterns or conceptualizations can be ascertained.

In an age of formal evaluations and institutional review boards or committees, this can be problematic, since researchers will usually be expected to offer clear and concise research questions or hypotheses at the outset, accompanied by a critical review of the relevant literature, to sustain the argument that the proposed research offers some value and validity in terms of novelty or affirmation of existing claims. Research based on GTM must provide other criteria at these early stages, and this can be problematic. Glaser’s position has always been that GTM researchers should avoid the relevant literature at the outset, but, in practice, this often proves impossible and inadvisable. Review committees expect that researchers can position their proposals against existing work, and this can only be done on the basis of a critical review of the literature. Moreover, GTM researchers themselves often point out that they need to explore existing work to have confidence in the potential value of their own studies and ideas.

In recent years, there has been a burgeoning literature offering guidelines and justifications for many qualitative research methods specifically aimed at assisting reviewers and evaluators, as well as researchers, in assessing proposals oriented around methods such as GTM (see Bryant, 2017 , particularly ch. 18). This should provide a more supportive basis for consideration of such proposals, particularly GTM, where the initial stages provide such a crucial aspect in guiding the later ones.

Coding, Memoing, Theoretical Sampling, Theoretical Saturation

For many people, GTM is regarded as a method that relies on “coding”; indeed, for some, this is the be-all and end-all of the method. Thus, some research papers claiming use of GTM offer nothing further than reference to interview data, together with some codes that have been developed from that material. The outcome is then often presented in the form of a diagrammatic model linking them together in some manner. Partly as a consequence of this, many editors and reviewers have something of a low regard for GTM. Many researchers, however, particularly those in the early stages of their careers and undertaking doctoral research, start to use GTM and find themselves overwhelmed by the outcome of early coding exercises on their data. It is not unusual for such researchers to produce several hundred codes from one or two initial interviews and then double this number for subsequent ones—not so much “saturation” as inundation.

As was pointed out earlier, coding was not unique to Glaser and Strauss’s conception of GTM, although the way in which it is incorporated into the method certainly was, in that codes are developed subsequent to the start of data gathering. For many researchers, GTM relies on interview data, and the data forms the source material for coding. But it is worth recalling Glaser’s dictum of “all is data” and understanding this as encompassing many other types of source material, for example, documents, articles, web pages, tweets, and so on.

To illustrate some of the issues around coding and the way in which the method progresses, it is best to use some examples, even if they are somewhat constrained. To start with, Table 7.1 shows an extract from a paper on GTM (Giske & Artinian, 2007 ); the text on the left-hand side is taken verbatim from an interview, the comments on the right-hand side are the researchers’ initial codes.

Note : Tove Giske, Bergen Deaconess University College Bergen, Norway; Barbara Artinian, School of Nursing Azusa Pacific University Azusa, California © 2007 Giske et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

These initial codes can be thought of as ways in which the researcher has sought to highlight some key aspects of the “data.” For those writing from a basis in traditional GTM, as claimed and exemplified by Glaser’s work, this is seen and described in terms of the initial stages in the process of emergence. But the use of a phrase such as “the theory emerges from the data” is problematic, since it obliterates the active roles of the researcher(s). Different researchers may look at the same data and produce a range of codes; some may be common to several or all co-researchers, and others may only have been developed by one researcher. The example in Table 7.1 is the work of more than one researcher and so may have come about in its published form only after discussion and revision among the research team. This is grist to the mill for those working within a constructivist orientation; different people will construct or develop codes as the result of complex interactions between themselves and the data. This goes on in a far less formal manner all the time and is readily exemplified by the comments section appended to articles on the Web; they often result in such disparate comments from readers that one wonders if they have all read the same article.

In GTM, the coding process is far more rigorous and develops through use of the method, as will be described later. But, to demonstrate the initial stages, readers are invited to look at the brief extract—Table 7.2 —from an article published in the U.K. newspaper The Guardian in late March 2012 as the first edition of this chapter was being drafted. The column on the right-hand side has been left blank; in a manner similar to that shown in the earlier extract, try to come up with some initial codes of your own. Details of the full article are given in Doctorow (2012).

Table 7.3 shows the codes that I have made on the basis of my reading of the data. Some of the codes you produced may be similar to those on the right-hand side, but others may be different. The constructivist orientation clarifies the interactive process that underlies the production—construction—of these codes. The codes you produced will depend not only on the extract itself, but also on a host of other factors bearing on your own experiences, interests, and way of understanding and interpreting the extract itself.

One possible set of codes, differing markedly from those in Table 7.3 , might have come from someone deciding to focus on the extract from a journalistic perspective, one responding to the question, What is happening here? in the sense of contextualizing the article as something published by a British newspaper generally regarded as taking a liberal, or left-of-center, stance on many aspects, particularly those concerning citizens’ privacy and rights. There is no right or wrong set of codes to be derived from this initial process: only codes that might prove to be useful in developing an explanation, a model, a theory of some aspect of social life. Glaser and Strauss exemplified this in their early work, with their first extended GTM publication focusing on awareness and their subsequent one focusing on time.

There are several ways in which initial codes can be developed, and researchers can and should try several of them when first starting to use GTM. The coder in Table 7.1 broke down the data into smaller units and then summarized each part using terms similar or identical to those used in the original. You may have adopted a similar strategy in developing codes for Table 7.2 . The important point to note is that there is no one, correct way of coding; GTM research is oriented toward the development of a model or theory that is “grounded” in the data in some substantive fashion, so that it has grab, fit, and the like.

I have deliberately used the plural form—researchers—to stress that, although much of the GTM literature implies that research is carried out by a single person, in practice, this is not usually the case. Carolyn Wiener, in her chapter on teamwork and GTM, offers some important observations on this issue, illustrating her account with observations from her experience as a member of the team that Strauss set up for a GTM research project in the 1970s (Wiener, 2007 ). Moreover, even when there is a lone researcher—as in the case of most Ph.D. research—this person should be encouraged to discuss codes and coding with their research advisors and peers. This is common to all strands of GTM, with Glaser continuing to offer GTM workshops where issues such as coding can be discussed with others.

In these early stages, as well as coding, GTM researchers must record their ideas in the form of memos. Memos are a critical part of GTM, and memoing is an activity that often proves extremely valuable to other forms of research. In the earliest stages, memos may be created in the form of fairly unstructured notes and comments about the developing research, focusing on the researcher’s experiences in using the method, as well as on the early results themselves. Thus, an early memo might be in the form of a researcher, new to GTM, reflecting on the experience of coding. Alternatively, an early memo, related to the extract in Table 7.1 , might add some detail to the context of the two interviews used in the coding—Interviews 3 and 9—which then might be used in later stages.

As the research develops, memos become more formal in the sense that they should be written with an eye on a wider readership and perhaps eventual publication and dissemination. Glaser has suggested that researchers should aim to develop a set of memos that can then provide the basis for publications. This may not always be possible, but GTM researchers should certainly bear in mind that memoing is an important component of the method, one that should be undertaken in a serious and consistent fashion throughout the research itself. (Further examples of memos can be found in Charmaz, 2006 , 2014a , ch. 4; and in Bryant, 2017 , which makes extensive use of a variety of outputs from Ph.D. students.)

All coding in GTM should start with open coding . Charmaz defined coding as

the process of defining what the data is about. Unlike quantitative data which applies preconceived categories or codes to the data, a grounded theorist creates qualitative codes by defining what he or she sees in the data. Thus, the codes are emergent—they develop as the researcher studies his or her data. The coding process may take the researcher to unforeseen areas and research questions. Grounded theory proponents follow such leads; they do not pursue previously designed research problems that lead to dead-ends. (Bryant, 2017 , p.120)

Open coding is the first stage of coding and usually involves close scrutiny of data. If the data are in the form of written documentation or verbatim or near-verbatim interview transcripts, then this may be done line by line or even word by word. The examples given in Table 7.1 through 7.3 demonstrate this level of analysis. The idea is to capture certain key aspects of the data, reducing the complexity by providing a smaller number of more abstract terms. But researchers must understand that coding also involves ignoring or setting aside some aspects of the data; a failure to find a balance between these two strategies will usually result in a massive number of codes, with little or no form of abstraction or conceptualization. A key lesson to be understood from constructivist GTM is that each researcher will necessarily derive his or her own distinctive set of codes from the data; other researchers might derive broadly similar codes, but they might also produce significantly different ones. For constructivist GTM, coding is a process whereby researchers enter into a dialogue with data—that is, it is a relationship that depends on both the nature of the data and the experience and background of the researcher.

Subsequent strategies will depend on what has transpired from these initial efforts and on the choices made by the researcher or research team. But what all strategies have in common are ways in which they facilitate the move from a large number of codes, often anchored in the terms or phrases used in the source data, to a narrower set of high-level codes that encompass the richness of the source materials in some manner. This may involve the researcher choosing a specific aspect of the research context for further development, as exemplified in Glaser and Strauss’s first GTM study that focused on the concept of awareness. Only later did they develop a second concept of time (Glaser & Strauss, 1968 ).

Returning to the first example in Table 7.1 , the right-hand side of the table includes these later codes (Table 7.4 )—classified by these authors as selective coding . Note that these codes can be seen to encompass the earlier codes but work at a higher level of abstraction. Again, it is not a case of the codes being correct or incorrect; rather, they are judged in terms of whether they move the process of conceptualization forward in the articulation of a useful and credible grounded theory.

Glaser has consistently advocated that researchers seek to develop codes based on gerunds, and Charmaz strongly supports this idea. Gerunds are the verb forms of nouns, so, in English, the gerund form of the noun interception is intercepting . Using gerunds should focus the attention of the research on the processes and actions that, in part, constitute the social context under investigation. Taking this into account, the more focused codes for the extract from The Guardian might now be revised along the lines shown in Table 7.5 —although several of the original codes were themselves in gerund form.

At this stage, it might be useful to create a memo for “Employer intercepting and monitoring”:

A wide range of employers seek to monitor the use of information technology and related technologies by their employees. Increasingly, this monitoring extends to a wide range of communication practices, and the monitoring itself has been taken up by other groups, including school administrators checking on students’ use of school-issued laptops.

Consider the growth of mobile technologies and the extent to which employers might claim justified monitoring of employees using their work-supplied mobile devices, such as smartphones or tablet PCs.

Once a researcher has developed his or her ideas to something akin to this level of conceptualization, there is a basis for theoretical sampling , a GTM practice that Glaser and Strauss defined as “the process of data collection for generating theory whereby the analyst jointly collects, codes, and analyses his data and decides what data to collect next and where to find them, in order to develop his theory as it emerges” (Glaser & Strauss, 1967 , p. 45).

We have noted that

when engaging in theoretical sampling, the researcher seeks people, events, or information to illuminate and define the boundaries and relevance of the categories. Because the purpose of theoretical sampling is to sample to develop the theoretical categories, conducting it can take the researcher across substantive areas. (Bryant and Charmaz, 2007a , p. 611)

In effect, this amounts to a more directed and focused search for evidence that might uphold, enhance, or undermine the initial ideas generated from the earlier findings. Researchers using GTM must make this move clear in reporting the progress of their work, so that there is no misunderstanding about the strategy employed to identify the sample used.

The issue arises of how large a sample is required for the research to provide the basis for any reasonable and justifiable conclusions. GTM deals with this under the heading of theoretical saturation: “the point at which gathering more data about a theoretical category reveals no new properties nor yields any further theoretical insights about the emerging grounded theory” (Charmaz, 2014a , p. 344).

This has proved to be an elusive concept in the literature, and many researchers and reviewers, among others, have wondered not only what the term means, but also how a researcher might know that he or she has reached this position. In straightforward terms, the response is that, for instance, in research based on interviews, saturation is reached when responses given in later stages of the interviewing process yield confirmation of earlier findings, but nothing significant or new. In such cases, the researcher can decide that no further interviews are necessary, and the research itself can move on to its final stages. It must be stressed, however, that this is not a claim that further research will fail to add new data; further investigation will almost inevitably yield something new. Claims for theoretical saturation, however, are of a different order; new data has not added anything to the model or grounded theory already derived from existing data. (See Bryant, 2017 , ch. 12, for further details.)

Some commentators have argued that this decision point appears to be somewhat arbitrary and that, all too often in the literature, the researcher simply reports that saturation was reached, with little or no evidence. With regard to the former point, the decision to stop further gathering of evidence based on some criterion of sufficiency applies to all forms of research: When does one have enough data to start to draw some conclusions? In quantitative research, this usually takes the form of statements regarding the size and nature of the sample and its relationship to a wider population. In qualitative research, this is less clear-cut, but amounts to the same thing. The key is for researchers to clarify the basis on which they made the decision, so that readers and assessors can decide whether it was indeed justified, and subsequent researchers can then ascertain whether there might be a basis for developing this research in other areas or with other respondents. In all cases, there is always the possibility of what might be termed the black swan research event , that is, a research finding that completely undermines the pattern that seems to have been developing from findings to date. But that is an inescapable aspect of all forms of investigation.

With regard to the latter point, however, GTM researchers should not simply state that saturation was reached; they must provide clear justification and evidence for this to be the case.

Using the Literature

Researchers are usually expected to have reviewed the literature relevant to their research topic early in the process. In this way, they can justify their proposal as a potential contribution to knowledge in contrast to existing research, current issues, and concerns. When Glaser and Strauss introduced the idea of GTM, they were keen to ensure that researchers, particularly early-career doctoral students, were presented with an alternative to the literature-derived form of research that was predominant at the time, in which doctoral students studied the works of the great theorists and developed their research on some aspect of it.

The outcome was that GTM was seen as advocating that researchers should not engage with the literature in the early stages of their work. Glaser, in particular, constantly advocated that researchers stay away from the relevant literature until much later in their research, although he has also stressed that researchers should not take this as a reason to stop reading; on the contrary, he advised that researchers should read avidly and widely.

There are a number of problems with this position. The main problem is that researchers must have some familiarity with the current status of work that has been carried out in the general area in which they are interested; otherwise, they have no basis on which they can claim novelty or justification for their plans. Indeed, one of the reasons that they plan to do their research may be that they have knowledge and even practical experience of the area and its key issues. Keeping an open mind is certainly important, but either pretending to have an empty head or deliberately making it so by avoiding the literature is not feasible, particularly if one has to present the proposal to a review board.

The result is that there is no way of avoiding some form of literature review in the early stages of one’s research. But, in the context of GTM, there are a number of issues to take into account. One issue is that the literature itself can be treated as data, with the researcher pointing to key issues and concerns and using them as the basis for some initial coding. This may help in developing a proposal that, although devoid of specific research questions and hypotheses, still provides readers and assessors with an understanding of the general research area, as well as with the basis for some confidence that the research will develop and lead to appropriate outcomes.

In subsequent stages of the research, it may prove to be the case that the findings lead away from the initial ideas, often quite markedly. Even if they do not, once the researcher has developed the basis for a new model or theory, there is a need to go to the literature in a far more focused manner to hold up one’s concepts against the concepts most closely related to the eventual findings. In many cases, GTM researchers have found that the literature they need to turn to in the later stages of their research is far different from what they assessed at the outset, usually because their research has taken them in unexpected directions. So, the response to anyone who criticizes GTM for ignoring the literature is to point out that, on the contrary, the method requires at least two stages of engagement: one at the start and a potentially more rigorous and contrasting one near the end of the process. (n.b. Doctoral students especially are advised to avoid the term literature review for these later stages of engagement with literature, because it will confuse and mislead examiners. Far better to refer to it as a key part of theoretical coding, clarifying the manner in which relevant sources are identified, derived from the putative grounded theory developed from the research itself.)

Results, Theories, and Publications

This chapter is designed to give you a brief overview of GTM, rather than a detailed account. The stages from initial coding through to more focused coding can take a great deal of time, effort, and ingenuity, but that is common to all forms of research. The extent to which research can be supported by methodological recommendations is controversial. Glaser and Strauss parted company on precisely this point in the 1990s, with Glaser accusing Strauss of undermining their original concept of GTM, replacing it with what Glaser saw as a far too prescriptive account of coding and generation of theories. (Various accounts of this can be found in Bryant, 2017 ; Bryant & Charmaz, 2007b, 2007c; and Glaser, 1992 .)

One of the key issues for GTM, however, must be the outcome and its dissemination. Whatever the differences might be between the approaches to GTM—Glaser and Strauss’s, Strauss and Corbin’s, Glaser’s, Charmaz and Bryant’s—they all share the aim of providing researchers with a series of pointers to guide them from early ideas and insights toward substantive theories or models that have grab and fit and that work in some manner. The way in which these criteria might be assessed will depend on others having access to the account of the research itself, either in the form of published papers or perhaps more directly as a presentation by the researcher to the other participants (Turner, 1983 ). Charmaz expanded on these criteria in her work since the 1990s, offering an alternative statement that encompasses credibility, originality, resonance, and usefulness (see Future Directions).

Some of these issues can be illustrated using the examples presented earlier. The full table of codes from Giske and Artinian ( 2007 ) is shown in Table 7.6 , with all three stages of coding. There are now three “final concepts,” all in gerund form. If readers refer to the full paper, they will find a very clear and succinct account of the way in which the researchers moved from this to a grounded theory of “preparative waiting.”

Giske and Artinian ( 2007 ) presented their results not only in diagrammatic form, but also with textual explanation. This combination is a practice to be strongly encouraged because diagrams are often useful in summarizing lengthy expositions and in guiding readers in the development of research accounts; however, diagrams rarely, if ever, serve as satisfactory explanations on their own. A picture may be worth a thousand words, but researchers must ensure that the thousand words conjured for the reader bear some resemblance to those intended by the writer.

Theoretical Sensitivity

Theoretical sensitivity is in many ways the holy grail of GTM and, indeed, of research in general. Kelle ( 2007 , p. 193) summarized it as follows: “In developing categories the sociologist should employ theoretical sensitivity , which means the ability to ‘see relevant data’ and to reflect upon empirical data material with the help of theoretical terms.” Glaser’s book of this title (1978) is a must read for those interested in GTM, and it should also be on the reading lists for all courses on research methods and research design.

The concept is very much a case of what might be termed IKIWISI rather than WYSIWYG; that is, I’ll know it when I see it , rather than What you see is what you get . This is not particularly helpful as a response to novice researchers who ask for more information about the term and perhaps even expect clear and concise guidelines for ensuring this aspect. The term grab is relevant here, since it can also be applied to the way in which one’s research findings grab the imagination of one’s peers and colleagues in the relevant research community. Moreover, it brings into consideration the ways in which researchers actively participate in shaping or constructing their studies and eventual findings; that is what Kelle ( 2007 , p. 193) meant by a researcher’s ability to “see relevant data.”

Perhaps it is best to think of theoretical sensitivity as a research horizon, something that is always in front of us, but that inevitably recedes as we approach it. In any case, it will usually be presumptive of a researcher to claim that he or she has this sensitivity; it is far better to present one’s findings and assess the ways in which one’s colleagues respond, using this as a guide to the extent to which theoretical sensitivity has been demonstrated.

In my recent book on GTM (Bryant, 2017 ) I introduced the term methodological sensitivity as an important complement to Glaser and Strauss’s term, defining it as

the skill or aptitude required by researchers in selecting, combining, and employing methods, techniques, and tools in actual research situations. Researchers can and need to develop this skill as a result of a combination of guidance from and working with other researchers; insightful study of available research methods, techniques, and tools; and learning from their own experience. (p. 36)

Its importance is evident as researchers progress through their investigations and understand that a research project takes on a life of its own and that researchers must find a balance between adhering to a method itself or judging if and when other options should be considered and alternatives employed (Bryant, 2017 , ch. 19, comprises four accounts of use of GTM by Ph.D. students, clearly demonstrating this aspect).

Alternative Approaches

The various exchanges between Glaser and Strauss in light of their individual accounts of GTM, as well as the more recent ones focused on objectivist and constructivist approaches, might lead researchers to believe that there is some fairly strict gatekeeping going on with GTM. To some extent, this is correct, since there are many instances in which use of the method has been claimed in research proposals and publications but amounts to no more than a cursory incorporation of some aspect of GTM—usually the coding of data after some initial phase of collection.

However, there are many cases in which researchers have used GTM in unorthodox ways, demonstrating their methodological sensitivity , producing results with grab and fit. 3 For instance, one of my Ph.D. students had set out to administer a fairly structured questionnaire among a group of potential respondents but found that their background stories were far more interesting and did not fit into her initial research strategy. Rather than “forcing” these responses into her initial framework or simply ignoring the rich information that she had unearthed, she changed tack and started to analyze her data using GTM techniques. Since she had already gathered her data, I advised her to code one or two of her interviews and see what transpired. Eventually, she managed to develop a set of codes and applied them to her other interviews and observations, resulting in a model that certainly had grab and fit. 4

Future Directions: What Is a (Grounded) Theory Anyway?

I deliberately used terms such as model, framework , and theory almost interchangeably in the earlier sections. Some writers make specific distinctions between these terms, but I chose not to. One of the issues with regard to use of GTM is the expectation that the outcome of any such research should result in a theory—but what exactly is a theory, whether of the grounded variety or any other type?

There is currently a good deal of discussion about the status of the term theory. Those arguing in favor of some form of creationism or intelligent design often make statements to the effect that “evolution is only a theory ,” that it is not fully proven, and therefore alternative claims to knowledge, however tenuous or problematic, must be granted equal status. This is to confuse the meanings of the term. In cases such as the theory of gravity, or relativity, or evolution, the term refers to a body of knowledge and concepts that have stood both the test of time and an extended time of testing and various forms of rigorous investigation. In more colloquial use, people talk about their own particular “theories” of anything from the origin of the universe, the economic crash of 2007–2008, or how to pick winners in horse races—in this sense, a theory is no more than a guess or a hunch.

In an earlier paper (Bryant, 2009 ), I noted that, for pragmatists such as John Dewey and William James (particularly Dewey), a theory was something to be judged in terms of its usefulness rather than its truthfulness. Consequently, a theory should be regarded as a tool, and a tool is only useful for certain tasks. This, in fact, characterizes what Glaser and Strauss ( 1967 , p. 177) meant by the term substantive theory as opposed to formal theory :

By substantive theory we mean theory developed for a substantive or empirical area of sociological inquiry, such as patient care, geriatric life styles etc.… By formal theory we mean theory developed for a formal or conceptual area of sociological area such as status passage, stigma, deviant behavior, etc.

So, terms such as grab, fit, and work can then be seen as ways in which research outcomes can be judged, whether these results are regarded as theories, models, frameworks, or something else. In all cases, the outcome can be evaluated in terms of whether it has some use within the context from which it was derived. These criteria should not be restricted to GTM-oriented research, but if this form of research is to be assessed in terms of its “theoretical” outputs, then it is important that the nature of such results is understood.

Charmaz offered an alternative set of criteria—credibility, originality, resonance, and usefulness. These are explained at some length in both editions of Constructing (Charmaz, 2006 , 2014a ). Charmaz situated her discussion against general issues regarding criteria for evaluating research, as well as those specifically pertaining to GTM.

GTM has developed into a mature family of methods and now provides researchers with a host of possible strategies, techniques, and guidelines. It is important that the intricacies and rich potential of GTM are understood, both by researchers and by those who judge and evaluate research proposals, funding applications, and articles submitted for publication. Use of the method continues to grow and so, too, does the supporting literature on the method itself. The extent to which researchers now must articulate their methodological strategies is to be welcomed, but not if it starts to obscure the research itself. It is important that those involved in research, particularly those in positions of authority whose decisions can encourage or deter research projects, understand the intricacies of the plethora of research methods and that researchers themselves clarify and justify their research approaches so that their various audiences can assess the ways in which their efforts have achieved fruition.

Locating GTM within the pragmatist tradition, as I have argued elsewhere (Bryant, 2009 , 2017 ), implies an understanding of the process of research as a continuing dialogue. All outcomes must be seen as, at best, provisional, affording the basis for further research and investigation. In light of this, I conclude by offering some issues for readers to ponder and a list of sources, to some of which I have added a brief indication or comment.

To what extent is a researcher’s epistemological position important in guiding their research? Has it been an issue in your own research or in the way in which you have framed research proposals with which you have been involved?

There is now a wide variety of software tools available, either specifically aimed at GTM or supporting qualitative research in more general ways. To what extent do such tools impact upon the research process, either positively or negatively?

Try to read several articles in which the researchers indicate that they have used GTM. How do they differ from each other? What do they have in common?

Research based on GTM does not start out with specific hypotheses; indeed, hypotheses can be the result of this form of research. How should such hypotheses be taken up and used in further research? Can you find any examples in the literature in your field of expertise?

Suggestions for Further Reading

Although the three books published by Glaser and Strauss in the 1960s are rightly regarded as the founding texts for GTM, the best introduction to the method itself—together with clearly worked examples of coding, memo writing, and other key features—is to be found in Charmaz’s ( 2006 , 2014a ) Constructing Grounded Theory . Glaser’s (1978) Theoretical Sensitivity should be read thoroughly, as should the appendix to Glaser and Strauss’s (1965) Awareness . The Handbook of Grounded Theory provides a valuable overview of many aspects of GTM in recent years, with contributions from Glaser, as well as many of those who were part of the UCSF doctoral program in the 1960s. There are also chapters from German-speaking contributors who were influenced directly or indirectly by Strauss as he lectured on the method in Germany.

In 2019 we published a new handbook, The Handbook of Current Developments in Grounded Theory (Bryant & Charmaz, 2019 ). This is a companion volume to the earlier handbook, and comprises entirely new chapters discussing GTM and the ways it has developed in recent years. My planned introductory essay for the volume was eventually published as a separate monograph, The Varieties of Grounded Theory (Bryant, 2019 ). It covers key issues relating to GTM, and although closely aligned to the new handbook, can be read on its own.

My own recent book on GTM (Bryant, 2017 ) gives a detailed account of GTM, incorporating examples from several of my Ph.D. students. Chapter 19 comprises four verbatim accounts, illustrating different ways in which GTM-oriented doctoral research was carried out.

Kathy Charmaz continues to publish widely, and her contribution to Wertz et al. ( 2011 ) should be of particular interest since it situates GTM against several other qualitative approaches.

If you contemplate using GTM in your own research, you should use keywords or other searches to review recent journals in your area of study to find examples of the ways in which others have used the method. This seems to go against Glaser’s line that you should not look at the relevant literature until you reach the later stages of your research. But this seems far less feasible with the burgeoning research and the demand by reviewers and evaluators that a case be made for a research proposal to demonstrate awareness of existing work, together with critical insights regarding prior work and the methods employed. It is worth reiterating Dey’s (2007) point about “an open mind not being the same as an empty head”—something that should apply to all forms of research.

Quint took this early work forward, pioneering nursing and care for the terminally ill.

This section offers only a brief account of the method—a more detailed exposition can be found in my recent book Grounded Theory and Grounded Theorizing (Bryant, 2017 ).

Several examples of this can be found in the numerous examples referred to in Bryant 2017 .

See the account given by Premila Gamage in Bryant, 2017 , ch. 19.

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Your complete guide to grounded theory research.

11 min read If you have an area of interest, but no hypothesis yet, try grounded theory research. You conduct data collection and analysis, forming a theory based on facts. Read our ultimate guide for everything you need to know.

What is grounded theory in research?

Grounded theory is a systematic qualitative research method that collects empirical data first, and then creates a theory ‘grounded’ in the results.

The constant comparative method was developed by Glaser and Strauss, described in their book, Awareness of Dying (1965). They are seen as the founders of classic grounded theory.

Research teams use grounded theory to analyze social processes and relationships.

Because of the important role of data, there are key stages like data collection and data analysis that need to happen in order for the resulting data to be useful.

The grounded research results are compared to strengthen the validity of the findings to arrive at stronger defined theories. Once the data analysis cannot continue to refine the new theories down, a final theory is confirmed.

Grounded research is different from experimental research or scientific inquiry as it does not need a hypothesis theory at the start to verify. Instead, the evolving theory is based on facts and evidence discovered during each stage.Also, grounded research also doesn’t have a preconceived understanding of events or happenings before the qualitative research commences.

Free eBook: Qualitative research design handbook

When should you use grounded theory research?

Grounded theory research is useful for businesses when a researcher wants to look into a topic that has existing theory or no current research available. This means that the qualitative research results will be unique and can open the doors to the social phenomena being investigated.

In addition, businesses can use this qualitative research as the primary evidence needed to understand whether it’s worth placing investment into a new line of product or services, if the research identifies key themes and concepts that point to a solvable commercial problem.

Grounded theory methodology

There are several stages in the grounded theory process:

1. Data planning

The researcher decides what area they’re interested in.

They may create a guide to what they will be collecting during the grounded theory methodology. They will refer to this guide when they want to check the suitability of the qualitative data, as they collect it, to avoid preconceived ideas of what they know impacting the research.

A researcher can set up a grounded theory coding framework to identify the correct data. Coding is associating words, or labels, that are useful to the social phenomena that is being investigated. So, when the researcher sees these words, they assign the data to that category or theme.

In this stage, you’ll also want to create your open-ended initial research questions. Here are the main differences between open and closed-ended questions:

These will need to be adapted as the research goes on and more tangents and areas to explore are discovered. To help you create your questions, ask yourself:

• What are you trying to explain?
• What experiences do you need to ask about?
• Who will you ask and why?

2. Data collection and analysis

Data analysis happens at the same time as data collection. In grounded theory analysis, this is also known as constant comparative analysis, or theoretical sampling.

The researcher collects qualitative data by asking open-ended questions in interviews and surveys, studying historical or archival data, or observing participants and interpreting what is seen. This collected data is transferred into transcripts.

The categories or themes are compared and further refined by data, until there are only a few strong categories or themes remaining. Here is where coding occurs, and there are different levels of coding as the categories or themes are refined down:

• Data collection (Initial coding stage): Read through the data line by line
• Open coding stage: Read through the transcript data several times, breaking down the qualitative research data into excerpts, and make summaries of the concept or theme.
• Axial coding stage: Read through and compare further data collection to summarize concepts or themes to look for similarities and differences. Make defined summaries that help shape an emerging theory.
• Selective coding stage: Use the defined summaries to identify a strong core concept or theme.

During analysis, the researcher will apply theoretical sensitivity to the collected data they uncover, so that the meaning of nuances in what they see can be fully understood.

This coding process repeats until the researcher has reached theoretical saturation. In grounded theory analysis, this is where all data has been researched and there are no more possible categories or themes to explore.

3. Data analysis is turned into a final theory

The researcher takes the core categories and themes that they have gathered and integrates them into one central idea (a new theory) using selective code. This final grounded theory concludes the research.

The new theory should be a few simple sentences that describe the research, indicating what was and was not covered in it.

An example of using grounded theory in business

One example of how grounded theory may be used in business is to support HR teams by analyzing data to explore reasons why people leave a company.

For example, a company with a high attrition rate that has not done any research on this area before may choose grounded theory to understand key reasons why people choose to leave.

Researchers may start looking at the quantitative data around departures over the year and look for patterns. Coupled with this, they may conduct qualitative data research through employee engagement surveys , interview panels for current employees, and exit interviews with leaving employees.

From this information, they may start coding transcripts to find similarities and differences (coding) picking up on general themes and concepts. For example, a group of excepts like:

• “The hours I worked were far too long and I hated traveling home in the dark”
• “My manager didn’t appreciate the work I was doing, especially when I worked late”
• There are no good night bus routes home that I could take safely”

Using open coding, a researcher could compare excerpts and suggest the themes of managerial issues, a culture of long hours and lack of traveling routes at night.

With more samples and information, through axial coding, stronger themes of lack of recognition and having too much work (which led people to working late), could be drawn out from the summaries of the concepts and themes.

This could lead to a selective coding conclusion that people left because they were ‘overworked and under-appreciated’.

With this information, a grounded theory can help HR teams look at what teams do day to day, exploring ways to spread workloads or reduce them. Also, there could be training supplied to management and employees to engage professional development conversations better.

 Advantages of grounded theory

• No need for hypothesis – Researchers don’t need to know the details about the topic they want to investigate in advance, as the grounded theory methodology will bring up the information.
• Lots of flexibility – Researchers can take the topic in whichever direction they think is best, based on what the data is telling them. This means that exploration avenues that may be off-limits in traditional experimental research can be included.
• Multiple stages improve conclusion – Having a series of coding stages that refine the data into clear and strong concepts or themes means that the grounded theory will be more useful, relevant and defined.
• Data-first – Grounded theory relies on data analysis in the first instance, so the conclusion is based on information that has strong data behind it. This could be seen as having more validity.

Disadvantages of grounded theory

• Theoretical sensitivity dulled – If a researcher does not know enough about the topic being investigated, then their theoretical sensitivity about what data means may be lower and information may be missed if it is not coded properly.
• Large topics take time – There is a significant time resource required by the researcher to properly conduct research, evaluate the results and compare and analyze each excerpt. If the research process finds more avenues for investigation, for example, when excerpts contradict each other, then the researcher is required to spend more time doing qualitative inquiry.
• Bias in interpreting qualitative data – As the researcher is responsible for interpreting the qualitative data results, and putting their own observations into text, there can be researcher bias that would skew the data and possibly impact the final grounded theory.
• Qualitative research is harder to analyze than quantitative data – unlike numerical factual data from quantitative sources, qualitative data is harder to analyze as researchers will need to look at the words used, the sentiment and what is being said.
• Not repeatable – while the grounded theory can present a fact-based hypothesis, the actual data analysis from the research process cannot be repeated easily as opinions, beliefs and people may change over time. This may impact the validity of the grounded theory result.

What tools will help with grounded theory?

Evaluating qualitative research can be tough when there are several analytics platforms to manage and lots of subjective data sources to compare. Some tools are already part of the office toolset, like video conferencing tools and excel spreadsheets.

However, most tools are not purpose-built for research, so researchers will be manually collecting and managing these files – in the worst case scenario, by pen and paper!

Use a best-in-breed management technology solution to collect all qualitative research and manage it in an organized way without large time resources or additional training required.

Qualtrics provides a number of qualitative research analysis tools, like Text iQ , powered by Qualtrics iQ, provides powerful machine learning and native language processing to help you discover patterns and trends in text.

This also provides you with research process tools:

• Sentiment analysis — a technique to help identify the underlying sentiment (say positive, neutral, and/or negative) in qualitative research text responses
• Topic detection/categorisation — The solution makes it easy to add new qualitative research codes and group by theme. Easily group or bucket of similar themes that can be relevant for the business and the industry (eg. ‘Food quality’, ‘Staff efficiency’ or ‘Product availability’)

Related resources

Market intelligence 10 min read, marketing insights 11 min read, ethnographic research 11 min read, qualitative vs quantitative research 13 min read, qualitative research questions 11 min read, qualitative research design 12 min read, primary vs secondary research 14 min read, request demo.

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Grounded theory, mixed methods, and action research

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• Lorelei Lingard , associate professor and BMO Financial Group professor in health professions education research 1 ,
• Mathieu Albert , assistant professor 2 ,
• Wendy Levinson , Sir John and Lady Eaton professor and chair and physician in chief, Sunnybrook Health Sciences Centre 3
• 1 SickKids Learning Institute and Department of Paediatrics and Wilson Centre for Research in Education, University of Toronto, 200 Elizabeth Street, Eaton South 1-565, Toronto, ON, Canada M5G 2C4
• 2 Department of Psychiatry and Wilson Centre for Research in Education, University of Toronto
• 3 Department of Medicine, University of Toronto
• Correspondence to: L Lingard lorelei.lingard{at}utoronto.ca

These commonly used methods are appropriate for particular research questions and contexts

Qualitative research includes a variety of methodological approaches with different disciplinary origins and tools. This article discusses three commonly used approaches: grounded theory, mixed methods, and action research. It provides background for those who will encounter these methodologies in their reading rather than instructions for carrying out such research. We describe the appropriate uses, key characteristics, and features of rigour of each approach.

Grounded theory: what is it and when is it used?

Grounded theory was developed by Glaser and Strauss.[1] Its main thrust is to generate theories regarding social phenomena: that is, to develop higher level understanding that is “grounded” in, or derived from, a systematic analysis of data. Grounded theory is appropriate when the study of social interactions or experiences aims to explain a process, not to test or verify an existing theory. Researchers approach the question with disciplinary interests, background assumptions (sometimes called “sensitising concepts”[2]) and an acquaintance with the literature in the domain, but they neither develop nor test hypotheses. Rather, the theory emerges through a close and careful analysis of the data.

What are the key features of grounded theory?

Key features of grounded theory are its iterative study design, theoretical (purposive) sampling, and system of analysis.[3] An iterative study design entails cycles of simultaneous data collection and analysis, where analysis informs the next cycle of data collection. In a study of the experience of caring for a dying family member, for instance, preliminary analysis of interviews with family care providers may suggesta theme of “care burdens,” and this theme could be refined by interviewing participants who are at variouspoints in the care trajectory, who might offer different perspectives. Analysis of the subsequent phase of data collection will lead to further adaptations of the data collection process to refine and complicate the emerging theory of care burdens. In keeping with this iterative design, the sampling process proceeds on theoretical grounds: the sample is not set at the outset but is selected purposefully as the analysis progresses; participants are chosen for their ability to confirm or challenge an emerging theory.

The central principle of data analysis in grounded theory research is constant comparison. As issues of interest are noted in the data, they are compared with other examples for similarities and differences. Through the process of constant comparison, for which a number of formal approaches are available,[4] emerging theoretical constructs are continually being refined through comparisons with “fresh” examples from ongoing data collection, which produces the richness that is typical of grounded theory analysis.

Iterative study design, theoretical sampling, and system of analysis are intimately related. An iterative study design requires theoretical sampling for iterations to be meaningful, and constant comparative analysis allows the integration of new and existing data in this iterative cycle, towards a well grounded theory. Therefore, a study must use all three of these features to allow the emergence of new conceptual models—such as “clinical oversight” (box 1)—that extend beyond conventional thinking.

Box 1 Grounded theory study

A study of clinical supervision using interviews and observations took place in the emergency departments and inpatient teaching wards (general internal medicine) in two teaching hospitals.[5] Its aim was to understand how clinical teachers in these settings balanced the goals of supervising trainees to ensure patient safety and allowing trainees sufficient independence to develop their competence. In an era of increasing concern for patient safety, the authors aimed to develop a conceptual model of clinical supervision to inform and guide policy and research.

The principal author (a licensed physician) and a trained research assistant conducted non-participant observations of 12 internal medicine and emergency medicine teaching teams during regular clinical activities. Observations focused on the interactions among trainees and teachers. During and after the observation phase they interviewed 65 team members (teachers, trainees, and nurses) about supervision.

The researchers used an iterative approach to analyse field notes and interview transcripts on an ongoing basis throughout the study. This allowed them to pursue emergent themes in subsequent data collection. Saturation sampling was used, in which observations and interviews stopped when no new, dominant issues were emerging in the dataset. Triangulation among multiple datasets (observations in four distinct settings, interviews with teachers and trainees) provided the basis for a comprehensive model of the range and pattern of supervision strategies (clinical oversight) used by clinical teachers on these teams.

Mixed methods: what is it and when is it used?

Mixed methods research combines elements from both qualitative and quantitative paradigms to produce converging findings in the context of complex research questions. There are tensions between these methods in terms of their values and processes, but these very tensions can generate new insights. In medicine, mixed methods have arisen in the wake of attention to the psychosocial determinants of health and the human aspects of medical care. For instance, a study of quality of care in people with diabetes might measure the frequency of foot and eye examinations, or glycated haemoglobin (HgA 1c ) concentrations, and interviews with patients might address barriers to achieving these goals.

What are the key features of mixed methods?

The mixing of methods may happen within one study or across several studies in a research programme. The strategy for mixing methods must be explicit and justified in terms of the sequence of methods (concurrent, qualitative first, or quantitative first), the priority among methods (equal, or either method prioritised), and the nature and timing of integration (full or partial, during data collection, analysis, or interpretation).[6] A study of nurses’ perceptions of medical error might first distribute an attitude survey, followed by focus groups, so that the focus groups can be organised to include participants with a range of attitudes for the purposes of exploring the implications of varying attitudes towards error. In this study, the methods are integrated during data collection and analysis, with the quantitative method first in the sequence and the qualitative method prioritised in terms of the dominant aim of the research.

Central to the effectiveness of a mixed methods study is a clear and strategic relationship among the methods in order to ensure that the data converge or triangulate to produce greater insight than a single method could. Because qualitative and quantitative methods derive from different traditions, mixed methods research must take care to negotiate back and forth between these different approaches rather than dichotomising their values and methods. Qualitative research emphasises an inductive-subjective-contextual approach and quantitative research emphasises a deductive-objective-generalising approach, but these broad tendencies are neither absolute nor mutually exclusive.[7] Good mixed methods research negotiates these tendencies by articulating how and why criteria from both paradigms are integrated.

Box 2 Mixed methods study

A study of caregiver burden sought to extend understanding of the social experience of mothering children with disabilities.[8] It aimed to explore in depth the nature of the burdens perceived and the possibility of benefits of the maternal care giving role through a concurrent, mixed method approach. It surveyed 81 mothers of children with disabilities and followed up with in-depth interviews with a purposeful sample of seven of these mothers 1-3 years after the survey.

Interviewees were selected on the basis of the degree to which they represented the diversity of background characteristics among survey participants. In interviews, mothers were asked to share the stories of their children’s births and diagnoses and their own and their children’s interactions with family members, neighbours, friends, service providers, and members of the wider community. They were not specifically queried about stigma, burden, or perceived benefits (designated survey items) but were asked to talk about how their parenting experiences had affected them.

Data from the survey and the interviews were triangulated in the analysis in order to produce greater insight than would be gained by a single method. For instance, while the survey results emphasised the sociostructural constraints that produce a burden of care, the interview results illustrate that, despite these sociostructural constraints, most mothers perceive valuable benefits in having a child with a disability. These perceived benefits can be negatively affected by perceived stigma.

Action research: what is it and when is it used?

In action research studies (also referred to as community based research, participatory action research, or collaborative inquiry),[9] research is not done on or with participants; research is designed, carried out, and integrated by the participants in partnership with the researchers. Based in emancipatory social theory and designed to democratise the research process, action research is an iterative process in which researchers and practitioners act together in the context of an identified problem to discover and effect positive change within a mutually acceptable ethical framework. For example, researchers and community leaders might explore approaches to obesity prevention through surveys or interviews conducted in local churches, community centres, or schools. Because it embraces a tension between local solutions and transferable knowledge, action research can help make results of such research more generally applicable.[10]

What are the key features of action research?

The key features of action research include its collaborative nature, its egalitarian approach to power and education in the research process, and its emphasis on taking action on an issue. The extensive collaboration between researchers and partners in action research must extend across each stage of research, from identifying the problem to disseminating the results. This collaboration entails shared control of the agenda and also involves reciprocal education to improve researchers’ and research partners’ understanding of one another’s positions and contributions. Finally, the study must blend scientific inquiry with social action by creating knowledge that is relevant to the research partners’ needs and interests. For instance, in an action research project for preventing falls in a long term care facility, researchers and staff would collaboratively define the problem and the research design; the staff might conduct interviews with colleagues and patients, and the solutions that are decided and implemented will be based on the needs and priorities of the staff.

Box 3 Action research study

A study of the impact of interprofessional care coordinators took place in the general and emergency medicine service of an inner London hospital trust.[11] The study sought to explore the characteristics and impact of the development of the new role of interprofessional care coordinator (IPCC) on the working of the interprofessional team in an acute medical inpatient setting. In the context of changing models of service delivery in UK health and social care, the authors aimed to understand the impact of a new support worker role on the work of existing practitioners.

Data were collected using a variety of methods, including 37 individual semistructured interviews and 16 focus groups with IPCCs, managers, and interprofessional team colleagues; 24 half day observations of IPCCs; field notes from two years of participant observation; and systematic analysis of relevant documents from the hospital trust.

The study unfolded within three main action research cycles. In each cycle, the lead investigator worked collaboratively with participants to consider findings to date, decide what (if any) changes were needed in response to the findings, and take forward any developments that had been agreed. These main cycles were “communicating about the IPCC role,” “exploring issues of accountability,” and “improving interprofessional working.” Further data were collected to illuminate the process and outcomes of change within each of the cycles.

These methods can be useful in answering clinical and health delivery research questions in ways that challenge conventional thinking, offer multidimensional insights, and provide local solutions. Box 4 lists key elements to look for in research papers written using each of these approaches.

Box 4 Key elements to look for in research papers

Grounded theory.

Does the research question indicate that a theory is needed?

Is the study designed to support iterative data collection and analysis in a context of theoretical sampling?

Does the discussion explain how the theory responds to the original research question?

Mixed methods

Is the research question appropriate for mixed methods or would a single method suffice?

Is the relation among the methods clear in terms of their sequence, priority, and integration?

Does the discussion relate the findings to a complex understanding of a multifaceted phenomenon?

Action research

Does the research question arise from a situated problem that is best understood through a collaborative research partnership?

Are the research agenda and activities shared by researchers and partners?

Do the results meet the partners’ needs in a collaborative and equitable manner? Is the identified problem acted on in a substantive way?

Further reading

Creswell J. Research design: qualitative, quantitative and mixed methods approaches . 2nd ed. Thousand Oaks, CA: Sage, 2003.

Green LW, George MA, Daniel M, et al. Guidelines for participatory research in health promotion. In: Minkler M, Wallerstein N, eds. Community based participatory research for health . San Francisco, CA: Jossey-Bass, 2003:419-28.

Meyer J. Action research. In: Pope C, Mays N, eds. Qualitative research in health care . 3rd ed. Malden, MA: Blackwell, 2006:121-42.

Strauss A, Corbin J. Grounded theory in practice . Thousand Oaks, CA: Sage, 1997.

Winter R, Munn-Giddings C. A handbook for action research in health and social care . London: Routledge, 2001.

Hall W, Callery P. Enhancing the rigor of grounded theory: incorporating reflexivity and relationality. Qualitative Health Research 2001;11:257-72.

Kennedy T, Lingard L. Making sense of grounded theory. Medical Education 2006;40:101-8.

McGhee G, Marland GR, Atkinson J. Grounded theory research: literature reviewing and reflexivity. Journal of Advanced Nursing 2007;60:334-42.

Morgan D. Practical strategies for combining qualitative and quantitative methods: applications to health research. Qualitative Health Research 1998;8:362-76.

Summary points

Understanding the appropriate uses and key features of qualitative methodologies can help readers in critically appraising the literature

Grounded theory, mixed methods, and action research are commonly used in health research

Each methodology is appropriate for particular research questions and contexts, yielding insights of relevance to clinical and health delivery issues

Cite this as: BMJ 2008;337:a567

• Related to doi: , 10.1136/bmj.a288
• doi: , 10.1136/bmj.a1020
• doi: , 10.1136/bmj.a879
• doi: , 10.1136/bmj.a949
• doi: 10.1136/bmj.a1035

This is the second in a series of six articles that aim to help readers to critically appraise the increasing number of qualitative research articles in clinical journals. The series editors are Ayelet Kuper and Scott Reeves.

For a definition of terms, see the first article in this series.

Contributors: LL, MA, and WL researched, wrote, and revised the article. LL is guarantor.

Funding: None.

Competing interests: None declared.

Provenance and peer review: Commissioned; externally peer reviewed.

• Glaser B, Strauss A. The discovery of grounded theory: strategies for qualitative research . Chicago: Aldine, 1967 .
• Blumer H. Symbolic interactionism: perspective and method . Englewood Cliffs, NJ: Prentice Hall, 1968 .
• Kennedy T, Lingard L. Making sense of grounded theory. Med Educ 2006 ; 40 : 101 -8. OpenUrl CrossRef PubMed Web of Science
• Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory . 2nd ed. Thousand Oaks, CA: Sage, 1998 .
• Kennedy TJ, Lingard L, Baker GR, Kitchen L, Regehr G. Clinical oversight: conceptualizing the relationship between supervision and safety. J Gen Intern Med 2007 ; 2 : 1080 -5. OpenUrl
• Creswell J. Research design: qualitative, quantitative and mixed methods approaches . 2nd ed. Thousand Oaks, CA: Sage, 2003 .
• Morgan DL. Paradigms lost and paradigms regained: methodological implications of combining qualitative and quantitative methods. J Mixed Methods Res 2007 ; 1 : 48 -76. OpenUrl CrossRef
• Green SE. “We’re tired, not sad”: benefits and burdens of mothering a child with a disability. Soc Sci Med 2007 ; 64 : 150 -63. OpenUrl CrossRef PubMed Web of Science
• Gibson N, Gibson G, Macaulay A. Community-based research: negotiating research agendas and evaluating outcomes. In: Morse J, Swanson J, Kuzel A, eds. The nature of qualitative evidence . Thousand Oaks, CA: Sage, 2001 :161-84.
• Meyer J. Action research. In: Pope C, Mays N, eds. Qualitative research in health care . 3rd ed. Malden, MA: Blackwell Publishing, 2006 :121-42.
• Bridges J, Meyer J, Glynn M, Bentley J, Reeves S. Interprofessional care co-ordinators: the benefits and tensions associated with a new role in UK acute health care. Int J Nurs Stud 2003 ; 40 : 599 -607. OpenUrl CrossRef PubMed Web of Science

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• Volume 19, Issue 2
• What is grounded theory?
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• Helen Noble 1 ,
• Gary Mitchell 2
• 1 School of Nursing and Midwifery, Queens's University Belfast , Belfast , UK
• 2 Four Seasons Health Care , Belfast , UK
• Correspondence to : Dr Helen Noble , School of Nursing and Midwifery, Queens's University Belfast, Belfast BT9 7BL, UK; Helen.noble{at}qub.ac.uk

https://doi.org/10.1136/eb-2016-102306

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Introduction

Grounded theory (GT) is a research method concerned with the generation of theory, 1 which is ‘grounded’ in data that has been systematically collected and analysed. 2 It is used to uncover such things as social relationships and behaviours of groups, known as social processes. 3 It was developed in California, USA by Glaser and Strauss during their study—‘Awareness of Dying’. 1 It is a general methodology for developing theory that is grounded in data which is systematically gathered and analysed.

Features of GT

Data collection and analysis occur simultaneously.

Categories and analytic codes developed from data. Pre-existing conceptualisations not to be used—this is known as theoretical sensitivity (see below).

Theoretical sampling used to refine categories.

Abstract categories constructed inductively.

Social processes discovered in the data.

Analytical memos used between coding and writing.

Categories integrated into a theoretical framework. 4

Carrying out a GT study

Theoretical sampling.

Glaser and Strauss (1967) first mentioned theoretical sampling and described a process of generating theory from data which includes collecting the data, then coding and analysing the data. 1 Next the researcher makes a conscious decision about what further detail they feel needs exploring as the new theory develops. It usually takes place after some initial key concepts or categories have been identified, for example, you might decide to interview patients about their experience of heart failure. They may talk about systematic errors occurring in the general practice surgery. From this analysis of the data you may decide to approach and interview GPs to explore their views on patients’ comments. Theoretical sampling therefore, is used to produce more data to endorse or refute the categories that have been identified in the previous analysis. 6

Theoretical sensitivity

Theoretical sensitivity refers to the insight of the researcher. It concerns the researcher being able to give meaning to data, understand what the data says, and being able to separate out what is relevant and what is not. By being theoretically sensitive and using insight, the researcher is able to develop a theory that is grounded, theoretically dense, and cohesive. 7 Sensitivity comes from several sources including (1) literature—in depth reading offers a rich understanding of the phenomena being studied; (2) professional and personal experience—offers an understanding of the events and topics being explored; (3) the analytic process—allows for insight and understanding of the phenomena. 8

Analysis of data in GT

There are three stages of data analysis in GT: 8

Open coding: this involves line by line coding where concepts and key phrases are identified and highlighted and moved into subcategories, then categories. This breaks the data down into conceptual components and the researcher can start to theorise or reflect on what they are reading and understanding—making sense of the data. The data from each participant will be ‘constantly compared’ for similarities.

Axial coding: at this stage relationships are identified between the categories, and connections identified.

Selective coding: this involves identifying the core category and methodically relating it to other categories. The relationships must be authenticated and categories refined. Categories are then integrated together and a GT identified.

Analytical notes are encouraged. These are notes to oneself to explain thought patterns in relation to the data analysis. Final theory is usually generated from the integration of several analytical memos.

The core category

The core category is the chief phenomena around which the categories are built. Theory is generated around a core category. The core category should account for the variation found in the data, that is, the categories will relate to it in some way. The categories demonstrate how the core category is situated in the lives of those participating in the study.

Example of a GT case study

As illustrated, GT methodologies involve the construction of new theory through the analysis of data. In a study carried out by Beech et al , 9 the authors sought to explore patient participant experiences of recovery following surgical intervention for colorectal cancer. Beech et al 9 opted to use GT because previous studies had sought to answer this research question by measuring quantifiable biomedical markers, such as symptoms of pain, insomnia or fatigue. According to the authors, there was a paucity of empirical literature around the topic from a holistic perspective, for example social, psychological and cultural aspects of a person's well-being.

Twelve participants were interviewed four times, over a 1-year period. The authors used theoretical sampling to guide the researcher as data were collected. It helped facilitate the development of theory as it emerged, not once data collection was complete. 1 Initial participants were selected based on ‘subject area’, as is recommended in theoretical sampling. Each had undergone a surgical procedure to remove a tumour in their bowel or rectum and had not received prescribed chemotherapy or radiotherapy. The authors initially asked patient participants to describe their experiences to date.

Data analysis of the interviews was carried out according to the steps described by Strauss and Corbin. 10 The authors began by coding each line of each patient participant transcript. Similar codes were then grouped together to form subcategories and within these subcategories categories were identified. The authors then grouped together the categories to form theory related to patient participant experiences of recovery following surgical intervention for colorectal cancer. The process of data collection continued until each category was saturated and no new data emerged.

Patient participants described their recovery in three phases identified from three categories; disrupting the self, repairing the self and restoring the self. The authors also noted how the process was linear in that all participants went through the stages, for example, phase one began at prediagnosis and ended at the conclusion of surgery; phase two commonly lasted between 3 and 6 months and phase three, from 6 months onwards, was related to a person's fluctuating level of wellness and illness. Notably, these three categories were underpinned by various subcategories, which were generated from initial codes. For example, the second category Beech et al 4 identified, ‘disrupting the self’, was made up of the three subcategories; body repair, autonomy and re-establishing personal identity ( figure 1 ).

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Grounded theory data analysis.

Importantly, the authors encapsulated the three categories to present a pertinent theory related to patient participant experiences of recovery following surgical intervention for colorectal cancer. They found that recovery is more than physical repair. It is a process of restoring a sense of wellness demonstrated through an awareness and enjoyment of the physical, emotional, social and spiritual aspects of life, in other words, holistic health. 9

By using GT and adhering to this as a research method, a theory will be produced that is grounded in your data. 10 It is a research method which uses strict procedures for data analysis and will enable you to search for and conceptualise the hidden social and collective patterns and constructions in your area of interest.

• Glaser BG ,
• Strauss A ,
• Faithfull S

Competing interests None declared.

Provenance and peer review Not commissioned; internally peer reviewed.

Read the full text or download the PDF:

10 Grounded Theory Examples (Qualitative Research Method)

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

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

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

Grounded Theory Definition and Overview

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

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

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

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

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

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

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

Real-Life Grounded Theory Examples

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

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

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

Title: A taxonomy of dignity: a grounded theory study

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

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

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

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

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

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

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

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

Title: Victimising of school bullying: a grounded theory

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

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

Hypothetical Grounded Theory Examples

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

Suggested Data Analysis Method: Coding and constant comparative analysis

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

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

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

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

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

Suggested Data Analysis Method: Constant comparative analysis

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

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

Suggested Data Analysis Method: Iterative Coding

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

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

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

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

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

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

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

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

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

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

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

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

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Qualitative Research Methods In Business

Techniques for Data Collection and Analysis

• © 2024
• José Osvaldo De Sordi 0

Federal University of São Paulo, Jundiai, Brazil

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• Includes end-of-chapter discussion questions to help students better grasp the concepts
• Presents text excerpts from scientific articles in which particular techniques were applied
• Offers a list of recommended readings that allows reader to have broader perception of text

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Table of contents (10 chapters)

Front matter, introduction to qualitative research approach, overview of qualitative research.

• Jose Osvaldo De Sordi

Qualitative Research Strategies

Research strategies according to the constructivist paradigm, research strategies according to the pragmatic paradigm, research strategies according to the transformative paradigm, qualitative data collection, techniques for data collection, dealing with people during the research process, techniques for qualitative data analysis, content analysis technique, software-technique in support of qualitative analyses, writing and publishing qualitative research findings, communicating the findings of qualitative research, planning the publication of qualitative research, back matter.

• claimant-participant research
• focus group
• crowdsourcing
• transcription
• codification
• phenomenology
• design science research
• action research
• ethnography
• grounded theory
• content analysis
• observation
• constructivism

About this book

The challenges of developing research and generating scientific knowledge in environments that involve subjective aspects related to employees, customers, managers, leaders, inspectors, auditors, among other stakeholders in the business environment, can be overwhelming for students that are new to this type of inquiry. This textbook presents an integrated view of qualitative research strategies with data collection and analysis techniques.

The book explores nine distinct research strategies, namely ethnography, phenomenology, grounded theory, case study, design science research, grounded design, action research, participatory action research, and action-design research.

In terms of analyzing data, the author describes various reading techniques, how to code the text, and how to use software to aid in the analysis.

The final section of the book explains how to write up the results of qualitative research, including article structure and selecting an outlet for publication.

Students will benefit from the plentiful examples and exercises that highlight the interweaving of data collection and analysis as well as concrete guidelines on engaging in qualitative research. At a time in which qualitative research is becoming more rigorous to meet the demands of the field, this textbook will prove a valuable resource for the next generation of business researchers.

Authors and Affiliations

José Osvaldo De Sordi

About the author

José Osvaldo De Sordi is a Lecturer/Researcher of the PhD Program in Business Management at Centro Universitário Campo Limpo Paulista (UNIFACCAMP), Brazil and Professor of the Administration course at Federal University of São Paulo (UNIFESP), Brazil. He has published 10 books, one of them focused on the Business Process Management.

Bibliographic Information

Book Title : Qualitative Research Methods In Business

Book Subtitle : Techniques for Data Collection and Analysis

Authors : José Osvaldo De Sordi

DOI : https://doi.org/10.1007/978-3-031-50323-8

Publisher : Palgrave Macmillan Cham

eBook Packages : Business and Management , Business and Management (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024

Softcover ISBN : 978-3-031-50325-2 Due: 04 July 2024

eBook ISBN : 978-3-031-50323-8 Published: 30 May 2024

Edition Number : 1

Number of Pages : XIII, 142

Number of Illustrations : 2 b/w illustrations, 4 illustrations in colour

Topics : Business and Management, general

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A Grounded Theory Exploration of Addictions Treatment Within a Commercial Airline Setting

• PMID: 38790122
• DOI: 10.3357/AMHP.6411.2024

INTRODUCTION: An Australasian Airline's Alcohol and Other Drug (AOD) Program demonstrates abstinence rates that exceed those of general AOD programs. The reasons for this are unclear. The purpose of this research was to develop a theory as to why this program is successful. METHODS: A qualitative examination following grounded theory methodology was undertaken. AOD program patients and healthcare professionals were interviewed until content saturation was reached. Data analysis followed grounded theory to identify the key concepts associated with the program's success. RESULTS: The core theory that emerged highlighted the pivotal roles of a strong employee-company relationship, shared values, and a safety-focused culture in explicating the program's success. This moves beyond the "carrot and stick" model of motivation, where belonging to this organization and safety consciousness serve as powerful drivers for abstinence. Challenges and barriers highlighted some unique challenges to the program in managing the coronavirus pandemic and the difference in approach to substance use in community spaces versus safety-critical employment. DISCUSSION: This research expands the understanding of this AOD program's success in a safety-critical industry, emphasizing the elements of a working relationship that are beyond positive or negative reinforcement. Future research should work to quantify and test the generalizability of these findings. Nairn J, Bell E, Myers J, Higgins M, Johnston B, Newton-Howes G. A grounded theory exploration of addictions treatment within a commercial airline setting . Aerosp Med Hum Perform. 2024; 95(6):313-320.

• Grounded Theory*
• Middle Aged
• Qualitative Research
• Substance-Related Disorders* / psychology
• Substance-Related Disorders* / therapy

• Systematic Review
• Open access
• Published: 30 May 2024

Patient experiences: a qualitative systematic review of chemotherapy adherence

• Amineh Rashidi 1 ,
• Susma Thapa 1 ,
• Wasana Sandamali Kahawaththa Palliya Guruge 1 &
• Shubhpreet Kaur 1  

BMC Cancer volume  24 , Article number:  658 ( 2024 ) Cite this article

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Metrics details

Adherence to chemotherapy treatment is recognized as a crucial health concern, especially in managing cancer patients. Chemotherapy presents challenges for patients, as it can lead to potential side effects that may adversely affect their mobility and overall function. Patients may sometimes neglect to communicate these side effects to health professionals, which can impact treatment management and leave their unresolved needs unaddressed. However, there is limited understanding of how patients’ experiences contribute to improving adherence to chemotherapy treatment and the provision of appropriate support. Therefore, gaining insights into patients’ experiences is crucial for enhancing the accompaniment and support provided during chemotherapy.

This review synthesizes qualitative literature on chemotherapy adherence within the context of patients’ experiences. Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase, Scopus, and the Cochrane Library, systematically searched from 2006 to 2023. Keywords and MeSH terms were utilized to identify relevant research published in English. Thirteen articles were included in this review. Five key themes were synthesized from the findings, including positive outlook, receiving support, side effects, concerns about efficacy, and unmet information needs. The review underscores the importance for healthcare providers, particularly nurses, to focus on providing comprehensive information about chemotherapy treatment to patients. Adopting recommended strategies may assist patients in clinical practice settings in enhancing adherence to chemotherapy treatment and improving health outcomes for individuals living with cancer.

Peer Review reports

Introduction

Cancer can affect anyone and is recognized as a chronic disease characterized by abnormal cell multiplication in the body [ 1 ]. While cancer is prevalent worldwide, approximately 70% of cancer-related deaths occur in low- to middle-income nations [ 1 ]. Disparities in cancer outcomes are primarily attributed to variations in the accessibility of comprehensive diagnosis and treatment among countries [ 1 , 2 ]. Cancer treatment comes in various forms; however, chemotherapy is the most widely used approach [ 3 ]. Patients undergoing chemotherapy experience both disease-related and treatment-related adverse effects, significantly impacting their quality of life [ 4 ]. Despite these challenges, many cancer patients adhere to treatment in the hope of survival [ 5 ]. However, some studies have shown that concerns about treatment efficacy may hinder treatment adherence [ 6 ]. Adherence is defined as “the extent to which a person’s behaviour aligns with the recommendations of healthcare providers“ [ 7 ]. Additionally, treatment adherence is influenced by the information provided by healthcare professionals following a cancer diagnosis [ 8 ]. Patient experiences suggest that the decision to adhere to treatment is often influenced by personal factors, with family support playing a crucial role [ 8 ]. Furthermore, providing adequate information about chemotherapy, including its benefits and consequences, can help individuals living with cancer gain a better understanding of the advantages associated with adhering to chemotherapy treatment [ 9 ].

Recognizing the importance of adhering to chemotherapy treatment and understanding the impact of individual experiences of chemotherapy adherence would aid in identifying determinants of adherence and non-adherence that are modifiable through effective interventions [ 10 ]. Recently, systematic reviews have focused on experiences and adherence in breast cancer [ 11 ], self-management of chemotherapy in cancer patients [ 12 ], and the influence of medication side effects on adherence [ 13 ]. However, these reviews were narrow in scope, and to date, no review has integrated the findings of qualitative studies designed to explore both positive and negative experiences regarding chemotherapy treatment adherence. This review aims to synthesize the qualitative literature on chemotherapy adherence within the context of patients’ experiences.

This review was conducted in accordance with the Joanna Briggs Institute [ 14 ] guidelines for systemic review involving meta-aggregation. This review was registered in PROSPERO (CRD42021270459).

Search methods

The searches for peer reviewed publications in English from January 2006-September 2023 were conducted by using keywords, medical subject headings (MeSH) terms and Boolean operators ‘AND’ and ‘OR’, which are presented in the table in Appendix 1 . The searches were performed in a systematic manner in core databases such including Embase, Medline, PsycINFO, CINAHL, Web of Science, Cochrane Library, Scopus and the Joanna Briggs Institute (JBI). The search strategy was developed from keywords and medical subject headings (MeSH) terms. Librarian’s support and advice were sought in forming of the search strategies.

Study selection and inclusion criteria

The systematic search was conducted on each database and all articles were exported to Endnote and duplicates records were removed. Then, title and abstract of the full text was screened by two independent reviewers against the inclusion criteria. For this review, populations were patients aged 18 and over with cancer, the phenomenon of interest was experiences on chemotherapy adherence and context was considered as hospitals, communities, rehabilitation centres, outpatient clinics, and residential aged care. All peer-reviewed qualitative study design were also considered for inclusion. Studies included in this review were classified as primary research, published in English since 2006, some intervention implemented to improve adherence to treatment. This review excluded any studies that related to with cancer and mental health condition, animal studies and grey literature.

Quality appraisal and data extraction

The JBI Qualitative Assessment and Review Instrument for qualitative studies was used to assess the methodological quality of the included studies, which was conducted by the primary and second reviewers independently. There was no disagreement between the reviews. The qualitative data on objectives, study population, context, study methods, and the phenomena of interest and findings form the included studies were extracted.

Data synthesis

The meta-aggregation approach was used to combine the results with similar meaning. The primary and secondary reviewers created categories based on the meanings and concept. These categories were supported by direct quotations from participants. The findings were assess based on three levels of evidence, including unequivocal, credible, and unsupported [ 15 , 16 ]. Findings with no quotation were not considered for synthesis in this review. The categories and findings were also discussed by the third and fourth reviewers until a consensus was reached. The review was approved by the Edith Cowan University Human Research Ethics Committee (2021–02896).

Study inclusion

A total of 4145 records were identified through a systematic search. Duplicates ( n  = 647) were excluded. Two independent reviewers conducted screening process. The remaining articles ( n  = 3498) were examined for title and abstract screening. Then, the full text screening conducted, yielded 13 articles to be included in the final synthesis see Appendix 2 .

Methodological quality of included studies

All included qualitative studies scored between 7 and 9, which is displayed in Appendix 3 . The congruity between the research methodology and the research question or objectives, followed by applying appropriate data collection and data analysis were observed in all included studies. Only one study [ 17 ] indicated the researcher’s statement regarding cultural or theoretical perspectives. Three studies [ 18 , 19 , 20 ] identified the influence of the researcher on the research and vice-versa.

Characteristics of included studies

Most of studies conducted semi-structured and in-depth interviews, one study used narrative stories [ 19 ], one study used focus group discussion [ 21 ], and one study combined focus group and interview [ 22 ] to collect data. All studies conducted outpatient’s clinic, community, or hospital settings [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The study characteristics presented in Appendix 4 .

Review findings

Eighteen findings were extracted and synthesised into five categories: positive outlook, support, side effects, concern about efficacy and unmet information needs.

Positive outlook

Five studies discussed the link between positivity and hope and chemotherapy adherence [ 19 , 20 , 23 , 27 , 28 ]. Five studies commented that feeling positive and avoid the negativity and worry could encourage people to adhere in their mindset chemotherapy: “ I think the main thing for me was just keeping a positive attitude and not worrying, not letting myself worry about it ” [ 20 ]. Participants also considered the positive thoughts as a coping mechanism, that would help them to adhere and complete chemotherapy: “ I’m just real positive on how everything is going. I’m confident in the chemo, and I’m hoping to get out of her soon ” [ 23 ]. Viewing chemotherapy as part of their treatment regimen and having awareness of negative consequences of non-adherence to chemotherapy encouraged them to adhere chemotherapy: “ If I do not take medicine, I do not think I will be able to live ” [ 28 ]. Adhering chemotherapy was described as a survivor tool which helped people to control cancer-related symptoms: “ it is what is going to restore me. If it wasn’t this treatment, maybe I wasn’t here talking to you. So, I have to focus in what he is going to give me, life !” [ 27 ]. Similarly, people accepted the medical facts and prevent their life from worsening; “ without the treatment, it goes the wrong way. It is hard, but I have accepted it from the beginning, yes. This is how it is. I cannot do anything about it. Just have to accept it ” [ 19 ].

Finding from six studies contributed to this category [ 20 , 21 , 23 , 24 , 25 , 29 ]. Providing support from families and friends most important to the people. Receiving support from family members enhanced a sense responsibility towards their families, as they believed to survive for their family even if suffered: “ yes, I just thought that if something comes back again and I say no, then I have to look my family and friends in the eye and say I could have prevented it, perhaps. Now, if something comes back again, I can say I did everything I could. Cancer is bad enough without someone saying: It’s your own fault!!” [ 29 ]. Also, emotional support from family was described as important in helping and meeting their needs, and through facilitation helped people to adhere chemotherapy: “ people who genuinely mean the support that they’re giving […] just the pure joy on my daughter’s face for helping me. she was there day and night for me if I needed it, and that I think is the main thing not to have someone begrudgingly looking after you ” [ 20 ]. Another study discussed the role family, friends and social media as the best source of support during their treatment to adhere and continue “ I have tons of friends on Facebook, believe it or not, and it’s amazing how many people are supportive in that way, you know, just sending get-well wishes. I can’t imagine going through this like 10 years ago whenever stuff like that wasn’t around ” [ 23 ]. Receiving support from social workers was particularly helpful during chemotherapy in encouraging adherence to the chemotherapy: “ the social worker told me that love is courage. That was a huge encouragement, and I began to encourage myself ” [ 25 ].

Side effects

Findings from five studies informed this category [ 17 , 21 , 22 , 25 , 26 ]. Physical side effects were described by some as the most unpleasure experience: “ the side effects were very uncomfortable. I felt pain, fatigue, nausea, and dizziness that limited my daily activities. Sometimes, I was thinking about not keeping to my chemotherapy schedule due to those side effect ” [ 17 ]. The impact of side effects affected peoples’ ability to maintain their independence and self-care: “ I couldn’t walk because I didn’t have the energy, but I wouldn’t have dared to go out because the diarrhoea was so bad. Sometimes I couldn’t even get to the toilet; that’s very embarrassing because you feel like you’re a baby ” [ 26 ]. Some perceived that this resulted in being unable to perform independently: “ I was incredibly weak and then you still have to do things and you can’t manage it ” [ 22 ]. These side effect also decreased their quality of life “ I felt nauseated whenever I smelled food. I simply had no appetite when food was placed in front of me. I lost my sense of taste. Food had no taste anymore ” [ 25 ]. Although, the side effects impacted on patients´ leisure and free-time activities, they continued to undertake treatment: “ I had to give up doing the things I liked the most, such as going for walks or going to the beach. Routines, daily life in general were affected ” [ 21 ].

Concern about efficacy

Findings form four studies informed this category [ 17 , 18 , 24 , 28 ]. Although being concerned about the efficacy of the chemotherapy and whether or not chemotherapy treatment would be successful, one participant who undertook treatment described: “the efficacy is not so great. It is said to expect about 10% improvement, but I assume that it declines over time ” [ 28 ]. People were worried that such treatment could not cure their cancer and that their body suffered more due to the disease: “ I was really worried about my treatment effectiveness, and I will die shortly ” [ 17 ]. There were doubts expressed about remaining the cancer in the body after chemotherapy: “ there’s always sort of hidden worries in there that whilst they’re not actually taking the tumour away, then you’re wondering whether it’s getting bigger or what’s happening to it, whether it’s spreading or whatever, you know ” [ 24 ]. Uncertainty around the outcome of such treatment, or whether recovering from cancer or not was described as: “it makes you feel confused. You don’t know whether you are going to get better or else whether the illness is going to drag along further” [ 18 ].

Unmet information needs

Five studies contributed to this category [ 17 , 21 , 22 , 23 , 26 ]. The need for adequate information to assimilate information and provide more clarity when discussing complex information were described. Providing information from clinicians was described as minimal: “they explain everything to you and show you the statistics, then you’re supposed to take it all on-board. You could probably go a little bit slower with the different kinds of chemo and grappling with these statistics” [ 26 ]. People also used the internet search to gain information about their cancer or treatments, “I’ve done it (consult google), but I stopped right away because there’s so much information and you don’t know whether it’s true or not ” [ 21 ]. The need to receive from their clinicians to obtain clearer information was described as” I look a lot of stuff up online because it is not explained to me by the team here at the hospital ” [ 23 ]. Feeling overwhelmed with the volume of information could inhibit people to gain a better understanding of chemotherapy treatment and its relevant information: “ you don’t absorb everything that’s being said and an awful lot of information is given to you ” [ 22 ]. People stated that the need to know more information about their cancer, as they were never dared to ask from their clinicians: “ I am a low educated person and come from a rural area; I just follow the doctor’s advice for my health, and I do not dare to ask anything” [ 17 ].

The purpose of this review was to explore patient’s experiences about the chemotherapy adherence. After finalizing the searches, thirteen papers were included in this review that met the inclusion criteria.

The findings of the present review suggest that social support is a crucial element in people’s positive experiences of adhering to chemotherapy. Such support can lead to positive outcomes by providing consistent and timely assistance from family members or healthcare professionals, who play vital roles in maintaining chemotherapy adherence [ 30 ]. Consistent with our study, previous research has highlighted the significant role of family members in offering emotional and physical support, which helps individuals cope better with chemotherapy treatment [ 31 , 32 ]. However, while receiving support from family members reinforces individuals’ sense of responsibility in managing their treatment and their family, it also instils a desire to survive cancer and undergo chemotherapy. One study found that assuming self-responsibility empowers patients undergoing chemotherapy, as they feel a sense of control over their therapy and are less dependent on family members or healthcare professionals [ 33 ]. A qualitative systematic review reported that support from family members enables patients to become more proactive and effective in adhering to their treatment plan [ 34 ]. This review highlights the importance of maintaining a positive outlook and rational beliefs as essential components of chemotherapy adherence. Positive thinking helps individuals recognize their role in chemotherapy treatment and cope more effectively with their illness by accepting it as part of their treatment regimen and viewing it as a tool for survival. This finding is supported by previous studies indicating that positivity and positive affirmations play critical roles in helping individuals adapt to their reality and construct attitudes conducive to chemotherapy adherence [ 35 , 36 ]. Similarly, maintaining a positive mindset can foster more favourable thoughts regarding chemotherapy adherence, ultimately enhancing adherence and overall well-being [ 37 ].

This review identified side effects as a significant negative aspect of the chemotherapy experience, with individuals expressing concerns about how these side effects affected their ability to perform personal self-care tasks and maintain independent living in their daily lives. Previous studies have shown that participants with a history of chemotherapy drug side effects were less likely to adhere to their treatment regimen due to worsening symptoms, which increased the burden of medication side effects [ 38 , 39 ]. For instance, cancer patients who experienced minimal side effects from chemotherapy were at least 3.5 times more likely to adhere to their treatment plan compared to those who experienced side effects [ 40 ]. Despite experiencing side effects, patients were generally willing to accept and adhere to their treatment program, although one study in this review indicated that side effects made some patients unable to maintain treatment adherence. Side effects also decreased quality of life and imposed restrictions on lifestyle, as seen in another study where adverse effects limited individuals in fulfilling daily commitments and returning to normal levels of functioning [ 41 ]. Additionally, unmet needs regarding information on patients’ needs and expectations were common. Healthcare professionals were considered the most important source of information, followed by consultation with the internet. Providing information from healthcare professionals, particularly nurses, can support patients effectively and reinforce treatment adherence [ 42 , 43 ]. Chemotherapy patients often preferred to base their decisions on the recommendations of their care providers and required adequate information retention. Related studies have highlighted that unmet needs among cancer patients are known factors associated with chemotherapy adherence, emphasizing the importance of providing precise information and delivering it by healthcare professionals to improve adherence [ 44 , 45 ]. Doubts about the efficacy of chemotherapy treatment, as the disease may remain latent, were considered negative experiences. Despite these doubts, patients continued their treatment, echoing findings from a study where doubts regarding efficacy were identified as a main concern for chemotherapy adherence. Further research is needed to understand how doubts about treatment efficacy can still encourage patients to adhere to chemotherapy treatment.

Strengths and limitation

The strength of this review lies in its comprehensive search strategy across databases to select appropriate articles. Additionally, the use of JBI guidelines provided a comprehensive and rigorous methodological approach in conducting this review. However, the exclusion of non-English studies, quantitative studies, and studies involving adolescents and children may limit the generalizability of the findings. Furthermore, this review focuses solely on chemotherapy treatment and does not encompass other types of cancer treatment.

Conclusion and practical implications

Based on the discussion of the findings, it is evident that maintaining a positive mentality and receiving social support can enhance chemotherapy adherence. Conversely, experiencing treatment side effects, concerns about efficacy, and unmet information needs may lead to lower adherence. These findings present an opportunity for healthcare professionals, particularly nurses, to develop standardized approaches aimed at facilitating chemotherapy treatment adherence, with a focus on providing comprehensive information. By assessing patients’ needs, healthcare professionals can tailor approaches to promote chemotherapy adherence and improve the survival rates of people living with cancer. Raising awareness and providing education about cancer and chemotherapy treatment can enhance patients’ understanding of the disease and its treatment options. Utilizing videos and reading materials in outpatient clinics and pharmacy settings can broaden the reach of educational efforts. Policy makers and healthcare providers can collaborate to develop sustainable patient education models to optimize patient outcomes in the context of cancer care. A deeper understanding of individual processes related to chemotherapy adherence is necessary to plan the implementation of interventions effectively. Further research examining the experiences of both adherent and non-adherent patients is essential to gain a comprehensive understanding of this topic.

Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. on our submission system as well.

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Amineh Rashidi, Susma Thapa, Wasana Sandamali Kahawaththa Palliya Guruge & Shubhpreet Kaur

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First author (AR) and second author (ST) conceived the review and the second author oversight for all stages of the review provided by the second author. All authors (AR), (ST), (WG) and (SK) undertook the literature search. Data extraction, screening the included papers and quality appraisal were undertaken by all authors (AR), (ST), (WG) and (SK). First and second authors (AR) and (ST) analysed the data and wrote the first draft of the manuscript and revised the manuscript and all authors (AR), (ST), (WG) and (SK) approved the final version of the manuscript.

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The review was approved by the Edith Cowan University Human Research Ethics Committee (2021–02896). A proposal for the systematic review was assessed by the Edith Cowan University Human Research Ethics Committee and deemed not appropriate for full ethical review. However, a Data Management Plan (2021-02896-RASHIDI) was approved and monitored as part of this procedure. Raw data was extracted from the published manuscripts and authors could not identify individual participants during or after this process.

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Rashidi, A., Thapa, S., Kahawaththa Palliya Guruge, W. et al. Patient experiences: a qualitative systematic review of chemotherapy adherence. BMC Cancer 24 , 658 (2024). https://doi.org/10.1186/s12885-024-12353-z

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Received : 17 November 2023

Accepted : 07 May 2024

Published : 30 May 2024

DOI : https://doi.org/10.1186/s12885-024-12353-z

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