Rotterdam: Sense Publishers, 2: 143-152. 10.1111/j.1834-7819.2008.00071.x. PubMed Central  1992, Mill Valley CA, USA: Sociology Press, Corbin J, Strauss AL: Basics of qualitative research. The authors received financial support for the research from the following funding agencies: University of Sydney Postgraduate Award 2009; The Oral Health Foundation, University of Sydney; Dental Board New South Wales; Australian Dental Research Foundation; National Health and Medical Research Council Project Grant 632715. 2005, Thousand Oaks, CA: Sage. Qual Res. 1983, 11: 228-235. What evaluative criteria should be used in judging the research products? Abstract. Two initial interview schedules were designed for each group of participants: 1) dentists and dental practice staff and 2) dental patients. Our theory, which is expressed as a set of concepts that are related to one another in a cohesive way, now accounts adequately for all the data we have collected. Qualitative and quantitative data generation techniques can be used in a grounded theory study. Grounded theory studies are characterised by theoretical sampling, but this requires some data to be collected and analysed. Many authors label their work 'grounded theory' but do not follow the basics of the methodology [10, 11]. DentoMaxilloFac Rad. Grounded theory is a systematic methodology that has been largely, but not exclusively, applied to qualitative research conducted by social scientists.The methodology involves the construction of hypotheses and theories through the collecting and analysis of data. Below are the links to the authors’ original submitted files for images. This kind of information makes it easier for researchers to analyze the influence of so… Interview in grounded theory, Charmaz approach Mohammad Sajjad Lotfi: PhD Student Of Gerontology Sajjad.Lotfi@yahoo.Com 2. ): Developing Grounded Theory: The Second Generation. Google Scholar. Pitts NB: The use of bitewing radiographs in the management of dental caries: scientific and practical considerations. 2001, 32 (1): 38-56. BMC Med Res Methodol 11, 128 (2011). Interviews were semi-structured and based loosely on the research questions. It was introduced by Glaser & Strauss in 1967 to legitimize qualitative research. In these memos, we made comparisons between data, cases and codes in order to find similarities and differences, and raised questions to be answered in continuing interviews. PubMed  The MPP tested whether dentists could increase their use of preventive techniques. 10.1111/j.1600-0528.1983.tb01883.x. From those who agreed, we used the quantitative data from the MPP to select an initial sample. Because our aim was to understand the process of implementing the protocols, including the conditions and consequences of variation in the process, we needed to understand how implementation might fail. 10.1111/j.1834-7819.2007.00004.x. CAS  Like any method of research, the qualitative analysis also has its own set of ups and downs. We explain how these steps were consistent with grounded theory methodology, and show how they related to one another. Our initial research questions were: What was the process of implementing (or not-implementing) the protocols (from the perspective of dentists, practice staff, and patients)? We know that preventive techniques can arrest early tooth decay and thus reduce the need for fillings [28–32]. 2008, 53: 340-348. We analysed the interview transcripts as soon as possible after each round of interviews in each dental practice sampled as shown on Figure 1. Dixon-Woods M, Booth A, Sutton AJ: Synthesizing qualitative research: a review of published reports. The inductive approach to social science research known as grounded theory represents a bottom-up method in which theory emerges from a process of data collection, coding and analysis. Check out the table below to understand the elements of a grounded theory … Google Scholar. This seemed to be a potentially important explanation for non-implementation of the protocols. J Marriage Fam. The current paper aims to provide useful information for the new-comers and fit them well in grounded theory research. Research questions clearly delineated (sometimes with sub-questions) Scope of the research question(s) needs to be manageable within the time frame and context of … For this reason, we added new questions for the interviews in Dental Practice 2 to directly investigate "effectiveness", "evidence" and how dentists took up new technologies in their practice. All authors read and approved the final manuscript. The researcher/interviewer (AS) travelled to a rural town in NSW where interviews took place. Interviews were digitally recorded and professionally transcribed. This is an example of the 'openness' of a grounded theory study potentially subtly shifting the focus of the study. At the end of our data collection and analysis from Dental Practice 1, we had developed a tentative model of the process of implementing the protocols, from the perspective of dentists, dental practice staff and patients. 1991, 19: 268-271. (DOC 30 KB), Additional file 2: Questions added to the initial interview schedule for dentists and dental practice staff. Google Scholar, Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada, Tri-Council Policy Statemen: Ethical Conduct for Research Involving Humans . Then during a return visit, patient interviews were completed, again with memo-writing during the data-collection period. Planning a grOunded TheOry sTudy 17 of theory that explicates a phenomenon from the perspective and in the context of those who experience it. Grounded theory is: a research method that will enable you to:; develop a theory which; offers an explanation about; the main concern of the population of your substantive area and; how that concern is resolved or processed. Morse JM, Stern PN, Corbin J, Bowers B, Charmaz K, Clarke AE, (eds. The application of grounded theory was the conduit to theory development in this study. However there was a new, important, unexpected finding in Dental Practice 2. & Charmaz, K. (2007). ​The key when designing a grounded theory research question, is to keep it "broad, open-ended and action oriented" (McLeod, 2011, p.120). Those that do exist have focused on Strauss and Corbin's methods [20–25]. Edited by: Higgs J, Cherry N, Macklin R, Ajjawi R. 2010, Practice, Education, Work and Society Series. Our detailed explanation of our experience in this grounded theory study is intended to provide, vicariously, the kind of 'experience' that might help other qualitative researchers in medicine and health to apply and benefit from grounded theory methodology in their studies. Article  Examples of Grounded Theory. Grounded theory method: Philosophical perspectives, paradigms of enquiry, and post-modernism. Tan PL, Evans RW, Morgan MV: Caries, bitewings, and treatment decisions. Grounded theory is a well-known methodology employed in many research studies. Espelid I, Tveit A, Haugejorden O, Riordan P: Variation in radiographic interpretation and restorative treatment decisions on approximal caries among dentists in Norway. Grounded theory is the methodology most-often cited by authors of qualitative studies in medicine, but it has been suggested that many 'grounded theory' studies are not concordant with the methodology. This code captured the social process that dentists went through when faced with new information or a practice challenge. Article  Qual Res. Just … These are examples of ways in which participants did not simply adopt protocols in a simple way, but needed to adapt the protocols and their own routines as they moved toward more preventive practice. Community Dent Oral Epidemiol. At time of writing, we have reached theoretical saturation (see Table 1). 2004, 38: 294-304. We aimed to understand how the protocols had been implemented, including the conditions and consequences of variation in the process. Edited by: Morse JM, Stern PN, Corbin J, Bowers B, Charmaz K, Clarke AE. As a modern model of ethnographic investigation, netnography uses the data gathered through digital communications in varying online communities to trace and analyze patterns of social interaction. 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. The following points describe what was crucial for this study to achieve quality. Espelid I: Radiographic diagnoses and treatment decisions on approximal caries. All responses were anonymised before analysis, and we took particular care not to reveal potentially identifying details of places, practices or clinicians. Each time we reminded the committee that our study design was intended to evolve with ongoing modifications. Adaptation occurred over time and involved practical, historical and philosophical aspects of dental care. 1995, 311: 182-, CAS  10.1177/1468794109106605. Grounded theory and ethnography are similar designs and approaches to research questions. How to do a grounded theory study: a worked example of a study of dental practices. A sign of grounded theory research is that the author employs multiple passes to the field to collect data. Qualitative research is increasingly popular in health and medicine. This model includes relationships among concepts, consequences of the process, and variations in the process. We documented a worked example of using grounded theory methodology in practice. file containing initial interview schedule for dentists and dental practice staff. Throughout the study, we wrote extensive case-based memos and conceptual memos. Some dental practices underwent a slow process of adapting evidence-based guidance to their existing practice logistics. Even some of their methodological considerations are alike, particularly in that both grounded theory and ethnography use observation as the primary tool of data collection (Najafi, … Other aspects covered © 2020 BioMed Central Ltd unless otherwise stated. We thank dentists, dental practice staff and patients for their invaluable contributions to the study. Avoid preconceived theories an… 2008, Thousand Oaks, CA: Sage, 3, Charmaz K: Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Grounded theory studies are generally focused on social processes or actions: they ask about what happens and how people interact. Time was needed to allow dentists and practice staff to go through this process of slowly adapting their practices to this new way of working. 5. The Qualitative Report. To start the grounded theory process, you should: 1. These memos assisted the researcher to make comparison among her reflections, which enriched data analysis and guided further data collection. For example, an evaluation of a health service may be better carried out by means of a descriptive qualitative design, where highly structured questions aim to garner participant’s views, rather than their lived experience. The researcher then took a month for data analysis in which coding and memo-writing occurred. 1985, 13: 26-29. This shows the influence of symbolic interactionism, a social psychological approach focused on the meaning of human actions [39]. Featherstone JDB: The caries balance: The basis for caries management by risk assessment. This grounded theory study builds on a previous Australian Randomized Controlled Trial (RCT) called the Monitor Dental Practice Program (MPP) [27]. 2009, 9: 355-381. Table 4 illustrates a conceptual memo. To address this problem, we will provide a brief outline of the history and diversity of grounded theory methodology, and a worked example of the methodology in practice. We then recruited 12 patients who had been enrolled in the MPP, based on their clinically measured risk of developing tooth decay: we selected some patients whose risk status had gotten better, some whose risk had worsened and some whose risk had stayed the same. We now had a detailed provisional model of the successful process implemented in Dental Practice 1. The fifth, emerging variant is 'Dimensional Analysis' [17] which is being developed from the work of Leonard Schaztman, who was a colleague of Strauss and Glaser in the 1960s and 1970s. Participants in the previous MPP study provided our population [27]. Oral Health Prev Dent. A concrete example of one of our final key concepts is the process of "adapting to" prevention. In our analysis of data from Dental Practice 1, we had learned that "effectiveness" of treatments and "evidence" both had a range of meanings. Simply put, netnography is online ethnography research, that is, it is the conducting of ethnography research via the internet. It is important to keep in mind that grounded theory research questions seek to understand, and make explicit, the social processes and implicit belief systems that underlie behaviour in the phenomena under observation (Moghaddam 2006; McLeod, 2011). The Application of Grounded Theory: An Example from Nursing Workforce Research . Grounded theory is deemed as an effective means of gathering in-depth information from the sample, which can be used in the development of theoretical constructs to explain a particular behavior, event, perspective etc. CAS  Community Dent Oral Epidemiol. Coding occurs in stages. Examples of Purpose Statement and Research Question for Grounded Theory(Mapping the Process: An Exemplar of Process and Challenge in Grounded TheoryAnalysis)• Article discuss theoretical considerations and use a visual model to illustrate how theyapplied grounded theory … BMJ. Through coding, you define what is happening in the data and begin to grapple with what it means'. By employing grounded theory methodology rigorously, medical researchers can better design and justify their methods, and produce high-quality findings that will be more useful to patients, professionals and the research community. LaRossa R: Grounded theory methods and qualitative family research. In recent decades, qualitative researchers in health and medicine have founded specialist journals, such as Qualitative Health Research, established 1991, and specialist conferences such as the Qualitative Health Research conference of the International Institute for Qualitative Methodology, established 1994, and the Global Congress for Qualitative Health Research, established 2011 [1–3]. With permission of the ethics committee; we sent letters to the participants in the MPP, inviting them to participate in a further qualitative study. In our experience, medical researchers are often concerned about the ethics oversight process for such a flexible, unpredictable study design. In this chapter we introduce grounded theory methodology and methods. For this reason, we theoretically sampled participants from Dental Practice 2, where uptake of the MPP protocols had been very limited according to data from the RCT trial. Walker D, Myrick F: Grounded theory: an exploration of process and procedure. Privacy In the intervention arm, dentists were provided with a set of evidence-based preventive protocols to apply [38]; control practices provided usual care. The initial questions for dentists and practice staff are in Additional file 1. Bryant, A. There has been some discussion in the literature about what characteristics a grounded theory study must have to be legitimately referred to as 'grounded theory' [18]. 10.1111/j.1600-0528.1986.tb01069.x. We managed this process as follows. Terms and Conditions, This was a purposive sampling strategy, to give us the best possible access to the process of successfully implementing the protocols. 2. research. The intent was to explore nurse manager, educator, preceptor, and new … Qualitative Research Questions: Qualitative research questions are the central elements of study as they develop a theoretical framework for the research study.They are more advantageous than quantitative studies because they provide a richer view of the subject. This paper starts with definitions, origin and applications of grounded theory, followed by types of grounded theory research designs and the key characteristics of grounded theory. One hour in-depth interviews were conducted. J Clin Periodontol. 4. GTM is based around heuristics and guidelines rather than rules and prescriptions. We describe our sampling, data collection, data analysis and interpretation. As the RCT unfolded, it was discovered that practices in the intervention arm were not implementing the preventive protocols uniformly. Sbaraini A, Evans RW: Caries risk reduction in patients attending a caries management clinic. This question was the starting point for our grounded theory study. We also learned that new technologies - in particular digital x-rays and intra-oral cameras - had been unexpectedly important to the process of implementing the protocols. Coding is essential to the development of a grounded theory [15]. PubMed  Kendall J: Axial coding and the grounded theory controversy. Furthermore, grounded theory questions should en-capture the action and process of people. Sarker S, Lau F, Sahay S: Using an adapted grounded theory approach for inductive theory about virtual team development. Qual Res. In our initial application we provided a long list of possible recruitment strategies and interview questions, as suggested by Charmaz [15]. AS, SMC, RWE, and AB have been involved in drafting the manuscript and revising it critically for important intellectual content. The increasing popularity of qualitative methodologies for medical research has led to an increasing awareness of formal qualitative methodologies. Caries Res. CAS  Against this background, the chapter Google Scholar, Glaser BG, Strauss AL: The Discovery of Grounded Theory: Strategies for Qualitative Research. Despite being able to adapt or not, all dentists trusted the concrete clinical evidence that they have produced, that is, seeing results in their patients mouths made them believe in a specific treatment approach. Grounded theory involves the collection and analysis of data. We found that these patients (10 reliable and 7 unreliable) talked in very similar ways about dental care. If your desire is to perform a qualitative study, it will probably be a lot easier to develop your research question if you first become familiar with some of qualitative research’s basic … We thank Emeritus Professor Miles Little for his time and wise comments during the project. Aust Dent J. WJNR. By comparing codes against codes and data against data, we distinguished the category of "seeking out evidence" from other focused codes, such as "gathering and comparing peers' evidence to reach a conclusion", and we understood the relationships between them. PubMed  So, by sampling dentists from both intervention and control group from the previous MPP study, we aimed to confirm or disconfirm the broader reach of our emerging theory and to complete inductive development of key concepts. Article  Initial coding identifies many different processes. After our initial data collection and analysis, we used theoretical sampling (see Table 1) to determine who to sample next and what questions to ask during interviews. Article  Example: How often do people aged 30 to 40 visit their parents? We have already described our initial purposive sampling. 2007, 7 (3): 327-353. This paper provides a detailed explanation of how a study evolved using grounded theory methodology (GTM), one of the most commonly used methodologies in qualitative health and medical research [[8], p47]. 10.1177/1468794107078515. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2288/11/128/prepub. After theoretical sampling, we could begin coding theoretically. Telephone interviews were of comparable length, content and quality to face to face interviews, as reported elsewhere in the literature [40]. Dentist and practice staff interviews were done in one week. This may be in part because there are few practical examples of grounded theory in use in the literature. 1996, 25: 5-16. Data Base Adv Inf Sy. 1. We have looked rigorously for events or accounts not explained by the emerging theory so as to develop it further to explain all of the data. The MPP included 22 private dental practices in NSW, randomly allocated to either the intervention or control group. Aust Dent J. Charmaz's method, like Glaser's method [13], captures actions or processes by using gerunds as codes (verbs ending in 'ing'); Charmaz also emphasises coding quickly, and keeping the codes as similar to the data as possible. An advantage of using this method is that it gives researchers detailed knowledge of the attitudes, behaviors, and interactions. This requires decisions about which initial codes are most prevalent or important, and which contribute most to the analysis. We did this as the study progressed - detailed below. 10.1177/1468794104041110. Qual Res. This finding suggested to us that some deeply-held assumptions within the dental profession may not be shared by dental patients. There are a number of important assurances of quality in keeping with grounded theory procedures and general principles of qualitative research. Dentists talked about "unreliable" patients - that is, patients who were too unreliable to have preventive dental care offered to them. 10.1111/j.1741-3737.2005.00179.x. However, we did not yet understand how the process might vary or go wrong, as implementation in the first practice we studied had been described as seamless and beneficial for everyone. BMC Medical Research Methodology We have presented the developing theory to specialist dental audiences and to the participants, and have found that it was accepted by and resonated with these audiences. This grounded theory study builds on a previous Australian Randomized Controlled Trial (RCT) called the Monitor Dental Practice Program (MPP) . Google Scholar. Types one and two are the work of the original authors: Barney Glaser's 'Classic Grounded Theory' [13] and Anselm Strauss and Juliet Corbin's 'Basics of Qualitative Research' [14]. Sampling must thus begin purposively, as in any qualitative study. Emergence vs Forcing. Founded on the seminal 1967 book 'The Discovery of Grounded Theory' [12], the grounded theory tradition is now diverse and somewhat fractured, existing in four main types, with a fifth emerging. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature. The researcher wrote memos throughout this week. Using this constant comparative method (see Table 1), we produced a theoretical code: "making sense of evidence and constructing knowledge". We have used these procedures to construct a detailed, multi-faceted model of the process of incorporating prevention into private general dental practice. All researchers supported analysis activities; a regular meeting of the research team was convened to discuss and contextualize emerging interpretations, introducing a wide range of disciplinary perspectives. We also changed our interview questions based on the analysis we had already done (see Additional file 2). We asked research questions that were open, and focused on social processes. 10.1111/j.1834-7819.2002.tb00317.x. SMC made substantial contribution during data collection, analysis and data interpretation. Important practical, philosophical and historical elements as well as barriers and facilitators were present during a complex adaptation process. California Privacy Statement, We know that preventive techniques can arrest early tooth decay and thus reduce the need for fillings [28–32]. This is particularly so for grounded theory, one of the most-cited qualitative methodologies in medical research [[8], p47]. This is because people are purposeful agents involved in action, which often results in a response to change or the process of change (McLeod, 2011). In initial coding, the researcher generates as many ideas as possible inductively from early data. Bodies overseeing human research ethics, such as the Canadian Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, and the Australian National Statement on Ethical Conduct in Human Research [6, 7], have included chapters or sections on the ethics of qualitative research. The MPP protocols used in the RCT guided dentists to systematically apply preventive techniques to prevent new tooth decay and to arrest early stages of tooth decay in their patients, therefore reducing the need for drilling and filling. Writing case-based memos right after each interview while being in the field allowed the researcher/interviewer to capture initial ideas and make comparisons between participants' accounts. 10.1111/j.1600-0528.1985.tb00414.x. An exception is Charmaz's own description of her study of chronic illness [26]; we applied this same variant in our study. For example, using theoretical sampling or modifying interview questions for the purpose of collecting specific data needed to fill in the emerging theory. Application for adults. 1. We confirmed and enriched our understanding of dentists' processes for adopting technology and producing knowledge, dealing with complex cases and we further clarified the concept of evidence. After the first few interviews, we had a large amount of data and many initial codes. We developed our coding systems individually and through team meetings and discussions. Google Scholar. Using grounded theory as an example, this paper examines three methodological questions that are generally applicable to all qualitative methods. These questions guide the researcher and help to frame the context of the study and the collection of data. Qualitative research, sometimes also referred to as naturalistic inquiry, is a distinct field of research with its own research philosophy, theory and methodology. Patients were asked questions about what kind of services dentists should provide and what patients valued when coming to the dentist. Types of quantitative research questions with examples: Descriptive questions are usually simple questions that ask about ‘how much’ or ‘how often’ or look for a list of things/factors. AS carried out data collection, analysis, and interpretation of data. 2001, 322: 1115-1117. Theory as the product of the investigative processes is the hallmark of grounded theory research. In this paper we provide a worked example of a grounded theory project. Qualitative methodologies are increasingly popular in medical research. This allowed the process of theoretical sampling to occur. Asking questions of the data: memo writing in the grounded theory tradition. Does not suit all health research questions. We fleshed out each major focused code, examining the situations in which they appeared, when they changed and the relationship among them. Crafting and Conducting Intensive Interviews • In the following, one of my research assistants interviewed a middle- aged woman, Carla, about having a life-threatening illness. Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia, Alexandra Sbaraini, Stacy M Carter & Anthony Blinkhorn, Population Oral Health, Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia, Alexandra Sbaraini, R Wendell Evans & Anthony Blinkhorn, You can also search for this author in Cite this article. As in any ethical study, we ensured that participation was voluntary, that participants could withdraw at any time, and that confidentiality was protected. We have drawn diagrams and written memos. Sbaraini, A., Carter, S.M., Evans, R.W. After a few interviews, the interviewer/researcher also began making and recording comparisons among these memos. file containing a figure illustrating the study design. 2004, 31: 749-757. We interviewed all consenting staff who had been involved in the MPP (one dentist, five dental assistants). We developed a detailed model of the process of adapting preventive protocols into dental practice, and analysed the variation in this process in different dental practices.

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