Constructivist Grounded Theory Methods Research Articles

The assessment and management of fatigue following paediatric acquired brain injury: rehabilitation clinicians’ perspectives

ABSTRACT Fatigue is common following paediatric acquired brain injury (ABI) and can negatively impact quality of life. Despite this, there is limited understanding of how clinicians currently assess and manage fatigue in rehabilitation. This study explored how Australian rehabilitation clinicians recognize, assess, and manage fatigue following paediatric ABI. Using a qualitative research design, semi-structured interviews were conducted with 11 clinicians who work with children (0-18 years) with ABI in rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and sub-themes were developed: (1) Reaching a shared understanding: Identifying and understanding fatigue; Unpacking fatigue with children and their families; and (2) Using the shared understanding: Clinicians working collaboratively to manage fatigue; Planning for and supporting children and their family through transitions; Anticipating and problem-solving speedbumps. Participants reflected on the importance of reaching a shared understanding of fatigue within each child's unique context, requiring the collaborative effort of the child, family, school, and interdisciplinary rehabilitation team, to problem-solve and manage fatigue together over time. These findings provide insights into the processes of assessing and managing fatigue from rehabilitation clinicians’ perspectives and highlight the importance of a collaborative approach to support the individual needs of the child during their rehabilitation.

Parents’ and Teachers’ Perceptions of the Transportation Experiences of Youth With Intellectual and Developmental Disabilities

Enhancing transportation skills is crucial in promoting quality of life for youth with intellectual and developmental disabilities (IDD). To learn about transportation skill development and improve the transportation experiences of youth with IDD in China, we conducted in-depth interviews with special education teachers and parents of transition-age youth with IDD (i.e., 23 teachers and 19 parents) from five major cities in China. The purpose of this study was to explore the transportation experiences of youth with IDD through parents’ and teachers’ perspectives. Adopting the constructivist grounded theory method, three main themes were identified: (1) the need to develop transportation skills, (2) the practices for supporting transportation, and (3) the challenges of transportation for youth with IDD in China. The findings ascertain the importance of travel training to promote community inclusion of transition-age youth with IDD and disclose the helpful practices and existing barriers for improving youth’s transportation skills. Limitations and implications for research, policy, and practice are also described.

“Smoking weed it gets you over the hump”: Cannabis co-use as a facilitator of decreased opioid use among people who inject drugs in Los Angeles, California

IntroductionOpioid overdose mortality rates have surged dramatically in the last decade due largely to fentanyl in the illicit US drug supply. As of June 2024, 38 states, three territories, namely US Virgin Islands, Guam and the Northern Mariana Islands, and the District of Columbia, allow the medical use of cannabis products. However, there remains limited qualitative community-based evidence on the role of cannabis co-use among opioid using and injecting populations. In this study, we present data from people who inject drugs (PWID)’s co-use of cannabis-opioid. MethodsWe conducted 30 one-on-one semi-structured interviews with PWID from July 2021 to April 2022 at two community sites in Los Angeles, CA, near a syringe service program and a methadone clinic. Interviews were recorded and transcribed. We used constructivist grounded theory methods for identifying and comparing the emerging themes that appeared across transcripts to construct a conceptual explanation of how PWID co-used cannabis and opioids. Participant inclusion criteria included injection drug use, opioid and cannabis use, English fluency, and age 18+ years. ResultsPWID described that cannabis co-use assisted in developing patterns of reduced opioid use in a number of ways: 1) maintain opioid cessation and/or adhere to opioid use disorder treatment by managing cessation-specific symptoms, 2) manage symptoms of opioid withdrawal episodically and, 3) decrease opioid use due to low barrier accessibility of cannabis. DiscussionParticipants reported myriad benefits of opioid and cannabis co-use for reducing patterns of opioid use. These findings have two major harm reduction implications for PWID: 1) the distribution of cannabis via low threshold peer programming and interventions can facilitate changes in opioid use patterns and 2) access to cannabis co-use, potentially alongside existing Medication for Opioid Use Disorder, in treatment settings may improve efficacy of uptake and treatment outcomes and goals for individual PWID.

Encountering the health and social environment after a pregnancy loss: A grounded theory study from male perspective

AimTo develop an empirical model that explores and explains the social process of the encounters of men who suffered pregnancy loss with health and social environments. MethodsA constructivist grounded theory method was performed, whereby 23 couples were interviewed using a semi-structured interview. Men that suffered pregnancy loss were analysed iteratively, with line-by-line and incident-to-incident coding, focused coding and axial coding, until data saturation and the emergence of theory. ResultsThe theory Behind bars that hide and mask them illustrates the social process of the encounters of men who suffered pregnancy loss with the health and social environment. Social taboo and gender stereotypes could repress, marginalize, and hide men's feelings. This transposed into the healthcare setting, which focused on the physical aspects of the woman, and lacked an emotional approach, follow-up, and sensitivity. Men reported a lack of recognition or family and social support. ConclusionMany men report not feeling involved in the care process after pregnancy loss, in addition to the prioritisation of medicalised care, which can be explained by a medical paternalism approach. These results provide a basis to reflect and plan the inclusion of men for the provision of comprehensive and couple-centred care. Implications for practiceCommunication strategies and emotional management, self-reflection of health professionals, theoretical-practical content with a gender perspective in the training of nurses and midwives, involvement of the organisation and leadership, and further research is required.

Peer Collaborative Clinical Decision Making in Nursing Simulation: A Theoretical Framework.

Collaboration and decision making among nursing students are essential competencies in nursing education. However, how students collaborate and make decisions in simulation is a complex phenomenon and not well understood. This study aimed to develop a framework that describes peer collaborative clinical decision making (PCCDM) among nursing students in simulation. Charmaz's constructivist grounded theory method was used. The sample included 32 participants (16 dyads) from two nursing programs. The PCCDM framework described three interrelated functional domains (cognition, behavior, and emotion) experienced through three interrelated processes (awareness, communication, and regulation), alternating between individual and collaborative spaces and changing across time according to the simulation's acuity levels. The PCCDM framework provides a model that reflects how these processes unfold over time in simulations, which can be applied in nursing simulation, classroom, and clinical settings that require students to make collaborative decisions. [J Nurs Educ. 2024;63(7):435-443.].

Understanding experiences and interactions of children with Asperger’s syndrome in Virtual Reality-based learning systems

ABSTRACT Asperger’s syndrome is part of the large group of Autism Spectrum Disorders. Children with Asperger’s syndrome suffer from communication difficulties, which leads to disabilities related to social skills and learning. One of the novel suggested approaches to help in their social interaction and learning has been the use of Virtual Reality environments. Following this path, in this long-term study, we explored the social interaction and communication of children with Asperger’s syndrome within a Virtual Reality-based learning system. Children with Asperger’s syndrome used the system in a controlled environment for three months. By conducting a qualitative study based on Constructivist Grounded Theory methods and the Experimental Analysis of Behavior, involving the children, their teachers and mental health experts, we perceived that after initially demonstrating discomfort with the system’s characters, children interacted with the characters of the VR system, facing their communication difficulties, and expressing emotional states (e.g. fear, shyness, and probable suicidal desire). Based on the results, we provide novel insights related to the perception of children with Asperger’s syndrome regarding the use of Virtual Reality-based learning systems.

A population-centered model for public health medicine

ObjectivesPublic health physicians (PHPs) are trained in both medicine and public health, yet practice models in each of these fields incompletely describe their work. A model of practice for public health physicians would better enable training and professional development in the specialty. The objective of this study was to develop an empirically grounded method of the practice of public health medicine by public health physicians. Study designThis was designed as a constructivist grounded theory (CGT) study. Semistructured interviews with 18 public health physicians in Canada were conducted over the course of 1 year. MethodsTranscribed interviews were coded in three stages (line-by-line, focused, and theoretical). Constant comparison, theoretical sampling, reflective and analytic memos, and team discussion on reflexivity were used to ensure rigor and the proper application of CGT methods. ResultsThe key finding of this study is the population-centered medical method (POP-CMM), an empirically grounded method of PHP practice. In this model, PHPs bring values, knowledge, and stances to their practice of medicine with populations as patients. They work to diagnose and intervene on public health issues, with a focus on prevention and systems. Essential to this work is knowledge sharing and relationship building between physicians and populations. ConclusionsPOP-CMM represents a method of practice for PHPs. Further exploration of this method in other countries and systems would bring insight into PHP practice globally. The model has important connections to the practice of medicine and presents the possibility of developing a general model of physician practice for a range of patients, from individuals to populations.

Understanding how neglected tropical diseases programs in five Asia-Pacific countries adjusted to the COVID-19 pandemic: A qualitative study.

Following the COVID-19 pandemic declaration, the World Health Organization recommended suspending neglected tropical diseases (NTD) control activities as part of sweeping strategies to minimise COVID-19 transmission. Understanding how NTD programs were impacted and resumed operations will inform contingency planning for future emergencies. This is the first study that documents how South-East Asian and Pacific NTD programs addressed challenges experienced during the COVID-19 pandemic. Data was collected through semi-structured interviews with 11 NTD Program Coordinators and related personnel from Fiji, Papua New Guinea, The Philippines, Timor-Leste, and Vanuatu. Constructivist grounded theory methods were drawn on to generate an explanation of factors that enabled or hindered NTD program operations during the COVID-19 pandemic. The COVID-19 pandemic disrupted NTD programs in all countries. Some programs implemented novel strategies by partnering with services deemed essential or used new communications technology to continue (albeit scaled-back) NTD activities. Strong relationships to initiate cross-program integration, sufficient resources to implement adapted activities, and dedicated administrative systems were key enabling factors for recommencement. As the COVID-19 pandemic continued, exacerbating health resources scarcity, programs faced funding shortages and participants needed to find efficiencies through greater integration and activity prioritisation within their NTD units. Emphasising community-led approaches to restore trust and engagement was critical after widespread social anxiety and disconnection. Sustaining effective NTD programs during a global emergency goes beyond managing immediate activity disruptions and requires attention to how NTD programs can be better ensconced within wider health programs, administrative, and social systems. This study underscores the importance of pre-emergency planning that reinforces NTD control programs as a critical service at all health systems levels, accompanied by governance arrangements that increase NTD staff control over their operations and strategies to maintain strong community relationships. Ensuring NTD units are supported via appropriate funding, personnel, and bureaucratic resources is also required.

Interdisciplinary research approach based on a mixed-methods design to explore patient altruism at the end of life: a study protocol

IntroductionIn the end of life context, patients are often seen as somewhat passive recipients of care provided by health professionals and relatives, with little opportunity to be perceived as autonomous...

Experiences of Menopausal Transition Among Vietnamese Women: A Grounded Theory Analysis.

Background and Purpose: Complaints about menopause vary between cultures, and the experience of menopause changes significantly in women living in different countries. Limited evidence is available regarding the menopausal experience among Asian women. This study aims to explore the menopausal transition experiences of Vietnamese women. Methods: A qualitative inquiry was undertaken using the grounded theory approach. Semi-structured interviews were conducted and analyzed following constructivist grounded theory methods. Results: In the early transition, women's lives underwent many challenges. They had physical manifestations of menopause and difficulty in their sexual life. Later, women identified that their psychosocial impacts were affected, leading to emotional changes and changes in perceptions of others about the menopausal transition. The study also showed that each woman had their own beliefs and religion. Finally, after experiencing physical and mental changes, women found methods for discomfort relief. These methods included seeking information, applying strategies to manage menopausal challenges and consequences, and maintaining balance. Implications for Practice: The diverse perspectives on women's menopausal transition can help nurses and other health care professionals to provide culturally appropriate care for women.

Principals’ Conceptions of Their Roles Supporting Self-Contained Programs for Students With Emotional/Behavioral Disorders

Special educators serving students with emotional/behavioral disorders (EBD) depend on their principals’ support, yet prior research has not explored principals’ roles in supporting these programs. Using constructivist grounded theory methods, we analyzed interviews with five elementary school principals about their roles in supporting self-contained programs for students with EBD. Principals held widely varying conceptions of students with EBD, visions for their program, and understandings of their own roles and responsibilities for their programs; collectively, interactions among these gave rise to principals’ senses of agency, both for the program’s capacity to be a causal agent in promoting student growth and their own capacity, as leaders, to improve the program. Our findings indicate the centrality of principals’ conceptions of EBD for how they support self-contained programs for students with EBD, which has important implications for future research and practice regarding principal leadership for special education.

“If you don’t actually care for somebody, how can you help them?”: Exploring Young People’s Core Needs in Mental Healthcare—Directions for Improving Service Provision

Youth suicide and mental health are important issues of global concern that require timely and evidence-based interventions to increase quality of life and prevent deaths. Findings report that young people have lower mental health help-seeking rates, and there is a lack of qualitative research examining why. The aim of this research study was to further understanding on young people’s core needs in mental healthcare based on actual experiences (PLE) of help-seeking with providers of mental health services. Constructivist Grounded Theory methods (Charmaz, 2014) informed this study design, and in-depth interviews and a focus group were conducted with 18 young people. The findings were presented across four sub-categories, which together describe the common factors, that are regarded as essential in youth mental healthcare provision. These include: 1. The services; 2. The helper; 3. The interventions, and 4. The impact of development. Critical discussion into young people’s needs in mental healthcare was provided including the key service factors, approach and rapport with helpers, types of intervention and alignment with typical developmental capacity. This article provides guidance on how to improve, design, or reform service provision, and can be a useful resource for policy makers, service providers and practitioners. This study concluded that youth participation in the co-design of service provision is important as it can reduce health disparities and ensure that services provide relevant, respectful and suitable care that reflects the way in which young people experience mental health problems as well as the ways in which they want to be helped.

Children's approaches to solving puzzles in videogames

Puzzles are a core component of many videogames. While research has explored the potential of using puzzles in games to provide players with challenges they enjoy, little is known about how children seek information while solving puzzles in videogames. Using a constructivist grounded theory method, this study examines children's (ages 11–14) puzzle-solving approaches within a game titled GEM of the Forest [name anonymized]. The results show that children relied on two sources of information to solve puzzles: (1) information from the out-of-game world including players' prior game experiences, and (2) information within the game world including instructions, hints, inventory, and feedback. We present an empirically grounded theoretical model to understand children's information seeking behaviors while solving in-game puzzles. This paper contributes a theoretical understanding of children's information seeking behavior and strategies to solve puzzles in games. Additionally, we provide a description of the utility of this framework through design implications for the design of information in technologies that seek to engage children in puzzles.

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study

BackgroundWomen referred to social work services during pregnancy are more likely to experience social disadvantage than those who are not, resulting in reduced antenatal care attendance. Lack of antenatal care engagement leads to poor identification and management of concerns that can have immediate and long-term health consequences for women and their babies. Identifying the barriers and enablers to antenatal care attendance for women referred to social work services is important for designing models of care that promote effective engagement. AimsThis study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare. MethodsA qualitative descriptive study using constructivist grounded theory methods was undertaken. Ten women referred to social work services and 11 antenatal healthcare providers were purposively recruited for interviews from a regional maternity service in Victoria, Australia. FindingsContinuity of care and healthcare providers partnering with women were central to effective engagement with antenatal care services. Three interrelated concepts were identified: 1) experiences of the hospital environment and access to care; 2) perceptions of care influence engagement, and 3) motivations for regularly attending services. ConclusionsContinuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.

“Something Had to Give”: A qualitative study of fathering in the early months of a global pandemic

Sensitized by ecological theory, this qualitative study explored how COVID-19 shaped fathering processes in the United States for fathers of young children. Scholars emphasize the need to understand how sociocultural and economic uncertainty impacts parenting processes. The COVID-19 pandemic presents a unique opportunity to examine how the environmental press of a global crisis impacts the proximal processes of fathering, which serve as important engines of development. Guided by grounded theory methodology, we conducted semi-structured interviews with 45 fathers of children aged four and younger who lived in the U.S. Data were analyzed using constructivist grounded theory methods. Contextual features of COVID-19 were a form of environmental press that enabled and constrained proximal processes of father-child interactions, interdependence among coparents, and intrapersonal adjustments with stress. Although the pandemic yielded many challenges, fathers’ narratives embodied ideals of engaged fathering that centered on men’s active presence in their children’s lives and reflected processual changes in his context that transformed fathering. Policies, programs, and practitioners can enable fathering proximal processes to accommodate familial needs in caregiving roles of young children, specifically in times of crisis and transition.

OTHER-INITIATED INTERACTIONS THAT CONTRIBUTE TO RESILIENT OUTCOMES AMONG YOUNG ADULTS RAISED BY CAREGIVERS WHO MISUSE ALCOHOL

This study offers an understanding of interactional resilience processes between young adults raised by caregivers who misused alcohol and people in their social-ecology who initiated supportive interactions that enabled them to achieve better-than-expected outcomes. Multiple in-depth face-to-face interviews and a draw-and-write methodology were used with 15 National University of Lesotho undergraduate students raised by caregivers who misused alcohol. An interactional resilience approach, building on person-in-environment and social-ecology perspectives on resilience, informed this study. Using constructivist grounded theory methods of data analysis, three themes were formulated: (a) other-initiated material support that elicits a response of resolve or obligation towards the other; (b) other-initiated sustained emotional support that elicits a response of hope for the future; and (c) other-initiated challenging support that elicits a change in behaviour. Given these findings, the study recommends that child and youth workers and social workers cultivate enabling and support-initiating social environments in key contexts such as schools, churches, and clubs, and develop children and young people’s skills to respond to and receive such support.

Identifying Barriers to Mental Health Services Utilization for Black Youth in the United States: A Qualitative Study

Mental health in Black communities and racial/ethnic disparities in mental health service utilization remain growing concerns. Evidence suggests that psychotic disorders may be more prevalent among Black individuals than white individuals and the Black community faces barriers to care that can negatively influence outcomes. To better understand these barriers, we interviewed mental healthcare providers (n = 11) and Black young adults with first-person experience of psychosis (n = 13) about the experiences of minority young adults with mental health treatment. We analyzed interview transcripts and, consistent with constructivist grounded theory methods, identified iterative patterns across individuals about barriers to care. From the 11 mental healthcare providers and 13 Black young adults in the present analyses, five overarching themes emerged: lack of knowledge about mental health helpseeking, material resource unavailability, stigma, lack of family support, and trauma. These themes represented factors that dissuaded individuals from seeking care and must be addressed to improve engagement and outcomes for minority young adults. Innovative approaches to improving mental health literacy and decreasing stigma, along with systemic, policy-based economic changes, may provide starting points for effectively addressing these barriers.

Mexican American Intergenerational Research: Transformative Model of Occupational Therapy.

Thirty-seven interviews of Mexican American women who crossed the border into the United States during the era of the Mexican Revolution of 1910 were analyzed using constructivist grounded theory methods. The intent is to expand the occupational therapy profession's occupational consciousness and cultivate cultural humility. Four themes emerged from the data: suffering, work, yearning for an education, and compassion for others. The findings suggest that environmental barriers such as hierarchy (patriarchy and discrimination) and physical barriers (limited access to built environments, lack of nonexploitative work opportunities, and hostile educational institutions) prevented occupational participation. Small acts of resistance through everyday living (finding joy, playing, self-sufficiency, and community organizing) were identified as facilitators of occupational participation. The research findings challenge proposed assumptions found within the occupational therapy literature: (1) humans and occupations exist as separate from their environments, and (2) work, productivity, and leisure contribute positively to health. The Transformative Model of Occupational Therapy is introduced as a decolonized framework that inextricably links individual health to community and global health. The model centers play, social participation, work, and education as occupations that contribute to the common good. These occupations are kept in equilibrium within the Four Pillars of Culture (self-determination, compassion, sustainability, and language) or the cultural values identified and derived from the stories.

Patient-driven decisions and perceptions of the ‘safest possible choice’: insights from patient-provider conversations about how some breast cancer patients choose contralateral prophylactic mastectomy

Objective Observe patient-clinician communication to gain insight about the reasons underlying the choice of patients with unilateral breast cancer to undergo contralateral prophylactic mastectomy (CPM), despite lack of survival benefit, risk of harms, and cautions expressed by surgical guidelines and clinicians. Methods & Measures WORDS is a prospective study that explored patient-clinician communication and patient decision making. Participants recorded clinical visits through a downloadable mobile application. We analyzed 44 recordings from 22 patients: 9 who chose CPM, 8 who considered CPM but decided against it, and 5 who never considered CPM. We used abductive analysis combined with constructivist grounded theory methods. Results Decisions to undergo CPM are patient-driven and motivated by perceptions that CPM is the most aggressive, and therefore safest, treatment option available. These decisions are shaped not primarily by the content of conversations with clinicians, but by the history of cancer in patients’ families, their own first-hand experiences with cancers among loved ones, fear for their children, and anxiety about cancer recurrence. Conclusion The perception that CPM is the safest, most aggressive option strongly influences patients, despite scientific evidence to the contrary. Future efforts to address high CPM rates should focus on patient-driven decision making and cancer-related fears.

Adopting standardized cancer patient pathways as a policy at different organizational levels in the Swedish Health System

BackgroundStandardized cancer patient pathways as a new policy has been adopted in healthcare to improve the quality of cancer care. Within the health systems, actors at different levels manage the adoption of new policies to develop healthcare. The various actors on different levels play an important role and influence the policy adoption process. Thus, knowledge about how these actors use strategies when adopting cancer patient pathways as a policy in the health system becomes central.MethodThe study’s aim was to explore how actors at different organizational levels in the health system adopted cancer patient pathways. Our overarching case was the Swedish health system at the national, regional, and local levels. Constructivist Grounded Theory Method was used to collect and analyze qualitative interviews with persons working in organizations directly involved in adopting cancer patient pathways at each level. Twelve individual and nine group interviews were conducted including 53 participants.ResultsOrganizational actors at three different levels used distinct strategies during the adoption of cancer patient pathways: acting as—missionaries, fixers, and doers. Acting as missionaries consisted of preaching the idea of cancer patient pathways and framing it with a common purpose to agree upon. Acting as fixers entailed creating a space to put cancer patient pathways into practice and overcome challenges to this. Acting as doers comprised balancing breadth and speed in healthcare provision with not being involved in the development of cancer patient pathways for the local context. These strategies were not developed in isolation from the other organizational levels but rather, each level interacted with one another.ConclusionsWhen adopting new policies, it is important to be aware of the different strategies and actors at various organizational levels in health systems. Even when actors on different levels developed separate strategies, if these contribute to fulfilling the four domains of inter-organizational collaboration, they can work well together to adopt new policies. Our study highlighted that the application of two domains was lacking, which meant that local actors were not sufficiently involved in collaboration, thus constricting the local use and optimization of cancer patient pathways in practice.