Constructivist Grounded Theory Methods Research Articles

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.

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.

Qualitative differences in perspective on children’s quality of life between children with cerebral palsy and their parents

BackgroundCerebral palsy (CP) is one of the most common childhood disabilities, impacting many areas of a child’s life. Increasingly, quality of life (QOL) measures are used to capture holistic wellbeing of children with CP. However most validated QOL measures for children are based on adult perspective only, with limited focus on child perspective. Conceptual differences between children’s and adults’ definitions of QOL may reflect different underlying QOL models which contribute to measurement score divergence. This qualitative study investigated the conceptual meaning of QOL for children with CP, comparing child and parent perspectives. Eighteen families completed 8 child interviews and 18 parent interviews. Children (11 boys, 7 girls) represented the spectrum of motor functioning, with comorbidities including epilepsy, intellectual disability, and communication impairments. Child and parent interviews were analysed separately using constructivist grounded theory methods and then findings were integrated to examine similarities and differences.ResultsAll participants sought child inclusion in social activities, education, and recreation, requiring negotiation, adaptations, and advocacy. Five conceptual categories emerged from child interviews: socialising, play, negotiating limitations, self-identity, and developing agency. This reflected an individual model of QOL supporting child development goals. Parent interview findings revealed concepts related to child-specific QOL (day-to-day functioning and enabling child goals), as well as parent and family functioning concepts aligned to models of “family QOL”, embracing impacts of family relationships and the interdependence of QOL among family members.ConclusionsThis study identified similarities and differences in child and parent perceptions of QOL for the child with CP. Children provided insights into the importance of play and peer support, and their developing self-identity and sense of agency. Self-directed free play, especially, was identified by children but not parents as a central everyday activity promoting wellbeing and social inclusion. Parents discussed family functioning and aspects outside of child sight, such as managing time and financial resources. Relying on parents’ perspective alone to model child QOL misses valuable information that children contribute. Equally, child report alone misses parent experiences that directly influence child QOL. There is value in incorporating family QOL into parent reports while developing a conceptually separate child self-report QOL instrument.

"It's Not Something That I Realized Until I Started Working Here": A Constructivist Grounded Theory of Knowledge Transmission in Victim Service Providers.

National estimates indicate that intimate partner violence (IPV) impacts people of all social demographics. Although IPV is a pervasive issue, LGBTQ+ individuals and heterosexual men note stark disparities in responses from victim advocates compared to heterosexual women. To highlight the influence of agency training on advocates' perceptions of IPV and diverse survivor populations, interviews were conducted with victim advocates and constructivist grounded theory methods were employed. Analyses show that advocates undergo a three-phase process of learning about IPV when starting at their agencies. Advocate's narratives highlight limitations in training and the importance of workplace experiences in growing understanding of IPV.

Sense of community and well-being in diaspora festivals

This study was prompted by a lack of empirical research addressing the overlap between sense of community and eudemonic well-being components, the limited attention paid to immigrant perspectives in well-being studies, and the presence of under-researched type of festival and population. To address these gaps, this study aimed to identify the dimensions of sense of community and the well-being outcomes of diaspora festivals. The study targeted an understudied group and its festivals: those of the Ethiopian diaspora community in the United States. Guided by the constructivist grounded theory method, the study obtained data through guided interviews, and simultaneously analyzed them to construct six domains of a sense of community applicable to diaspora festivals. The six elements of a sense of community were a sense of belonging, a sense of togetherness, serving the com­munity, recognition, social support, and connection with diaspora, and comprised at least one eudemonic well-being component. Engagement, positive relationships, finding meaning in life, and a sense of achievement, were inherent in more than three of the six domains of a sense of community. Other well-being elements such as physical health and spirituality were evident in one domain. In conclusion, this study offers theoretical contributions to festival tourism, community psychology, human/tourism geography, and positive psychology research in multiple ways.

Workplace violence in the COVID-19 era: a qualitative analysis of harassment and threats against public health professionals in Canada

ObjectivesThis study reports the results of a qualitative study involving public health professionals and documents their experiences with cyberviolence, harassment and threats during the COVID-19 pandemic.Method and analysisThe research adopted...

Impeded choice and control within the NDIS: experiences of people living with psychosocial disability

The aim of this study was to explore the choice and control that people with a psychosocial disability (disability related to consequences of mental ill-health) experience as they engaged with the National Disability Insurance Scheme (NDIS) and to understand aspects that impeded their choice and control. NDIS is an Australian, personalised funding, insurance scheme designed to provide supports that enable individuals living with disability to live an ‘ordinary’ contributing life. This lived-experience-led, qualitative study employed constructivist grounded theory methods. Twenty people were interviewed in-depth. Findings evidenced the poor experiences of choice and control people had on the Scheme. Choice and control were impeded by systems and processes as well as failure to accommodate for challenges associated with mental ill-health. Introduction of the ‘psychosocial recovery framework’ offers hope of improved experiences of choice and control, but it needs to be accompanied by cultural change across the NDIS service system.

Emotional and Hedonic Well-Being Experiences of Diaspora Festival Visitors: A Contemporary Migrants’ Perspective

This study explores the emotional experiences of individuals attending diaspora festivals using guided interviews of members of the Ethiopian diaspora. A constructivist grounded theory method was applied and a conceptual model comprised of emotional experiences was created. The findings demonstrated five main emotional experiences associated with diaspora festivals: happiness (the most common), pride, arousal, feeling at home, and feeling not lonely. The study confirmed that feeling at home and not lonely were emotions that were unique to diaspora festivals. The study also identified various specific emotion evokers, including homeland atmosphere, homeland people, religious activities, and the availability of the festival. Key theoretical and practical implications include constructing the diaspora festival emotional experience model, broadening our understanding of hedonic well-being, and incorporating the perspectives of contemporary African migrants, all of which can inform marketing strategies, policy development, and societal problem-solving.

Move Analysis of Sri Lankan Legal Letters of Demand for Teaching English for Specific Purposes (ESP)

Though lawyers often expect their apprentices to have a sufficient command of legal letter writing, structuring a legal letter seems to be a challenging task for the apprentices. Many genre analyses in English for Specific Purposes (ESP) have proposed move-step models or sequences of communicative functions (moves) and strategies used to predict those moves (steps) to help ESP learners to write professional letters. However, there is a paucity of move analysis of legal letters of demand though it is a frequently used genre by lawyers. Therefore, this study analyzed 30 authentic legal letters of demand, collected from 15 Sri Lankan lawyers to identify patterns in the genre organization. The Constructivist Grounded Theory methods were intersected with the move analysis to analyze emergent moves and steps. The results include a sequence of four obligatory moves (i.e., Opening, Stating Background Details, Stating the Cause of Action, Demanding), and an optional move (Closing), which were realized in 14 steps, and classified into obligatory, conventional and optional. The accuracy of the moves and steps generated were checked for consistency with two lawyers who were interviewed at two stages of coding the letters. The move-step model could be incorporated into teaching materials of legal letters of demand writing, to help novices learn the rhetorical structure and discursive practices associated with writing legal letters of demand. The model contributes to the body of knowledge of ESP genre analysis, move analysis and to the field of teaching English for Legal Purposes.

Struggling to manage: A constructivist grounded theory of hoarding behaviours

AbstractHoarding behaviours can cause numerous problems including health risks, family conflict, and removal of children and pets from the home. Hoarding research typically adopts a cognitive‐behavioural framework and uses quantitative methods; we aimed to further understand the development of hoarding behaviour from a qualitative perspective. Constructivist grounded theory methods were employed across two phases of data collection via semi‐structured interviews with participants identifying as exhibiting hoarding behaviours. Provisional categories were developed in phase one; further data analysis in phase two helped to establish our grounded theory. The theoretical core is a struggle to manage possessions and life, including life transitions such as moving to a new home and starting or finishing university. ‘Struggling to manage’ incorporates emotional struggles with possessions and the impacts of personal trauma and overwhelming life events. A further category, ‘Trying to overcome hoarding’ incorporates participants' efforts to manage and overcome their hoarding. Findings highlight the importance of viewing hoarding in a holistic context.

Examining the Influence of Pre-HAART Experiences on Older, Self-Identifying Gay Men’s Contemporary Constructions of Quality of Life (QOL)

ABSTRACT Some older gay men (50+) experience diminished quality of life (QOL) due to historical and ongoing discrimination in addition to living through a collective trauma—the pre-HAART era of the HIV/AIDS epidemic—characterized by the absence of treatment and rampant discrimination targeting gay men. A growing body of literature, however, illustrates that older gay men demonstrate remarkable resilience but little is known about how QOL is conceptualized and how these conceptualizations are potentially shaped by pre-HAART experiences. The current study drew on constructivist grounded theory methods to examine how QOL is conceptualized in light of the sociohistorical relevance of pre-HAART. Twenty Canadian based gay men aged 50+ participated in semi-structured interviews via Zoom. Ultimately, QOL is understood as experiencing contentment, which is made possible by the development and implementation of three key processes: (1) developing and cultivating meaningful connections, (2) growing into and embracing identity, and (3) appreciating the capacity to do what brings joy. QOL for this group is greatly informed by a context of disadvantage, and the demonstrated resilience warrants further investigation to meaningfully support the overall well-being of older gay men.