Constructivist Grounded Theory Methods Research Articles

P-515 An Exploration of Young Women’s Process of Adjustment in Spontaneous Premature Ovarian Insufficiency: A Grounded Theory Study

Abstract Study question How do young women process their condition? Summary answer Throughout the women's adolescence and early twenties, they continually reconceptualised their menopausal body, until they achieved a sense of being developmentally ‘fully grown’. What is known already Premature Ovarian Insufficiency (POI) is the decline of ovarian function before the age of 40 (Cooper et al., 2011) Prevalence rates of POI can reach 3-6% of women aged between 12 and 40 and for the majority of cases no known cause will be found. This is referred to as spontaneous or idiopathic POI and can be a life changing diagnosis with profound physical and psychological consequences (Webber., 2017). However, little is known about younger women's experiences of receiving a diagnosis, treatment and overall experiential nature of the condition by women of their age. Study design, size, duration Women that received a diagnosis between the ages of 12 to 20 years old (adolescence) were interviewed. Participants/materials, setting, methods Semi-structed interviews were conducted over Zoom, with twelve women that had experienced a diagnosis of POI/POF during their adolescence (now aged 21 to 35 years old). The interviews were transcribed and analysed following constructivist Grounded Theory methods. Main results and the role of chance The gradual awareness of physical developmental differences from their peers evoked a strong desire to recreate naturally occurring ‘womanly' milestones, such as the development of hips and breasts, menstruating, and future family planning. The young women described an all consuming compulsion to ‘keep up' with their peers following their diagnosis, during their teenage years and into their twenties, falling a sense of "falling behind". This required the young women to continually reconceptualize their menopausal body, how they perceived its purpose and its appearance, allowing them to eventually maturate their self-perception of their body. Viewing themselves as ‘fully grown' women and no longer developmentally different to other women. Limitations, reasons for caution The research findings are limited to the confines of qualitative research and therefore larger studies are suggested, moving forward. Wider implications of the findings The research suggests that psychological support aimed at supporting the menopausal transition at this early age would be greatly beneficial to young women that have received a diagnosis. This may protect against the later development of body dysmorphic presentations and depression related conditions. Trial registration number N/A

How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study.

PurposeIn competency-based medical education, workplace-based assessment provides trainees with an opportunity for guidance and supervisors the opportunity to judge the trainees’ clinical practice. Learning from assessment is enhanced when trainees reveal their thinking and are open to critique, which requires trust in the assessor. If supervisors knew more about how trainees come to trust them in workplace-based assessment, they could better engender trainee trust and improve trainees’ learning experience.MethodFrom August 2018 to September 2019, semistructured interviews were conducted with 17 postgraduate anesthesia trainees across Australia and New Zealand. The transcripts were analyzed using constructivist grounded theory methods sensitized by a sociocultural view of learning informed by Wenger’s communities of practice theory.ResultsParticipants described a continuum from a necessary initial trust to an experience-informed dynamic trust. Trainees assumed initial trust in supervisors based on accreditation, reputation, and a perceived obligation of trustworthiness inherent in the supervisor’s role. With experience and time, trainees’ trust evolved based on supervisor actions. Deeper levels of trainee trust arose in response to perceived supervisor investment and allowed trainees to devote more emotional and cognitive resources to patient care and learning rather than impression management. Across the continuum from initial trust to experience-informed trust, trainees made rapid trust judgments that were not preceded by conscious deliberation; instead, they represented a learned “feel for the game.”ConclusionsWhile other factors are involved, our results indicate that the trainee behavior observed in workplace-based assessment is a product of supervisor invitation. Supervisor trustworthiness and investment in trainee development invite trainees to work and present in authentic ways in workplace-based assessment. This authentic engagement, where learners “show themselves” to supervisors and take risks, creates assessment for learning.

"We're Constantly Learning": Identifying and Disrupting White Supremacy Within a Victim Services Organization.

Many victim service organizations are seeking to realign service delivery around principles of racial equity. Dismantling institutional racism is a complex, intensive, and long-term process. Therefore, despite this imperative from the field, our knowledge about how social service organizations can effectively advance anti-oppressive practice is limited. This study examined victim advocate perspectives on the role institutional racism played within their work and the supports needed to undo institutional racism within their organization. Six focus groups were conducted with a meaningful cross section of staff members (n = 53) across the organization. Semi-structured interview guides included questions in four domains: (1) racism within client work, (2) challenges to addressing racism, (3) effective solutions, and (4) helpful organizational supports. Transcripts were thematically analyzed using modified constructivist grounded theory methods. Two overarching themes, Identifying Institutional Racism in the Workplace and Advancing Anti-racist Practice, and six subthemes emerged from the analysis. Advocates identified that naming and becoming comfortable talking about race was essential. Further, they believed it was important to acknowledge the ways in which that racism was implicitly built into helping systems at large. Advocates explored how internalized racial stereotypes influenced interactions between black, indigenous, and people of color (BIPOC) and white advocates and their clients in complex ways. Advocates highlighted organizational efforts that supported ongoing personal reflection, the creation of an accountable community, and staff empowerment within the organization as being critical to advancing anti-racist practice. Some advocates also wanted to see the organization move further in the direction of standing with BIPOC communities, particularly around criminal justice concerns. Findings provide important timely insights into how institutional racism manifests within victim service organizations and what organizational actions encourage anti-oppressive practices and culture.

Doing Place: A context specific framework for sustaining commitments in Appalachian Kentucky

ABSTRACT In the context of high outmigration, this study drew on the experiences of college educated young adults (N = 30) who made conscious commitments to live in Appalachian Kentucky and work on social, economic, and environmental changes in the region. Using Constructivist Grounded Theory methods, we present doing place as a context specific framework that highlights three dynamic and multi-directional strategies that guided participants’ decisions, commitments, and meaning making. Working out place emphasized how place is acquired and navigated. Keeping peace in place highlighted the strategies engaged to maintain relationships and well-being in place. Connecting to the big picture depicted how meaning making is infused throughout these experiences. These including working out place, keeping peace in place, and connecting to the big picture. We discuss theoretical contributions to place and practical implications in social work education and practice in and beyond the region.

Impact of German Students’ Digital Readiness for Online- Learning on Factors of Challenges and Mediating Role of German Teachers’ Support at Foreign Languages Universities in Myanmar during COVID- 19 Pandemic: Perspectives from Developing Country

The purpose of this study is to examine the connection between German students’ digital readiness for online learning, their challenges and the support of German teachers at Foreign Languages Universities in Myanmar. The COVID-19 pandemic has impacted educational institutions across the world. In Myanmar, all the learning methods shifted to online instruction. However, there are a limited number of factors that influence students’ online learning. Some of these include digital readiness and support from teachers. In addition, several challenges exist regarding their educational backgrounds. The data for this research were collected through conducting in-depth interviews with German teachers (n=10) and surveys of German students (n=112). This study took an exploratory mixed-method design. In qualitative analysis, the constructivist grounded theory method is used for data collection and the data analysis is also described and justified by Charmaz (2014) as a general guide. In the quantitative analysis, the data were analyzed using descriptive statistics through SPSS 27.0. Findings reveal that German students faced a limited number of challenges and the level of German student’s digital readiness and teachers’ support positively impacted on these factors of challenges for online learning during Covid-19 pandemic. The data analyzed showed that each of their challenges varied according to their perceptions and readiness to technology integration. To sum up, this research offers factors of challenges which significantly correlate with digital readiness and teachers’ support during the corona-crisis in developing country.

An Analysis of Comparative Perspectives on Economic Empowerment among Employment-Seeking Survivors of Intimate Partner Violence (IPV) and Service Providers

Purpose: The purpose of this study is to compare perspectives on economic empowerment in the context of employment seeking among intimate partner violence (IPV) survivors and service providers specializing in IPV-related trauma. This study addressed the following question is: How do employment-seeking IPV survivors and service providers conceptualize and understand empowerment? Insights into how each group conceives of economic empowerment and its attainment following IPV experiences can help to inform an effective service curriculum that can be used to facilitate optimal employment outcomes among survivors. Methods: A constructivist grounded theory method was used to develop a theoretical framework for conceptualizing how economic empowerment is understood by employment-seeking survivors of IPV, and IPV service providers. Twenty-six participants were recruited (survivors, n = 16; service providers, n = 10) in a large northeastern U.S. city. Interview questions focused on how IPV survivors and service providers identify and conceptualize economic empowerment, and how support services respond to survivors’ needs around empowerment, particularly through help with employment seeking. Results: Data were coded and analyzed following data analysis stages: (a) initial coding; (b) constant comparison; and, (c) focused coding. Three main themes emerged from the narrative data: (1) structural characteristics shape individual experiences and perspectives of empowerment; (2) peer support as an integral component to empowerment; and (3) employment attainment as economic empowerment. Though perspectives on economic empowerment were often aligned, some key differences emerged. Whereas providers tended toward a more restricted, micro-level view of empowerment as primarily an attribute of the individual, survivors were inclined toward a structuralist perspective that considers how individuals’ experiences of empowerment are shaped by broader, institutional-level factors. Conclusions: Findings from this study build on prior research on the experiences of IPV survivors. The focus on experiences of empowerment in the context of employment-seeking can inform work on building more effective support services for survivors that avoid reductionist approaches that could be perceived by survivors as “victim-blaming” by incorporating a sensitivity to empowerment as derived from structural factors that shape individual experience.

A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics

BackgroundExpanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists’ rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics.MethodsWe conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts.ResultsMost pharmacists operated “restrictive OTC” pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated “open OTC” pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community.ConclusionOur results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.

No One Has Bothered to Know: Understanding the Constructions of Teaching Excellence in Higher Education Institutions of Zambia: A Hermeneutic Phenomenological Approach

Purpose: The aim of this paper is to understand from the teaching life world of quality assurance and education actors in the higher education institutions, their construction of teaching excellence. Design: Charmazian constructivist Grounded Theory Method was employed. Hermeneutic constructivist philosophy guided this study and 29 participants were interviewed using criterion i sampling. Findings: Eleven categories of teaching excellence emerged from the data and the constructions of teaching excellence were multifaceted. Based on the participants’ voices, there is no universally accepted definition of teaching excellence. There is no consensus of opinion on what constitutes teaching excellence in all higher education environments. However, research suggests that Teaching Excellence practices were beginning to be applied on an institutional level as a management tool though not recognised by the term teaching excellence. Nevertheless, it was not being practiced extensively, and was implemented in pockets, with emphasis on quality teaching more than teaching excellence, and not generally implemented in a systemic way. Practical implications: The teaching excellence categories that we have generated in this study could be one source of elements our policy makers could consider when developing teaching excellence policy instruments such as Teaching Excellence Framework (TEF). Such Instruments could support the enhancement of educational provision across our higher education system. Therefore, rather than focusing on developing metrics of teaching excellence, it is could be more effective to focus also on how these institutions could enhance their educational provision. Originality: The study provides empirical contextual individualised constructed constructs of teaching excellence. Conclusion: We stated in the title “No one has bothered to know”. Now we have known that the constructions of teaching excellence are multifaceted. The implication of the findings is that phenomenology is a powerful research strategy that is well suited for exploring challenging problems in quality assurance research. By building a better understanding of the nature of phenomenology and working to ensure proper alignment between the specific research question and the researcher’s underlying philosophy, we hope to encourage quality assurance and teaching excellence scholars to consider the utility of phenomenology when addressing their research questions.

Blurring boundaries: Toward the collective empathic understanding of product requirements

Many software product companies create cross-functional development teams that own a product or a defined set of features. These product teams often require a deep and collective understanding of the product domain, a rich context within which to understand the product requirements and to make decisions throughout the development process. Little is known about what supports or impedes these teams in collectively achieving this deep understanding. This paper identifies certain organisational conditions that impact teams in this respect. Using Constructivist Grounded Theory method, we studied 18 teams across seven software companies creating products for a diverse range of markets. The study found certain organisational and planning process factors play a significant role in whether product development teams have the potential to collectively develop deep domain understanding. These factors also impact individual and development team dynamics. We identify two essential metaphorical dynamics, broadening the lens and blurring boundaries, that cross-functional product teams employ in order to fully embrace product ownership, visioning, and planning towards achieving this rich context for understanding product requirements. We also conclude that the highly specialised nature of many organisational models and development processes is contraindicated for cross-functional product development teams in achieving this deep collective understanding and we call for a revisiting of conventional organisational and product planning practices for software product development.

Exploration of Omani Cycle 1 English Teachers’ Continuous Assessment Practices and Perceptions

Aim: This article presents the findings from a qualitative exploratory study conducted in Oman that sought to uncover the factors leading to the identified gap between the SAH CA assessment standards and current grades 1 and 2 teachers’ practices. The research investigated Omani grade 1 and 2 English teachers' practices and perceptions regarding the implementation of continuous assessment (CA) in teaching English as a foreign language.
 Study Design: A constructivist grounded theory method investigation was conducted to examine the influence of teachers’ beliefs, previous experience and contextual factors on their CA classroom practices and to discover the relationship between teachers’ stated beliefs and their actual classroom practices leading to the gap between CA standards and their practices. Three instruments were used namely classroom observations, semi-structured interviews, and artifact analysis. Six teachers from Al Dhahirah were observed and three teachers out of the six were interviewed to seek an in-depth understanding of their beliefs. A three-stage coding process and the constant comparative method were used to analyze the data and triangulate beliefs and practices.
 Results: Even though results demonstrated that teachers believed in the importance of CA and expressed positive beliefs towards CA, the analysis showed a gap between the teachers’ actual practices and their stated beliefs regarding CA implementation in their practices. Moreover, findings highlighted the influence of the teachers’ previous experience and impeding contextual factors on the teachers’ CA practices.
 Recommendations: Therefore, it is recommended to involve teachers in consistent in-service training as well as CA discussion sessions to support CA practices directing the teachers’ attention to the bright side of the assessment, its advantages, and its importance in the teaching learning process. Providing teachers with assistant teachers may help to alleviate overcrowded classes and heavy timetables. In addition, reducing the number of textbooks in the syllabus would provide more time for assessment in daily teaching.

Participants' Perspective of Engaging in a Gym-Based Health Service Delivered Secondary Stroke Prevention Program after TIA or Mild Stroke.

People who have had a transient ischemic attack (TIA) or mild stroke have a high risk of recurrent stroke. Secondary prevention programs providing support for meeting physical activity recommendations may reduce this risk. Most evidence for the feasibility and effectiveness of secondary stroke prevention arises from programs developed and tested in research institute settings with limited evidence for the acceptability of programs in ‘real world’ community settings. This qualitative descriptive study explored perceptions of participation in a secondary stroke prevention program (delivered by a community-based multidisciplinary health service team within a community gym) by adults with TIA or mild stroke. Data gathered via phone-based semi-structured interviews midway through the program, and at the end of the program, were analyzed using constructivist grounded theory methods. A total of 51 interviews from 30 participants produced two concepts. The first concept, “What it offered me”, describes critical elements that shape participants’ experience of the program. The second concept, “What I got out of it” describes perceived benefits of program participation. Participants perceived that experiences with peers in a health professional-led group program, held within a community-based gym, supported their goal of changing behaviour. Including these elements during the development of health service strategies to reduce recurrent stroke risk may strengthen program acceptability and subsequent effectiveness.

A Social Quest for Language and Cultural Capital: Exploring Iranian English Language Majors’ Habitus

This research study was conducted to investigate the most representative characteristics of the habitus developed by academically successful Iranian English majors. Learning a second or foreign language, like many sociocultural practices, from a Bourdieusian perspective, is informed by the interrelation between habitus, field, and cultural capital (CC). Within an exploratory qualitative design, utilizing the Biographical Narrative Interpretive Method of both semi-structured and unstructured one-on-one interviews, seven academically successful BA students majoring in English language studies were studied in an attempt to explore their CC and habitus. Each participant was interviewed in 3 separate sessions. The constructivist grounded theory method was adopted to analyze the collected data. Constructed on 75 initial codes, 22 focused codes, 10 categories, and 4 themes, two major themes were most relevantly indicative of theoretical associations with the research problem. The findings suggest that the habitus developed by the English majors in this study was representative of their accumulation of certain forms of CC. Their habitus seemed to have been developed under the influence of their interaction with the mediatory field of learning and majoring in a foreign language. In an exigency-driven social quest for certain forms of cultural capital, the participants’ habitus were majorly characterized and influenced by their strategic accumulation of institutional and social capital, their field-oriented social identities, and their strategic administration of CC in the field. The knowledge developed by the findings of this study can provide useful sociocultural insights into academic achievements of English language majors.

Engaging children and adolescents with acquired brain injury and their families in goal setting: The family perspective

ABSTRACT This study explored the experiences of goal setting in paediatric rehabilitation from the perspectives of children and adolescents with acquired brain injury (ABI) and their parents in paediatric rehabilitation. Using a qualitative research design, 15 semi-structured interviews were conducted with 13 parents and 8 young people with ABI aged between 9 and 18 years who were engaged in outpatient rehabilitation. Interview transcripts were analysed using constructivist grounded theory methods. Two main themes and several sub-themes emerged: Experiences of goal setting: The role of professionals; The role of the young person; and The role of the parents. Working as a team: Understanding each other and building trust; Communicating, sharing knowledge and different perspectives; and Being flexible. These themes reflect parent’s and young people’s experience of goal setting during paediatric rehabilitation for ABI and suggest clinicians play an important role in educating young people and their families about goal setting in the outpatient rehabilitation context. Young people and their parents also perceive the focus of outpatient rehabilitation as working collaboratively with clinicians to gain knowledge to manage the consequences of ABI. Our findings emphasize the importance of the therapeutic consumer–clinician relationship and the need to actively engage young people in goal setting.

City Branding Kota Ternate

City branding has become a massive effort by many cities as tourist destinations to promote the city nationally and internationally. Ambon City, the Capital of Maluku Province, known as the “City of Music,” and the City of Solo with “Solo the Spirit of Java,” are examples of city branding. In North Maluku Province, Ternate City has a long history of colonialism, international trade, and a developing city. Unfortunately, inconsistencies still exist in how the city should be known. This study aims to identify and define city branding by using the constructivist grounded theory method. The themes identified were quality tourism, economic value, community engagement, stakeholder consensus, legendary ancient leadership, and historic and renowned commodity. Six main themes are theoretically based on how to branding Ternate city and involving seven important participants. These themes are then used to define the branding of Ternate City. Current research offers a testable model to brand a place or city based on the identified subjects. At the same time, potential future studies are also suggested regarding the weaknesses of the current study.

Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

BackgroundEnrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study’s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky.MethodsWe conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017–2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory.ResultsStigma, a feature of IREF’s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID’s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment.ConclusionsFeatures of the social and healthcare environments operating at the meso-level, as well as PWID’s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.

The culturally responsive science teaching practices of undergraduate biology teaching assistants

AbstractScience as an enterprise has been and continues to be exclusionary, perpetuating inequities among whose voice is heard as well as what/whose knowledge is recognized as valid. Women, people of color, and persons with disabilities are still vastly outnumbered in science and engineering by their White, male counterparts. These types of imbalances create a gatekeeping culture of inequity and inaccessibility, particularly for traditionally underrepresented students. Science classrooms, especially at the undergraduate level, strive to mimic the broader practices of the scientific community and therefore have tremendous potential to perpetuate the exclusion of certain groups of people. They also have, however, the potential to be a catalyst for equitable participation in science. Utilizing pedagogies of empowerment such as culturally responsive science teaching (CRST) in undergraduate classrooms can mitigate the gatekeeping phenomenon seen in science. Teaching assistants (TAs) engage in more one‐on‐one time with students than most faculty in undergraduate biology education, yet minimal pedagogical training is offered to them. Therefore, training for improved pedagogical knowledge is important for TAs, but training for CRST is critical as TAs have broad and potentially lasting impact on students. This study explores the ways in which undergraduate biology TAs enact CRST. Using constructivist grounded theory methods, this study examined TAs' reflections, observation field notes, semistructured interviews, and focus groups to develop themes surrounding their enactment of CRST. Findings from this study showed that undergraduate biology TAs enact CRST in ways described by four themes: Funds of Knowledge Connections, Differentiating Instruction, Intentional Scaffolding, and Reducing Student Anxiety. These findings provide new insights into the ways undergraduate science education might be reimagined to create equitable science learning opportunities for all students.

Making sense of business analytics in project selection and prioritisation: insights from the start-up trenches

PurposeThe study aims to provide insights in the sensemaking process and the use of business analytics (BA) for project selection and prioritisation in start-up settings. A major focus is on the various ways start-ups can understand their data through the analytical process of sensemaking.Design/methodology/approachThis is a comparative case study of two start-ups that use BA in their projects. The authors follow an interpretive approach and draw from the constructivist grounded theory method (GTM) for the purpose of data analysis, whereby the theory of sensemaking functions as the sensitising device that supports the interpretation of the data.FindingsThe key findings lie within the scope of project selection and prioritisation, where the sensemaking process is implicitly influenced by each start-up's strategy and business model. BA helps start-ups notice changes within their internal and external environment and focus their attention on the more critical questions along the lines of their processes, operations and business model. However, BA alone cannot support decision-making around less structured problems such as project selection and prioritisation, where intuitive judgement and personal opinion are still heavily used.Originality/valueThis study extends the research on BA applied in organisations as tools for business development. Specifically, the authors draw on the literature of BA tools in support of project management from multiple perspectives. The perspectives include but are not limited to project assessment and prioritisation. The authors view the decision-making process and the path from insight to value, as a sensemaking process, where data become part of the sensemaking roadmap and BA helps start-ups navigate the decision-making process.

Why do chronic illness patients decide to use complementary and alternative medicine? A qualitative study

Background and purposeA substantial proportion of European and American people now use healthcare options known as complementary and alternative medicine (CAM). This study aimed to understand the processes and decisional pathways through which chronic illness patients choose treatments outside of regular allopathic medicine. Materials and methodsThis qualitative study used Charmaz's constructivist grounded theory methods to collect and analyze data. Using theoretical sampling, 21 individuals suffering from chronic illness and who had used CAM treatment participated in face-to-face in-depth interviews conducted in Miami/USA. ResultsSeven overarching themes emerged from the data to describe how and why people with chronic illness choose CAM treatments. These themes included 1) influences, 2) desperation, 3) being averse to allopathic medicine and allopathic medical practice, 4) curiosity and chance, 5) ease of access, 6) institutional help, and 7) trial and error. ConclusionIn selecting treatment options that include CAM, individuals draw on their social, economic, and biographical situations. Though exploratory, this study sheds light on some of the less examined reasons for CAM use.

Shared mental models and perceived proximity: a comparative case study

PurposeThe aim of this study is to understand how virtual teams experience perceived proximity. Existing literature suggests that perceived proximity can be achieved through quality communication and increased identification. However, not much is known as to how these two may be achieved within the context of virtual teams.Design/methodology/approachThe authors address their research question through a comparative case study, with the help of two virtual teams of software developers and the authors adopt a subset from the Constructivist Grounded Theory Method procedures for the purposes of coding to understand the potential explanations regarding the two teams' differences in perceptions of perceived proximity.FindingsThe authors’ study shows that shared mental models support quality communication and team members to identify with the shared values of their team. Quality communication is easier achieved when the team shares a dynamic and evolving understanding of the tools for communication and collaboration. The authors also draw attention to the importance of how work is organised and the influence of the temporal dimension on virtual teams beyond the temporal organisation of collaborative work.Originality/valueThe value of this study is found in its contribution towards the development of a formal connection between perceived proximity and shared mental models, that is empirically grounded, and which holds an explanatory value in addressing how perceived proximity can be supported rather than compromised.

We say we are doing primary health care but we're not: Remote area nurses’ perspectives on the challenges of providing primary health care services

BackgroundNurses are essential in global strategies to improve population health. However, there is a paucity of research that describes the application of primary health care from a nursing perspective. Australian remote area nurses work in primary health care clinics which are often the only health care service within the community. Services include acute care response as well as health promotion and public health activities. Question, Hypothesis or AimTo explore the meaning and application of primary health care principles from the perspective of nurses in Australian remote settings. MethodsTelephone interviews were conducted with registered nurses and nurse practitioners working in Australian remote settings using constructivist grounded theory methods during 2014 and 2015. FindingsNurses in remote settings considered primary health care to be an holistic social model of care that included caring for the community as well as the individual. However, they were unable to provide care consistent with their intention due to the resource-poor nature of the remote setting. Inadequate physical resources, limited specialist health services, and a lack of time were found to impact on remote area nurses’ abilities to provide primary health care. DiscussionThis study is unique in its description of a cause of remote area nurse stress as being the inability to provide primary health care in line with their expectations. ConclusionAppropriate resourcing is essential for nurses to be able to provide a comprehensive array of holistic services in line with community-identified need that also reflect their own definitions of primary health care.