Funded by the VA HSR&D (Project# SDR 10-012)

Spotlight on Women Cyberseminar Series
Wh t i G d d Th A 

Wh

a

t

is 

Groun

d

e

d Theory, 

Any

An Overview with Examples from 

Qualitative Research on Women Vet

Alison B. Hamilton, Ph.D., M.P.H

VA HSR&D CyberSeminar

S

p g otli

ght on Women’s Health

April 28, 2011

VA HSR&D CeVA HSR&D Ce

the Study of He

Provider B
Poll Question:

Do you conduct qualitative research or plan to conDo you conduct qualitative research, or plan to con

qualitative research in the future?

Yes, I conduct qualitative research.I plan to conduct qualitative research in the futuNo, I do not conduct qualitative research.
Poll Question:

Are you familiar with grounded theory?

Yes, very familiarYes, somewhat familiarI have heard of itNo, not familiar
Thank you Thank you

• To the HSR&D Women’s Health Research C

To the HSR&D Women’s Health Research C

for sponsoring this CyberSeminar

• To m

y g collea

gues Barbara Bokhou

r and Susa

for their ongoing collaboration on all matters 

• To my colleagues at the HSR&D Center of Ex

the Study of Healthcare Provider Behavior fothe Study of Healthcare Provider Behavior, fo

valuable feedback (Sangeeta Ahluwalia, CouArmstrong, Nikki Armstrong, Jaimi Butler, Ism

Canelo, Angela Cohen Jill Darling Jackie Fi

Angela Cohen, Jill Darling, Jackie Fi

Katherine Hoggatt, Debbie Jenkins, Ruth KlaMacGregor, Fran Nedjat-Haiem, Sabine Oish

Rodriguez Rebecca Rodriguez, Rebecca Shoai, Barbara Simon 

Barbara Simon, 

Tisnado, Donna Washington, Tamar Wyte, & Yano)
Overview of Presentation Overview of Presentation

1. B i f hi t f d d th (GT) B

rie

f hi

s

tory o

f groun

d

e

d theory (GT)

2. Basic premises and key components 3. A hi d t l i ith GT Approaching 

d

a

ta analysis with GT

4. When GT may and may not be approp5. Other approaches besides GT Other approaches besides GT6. Qualitative studies that used GT: focus 

Veterans

7. Suggestions for working with qualitativ8. Importance of qualitative research in h

Importance of qualitative research in h

services research on women Veterans

9. Questions/comments?
Grounded theory is Grounded theory is not

...

• Defined in only one way by o

Defined in only one way, by o

two people 

•

Only about qualitative data an

• The only way to approach qua

The only way to approach qua

data

• Li it d t lit ti h Li

mit

e

d

to qualit

ative researc

h
First some history First, some history

• GT developed by 2 sociologists Barney 

GT developed by

2 sociologists, Barney 

Anselm Strauss

• R t i b li i t ti i (H 

Roo

ts in sym

b

olic in

teractionism (Her

Blumer): focus on how meaning is cre

d i i l i t ti during social in

teractions

• Developed the constant comparison me

which became GT, with publication of ThDiscovery of Grounded Theory (1967)

• Developed at a time when qualitative 

was seen as unscientific or non-s

yste

• Glaser and Strauss came to disagree ab
History continued History, continued

• GT has become the paradigm of choice 

GT has become the paradigm of choice 

qualitative research

• Wh ? It ff l ti t h t t d 

Wh

y

? It offers a solution 

to w

h

a

t

to 

do 

pile of non-numerical data; provides a 

proced d f ti 

dures, an

d a means o

f generati

• Many others have taken on GT in differe

• Charmaz: Constructing Grounded Th• Corbin & Strauss Corbin

& Strauss

• SAGE Handbook of Grounded Theor• Ad l Cl k Sit ti l A l i ( 

Ad

ele Clar

ke: Situational Analysis 

(po

GT)
Basic premises of GT Basic premises of GT

• Theor

y ,, y comes from data, i.e., theor

y is 

“grounded” in data

• Everything related to the subject of stud

• Approach data to find theory, rather than 

approach data with theory

• Allow data to move toward a hypothesis

than start with a hypothesis

• Trying to answer the question, “What’s r

going on, and how?”

• S d l i EARLY f fi d Start 

data analysis EARLY, a

fter first 

dat

collection episode

– No break between data collection & analysis No break between data collection

& analysis
Key components of GT Key components of GT

• Fit

– Do the concepts fit with what’s been describe

incidents) by participants?

• Relevance

– Does the study address something of concern 

Does the study address something of concern 

people affected by a given phenomenon?

• W

o ab y rk ilit

y

– Does the theory explain how a phenomenon i

addressed/solved/managed?

• Modifiability

– Can the theory be modified upon introduction 

Can the theory be modified upon introduction 

data?
Other components of GT Other components of GT

•

“Hard

-core

” GT (Glaserian Glaserian GT

– No 

pre-existin

gg 

 knowled

ge abou

(e.g., through literature review)

– No taping or transcribing; move 

No taping or transcribing; move 

notes to concepts

– No discussion of emergent theo

(limit ideas to data only not to o(limit ideas to data only, not to o

impressions/ideas)
Approaching analysis with G

Approaching analysis with G

• “Open coding Open coding

” or

“substantive coding substantive coding

– Inductive approach: go with what the dat

• Id tif th “ b t ” Identify the 

“su

b

s

tance

”

– Can be very micro-level (e.g., line-by-line

• Codes are combined to generate con

– Codes change over time Codes change over time– Concepts change over time– Constant comparison across data source

critical
Approaching analysis with G

Approaching analysis with Gfrom Wagne, Lukassen, Mahlendorf, 2010
Approaching analysis with GT:

“A i l di ” & “ l ti di ” “A

xial coding

”

&

“selective coding

”

• Axial coding proposed by Strauss 

Axial coding proposed by Strauss

Corbin in 1990

– Putting data back together by making Putting data back together by making

connections across codes, categories

concepts

• Selective coding happens after ope

coding

– Focus on particular concept and revis– May revisit subset of data that pertain

concept 

( g) theoretical sampling)
Approaching analysis with GT:

W iti r ng memos

• Writing about what Writing about what s’ being observed 

being observed 

data

• Keeping track of ideas, relationships 

between codes,g p emer

gent conce

pts

• There are no rules about how a mem

sh ld l k h ld b f hould loo

k; memos s

hould

be 

freeflowing, stream of consciousness, a

constant throughout analysis

• Reflecting on one Reflecting on one s’ role in the resea

role in the resea
When might GT be appropr

When might GT be appropr

• When the goal is to generate When the goal is to generate

concepts that explain a given 

phenomenon (“why” or “how,” n“what )”

)

• When research desi

gn and dat

collected lend themselves to thdevelopment of theory development of theory
When might GT not be approp

When might GT not be approp

• When straight description of a When straight description of

a

phenomenon is the goal (not “w

but “what”)

• Wh th i t th l f th When theory is no

t the goal o

f th

p j ro

ject

• When the project was not initiall

up to explore a given phenomen(sometimes)
What else is there besides G

What else is there besides G• Five Ways of Doing Qualitative Ana

Five Ways of Doing Qualitative Ana

Phenomenological Psychology, Gro

Theory Discourse Analysis NarratiTheory, Discourse Analysis, Narrati

Research, and Intuitive Inquiry (Ma

2011)

• Creswell, Qualitative Inquiry and 

R h D i Ch i Researc

h

Des

ign: Choos

ing among 

Approaches, 2006 (narrative, 

ph l d d th henomenology, groun

d

e

d theory, 

ethnography, and case studies) 
What else is there besides 

What else is there besides 

Choose your Method: A Comparison of Phenomen

Discourse Analysis, and G (S 

rounded Theory (Sta

Trinidad, QHR, 2007)

• Phenomenology 

– Study how people make meaning of their lived experie

• Discourse analysis 

– Examine how language is used to accomplish persona

and political projects

• Grounded theory 

– Develop explanatory theories of basic social processe

co e nt

ext 

– “Grounded theory examines the “six Cs” of social proc

(causes, contexts, contingencies, consequences, covaand conditions) to understand the patterns and relatio

among th l t (St & C bi 1998) ” these elemen

ts (Strauss 

&

Corbin, 1998).”
What else is there besides G

What else is there besides G

Starks & Trinidad cont Starks

& Trinidad, cont.

Applied all 3 methods to a single data 

• Interview study with 25 primary ca

physicians (PCPs) that explored thphysicians (PCPs) that explored th

of informed decision making (IDM) 

context of prostate cancer screenincontext of prostate cancer screenin

• One’s anal

y pp p tic approach sha

pes th

research questions, attention to daconclusions

—and products and, products
Additional considerations in qualitative da

analysis: establishing trustworthiness analysis: establishing trustworthiness

Lincoln & Lincoln

& Guba, Naturalistic Inquiry Naturalistic Inquiry (1

• Using a constructivist approach to 

qualitative research [instead of a poapp ] roach

]

– Credibility [internal validity]– Trans

ferability [external validity]

– De

p y [ y] endabilit

y

[reliability]

– Confirmability [objectivity]
Getting in the data: some examples from 

qualitative research on women Veterans qualitative research on women Veterans

Hamilton Poza Washington Hamilton, Poza, WashingtonPathways to homelessness among wome

Veterans ( Veterans

(WHI, accepted for publicatio

accepted for publicatio

• 3 focus groups conducted to understan

risk factors (identified in survey) “work”

• Semis uc u ed e e gu de truc

t

u

red int

ervi

ew guide

• Used constant comparison approach/G

– Wh ? I t t d i Wh

y

? In

teres

t

e

d in d l i th developing theory

ab 

ou

women Veterans become homeless, in orde

identify critical junctures for intervention/preidentify critical junctures for intervention/pre
Getting in the data: some examples from 

qualitative research on women Veterans qualitative research on women VeteransFour iterative sta

g p es in constant com

pariso

method (Glaser, 1965): 

1) comparing “incidents” (i.e., discrete narra

experi ) ences

)

Ægenerati t i ng ca

tegories

-e.g., experience of pre-military homelessness 

category of pre category of pre

-military adversity military adversity

2) integrating categories

-discover

y p gg of relationshi

ps amon

g cate

gories

3) delimiting a theory for how the categorie

to each other

-e.g., “roots” of homelessness

4) writing the theory

- “web of vulnerability”
Getting in the data: some examples from 

qualitative research on women Veterans qualitative research on women Veterans

Mattocks attoc

k

s et

al.

Women Veterans’ Reproductive Health Preference

Experiences: A Focus Group Analysis (WHI, 20

• Focus group data (5 groups, n=25)• Semi

-structured interview guide structured interview guide

• Used concepts from GT

– Inde

p p endent o

pen codin

g

Æcode definitions

– Coders compared codes, resolved discrepan

refined, achieved final coding structure (25 c

– Codes were combined (axial coding) into bro

categories, which became themes

– Reported 5 major themes across groups & Reported

5 major themes across groups

&

participants
Sugg g q estions for workin

g with 

qualitativ

• Consider which approach best suits the 

your project, and establish research desyour project, and establish research des

accordingly

• If you plan to use GT, specify whose ver

GT, read the sources, and make sure theconsistent with what you are proposing

– If l t di f dif GT b 

If you plan 

to diverge 

from or modify GT, 

be e

about the changes

• During analysis, check original GT sourc

During analysis, check original GT sourc

make sure you’re still using the version yselected 

• Consider using more than one analytic a

to your data

– C id i th d i t t ith GT 

Consider using meth

o

ds consis

ten

t with GT p
Sugg g q estions for working with qualitativ

• Make sure everyone on the analytic 

Make sure everyone on the analytic 

has a shared understanding of the a

process

• Document yy 

our and your team’s ana

process

• In your manuscripts spell out your p

In your manuscripts, spell out your p

in a way that non-qualitative audien

understand (strive for transparency) understand (strive for transparency)
Importance of qualitative research in healt

services research on women Veterans services research on women Veterans• Bean

-Mayberry Mayberry s’ systematic review (2010) 

systematic review (2010) 

that most studies of women Veterans have observational/descriptive

– Trend toward more implementation resea

Trend toward more implementation resea

which will increasingly involve qualitative 

• With large-scal VA i iti ti h PAC

le VA initi

atives suc

h as PAC

in-depth understanding of women Veteranshealthcare 

p p references and ex

periences is 

– Qualitative research can contribute to 

development of services that are attuned 

women s’ preferences preferences
References noted

Bean-Mayberry B Huang C Mayberry, B., Huang, C., Batuman Batuman, F., Goldzweig Goldzweig, C Washington D L Yano E 

C., Washington, D.L., Yano, E

I.M. (2010) Systematic Review of Women Veterans Health Research 2004–2008 Washington (DC): Department of Veterans Affairs; 2010 Oct. Available from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=vawomen

Glaser B G (1965) The constant comparative method of qualitative analysis Social PGlaser, B.G. (1965). The constant comparative method of qualitative analysis. Social P

436-445. 

Hamilton, A.B., Poza, I., Washington, D. (in press) “Homelessness and trauma go hand

Pathways to homelessness among women Veterans. Women’s Health Issues (S

on Active on Active-Duty Military Women Duty Military Women s’ Health and Health Care Delivery) Health and Health Care Delivery).

Mattocks, K.M., Nikolajski. C., Haskell, S., Brandt, C., McCall-Hosenfeld, J., Yano, E., 

Borrero, S. (2011) Women veterans' reproductive health preferences and experiegroup analysis. Women’s Health Issues, 21(2), 124-9. 

Miller S & Fredericks M (1999) How does grounded theory explain? Qualitative InquMiller, S. & Fredericks, M. (1999) How does grounded theory explain? Qualitative Inqu

Starks, H., Trinidad, S.B. (2007) Choose your method: A comparison of phenomenolog

analysis, and grounded theory. Qualitative Health Research, 17, 1372 .

Wagne, S.M., Lukassen, P., Mahlendorf, M. (2010) Misused and missed use — Ground

Objective Hermeneutics as methods for research i Objective Hermeneutics as methods for research in industrial marketing Industri

industrial marketing. Industri

Management, 39, 5–15

Additional sources of interest:

Hsieh H F Shannon S E (2005) Three approaches to qualitative content analysis QHsieh, H.F., Shannon, S.E. (2005) Three approaches to qualitative content analysis. Q

Research, 15(9), 1277-88. 

Kearney, M.H., Murphy, S., Rosenbaum, M. (1994) Mothering on crack cocaine: a grou

analysis. Social Science & Medicine, 38, 351-61. 

Thomas G James D (2006) Reinventing grounded theory: Some questions about thThomas, G., James, D. (2006). Reinventing grounded theory: Some questions about th

and discovery. British Educational Research Journal, 32, 767-795. 
For more information: For more information:

Alison B. Hamilton, Ph.D., M.P.H

alison hamilton@va gov alison.hamilton@va.gov

alisonh@ucla.edu

For additional guidance with qualitative data analyFor additional guidance with qualitative data analyhttp://www.hsrd.research.va.gov/for_researchers/ca s/a c es/ s rs/a

r

chives/

h

srm-06 0 pd 141

0.pd

f

(CyberSeminar by Susan Zickmund on 6/14/2010)