Use of Grounded Theory in Cardiovascular Research

Medical research is dominated by quantitative, hypothesis driven research methods. According to Krumholtz, Bradley, and Curry (2013) there is a need for more rigorous qualitative research, especially in areas where little is known, such as health literacy. Rather than relying on surveys and statistical analysis of quantitative studies, qualitative and mixed methods research can take an inductive approach to new discovery, which may lead to better hypotheses, better tools and strategies, and ultimately, better outcomes. Qualitative and mixed methods research should be used to investigate complex phenomena that are difficult to measure providing a deeper understanding and leading to better approaches, strategies, instrumentation, hypotheses, and outcomes (Curry, Nembhard, & Bradley, 2009). Qualitative methods can expand and enhance the role of quantitative research methods, especially in complex areas where little information is available, or where there is a high degree of variability in results from quantitative studies. This paper is designed to demonstrate the use of rigorous grounded theory methodology in a qualitative study of the development of health literacy skills in patients with cardiovascular disease and diabetes.Background on the StudyThe knowledge and skills necessary to manage health and prevent disease are known as health literacy (Parker & Ratzan, 2012). An estimated 90 million Americans lack the skills to understand their condition and related numbers, navigate the health system, communicate with their healthcare provider, and make good health related decisions (Kutner, Greengerg, Jin, & Paulsen, 2006). A National Action Plan was developed by U.S. Department of Health and Human Services in 2010 to create a more health literacy society, and a Health Literacy Toolkit was developed to help healthcare providers communicate more effectively with their patients (Dewalt et al., 2010). Since a national assessment of health literacy has not been conducted since 2003 (Kutner et al.), it is unclear how effective the Action Plan, Toolkit, and other strategies have been.Just as there are many forms of quantitative methods, such as registries, clinical trials, and predictive analytics, there also are several forms of qualitative methods, including narratives, case studies, phenomenology, ethnography, and grounded theory. While grounded theory is a popular method of conducting qualitative research, many studies that claim to use grounded theory do not in fact follow the principles of grounded theory (Barbour, 2001). Also, within each of these methods difference strategies of data collection and analysis are used. The purpose of this paper is to provide an example of how grounded theory was used in a study looking at how health literacy skills are developed in patients with cardiovascular disease and diabetes.Background on Grounded TheoryA grounded theory approach was used to gain perspective and a greater insight into the process of learning, the building of knowledge and the development of health literacy skills in patients diagnosed with a heart disease, heart failure, diabetes, high cholesterol, and high blood pressure. Grounded theory was discovered by Glaser and Strauss (1967) as a method of developing theory from empirical data, rather than simply testing hypotheses based on classical theories. While grounded theory is increasingly used in medical research there are several forms of grounded theory, based on the interpretive approach (Sbaraini, Carter, Evand, & Blinkhorn, 2011). The original grounded theory method, developed by Glaser and Strauss (1967) comes from a postpositive framework. Glaser and Strauss eventually developed their own separate methodology for grounded theory (Corbin & Strauss, 2015; Glaser, 1992). The different methods of conducting grounded theory represent different philosophical frameworks, making it necessary for the researcher to select the approach with the best methodological fit (Charmaz, 1990; Glaser & Strauss; Glaser, 1992; Strauss & Corbin, 1990). …