Selecting a Grounded Theory Approach for Nursing Research

Abstract

Grounded theory is a commonly used research methodology. There are three primary approaches to grounded theory in nursing research: those espoused by Glaser, Strauss and Corbin, and Charmaz. All three approaches use similar procedures, yet there are important differences among them, which implies that researchers need to make careful choices when using grounded theory. Researchers new to grounded theory need to find the most appropriate approach that fits their research field, topic, and researcher position. In this article, we compare the three grounded theory approaches. Choices of a grounded theory approach will depend on the researcher’s understanding of the philosophical underpinnings of all three approaches. Practical aspects of grounded theory approaches should match the information processing styles and analytical abilities of the researcher and the intended use of the theory. We illustrate key aspects of decision making about which method to select by drawing upon the first author’s experiences in his doctoral research.

Introduction

Grounded theory is a research approach that appeals to nurses for several reasons. Grounded theory helps nurses to understand, develop, and utilize real-world knowledge about health concerns (Nathaniel & Andrews, 2007). In practice, grounded theories enable nurses to see patterns of health in groups, communities, and populations and predict health and practice concerns in nursing care. Conducting useful and informative grounded theory research in nursing is not as simple, however, as just “doing a grounded theory.” When deciding to use grounded theory to inform nursing practice, researchers must be cognizant of different approaches to grounded theory that the research approach matches the research aims, researcher intent and position, and that the resultant theory is potent and useful.

In this article, we explore key aspects of grounded theory that intersect with deciding which approach best fits nursing research. Classical grounded theory was developed first by both Glaser and Strauss in 1967 (Glaser & Strauss, 1967), although Strauss has since modified his perspective on grounded theory. Over time, three distinct perspectives on grounded theory have emerged. These are the perspectives of (a) Barney Glaser, (b) Anselm Strauss and Juliet Corbin, and (c) Kathy Charmaz. These approaches use similar procedures and vocabulary, yet there are also important differences among them. Researchers who wish to use grounded theory methodology face challenges in making the decision of selecting a most appropriate approach for their specific research situation. A nursing researcher’s critical reflection on the three different grounded theory approaches is crucial to make an informed methodological choice that fits with the researcher’s philosophical position, research question, and research objectives.

The aim of this article is to inform nursing researchers, particularly those who may be new to grounded theory, about different grounded theory perspectives for their research. We draw upon the first author’s experiences of selecting a grounded theory method for his doctoral research project focused on understanding how South Asian men manage their hypertension. In this article, we describe and explain the three grounded theory approaches and, specifically, why Charmaz’s grounded theory approach was selected for the project. We begin with an overview of grounded theory philosophy and method, and move to considerations about application of grounded theory to nursing research. The article concludes with recommendations for nurse researchers who are new to using grounded theory in their work.

Why Are the Different Grounded Theory Perspectives Worth Considering?

Some researchers use coding and categorizing as a way to organize, analyze, and present data and refer to this process as grounded theory. Grounded theory is, however, more than the process of coding data and naming themes. Grounded theory is a systematic research methodology used to construct an explanatory model or theory about a phenomenon of interest (Strauss & Corbin, 1990, 1998). A grounded theory encompasses the interconnections of concepts and categories to interpret and explain patterns or process (es) of a psychosocial phenomenon (Charmaz, 2014).

Schreiber (2001) asserted that grounded theory is “useful for research in areas . . . where there are major gaps in our understanding, and where a new perspective might be beneficial” (p. 57). Nurses require new knowledge to address the challenges of meeting the dynamic health care needs of society. Studies using grounded theory methodology can generate new nursing knowledge derived from real interactions with patients as well as other key aspects of nursing practice. A grounded theory is constructed through a process of developing an understanding of participants’ experiences, as well as by interpreting how participants make sense of their perceptions and actions (Charmaz, 2014).

Glaser, Strauss and Corbin, and Charmaz’s approaches to grounded theory have important philosophical and methodological similarities as well as differences. These similarities and differences among the approaches can lead to confusion and uncertainty about how best to proceed in conceptualizing and designing a grounded theory study. It may be challenging for researchers to understand how to select the most appropriate approach for their specific research situation. Nursing researchers must reflect on the different methodological approaches to grounded theory to determine the best fit for the substantive topic, the research question, and the researcher.

Similarities and Differences Between Grounded Theory Approaches

In the following section, we discuss similarities and differences between Glaser, Strauss and Corbin, and Charmaz’s grounded theory approaches. First, we explain philosophical differences, and then we explicate the theoretical and practical differences of the three approaches.

Glaser’s approach, referred to as classical grounded theory is most closely aligned with the original grounded theory methodology (Glaser, 1978). Later, Strauss, along with Juliet Corbin, developed their approach in a different way. Strauss and Corbin introduced further systematic procedures for data analysis to the grounded theory methodology (Strauss & Corbin, 1990, 1998). Charmaz introduced a constructivist perspective to grounded theory methodology (Charmaz, 2006, 2014).

Philosophical Underpinnings of Grounded Theory Methods

While the three perspectives proffered by these grounded theorists possess similar methods and vocabulary, they also have key differences that need to be delineated. The different grounded theorists agree on the need to develop theoretical understanding of psychosocial phenomena (Charmaz, 2014; Glaser, 1978; Strauss & Corbin, 1998), but they differ in the way they engage with aspects of being and reality (ontology) and how knowledge is acquired (epistemology; Charmaz, 2014; Crotty, 2011). Crotty (2011) asserted that there is an affinity between one’s beliefs about what constitutes reality (the things and experiences that are present in the world) and the choices one makes about methods that will develop and advance knowledge about that reality. Therefore, to choose an appropriate grounded theory approach, one must understand the philosophical beliefs that differentiate the three grounded theory perspectives. Table 1 demarcates philosophical considerations of the three grounded theory perspectives and their usefulness in the respective approaches.

Table 1.

Differences in Philosophical Considerations and Their Usefulness Among Three Grounded Theory Perspectives.

Areas of Differences	Glaser	Strauss and Corbin	Charmaz
Philosophical considerations	Positivistic perspective implied. Believes in one reality. Researcher remains neutral (objectivist) and let data speak for itself (passive approach).	Postpositivist perspective implied. Acknowledge implausibility of seeing reality as it “really” is. Researcher controls personal influence by using procedures to maximize objectivity.	Constructivist perspective. Believes in multiple perspectives of reality. Researcher passionately engages in interpretation.
Useful perspective when—	Researcher believes in one reality of a phenomenon of interest. Personal biases can contaminate data, remaining uninformed about the phenomena is helpful for the inquiry.	Researcher is hesitant to apprehend reality as “really” is. Personal biases can contaminate data but are unavoidable, however, could be minimized.	Researcher is aware of changing context or competing perspectives of reality. Personal knowledge and experience can aid knowing.

Glaser’s grounded theory is both positivist and objectivist; to discover a grounded theory, he positioned researchers as distant observers. Glaser rejected other perspectives on grounded theory because, in his view, all other perspectives forced a bias on emerging theory (Glaser & Holton, 2004). Strauss and Corbin (1998) shifted to a more postpositivist position, acknowledging the possibility of multiple viewpoints, while maintaining an objectivist perspective on a knowable, external reality. Charmaz’s (2014) grounded theory represents more of a departure from objectivism. Charmaz espoused a constructivist–interpretivist perspective to acknowledge researchers’ active engagement in coconstruction of knowledge alongside research participants. Charmaz also took a distinct position from the other two grounded theory perspectives by advocating for researchers to be integral rather than “at a distance” during data analysis and interpretation.

Glaser’s philosophical orientation

Glaser denied having any philosophical orientation associated with his grounded theory perspective. He argued that the “quest for an ontology and epistemology for justifying GT [grounded theory] is not necessary” (Glaser, 2005, p. 5). Instead, Glaser believed that the specific context and research question would shape any philosophical dimensions of the research (Glaser, 2005). Glaser’s rejection of the researcher taking a philosophical position has been criticized as naïve because Glaser’s advocacy for and use of pure induction—letting data speak for themselves—is grounded in positivism (Thornberg, 2012).

Glaser goes further in his positivist philosophical inclinations. He contended that there is a social process underlying a phenomenon of interest (Glaser, 1978). This positions grounded theory as a quest for the “reality” of a phenomenon that is considered to exist, perhaps covertly, somewhere in the research field. The reality, which lies in the field and remains independent of the researcher, can be discovered if the researcher holds aside their personal and professional bias (remains objective) and lets data speak for themselves. Glaser viewed the grounded theory researcher as a neutral inquirer and observer (objectivist) who recognizes patterns in data (distant observer) and “discovers” the theory that describes the “reality” existing in the field (realist).

Glaser’s classical grounded theory can, then, be suitable for those researchers who (a) believe that there is a reality to be uncovered about a phenomenon of interest, and it is within human capacity to understand the reality, and (b) believe that reality can manifest itself if researchers minimize personal bias and let data speak.

Strauss and Corbin’s philosophical orientation

Like Glaser, Strauss and Corbin (1990) did not articulate an initial philosophical orientation. However, their writing and approach to grounded theory methodology and research methods implies a more postpositivist position than Glaser’s classical grounded theory.

Strauss and Corbin did not contradict the realist idea that an independent reality exists. Unlike Glaser, however, Strauss and Corbin were cautious of researchers’ ability to apprehend reality (Strauss & Corbin, 1994, 1998) As a result, Strauss and Corbin called into question a researcher’s ability to build theory that describes a phenomenon as it “really” is. Instead, Strauss and Corbin aimed to depict a close representation of reality through maintaining a practical and “objective stance” (Strauss & Corbin, 1998), while accepting the inevitable influence of researchers’ subjectivity of the research process. Strauss and Corbin thus espoused a systematic approach to conducting grounded theory research to minimize subjective bias of researchers and to achieve maximum objectivity.

Strauss and Corbin’s perspective can be suitable for those researchers who (a) recognize human, practical, and pragmatic limitations to fully understand reality as it “really” is; (b) accept the inevitability of personal bias of the researcher, while also seeking to limit personal bias; and (c) maintain an objectivist perspective by (as far as possible) controlling the inquiry and systematizing it.

Charmaz’s philosophical orientation

Charmaz (2014) espoused a constructivist perspective, in which “reality” is a function and outcome of interpretation and human interaction around a given phenomenon. As such, Charmaz embraced an interpretive approach to grounded theory. Unlike Glaser, Charmaz (2014) believed there is always a possibility of multiple and even competing perspectives of phenomena in a highly complex social world. Although Charmaz (as well as Strauss and Corbin) accepted the possibility of multiple perspectives of reality, Charmaz differed with Strauss and Corbin (as well as Glaser) on how to go about acquiring knowledge about reality. Charmaz viewed research as a collective process involving researchers and the participants. Therefore, her work encourages researchers to engage with multiple interpretations of the phenomenon of interest. Charmaz also encourages researchers to check how participants make sense of their own and the researcher’s interpretations.

Charmaz (2014) believed that reality is dynamic, and that people construct local meaning about reality to understand and act on it within their immediate context. She, thus, strived for local and contextual knowledge about phenomena. Charmaz’s approach to grounded theory considers previous personal and professional experiences of the researcher as well as existing knowledge such as extant literature (which may be held in abeyance using Glaser’s approach) to challenge established viewpoints or to aid to a new understanding of a phenomenon under study.

Charmaz’s grounded theory perspective can be useful to understand local issues, which may change over time as conditions change. The interpretive aspect of Charmaz’s approach can benefit researchers who see value in and cannot separate themselves from their personal and professional experiences as well as from existing knowledge that informs their inquiry.

Theoretical and Practical Considerations of Grounded Theory Methods

Although the three grounded theory perspectives differ philosophically, they contain similarities derived from the common origin of the methodology. The similarities are more prominent in the practical aspects as compared to the philosophical underpinnings of the three grounded theory approaches. All grounded theory researchers rely on data, such as interview data, gathered directly from people in natural settings. All approaches primarily utilize induction as an analytic tool for theoretical sampling—that is to say, sampling people and events based on the direction of the emerging theory—collecting and analyzing data. In all approaches, data collection and analysis occur concurrently. Here, we explicate practical (data collection) and theoretical (logical and analytical) similarities and differences of the three grounded theory perspectives.

Theoretical considerations

Theoretical considerations extend from the philosophical positions of researchers (Crotty, 2011). In grounded theory, theoretical perspectives of the theorists shape the ways they approach collecting and analyzing field data.

Glaser’s classical grounded theory

Induction is the main analytic tool used by Glaser. In classical grounded theory, induction involves the researcher moving to a general theory of how something happens based on an inquiry into and observation of specifics in the research field. Glaser (2002) emphasized that the researcher should approach the field without any hypothesis or preconceived ideas of what they will find (Glaser, 2002). He wished to hold in abeyance personal experiences and knowledge, including extant literature, to let data themselves speak and to let the theory be “discovered.”

In professions like nursing, not all experience can be held in abeyance because nurses conduct research in areas where they practice or otherwise have expertise (Reay, Bouchal, & Rankin, 2016). Glaser (2002) asserted, “data are rendered objective to a high degree by . . . looking at many cases of the same phenomenon, when jointly collecting and coding data, to correct for bias and to make the data objective” (para. 24). Glaser encouraged researchers to take a neutral and passive position—to attend to emerging data inductively and identify patterns—and by doing so having trust in the process that the theory will be “discovered.”

In a recent study of nurse–patient collaboration, Sørensen, Frederiksen, Groefte, and Lomborg (2013) described a meticulous inductive process of working with data to develop their grounded theory. The first author, Sørensen, also a nurse, collected all data wearing a nursing uniform to keep her position neutral in the research setting. She made field observations and interviewed participants in the same natural setting to collect data. Participant observation helped Sørensen to discover what was happening in the field. Field interviews helped her to constantly compare her observations with participants’ perceptions of their experiences in the setting. To keep the analysis objective and avoid biases, Sørensen recorded her observations and memos immediately after completion of the data collection sessions.

Strauss and Corbin’s grounded theory

Strauss and Corbin shared many of Glaser’s theoretical tenets, yet took a different stance while developing a grounded theory. One common theoretical tenet shared by Glaser, as well as Strauss and Corbin, is that a grounded theory resembles the research field from which it is developed (Strauss & Corbin, 1998). However, unlike Glaser, Strauss and Corbin did not use pure induction to develop a grounded theory. They also included deduction (testing abstract ideas against emerging data) in their analysis (Strauss & Corbin, 1990, 1998). This process was used by Roberts and Bowers (2015) as they developed their grounded theory of relationship development in nursing homes. They illustrated how they tested hypothetical ideas against emerging data before accepting them into a developing theory. When using Strauss and Corbin’s method, personal experience and existing literature can be used to gain theoretical sensitivity (understanding nuances of data), however, they are not used in data analysis (Strauss & Corbin, 1990, 1998).

Strauss and Corbin (1998) developed procedures to build a grounded theory while maintaining a balance between objectivity and creativity. They guided others on how to systematically gather and analyze grounded data (Strauss & Corbin, 1998). Their systematic approach drives their coding and sampling procedures (discussed later) and the use of what is called a conditional matrix. A conditional matrix is a coding tool used to account for complex interrelationship of actions and interactions; it uses visual representations to assist in data collection and analysis, and as a means to maintain rigor and integrity of the research (Strauss & Corbin, 1990). The visual representation in a conditional matrix, which helps researchers see an emerging theory and interconnections of categories.

Strauss and Corbin’s approach has been criticized for being overly systematic and too technical to allow researchers to engage creatively in the research process (Melia, 1996). Yet, their systematic approach guides researchers to develop theory in a clear, systematic fashion. This aspect of Strauss and Corbin’s approach has been cited as useful for those who are new to grounded theory research and who would benefit from more structure to guide their analysis (de Beer & Brysiewicz, 2016).

Charmaz’ constructivist grounded theory

Charmaz maintained that the iterative processes of data collection and analysis, and the intimate connection that researchers and participants have with data and the emerging theory, makes grounded theory development a coconstructed endeavor (Charmaz, 2014). Both induction and deduction are used when and where needed to make sense of the grounded data. Charmaz encouraged researchers to engage in a creative process of theory coconstruction and to use other analytic tools such as abduction (Charmaz, 2014). Abduction involves engaging intuitive and creative ideas that may explain unanswered or unexpected observations (Bruscaglioni, 2016; Charmaz, 2014). For Charmaz (2014), abductive reasoning enriches theory construction by facilitating reexamination of data or prompting collection of more data to explain unanswered or unexpected observations. In a study of nurses’ “wisdom in action” in an emergency room setting, Matney, Staggers, and Clark (2016) used diagramming as a way to reexamine data when they noticed that the category of “knowledge” (p. 4) was missing from their theory. This allowed for reevaluation, refinement, and substantiation of categories. Abductive reasoning is informed by personal and professional knowledge and experiences of the researcher. Charmaz advocated for this type of knowledge, believing that an informed researcher enriches theory construction.

In contrast, Strauss and Corbin (1998) viewed the interconnection of researcher and participants as biased and labeled interpretation as “speculation” (p. 12). They maintained that “theory derived from data is more likely to resemble the “reality” than . . . [a theory that is] derived by putting together a series of concepts based on experience or solely through speculation” (Strauss & Corbin, 1998, p. 12). Charmaz maintained that the scope of grounded theory is limited if researchers only attend to objective data while ignoring expertise and experiences of the researcher (Charmaz, 2014). Put another way, experience and expertise become reference points to ask relevant questions and can enhance the researcher’s theoretical sensitivity, that is, the ability to see, define, and express phenomena and their interrelationships in abstract form (Charmaz, 2014). She further advocated using the researcher’s full interpretive potential to explore the data grounded in the field, coconstruct a theory with participants, and check back in the field to determine if the theory makes sense to research participants and other knowledge users such as nurses (Charmaz, 2014).

Practical considerations

Participant interviewing is a frequent data collection method in grounded theory (Charmaz, Thornberg, & Keane, 2017). Interview data are then coded (a label is given to a set of data) and memos (the researcher’s notes on interactions with the data) are written to aid ongoing analysis. The coding process is the major practical endeavor in grounded theory approaches. Practical actions (such as theoretical sampling, coding, constant comparison, identification of data saturation) are integral to the coding process.

Coding process

Codes are “the building blocks” in a grounded theory (Glaser, 1978, p. 55). Coding is a way to make sense of field data (Charmaz, 2014). Coding breaks data into small pieces and forms concepts: abstract ideas that account for data (Charmaz, 2014). Coding further identifies similar concepts from coded data and relates them to each other to build abstract categories that fit together to develop a comprehensive theory (Charmaz, 2014; Glaser, 1978; Strauss & Corbin, 1998). For example, Rose, Mallinson, and Walton-Moss (2002) conducted a study by interviewing 23 participants to understand their responses to mental illness of a family member. The researchers coded, linked, and grouped the interview data in concepts and categories, which resulted in a comprehensive theory of how families responded to mental illness.

For Glaser, Strauss and Corbin, and Charmaz, coding is an initial opportunity for researchers to pause and ponder on social processes of interest. Coding is an ongoing process to break down, analyze, and synthesize data as a theory is being built. As with other aspects of grounded theory, there are similarities and differences in how Glaser, Strauss and Corbin, and Charmaz addressed coding processes.

Early stage of coding

The initial coding process is similar in the three grounded theory approaches (Charmaz, 2014; Glaser, 1978; Strauss & Corbin, 1998). The three theorists begin the coding process by breaking data into smaller segments (word-by-word or line-by-line) and by analytically attending to each piece of datum. In the beginning stage of all three approaches, small pieces of data are grouped and labeled based on their properties or characteristics. Glaser and Strauss and Corbin named this beginning phase of coding as “open coding” (Glaser, 1978; Strauss & Corbin, 1998), whereas Charmaz referred to it as “initial coding” (Charmaz, 2006).

When the initial or open coding phase is complete, researchers begin to see the “direction” of emerging data. Some codes begin to form concepts while others loosely float between the emerging concepts. That is to say, some codes do not immediately fit within a particular concept. Eventually, through ongoing coding, all codes relevant to the emerging theory integrate into concepts. Concepts begin to synthesize into categories at an advanced stage of open or initial coding. This process of codes to concepts and concepts to categories and formation of their interrelations is iterative and continued in further coding stages. Major concepts and categories are formed in the initial phase and continue to develop in further stages of analysis regardless of an approach being followed. The emerging concepts and categories of a developing theory guide the researcher to begin theoretical sampling, looking for data that may be pertinent to and further inform the emerging categories.

Selective or focused coding

Data collection and analysis flow into the next phase of coding with some similarities and differences among the three approaches. A researcher begins to pinpoint relevant data regardless of the grounded theory approach being followed. Researchers select major categories based on what is relevant to the emerging theory. For example, a selected category is relevant if it stands to explain part of an underlying process or pattern of the phenomenon. Researchers collect more data pertinent to select categories (selective or focused coding) through an inductive process known as constant comparison in which the researcher compares data to data, incident to incident, and category to category (Charmaz, 2014).

Glaser proposed to hold progression to selective coding until a core category is found during the open coding phase (Glaser, 1978). The core category is a broad and overarching conceptual category, which can incorporate all data including other emerging concepts and categories: as such, the core category is expressed at a higher level of abstraction as compared to other emerging categories. Using Glaser’s approach, the process of relating emerging concepts with categories begins during open coding and carries forward to the selective coding phase, when a core category emerges. Selective coding is used to refine the core category and raise it to a high level of abstraction where all data fit. Glaser recommended researchers attend to the theoretical gaps and continue to ask and explain “how the main concern [problem or the phenomenon] is resolved” (Glaser & Holton, 2004, para. 54) until no new data emerge (data saturation) and theory is formed.

Unlike Glaser, Strauss and Corbin (1998) proposed an extensive scheme of coding for the selective phase and added an intermediate stage of “axial coding,” which overlaps between the open coding and selective coding phases in the other two perspectives. Axial coding is “reassembling” (Strauss & Corbin, 1998) the fractured data that have started to make sense during open coding.

Reassembling is done by exploring and articulating clear and complete conceptual relationships of emerging “categories to subcategories along the lines of their properties and dimensions” (Strauss & Corbin, 1998, p. 123). The fractured data are reviewed during axial coding through the lens of an organizational scheme that Strauss and Corbin called a “paradigm” (Strauss & Corbin, 1998). The researcher explores structure and process related to a phenomenon under study to develop a paradigm. A structure is set of conditions where the phenomenon happens and participants’ “action/interactional strategies and [related] consequences” (Strauss & Corbin, 1990, p. 99) form the process. The structure and process are revealed by asking “questions about the phenomenon such as when, where, why, who, how, and with what consequences” (Strauss & Corbin, 1998, p. 125). It is at this stage that researchers start to piece together what matters and what happens in a process.

Subsequently, analysis moves into the selective coding phase where data are further refined until “no new properties, dimensions, or relationships emerge during analysis” (data saturation; Strauss & Corbin, 1998, p. 143). Categories, subcategories, and their interrelations are raised to higher level of abstraction that is described and explained in a comprehensive and figurative model or theory.

Charmaz, like other grounded theorists, guided researchers to move into the focused coding phase by attending to the most significant codes appeared during the open coding phase. However, Charmaz’s scheme of selective or focused coding is not as elaborate as that of Strauss and Corbin’s axial and selective coding. Charmaz claimed that moving to focused coding is spontaneous when the researcher begins to “synthesize, analyze and conceptualize larger segments of [line-by-line] data” of the open coding phase (Charmaz, 2014, p. 138). Frequently occurring codes that conceptually merge into each other begin to emerge as core or central categories and provide the direction for further theoretical sampling. An iterative process of coding continues until the developing theory takes shape, data saturation occurs, and all data fit.

Eventually, in all approaches, the researchers select a “core category” that emerges as central to explaining all relevant data around which a theory is developed. This takes the concepts and categories to a high level of abstraction, building a concise and comprehensive understanding that accounts for all data.

Summary

Similarities between grounded theory methods are related to vocabulary and process. All grounded theorists utilize constant comparison as a tool to (a) gain theoretical sensitivity, (b) facilitate theoretical sampling, (c) refine the categories and raise them to increasingly higher level of abstraction, and (d) link abstraction back to source data. Methods and their technical vocabulary (such as coding, memo writing, theoretical sampling, and data saturation) are similar in all the approaches, and all generate theories (or models) to explain the phenomena under investigation.

Differences between the grounded theory approaches are located in distinctions in philosophical and theoretical assumptions. While using the same grounded theory methods (such as coding and theoretical sampling), all three engage in different analytical processes. Glaser’s objective, inductive, passive approach would produce a different grounded theory than would Strauss and Corbin’s procedural approach or Charmaz’s interpretive, coconstructed approach. An appreciation of the similarities and differences in the different grounded theory approaches can help nurse researchers to decide on an appropriate grounded theory to use.

Selecting an Appropriate Grounded Theory Approach

Each grounded theory perspective is more suitable for some contexts than others. In Table 2, we have summarized key components of grounded theory that influence researchers’ choices about which method to select. We now turn to apply these choices to a study to understand how 55 years and older South Asian men manage their hypertension in a Canadian health care setting. The focus of the inquiry is to (a) understand patterns of people’s behavior (what they do), (b) understand how they interpret their experiences, and (c) develop theory that calls forth rather than suppresses or obscures participants’ voices.

Table 2.

Considerations of Choosing an Appropriate Grounded Theory Approach.

Areas of Choice	Glaser	Strauss and Corbin	Charmaz
Philosophy	Researchers’ influence and values are denied. Researchers remain objective.	Researchers’ influence and values are recognized. Researchers distant from data and analysis.	Researchers’ influence and values are acknowledged. Researchers passionately engage.
Focus	Developing grounded theory that accounts for all data.	Developing well organized and detailed grounded theory.	Coconstructing a theoretical understanding of people’s experiences and their interpretations.
Research context	Disregarding scholarly discourse. Aim to explore context-independent data to generalize in broader context.	Selective to scholarly discourse. Aim to explore local issues to generalize in broader context.	Attending to scholarly discourse. Aim to explore local issues for local context.
Analytic style	Passively attending to emerging data. Constant comparing for a core category; inductive approach; open and selective coding.	Action-oriented microanalysis through structured procedures. Constant comparing to select a central category; inductive and deductive approaches; open, axial, and selective coding.	Actively utilizing researcher’s creative interpretation. Constant comparing for relevant categories; inductive, deductive, and abductive approaches; initial and focused coding.
Utility	Appropriate to develop broader theory across substantive areas. May take years to develop a theory that can be applicable across areas of interest.	Appropriate to account for a wide range of variables to enhance generalizability and predictive power of the theory. Prescriptive approach may develop a superficial description of the variables.	Appropriate to develop a theory with full breadth and depth of a phenomenon in its local context. May not be generalized away from the context of origin.

Reflection on the Philosophy

The first author of this article identifies as a South Asian man, licensed to practice as a registered nurse (RN), and as someone diagnosed with hypertension. This identity has been instrumental in shaping his interest in the research topic as well as subsequent conversations with other South Asian people and health professionals about health in this population. As such, the first author was already grounded in subjective experiences related to the phenomenon, which guided the shaping of his study. The first author was quickly aware that, for him, hypertension in South Asian people was not an objectifiable phenomenon; in fact, he was deeply embedded in the fields of experience and health care practice already, as a patient and as a practicing RN. For these reasons, Glaser’s as well as Strauss and Corbin’s grounded theory approaches did not seem like an appropriate choice because both emphasized a distance from the phenomenon that did not seem achievable. Charmaz’s perspective was an obvious choice that acknowledged the value of the embedded researcher.

Focus of the Inquiry

In our example, the focus of the inquiry is to coconstruct a grounded theory to fill a gap in knowledge about how 55 years and older South Asian men manage their hypertension. The literature points to hypertension management being problematic in this population (Leenen et al., 2008; Quan et al., 2013). As well, from his own experiences of being an RN and a patient, the first author noticed gaps in care. Because he felt already embedded in the research field, with a vested interest in this topic, the first author occupied an interesting insider–outsider position that pointed toward adopting a coconstructed approach to grounded theory.

Reflecting Upon the Research Context

In our example, the research context is Alberta’s South Asian Communities as well as Alberta’s health care system. In these contexts, people of South Asian origin are nearly three times more likely to develop hypertension as compared to their Caucasian counterparts (Leenen et al., 2008; Quan et al., 2013). For this reason, we wanted to inquire into the phenomenon in the local context. By following Charmaz’s method we were able to attend to the immediate context for the research by reviewing the scholarly literature (if needed) as well as exploring local contexts from where data would be collected and with whom the theory would be coconstructed.

Attending to Analytic Styles

Because the first author had personal and professional insights into managing hypertension for a South Asian man in Canada, intuition and imagination were already at play. Charmaz’s approach with its capacity for abductive reasoning seemed a good fit to facilitate the first author’s and participants’ engagement around the topic. Charmaz’s approach made room for intuitive and imaginative explanations, which could guide further direction of data collection and analysis.

We felt that Charmaz’s approach could allow the first author to attend to unpredicted or unexplained observations by drawing inferences from his insights, but we also felt it might help him to reassess and challenge prior knowledge by comparing and contrasting with emerging data. Charmaz’s approach best suited the first author’s work because it provides analytical tools of abductive thinking and interpretive reasoning to make use of all accounts including participants’ and the researcher’s own experiences or interpretations.

Intended Application of the Research

The intention of the research in this example is to develop an in-depth understanding of how South Asian men manage their hypertension and apply that knowledge to the local context, particularly in relation to health care. Charmaz’s (2014) approach is exploratory, interactive, interpretive, and coconstructive, and enables understanding of the breadth and depth of a phenomenon in its local context. As a South Asian man with hypertension, the first author was well positioned to engage with the South Asian community in ways that permitted exploration, and coconstruction. As well, given that little is known about how South Asians in Canada manage hypertension, Charmaz’s interpretivist and exploratory approach fits well.

While Glaser encouraged researchers to “discover” a broader theory to generalize across substantive areas of interest (Glaser, 2006), classical grounded theory remains “abstract of time, place and people [context]” (Glaser & Holton, 2004, para. 4). For example, a study of hypertension among 55 years and older South Asians can be transferrable to study chronic illnesses across populations (Glaser, 2006). However, it may take years to develop a theory to this higher level of abstraction and, as such, could complicate and fall outside of the scope of manageable PhD work.

Strauss and Corbin were also proponents of achieving maximum generalizability and predictive power of the theory through precisely structuring the research process in a framework (Strauss & Corbin, 1998). However, the first author engaged intimately with research participants who have shared similar experiences; the unexpected and unpredictable nature of the research relationship does not lend itself well to structure. Therefore, Charmaz’s approach was an obvious choice for allowing the researcher’s full engagement as well as attending to local context.

Conclusion

Grounded theory methodology is a promising approach to develop theoretical understanding of psychosocial phenomena. There are three major grounded theory perspectives espoused by Glaser, Strauss and Corbin, and Charmaz. Selecting a grounded theory approach is not a straightforward decision-making process because the similarities and distinctions can be unclear. All three major grounded theory perspectives can be instrumental to enhance conceptual understanding of a phenomenon. Making an appropriate choice of methodology is complex and requires understanding of all the three major approaches in nursing. Therefore, researchers should carefully select an approach that is the best fit to a specific research context.

Choice of a grounded theory approach will depend on the researchers’ philosophical inclinations and their understanding of the philosophical underpinnings of the three major grounded theory approaches. Philosophical positioning helps researchers to decide how to position the research amid existing knowledge and scholarship, as well as to decide on what counts as useful knowledge to inform the development of a grounded theory. Practical aspects of grounded theory approaches should match the information processing and analytical styles of the researcher and the intended use of the theory.

Author Biographies

Shaminder Singh, RN, MSc (Psychology), is a doctoral candidate at the University of Calgary, Faculty of Nursing in Calgary, Alberta, Canada.

Andrew Estefan, RPN, PhD, is an associate professor at the University of Calgary, Faculty of Nursing, Calgary, Alberta, Canada.