Building a Classic Grounded Theory: Some Reflections...

Lee Yarwood-Ross, University of Wolverhampton Kirsten Jack, Manchester Metropolitan University Abstract This article focuses on some of our reflections of using processes inherent within classic grounded theory methodology to build knowledge surrounding military personnel who experienced combat-related limb-loss from the Iraq and Afghanistan conflicts. We conclude that instead of adding to the issue of mixing different grounded theory perspectives, researchers should instead follow guidance from one approach to avoid becoming perplexed as each strand produces a different product. This article provides our own philosophy and compatibility with a classic grounded theory approach, and we encourage researchers to capitalise on the wealth of exemplar theories within the Grounded Theory Review journal and to engage with Barney Glaser’s books.  Keywords: Classic Grounded Theory, Grounded Theory, Combat-Related Limb-Loss, Military Trauma, Combat-Trauma. Introduction           Classic grounded theory methodology can be embraced by both quantitative and qualitative researchers (Glaser, 1998, 2008), however in nursing research it has tended to be used for its power in generating knowledge using a qualitative approach to build theories that are discovered or constructed from the data (Glaser 1998; Chun Tie et al., 2019). Specifically, nursing researchers have tended to embrace grounded theory to study areas relating to clinical practice or education (See for example Li et al., 2015 and McCallin, 2011). As a nurse, I (the first author will be referred to in the first person in the article to show that this article is based on his doctoral work) had a prior interest in the effects of amputation on people’s wellbeing, and spending part of my youth as a military child, this interest expanded to understanding the psychosocial impact of combat-related limb-loss on military personnels’ physical and mental health. I focused specifically on military personnel from the Iraq and Afghanistan conflicts as there was little insight available in the extant literature for this group of people.             Grounded Theory is, arguably, one of the most misunderstood and misinterpreted methodologies (Olshansky, 2015). Specifically, Timonen et al. (2018) argued that the lack of understanding often existing among researchers relates to the core processes of grounded theory; for example, confusing the general ideas of saturation in qualitative research with that of theoretical saturation (a core tenet of grounded theory), which leads to researchers applying procedures thus making it more difficult to facilitate a grounded theory product. Bryant (2021) also reinforced the misunderstanding that often occurs when researchers may not be aware of the methodology’s inherent sampling procedures, where data collection begins purposively followed by theoretical sampling. Ultimately, I chose to adopt a classic grounded theory (CGT) approach and this article provides our tussles with some aspects relating to the methodology and uses a reflective style of writing that may prove to be useful to other researchers contemplating the use of CGT in their own research endeavours.           Our journey began reading the SAGE Handbook of Grounded Theory (Bryant & Charmaz, 2007) that provided us with the perspectives and uses of the methodology across disciplines. However, it was overt that there were also various approaches to doing grounded theory research, and further exploration of the extant literature led us to a plethora of critical research available that discussed the different “strands” of GT. We read the contentious issues surrounding the methodology, but importantly, a seminal piece of work that settled our own decision-making around GT as whole was written by Glaser (2014) that concluded “GT methods are just different, not better or worse” (p. 3). However, one does need to...

Remote Female Fixation—A Grounded Theory on Semi-Illegal Sharing of Nude Imagery Online...

Hilde Otteren, PhD Astrid Gynnild, PhD[1] Abstract In this article, we present the classic grounded theory of remote female fixation, which provides new knowledge on the illegal sharing of sexualized images of young girls in networked communities on the internet. This sharing occurs without consent and usually without the girls even knowing about it. In the study, we identified the main concern and action strategies of the anonymous users of a large online forum for the sharing of nude images. The data were gathered from 20 different online comment sections of the Norwegian branch of a global, anonymous community with a reputation for extensive sharing of nude images of young women. By carefully analyzing the data, we found that the forum’s users had an ongoing need to master their own female fixations, which they satisfied through the process of remote female fixation. In this process, forum users engaged in the following four interdependent strategies: continuous competition, loyalty-based inclusion, irregular rewarding, and tactical negotiation. By identifying the forum users’ shared concern, this theory may help explain the increasing presence of sexual abuse in digital environments. Key words: grounded theory methodology; networked community; non-consensual nude image sharing; digital sexual abuse; gameplay; patterns of behavior; digital media Introduction Young women continuously experience different types of systematic, sexualized violence and abuse in cyberspace. In a report on women’s rights and gender equality commissioned by the European Parliament (2018) it was shown that 20 percent of young women in the European Union have experienced hypersexual harassment. The Nordic Gender Equality Fund noted that the sharing of non-consensual nude images occurs frequently and is a gendered problem with serious consequences for the affected individuals (KUN, 2017). According to data on non-consensual pornography among adults in the United States, higher rates of victimization and lower rates of perpetration had been reported for women than for men, underlining the fact that nude image sharing is a gendered sexual problem (Ruvalcaba & Eaton, 2020). Our inspection was inspired by the presence of conflicting or opposing views and actions on sexual harassment in the public sphere. In 2016, people in many countries began speaking out against sexual harassment through the international #MeToo movement. In the media, the unified public condemnation of harassment and violence against women was absolute. At the same time, the Norwegian authorities uncovered a massive international, digital network of pedophiles for sharing illegal images and videos of children on the internet. The global debate also brought to light several online and semi-illegal platforms for the sharing of nude images. The public disapproval of such behavior increased, and there were no opposing voices in the Norwegian public discourse. The image sharers themselves remained invisible, causing much speculation as to who they were, what their motivations might have been, and what their practices were. The aim of our study, in which we investigated the actual image sharers and their practices, was thus to contribute new knowledge to society’s understanding of the people who share illicit images. Most research on digital criminal violations against women, both in the Norwegian and the international context, is focused on nude image sharing in relation to the victims and their experiences (Ruvabalca & Eaton, 2020), definitions of revenge porn (Stroud, 2014), or legal and educational aspects to do with crime prevention and the criminalization of non-consensual image sharing (Kinge, 2017; Krieger, 2017; Rønning, 2018; Skavlan & Viste 2018; Yar &Drew, 2019). However, only in a few inquiries the perpetrators’ motivations or actions had...

Pluralistic task shifting for a more timely cancer diagnosis: A grounded theory study from a primary care perspective...

Hans Thulesius, Ulrika Sandén, Davorina Petek, Robert Hoffman, Tuomas Koskela, Bernardino Oliva-Fanlo, Ana Luisa Neves, Senada Hajdarevic, Lars Harrysson, Berit Skjodeborg Toftegaard, Peter Vedsted, Michael Harris,The Örenäs Research Group, Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland [1] Key words: Cancer, diagnosis, primary care, grounded theory, screening, qualitative data  Abstract Objective: To explore how cancer could be diagnosed in a more timely way. Design: Classic grounded theory analysis of primary care physicians’ free text survey responses to: “How do you think the speed of diagnosis of cancer in primary care could be improved?” and secondary analysis of primary care physician interviews, survey responses, literature. Setting: Primary care in 20 European Örenäs Research Group countries. Subjects: Primary care physicians: 1352 survey respondents (2013-2016), 20 Spanish and 7 Swedish interviewees (2015-2019). Main outcome measures: Conceptual explanation of how to improve timeliness of cancer diagnosis. Results: Pluralistic task shifting is a grounded theory of a composite strategy. It includes task sharing – among nurses, physicians, nurse assistants, secretaries and patients – and changing tasks with cancer screening when appropriate or cancer fast-tracks to accelerate cancer case finding. A pluralistic dialogue culture of comprehensive collaboration and task redistribution is required for effective pluralistic task shifting. Pluralistic task shifting relies on cognitive task shifting, which includes learning more about slow analytic reasoning and fast automatic thinking initiated by pattern recognition; and digital task shifting, which by use of eHealth and telemedicine bridges time and place and improves power symmetry between patients, caregivers and clinicians. Financial task shifting thatinvolvescost trackingfollowed byreallocation of funds is necessary for the restructuring and retraining required for successful pluralistic task shifting. A timely diagnosis reduces expensive investigations and waiting times. Also, late-stage cancers are costlier to treat than early stage cancers. Timing is central to cancer diagnosis: not too early to avoid overdiagnosis, and never too late. Conclusions: We present pluralistic task shifting as a conceptual summary of strategies needed to optimise the timeliness of cancer diagnosis. Key Points Cancer diagnosis is under-researched in primary care, especially theoretically. Thus, we analysed and conceptualised the field using classic grounded theory: Pluralistic task shifting is a conceptual explanation of how the timeliness of cancer diagnosis could be improved, with data derived mostly from primary care physicians. This includes task sharing and changing tasks including screening and cancer fast-tracks to accelerate cancer case finding, and requires cognitive task shifting emphasising learning, and digital task shifting involving the use of eHealth and telemedicine. Financial task shifting with cost tracking and reallocation of funds is eventually necessary for successful pluralistic task shifting to happen. Introduction Diagnosing cancer is heterogeneous, in that it depends on disease type, age, gender, socioeconomic and geographical context, and type of healthcare system (1-3). Some cancers, such as breast cancer, colorectal cancer and prostate cancer, may be detected by screening in an early asymptomatic phase of the disease (4). However, the majority of cancers are discovered by case finding: symptoms and signs of the cancer are assessed through consultations with health care professionals (5) and most cancer patients are first seen by a primary care physician (1,2). Work-up of a cancer diagnosis often requires several different assessment methods, which may or may not include a physical examination (5). These are followed by technical procedures which include diagnostic imaging techniques and blood tests (2). A histological examination of body tissue or cells ultimately confirms the cancer diagnosis, except for some late-stage cancers, often in the elderly, which may only be discovered by diagnostic imaging or at autopsy (6). Many countries have introduced fast-track systems for detecting cancer that...

De-shaming for believability: A Grounded Theory of physicians’ communication with patients about adherence to HIV medication in San Francisco and Copenhagen...

Toke S. Barfod, MD PhD [1] Abstract To be “adherent” to a medication means to take the medicine as agreed upon. Poor adherence is the main barrier to the effectiveness of HIV medication. Communication between patient and physicians is a major factor in adherence. We found that this communication is very often awkward and superficial, if not completely lacking. According to the proposed theory, it is a core determinant of adherence communication whether or not physicians use a “de-shaming” communication strategy. When physicians do not, they receive answers with low believability, and may even abstain from exploring the possibility of non-adherence. Furthermore, physicians have difficulty in handling low believability of patient statements, and their more or less beneficial strategies may have negative consequences for the relation between patient and physician, and for the patient’s adherence. The here proposed theory “de-shaming for believability” suggests that communication with patients about adherence can be understood as four steps governed mainly by three factors. The four steps are: deciding whether to ask about adherence or not, pre-questioning preparations, phrasing the question, and responding to the patient’s answer. The three factors/determinants are: the communicator’s perceptions of adherence, awkwardness, and believability. Introduction Background: HIV Treatment and Adherence           When patients take their medication as agreed upon, they are said to “have good adherence” (Osterberg & Blaschke, 2005). However, patients often have poor adherence (Osterberg & Blaschke, 2005), and especially in HIV treatment, it is one of the main causes of treatment failure (Osterberg & Blaschke, 2005; Wood, et. al, 2004; Dybul et.al., 2002). HIV treatment requires good adherence in order to maintain maximum treatment efficacy and avoid that the HIV virus mutates and becomes resistant to treatment (Osterberg & Blaschke, 2005; Wood, et. al, 2004; Dybul et.al., 2002). Still, around one fourth of patients have poor adherence to HAART (Wood et. al.,  2004; Barfod et.al., 2005). Several factors are related to poor adherence, especially patient-related factors such as depression, abuse, and weak social support, but also regimen complexity, patient’s lack of trust in the treatment, and poor patient-physician relations (Barfod et.al., 2005; Fogarty et. al., 2002). When looking at physician factors, we find that experienced physicians achieve better patient adherence (Delgado et.al., 2003), and that trusting patient-physician relations (Heckman et.al., 2004; Mostashari et. al., 1998) and open communication (Schneider et. al., 2004) are associated with better adherence to HAART. In interviews, patients also stress that communication with physicians is important in maintaining adherence to HAART (Roberts, 2002) as well as other diseases (Osterberg & Blaschke, 2005; Cox et. al., 2004). Accordingly, guidelines for treating patients with HAART recommend that adherence be addressed at all follow-up visits to prevent treatment failure (Dybul et.al., 2002; Poppa et. al., 2004). The majority of physicians dealing with HIV also report that they do so (Roberts & Volberding, 1999; Gerbert et.al., 2000; Roberts, 2000; Golin et.al., 2004).           Physicians’ communication with patients about adherence to HAART can, however, be problematic. In descriptive questionnaire and interview studies physicians have identified lack of time and resources, as well as their own lack of training as the main barriers to their communication with HIV-positive patients about adherence (Gerbert et.al., 2000; Roberts, 2000; Golin et.al., 2004). Furthermore, a recent systematic review has concluded that two-way discussions and partnership in treatment decisions regarding medicine-taking in general most likely seldom take place(Cox et. al., 2004). To our knowledge, no observational study exploring physicians’ communication with patients about adherence to HAART has been done and no analytical...

Surviving Situational Suffering: A classic grounded theory study of post-secondary part-time educators in the United States...

Barry Chametzky Abstract Administrators at post-secondary institutions in the United States hire contingent faculty members to teach a great many classes.  It is therefore valuable to understand what the issues are for these on-demand, non-tenured faculty members.  The theory of surviving situational suffering explains how part-time adjunct educators in the United States resolve their main concern—maintaining employment—within a context of reduced appreciation, underutilization, and ingratitude.  Just as with various historical events now considered discriminatory, the theory explores a form of bias and intolerance in higher education that needs to be openly discussed and addressed.  The theory consists of three broad categories: (a) limiting, (b) balancing conflict, and (c) falling short.  Though the substantive area is post-secondary educational institutions, the ideas presented in this paper are easily generalizable to other areas in life whenever someone is trying to survive situational anxieties. Introduction As an on-demand faculty member at a post-secondary school, I knew that when I started this research, the topic would hit close to home.  I also realized that I had preconceptions and feelings stemming from my educational experiences as a part-time adjunct educator.  Yet, by being true to the tenets of classic grounded theory, I treated those positive and negative feelings as additional elements of data (Glaser, 2007).           Numerous reasons exist to explain why some people choose to work as contingent adjunct educators.  For some people, being an adjunct is convenient, as they need to be able to deal easily with family or personal issues.  Because of this flexibility, the idea to keeping a professional foothold in education has value and appeal.  Other instructors, including this researcher, enjoy bonding with learners inside and outside of the class environment and feel that they are making an impact.  Still other people feel that teaching is more than a job; it is a calling.  For many people, being an educator is a privilege of which the students are the most important part.  There exists nothing higher than to be able to influence the course learners and how they perceive the subject.           While these worthwhile reasons are noble, a darker side exists to being a part-time adjunct educator.  The purpose of this classic grounded theory study is to examine what it is like being an on-demand instructor at post-secondary U.S. schools.  According to one participant, this research is “a conversation that needs to be had.” Data Gathering and Analysis In order to “instill a spill” (Glaser, 2009, p. 22), I conducted interviews with 11 participants (three male, eight female) and asked the following grand tour question (Spradley, 1979): What is it like being an on-demand adjunct in the US?  Through the iterative classic grounded theory process of coding, memoing, sorting, conceptualization, and constant comparison (Glaser, 1965), and with suspended preconception (to the extent possible [Simmons, 2011]), I discovered the theory of surviving situational suffering; it explains how contingent educators resolve their main concern—maintaining employment—within a context of reduced appreciation, underutilization, and ingratitude.           No theory exists in isolation.  It was important, therefore, to situate it within the context of extant literature.  As such, when I explained the theory, I was able to use extant literature to support its key elements. The Theory of Surviving Situational Suffering The theory of surviving situational suffering consists of three categories: limiting, balancing conflict, and falling short.  Because of the continual cause-effect and conditional relationship that exists in the theory, the categories have a strong interdependency that permits people to move from the beginning to...