Data Analysis: Generating the Theory

The procedures followed for data gathering and analysis in this study followed guidelines established for conducting a CGT study, which included selective and theoretical sampling. Selective sampling meant engaging with service users who had experienced acute psychosis and had communications with nurses, and nurses who had communication with service users, in order to ascertain their first-hand accounts. This was considered appropriate in order to gain some understandings of communication patterns between them.

Data analysis commenced immediately after the first interview. As already mentioned, interviews were tape recorded, verbatim transcripts were made by the researcher of all interviews and any personal identifiers removed. At this stage of the analysis a concurrent process of reading and analysing occurred which allowed the researcher to recall non-verbal nuances that could impact on the possible meaning of a statement, hence reducing possible misinterpretations.

4.5.1 Open Coding

Open coding was the first stage of the analysis, which according to Charmaz (2006), is the process of defining what the data is about. It was conducted in the first four interviews and provided “a point of departure” (Charmaz 2006, p.100). Here coding of the data occurred and questions were asked of the data where indicators for a tentative main concern and a core category were sought through data coding, conceptualisation and the comparative method (Holton 2007; Glaser 1998, 1978). When coding, action verbs (gerunds) were used, which helped the researcher to detect processes that stay close to the data. It assisted in getting a strong sense of action and progression relating to the studied area (Charmaz 2006). It also helped the researcher to move from description to conceptualisation.

Upon commencing open coding, Glaser’s (1998) advice about reading the transcripts line by line and coding was followed. However, despite the above guidelines, this researcher found the process of open coding in the early stages quite confusing and frustrating, as it resulted in over 180 codes with an accompanying desire to put some order on them by naming some of the categories with codes with professionally laden concepts. This researcher was worried that something important would be missed. It occurred as the term ‘line by line’ coding was

literally interpreted, rather than coding incidents. Here, the ‘incident’ is the unit of analysis – it is not the people, it focuses on people’s behaviour and picks up patterns. I had doubted Glaser’s (1998) assertion that if an issue was significant in terms of theory, it would reappear at a later point.

In addition, putting the researcher’s own preconceived ideas or biases on codes ran the risk of what Barney Glaser referred to as, ‘forcing the data’, rather than remaining open to naming the codes that relate to participants’ data, unless the researcher’s preconceived ideas are relevant and codes have “emergent fit” (Glaser 1998, p.81). For example, the ‘in vivo’ code digging too deep is an incident which gives a sense of a worry nurses experience regarding the possibility of making things worse for the service users when communicating with them that was relevant and had emergent fit. The process entailed putting trust in the method through repeatedly asking myself: What is this a study of? What categories does this incident indicate? What property of what category does this incident indicate? (Glaser 1998, p. 123). As well as coding for incidents, using the constant comparison method, theoretical sampling and memoing helped to get through this confusion and frustration (see examples of open coding in Appendix D (p.237). In addition, heeding Holton’s (2007) advice of being patient, staying with the process while striving for higher levels of concepts in the naming of codes also helped. See Appendix E1 (p.241) and E2 (p.247) for examples of how initial open coding was raised to higher level concepts.

4.5.2Process of Identifying the Main Concern

According to Glaser (2005), if a researcher does not conceptualise participants’ main concerns it become difficult to discover the core category. As the study proceeded, a main concern began to emerge through constant comparison, selective sampling and writing memos which established the processes participants used to resolve their main concern.

The identification of the participants’ main concern was somewhat complex as there were two distinct groups included in the study. The issue was to get a main concern that encompassed both groups because at times what seemed like a main concern only applied to one group. For example, at one point it appeared that the main concern was centred on the psychosocial process of being silenced; in relation to what could and could not be said in conversation. However, this proposed main concern did not pattern out as it mainly applied to service users. Later, possible main concern that spanned all groups was identified as, avoiding possible dire consequences when conversing with each other, but it also did not

seem to fit. However, it was though using the process of CGT which includes asking ‘what is the participants’ main concern?’ and ‘how do they resolve their concern?’ of myself that this researcher was able to conceptualised the main concern that had a fit for both groups.

4.5.3The Process of Identifying the Core Category

As the study preceded a core category began to emerge through constant comparison and selective sampling of the processes participants used to resolve their main concern (Glaser 2003). The core category (sometimes referred to as the core variable) can be any theoretical code and appears to explain how the main concern of the participants is constantly processed or resolved. It is the highest conceptual level and relates to all other concepts. It becomes the focus of further selective data collection and coding. Interviewees were invited to share issues that seemed important to them in relation to communications between service users and nurses. Theoretical sampling involved one-to-one interviews and facilitated more in-depth processes that give rise to the core category. According to Glaser (1998, p.115), “understanding and accounting for these actions from the perspective of the participants in the substantive area under study”, is what defines grounded theory.

Therefore, the core category’s main function is to integrate the theory by making it dense and saturated. Although the above might appear a straight forward process, identifying the core category was also not a straight forward process as frequently people are not aware of their latent patterns of behaviour and it takes time for their concerns and the core category to emerge, hence, it took a period of time for it to be identified. It emerged as a result of adhering to the constant comparative method: theoretical sampling, memo writing, using mind maps, sorting and preconscious processing. This was followed by trying to pattern it out. Some tentative core categories were ‘walking the line of permissible talk’, ‘negotiating permissibility’ and ‘guarded openness’. It was only after interviewing ten participants that the core category that involved guardedness met with CGT’s criteria of constantly recurring in the data, has the most explanatory power, and integrates all other categories. See Appendix F 1 (p.257), 2 (p.259) and 3 (p.262) regarding theoretical memos relating to the development of the core category.

Identifying gaps in the developing theory also led to interviewing different cohorts of service users and nurses about emergent issues of concern and their resolution, such as a gender, and context (community and in-patient). To elaborate the above examples, a service user participant identified finding it easier to talk with female nurses than male nurses. However,

theoretical sampling on this issue did not result in a category, as other participants did not consider the nurse’s gender an issue when choosing a nurse to talk to. The second example refers to the context in which the conversations occurred. Some nurse participants had reported that they viewed the service user differently once they had met in his/her own home, as this influenced their conversations. As a consequence, data around different aspects of the context of conversations between the two groups were explored. As already outlined, this data was then coded and saturated by looking for comparison groups. In addition, some biographical texts of people who experienced psychosis were also used as part of the theoretical sampling process. Relevant parts were identified and integrated using CGT procedures.

4.5.4Theoretical Saturation

Theoretical saturation occurs when no additional data is found to further develop properties of a category (Glaser and Strauss 1967). The researcher stopped data collection after the sixteenth interview, as few changes were made since the fourteenth interview. However, the researcher was cognisant that maybe if he continued, more interviews might yield a new property of a concept, but it appeared that those concepts that were developed had reached saturation point so a decision was made to cease date collection.

4.5.5 Theoretical Memos

Throughout the research, memos were written. Memos are memorandums of what the researcher thinks about the coded data that seemed to cluster together (Stern, 2007). They are the essential step between the collections of data and writing drafts of the theory, as they help to analyse the data and codes from the beginning of the process, in that they capture and keep track of the emergent theory.

Memos were initially hand written with a sense of ‘free writing’; writing quickly with an emphasis of putting ideas into paper, rather than adhering to any formal writing style or grammar. These memos were later transcribed to computer files and expanded on. At the outset, I transcribed the interviews in one column, coded the data in an adjacent column and wrote brief memos as a footnote note at the bottom of the page (see an example in Appendix D (p.237)). Putting my thoughts on paper helped as it made the data more manageable: gave a space for articulating comparisons between: indicators and indicators; indicators and codes; codes and other codes; and codes and categories. It also helped to develop my analytic ideas, and indicated where I should go next to gather the next tranche of data, such as, theoretical

questions that needed exploration, and process decisions. I also carried a note book that recorded my ideas about the particular parts of the study that I happened to be involved in. Glaser (1998, p.178) calls this “preconscious processing”; ideas that occur seemingly at random but are as a result of one’s mind continually processing the data. These reflections/ideas were later expanded on or added to an existing memo. The process of memoing also helped manage my own biases creeping into the analysis without any obvious fit, as writing memos while constantly comparing, articulated what had emerged, fitted and relevant. For example, at one point I thought a category was ‘losing voice’, which referred to how participants felt silenced by the mental health service customs and practices. However, in the process of writing a memo on the above issue it became obvious that this did not fit, in addition to it not patterning out.

It is also important to note that participant service users’ and nurses’ quotes will be used in Chapters 5, 6 and 7 in order to illustrate the theory emerging from the data, so as to enhance its readability, and to offer the reader a way to access the depth of feelings about certain issues.