This section details the research methods used in analysis of the data. Grounded theory is not a linear process. Rather, the approach is concurrent, iterative and integrative as data collection, analysis and conceptual theorising occur
simultaneously and from the beginning of the research process. This process
continues throughout until the theory is developed. In the current study, through data collection and analysis, theoretical possibilities within the data emerged. Some of
Page | 126 this process is difficult to document in a form that fully captures its complexity and the abstract nature of parts of the work. This section on analysis of the data provides a written account of this part of the research journey.
Data, according to Charmaz (2000), are narrative reconstructions of experience, they are not the original experience itself (p514). The different sources of data used were interviews with children; their drawing and associated writings; my own
observations documented in memos; and as is consistent with grounded theory, relevant literature, including reports, records and reflections. Analysis of the data began with coding.
Coding of data was undertaken according to the processes described by Charmaz (2006). The process of coding had two phases – initial and focused coding. Although Charmaz does not provide a detailed explanation of the steps between the major phases of coding and analysis (Chen and Boore 2009, p7), the following sections outline the processes that were used in the research. Developing concepts and theoretical frameworks had several phases:
1. Creating and refining the research and data collection questions; 2. Data collection and initial coding;
3. Initial memos raising codes to tentative categories; 4. Further data collection and focused coding;
5. Advanced memos refining conceptual categories – adopting certain categories as theoretical concepts;
6. Sorting memos;
7. Integrating memos and diagramming concepts; and 8. Writing the first draft.
Figure 6 presents the analytic process used in the study, based on Charmaz (2006, p11).
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Writing the first draft
Integrating memos diagramming concepts
Sorting memos
Theoretical sampling seek specific new data
Data collection ---Focused coding
Initial memos raising codes to tentative categories Initial coding data collection Research problem and opening
research questions Further theoretical sampling if needed Adopting certain categories as theoretical concepts Theoretical memo- writing and further refining of concepts Sensitizing concepts and general disciplinary perspectives Re examination of earlier data Advanced memos refining conceptual categories
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Initial coding
Coding of the emerging data was undertaken as it was collected, and this allowed me to start to define and categorise the data. An early course of action in studying the emerging data involved line-by-line coding. This form of coding required examining each of the transcripts from the participant interviews, as well as their stories, line- by-line. This form of coding prompted close study of the data – line-by-line – and the beginning conceptualisation of ideas (Charmaz 2006, p11) (Appendix 5 is an
example of line-by-line coding of an excerpt from one interview). The initial coding assisted in analysis of the data from the ground up, based on the participants actions and statements, and reduced the likelihood of superimposing my own preconceived notions on the data (Charmaz 2006, p51).
Often the children’s own words (in vivo coding) or gerunds (words ending in ing that reflect process rather than topic) were used as codes. This was in order to convey a sense of action and imagery as well as to stay close to the data, and therefore the meanings the children were conveying. Starting with the words and actions of the children helped to preserve the fluidity and provided a way of looking at their experience, from their perspective. Appendix 6 is an example of texts across interviews for the code ‘being scared’.
If the participant’s meanings and actions are glossed over, the grounded theory is more likely to reflect an outsider’s view, rather than an insider’s view. In addition, there is a risk of importing an alien professional language to describe the
phenomenon (Charmaz 2006, p49). The codes used in the analysis of the data were close to the data, as they came from the data and they give an indication of the children’s own perspective, using the language of the children. Further, it was also evident that in vivo codes from within the data provided symbolic markers of the children’s own language and meanings.
One example of this form of coding, that is both in vivo coding and a gerund is provided. When asked what he thought when first told he would need an operation, one boy said he didn’t really like the idea, but it sounded exciting (Boy, 6yrs). It sounded exciting was an initial in vivo code that was used to indicate one of the positive feelings children described around their hospitalisation and surgery,
Page | 129 that is also in the form of a gerund. This code describes the fear children expressed that being in hospital would mean that they were left alone, and that they would be away from their parents. Hurting was another initial code and expressing this concept as a gerund preserves the sense of action that is a part of the children’s experience of pain. Replacing the gerund ‘hurting’ with a noun like ‘hurt’ or ‘pain’ for this code risked reducing this important notion to a mere topic, and therefore losing the sense of action and process inherent within it (Charmaz 2006, p49).
Focused coding
Focused coding was the next major step in the coding process, and focused coding is more directed, selective and conceptual than the initial coding process. Focused coding was used to synthesise and explain larger segments of data and required using the most significant or frequent earlier codes to sift through this data (Charmaz 2006, p57). When undertaking focused coding, I moved across interviews, drawings, stories and observations and compared the children’s experiences, actions and their interpretations of what was happening. So in relation to the code ‘hurting’ for
example, I looked at all the sources of data to see how each child talked about pain. I compared what each said about the experience and this helped me to refine the code of ‘hurting’. I was led to look at the causes of their hurting; the effect of their
hurting; the ways the children actively responded to experiencing pain; the strategies they used; and the supportive strategies they drew on. I went on to develop the initial code ‘hurting’ as a category.
A category is a theme or variable that aims to make sense of what the participant has said. It is interpreted in the light of the situation, and other interviews, and the emerging theory. Categories explicate ideas, events, or processes in the data
(Charmaz 2006, p91). The early categories were considered provisional because, in keeping with the grounded theory method, it was important to remain open to further analytic possibilities. Ongoing comparative analysis and conceptualisation resulted in some changes in the initial coding. So that an early code ‘being in hospital’ was further developed to ‘sense of place’ part of the category ‘locating their selves’. This was in recognition that part of the process of making sense of the experience of hospitalisation for surgery required the children to make sense of the place they were in.
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Constant comparative analysis
Grounded theory utilises constant comparative analysis to establish analytic distinctions and to determine if the data supports and continues to support the categories that are emerging (Holton 2007, p277). The constant comparison method required that I continually return to the data, and the words of the children, using previous data and analysis to influence future collection and analysis. The process of constant comparison involved comparing incidents to other incidents to establish uniformities and varying conditions that could be identified. It also involved comparing emerging concepts to more incidents for the purpose of ‘theoretical elaboration, saturation and densification of concepts’ as well as the comparison of emergent concepts with each other (Holton 2007, p278). Associated with this process was memo writing, and I wrote a number of memos about my interpretations and analysis throughout the process (Memo writing is discussed in more detail below).
Analysis of the data showed that children often talked about their need for their parents to be with them throughout their hospital stay. One child said one of the most important things for her in hospital was that
Mum and dad had to stay with me, that one of them had to stay with me (Girl, 8yrs).
Whilst this was a common idea expressed by a number of the children, analysis and comparison of the data revealed another view that was expressed by other children. The parents of some children did not spend all day and all night in hospital with them, but one of their parents was noted to be present at crucial times of the
children’s admission, such as their induction of anaesthetic. According to all of the children, it was most important for a parent to be with them at such times. So the need for parents to be in constant attendance turned out to be one view of the
children. Another view was that the children’s parents needed to be present at crucial periods during the hospitalisation.
The coding process made me think about the data in new ways. Some of my own taken for granted, hidden assumptions were challenged, and I was made to look at what was (seemingly) familiar in a new light. One example of this was the children’s
Page | 131 acceptance of the need for their surgery to make them better. When I asked in an early interview how the child felt when he woke from his anaesthetic he told me he felt better (Boy, 6yrs). When I clarified (for myself) what he meant by this, he meant that his surgery for acute appendicitis made him feel better. What I was expecting to hear was something quite different, perhaps that he was in pain or felt unwell on waking. These things were indeed described by this child, as well as by others, but the notion of the surgery making the children better was something I had not expected to hear from them. This notion came to be recognised as an aspect of the children’s resilience and coping strategies in the theorising of the data.
Memo writing
Through memo writing, my thoughts about what I was seeing in the data, the similarities and the differences were captured and explored. Memo writing is a pivotal step in grounded theory between data collection and writing drafts and is where researchers stop and analyse their ideas about their codes and emerging categories. Potential categories are established, and the codes they subsume are identified through the activity. I found that the sorting of memos helped in the generation of the theoretical outline or conceptual framework for the work. The process assisted in looking for similarities and connections within the data, where to locate codes and categories, and in the resultant theoretical higher order
conceptualisations. Ideas and insights were developed and, as Charmaz (2006) states, memo writing forced me to stop and engage different categories – my memos formed a place for exploration and discovery around the ideas I had about what I had ‘seen, sensed, heard and coded’ (p82).
Achieving saturation or theoretical sufficiency
The notion of saturation in grounded theory is that data collection stops when saturation occurs: Saturation has been defined as ‘data adequacy’ that involves collection of data until no new information is obtained (Morse 1995, p147). Charmaz (2006) states that saturation is when new data no longer trigger new theoretical insights, and new properties of core theoretical categories are no longer revealed (p113).
However, saturation does not simply mean the repetition of the same events or stories. The frequency of reportings in the data is not of major importance. Important
Page | 132 to the process of analysis of data, however, is that all data is given equal attention: ‘eliciting all forms or types of occurrences, valuing variation over quantity’ (Morse 1995, p147). Richness of data comes from detailed description and does not depend on the frequency something is stated. It may, in fact, be the infrequently occurring ‘gem’ that provides perspective and becomes a central key to understanding and development of a theory explaining the phenomenon. There are few guidelines or tests of adequacy for determining the sample size or the amount of data required to achieve saturation (Morse 1995, p147). And according to Charmaz (2006), the notion of saturation of categories supersedes that of sample size, and sample sizes for some studies may be quite small, yet still achieve the requirements for a project (p114). A grounded theory study needs to be representative, but researchers are advised that it is unnecessary and even defeating to collect huge amounts of data. The risk is that large files go unanalysed, or the researcher becomes overwhelmed by the sheer volume of data and loses sight of the fundamental processes within the area of study (Stern 2007, p117).
The notion of saturation and whether saturation is at all achievable has been
challenged and the term ‘theoretical sufficiency’ has been used instead to indicate the adequacy of data and fullness of coding (Dey 2007, 2003, Charmaz 2006, p114). The reasons for this position are that categories are in reality produced through partial rather than exhaustive coding, and because coding is not achieved for all data. It is argued that the term ‘saturation’ is imprecise in grounded theory studies and that categories are suggested by the data, rather than saturated by the data. Saturation may in effect be an artefact of the way researchers focus and manage data collection, and the resulting legitimacy of claims about saturation can be questioned (Charmaz 2006, p114).
Data collection for the study continued until no new theoretical insights were
achieved. In recognition of the concerns about the notion of saturation, the adequacy of this sample size and associated data will be determined by the thoroughness of the data as well as the rigour of the analysis. The aim of this study is to achieve the theoretical sufficiency Dey and Charmaz call for.
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Theoretical sampling
Theoretical sampling is all about the concepts and categories you are developing and the testing you do of them (Charmaz in Puddephatt 2006, p15).
Theoretical sampling means seeking and collecting data that elaborates and refines categories in an emerging grounded theory. ‘Theoretical sampling involves starting with data, and then examining these ideas through further empirical enquiry’ (Charmaz 2006, p102). When questions arise from the data and when gaps are identified, the researcher seeks to answer the questions and close the gaps. This can be achieved through returning to individual research participants, or by seeking this information from other research participants. This process of theoretical sampling achieves increased understanding and strengthens the analytic categories.
Theoretical sampling differs from initial sampling and purposeful sampling. In initial sampling, criteria for people, cases or situations are established prior to entering the field - it is where the researcher begins. Purposeful sampling seeks a representative sample based on, for example, quotas or demographics. However, theoretical
sampling relates to conceptual and theoretical development – it directs the researcher where to go, based on the theoretical analysis (Charmaz 2006, p96). Theoretical sampling is where statements, events or cases are sought to illuminate categories so as to fill the properties of the categories, as well as to assist in determining how processes develop and change.
In this study, theoretical sampling was undertaken, but as has been found in other grounded theory studies with children (Coyne 2005), this part of the process was not straight forward. Careful consideration was required to determine how this crucial component of a grounded theory study was to be achieved. The research plan included the provision for interviewing individual children on more than one
occasion. Initially, the main reason for this was to enable me to follow the children’s experiences of hospitalisation and surgery over time. However, the ability to conduct follow-up interviews with key ‘informants’ (Charmaz 2006, p111) also provided the important opportunity to follow-up major ideas and thus allow for theoretical
sampling. The provision for possible subsequent interviews and observations to allow for theoretical sampling and address conceptual issues is a strategy identified by Charmaz (2006, p111). Theoretical sampling was used in order to refine
Page | 134 categories that were emerging, and to develop their properties. For example, early on in the data analysis, I identified a category that related to the children’s interactions with nurses. In analysis of the first interview, the child referred to his interactions with nurses on different occasions. In a couple of instances, he talked about them in a rather remote fashion, and he mistook the hospital clowns as nurses dressed up. I wondered what his interactions with nurses meant for him as well as for other children. Theoretical memos helped me to explore and refine this idea. Theoretical sampling required me to check my ideas against direct empirical realities, moving back and forth between the category and the data (Charmaz 2006, p110). In my subsequent interviews with children, including the follow-up interview with this child, I questioned directly around this aspect of the children’s experience.
Theoretical sorting
Sorting, diagramming (through the use of Rich Picture Diagrams – described
previously) and integration of memos were inter-related processes that were required strategies in the theoretical development of the analysis. The sorting of analytic memos served the emerging theory and provided the means for creating and refining theoretical links. Sorting assisted in the theoretical integration of categories and prompted the comparison of categories at an abstract level (Charmaz 2006, p115). The sorting, comparing and integration of memos was complicated by the fact that more than one process was identified and several categories were present - so the process was not ‘clear-cut’ (Charmaz 2006, p117). I was required to try several different sortings and the suggested process by Charmaz (2006) assisted this work:
• Sort memos by the title of each category • Compare categories
• Use the categories carefully
• Consider how their order reflects the studied experience • Think how their order fits the logic of the categories
• Create the best possible balance between the studied experience, the categories and the theoretical statements about them (p117).
The practical activity included experimenting with several different arrangements of memos using cards with the title of the different categories and using the Rich Pictures to visualise relationships between different concepts and categories.
Page | 135 Because there were several categories, the process of sorting and diagramming