MAJOR ELEMENTS

MINOR ELEMENTS Ontology Subtle realism Social interactionism Social constructionism Epistemology Interpretivism Realist evaluation Methodology Grounded theory Longitudinal qualitative research (QLR) Methods Serial interviews Diaries Observations

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Grounded theory

Grounded theory was first developed in 1967 as a rigorous methodology for use in developing theory that is grounded in data systematically gathered and analysed (Glaser & Strauss, 1967). What differentiates grounded theory from other

interpretive approaches is that it goes beyond induction to making conjectures and hypotheses and then checking them, so that the researcher engages in deductive reasoning as the inquiry proceeds. Concepts and theories are derived from the stories constructed by participants to explain and make sense of their lives (Corbin & Strauss, 2008). The ‘groundedness’ of this approach results from a commitment to analyse what has been observed in the field or in the data and remaining open to unanticipated directions, rather than being limited to preconceived hypotheses (Charmaz, 1990). This involves following interests, leads and hunches found in the data throughout the research and writing processes. There is also an ongoing search for evidence that disconfirms the emerging theory in an attempt to enhance its validity in accounting for the research phenomenon or situation. In the present study, it rapidly became clear that a narrow focus on behaviour change would not result in the development of a theory that accounted for the main concerns of the participants. This demonstrates one of the main features of grounded theory – resulting from its theoretical basis in social interactionism – which is that the researcher must remain open and sensitive to the main concern or problem for people in the study setting (Baker, Wuest & Noerager-Stern, 1992; Becker, 1993).

The original grounded theory methodology sought to combine the precision of statistical methods with the more fluid theory-generating style of the Chicago school of sociology (Baker, Wuest & Noerager-Stern, 1992). Positivism was the prevailing paradigm of that time and so the method had to be couched in language that could easily be understood and that was acceptable to quantitative methodologists (Coyne, 1997). However, this led to criticisms regarding the use of terminology that is often alien to other disciplines. Furthermore, Glaser and Strauss’ earliest works have both phenomenological and positivistic emphases and therefore sometimes seem confusing and inconsistent. They lean towards assuming that the theoretical categories derive from the data and that the researcher remains passive, coming close to positing an external reality (Charmaz, 1990). Strauss’ more recent explication of grounded theory reveals an actively involved researcher who

constructs categories and concepts, and acknowledges the multiple standpoints and realities of both researchers and participants. This approach was considered

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interactions, exchanges and choices of people in the social context in which they occur. It also involves the provision of clear guidance on how to structure the data via a well-defined coding paradigm (Robson, 2002; Corbin & Strauss, 2008). Table 5 summarises key differences between Glaser’s version of grounded theory and the Corbin and Strauss version employed in this study (Cooney, 2010).

Table 5: A comparison of the main approaches to grounded theory

Key Features Glaser Strauss and Corbin

Ontology and epistemology

Realist: assumes the

existence of an objective and external reality

Follows positivism

Relativist: multiple realities exist and are interpreted rather than fully known

Post-positivist, then constructivist

Researcher role Independent, neutral

observer who discovers data

Researcher and participant co- construct the data and

resulting theory

Literature review

Postponed until fieldwork is completed and used to support the emerging theory

Preliminary review enhances theoretical sensitivity

Later reviews support emerging theory

Research question

Emerges over the course of the study

Derived from early literature searches, prior experience, etc, and modified during the study

Data analysis Vague description of substantive and theoretical coding processes

Largely inductive and unstructured

Clearly described process, with an emphasis on deduction and validation

Criticised as being programmatic and over- formulaic

Outcomes A grounded theory

Failure to produce a theory is contrary to the goals of the methodology

A grounded theory

Some studies will use the techniques associated with the methodology to produce thick descriptions

My rationale for the place of the literature review in this research was set out in Chapter 3. It would not have been appropriate to ignore the existing literature, nor would it have been appropriate for me to remain passive and independent, rather than being actively involved in constructing categories and concepts during the study. The social constructionist perspective put forward by Charmaz (1990; 2003) views the process of categorisation as dialectical and active; the interaction

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between the researcher and participants, and subsequent interaction between researcher and data, results in ‘discovering’ the key concepts. Whereas objectivist grounded theory views the data as ‘real’ in and of themselves, constructivists view data analysis as a construction that locates the data in time, place, culture and context. This fits with the aim and theoretical basis of the present study, in terms of attempting to explore the experiences of people making health-related behaviour changes within the context of their everyday lives. It also builds upon a symbolic interactionist perspective in being based on the following assumptions: a) multiple realities exist; b) data reflect the researcher’s and the participant’s mutual

constructions; and c) the researcher enters and is affected by participants’ worlds (Charmaz, 2003). By selecting this approach, I set out to produce a theory that was relevant and able to guide action and practice.

Longitudinal qualitative research

Grounded theory researchers should return to the field continually in order to test the relevance of their ideas and achieve more nuanced understandings of the social processes in action (Glaser & Strauss, 1967; Charmaz, 2003). Sequential interviews were used in this study to explore the dynamic process of receiving support from a health trainer and attempting to make and maintain lifestyle changes. One of the specific strengths of repeated interviews is the accumulation of responses that can be read and compared against each other, so that a picture is built up of beliefs and orientations across different times, moods and situations. This approach, referred to as longitudinal qualitative research (QLR), involves recursive, comparative

movement between past, present and future to give insight into the histories, orientations and aspirations of individuals (McLeod, 2003; Saldana, 2003). The distinguishing feature of QLR is the way in which temporality is designed into the research process, making change a central focus of analytic attention (Thomson, Plumridge & Holland, 2003). Longitudinal designs focus on the interaction of

institutional and social contexts and the conditions these create, as well as personal biographies (McLeod, 2003). The use of QLR in this study – under the umbrella of grounded theory – has enabled prospective and retrospective understandings of health and lifestyle, as well as providing an opportunity to compare and move between the two. This approach is highly relevant in the current context in which individual behaviour change is seen as key to achieving policy goals (Thomson, Plumridge & Holland, 2003; Corden & Millar, 2007a). Following people over time provides an opportunity to explore how and why they make choices that add up to

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trajectories of individual life histories and, more specifically, to understand the ways in which they respond to and use particular services (Corden & Millar, 2007b).

All QLR studies involve data collection at more than one point in time, although the overall duration of the research can differ widely. A long-term approach is often required to investigate life course transitions, whereas short-term studies might involve intensive tracking through an organisational process (Holland, Thomson & Henderson, 2006). Given the duration of the doctoral project, a pragmatic approach was taken in the selection of a 12-month follow-up period for this study. It is

recognised that windows of observation are rarely sufficient to pick up all relevant change and that knowledge about prior history is generally needed to contextualise particular changes (Corden & Millar, 2007a). Asking prospective and retrospective questions over time means that a body of evidence from different perspectives is accumulated, and that responses can be read, checked and compared against each other (McLeod, 2003). The purpose is not to check for accuracy; instead, putting individual stories ‘in conversation’ with one another provides an opportunity to explore any gaps between the things people say and do. Asking participants to apply hindsight to their narratives is one of the tools of QLR and can produce

important insights (Corden & Millar, 2007a). Returning to the field also contributes to the theoretical sampling process, which is a fundamental aspect of grounded theory research. This involves obtaining additional data to make the emerging theoretical categories more precise, explanatory and predictive (Charmaz, 2003). However, the possibility for changing interpretations over time can present a challenge to drawing clear conclusions from study findings. Other challenges associated with longitudinal approaches include sample attrition, maintaining informed consent and

confidentiality, and the risk of conditioned responses or other effects associated with the extended research relationship. These are discussed in detail in Chapter 5.

An argument for pluralism

Figure 10 demonstrates the hierarchical relationship between grounded theory and QLR in this study, as well as the various other elements of the research design. It is possible that adopting a pluralistic approach might render the study vulnerable to accusations of ‘method slurring’ (Baker, Wuest & Noerager-Stern, 1992). One of the strongest arguments for sticking to a particular methodology is to avoid the

possibility of competing explanations for phenomena. However, this argument arises from the misconception that conformity with well-known analytic techniques and methods automatically guarantees rigour (Johnson, Long & White, 2001). By

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ignoring their instincts and focusing too closely on published procedures, the researcher may find themselves in a situation with “the technical tail beginning to wag the theoretical dog” (Melia, 1996, p.376). Hammersley and Atkinson (1995, p.6) called for a more flexible and naturalistic approach, suggesting that “A first

requirement of social research... is fidelity to the phenomena under study, not to any set of particular methodological principles”. This provides support for pragmatic pluralism, which is entirely consistent with my own view of research methodologies as complementary strategies to help the researcher come to grips with a complex social world and the data which might emerge from its study. An eclectic research design drawing on methods from a range of qualitative approaches could potentially have broader relevance to wider socio-political issues (Johnson, Long & White, 2001). It has also been suggested that more applied and pragmatic approaches might enhance both the theoretical and practical relevance of research findings, and thereby have greater potential to advance public health science. At the same time, the consistent use of grounded theory throughout the research process described in this thesis ensures that the study findings remain grounded in the data.

Chapter summary

In this chapter, key philosophical debates around health and social research have been explored and conclusions drawn regarding the most appropriate approach for this study. There is considerable support for pragmatic and interpretive approaches to studying complex public health problems. The research aim of seeking an understanding of the processes involved in making health-related behaviour changes required an approach capable of capturing the meaning of these experiences for the participants. Hence, a qualitative interpretive approach was chosen. Corbin and Strauss’s (2008) take on grounded theory is presented as the over-arching methodology, with the use of a longitudinal study design. Grounded theory is particularly well suited to exploring basic social processes such as health service use and behaviour change, which constitute the focus of this research. The decision to use Corbin and Strauss’s version of the methodology is justified by its acknowledgement of the existence of multiple realities that can only be interpreted rather than fully known. This is supported by both the subtle realist and symbolic interactionist perspectives. The following chapter details the activities involved in constructing the study data through sample selection, fieldwork and analytical processes, as well as ethical considerations and efforts to enhance rigour.

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