Overview of the theory

The proposed substantive theory is conceptualised as Self-empowering to maintain and

enhance personal identity as an older adult with depression. The theory is comprised of

a basic social psychological problem—the core problem—a core category, three categories and related strategies, all of which are moderated by contextual determinants. These elements are summarised in Figure 3136 _{and Table 5. A synopsis of each follows.}

5.3.1 Core problem

The core problem is an abstract concept that allows sufficient flexibility for the researcher to follow the data and explore the topic in depth. This becomes apparent to the researcher as data are collected and analysed (Corbin & Strauss, 2015). In the current study, the core problem was conceptualised as Struggling to maintain personal identityas an older adult

with depression. Although the problem was experienced in individual ways, a lack of a

135 _{The progressive focusing of observations is also referred to as grand-tour observations (rich descriptions of a social situation) and} mini-tour observations (detailed descriptions of smaller units of experience) (Spradley, 1980).

sense of personal identity, or individuality, was shared by participants, as they sought a diagnosis and ongoing support for depression.

Several internal (individual) and external factors contributed to the experience of the core problem. Participants’ individual characteristics, for example, were evident in how they recognised and responded to a diagnosis of depression. This process reflected their personal history and individual capacity. External factors included individual and community perceptions of age, and the attitudes of health professionals towards older adults, specifically those who presented with symptoms of depression. The availability and quality of support also influenced how the core problem was experienced.

Table 5: Overview of the theory

Core problem

Struggling to maintain personal identity as an older adult with depression

Core category

Self-empowering to maintain and enhance personal identity as an older adult with depression

Transitional themes

Accepting a change in wellness-illness status

Adapting to the changeable nature of depression

Creating new meaning

Categories Taking Stock Accessing Support Reclaiming Self- identity Strategies and sub- strategies Evaluating well-being  Challenging

assumptions about age and depression

 Seeking answers Coming to terms with the diagnosis  Accepting the diagnosis  Taking personal responsibility Overcoming barriers Resolving personal barriers Addressing external barriers Becoming informed and engaged

Improving mental health literacy

Making informed decisions Harnessing formal support Securing services

Establishing a therapeutic alliance

Optimising informal support Maximising positive relationships Helping others Empowering myself Fostering self- determination Embracing self- management Striving for a meaningful existence Seeking solitude Setting my own pace

Planning for the future

Contextual determinants

Perspectives on age and depression influencing help-seeking

Ability to navigate and access the health care system

Individual capacity for self-management

5.3.2 Core category

As the central phenomenon, the core category represents the main theme of the research. To tie all the other categories together, the core category must offer significant explanatory power. In Glaser’s (1978) words, the core category must have “grab” and “carry through” (pp. 94-95). The core category, Self-empowering to maintain and

enhance personal identity as an older adult with depression, recurs frequently in the data

and represents the central process by which participants responded to the problem of

Struggling to maintain personal identity. The processual nature of how they responded to

Accepting a change in wellness-illness status, Adapting to the changeable nature of

depression and Creating new meaning. The core category in the current study is a basic

social psychological process, as it connects the sequences of individual behaviours and interactions, as they relate to the core problem. It comprises interlinked conceptual elements, relating to empowerment, personal identity and self-management. Evident in the ways in which participants embraced self-determination and self-management, empowerment is closely associated with a sense of personal identity. By integrating their sense of self into strategies for managing depression, they reported increased confidence in improving their well-being.

5.3.3 Categories and strategies

Three categories are embedded in the core category: Taking Stock, Accessing Support and

Reclaiming Self-identity. Together, these categories incorporate the strategies and sub-

strategies used by older adults to address the core problem. A different, but related and complementary, process is represented by each category. In many ways, each category facilitates or augments the other two categories, as each one informs and enhances the effectiveness of the others.

Taking Stock

The first category, Taking Stock, reflects participants’ judgements about their well-being

and quality of life, and their efforts to adapt to a diagnosis of depression. The abstraction

of Taking Stock reflects the ways in which current circumstances were evaluated and

expectations moderated in response to changes in wellness-illness status following the diagnosis of depression. Although Taking Stock is a subjective experience, it occurs within a broader biopsychosocial framework comprised of biological, psychological and social influences. Participants employed the strategies of Evaluating well-being and

Coming to terms with the diagnosis as initial steps to making sense of their current

circumstances. Evaluating well-being involved making judgements about their well- being and quality of life by Challenging assumptions about age and depression and

Seeking answers, while Coming to terms with the diagnosis involved Accepting the

from which participants sought to harness support to manage their unique experience of depression.

Accessing Support

The second category, Accessing Support, captures participants’ efforts to improve their

mental health literacy, access formal support and optimise informal support. However, they had to overcome personal and external barriers before they could harness support. Through the strategy of Becoming informed and engaged, they sought to improve their capacity to take an active role in discussions and decision-making about their treatment options. This facilitated their efforts towards Harnessing formal support and Optimising

informal support. These strategies represent the ways in which they identified services

and maximised the benefits of those services that met their needs and preferences.

Accessing Support also relates to informal support provided by significant others, while

helping others was a way of connecting with the broader community.

Reclaiming Self-identity

The third category, Reclaiming Self-identity, represents the related aspects of participants’

views and behaviours, and reflects their efforts and actions in the previous categories of

Taking Stock and Accessing Support. The two main strategies within this category were

Empowering myself and Striving for a meaningful existence. Drawing on individuals’

autonomy and expertise, the concept of empowerment reflected their efforts to master their current circumstances in ways that improve well-being. Within this category, the concepts of self-determination and self-management were explored. The strategy of

Striving for a meaningful existence reflects participants’ need for solitude, the importance

of a daily routine and a way to prioritise tasks, and anticipation of future needs.

5.3.4 Contextual determinants

In a grounded theory study, each participant’s actions-interactions towards a specific phenomenon can be located and explained by examining the context in which they take place. Participants typically express contextual determinants as explanations or reasons for what they feel, think, say and do in response to a problem (Corbin & Strauss, 2015).

In this way, contextual determinants influence—positively or negatively—their experience of the phenomenon under study. To illustrate, personal and environmental contexts influence the meanings individuals assign to experiences, and the ways in which they respond to them. Three over-arching contextual determinants shaped their efforts to establish a sense of self by managing their experience of depression: Perspectives on age

and depression influencing help-seeking, Ability to navigate and access the health care

system and Individual capacity for self-management. In addition, each category was

influenced by its own contextual determinants that influenced the way they experienced transitions between wellness-illness states.