#AppliedMedEdMethods101: Constructivist Grounded Theory

(From the EiC: This is the last of our #AppliedMedEdMethods101. For: Systematic Review; Generalizability TheoryPhenomographyCritical Discourse Analysis; ValidityPre-Post Simulation; RCT; Education Research, Retrospective Cohort Studies)

By: Lindsay Melvin (@LMelvinMD) and Shiphra Ginsburg (@sginsburg1)

You are a clinician educator who wants to understand more about what activities learners deem to be “service” vs “education” and why, and how these service activities impact the resident educational experience on the medical wards. You wonder which methodology would best facilitate you answering your research question.

Why Constructivist grounded theory?

Constructivist grounded theory (CGT) is a qualitative research methodology that seeks to understand and explore a social process where no adequate prior theory exists. CGT uses an inductive approach to generating a new theory from the data gathered through participant interviews or focus groups. The approach is “grounded” in the participants’ own words and experiences. The ‘constructivist’ element of CGT refers to the fact that the evolving theory is constructed by the researcher and participants.  Prior work and knowledge of the literature can inform the current study and are often brought in as “sensitizing concepts”. CGT is a flexible process; there is no one correct way to do it – but there are several key guiding principles to be followed.

Data collection and analysis

A key feature in CGT is that analysis proceeds alongside – and informs – future data collection in an iterative process. Sampling is theoretical, meaning that participants are selected as data sources able to richly contribute to the understanding about a specific social phenomenon. Subsequent sampling attempts to elaborate and refine upon the evolving interpretations by seeking confirming and disconfirming views. The interview guide often evolves to allow for probing of ideas or themes identified earlier.

Coding is the process of taking participant’s own words and identifying patterns. In grounded theory, we often begin with “open coding” where each line or paragraph of text is read analytically by the researcher. The researcher asks questions, such as, “What is happening here?”,  remaining open to engage conceptually with participant data. Constant comparison is the process whereby each new code or finding is compared with existing codes to define and refine the characteristics of each category. After many codes are generated through open coding, axial coding occurs to explore the relationship between these codes, creating larger buckets of information or categorizations of the patterns identified. These are then organized into themes. The researcher continues to engage analytically with the data to understand how codes relate to one another and ultimately raise the categorizations of patterns to the conceptual level.

Data collection and analysis proceed until theoretical sufficiency has been reached. This is not to imply that nothing new can be learned from further data, but that the current codes and themes contain enough breadth and depth for the researcher to gain an adequate understanding of the process.

The goal of CGT is to develop a conceptual model or theory that describes the social process in question. This does not refer to the development of a new, capital “T” theory but rather a more nuanced and deeper understanding of a phenomenon. Charmaz prefers the term “theorizing”, which is an interpretive practice of engaging with the world (or at least with the data) and constructing an abstract understanding of it.

The role of the researcher

CGT recognizes that the researcher is an important part of the research process. Researchers must be reflexive about their position in relation to the research question, participants, and social process. The process of writing memos throughout the data collection and analysis is an important component of CGT research. Memos serve to document new ideas or insights, reactions and sentiments about the data collection and analysis. Memos may be free form thoughts, diagrams or sketches, or include quotations from the data. Revisiting memos throughout the data collection and analysis iteratively facilitates interpretation of the data, moving from the categories of themes to the concepts that ultimately shape a theoretical framework.

But is it “generalizable”?

In qualitative research, findings are discussed not in terms of generalizability but of transferability, which refers to how the findings of a particularly study can be transferred to another context or setting. Researchers should therefore provide sufficient description of the phenomenon, context and participants enrolled for the reader to be able to judge whether or not the findings might be transferable to their setting.

3 Take Home Points

  • Constructivist grounded theory is a methodology used to understand a social process or phenomenon inductively, where knowledge is constructed from participant experiences.
  • Data collection and analysis in constructivist grounded theory is done iteratively, using constant comparison to inform and refine future sampling and data analysis.
  • In constructivist grounded theory, the researcher is an integral part of the research process. Understanding the role of the researcher, through memos and reflexivity, facilitates data analysis and interpretation.

Back to the research question…

After reading this primer, you feel CGT is a good methodological fit to answer your research question. You decide to set up a research team to include a resident to gain additional “insider” perspective during data collection and analysis. You aim to recruit residents across the spectrum of training in your field. You and your research team develop a semi-structured interview guide to explore what tasks are considered “service” vs “education”, how these tasks impact learning, and if this perspective varies across residency levels. In line with CGT, you conduct data collection and analysis iteratively and meet several times with your research team until theoretical sufficiency has been reached.

References

Watling CJ, Lingard L. Grounded theory in medical education research: AMEE Guide No. 70. Medical teacher. 2012;34(10):850-861.

This article is an outstanding, approachable guide to grounded theory work in medical education.

Charmaz K. Constructing grounded theory: A practical guide through qualitative research. SagePublications Ltd, London. 2006.

This book provides a more in-depth approach to constructivist grounded theory research from a modern leader in CGT methodology.

Featured image via markmags on Pixabay