grounded theory research design example

10 Grounded Theory Examples (Qualitative Research Method)

Chris Drew (PhD)

Dr. Chris Drew is the founder of the Helpful Professor. He holds a PhD in education and has published over 20 articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education. [Image Descriptor: Photo of Chris]

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Grounded theory is a qualitative research method that involves the construction of theory from data rather than testing theories through data (Birks & Mills, 2015).

In other words, a grounded theory analysis doesn’t start with a hypothesis or theoretical framework, but instead generates a theory during the data analysis process .

This method has garnered a notable amount of attention since its inception in the 1960s by Barney Glaser and Anselm Strauss (Corbin & Strauss, 2015). 

Grounded Theory Definition and Overview

A central feature of grounded theory is the continuous interplay between data collection and analysis (Bringer, Johnston, & Brackenridge, 2016).

Grounded theorists start with the data, coding and considering each piece of collected information (for instance, behaviors collected during a psychological study).

As more information is collected, the researcher can reflect upon the data in an ongoing cycle where data informs an ever-growing and evolving theory (Mills, Bonner & Francis, 2017).

As such, the researcher isn’t tied to testing a hypothesis, but instead, can allow surprising and intriguing insights to emerge from the data itself.

Applications of grounded theory are widespread within the field of social sciences . The method has been utilized to provide insight into complex social phenomena such as nursing, education, and business management (Atkinson, 2015).

Grounded theory offers a sound methodology to unearth the complexities of social phenomena that aren’t well-understood in existing theories (McGhee, Marland & Atkinson, 2017).

While the methods of grounded theory can be labor-intensive and time-consuming, the rich, robust theories this approach produces make it a valuable tool in many researchers’ repertoires.

Real-Life Grounded Theory Examples

Title: A grounded theory analysis of older adults and information technology

Citation: Weatherall, J. W. A. (2000). A grounded theory analysis of older adults and information technology. Educational Gerontology , 26 (4), 371-386.

Description: This study employed a grounded theory approach to investigate older adults’ use of information technology (IT). Six participants from a senior senior were interviewed about their experiences and opinions regarding computer technology. Consistent with a grounded theory angle, there was no hypothesis to be tested. Rather, themes emerged out of the analysis process. From this, the findings revealed that the participants recognized the importance of IT in modern life, which motivated them to explore its potential. Positive attitudes towards IT were developed and reinforced through direct experience and personal ownership of technology.

Title: A taxonomy of dignity: a grounded theory study

Citation: Jacobson, N. (2009). A taxonomy of dignity: a grounded theory study. BMC International health and human rights , 9 (1), 1-9.

Description: This study aims to develop a taxonomy of dignity by letting the data create the taxonomic categories, rather than imposing the categories upon the analysis. The theory emerged from the textual and thematic analysis of 64 interviews conducted with individuals marginalized by health or social status , as well as those providing services to such populations and professionals working in health and human rights. This approach identified two main forms of dignity that emerged out of the data: “ human dignity ” and “social dignity”.

Title: A grounded theory of the development of noble youth purpose

Citation: Bronk, K. C. (2012). A grounded theory of the development of noble youth purpose. Journal of Adolescent Research , 27 (1), 78-109.

Description: This study explores the development of noble youth purpose over time using a grounded theory approach. Something notable about this study was that it returned to collect additional data two additional times, demonstrating how grounded theory can be an interactive process. The researchers conducted three waves of interviews with nine adolescents who demonstrated strong commitments to various noble purposes. The findings revealed that commitments grew slowly but steadily in response to positive feedback, with mentors and like-minded peers playing a crucial role in supporting noble purposes.

Title: A grounded theory of the flow experiences of Web users

Citation: Pace, S. (2004). A grounded theory of the flow experiences of Web users. International journal of human-computer studies , 60 (3), 327-363.

Description: This study attempted to understand the flow experiences of web users engaged in information-seeking activities, systematically gathering and analyzing data from semi-structured in-depth interviews with web users. By avoiding preconceptions and reviewing the literature only after the theory had emerged, the study aimed to develop a theory based on the data rather than testing preconceived ideas. The study identified key elements of flow experiences, such as the balance between challenges and skills, clear goals and feedback, concentration, a sense of control, a distorted sense of time, and the autotelic experience.

Title: Victimising of school bullying: a grounded theory

Citation: Thornberg, R., Halldin, K., Bolmsjö, N., & Petersson, A. (2013). Victimising of school bullying: A grounded theory. Research Papers in Education , 28 (3), 309-329.

Description: This study aimed to investigate the experiences of individuals who had been victims of school bullying and understand the effects of these experiences, using a grounded theory approach. Through iterative coding of interviews, the researchers identify themes from the data without a pre-conceived idea or hypothesis that they aim to test. The open-minded coding of the data led to the identification of a four-phase process in victimizing: initial attacks, double victimizing, bullying exit, and after-effects of bullying. The study highlighted the social processes involved in victimizing, including external victimizing through stigmatization and social exclusion, as well as internal victimizing through self-isolation, self-doubt, and lingering psychosocial issues.

Hypothetical Grounded Theory Examples

Suggested Title: “Understanding Interprofessional Collaboration in Emergency Medical Services”

Suggested Data Analysis Method: Coding and constant comparative analysis

How to Do It: This hypothetical study might begin with conducting in-depth interviews and field observations within several emergency medical teams to collect detailed narratives and behaviors. Multiple rounds of coding and categorizing would be carried out on this raw data, consistently comparing new information with existing categories. As the categories saturate, relationships among them would be identified, with these relationships forming the basis of a new theory bettering our understanding of collaboration in emergency settings. This iterative process of data collection, analysis, and theory development, continually refined based on fresh insights, upholds the essence of a grounded theory approach.

Suggested Title: “The Role of Social Media in Political Engagement Among Young Adults”

Suggested Data Analysis Method: Open, axial, and selective coding

Explanation: The study would start by collecting interaction data on various social media platforms, focusing on political discussions engaged in by young adults. Through open, axial, and selective coding, the data would be broken down, compared, and conceptualized. New insights and patterns would gradually form the basis of a theory explaining the role of social media in shaping political engagement, with continuous refinement informed by the gathered data. This process embodies the recursive essence of the grounded theory approach.

Suggested Title: “Transforming Workplace Cultures: An Exploration of Remote Work Trends”

Suggested Data Analysis Method: Constant comparative analysis

Explanation: The theoretical study could leverage survey data and in-depth interviews of employees and bosses engaging in remote work to understand the shifts in workplace culture. Coding and constant comparative analysis would enable the identification of core categories and relationships among them. Sustainability and resilience through remote ways of working would be emergent themes. This constant back-and-forth interplay between data collection, analysis, and theory formation aligns strongly with a grounded theory approach.

Suggested Title: “Persistence Amidst Challenges: A Grounded Theory Approach to Understanding Resilience in Urban Educators”

Suggested Data Analysis Method: Iterative Coding

How to Do It: This study would involve collecting data via interviews from educators in urban school systems. Through iterative coding, data would be constantly analyzed, compared, and categorized to derive meaningful theories about resilience. The researcher would constantly return to the data, refining the developing theory with every successive interaction. This procedure organically incorporates the grounded theory approach’s characteristic iterative nature.

Suggested Title: “Coping Strategies of Patients with Chronic Pain: A Grounded Theory Study”

Suggested Data Analysis Method: Line-by-line inductive coding

How to Do It: The study might initiate with in-depth interviews of patients who’ve experienced chronic pain. Line-by-line coding, followed by memoing, helps to immerse oneself in the data, utilizing a grounded theory approach to map out the relationships between categories and their properties. New rounds of interviews would supplement and refine the emergent theory further. The subsequent theory would then be a detailed, data-grounded exploration of how patients cope with chronic pain.

Grounded theory is an innovative way to gather qualitative data that can help introduce new thoughts, theories, and ideas into academic literature. While it has its strength in allowing the “data to do the talking”, it also has some key limitations – namely, often, it leads to results that have already been found in the academic literature. Studies that try to build upon current knowledge by testing new hypotheses are, in general, more laser-focused on ensuring we push current knowledge forward. Nevertheless, a grounded theory approach is very useful in many circumstances, revealing important new information that may not be generated through other approaches. So, overall, this methodology has great value for qualitative researchers, and can be extremely useful, especially when exploring specific case study projects . I also find it to synthesize well with action research projects .

Atkinson, P. (2015). Grounded theory and the constant comparative method: Valid qualitative research strategies for educators. Journal of Emerging Trends in Educational Research and Policy Studies, 6 (1), 83-86.

Birks, M., & Mills, J. (2015). Grounded theory: A practical guide . London: Sage.

Bringer, J. D., Johnston, L. H., & Brackenridge, C. H. (2016). Using computer-assisted qualitative data analysis software to develop a grounded theory project. Field Methods, 18 (3), 245-266.

Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory . Sage publications.

McGhee, G., Marland, G. R., & Atkinson, J. (2017). Grounded theory research: Literature reviewing and reflexivity. Journal of Advanced Nursing, 29 (3), 654-663.

Mills, J., Bonner, A., & Francis, K. (2017). Adopting a Constructivist Approach to Grounded Theory: Implications for Research Design. International Journal of Nursing Practice, 13 (2), 81-89.

• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd/ 119 Bloom’s Taxonomy Examples
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• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd/ Forest Schools Philosophy & Curriculum, Explained!

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• Correspondence
• Open access
• Published: 09 September 2011

How to do a grounded theory study: a worked example of a study of dental practices

• Alexandra Sbaraini 1 , 2 ,
• Stacy M Carter 1 ,
• R Wendell Evans 2 &
• Anthony Blinkhorn 1 , 2  

BMC Medical Research Methodology volume  11 , Article number:  128 ( 2011 ) Cite this article

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Qualitative methodologies are increasingly popular in medical research. Grounded theory is the methodology most-often cited by authors of qualitative studies in medicine, but it has been suggested that many 'grounded theory' studies are not concordant with the methodology. In this paper we provide a worked example of a grounded theory project. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature.

We documented a worked example of using grounded theory methodology in practice.

We describe our sampling, data collection, data analysis and interpretation. We explain how these steps were consistent with grounded theory methodology, and show how they related to one another. Grounded theory methodology assisted us to develop a detailed model of the process of adapting preventive protocols into dental practice, and to analyse variation in this process in different dental practices.

Conclusions

By employing grounded theory methodology rigorously, medical researchers can better design and justify their methods, and produce high-quality findings that will be more useful to patients, professionals and the research community.

Peer Review reports

Qualitative research is increasingly popular in health and medicine. In recent decades, qualitative researchers in health and medicine have founded specialist journals, such as Qualitative Health Research , established 1991, and specialist conferences such as the Qualitative Health Research conference of the International Institute for Qualitative Methodology, established 1994, and the Global Congress for Qualitative Health Research, established 2011 [ 1 – 3 ]. Journals such as the British Medical Journal have published series about qualitative methodology (1995 and 2008) [ 4 , 5 ]. Bodies overseeing human research ethics, such as the Canadian Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, and the Australian National Statement on Ethical Conduct in Human Research [ 6 , 7 ], have included chapters or sections on the ethics of qualitative research. The increasing popularity of qualitative methodologies for medical research has led to an increasing awareness of formal qualitative methodologies. This is particularly so for grounded theory, one of the most-cited qualitative methodologies in medical research [[ 8 ], p47].

Grounded theory has a chequered history [ 9 ]. Many authors label their work 'grounded theory' but do not follow the basics of the methodology [ 10 , 11 ]. This may be in part because there are few practical examples of grounded theory in use in the literature. To address this problem, we will provide a brief outline of the history and diversity of grounded theory methodology, and a worked example of the methodology in practice. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature.

The history, diversity and basic components of 'grounded theory' methodology and method

Founded on the seminal 1967 book 'The Discovery of Grounded Theory' [ 12 ], the grounded theory tradition is now diverse and somewhat fractured, existing in four main types, with a fifth emerging. Types one and two are the work of the original authors: Barney Glaser's 'Classic Grounded Theory' [ 13 ] and Anselm Strauss and Juliet Corbin's 'Basics of Qualitative Research' [ 14 ]. Types three and four are Kathy Charmaz's 'Constructivist Grounded Theory' [ 15 ] and Adele Clarke's postmodern Situational Analysis [ 16 ]: Charmaz and Clarke were both students of Anselm Strauss. The fifth, emerging variant is 'Dimensional Analysis' [ 17 ] which is being developed from the work of Leonard Schaztman, who was a colleague of Strauss and Glaser in the 1960s and 1970s.

There has been some discussion in the literature about what characteristics a grounded theory study must have to be legitimately referred to as 'grounded theory' [ 18 ]. The fundamental components of a grounded theory study are set out in Table 1 . These components may appear in different combinations in other qualitative studies; a grounded theory study should have all of these. As noted, there are few examples of 'how to do' grounded theory in the literature [ 18 , 19 ]. Those that do exist have focused on Strauss and Corbin's methods [ 20 – 25 ]. An exception is Charmaz's own description of her study of chronic illness [ 26 ]; we applied this same variant in our study. In the remainder of this paper, we will show how each of the characteristics of grounded theory methodology worked in our study of dental practices.

Study background

We used grounded theory methodology to investigate social processes in private dental practices in New South Wales (NSW), Australia. This grounded theory study builds on a previous Australian Randomized Controlled Trial (RCT) called the Monitor Dental Practice Program (MPP) [ 27 ]. We know that preventive techniques can arrest early tooth decay and thus reduce the need for fillings [ 28 – 32 ]. Unfortunately, most dentists worldwide who encounter early tooth decay continue to drill it out and fill the tooth [ 33 – 37 ]. The MPP tested whether dentists could increase their use of preventive techniques. In the intervention arm, dentists were provided with a set of evidence-based preventive protocols to apply [ 38 ]; control practices provided usual care. The MPP protocols used in the RCT guided dentists to systematically apply preventive techniques to prevent new tooth decay and to arrest early stages of tooth decay in their patients, therefore reducing the need for drilling and filling. The protocols focused on (1) primary prevention of new tooth decay (tooth brushing with high concentration fluoride toothpaste and dietary advice) and (2) intensive secondary prevention through professional treatment to arrest tooth decay progress (application of fluoride varnish, supervised monitoring of dental plaque control and clinical outcomes)[ 38 ].

As the RCT unfolded, it was discovered that practices in the intervention arm were not implementing the preventive protocols uniformly. Why had the outcomes of these systematically implemented protocols been so different? This question was the starting point for our grounded theory study. We aimed to understand how the protocols had been implemented, including the conditions and consequences of variation in the process. We hoped that such understanding would help us to see how the norms of Australian private dental practice as regards to tooth decay could be moved away from drilling and filling and towards evidence-based preventive care.

Designing this grounded theory study

Figure 1 illustrates the steps taken during the project that will be described below from points A to F.

Study design . file containing a figure illustrating the study design.

A. An open beginning and research questions

Grounded theory studies are generally focused on social processes or actions: they ask about what happens and how people interact . This shows the influence of symbolic interactionism, a social psychological approach focused on the meaning of human actions [ 39 ]. Grounded theory studies begin with open questions, and researchers presume that they may know little about the meanings that drive the actions of their participants. Accordingly, we sought to learn from participants how the MPP process worked and how they made sense of it. We wanted to answer a practical social problem: how do dentists persist in drilling and filling early stages of tooth decay, when they could be applying preventive care?

We asked research questions that were open, and focused on social processes. Our initial research questions were:

What was the process of implementing (or not-implementing) the protocols (from the perspective of dentists, practice staff, and patients)?

How did this process vary?

B. Ethics approval and ethical issues

In our experience, medical researchers are often concerned about the ethics oversight process for such a flexible, unpredictable study design. We managed this process as follows. Initial ethics approval was obtained from the Human Research Ethics Committee at the University of Sydney. In our application, we explained grounded theory procedures, in particular the fact that they evolve. In our initial application we provided a long list of possible recruitment strategies and interview questions, as suggested by Charmaz [ 15 ]. We indicated that we would make future applications to modify our protocols. We did this as the study progressed - detailed below. Each time we reminded the committee that our study design was intended to evolve with ongoing modifications. Each modification was approved without difficulty. As in any ethical study, we ensured that participation was voluntary, that participants could withdraw at any time, and that confidentiality was protected. All responses were anonymised before analysis, and we took particular care not to reveal potentially identifying details of places, practices or clinicians.

C. Initial, Purposive Sampling (before theoretical sampling was possible)

Grounded theory studies are characterised by theoretical sampling, but this requires some data to be collected and analysed. Sampling must thus begin purposively, as in any qualitative study. Participants in the previous MPP study provided our population [ 27 ]. The MPP included 22 private dental practices in NSW, randomly allocated to either the intervention or control group. With permission of the ethics committee; we sent letters to the participants in the MPP, inviting them to participate in a further qualitative study. From those who agreed, we used the quantitative data from the MPP to select an initial sample.

Then, we selected the practice in which the most dramatic results had been achieved in the MPP study (Dental Practice 1). This was a purposive sampling strategy, to give us the best possible access to the process of successfully implementing the protocols. We interviewed all consenting staff who had been involved in the MPP (one dentist, five dental assistants). We then recruited 12 patients who had been enrolled in the MPP, based on their clinically measured risk of developing tooth decay: we selected some patients whose risk status had gotten better, some whose risk had worsened and some whose risk had stayed the same. This purposive sample was designed to provide maximum variation in patients' adoption of preventive dental care.

Initial Interviews

One hour in-depth interviews were conducted. The researcher/interviewer (AS) travelled to a rural town in NSW where interviews took place. The initial 18 participants (one dentist, five dental assistants and 12 patients) from Dental Practice 1 were interviewed in places convenient to them such as the dental practice, community centres or the participant's home.

Two initial interview schedules were designed for each group of participants: 1) dentists and dental practice staff and 2) dental patients. Interviews were semi-structured and based loosely on the research questions. The initial questions for dentists and practice staff are in Additional file 1 . Interviews were digitally recorded and professionally transcribed. The research location was remote from the researcher's office, thus data collection was divided into two episodes to allow for intermittent data analysis. Dentist and practice staff interviews were done in one week. The researcher wrote memos throughout this week. The researcher then took a month for data analysis in which coding and memo-writing occurred. Then during a return visit, patient interviews were completed, again with memo-writing during the data-collection period.

D. Data Analysis

Coding and the constant comparative method.

Coding is essential to the development of a grounded theory [ 15 ]. According to Charmaz [[ 15 ], p46], 'coding is the pivotal link between collecting data and developing an emergent theory to explain these data. Through coding, you define what is happening in the data and begin to grapple with what it means'. Coding occurs in stages. In initial coding, the researcher generates as many ideas as possible inductively from early data. In focused coding, the researcher pursues a selected set of central codes throughout the entire dataset and the study. This requires decisions about which initial codes are most prevalent or important, and which contribute most to the analysis. In theoretical coding, the researcher refines the final categories in their theory and relates them to one another. Charmaz's method, like Glaser's method [ 13 ], captures actions or processes by using gerunds as codes (verbs ending in 'ing'); Charmaz also emphasises coding quickly, and keeping the codes as similar to the data as possible.

We developed our coding systems individually and through team meetings and discussions.

We have provided a worked example of coding in Table 2 . Gerunds emphasise actions and processes. Initial coding identifies many different processes. After the first few interviews, we had a large amount of data and many initial codes. This included a group of codes that captured how dentists sought out evidence when they were exposed to a complex clinical case, a new product or technique. Because this process seemed central to their practice, and because it was talked about often, we decided that seeking out evidence should become a focused code. By comparing codes against codes and data against data, we distinguished the category of "seeking out evidence" from other focused codes, such as "gathering and comparing peers' evidence to reach a conclusion", and we understood the relationships between them. Using this constant comparative method (see Table 1 ), we produced a theoretical code: "making sense of evidence and constructing knowledge". This code captured the social process that dentists went through when faced with new information or a practice challenge. This theoretical code will be the focus of a future paper.

Memo-writing

Throughout the study, we wrote extensive case-based memos and conceptual memos. After each interview, the interviewer/researcher (AS) wrote a case-based memo reflecting on what she learned from that interview. They contained the interviewer's impressions about the participants' experiences, and the interviewer's reactions; they were also used to systematically question some of our pre-existing ideas in relation to what had been said in the interview. Table 3 illustrates one of those memos. After a few interviews, the interviewer/researcher also began making and recording comparisons among these memos.

We also wrote conceptual memos about the initial codes and focused codes being developed, as described by Charmaz [ 15 ]. We used these memos to record our thinking about the meaning of codes and to record our thinking about how and when processes occurred, how they changed, and what their consequences were. In these memos, we made comparisons between data, cases and codes in order to find similarities and differences, and raised questions to be answered in continuing interviews. Table 4 illustrates a conceptual memo.

At the end of our data collection and analysis from Dental Practice 1, we had developed a tentative model of the process of implementing the protocols, from the perspective of dentists, dental practice staff and patients. This was expressed in both diagrams and memos, was built around a core set of focused codes, and illustrated relationships between them.

E. Theoretical sampling, ongoing data analysis and alteration of interview route

We have already described our initial purposive sampling. After our initial data collection and analysis, we used theoretical sampling (see Table 1 ) to determine who to sample next and what questions to ask during interviews. We submitted Ethics Modification applications for changes in our question routes, and had no difficulty with approval. We will describe how the interview questions for dentists and dental practice staff evolved, and how we selected new participants to allow development of our substantive theory. The patients' interview schedule and theoretical sampling followed similar procedures.

Evolution of theoretical sampling and interview questions

We now had a detailed provisional model of the successful process implemented in Dental Practice 1. Important core focused codes were identified, including practical/financial, historical and philosophical dimensions of the process. However, we did not yet understand how the process might vary or go wrong, as implementation in the first practice we studied had been described as seamless and beneficial for everyone. Because our aim was to understand the process of implementing the protocols, including the conditions and consequences of variation in the process, we needed to understand how implementation might fail. For this reason, we theoretically sampled participants from Dental Practice 2, where uptake of the MPP protocols had been very limited according to data from the RCT trial.

We also changed our interview questions based on the analysis we had already done (see Additional file 2 ). In our analysis of data from Dental Practice 1, we had learned that "effectiveness" of treatments and "evidence" both had a range of meanings. We also learned that new technologies - in particular digital x-rays and intra-oral cameras - had been unexpectedly important to the process of implementing the protocols. For this reason, we added new questions for the interviews in Dental Practice 2 to directly investigate "effectiveness", "evidence" and how dentists took up new technologies in their practice.

Then, in Dental Practice 2 we learned more about the barriers dentists and practice staff encountered during the process of implementing the MPP protocols. We confirmed and enriched our understanding of dentists' processes for adopting technology and producing knowledge, dealing with complex cases and we further clarified the concept of evidence. However there was a new, important, unexpected finding in Dental Practice 2. Dentists talked about "unreliable" patients - that is, patients who were too unreliable to have preventive dental care offered to them. This seemed to be a potentially important explanation for non-implementation of the protocols. We modified our interview schedule again to include questions about this concept (see Additional file 3 ) leading to another round of ethics approvals. We also returned to Practice 1 to ask participants about the idea of an "unreliable" patient.

Dentists' construction of the "unreliable" patient during interviews also prompted us to theoretically sample for "unreliable" and "reliable" patients in the following round of patients' interviews. The patient question route was also modified by the analysis of the dentists' and practice staff data. We wanted to compare dentists' perspectives with the perspectives of the patients themselves. Dentists were asked to select "reliable" and "unreliable" patients to be interviewed. Patients were asked questions about what kind of services dentists should provide and what patients valued when coming to the dentist. We found that these patients (10 reliable and 7 unreliable) talked in very similar ways about dental care. This finding suggested to us that some deeply-held assumptions within the dental profession may not be shared by dental patients.

At this point, we decided to theoretically sample dental practices from the non-intervention arm of the MPP study. This is an example of the 'openness' of a grounded theory study potentially subtly shifting the focus of the study. Our analysis had shifted our focus: rather than simply studying the process of implementing the evidence-based preventive protocols, we were studying the process of doing prevention in private dental practice. All participants seemed to be revealing deeply held perspectives shared in the dental profession, whether or not they were providing dental care as outlined in the MPP protocols. So, by sampling dentists from both intervention and control group from the previous MPP study, we aimed to confirm or disconfirm the broader reach of our emerging theory and to complete inductive development of key concepts. Theoretical sampling added 12 face to face interviews and 10 telephone interviews to the data. A total of 40 participants between the ages of 18 and 65 were recruited. Telephone interviews were of comparable length, content and quality to face to face interviews, as reported elsewhere in the literature [ 40 ].

F. Mapping concepts, theoretical memo writing and further refining of concepts

After theoretical sampling, we could begin coding theoretically. We fleshed out each major focused code, examining the situations in which they appeared, when they changed and the relationship among them. At time of writing, we have reached theoretical saturation (see Table 1 ). We have been able to determine this in several ways. As we have become increasingly certain about our central focused codes, we have re-examined the data to find all available insights regarding those codes. We have drawn diagrams and written memos. We have looked rigorously for events or accounts not explained by the emerging theory so as to develop it further to explain all of the data. Our theory, which is expressed as a set of concepts that are related to one another in a cohesive way, now accounts adequately for all the data we have collected. We have presented the developing theory to specialist dental audiences and to the participants, and have found that it was accepted by and resonated with these audiences.

We have used these procedures to construct a detailed, multi-faceted model of the process of incorporating prevention into private general dental practice. This model includes relationships among concepts, consequences of the process, and variations in the process. A concrete example of one of our final key concepts is the process of "adapting to" prevention. More commonly in the literature writers speak of adopting, implementing or translating evidence-based preventive protocols into practice. Through our analysis, we concluded that what was required was 'adapting to' those protocols in practice. Some dental practices underwent a slow process of adapting evidence-based guidance to their existing practice logistics. Successful adaptation was contingent upon whether (1) the dentist-in-charge brought the whole dental team together - including other dentists - and got everyone interested and actively participating during preventive activities; (2) whether the physical environment of the practice was re-organised around preventive activities, (3) whether the dental team was able to devise new and efficient routines to accommodate preventive activities, and (4) whether the fee schedule was amended to cover the delivery of preventive services, which hitherto was considered as "unproductive time".

Adaptation occurred over time and involved practical, historical and philosophical aspects of dental care. Participants transitioned from their initial state - selling restorative care - through an intermediary stage - learning by doing and educating patients about the importance of preventive care - and finally to a stage where they were offering patients more than just restorative care. These are examples of ways in which participants did not simply adopt protocols in a simple way, but needed to adapt the protocols and their own routines as they moved toward more preventive practice.

The quality of this grounded theory study

There are a number of important assurances of quality in keeping with grounded theory procedures and general principles of qualitative research. The following points describe what was crucial for this study to achieve quality.

During data collection

1. All interviews were digitally recorded, professionally transcribed in detail and the transcripts checked against the recordings.

2. We analysed the interview transcripts as soon as possible after each round of interviews in each dental practice sampled as shown on Figure 1 . This allowed the process of theoretical sampling to occur.

3. Writing case-based memos right after each interview while being in the field allowed the researcher/interviewer to capture initial ideas and make comparisons between participants' accounts. These memos assisted the researcher to make comparison among her reflections, which enriched data analysis and guided further data collection.

4. Having the opportunity to contact participants after interviews to clarify concepts and to interview some participants more than once contributed to the refinement of theoretical concepts, thus forming part of theoretical sampling.

5. The decision to include phone interviews due to participants' preference worked very well in this study. Phone interviews had similar length and depth compared to the face to face interviews, but allowed for a greater range of participation.

During data analysis

1. Detailed analysis records were kept; which made it possible to write this explanatory paper.

2. The use of the constant comparative method enabled the analysis to produce not just a description but a model, in which more abstract concepts were related and a social process was explained.

3. All researchers supported analysis activities; a regular meeting of the research team was convened to discuss and contextualize emerging interpretations, introducing a wide range of disciplinary perspectives.

Answering our research questions

We developed a detailed model of the process of adapting preventive protocols into dental practice, and analysed the variation in this process in different dental practices. Transferring evidence-based preventive protocols into these dental practices entailed a slow process of adapting the evidence to the existing practices logistics. Important practical, philosophical and historical elements as well as barriers and facilitators were present during a complex adaptation process. Time was needed to allow dentists and practice staff to go through this process of slowly adapting their practices to this new way of working. Patients also needed time to incorporate home care activities and more frequent visits to dentists into their daily routines. Despite being able to adapt or not, all dentists trusted the concrete clinical evidence that they have produced, that is, seeing results in their patients mouths made them believe in a specific treatment approach.

Concluding remarks

This paper provides a detailed explanation of how a study evolved using grounded theory methodology (GTM), one of the most commonly used methodologies in qualitative health and medical research [[ 8 ], p47]. In 2007, Bryant and Charmaz argued:

'Use of GTM, at least as much as any other research method, only develops with experience. Hence the failure of all those attempts to provide clear, mechanistic rules for GTM: there is no 'GTM for dummies'. GTM is based around heuristics and guidelines rather than rules and prescriptions. Moreover, researchers need to be familiar with GTM, in all its major forms, in order to be able to understand how they might adapt it in use or revise it into new forms and variations.' [[ 8 ], p17].

Our detailed explanation of our experience in this grounded theory study is intended to provide, vicariously, the kind of 'experience' that might help other qualitative researchers in medicine and health to apply and benefit from grounded theory methodology in their studies. We hope that our explanation will assist others to avoid using grounded theory as an 'approving bumper sticker' [ 10 ], and instead use it as a resource that can greatly improve the quality and outcome of a qualitative study.

Abbreviations

grounded theory methods

Monitor Dental Practice Program

New South Wales

Randomized Controlled Trial.

Qualitative Health Research Journal: website accessed on 10 June 2011, [ http://qhr.sagepub.com/ ]

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Acknowledgements

We thank dentists, dental practice staff and patients for their invaluable contributions to the study. We thank Emeritus Professor Miles Little for his time and wise comments during the project.

The authors received financial support for the research from the following funding agencies: University of Sydney Postgraduate Award 2009; The Oral Health Foundation, University of Sydney; Dental Board New South Wales; Australian Dental Research Foundation; National Health and Medical Research Council Project Grant 632715.

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Alexandra Sbaraini, Stacy M Carter & Anthony Blinkhorn

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Alexandra Sbaraini, R Wendell Evans & Anthony Blinkhorn

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The authors declare that they have no competing interests.

Authors' contributions

All authors have made substantial contributions to conception and design of this study. AS carried out data collection, analysis, and interpretation of data. SMC made substantial contribution during data collection, analysis and data interpretation. AS, SMC, RWE, and AB have been involved in drafting the manuscript and revising it critically for important intellectual content. All authors read and approved the final manuscript.

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Additional file 1: Initial interview schedule for dentists and dental practice staff. file containing initial interview schedule for dentists and dental practice staff. (DOC 30 KB)

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Additional file 2: Questions added to the initial interview schedule for dentists and dental practice staff. file containing questions added to the initial interview schedule (DOC 26 KB)

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Additional file 3: Questions added to the modified interview schedule for dentists and dental practice staff. file containing questions added to the modified interview schedule (DOC 26 KB)

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Sbaraini, A., Carter, S.M., Evans, R.W. et al. How to do a grounded theory study: a worked example of a study of dental practices. BMC Med Res Methodol 11 , 128 (2011). https://doi.org/10.1186/1471-2288-11-128

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Theory development.

Grounded theory proposes that careful observation of the social world can lead to the construction of theory (Rice & Ezzy, 1999). It is iterative and evolving, aiming to construct new theory from collected data that accounts for those data. It is also known as the “grounded theory method”, although the terms have become interchangeable (Bryant & Charmaz, 2007).

Grounded theory characteristics include:

• Data collection and analysis occurring simultaneously, with one informing the other.
• Data grouped into concepts, categories and themes.
• A data collection process influenced by the simultaneous development of those concepts, categories and themes.

Notably, data collection is cyclical and reflective. This is different from the more linear processes occurring in other methodologies.

Theoretical sampling is a key aspect of the sampling stage of grounded theory. Recruitment continues until the sample finally represents all aspects that make up the theory the data represent (Starks & Brown Trinidad, 2007). Participants are recruited based on their different experiences of a phenomenon.

Researchers collect participant data using these methods:

• Examination of documents
• Focus groups and interviews

Focus groups and interviews are typically being more practical in health research than observation (Starks & Brown Trinidad, 2007).

After the initial phase of data collection, researchers repeat the following cycle of steps:

Researchers’ developing understanding of the concepts, categories and relationships informs their actions at each step. These elements result in a theoretical framework explaining the data. 

This cycle reflects two crucial components of grounded theory:

• The process of coding, sorting and organising data. This aims to increasingly move towards more abstract terms in order to develop a related theory for the data
• The principle of constant comparison. This refers to the process of noting issues of interest in data and comparing them to other examples to identify similarities and differences.
• Widely used across a wide range of disciplines (Bryant & Charmaz, 2007).  
• Facilitates theory construction and the construction of fresh concepts. It also avoids assuming structures are stable (Charmaz, 2017). 
• Useful for when researchers wish to explain a process, not to test an existing theory. 

Limitations

• Inherently not useful for the application of received theory. 
• Not useful for testing hypotheses. 
• Analysis of data involves elements of researcher’s own subjective judgement.

Example questions

• How do perioperative nurses foster a culture of safety and risk aversion? 
• What is the impact of hand nerve disorders on a person’s function, activity and participation? 
• What are the barriers to health care access for a refugee population? 

Example studies

Attree, M. (2001). Patients' and relatives' experiences and perspectives of 'Good' and 'Not so Good' quality care . J Adv Nurs , 33(4), 456-466. doi: 10.1046/j.1365-2648.2001.01689.x 

Lingard, L., Reznick, R., Espin, S., Regehr, G., & DeVito, I. (2002). Team communications in the operating room: talk patterns, sites of tension, and implications for novices . Acad Med , 77(3), 232-237. doi: 10.1097/00001888-200203000-00013 

Pettersson, S., Ekstrom, M. P., & Berg, C. M. (2013). Practices of weight regulation among elite athletes in combat sports: a matter of mental advantage? J Athl Train , 48(1), 99-108. doi: 10.4085/1062-6050-48.1.04 

Bryant, A., & Charmaz, K. (2007). The SAGE handbook of grounded theory : SAGE Publications Ltd.

Charmaz, K. (2017). An introduction to grounded theory : SAGE Publications Ltd. 

Lingard, L., Albert, M., & Levinson, W. (2008). Grounded theory, mixed methods, and action research . BMJ , 337, a567. doi: 10.1136/bmj.39602.690162.47 

Rice, P. L., & Ezzy, D. (1999). Qualitative research methods: a health focus . South Melbourne, Australia: Oxford University Press. 

Starks, H., & Brown Trinidad, S. (2007). Choose Your Method: A Comparison of Phenomenology, Discourse Analysis, and Grounded Theory . Qualitative Health Research , 17(10), 1372-1380. doi: 10.1177/1049732307307031 

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• Helen Noble 1 ,
• Gary Mitchell 2
• 1 School of Nursing and Midwifery, Queens's University Belfast , Belfast , UK
• 2 Four Seasons Health Care , Belfast , UK
• Correspondence to : Dr Helen Noble , School of Nursing and Midwifery, Queens's University Belfast, Belfast BT9 7BL, UK; Helen.noble{at}qub.ac.uk

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Introduction

Grounded theory (GT) is a research method concerned with the generation of theory, 1 which is ‘grounded’ in data that has been systematically collected and analysed. 2 It is used to uncover such things as social relationships and behaviours of groups, known as social processes. 3 It was developed in California, USA by Glaser and Strauss during their study—‘Awareness of Dying’. 1 It is a general methodology for developing theory that is grounded in data which is systematically gathered and analysed.

Features of GT

Data collection and analysis occur simultaneously.

Categories and analytic codes developed from data. Pre-existing conceptualisations not to be used—this is known as theoretical sensitivity (see below).

Theoretical sampling used to refine categories.

Abstract categories constructed inductively.

Social processes discovered in the data.

Analytical memos used between coding and writing.

Categories integrated into a theoretical framework. 4

Carrying out a GT study

Theoretical sampling.

Glaser and Strauss (1967) first mentioned theoretical sampling and described a process of generating theory from data which includes collecting the data, then coding and analysing the data. 1 Next the researcher makes a conscious decision about what further detail they feel needs exploring as the new theory develops. It usually takes place after some initial key concepts or categories have been identified, for example, you might decide to interview patients about their experience of heart failure. They may talk about systematic errors occurring in the general practice surgery. From this analysis of the data you may decide to approach and interview GPs to explore their views on patients’ comments. Theoretical sampling therefore, is used to produce more data to endorse or refute the categories that have been identified in the previous analysis. 6

Theoretical sensitivity

Theoretical sensitivity refers to the insight of the researcher. It concerns the researcher being able to give meaning to data, understand what the data says, and being able to separate out what is relevant and what is not. By being theoretically sensitive and using insight, the researcher is able to develop a theory that is grounded, theoretically dense, and cohesive. 7 Sensitivity comes from several sources including (1) literature—in depth reading offers a rich understanding of the phenomena being studied; (2) professional and personal experience—offers an understanding of the events and topics being explored; (3) the analytic process—allows for insight and understanding of the phenomena. 8

Analysis of data in GT

There are three stages of data analysis in GT: 8

Open coding: this involves line by line coding where concepts and key phrases are identified and highlighted and moved into subcategories, then categories. This breaks the data down into conceptual components and the researcher can start to theorise or reflect on what they are reading and understanding—making sense of the data. The data from each participant will be ‘constantly compared’ for similarities.

Axial coding: at this stage relationships are identified between the categories, and connections identified.

Selective coding: this involves identifying the core category and methodically relating it to other categories. The relationships must be authenticated and categories refined. Categories are then integrated together and a GT identified.

Analytical notes are encouraged. These are notes to oneself to explain thought patterns in relation to the data analysis. Final theory is usually generated from the integration of several analytical memos.

The core category

The core category is the chief phenomena around which the categories are built. Theory is generated around a core category. The core category should account for the variation found in the data, that is, the categories will relate to it in some way. The categories demonstrate how the core category is situated in the lives of those participating in the study.

Example of a GT case study

As illustrated, GT methodologies involve the construction of new theory through the analysis of data. In a study carried out by Beech et al , 9 the authors sought to explore patient participant experiences of recovery following surgical intervention for colorectal cancer. Beech et al 9 opted to use GT because previous studies had sought to answer this research question by measuring quantifiable biomedical markers, such as symptoms of pain, insomnia or fatigue. According to the authors, there was a paucity of empirical literature around the topic from a holistic perspective, for example social, psychological and cultural aspects of a person's well-being.

Twelve participants were interviewed four times, over a 1-year period. The authors used theoretical sampling to guide the researcher as data were collected. It helped facilitate the development of theory as it emerged, not once data collection was complete. 1 Initial participants were selected based on ‘subject area’, as is recommended in theoretical sampling. Each had undergone a surgical procedure to remove a tumour in their bowel or rectum and had not received prescribed chemotherapy or radiotherapy. The authors initially asked patient participants to describe their experiences to date.

Data analysis of the interviews was carried out according to the steps described by Strauss and Corbin. 10 The authors began by coding each line of each patient participant transcript. Similar codes were then grouped together to form subcategories and within these subcategories categories were identified. The authors then grouped together the categories to form theory related to patient participant experiences of recovery following surgical intervention for colorectal cancer. The process of data collection continued until each category was saturated and no new data emerged.

Patient participants described their recovery in three phases identified from three categories; disrupting the self, repairing the self and restoring the self. The authors also noted how the process was linear in that all participants went through the stages, for example, phase one began at prediagnosis and ended at the conclusion of surgery; phase two commonly lasted between 3 and 6 months and phase three, from 6 months onwards, was related to a person's fluctuating level of wellness and illness. Notably, these three categories were underpinned by various subcategories, which were generated from initial codes. For example, the second category Beech et al 4 identified, ‘disrupting the self’, was made up of the three subcategories; body repair, autonomy and re-establishing personal identity ( figure 1 ).

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Grounded theory data analysis.

Importantly, the authors encapsulated the three categories to present a pertinent theory related to patient participant experiences of recovery following surgical intervention for colorectal cancer. They found that recovery is more than physical repair. It is a process of restoring a sense of wellness demonstrated through an awareness and enjoyment of the physical, emotional, social and spiritual aspects of life, in other words, holistic health. 9

By using GT and adhering to this as a research method, a theory will be produced that is grounded in your data. 10 It is a research method which uses strict procedures for data analysis and will enable you to search for and conceptualise the hidden social and collective patterns and constructions in your area of interest.

• Glaser BG ,
• Strauss A ,
• Faithfull S

Competing interests None declared.

Provenance and peer review Not commissioned; internally peer reviewed.

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Article Contents

Introduction, distinguishing features of grounded theory, the role and timing of the literature review.

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Grounded theory: what makes a grounded theory study?

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Carley Turner, Felicity Astin, Grounded theory: what makes a grounded theory study?, European Journal of Cardiovascular Nursing , Volume 20, Issue 3, March 2021, Pages 285–289, https://doi.org/10.1093/eurjcn/zvaa034

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Grounded theory (GT) is both a research method and a research methodology. There are several different ways of doing GT which reflect the different viewpoints of the originators. For those who are new to this approach to conducting qualitative research, this can be confusing. In this article, we outline the key characteristics of GT and describe the role of the literature review in three common GT approaches, illustrated using exemplar studies.

Describing the key characteristics of a Grounded theory (GT) study.

Considering the role and timing of the literature review in different GT approaches.

Qualitative research is a cornerstone in cardiovascular research. It gives insights in why particular phenomena occur or what underlying mechanisms are. 1 Over the past 2 years, the European Journal of Cardiovascular Nursing published 20 qualitative studies. 2–21 These studies used methods such as content analysis, ethnography, or phenomenology. Grounded theory (GT) has been used to a lesser extent.

Grounded theory is both a methodology and a method used in qualitative research ( Table 1 ). It is a research approach used to gain an emic insight into a phenomenon. In simple terms, this means understanding the perspective, or point of view, of an ‘insider’, those who have experience of the phenomenon. 22 Grounded theory is a research approach that originated from the social sciences but has been used in education and health research. The focus of GT is to generate theory that is grounded in data and shaped by the views of participants, thereby moving beyond description and towards theoretical explanation of a process or phenomenon. 23

Grounded theory as a method and methodology

One of the key issues with using GT, particularly for novices, is understanding the different approaches that have evolved as each specific GT approach is slightly different.

The tradition of GT began with the seminal text about classic GT written by Glaser and Strauss, 24 but since then GT has evolved into several different types. The approach to GT chosen by the researcher depends upon an understanding of the epistemological underpinnings of the different approaches, the match with the topic under investigation and the researcher’s own stance. Whilst GT is frequently used in applied health research, very few studies detail which GT approach has been used, how and why. Sometimes published studies claim to use GT methodology but the approaches that form the foundation of GT are not reported. This may be due to the word limit in academic journals or because legitimate GT approaches have not been followed. Either way, there is a lack of clarity about the practical application of GT. The purpose of this article is to outline the distinguishing characteristics of GT and outline practical considerations for the novice researcher regarding the place of the literature review in GT.

There are several distinguishing features of GT, as outlined by Sbaraini et al. 25 The first is that GT research is conducted through an inductive process. This means that the researcher is developing theory rather than testing it and must therefore remain ‘open’ throughout the study. In essence, this means that the researcher has no preconceived ideas about the findings. Taking an inductive approach means that the focus of the research may evolve over time as the researchers understand what is important to their participants through the data collection and analysis process.

With regards to data analysis, the use of coding is initially used to break down data into smaller components and labelling them to capture the essence of the data. The codes are compared to one another to understand and explain any variation in the data before they are combined to form more abstract categories. Memos are used to record and develop the researcher’s analysis of the data, including the detail behind the comparisons made between categories. Memos can stimulate the researcher’s thinking, as well as capturing the researcher’s ideas during data collection and analysis.

A further feature for data analysis in a GT study is the simultaneous data analysis and sampling to facilitate theoretical sampling. This means that as data analysis progresses participants are purposefully selected who may have characteristics or experiences that have arisen as being of interest from data collection and analysis so far. Questions in the topic guide may also be modified to follow a specific line of inquiry, test ideas and interpretations, or fill gaps in the analysis to build an emerging substantive theory. This evolving and non-linear methodology is to allow the evolution of the study as indicated by data, rather than analysing at the end of data collection. This approach to data analysis supports the researcher to take an inductive approach as discussed above.

Theoretical sampling facilitates the construction of theory until theoretical saturation is reached. Theoretical saturation is when all the concepts that form the theory being developed are well understood and grounded in data. Finally, the results are expressed as a theory where a set of concepts are related to one another and provide a framework for making predictions. 26 These key features of GT are summarized in Table 2 .

Distinguishing features of a GT study (adapted from Sbaraini et al. 25 )

The identification of a gap in the published literature is typically a requirement of successful doctoral studies and grant applications. However, in GT research there are different views about the role and timing of the literature review.

For researchers using classic Glaserian GT, the recommended approach is that the published literature should not be reviewed until data collection, analysis and theory development has been completed. 24 The rationale for the delay of the literature review is to enable the researcher to remain ‘open’ to discover theory emerging from data and free from contamination by avoiding forcing data into pre-conceived concepts derived from other studies. Furthermore, because the researcher is ‘open’ to whichever direction the data takes they cannot know in advance which aspects of the literature will be relevant to their study. 27

In Glaserian GT, the emerging concepts and theory from data analysis inform the scope of the literature review which is conducted after theory development. 24 This approach to the literature review aligns with the rather positivist stance of Glaser in which the researcher aims to remain free of assumptions so that the theory that emerges from the data is not influenced by the researcher. Reviewing the literature prior to data analysis would risk theory being imposed on the data. Perhaps counterintuitively, Glaser does recommend reading literature in unrelated fields to understand as many theoretical codes as possible. 28 However, it is unclear how this is different to reading literature directly related to the topic and could potentially still lead to the contamination of the theory arising from data that delaying the literature review is intended to avoid. It is also problematic regarding the governance processes around research, whereby funders and ethics committees would expect at least an overview of the existing literature as part of the justification for the study.

A study by Bergman et al. 29 used a classic Glaserian GT approach to examine and identify the motive of power in myocardial infarction patients’ rehabilitation process. Whilst the key characteristics of GT were evident in the way the study was conducted, there was no discussion about how the literature review contributed to the final theory. This may have been due to the word limit but illustrates the challenges that novice researchers may have in understanding where the literature review fits in studies using GT approaches.

In Straussian GT, a more pragmatic approach to the literature view is adopted. Strauss and Corbin 30 recognized that the researcher has prior knowledge, including that of the literature, before starting their research. They did not recommend dissociation from the literature, but rather that the literature be used across the various stages of the research. Published literature could identify important areas that could contribute to theory development, support useful comparisons in the data and stimulate further questions during the analytical process. According to Strauss and Corbin, researchers should be mindful about how published work could influence theory development. Whilst visiting the literature prior to data collection was believed to enhance data analysis, it was not thought necessary to review all the literature beforehand, but rather revisit the literature at later stages in the research process. 30

A study published by Salminen-Tuomaala et al. 31 used a Straussian GT approach to explore factors that influenced the way patients coped with hospitalization for acute myocardial infarction. The authors described a reflexive process in which the researcher noted down their preconceived ideas about the topic as part of the data analysis process. The literature review was conducted after data analysis.

The most recent step in the evolution of GT is the move towards a constructivist epistemological stance advocated by Charmaz. 32 In simple terms, this means that the underlying approach reflects the belief that theories cannot be discovered but are instead constructed by the researcher and their interactions with the participants and data. As the researcher plays a central role in the construction of the GT, their background, personal views, and culture will influence this process and the way data are analysed. For this reason, it is important to be explicit about these preconceptions and aim to maintain an open mind through reflexivity. 32 Therefore, engaging in a preliminary literature review and using this information to compare and contrast with findings from the research undertaken is desirable, alongside completing a comprehensive literature review after data analysis with a specific aim to present the GT.

A study published by Odell et al. 33 used the modified GT approach recommended by Charmaz 32 to study patients’ experiences of restenosis after Percutaneous Coronary Intervention. The authors described the different GT approaches and key features of GT methodology which clearly informed the conduct of the study. However, there was no detail about how the literature review was used to shape the data analysis process and findings.

A solution: be clear on the approach taken to the literature review and why

Despite the clear differences in the approach to the literature review in GT, there appears to be a lack of precise guidance for novice researchers regarding how in depth or exhaustive a preliminary literature review should be. This lack of guidance can lead to a variety of different approaches as evidenced in the GT studies we have cited as examples, which is a challenge for the novice researcher. This uncertainty is further compounded by the concurrent approach to data collection and analysis which allows for the research focus to evolve as the study progresses. The complexity of the research process and the role and timing of the literature review is summarized in Figure 1 .

Literature review in Grounded Theory.

Taking a pragmatic approach, researchers will need to familiarize themselves with the literature to receive funding and approval for their study. This preliminary literature review can be followed up after data analysis by a more comprehensive review of the literature to help support the theory that was developed from the data. The key is to ensure transparency in reporting how the literature review has been used to develop the theory. The preliminary literature review can be used to set the scene for the research as part of the introduction, and the more extensive literature review can then be used during the discussion section to compare the theory developed from the data with existing literature, as per Probyn et al. 34

Whilst this pragmatic approach aligns with Straussian GT and Charmaz’s constructivist GT, it is at odds with Glaserian GT. Therefore, if Glaserian GT is chosen, the researcher should be explicit about deviation and provide a rationale.

Word count for journal articles is often a limiting factor in how much detail is included in why certain methodologies are used. Submitting detail about the methodology and rationale behind it can be presented as online supplementary material, thereby allowing interested readers to access further information about how and why the research was executed.

The use of GT as a methodology and method can shed light on areas where little knowledge is already known, generating theory directly from data. The traditional format of a published article does not always reflect the iterative approach to the literature review and data collection and analysis in GT. This can generate tension between how the research is presented in relation to how it was conducted. However, one simple way to ensure clarity in reporting is to be transparent in how the literature review is used.

The authors received no financial support for the research, authorship or publication of this article.

Conflict of interest : The authors declare that there are no conflicts of interest.

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Chapter 10: Grounded Theory

Darshini Ayton

Learning outcomes

Upon completion of this chapter, you should be able to:

• Identify the three approaches to grounded theory research.
• Define the key terms and concepts used in grounded theory research.
• Discuss the advantages and disadvantages of grounded theory research.

What is a grounded theory study?

The key concept of grounded theory is building theory .

Grounded theory studies, developed by Barney Glaser and Anselm Strauss, aim to build theory ‘from the ground up’ – meaning ‘from the data’. 1,2 For many people, the idea of developing a theory can be intimidating. 3 However, the theories generated from grounded theory studies are rarely grand theories at the level developed by, for example, philosophers Foucault or Hegel. Rather, the focus is on discovering concepts that explain social processes, actions and interactions from the collected data. 1,2 In health and social care research, this can typically take the form of a framework or typology.

Since Glaser and Strauss initiated the grounded theory approach in the 1960s, multiple competing methods have arisen from different ontological and philosophical foundations, which are outlined in Table 10.1.

Table 10.1. Grounded theory approaches

To ensure that the theory is derived from the data, researchers undertaking Classical or Straussian Grounded Theory should have no preconceived theories before starting the research – which means they should not be seeking to test a theory – they should not be constrained by the literature when coding data and they should not impose prior concepts on the data. 3 Grounded theory is therefore inductive – it generates theory – as opposed to deductive – which tests theory. 4 Theories about social processes and actions should be generated systematically through research, and ‘discovered’ from the data rather than hypothesised and tested against data. 6 , 2 Hence, grounded theory studies suit research topics in which little is known about the ‘how and why’ of social processes. 5

Multiple forms of data collection can be employed in ground theory studies, with data collection and data analysis occurring concurrently to inform theory development. 1 For example, the researcher may conduct 20 interviews, undertake the analysis and begin to form a theory, and then, based on this theory, develop an interview guide that will elicit further theoretical development as more data is collected. This process happens across multiple cycles of data collection; analysis and data collection usually stops when theoretical saturation is reached. 7 Hence, the research is iterative and evolves through the collection and analysis of data. Theoretical saturation is when all the domains or aspects of the theory have been thoroughly examined. 1 Grounded theory studies can draw on other qualitative designs – for example, a researcher can conduct a grounded theory phenomenology study or a grounded theory case study. The approach to analysis is typically the constant comparative approach. 1,2

Advantages and disadvantages of grounded theory

The advantages of grounded theory studies include that the researcher is able to be immersed in the data at a detailed level, and this immersion occurs early in the research process, to enable the constant interplay between data collection and analysis. The concept of theoretical saturation ensures that the data accounts for all elements of the theory that is generated. However, the process of theoretical sampling and the iterative nature of going back and forth between data collection and data analysis can take a long time. In creating the theory, the context of the social processes may be lost and the overall theory may lack nuance. Consequently, it can be difficult to scale up the theory to different contexts. 4,8- 10 Examples of studies employing grounded theory are shown in Table 10.2.

Table 10.2. Examples of grounded theory studies

Grounded theory is an appropriate research design to explain a process through a theory. The design incorporates multiple forms of data collection and is iterative in approach, with cycles between data collection and analysis.

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• Rieger KL. Discriminating among grounded theory approaches. Nurs Inq . 2019;26(1):e12261. doi:10.1111/nin.12261
• Hunter A, Murphy K, Grealish A, Casey D, Keady J. Navigating the grounded theory terrain. Part 2. Nurse Res . 2011;19(1):6-11. doi:10.7748/nr2011.10.19.1.6.c8765
• Liamputtong P. Qualitative Research Methods . 5th ed. Oxford University Press; 2020.
• Belgrave LL, Seide K. Grounded theory methodology: principles and practices. In: Liamputtong P, ed. Handbook of Research Methods in Health and Social Sciences . Springer; 2019.
• Markey K, Tilki M, Taylor G. Reflecting on the challenges of choosing and using a grounded theory approach. Nurse Res . 2014;22(2):16-22. doi:10.7748/nr.22.2.16.e1272
• Creswell J, Hanson W, Clark Plano V, Morales A. Qualitative research designs: selection and implementation. Couns Psychol. 2007;35(2):236-264. doi:10.1177/0011000006287390
• Liamputtong P, Ezzy D. Qualitative Research Methods: A Health Focus . Oxford University Press; 1999.
• Breckenridge JP, Gray N, Toma M, et al. Motivating Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK. BMJ Open Qual . 2019;8(2):e000553. doi:10.1136/bmjoq-2018-000553
• Jacobson N. A taxonomy of dignity: a grounded theory study. BMC Int Health Hum Rights . 2009;9:3. doi:10.1186/1472-698X-9-3

Qualitative Research – a practical guide for health and social care researchers and practitioners Copyright © 2023 by Darshini Ayton is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Grounded Theory: Approach And Examples

Grounded theory is a qualitative research approach that attempts to uncover the meanings of people’s social actions, interactions and experiences….

Grounded theory is a qualitative research approach that attempts to uncover the meanings of people’s social actions, interactions and experiences. These explanations are called ‘grounded’ because they are grounded in the participants’ own explanations or interpretations.

Barney Glaser and Anselm Strauss originated this method in their 1967 book, The Discovery Of Grounded Theory . The grounded theory approach has been used by researchers in various disciplines, including sociology, anthropology, psychology, economics and public health.

Grounded theory qualitative research was considered path-breaking in many respects upon its arrival. The inductive method allowed the analysis of data during the collection process. It also shifted focus away from the existing practice of verification, which researchers felt didn’t always produce rigorous results.

  Let’s take a closer look at grounded theory research.

What Is Grounded Theory?

How to conduct grounded theory research, features of grounded theory, grounded theory example, advantages of grounded theory.

  Grounded theory is a qualitative method designed to help arrive at new theories and deductions. Researchers collect data through any means they prefer and then analyze the facts to arrive at concepts. Through a comparison of these concepts, they plan theories. They continue until they reach sample saturation, in which no new information upsets the theory they have formulated. Then they put forth their final theory.

  In grounded theory research, the framework description guides the researcher’s own interpretation of data. A data description is the researcher’s algorithm for collecting and organizing data while also constructing a conceptual model that can be tested against new observations.

  Grounded theory doesn’t assume that there’s a single meaning of an event, object or concept. In grounded theory, you interpret all data as information or materials that fit into categories your research team creates.

  Now that we’ve examined what is grounded theory, let’s inspect how it’s conducted. There are four steps involved in grounded theory research:

• STAGE 1: Concepts are derived from interviews, observation and reflection
• STAGE 2: The data is organized into categories that represent themes or subplots
• STAGE 3: As the categories develop, they are compared with one another and two or more competing theories are identified
• STAGE 4: The final step involves the construction of the research hypothesis statement or concept map

Grounded theory is a relatively recent addition to the tools at a researcher’s disposal. There are several methods of conducting grounded theory research. The following processes are common features:

  Theoretical Memoing

  compile findings.

Data collection in the grounded theory method can include both quantitative and qualitative methods.

By now, it’s clear that grounded theory is unlike other research techniques. Here are some of its salient features:

It Is Personal

It is flexible, it starts with data, data is continually assessed.

Grounded theory qualitative research is a dynamic and flexible approach to research that answers questions other formats can’t.

Grounded theory can be used in organizations to create a competitive advantage for a company. Here are some grounded theory examples:

• Grounded theory is used by marketing departments by letting marketing executives express their views on how to improve their product or service in a structured way
• Grounded theory is often used by the HR department. For instance, they might study why employees are frustrated by their work. Employees can explain what they feel is lacking. HR then gathers this data, examines the results to discover the root cause of their problems and presents solutions
• Grounded theory can help with design decisions, such as how to create a more appealing logo. To do this, the marketing department might interview consumers about their thoughts on their logo and what they like or dislike about it. They will then gather coded data that relates back to the interviews and use this for a second iteration

These are just some of the possible applications of grounded theory in a business setting.

Its flexibility allows its uses to be virtually endless. But there are still advantages and disadvantages that make the grounded theory more or less appropriate for a subject of study. Here are the advantages:

• Grounded theory isn’t concerned with whether or not something has been done before. Instead, grounded theory researchers are interested in what participants say about their experiences. These researchers are looking for meaning
• The grounded theory method allows researchers to use inductive reasoning, ensuring that the researcher views the participant’s perspectives rather than imposing their own ideas. This encourages objectivity and helps prevent preconceived notions from interfering with the process of data collection and analysis
• It allows for constant comparison of data to concepts, which refines the theory as the research proceeds. This is in contrast with methods that look to verify an existing hypothesis only
• Researchers may also choose to conduct experiments to provide support for their research hypotheses. Through an experiment, researchers can test ideas rigorously and provide evidence to support hypotheses and theory development
• It produces a clearer theoretical model that is not overly abstract. It also allows the researcher to see the connections between cases and have a better understanding of how each case fits in with others
• Researchers often produce more refined and detailed analyses of data than with other methods
• Because grounded theory emphasizes the interpretation of the data, it makes it easier for researchers to examine their own preconceived ideas about a topic and critically analyze them.

As with any method, there are some drawbacks too that researchers should consider. Here are a few:

• It doesn’t promote consensus because there are always competing views about the same phenomenon
• It may seem like an overly theoretical approach that produces results that are too open-ended. Grounded theory isn’t concerned with whether something is true/false or right/wrong
• Grounded theory requires a high level of skill and critical thinking from the researcher. They must have a level of objectivity in their approach, ask unbiased, open-minded questions and conduct interviews without being influenced by personal views or agenda.

While professionals may never have to conduct research like this themselves, an understanding of the kinds of analytical tools available can help when there are decisions to be made in the workplace. Harappa’s Thinking Critically course can help with just this. Analytical skills are some of the most sought-after soft skills in the professional world. The earlier managers can master these, the more value they’ll bring to the organization. With our transformative course and inspiring faculty, empower your teams with the ability to think through any problem, no matter how large.

Explore Harappa Diaries to learn more about topics such as Meaning Of Halo Effect , Different Brainstorming Methods , Operant Conditioning Theory of learning and How To Improve Analytical Skills to upgrade your knowledge and skills.

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How to do a grounded theory study: a worked example of a study of dental practices

Alexandra sbaraini.

1 Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia

2 Population Oral Health, Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia

Stacy M Carter

R wendell evans, anthony blinkhorn, associated data.

Qualitative methodologies are increasingly popular in medical research. Grounded theory is the methodology most-often cited by authors of qualitative studies in medicine, but it has been suggested that many 'grounded theory' studies are not concordant with the methodology. In this paper we provide a worked example of a grounded theory project. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature.

We documented a worked example of using grounded theory methodology in practice.

We describe our sampling, data collection, data analysis and interpretation. We explain how these steps were consistent with grounded theory methodology, and show how they related to one another. Grounded theory methodology assisted us to develop a detailed model of the process of adapting preventive protocols into dental practice, and to analyse variation in this process in different dental practices.

Conclusions

By employing grounded theory methodology rigorously, medical researchers can better design and justify their methods, and produce high-quality findings that will be more useful to patients, professionals and the research community.

Qualitative research is increasingly popular in health and medicine. In recent decades, qualitative researchers in health and medicine have founded specialist journals, such as Qualitative Health Research , established 1991, and specialist conferences such as the Qualitative Health Research conference of the International Institute for Qualitative Methodology, established 1994, and the Global Congress for Qualitative Health Research, established 2011 [ 1 - 3 ]. Journals such as the British Medical Journal have published series about qualitative methodology (1995 and 2008) [ 4 , 5 ]. Bodies overseeing human research ethics, such as the Canadian Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, and the Australian National Statement on Ethical Conduct in Human Research [ 6 , 7 ], have included chapters or sections on the ethics of qualitative research. The increasing popularity of qualitative methodologies for medical research has led to an increasing awareness of formal qualitative methodologies. This is particularly so for grounded theory, one of the most-cited qualitative methodologies in medical research [[ 8 ], p47].

Grounded theory has a chequered history [ 9 ]. Many authors label their work 'grounded theory' but do not follow the basics of the methodology [ 10 , 11 ]. This may be in part because there are few practical examples of grounded theory in use in the literature. To address this problem, we will provide a brief outline of the history and diversity of grounded theory methodology, and a worked example of the methodology in practice. Our aim is to provide a model for practice, to connect medical researchers with a useful methodology, and to increase the quality of 'grounded theory' research published in the medical literature.

The history, diversity and basic components of 'grounded theory' methodology and method

Founded on the seminal 1967 book 'The Discovery of Grounded Theory' [ 12 ], the grounded theory tradition is now diverse and somewhat fractured, existing in four main types, with a fifth emerging. Types one and two are the work of the original authors: Barney Glaser's 'Classic Grounded Theory' [ 13 ] and Anselm Strauss and Juliet Corbin's 'Basics of Qualitative Research' [ 14 ]. Types three and four are Kathy Charmaz's 'Constructivist Grounded Theory' [ 15 ] and Adele Clarke's postmodern Situational Analysis [ 16 ]: Charmaz and Clarke were both students of Anselm Strauss. The fifth, emerging variant is 'Dimensional Analysis' [ 17 ] which is being developed from the work of Leonard Schaztman, who was a colleague of Strauss and Glaser in the 1960s and 1970s.

There has been some discussion in the literature about what characteristics a grounded theory study must have to be legitimately referred to as 'grounded theory' [ 18 ]. The fundamental components of a grounded theory study are set out in Table ​ Table1. 1 . These components may appear in different combinations in other qualitative studies; a grounded theory study should have all of these. As noted, there are few examples of 'how to do' grounded theory in the literature [ 18 , 19 ]. Those that do exist have focused on Strauss and Corbin's methods [ 20 - 25 ]. An exception is Charmaz's own description of her study of chronic illness [ 26 ]; we applied this same variant in our study. In the remainder of this paper, we will show how each of the characteristics of grounded theory methodology worked in our study of dental practices.

Fundamental components of a grounded theory study

Study background

We used grounded theory methodology to investigate social processes in private dental practices in New South Wales (NSW), Australia. This grounded theory study builds on a previous Australian Randomized Controlled Trial (RCT) called the Monitor Dental Practice Program (MPP) [ 27 ]. We know that preventive techniques can arrest early tooth decay and thus reduce the need for fillings [ 28 - 32 ]. Unfortunately, most dentists worldwide who encounter early tooth decay continue to drill it out and fill the tooth [ 33 - 37 ]. The MPP tested whether dentists could increase their use of preventive techniques. In the intervention arm, dentists were provided with a set of evidence-based preventive protocols to apply [ 38 ]; control practices provided usual care. The MPP protocols used in the RCT guided dentists to systematically apply preventive techniques to prevent new tooth decay and to arrest early stages of tooth decay in their patients, therefore reducing the need for drilling and filling. The protocols focused on (1) primary prevention of new tooth decay (tooth brushing with high concentration fluoride toothpaste and dietary advice) and (2) intensive secondary prevention through professional treatment to arrest tooth decay progress (application of fluoride varnish, supervised monitoring of dental plaque control and clinical outcomes)[ 38 ].

As the RCT unfolded, it was discovered that practices in the intervention arm were not implementing the preventive protocols uniformly. Why had the outcomes of these systematically implemented protocols been so different? This question was the starting point for our grounded theory study. We aimed to understand how the protocols had been implemented, including the conditions and consequences of variation in the process. We hoped that such understanding would help us to see how the norms of Australian private dental practice as regards to tooth decay could be moved away from drilling and filling and towards evidence-based preventive care.

Designing this grounded theory study

Figure ​ Figure1 1 illustrates the steps taken during the project that will be described below from points A to F.

Study design . file containing a figure illustrating the study design.

A. An open beginning and research questions

Grounded theory studies are generally focused on social processes or actions: they ask about what happens and how people interact . This shows the influence of symbolic interactionism, a social psychological approach focused on the meaning of human actions [ 39 ]. Grounded theory studies begin with open questions, and researchers presume that they may know little about the meanings that drive the actions of their participants. Accordingly, we sought to learn from participants how the MPP process worked and how they made sense of it. We wanted to answer a practical social problem: how do dentists persist in drilling and filling early stages of tooth decay, when they could be applying preventive care?

We asked research questions that were open, and focused on social processes. Our initial research questions were:

• What was the process of implementing (or not-implementing) the protocols (from the perspective of dentists, practice staff, and patients)?

• How did this process vary?

B. Ethics approval and ethical issues

In our experience, medical researchers are often concerned about the ethics oversight process for such a flexible, unpredictable study design. We managed this process as follows. Initial ethics approval was obtained from the Human Research Ethics Committee at the University of Sydney. In our application, we explained grounded theory procedures, in particular the fact that they evolve. In our initial application we provided a long list of possible recruitment strategies and interview questions, as suggested by Charmaz [ 15 ]. We indicated that we would make future applications to modify our protocols. We did this as the study progressed - detailed below. Each time we reminded the committee that our study design was intended to evolve with ongoing modifications. Each modification was approved without difficulty. As in any ethical study, we ensured that participation was voluntary, that participants could withdraw at any time, and that confidentiality was protected. All responses were anonymised before analysis, and we took particular care not to reveal potentially identifying details of places, practices or clinicians.

C. Initial, Purposive Sampling (before theoretical sampling was possible)

Grounded theory studies are characterised by theoretical sampling, but this requires some data to be collected and analysed. Sampling must thus begin purposively, as in any qualitative study. Participants in the previous MPP study provided our population [ 27 ]. The MPP included 22 private dental practices in NSW, randomly allocated to either the intervention or control group. With permission of the ethics committee; we sent letters to the participants in the MPP, inviting them to participate in a further qualitative study. From those who agreed, we used the quantitative data from the MPP to select an initial sample.

Then, we selected the practice in which the most dramatic results had been achieved in the MPP study (Dental Practice 1). This was a purposive sampling strategy, to give us the best possible access to the process of successfully implementing the protocols. We interviewed all consenting staff who had been involved in the MPP (one dentist, five dental assistants). We then recruited 12 patients who had been enrolled in the MPP, based on their clinically measured risk of developing tooth decay: we selected some patients whose risk status had gotten better, some whose risk had worsened and some whose risk had stayed the same. This purposive sample was designed to provide maximum variation in patients' adoption of preventive dental care.

Initial Interviews

One hour in-depth interviews were conducted. The researcher/interviewer (AS) travelled to a rural town in NSW where interviews took place. The initial 18 participants (one dentist, five dental assistants and 12 patients) from Dental Practice 1 were interviewed in places convenient to them such as the dental practice, community centres or the participant's home.

Two initial interview schedules were designed for each group of participants: 1) dentists and dental practice staff and 2) dental patients. Interviews were semi-structured and based loosely on the research questions. The initial questions for dentists and practice staff are in Additional file 1 . Interviews were digitally recorded and professionally transcribed. The research location was remote from the researcher's office, thus data collection was divided into two episodes to allow for intermittent data analysis. Dentist and practice staff interviews were done in one week. The researcher wrote memos throughout this week. The researcher then took a month for data analysis in which coding and memo-writing occurred. Then during a return visit, patient interviews were completed, again with memo-writing during the data-collection period.

D. Data Analysis

Coding and the constant comparative method.

Coding is essential to the development of a grounded theory [ 15 ]. According to Charmaz [[ 15 ], p46], 'coding is the pivotal link between collecting data and developing an emergent theory to explain these data. Through coding, you define what is happening in the data and begin to grapple with what it means'. Coding occurs in stages. In initial coding, the researcher generates as many ideas as possible inductively from early data. In focused coding, the researcher pursues a selected set of central codes throughout the entire dataset and the study. This requires decisions about which initial codes are most prevalent or important, and which contribute most to the analysis. In theoretical coding, the researcher refines the final categories in their theory and relates them to one another. Charmaz's method, like Glaser's method [ 13 ], captures actions or processes by using gerunds as codes (verbs ending in 'ing'); Charmaz also emphasises coding quickly, and keeping the codes as similar to the data as possible.

We developed our coding systems individually and through team meetings and discussions.

We have provided a worked example of coding in Table ​ Table2. 2 . Gerunds emphasise actions and processes. Initial coding identifies many different processes. After the first few interviews, we had a large amount of data and many initial codes. This included a group of codes that captured how dentists sought out evidence when they were exposed to a complex clinical case, a new product or technique. Because this process seemed central to their practice, and because it was talked about often, we decided that seeking out evidence should become a focused code. By comparing codes against codes and data against data, we distinguished the category of "seeking out evidence" from other focused codes, such as "gathering and comparing peers' evidence to reach a conclusion", and we understood the relationships between them. Using this constant comparative method (see Table ​ Table1), 1 ), we produced a theoretical code: "making sense of evidence and constructing knowledge". This code captured the social process that dentists went through when faced with new information or a practice challenge. This theoretical code will be the focus of a future paper.

Coding process

Memo-writing

Throughout the study, we wrote extensive case-based memos and conceptual memos. After each interview, the interviewer/researcher (AS) wrote a case-based memo reflecting on what she learned from that interview. They contained the interviewer's impressions about the participants' experiences, and the interviewer's reactions; they were also used to systematically question some of our pre-existing ideas in relation to what had been said in the interview. Table ​ Table3 3 illustrates one of those memos. After a few interviews, the interviewer/researcher also began making and recording comparisons among these memos.

Case-based memo

We also wrote conceptual memos about the initial codes and focused codes being developed, as described by Charmaz [ 15 ]. We used these memos to record our thinking about the meaning of codes and to record our thinking about how and when processes occurred, how they changed, and what their consequences were. In these memos, we made comparisons between data, cases and codes in order to find similarities and differences, and raised questions to be answered in continuing interviews. Table ​ Table4 4 illustrates a conceptual memo.

Conceptual memo

At the end of our data collection and analysis from Dental Practice 1, we had developed a tentative model of the process of implementing the protocols, from the perspective of dentists, dental practice staff and patients. This was expressed in both diagrams and memos, was built around a core set of focused codes, and illustrated relationships between them.

E. Theoretical sampling, ongoing data analysis and alteration of interview route

We have already described our initial purposive sampling. After our initial data collection and analysis, we used theoretical sampling (see Table ​ Table1) 1 ) to determine who to sample next and what questions to ask during interviews. We submitted Ethics Modification applications for changes in our question routes, and had no difficulty with approval. We will describe how the interview questions for dentists and dental practice staff evolved, and how we selected new participants to allow development of our substantive theory. The patients' interview schedule and theoretical sampling followed similar procedures.

Evolution of theoretical sampling and interview questions

We now had a detailed provisional model of the successful process implemented in Dental Practice 1. Important core focused codes were identified, including practical/financial, historical and philosophical dimensions of the process. However, we did not yet understand how the process might vary or go wrong, as implementation in the first practice we studied had been described as seamless and beneficial for everyone. Because our aim was to understand the process of implementing the protocols, including the conditions and consequences of variation in the process, we needed to understand how implementation might fail. For this reason, we theoretically sampled participants from Dental Practice 2, where uptake of the MPP protocols had been very limited according to data from the RCT trial.

We also changed our interview questions based on the analysis we had already done (see Additional file 2 ). In our analysis of data from Dental Practice 1, we had learned that "effectiveness" of treatments and "evidence" both had a range of meanings. We also learned that new technologies - in particular digital x-rays and intra-oral cameras - had been unexpectedly important to the process of implementing the protocols. For this reason, we added new questions for the interviews in Dental Practice 2 to directly investigate "effectiveness", "evidence" and how dentists took up new technologies in their practice.

Then, in Dental Practice 2 we learned more about the barriers dentists and practice staff encountered during the process of implementing the MPP protocols. We confirmed and enriched our understanding of dentists' processes for adopting technology and producing knowledge, dealing with complex cases and we further clarified the concept of evidence. However there was a new, important, unexpected finding in Dental Practice 2. Dentists talked about "unreliable" patients - that is, patients who were too unreliable to have preventive dental care offered to them. This seemed to be a potentially important explanation for non-implementation of the protocols. We modified our interview schedule again to include questions about this concept (see Additional file 3 ) leading to another round of ethics approvals. We also returned to Practice 1 to ask participants about the idea of an "unreliable" patient.

Dentists' construction of the "unreliable" patient during interviews also prompted us to theoretically sample for "unreliable" and "reliable" patients in the following round of patients' interviews. The patient question route was also modified by the analysis of the dentists' and practice staff data. We wanted to compare dentists' perspectives with the perspectives of the patients themselves. Dentists were asked to select "reliable" and "unreliable" patients to be interviewed. Patients were asked questions about what kind of services dentists should provide and what patients valued when coming to the dentist. We found that these patients (10 reliable and 7 unreliable) talked in very similar ways about dental care. This finding suggested to us that some deeply-held assumptions within the dental profession may not be shared by dental patients.

At this point, we decided to theoretically sample dental practices from the non-intervention arm of the MPP study. This is an example of the 'openness' of a grounded theory study potentially subtly shifting the focus of the study. Our analysis had shifted our focus: rather than simply studying the process of implementing the evidence-based preventive protocols, we were studying the process of doing prevention in private dental practice. All participants seemed to be revealing deeply held perspectives shared in the dental profession, whether or not they were providing dental care as outlined in the MPP protocols. So, by sampling dentists from both intervention and control group from the previous MPP study, we aimed to confirm or disconfirm the broader reach of our emerging theory and to complete inductive development of key concepts. Theoretical sampling added 12 face to face interviews and 10 telephone interviews to the data. A total of 40 participants between the ages of 18 and 65 were recruited. Telephone interviews were of comparable length, content and quality to face to face interviews, as reported elsewhere in the literature [ 40 ].

F. Mapping concepts, theoretical memo writing and further refining of concepts

After theoretical sampling, we could begin coding theoretically. We fleshed out each major focused code, examining the situations in which they appeared, when they changed and the relationship among them. At time of writing, we have reached theoretical saturation (see Table ​ Table1). 1 ). We have been able to determine this in several ways. As we have become increasingly certain about our central focused codes, we have re-examined the data to find all available insights regarding those codes. We have drawn diagrams and written memos. We have looked rigorously for events or accounts not explained by the emerging theory so as to develop it further to explain all of the data. Our theory, which is expressed as a set of concepts that are related to one another in a cohesive way, now accounts adequately for all the data we have collected. We have presented the developing theory to specialist dental audiences and to the participants, and have found that it was accepted by and resonated with these audiences.

We have used these procedures to construct a detailed, multi-faceted model of the process of incorporating prevention into private general dental practice. This model includes relationships among concepts, consequences of the process, and variations in the process. A concrete example of one of our final key concepts is the process of "adapting to" prevention. More commonly in the literature writers speak of adopting, implementing or translating evidence-based preventive protocols into practice. Through our analysis, we concluded that what was required was 'adapting to' those protocols in practice. Some dental practices underwent a slow process of adapting evidence-based guidance to their existing practice logistics. Successful adaptation was contingent upon whether (1) the dentist-in-charge brought the whole dental team together - including other dentists - and got everyone interested and actively participating during preventive activities; (2) whether the physical environment of the practice was re-organised around preventive activities, (3) whether the dental team was able to devise new and efficient routines to accommodate preventive activities, and (4) whether the fee schedule was amended to cover the delivery of preventive services, which hitherto was considered as "unproductive time".

Adaptation occurred over time and involved practical, historical and philosophical aspects of dental care. Participants transitioned from their initial state - selling restorative care - through an intermediary stage - learning by doing and educating patients about the importance of preventive care - and finally to a stage where they were offering patients more than just restorative care. These are examples of ways in which participants did not simply adopt protocols in a simple way, but needed to adapt the protocols and their own routines as they moved toward more preventive practice.

The quality of this grounded theory study

There are a number of important assurances of quality in keeping with grounded theory procedures and general principles of qualitative research. The following points describe what was crucial for this study to achieve quality.

During data collection

1. All interviews were digitally recorded, professionally transcribed in detail and the transcripts checked against the recordings.

2. We analysed the interview transcripts as soon as possible after each round of interviews in each dental practice sampled as shown on Figure ​ Figure1. 1 . This allowed the process of theoretical sampling to occur.

3. Writing case-based memos right after each interview while being in the field allowed the researcher/interviewer to capture initial ideas and make comparisons between participants' accounts. These memos assisted the researcher to make comparison among her reflections, which enriched data analysis and guided further data collection.

4. Having the opportunity to contact participants after interviews to clarify concepts and to interview some participants more than once contributed to the refinement of theoretical concepts, thus forming part of theoretical sampling.

5. The decision to include phone interviews due to participants' preference worked very well in this study. Phone interviews had similar length and depth compared to the face to face interviews, but allowed for a greater range of participation.

During data analysis

1. Detailed analysis records were kept; which made it possible to write this explanatory paper.

2. The use of the constant comparative method enabled the analysis to produce not just a description but a model, in which more abstract concepts were related and a social process was explained.

3. All researchers supported analysis activities; a regular meeting of the research team was convened to discuss and contextualize emerging interpretations, introducing a wide range of disciplinary perspectives.

Answering our research questions

We developed a detailed model of the process of adapting preventive protocols into dental practice, and analysed the variation in this process in different dental practices. Transferring evidence-based preventive protocols into these dental practices entailed a slow process of adapting the evidence to the existing practices logistics. Important practical, philosophical and historical elements as well as barriers and facilitators were present during a complex adaptation process. Time was needed to allow dentists and practice staff to go through this process of slowly adapting their practices to this new way of working. Patients also needed time to incorporate home care activities and more frequent visits to dentists into their daily routines. Despite being able to adapt or not, all dentists trusted the concrete clinical evidence that they have produced, that is, seeing results in their patients mouths made them believe in a specific treatment approach.

Concluding remarks

This paper provides a detailed explanation of how a study evolved using grounded theory methodology (GTM), one of the most commonly used methodologies in qualitative health and medical research [[ 8 ], p47]. In 2007, Bryant and Charmaz argued:

'Use of GTM, at least as much as any other research method, only develops with experience. Hence the failure of all those attempts to provide clear, mechanistic rules for GTM: there is no 'GTM for dummies'. GTM is based around heuristics and guidelines rather than rules and prescriptions. Moreover, researchers need to be familiar with GTM, in all its major forms, in order to be able to understand how they might adapt it in use or revise it into new forms and variations.' [[ 8 ], p17].

Our detailed explanation of our experience in this grounded theory study is intended to provide, vicariously, the kind of 'experience' that might help other qualitative researchers in medicine and health to apply and benefit from grounded theory methodology in their studies. We hope that our explanation will assist others to avoid using grounded theory as an 'approving bumper sticker' [ 10 ], and instead use it as a resource that can greatly improve the quality and outcome of a qualitative study.

Abbreviations

GTM: grounded theory methods; MPP: Monitor Dental Practice Program; NSW: New South Wales; RCT: Randomized Controlled Trial.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

All authors have made substantial contributions to conception and design of this study. AS carried out data collection, analysis, and interpretation of data. SMC made substantial contribution during data collection, analysis and data interpretation. AS, SMC, RWE, and AB have been involved in drafting the manuscript and revising it critically for important intellectual content. All authors read and approved the final manuscript.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2288/11/128/prepub

Supplementary Material

Initial interview schedule for dentists and dental practice staff . file containing initial interview schedule for dentists and dental practice staff.

Questions added to the initial interview schedule for dentists and dental practice staff . file containing questions added to the initial interview schedule

Questions added to the modified interview schedule for dentists and dental practice staff . file containing questions added to the modified interview schedule

Acknowledgements

We thank dentists, dental practice staff and patients for their invaluable contributions to the study. We thank Emeritus Professor Miles Little for his time and wise comments during the project.

The authors received financial support for the research from the following funding agencies: University of Sydney Postgraduate Award 2009; The Oral Health Foundation, University of Sydney; Dental Board New South Wales; Australian Dental Research Foundation; National Health and Medical Research Council Project Grant 632715.

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Grounded theory is a research methodology that involves developing a theory or model based on empirical data. As its name suggests, its primary goal is to devise a theory that is grounded in the data and reflects the perspectives the people being studied. In grounded theory, data is collected through a process of constant analysis. Researchers compare new insights to existing data and revise their understanding until a clear theory emerges.

Want to develop a novice theory, but there is no available literature on the topic? Grounded theory will be your best bet if there are no existing hypotheses. In this guide, we will shed more light on this type of method and walk you through each step of the process. They say, grounded theory is a complex method. However after reading our blog post, you will realize that it’s not rocket science. But first things first, let’s start with a definition!

What Is Grounded Theory: Definition

Grounded theory (GT) is a popular research methodology used to develop a theory based on analysis of collected data. This research method is rather popular and can be applied in various studies. It is primarily used to understand behavioral patterns within a population.  Grounded theory was founded by Glaser and Strauss. They were the first researchers who offered a comparative method for qualitative data analysis. This ‘invention’ was a real breakthrough in the research field since they proved that a theory can be produced inductively. The researchers challenged the traditional viewpoint that only quantitative data can be integrated to generate a hypothesis.

Types of Grounded Theory in Research

There are 3 main types of grounded theory in research:

• Traditional This genre is otherwise known as classical GT. The main idea behind this approach is to develop a new theory after studying data. Coding (categorizing and numbering obtained data) is strictly inductive.
• Evolved Modified GT is more systematic than a classical approach. It focuses more on how to structure data obtained during research. The use of extra literature isn’t common.
• Constructivist Constructivist grounded theory relies more on researchers’ interpretation of the gathered data. This research method is aimed at understanding social patterns when no other study can’t explain it.

Grounded Theory Approach

Grounded theory approach is employed to refine the knowledge base. It helps to get new insights or develop hypotheses through systematic analysis. This approach is used when there is not much information on some phenomenon. Here are several distinct characteristics of a grounded theory approach: 

• Ideas appear from the collected data, not theoretical framework .
• Inductive methods are preferred over deductive ones.
• Codes sum up ideas and form categories.
• Theory is generated on the basis of categories.

As you can see, this method is the exact opposite of traditional studies that use theoretical frameworks. Here, you should first collect the data and then form a hypothesis, not the other way around. 

Grounded Theory Methodology

The grounded theory method begins with observation. As was mentioned earlier, you have to collect data prior to analyzing it. There are several ways of gathering the key information:

• Focus groups
• Participant observation.

Once your data is shovel-ready, you will be all set to code it. Data analysis methods applied in GT include: 

• Coding : determining the key properties to group elements by.
• Categorization : grouping similar ideas to form a hypothesis.
• Theoretical sampling : refining and adjusting categories.
• Memoing : writing down field notes that back up analysis.
• Integration : refined categories lay the basis for theoretical framework.

Important notice : you should collect and analyze data simultaneously. Grounded theory methods are flexible, so you can change a direction at any time. 

Grounded Theory Study: How It Works

Now that you know the main methods, let’s discuss how to build a grounded theory. There is an exact order you should follow. You basically should go all the way from sampling to hypothesis generation. Still, some procedures should take place during the whole course of study. In this regard, GT is more complicated than a simple linear process. So make sure you stick to our guidelines described below to run a successful study.

Purposive Sampling

Before gathering and analyzing data for a grounded theory study, you should conduct a purposive sampling. This type of sampling involves being selective. This way, you will be able to get answers from the right population. Use your own judgment when selecting participants for research. Here, you should pick those individuals that better fit your purpose.  Your results shouldn’t necessarily be statistically representative. However, you should carefully choose members to ensure that your qualitative data can be generalized.

Data Generation & Comparative Analysis in Grounded Theory

As noted above, both data collection and analysis should happen concurrently in grounded theory research. GT was initially designed to promote the idea that qualitative data can also be useful in generating hypotheses. That being said, you can gather both quantitative and qualitative research data. At the same time, you should also make constant comparative analysis. This process involves comparing the codes and categories (more on this below).

Grounded Theory Coding

Coding is the main data analysis technique used in grounded theory study. Coding in GT is an analytical process of assigning labels and categories. This analysis method allows us to structure qualitative data. There are 3 types of coding that make separate stages in GT:

• Initial coding (open coding) At this stage, researchers carefully go through the transcripts trying to recognize the key components. Later, these elements will form subcategories.
• Intermediate coding (axial coding) The main task of this stage is to identify a relationship between the initial codes. You will have to organize the codes and group them into categories.
• Advanced coding (selective coding) Selective coding is the last step in GT where you should find a connection between all categories. You will form a core category for developing a theory.

Once all categories are saturated and you don’t discover any additional details, you will be ready to build a grounded theory. This final point is called theoretical sensitivity. In other words, it’s an insight you get after analyzing all available data.

Theoretical Sampling

Sometimes, during grounded theory development you may need to generate more data. That’s when theoretical sampling comes into play. Theoretical sampling is a process that allows to add more categories or refine the existing ones. You may need it during any stage of data analysis. That’s when you will do data collection again.  For example, you may study participants’ reaction to a new treatment method. Then, you conduct an interview and do initial coding. Then, you notice that participants' overall well-being also improves. At this stage, you want to do theoretical sampling and ask more questions to see if this treatment has other positive effects.

Memoing in Grounded Theory Research

Memoing is an important part of any grounded theory research design . You will be writing the field notes during the entire process. Whether you decide to extract more details or organize your data, you should document each step. Memos, or notes, are written reflective pieces that allow you to track your ideas.

Grounded Theory Example

Let’s have a closer look at a grounded theory research example so you can see a complete picture.

Example Researchers want to observe teenagers’ recovery from anxiety attacks using a special therapy. They decided to do GT, because no qualitative data was considered before. They interviewed each participant and carefully read all the transcripts. Then, they identified similar components that later formed categories. Researchers found a core category that helped to develop a GT.

Grounded Theory Research Pros and Cons

As an alternative to a classical method, GT has many benefits. However, you should also be aware of its limitations. This will ensure that you choose the best strategy.

                               Grounded theory advantages and disadvantages

Grounded Theory: Final Thoughts

By using grounded theory research, you can generate a hypothesis emerging from data. This approach requires that you strictly follow the process and make a comparative analysis. Make sure you go through each stage of coding and you will be awarded with a unique idea on social phenomena.

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FAQ About Grounded Theory Qualitative Research

1. what topics are better suited for phenomenological and grounded theory.

Grounded theory is better suited to understand social phenomena that haven’t been studied before. This approach allows us to examine understudied social processes and develop a hypothesis on the topic. Phenomenological research deals with all topics related to human experiences from a participant’s perspective.

2. What is the difference between grounded theory and thematic analysis?

Grounded theory is an approach that helps to generate a hypothesis grounded in data though comparative analysis. Thematic analysis is a data analysis method that allows to determine similar patterns during careful reading of transcripts. This method is widely used in GT.

3. Does grounded theory have research questions?

Unlike other types of studies, grounded theory doesn’t have research questions that define the scope of the research process. Here, it is research that produces a question.

4. What is a grounded theory research design?

Grounded theory research design is a method of hypothesis generation with the help of concurrent data collection and analysis. This approach was offered to suggest that qualitative data can also be used to build theoretical knowledge. It’s widely used when there are no existing ideas on the topic.

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What is Grounded Theory?

Grounded theory is:

How do you do grounded theory.

• Is it for me?
• a research method that will enable you to:
• develop a theory which
• offers an explanation about
• the main concern of the population of your substantive area and
• how that concern is resolved or processed.

For example in my PhD study, the main concern of online learners is finding the time to study and temporal integration is the core category which explains how the concern is resolved or processed. Different types of learners employ different strategies: Jugglers and Strugglers employ successful temporal integration strategies which enable them to study (with more or less pain), whilst Fade-aways and Leavers are unsuccessful and fail to complete the programme. Understanding how temporal integration does or does not happen has implications for learning design and learner persistence.

For the nurses of Nathanial’s study, their main concern was moral distress and the core category which processed their concern was moral reckoning. For McCallin’s interdisciplinary teams the main concern was client service delivery and the core category – pluralistic dialoguing. We recommend that you read these studies to get an idea of what a grounded theory is – and is not. You will find many good examples of grounded theory in this Reader.

Grounded Theory is simply the discovery of emerging patterns in data. Grounded Theory is the generation of theories from data. (Glaser in Walsh, Holton et al 2015)

Grounded theory is a general research method

(and thus is not owned by any one school or discipline); which guides you on matters of data collection and details rigorous procedures for data analysis. You can use quantitative data; or qualitative data of any type e.g. video, images, text, observations, spoken word etc.

Grounded theory is a research tool which enables you to seek out and conceptualise the latent social patterns and structures of your area of interest through the process of constant comparison. Initially you will use an inductive approach to generate substantive codes from your data, later your developing theory will suggest to you where to go next to collect data and which, more-focussed, questions to ask. This is the deductive phase of the grounded theory process. (See page 37 of Theoretical Sensitivity ).

Grounded theory is first and foremost a research method. But the term ‘grounded theory’ is used in two ways :

• If you adhere to the strictures of grounded-theory-the-research-method you will engage in a research process that will produce;
• A theory-which-is-grounded-in-data ie. a grounded theory.

Thus both the research method and the output of the research process have the same name, which can be confusing!

A Grounded theory is the study of a concept (the core category).

The problem is that from this perspective, you are not going to know what you are studying until you have completed a significant amount of analysis: the core category is the concept to which all other concepts relate; and its discovery signals the end of the open coding stage.

The core category names a pattern of behaviour and in this pattern “you are going to see the general implications”. Listen to Barney Glaser explain in this video.

Grounded theory is therefore also an exploratory method.

As such it requires its own research design.

We can help! Find out more about mentoring and  progress your study with Fellows of the Grounded Theory Institute .

Helen Scott PhD 1 November, 2009 

The methodological stages are:

1. Identify your substantive area

This is your area of interest. Examples of substantive areas included dying in hospitals in the United States ( Glaser, 1967 ), online learning ( Scott, 2007 ), a cafe ( Rosenbaum, 2006 ), nursing practice ( Nathanial,2007 ), management studies ( Holton, 2007 ), work practices in journalism ( Gynnild, 2007 ), interdisciplinary teams in health services ( McCallin, 2007 ).Your study will be from the perspective of one of the groups of people of the substantive area. This group will  be your substantive population e.g. nurses (Glaser 1967), online learners (Scott 2007), nurses who have practiced in direct contact with patients (Nathanial, 2007), knowledge workers (Holton, 2007 ) journalists (Gynnild, 2006), health professionals (McCallin, 2007).

2. Collect data pertaining to the substantive area

A grounded theory may use qualitative data, quantitative data (e.g. Glaser 1964 and Glaser 2008 ) or a mixture of the two. Thus data types include but are not restricted to: collecting observations of the substantive area itself and activities occurring within the substantive area; accessing public or private record irrespective of form e.g. photograph, diary, painting, sculpture, biography, television broadcast, news report, survey, government or organisational document; conversing with individuals or a group of individuals, face-to-face or remotely either synchronously e.g. using video, audio or text chat, or asynchronously e.g using email or message forum.

3. Open code your data as you collect it.

Open coding and data collection are integrated activities thus the data collection stage and open coding stage occur simultaneously and continue until the core category is recognised/selected. (Note: there may be more than one potential core category). Open coding simply means code everything for everything – more on that in the section on  getting started . Eventually, as a result of your hard work and systematic analysis , the core category and the main concern emerge. It’s not magic! The core category is the concept which explains the behaviour in the substantive area i.e. it explains how the main concern is resolved or processed. For example in my study the main concern was finding time to study and the core category was ‘temporal integration’. See Chapter 4 of Theoretical Sensitivity and Chapter 9 of Doing Grounded Theory for guidance on open coding (1) .

4. Write memos throughout the entire process;

The development of your theory is captured in your memos; few memos = thin theory. Method memos chronicle tussles with the method and help write the chapter on method. But most importantly theoretical memos are written about concepts and their (potential) relationships with other concepts. It’s a low risk activity, so don’t be concerned about writing ‘bad’ memos; your memos will mature as your skill and your theory develop. For excellent guidance on how to write memos see Chapter 5 of “Theoretical Sensitivity” and in particular page 89.

5. Conduct selective coding and theoretical sampling;

Now that the core category and main concern are recognised; open coding stops and selective coding – coding only for the core category and related categories – begins. Further theoretical sampling is directed by the developing theory (who do I need to ask to learn more about these issues?). and the data used to saturate the core category and related categories. See page 141 of “Doing Grounded Theory” for an explanation of when a code can be considered saturated and page 52 of Discovery for a discussion on comparison groups. When your categories are saturated:

6. Sort your memos to find the theoretical code(s) which best organise your substantive codes.

(See Chapter 4 of “Theoretical Sensitivity” and Grounded Theory Perspectives III: theoretical coding ). Sorting is another low risk activity and can be done several times: for instance, you might sort to find the gaps in your theory or in order to write a working paper. When you feel that your theory is well formed…

7. Read the literature and integrate with your theory through selective coding

8. write up your theory..

If you follow the method as Glaser describes, you will end up with a theory. The quality of that theory will depend upon your skills and the skills you develop as you research.

Helen Scott PhD 1 November, 2009

(1) These are just two examples of where Glaser discusses open coding … there are others, these are offered as a guide.

This site recognises classic grounded theory as originated by Glaser and Strauss in 1967 and further explained and developed by Glaser over the following half a century. For nearly three decades Glaser has sought to differentiate between grounded theory and those methods which call themselves either grounded theory or a type of grounded theory but which he did not develop. Navigating your way to an understanding of the differences can be difficult and Antoinette McCallin has put together some guidance as to which ‘grounded theory’ might be for you.

Which grounded theory?

Dr antoinette mccallin.

Grounded theory is the most popular research method used by qualitative researchers in the social sciences. While the methodology originated in sociology (Glaser & Strauss, 1967 ) it has been applied to numerous disciplines since. Researchers outside of sociology have remodelled – adopted and adapted – the methodology to fit their own disciplinary knowledge generation. As a result, there are different methods all carrying the name grounded theory and sorting out the differences is important for the novice grounded theorist.

What sort of grounded theorist are you? How do you know? Are there any pointers that might help you identify your methodological fit? It is really important to clarify what type of grounded theorist you might be right from the beginning.

The easiest way to begin is to scan several seminal works. Essentially, methodological choice can be limited to three main versions. While Morse et al. (2009) suggest there are many more versions of the methodology, the most popular choices are:

• Glaser   (1978, 1998, 2001, 2003, 2005)
• Strauss and Corbin (1998) or Corbin and Strauss (2008)
• Charmaz (2006, 2009, 2014).

Where do you begin?

I recommend a quick perusal of Glaser (1998). If you are what is now known as a “classic” grounded theorist you will quickly understand what Glaser has to say about research, and appreciate his comments on participants identifying the research problem. Going into a research project prepared to put professional interests aside in the interests of participants identifying their concern in a particular situation will be an attractive way to start researching. You will welcome the notion of “trusting in emergence”, have no difficulty at all coping with constant comparison of data, and be sensitive to the fact that knowledge development surely begins with knowledge generation rather that knowledge verification. The suggestion that classic grounded theory is a-philosophical is likely significant. Perhaps you already understand that you are very different to phenomenological researchers who want to study philosophy in-depth? The focus on identifying group patterns of behaviour in grounded theory will appeal. Above all, referral to conceptualisation and generating a theoretical explanation of a substantive area will not send you running for the hills. Those beliefs will resonate with you and how you see your world. This type of grounded theorist wants to look at the whole and is respectful of the timelessness of this version of grounded theory. If you are still not sure there are some excellent examples of Glaser’s grounded theory in Glaser and Holton (2007) and in Artinian, Giske, and Cone (2009).

If you are unconvinced though it might be wise to read further. For instance, if you began arguing with me as you read that last paragraph, it may well be you are not a classic grounded theorist after all. You might be more at home with the Strauss and Corbin model (Strauss & Corbin, 1998; Corbin & Strauss, 2008) that provides intricate detail about specific research techniques and procedures. Their axial coding model, which studies conditions and dimensions of a situation, appeals to many potential grounded theory researchers. You may not end up with a theory that explains what is meaningful to the participants managing a problem, but you will be carefully guided through the research process. Students right across the world have found this version of grounded theory helpful. Glaser ( 1992 ) criticises it on the grounds that it emphasises “forced conceptual description” (p. 5). Nonetheless, this form of grounded theory appeals to researchers that want a clear philosophical base for theory development. Reference to symbolic interactionism will comfort you, your supervisors, not to mention your dissertation committee, as will the coding paradigm with all its intricacies. Structured detail reassures the novice researcher and provides clear boundaries of what to look for in specific situations, how, where, when, and why. If line by line analysis has you sighing with pleasure this model may be for you. If, on the other hand, detail tests your patience, if you are concerned that the participant voice may not be heard in your research, there is another option.

Maybe the specific techniques of the Strauss and Corbin model are too constraining? Perhaps you are a person who needs a flexible approach for your research? Possibly you are already impatient with the notion of constant comparative analysis? If that sounds like you, there is a popular alternative with the Charmaz (2006, 2009) constructivist version of grounded theory. Do you value individual’s story telling? Do you come alive when you can analyse an individual’s interpretation of an experience? Do you become argumentative when a “classic” grounded theorist states his or her research question is: “what is the main concern of ….. and how do you manage that”. The idea that individuals might have one main concern offends you and any mention of “managing a situation” is insensitive. Charmaz’s argument that there are multiple realities in the world and “generalisation are partial, conditional and situated in time and space” (p. 141) interests you. Co-constructing data with your participants and recognising the subjectivity that influences their lives is in keeping with your value system. Conceptualisation and the idea of finding a core category is much less interesting, as is presenting an abstract account of an experience. What is important is the participant’s narrative. Rich, accurate detailed descriptions are much more meaningful. Themes, not concepts and categories, are attractive, as is the notion of locating your participants in a world where the emphasis is on external locus of controls. This makes sense to you. If the freedom to situate participants under the banner of constructivism draws you, themes tempt you, and finding a core category upsets you, this version might appeal.

These observations come from working alongside students trying to find their place in grounded theory methodology. The rule of thumb is that, if a particular version of grounded theory appeals to you, you will read more and more. Reading as much as you can comes easily. If, though you struggle to understand a version from page two, your attention wanders, and you find yourself arguing with the writer, there is likely a dissonance between your innate belief systems, your way of thinking, and that particular version.

Your patterns of thinking influence who you become as a researcher. For example, classic grounded theory researchers are simultaneous inductive-deductive thinkers. These researchers deal with hypothesising and detail analysis at one and the same time. Strauss and Corbin grounded theorists that struggle with abstract theory development are strong concrete thinkers, while Charmaz grounded theorists are at ease with interpretive analysis, ill at ease with critical analysis.

As you check out the different versions be careful not to force yourself into a mould to please others for whatever reason. Finding your true identity as a researcher is crucial for the successful completion of your project. Adopting a methodology that is incongruent with your innate value system and way of thinking is unhealthy. If methodological choice is at odds with who you are, problems will emerge during data analysis, which is a clear indicator of thinking ability.

Artinian, B. M., Giske, T., & Cone, P. H. (2009). Glaserian grounded theory in nursing research: Trusting emergence. New York: Springer. Charmaz, K. (2006). Constructing grounded theory. A practical guide through qualitative analysis. London: Sage. Charmaz, K. (2009). Shifting the grounds: Constructivist grounded theory methods. In J. M. Morse, P. N. Stern, J. M. Corbin, B. Bowers, & A. E. Clarke, (Eds.). Developing grounded theory: The second generation (pp. 127-154). Walnut Creek, CA: University of Arizona Press. Corbin, J. A., & Strauss, A. (2008). Basics of qualitative research, 3rd ed. Thousand Oaks, CA: Sage. Glaser, B. G. (1992). Emergence vs forcing: Basics of grounded theory analysis. Mill Valley, CA: Sociology Press. Glaser, B. G. (2001). The grounded theory perspective: Conceptualization contrasted with description. Mill Valley, CA: Sociology Press. Glaser, B. G. (2002). Constructivist grounded theory? Forum Qualitative Social Research, 3(3). Glaser, B. G. (2003). The grounded theory perspective 11: Description’s remodelling of grounded theory. Mill Valley, CA: Sociology Press. Glaser, B. G. (2005). The grounded theory perspective 3: Theoretical coding. Mill Valley, CA: Sociology Press. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine Publishing. Glaser, B. G., & Holton, J. (Eds.). (2007). The Grounded Theory Seminar Reader. Mill Valley, CA: Sociology Press Morse, J.M., Stern, P.N., Corbin, J.M., Bowers, B., & Clarke, A.E. (2009). Developing grounded theory: The second generation. Walnut Creek, CA: University of Arizona Press.

© Antoinette McCallin, December 2009

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Core *Classic* Grounded Theory Texts

Books of World GT Day presenters, chairs and panelists

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The Varieties of Grounded Theory   US link    UK link

The SAGE Handbook of Grounded Theory US link   UK link

The SAGE Handbook of Current Developments in Grounded Theory Second Edition US link   UK link

Doing Grounded Theory: Issues & Discussion US link    UK link

Constructing Grounded Theory (Introducing Qualitative Methods series) Second Edition US link   UK link

Rediscovering Grounded Theory 1st Edition US link UK link

Situational Analysis: Grounded Theory After the Interpretive Turn Second Edition US link    UK link

Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory 4th edition US link    UK link

Grounded Theory. Zur sozialtheoretischen und epistemologischen Fundierung eines pragmatistischen Forschungsstils  UK link

Grounded Theory: A Practical Guide Second Edition  US link   UK link

Grounded Theory for Qualitative Research: A Practical Guide 1st Edition US link    UK link

Grounded Theory: The Philosophy, Method, and Work of Barney Glaser US link   UK link

Grounded Theory: Simple Definition and Examples

Design of Experiments > Grounded Theory

What is Grounded Theory?

Grounded theory involves the collection and analysis of data. The theory is “grounded” in actual data, which means the analysis and development of theories happens after you have collected the data. It was introduced by Glaser & Strauss in 1967 to legitimize qualitative research . However, it’s use isn’t limited to qualitative studies; it is a general method that can be applied to many areas of research.

To start the grounded theory process, you should:

• Identify the area of interest.
• Avoid preconceived theories and focus on the data only.
• Use theoretical sensitivity — an awareness of subtle messages and meanings in data.

Research stops when you have reached theoretical saturation : the point where you have sampled and analyzed your data until you have exhausted all theories and uncovered all data.

Grounded theory commonly uses the following data collection methods :

• Interviewing participants with open-ended questions.
• Participant Observation (fieldwork) and/or focus groups.
• Study of Artifacts and Texts

The general theory can be broken down into two parts: methods and products.

Grounded theory provides qualitative researchers with guidelines for collecting and analyzing data. Although there are “probably as many versions of grounded theory as there were grounded theorists” (Dey, 1999), all of the versions have the following aspects in common (Charmaz, 2006):

• Coding (labeling and categorizing) from collected data instead of relying on theories not grounded in data.
• Social processes are discovered in the data.
• Abstract categories are constructed inductively .
• Categories are refined using theoretical sampling.
• The gap between coding and writing is bridged with analytical memos.
• Categories are integrated into a theoretical framework.

In order to say that your research is based in grounded theory you must follow the explicit, sequential guidelines. Employing just one or two methods does not make the study “grounded.”

Data analysis should happen at the same time as data collection . In other words, you shouldn’t wait until all your data is collected before analyzing it; these methods should be fluid and change if your data uncovers a new theory or potential direction. This type of concurrent data analysis and data collection is often referred to as constant comparative analysis and theoretical sampling .

Coding should be line by line, open coding : read through data several times, creating summaries for the data using preliminary labels. Axial coding is used to create conceptual families from the summaries, followed by selective coding which turns the families into a formal framework with a variable that includes all of the collected data. See this blog post for some great examples of these coding types.

Beyer, W. H. CRC Standard Mathematical Tables, 31st ed. Boca Raton, FL: CRC Press, pp. 536 and 571, 2002. Agresti A. (1990) Categorical Data Analysis. John Wiley and Sons, New York. Kotz, S.; et al., eds. (2006), Encyclopedia of Statistical Sciences , Wiley. Wheelan, C. (2014). Naked Statistics . W. W. Norton & Company

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Your complete guide to grounded theory research.

11 min read If you have an area of interest, but no hypothesis yet, try grounded theory research. You conduct data collection and analysis, forming a theory based on facts. Read our ultimate guide for everything you need to know.

What is grounded theory in research?

Grounded theory is a systematic  qualitative research  method that collects empirical data first, and then creates a theory ‘grounded’ in the results.

The constant comparative method was developed by Glaser and Strauss, described in their book, Awareness of Dying (1965). They are seen as the founders of classic grounded theory.

Research teams use grounded theory to analyse social processes and relationships.

Because of the important role of data, there are key stages like data collection and data analysis that need to happen in order for the resulting data to be useful.

The grounded research results are compared to strengthen the validity of the findings to arrive at stronger defined theories. Once the data analysis cannot continue to refine the new theories down, a final theory is confirmed.

Grounded research is different from experimental research or scientific inquiry as it does not need a hypothesis theory at the start to verify. Instead, the evolving theory is based on facts and evidence discovered during each stage.Also, grounded research also doesn’t have a preconceived understanding of events or happenings before the qualitative research commences.

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When should you use grounded theory research?

Grounded theory research is useful for businesses when a researcher wants to look into a topic that has existing theory or no current research available. This means that the qualitative research results will be unique and can open the doors to the social phenomena being investigated.

In addition, businesses can use this qualitative research as the primary evidence needed to understand whether it’s worth placing investment into a new line of product or services, if the research identifies key themes and concepts that point to a solvable commercial problem.

Grounded theory methodology

There are several stages in the grounded theory process:

1. Data planning

The researcher decides what area they’re interested in.

They may create a guide to what they will be collecting during the grounded theory methodology. They will refer to this guide when they want to check the suitability of the qualitative data, as they collect it, to avoid preconceived ideas of what they know impacting the research.

A researcher can set up a grounded theory coding framework to identify the correct data. Coding is associating words, or labels, that are useful to the social phenomena that is being investigated. So, when the researcher sees these words, they assign the data to that category or theme.

In this stage, you’ll also want to create your open-ended initial research questions. Here are the main differences between open and closed-ended questions:

These will need to be adapted as the research goes on and more tangents and areas to explore are discovered. To help you create your questions, ask yourself:

• What are you trying to explain?
• What experiences do you need to ask about?
• Who will you ask and why?

2. Data collection and analysis

Data analysis  happens at the same time as data collection. In grounded theory analysis, this is also known as constant comparative analysis, or theoretical sampling.

The researcher collects qualitative data by asking open-ended questions in interviews and surveys, studying historical or archival data, or observing participants and interpreting what is seen. This collected data is transferred into transcripts.

The categories or themes are compared and further refined by data, until there are only a few strong categories or themes remaining. Here is where coding occurs, and there are different levels of coding as the categories or themes are refined down:

• Data collection (Initial coding stage): Read through the data line by line
• Open coding stage: Read through the transcript data several times, breaking down the qualitative research data into excerpts, and make summaries of the concept or theme.
• Axial coding stage: Read through and compare further data collection to summarise concepts or themes to look for similarities and differences. Make defined summaries that help shape an emerging theory.
• Selective coding stage: Use the defined summaries to identify a strong core concept or theme.

Image from StatisticsHowTo.com

During analysis, the researcher will apply theoretical sensitivity to the collected data they uncover, so that the meaning of nuances in what they see can be fully understood.

This coding process repeats until the researcher has reached theoretical saturation. In grounded theory analysis, this is where all data has been researched and there are no more possible categories or themes to explore.

3. Data analysis is turned into a final theory

The researcher takes the core categories and themes that they have gathered and integrates them into one central idea (a new theory) using selective code. This final grounded theory concludes the research.

The new theory should be a few simple sentences that describe the research, indicating what was and was not covered in it.

An example of using grounded theory in business

One example of how grounded theory may be used in business is to support HR teams by analysing data to explore reasons why people leave a company.

For example, a company with a high attrition rate that has not done any research on this area before may choose grounded theory to understand key reasons why people choose to leave.

Researchers may start looking at the quantitative data around departures over the year and look for patterns. Coupled with this, they may conduct qualitative data research through  employee engagement surveys , interview panels for current employees, and  exit interviews  with leaving employees.

From this information, they may start coding transcripts to find similarities and differences (coding) picking up on general themes and concepts. For example, a group of excepts like:

• “The hours I worked were far too long and I hated traveling home in the dark”
• “My manager didn’t appreciate the work I was doing, especially when I worked late”
• There are no good night bus routes home that I could take safely”

Using open coding, a researcher could compare excerpts and suggest the themes of managerial issues, a culture of long hours and lack of traveling routes at night.

With more samples and information, through axial coding, stronger themes of lack of recognition and having too much work (which led people to working late), could be drawn out from the summaries of the concepts and themes.

This could lead to a selective coding conclusion that people left because they were ‘overworked and under-appreciated’.

With this information, a grounded theory can help HR teams look at what teams do day to day, exploring ways to spread workloads or reduce them. Also, there could be training supplied to management and employees to engage professional development conversations better.

 Advantages of grounded theory

• No need for hypothesis – Researchers don’t need to know the details about the topic they want to investigate in advance, as the grounded theory methodology will bring up the information.
• Lots of flexibility – Researchers can take the topic in whichever direction they think is best, based on what the data is telling them. This means that exploration avenues that may be off-limits in traditional experimental research can be included.
• Multiple stages improve conclusion – Having a series of coding stages that refine the data into clear and strong concepts or themes means that the grounded theory will be more useful, relevant and defined.
• Data-first – Grounded theory relies on data analysis in the first instance, so the conclusion is based on information that has strong data behind it. This could be seen as having more validity.

Disadvantages of grounded theory

• Theoretical sensitivity dulled – If a researcher does not know enough about the topic being investigated, then their theoretical sensitivity about what data means may be lower and information may be missed if it is not coded properly.
• Large topics take time – There is a significant time resource required by the researcher to properly conduct research, evaluate the results and compare and analyse each excerpt. If the research process finds more avenues for investigation, for example, when excerpts contradict each other, then the researcher is required to spend more time doing qualitative inquiry.
• Bias in interpreting qualitative data – As the researcher is responsible for interpreting the qualitative data results, and putting their own observations into text, there can be researcher bias that would skew the data and possibly impact the final grounded theory.
• Qualitative research is harder to analyse than quantitative data – unlike numerical factual data from quantitative sources, qualitative data is harder to analyse as researchers will need to look at the words used, the sentiment and what is being said.
• Not repeatable – while the grounded theory can present a fact-based hypothesis, the actual data analysis from the research process cannot be repeated easily as opinions, beliefs and people may change over time. This may impact the validity of the grounded theory result.

What tools will help with grounded theory?

Evaluating qualitative research can be tough when there are several analytics platforms to manage and lots of subjective data sources to compare. Some tools are already part of the office toolset, like video conferencing tools and excel spreadsheets.

However, most tools are not purpose-built for research, so researchers will be manually collecting and managing these files – in the worst case scenario, by pen and paper!

Use a best-in-breed management technology solution to collect all qualitative research and manage it in an organised way without large time resources or additional training required.

Qualtrics provides a number of qualitative research analysis tools, like  Text iQ , powered by Qualtrics iQ, provides powerful machine learning and native language processing to help you discover patterns and trends in text.

This also provides you with research process tools:

• Sentiment analysis  — a technique to help identify the underlying sentiment (say positive, neutral, and/or negative) in qualitative research text responses
• Topic detection/categorisation — The solution makes it easy to add new qualitative research codes and group by theme. Easily group or bucket of similar themes that can be relevant for the business and the industry (eg. ‘Food quality’, ‘Staff efficiency’ or ‘Product availability’)

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