Qualitative research in healthcare: An introduction to grounded theory using thematic analysis

Abstract

As with all analytical approaches, grounded theory has drawbacks and limitations. It is important to have an understanding of these in order to assess the applicability of this approach to healthcare research. In this review we outline the principles of grounded theory, and focus on thematic analysis as the analytical approach used most frequently in grounded theory studies, with the aim of providing clinicians with the skills to critically review studies using this methodology. KeywordS 202participants, that is, hypotheses are developed from the data, rather than data collection being a process of testing a pre-existing hypothesis.11 Grounded theory starts with an inductive approach to generating hypotheses from the data; pre-existing knowledge about the topic is deliberately withheld until initial data collection and analysis are complete, in order to prevent it from influencing the research findings. 12 The researcher then goes through a series of systematic cycles of inductive elaboration, deduction and verification 13 in order to build on the initial analysis to develop an integrated 'theory' of action within a specific context. Data analysis in grounded theory is an iterative process where data collection and analysis occur concurrently: insights emerging from early data shape further data collection, which in turn adds to existing understanding, and so on until 'saturation' occurs; that is, no new insights emerge from further data collection.14 The process is therefore not purely inductive as it contains elements of what Peirce called 'abduction'. 15 This is a form of hypothetical inference where new or surprising events within the data prompt the researcher to create new potential hypotheses: 'The surprising fact, C, is observed. But if A were true, C would be a matter of course. Hence there is a reason to suspect that A is true'. 15 Hypotheses generated in this way might lead to further data collection with additional subjects or also re-interviews with earlier subjects to explore newly emerging themes from subsequent data.At the heart of most grounded theory approaches is the identification and progressive refinement of important themes from the data. 16 This process is based on the constant comparative method in which data are continuously categorised and compared across interviews, allowing the emergence of more abstract or theoretical categories that describe the latent patterns within the perspectives of participants. As this process develops, a degree of 'theoretical sensitivity' is required, 17 in that the developing categories increasingly draw on the experiences of the researcher and the existing literature in the area. The process of thematic analysis in relation to interview data is described below. themAtIc AnAlySIS -the proceSSThe process of conducting unstructured, semi-structured or structured interviews requires skill, and is described in detail elsewhere. 8,18 Interviews usually need to be part or fully transcribed to allow thematic analysis: this is time-consuming and can intro...

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