Jeffrey Michael Clair

Problematics of grounded theory: innovations for developing an increasingly rigorous qualitative method:

Our purpose in this article is to identify and suggest resolution for two core problematics of grounded theory. First, while grounded theory provides transparency to one part of the conceptualization process, where codes emerge directly from the data, it provides no such systematic or transparent way for gaining insight into the conceptual relationships between discovered codes. Producing a grounded theory depends not only on the definition of conceptual pieces, but the delineation of a relationship between at least two of those pieces. Second, the conceptualization process of grounded theory is done in hierarchical fashion, where individual codes emerge from the data but then are used to generate insight into more general concepts and thematic statements. But various works on grounded theory have failed to provide any systematic way of using data specific levels of scale (the codes) to gain insight into more macro levels of scale (concepts and themes). We offer fractal concept analysis as a means of resolving both of these issues. By using a logic structure generator, fractal concept analysis delineates self-similar conceptual frameworks at various levels of abstraction, yielding a method for linking concepts together within and between levels of scale encountered in the grounded theory coding and categorization process. We conclude that this fractal analytic technique can bolster the aims of grounded theory as a formalized and systematic process for generating theory from empirical data.

The Impact of Psychosocial Resources on Caregiver Burden and Depression: Sociological Variations on a Gerontological Theme

This article uses a psychosocial resources model to examine the distress process for a sample of 110 primary caregivers of geriatric outpatients. Two versions of the psychosocial resources model are tested—the mediation/deterioration and buffering model. For both models, we assess the role of social support and internal locus of control (mastery) in reducing the negative impact that life stressors have on caregiver burden and depressive symptomatology. Fifty-one percent of the sample are at the threshold for possible depression, indicative of the challenging circumstances of caregiving. One important finding is that caregiver burden and depression have significantly different correlates. Specifically, burden is primarily a function of chronic stressors (ADL) while depression is basically the result of acute stressors (caregiver life events). In addition, this psychosocial resources approach finds no support for the buffering model of caregiver depression.

Housing Patterns of Homeless People: The Ecology of the Street in the Era of Urban Renewal:

In this article, the authors examine the political and economic community dynamics of the street homeless as well as other groups involved in conflicts regarding the process of urban renewal. Since postwar suburban flight, homeless people have lived largely in the shadows of vacated city centers. But “not-in-my-backyard” (NIMBY) battles over the homeless have become increasingly common, especially as the influx of comfortably housed residents bring suburban expectations to urban centers, generating conflicts that affect homeless urban camp communities. Drawing on four years of ethnographic data, the authors describe social conflicts revolving around homelessness and urban renewal. Moreover, through examining the patterns of economy and polity among sectors with different economic positions in the city, the authors illustrate how “problematic” groups of people, such as the homeless, are not antithetical to community. Instead, they are key stakeholders in urban communities with goals, concerns, and desired boundaries similar to those who “legitimately” live downtown.

A SCALE TO ASSESS ATTITUDES TOWARD EUTHANASIA

The topic of euthanasia has been a matter of public debate for several decades. Although empirical research should inform policy, scale measurement is lacking. After analyzing shortcomings of previous work, we offer a systematically designed scale to measure attitudes toward euthanasia. We attempt to encompass previously unspecified dimensions of the phenomenon that are central to the euthanasia debate. The results of our pretest show that our attitude towards euthanasia (ATE) scale is both reliable and valid. We delineate active and passive euthanasia, no chance for recovery and severe pain, and patients autonomy and doctors authority. We argue that isolating these factors provides a more robust scale capable of better analyzing sample variance. Internal consistency is established with Cronbachs alpha = .871. Construct external consistency is established by correlating the scale with other predictors such as race and spirituality.

NEVER ENOUGH TIME How Medical Residents Manage a Scarce Resource

This article focuses on the management of time, a scarce resource. We report how medical residents in an outpatient clinic experience the time contingencies of their work setting, particularly, how they seek to control the work process. We analyze how residents learn about time management over the course of their residency and how they seek to control time when conducting examinations, dealing with other residents, and responding to their appointment schedules. Finally, we examine time as both a subjective experience and an axis of social organization.

Racial Differences in Attitudes toward Euthanasia

This article examines racial differences in attitudes toward euthanasia. Many researchers assert distrust of medicine as a substantive explanation for less favorable attitudes toward euthanasia among African Americans, although quantitative measurement has been unsuccessful in showing this. In this article, spiritual meaning, perceived capacity for discrimination (distrust), individual experiences with physicians, and access to healthcare are hypothesized as intervening variables in the relationship between race and attitudes toward euthanasia. With a distinction between individual and collective experiences with discrimination we use path analysis to test previous assertions that African American distrust of medicine leads to more negative attitudes toward euthanasia. Results indicate that while African Americans exhibit higher levels of distrust of medicine, this is not related to attitudes toward euthanasia, which seem predominantly to be a spiritual matter. Our findings have implications for legislative policy, treatment interventions, doctor-patient relations, and sociological understanding of the interaction of race, spirituality, experience, and attitudes.

The Medicalization of Homelessness and the Sociology of the Self: A Grounded Fractal Analysis

The purpose of this chapter is to illustrate the centrality of the tabula rasa concept of self for the medical model of homeless service provision. Using four years of ethnographic data analyzed with a grounded fractal methodology, we illustrate the logical interconnections between the particular phenomena of homeless service institutions and broad cultural contexts. While social science has been somewhat critical of the medicalization of homelessness, its shared supposition about the self has relegated it to structural critiques that offer little to the currently homeless and those who want to help them. In contrast, we illuminate a path toward the development of an alternative pedagogy of individualism that is more directly responsive to the problematics of the medical model of homeless service provision.

How Physicians View Caregivers: Simmel in the Examination Room

The presence of caregivers in medical encounters changes the doctor-patient relationship. Although there is extensive literature on how caregivers affect medical encounters, there is little research on how physicians view such caregivers. We explore that issue by conducting structured, in-depth interviews with eighteen pediatricians and eighteen geriatricians. The interviews were recorded and transcribed, content analysis was performed, and conceptual codes were developed based on material in the interviews. Findings support Simmels theory about the changes occurring when dyads become triads. Adding caregivers to medical encounters leads to a loss of intimacy between patients and physicians, decreased patient participation, and the formation of coalitions between physicians and caregivers. We conclude by urging medical schools to sensitize physicians to how caregivers affect medical encounters.

The insufficiency of fairness: The logics of homeless service administration and resulting gaps in service

This paper reports on discursive justifications of homeless service institutions in the USA, illustrating a conceptualization of service founded on economic logics of industry and the marketplace. Emerging from ethnographic data, we found that homeless service administrators utilized economic logics of justification to legitimize the exclusion of the street homeless by framing delivery within western notions of fair exchange and efficient production. When these logics are used exclusively to frame justifiable criteria for receiving services, certain people are empowered to participate in social welfare institutions, while others are disfranchised. We conclude that addressing gaps in service requires legitimizing varied administrative models, which, although underpinned by different, perhaps even oppositional, justifications, will engender a service sector responsive to the diversity of the homeless population.

Role-Taking Accuracy in Medical Encounters: A Test of two Theories

Abstract This paper tests five hypotheses derived from two contrasting theoretical perspectives on role-taking accuracy: a social contact theory and an institutional resource theory. We investigate how well doctors and patients perceive one anothers perspectives in a medical encounter. The cumulative weight of the data supports the proposed social contact theory. Increased contact between residents and patients, as reflected in physicians year in residency, contributes to more accurate role-taking on the part of physicians. Conditions of social compatibility between doctors and patients vis a vis gender or race lead to more accurate role-taking. Finally, personal characteristics are better predictors of role-taking accuracy than institutional status variables such as type of residency training program or doctors year in residency status.