Sarah Cowley

Developing a grounded theory approach: a comparison of Glaser and Strauss

Novice qualitative researchers are often unsure regarding the analysis of their data and, where grounded theory is chosen, they may be uncertain regarding the differences that now exist between the approaches of Glaser and Strauss, who together first described the method. These two approaches are compared in relation to roots and divergences, role of induction, deduction and verification, ways in which data are coded and the format of generated theory. Personal experience of developing as a ground theorist is used to illustrate some of the key differences. A conclusion is drawn that, rather than debate relative merits of the two approaches, suggests that novice researchers need to select the method that best suits their cognitive style and develop analytic skills through doing research.

Understanding marginalization as a social determinant of health

Population-based studies have drawn attention to the associations between social and material disadvantage and poor mental and physical health over the life course, thereby contributing to inequalities in health. More recently, research in Britain has demonstrated that the effects of such disadvantage are cumulative through childhood and has shown that ‘ethnic minorities’ are at particular risk. This study gathered data from persons at risk, specifically first-generation migrant teenaged girls and their mothers, in Britain and Canada, and identified marginalization as a central feature of their relationships with others. Bourdieus theoretical perspective is drawn on to examine the processes that contribute to marginalization and the conditions of broader society that sustain and reproduce them. It was the participants’ experience that their potential goes unrecognized, their opportunities to develop new relationships curtailed and possibilities to acquire new competences were eclipsed by others’ assumptions about them. The authors illustrate the social processes that contribute to the creation of tensions between seeking to belong and being assigned to the margins and consider their attendant influences on health. Taking direction from Bourdieu they illustrate ways in which discourses of marginalization and marginalizing practices associated with them can be interrupted, and in so doing work towards redressing processes that create a context for health inequalities.

Empowerment or control?An analysis of the extent to which client participation is enabled during health visitor/client interactions using a structured health needs assessment tool

The demand for explicitness in the way health visitors target their services has given rise to a plethora of different health needs assessment tools (HNATs). This paper describes an in-depth conversational analysis of the use in practice of these structured health needs assessment tools (HNATs) in two different NHS Community Trusts in England. These HNATs aimed to enable clients to participate in the assessment of their own health needs, as well as fulfilling the political requirements of justifying the expenditure of health visitor time where needs are identified. However, conversational analysis of 10 interactions showed that use of the instruments was associated with a failure to either identify needs that are relevant to the client or to enable clients to participate in the process. Use of the structured instrument simultaneously emphasises the significance of a professional lead, instead of client participation, and minimises the importance of inter-personal relationships and communication. In one site, a directly controlling style was apparent in the practice of health visitors who were, themselves, explicitly controlled by their managers. In the other site, professional expertise was emphasised, and a covert assessment style acted to disempower clients. The controlling nature of the interactions, the number of missed cues and the possibility of distress caused by the insensitivity of questioning style are all potentially harmful side effects of using structured instruments to assess needs. The problems seem to stem from the use of a pre-determined list of questions that form the basis for assuming that any familys health promotion needs can be categorised and predicted in advance. In conclusion, therefore, it is recommended that health visitors should use the open, conversational style of needs assessment that has been shown to be effective and acceptable, rather than an approach based on a structured instrument.

Using grounded theory to research parent participation.

There are many interpretations and applications of the grounded theory method which have contributed to different understandings of grounded theory and different versions of how the key components (theoretical sampling, constant comparative analysis and theoretical saturation) should be implemented. The esoteric terminology coupled with the matrix style of the analysis process can be challenging for new researchers. This paper uses data from a study on parent participation to illustrate the application of the key components of grounded theory. Grounded theory provides clear guidelines on how to analyse qualitative data and so is a rigorous method that provides structure and direction to the researcher. However, theoretical sampling with vulnerable groups can be problematic and requires further discussion and debate from other users of grounded theory.

Interprofessional working in palliative care in the community: a review of the literature

In the United Kingdom (UK) a range of professionals, who are employed within both statutory and non-statutory organisations, provide palliative care in the community. This paper explores how interprofessional working between these practitioners is facilitated, and considers how language and philosophies of care can impact upon the working relationship between professionals. It is suggested that often the difficulties experienced when working with another professional are outside the remit of the individuals involved. When working within large organisations within a legislative framework practitioners must be prepared to acknowledge the strengths of different groups, and to understand how these can be utilised to provide effective and appropriate palliative care.

Restoring embodied control following surgical treatment for colorectal cancer: a longitudinal qualitative study.

BACKGROUND This article presents the findings of a study about recovery following surgery for colorectal cancer. Most patients diagnosed with this cancer are treated with surgery. Few studies have employed a qualitative approach to examine their experiences and perceptions of recovering from this treatment. OBJECTIVES The purpose of this study was to discover the process of recovery for individuals following curative surgery for colorectal cancer. DESIGN This qualitative study drew on grounded theory methods and used a prospective longitudinal design. SETTINGS Ethical approval was granted by three Local Research Ethics Committees enabling patients to be recruited from three different hospitals in the South of England. PARTICIPANTS Purposive sampling was used to identify patients diagnosed with colorectal cancer who had had surgery with curative intent. METHODS Each participant was interviewed up to four times following their surgery: at 6 weeks then at 3, 6 and 12 months. Sixty-two interviews were conducted. Emerging concepts from the analysis defined further data collection. Relevant literature was theoretically sampled and all data analysed using constant comparison. Theoretical saturation was achieved. RESULTS Sixteen participants were recruited. Analysis of study data identified four conceptual stages representing the main phases individuals can experience during their recovery. They are: disembodiment, restoring embodiment, reclaiming control and managing embodied control. These occur in a stepwise progression, reflecting the emotional, physical and social processes involved in restoring perceived control over the body. They reflect the difficulty individuals can experience in understanding and self-managing their bodies. There is a desire to regain confidence and certainty over body function but this is threatened by fears about future health. CONCLUSIONS Achieving a sense of control of ones body, after surgery for colorectal cancer, proves to be a major challenge. Greater recognition of the consequences of cancer and its treatment upon the body and individualised management is required. Addressing how individuals can regain embodied control during their recovery needs to be integral within post-treatment support.

Working on person-centred planning From amber to green light?

This article reviews the practice and policy based literature on person-centred planning in learning disability services in England. Its aim is to identify the implications for the workforce in practice.The analysis found that implementation is often described as partial or slow and characterizes reasons for this at a number of levels, including the slow pace of change in service culture and power relations, immutable funding structures, services’ inflexible infrastructures, high levels of staff turnover and lack of training, inexperience among service management, inadequate staff supervision, and ambiguity among some stakeholders. Little substantial critique exists of the model itself. Analysis of the literature further reveals that the implementation of person-centred planning in practice is assisted by policy encouragement, service development and investment, favourable case reports and personal accounts, practitioner enthusiasm and positive evaluations.This article explores these to consider what facilitates the adoption of new elements of practice.

The development of palliative care in national government policy in England, 1986–2000

Palliative care is an established and expanding speciality, important in many areas of service delivery within health and social services and the voluntary sector. Traditionally, palliative care is viewed as most closely linked to cancer services. National government policy has an inevitable impact on the organization and provision of such services. As part of a wider project, an investigation of the content and development of English government policy relating to palliative care was carried out. The development of policy follows a cycle that has no closure; it takes place within changing contexts, between multiple organizations and across sectors. Data collection involved the collation and close examination of policy documents and other documents that demonstrably influenced policy. This was in order to identify a national view of policy intentions for palliative care. In total, 53 policy documents were examined. The analysis revealed a number of pertinent issues relating to shifts in funding policies and an evolving definition of palliative care. There is an increasing recognition in the policy documents of the need for palliative care to extend beyond the traditional focus on cancer services and terminal illness. In tandem, is an increasing recognition of the need for partnership between sectors, reflected in more recent health and social services legislation.

Health needs assessment in the health visiting service and the impact on the ethnic community.

The purpose of this article is to share the experience of using a health needs assessment tool in health visiting practice in Great Britain, with clients who do not speak English. This is an important issue in developing equity of practice across the growing multi-cultural and diverse populations of the United Kingdom. The paper outlines the findings relevant to these issues drawn from a wider study that used qualitative methods to observe and interview both health visitors and clients regarding the use of the tool. It focuses on one vignette to demonstrate the practical and difficult issues when a formal system is used to assess needs in clients who do not speak English as a first language.

Research and the organisation of complex provision: conceptualising health visiting services and early years programmes

This paper developed from discussions about the possible implementation and trial of an Australian maternal and early childhood sustained home visiting programme (MECSH), into a United Kingdom (UK) context. There are many similarities in services in the two countries, but some differences. To summarise and illustrate the complex and interconnected way that early years and preventive health services are specified, a diagram was developed, which provides a framework for this paper. The paper describes a health visiting service that encompasses universal, indicated and selective forms of prevention, with some embedded evidence-based programmes, forming part of a proactive and preventive service that is, itself, embedded within a wider resource system. Policy-driven terms derived from the English Health Visitor Implementation Plan have been used, but translated into the generic language of prevention (universal, indicated and selective), as a basis for future research. The place for different types of practitioner and needs of families with different levels of personal capacity or resource are also considered. Increased understanding about how social determinants affect the whole population across a gradient has drawn attention to the need for more universal prevention, to tackle health inequalities. The components of successful early intervention programmes are well established, but more information is needed to support universal preventive services, which are delivered in a way that is proportionate to need. This paper, including the diagram that summarises its contents, is presented to stimulate discussion as well as guide future research and service development.