Wendy A. Hall

Enhancing the Rigor of Grounded Theory: Incorporating Reflexivity and Relationality

Some proponents of the grounded theory method appear to treat interview and participant observation data as though they mirror informants’ realities. Others claim that grounded theory incorporates reflexivity. It is claimed in this article that the principal texts on grounded theory do not attend to the effects of interactions between researchers and participants in interview and participant observation contexts. Descriptions of the effects of interactions on interview data and attention to relationships between interviewers and interviewees are necessary for attending to the rigor of grounded theory findings. Therefore, it is argued that reflexivity and relationality, which are defined as attending to the effects of researcher-participant interactions on the construction of data and to power and trust relationships between researchers and participants, should be incorporated into grounded theory.

Using grounded theory to study the experience of software development

Grounded Theory is a research method that generates theory from data and is useful for understanding how people resolve problems that are of concern to them. Although the method looks deceptively simple in concept, implementing Grounded Theory research can often be confusing in practice. Furthermore, despite many papers in the social science disciplines and nursing describing the use of Grounded Theory, there are very few examples and relevant guides for the software engineering researcher. This paper describes our experience using classical (i.e., Glaserian) Grounded Theory in a software engineering context and attempts to interpret the canons of classical Grounded Theory in a manner that is relevant to software engineers. We provide model to help the software engineering researchers interpret the often fuzzy definitions found in Grounded Theory texts and share our experience and lessons learned during our research. We summarize these lessons learned in a set of fifteen guidelines.

Childbirth Fear, Anxiety, Fatigue, and Sleep Deprivation in Pregnant Women

OBJECTIVE To explore womens levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the third trimester of pregnancy. DESIGN A cross-sectional descriptive survey of a community sample. PARTICIPANTS Six hundred and fifty English-speaking nulliparous and multiparous women, 17 to 46 years of age and between 35 and 39 weeks gestation, with uncomplicated pregnancies. METHODS Wijma Delivery Expectancy/Experience Questionnaire, Spielberger State Anxiety Inventory, Mindells Sleep Questionnaire, and the Multidimensional Assessment of Fatigue Questionnaire. RESULTS Twenty-five percent of women reported high levels of childbirth fear and 20.6% reported sleeping less than 6 hours per night. Childbirth fear, fatigue, sleep deprivation, and anxiety were positively correlated. Fewer women attending midwives reported severe fear of childbirth than those attending obstetricians. Women with high childbirth fear were more likely to have more daily stressors, anxiety, and fatigue, as well as less help. Higher levels of anxiety predicted higher levels of childbirth fear among women. CONCLUSION One fourth of women reported high childbirth fear. Womens fear of childbirth was related to fatigue, available help, stressors, and anxiety. Fear of childbirth appears to be part of a complex picture of womens emotional experiences during pregnancy.

Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine.

ABSTRACT Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.

Twelve-month follow-up of a smoking relapse prevention intervention for postpartum women

This study examined the long-term effectiveness of a postpartum smoking relapse prevention intervention by evaluating the smoking status and smoking cessation self-efficacy of original study participants at 12 months following delivery. Two hundred and thirty-eight women who had participated in a randomized clinical trial, a nurse-delivered relapse prevention intervention, were visited in their homes. Data were collected on smoking status, self-efficacy, mental health, alcohol use, breast feeding, social support, smoking in the social environment, and sociodemographics. Smoking status was verified with measures of carbon monoxide in expired air. The 12-month continuous smoking abstinence rate was 21.0% in the treatment group and 18.5% in the control group; odds ratio (OR) = 1.17, 95% confidence interval (CI) = 0.62-2.22. One half (50.4%) of the control group and 41.2% of the treatment group reported smoking daily at 12 months; OR = 1.45, 95% CI = 0.87-2.43. The treatment group attained higher self-efficacy. Four variables were associated with relapse to daily smoking; breast feeding and mental health had protective effects, while partners who smoked and greater amount smoked prior to pregnancy had adverse effects.

Preventing smoking relapse in postpartum women

BACKGROUND Although many women quit smoking during pregnancy, the majority resume smoking shortly after giving birth. OBJECTIVES To test a program to prevent smoking relapse in the postpartum period by comparing the rates of continuous smoking abstinence, daily smoking, and smoking cessation self-efficacy in treatment and control groups. METHODS In a randomized clinical trial, nurses provided face-to-face, in-hospital counseling sessions at birth, followed by telephone counseling. The target population included women who quit smoking during pregnancy and who gave birth at one of five hospitals. The 254 participating women were interviewed 6 months after delivery and assessed biochemically to determine smoking status. RESULTS The 6-month continuous smoking abstinence rate was 38% in the treatment group and 27% in the control group (odds ratio [OR] = 1.63, 95% confidence interval [CI] .96 - 2.78). Significantly more control (48%) than treatment (34%) group participants reported smoking daily (OR = 1.80, 95% CI = 1.08 - 2.99). Smoking cessation self-efficacy did not vary significantly between the groups. CONCLUSIONS Smoking cessation interventions focusing on the prenatal period have failed to achieve long-term abstinence. Interventions can be strengthened if they are extended into the postpartum period.

Qualitative teamwork issues and strategies: coordination through mutual adjustment.

Multidisciplinary research teams that include faculty, students, and volunteers can be challenging and enriching for all participants. Although such teams are becoming commonplace, minimal guidance is available about strategies to enhance team effectiveness. In this article, the authors highlight strategies to guide qualitative teamwork through coordination of team members and tasks based on mutual adjustment. Using a grounded theory exemplar, they focus on issues of (a) building the team, (b) developing reflexivity and theoretical sensitivity, (c) tackling analytic and methodological procedures, and (d) developing dissemination guidelines. Sharing information, articulating project goals and elements, acknowledging variation in individual goals, and engaging in reciprocity and respectful collaboration are key elements of mutual adjustment. The authors summarize conclusions about the costs and benefits of the process.

Psychometric Evaluation of the Multidimensional Assessment of Fatigue Scale for Use with Pregnant and Postpartum Women.

Although fatigue is a common experience for pregnant women and new mothers, few measures of fatigue have been validated for use with this population. To address this gap, the authors assessed psychometric properties of the Multidimensional Assessment of Fatigue (MAF) scale, which was used in 2 independent samples of pregnant women. Results indicated that the psychometric properties of the scale were very similar across samples and time points. The scale possesses a high level of internal consistency, has good convergent validity with measures of sleep quality and depression, and discriminates well from a measure of social support. Contrary to previous evaluations of the MAF, data strongly suggest that the scale represents a unidimensional construct best represented by a single factor. Results indicate that the MAF is a useful measure of fatigue among pregnant and postpartum women.

A prospective study of effects of psychological factors and sleep on obstetric interventions, mode of birth, and neonatal outcomes among low-risk British Columbian women.

BackgroundObstetrical interventions, including caesarean sections, are increasing in Canada. Canadian women’s psychological states, fatigue, and sleep have not been examined prospectively for contributions to obstetric interventions and adverse neonatal outcomes.Context and purpose of the study: The prospective study was conducted in British Columbia (BC), Canada with 650 low-risk pregnant women. Of those women, 624 were included in this study. Women were recruited through providers’ offices, media, posters, and pregnancy fairs. We examined associations between pregnant women’s fatigue, sleep deprivation, and psychological states (anxiety and childbirth fear) and women’s exposure to obstetrical interventions and adverse neonatal outcomes (preterm, admission to NICU, low APGARS, and low birth weight).MethodsData from our cross-sectional survey were linked, using women’s personal health numbers, to birth outcomes from the Perinatal Services BC database. After stratifying for parity, we used Pearson’s Chi-square to examine associations between psychological states, fatigue, sleep deprivation and maternal characteristics. We used hierarchical logistic regression modeling to test 9 hypotheses comparing women with high and low childbirth fear and anxiety on likelihood of having epidural anaesthetic, a caesarean section (stratified for parity), assisted vaginal delivery, and adverse neonatal outcomes and women with and without sleep deprivation and high levels of fatigue on likelihood of giving birth by caesarean section, while controlling for maternal, obstetrical (e.g., infant macrosomia), and psychological variables.ResultsSignificantly higher proportions of multiparas, reporting difficult and upsetting labours and births, expectations of childbirth interventions, and health stressors, reported high levels of childbirth fear. Women who reported antenatal relationship, housing, financial, and health stressors and multiparas reporting low family incomes were significantly more likely to report high anxiety levels. The hypothesis that high childbirth fear significantly increased the risk of using epidural anaesthesia was supported.ConclusionsControlling for some psychological states and sleep quality while examining other contributors to outcomes decreases the likelihood of linking childbirth fear anxiety, sleep deprivation, and fatigue to increased odds of caesarean section. Ameliorating women’s childbirth fear to reduce their exposure to epidural anaesthesia can occur through developing effective interventions. These include helping multiparous women process previous experiences of difficult and upsetting labour and birth.

Weighing preterm infants before & after breastfeeding: does it increase maternal confidence and competence?

Purpose To determine whether weighing preterm infants before and after breastfeeding (“test weighing”) affects maternal confidence and competence. Methods A longitudinal, repeated measures control group study. Sixty mothers of preterm infants were randomly assigned to a test weight or nontest weight group. In the test weight group, nurses weighed infants before and after every breastfeeding while they were in hospital. Maternal confidence and competence were measured four times: (a) at 3 days after the initiation of breastfeeding, (b) at infants’ discharge from hospital, (c) at 1 week postdischarge, (d) at 4 weeks postdischarge. Results No significant differences in maternal confidence and competence at any of the measurement times were found. When change over time was examined using MANOVAs, the levels of competence and confidence in both groups had increased significantly. Clinical Implications The development of maternal confidence and competence in this group was independent of test weighing during hospitalization and calls into question claims that such interventions are necessary to develop competence or confidence in mothers of preterm infants.