Following a small piece of original research using the Grounded Theory Method (GTM), this article will describe the research question, rationale, methodological approach, and methods in exploring the experiences of a social worker in assessing capacity.
It will include the interview schedule and a description of my approach in the analysis. I will give a reflective account of my approach to data generation, analysis, its strengths and limitations using the GTM.
The article will conclude with my thoughts on what I will develop or do differently in the future.
Download the first chapter of the Making MCA Report Writing Easy eBook for free below.
What is Grounded Theory Approach to Research
Grounded theory is a qualitative research method which can be used to develop a theory grounded in data. This data is systematically collected and analysed.
The discovery of GTM in 1967 was triggered by Glaser and Strauss. In their book ‘The Discovery of Grounded Theory’, Glaser and Strauss specified a research approach which aimed at deriving theories systematically for human behaviour from empirical data (Glaser & Strauss, 1967).
Central to this approach was on generating and grounding data and allowing theories to emerge from data. However, in 1990, Strauss and Corbin suggested breaking down the coding process into 4 prescriptive steps – open, axial, selective and coding for a process (Urquhart, 2013).
Glaser objected to using a coding paradigm and the ‘conditional matrix’ that provide ready-made tools to assist with the conceptualisation process.
Glaser felt Strauss’s approach meant force coding through one paradigm or down one conditional path and ignored the emergent nature of GTM (claim there could be only one way of relating categories).
This led to a dispute between its co-founders resulting in 2 distinct strands of GTM – the Glaserian and Straussian. For brevity, I will be focusing on the Glaserian approach.
This is because it allows the researcher the flexibility of selecting many options for relating categories and allowing theories to emerge from the data.
Research Question and Rationale
The Mental Capacity Act (MCA) (2005) is a legislative framework that has been in force since 2007 and applies to England and Wales. Using a two-stage functional test of capacity the practitioner must determine if there is an impairment of, or, disturbance in the functioning of a person’s mind or brain (stage one).
If there is, then the practitioner must determine if the impairment or disturbance is sufficient that the person lacks the capacity to make a particular decision (stage two) (Brammer, 2010).
The MCA is mainly to promote and safeguard decision-making within a legal structure. It does this in two ways: by empowering people to decide for themselves wherever possible, and by protecting people who may lack capacity and allowing people to plan for a time when they might lack the capacity (Cowley & Graham, 2015).
However, research conducted by Graham (2016) indicated that despite efforts on promoting choice, control and rights there is growing evidence that the MCA is a safeguarding tool with concerns it limits people’s rights and may encourage risk-averse practice.
A small qualitative study conducted by Willner et al. (2010) indicates that using the MCA (2005) varies considerably among practitioners due to the complexity of service users’ needs.
Stevens (2013) highlights that understanding the most influential factors in using the MCA requires an exploration of experiences. However, literature suggests that the experiences of professionals in using the MCA has received little attention (Stevens & Hebblewhite, 2014).
Using a social constructionist stance, the study aimed to apply GTM in exploring the experiences of a social worker in assessing capacity.
Consideration was given to using other qualitative methods such as ethnography and semiotics in this research. But it was identified that many researchers have utilised ethnography intending to study people and cultures systematically through participant observation.
Researchers have also used semiotic analysis to understand and interpret signs, the meanings of signs, and the interaction of signs.
This research aimed to generate a theoretical understanding of a professional’s experience and also, to ascertain the main concern when using the MCA, as a result, GTM was most suited to this study.
Glaser (1978, 1998), defines GTM as an inductive process that focuses on the experiences and perceptions of research participants. Within this context, Urquhart (2013) asserts that using GTM ensures that theories are inductively developed encouraging innovation.
Data Collection in Grounded Theory Research
Before data collection, a research ethics application was made to gain ethical approval. A consent form, participant information sheet and a proposal were completed. Data was collected via a face-to-face interview using open-ended questions:
- Tell me about your role and what is expected of you in this service.
- What do you think about the MCA framework?
- Why would you use the MCA in your practice?
- How do you know when to use the MCA framework?
- Tell me about your experience of using the MCA?
- How do you feel about using the MCA? (Reflective question)
- What factors do you feel could influence how you use the MCA?
- Why do you think these factors are important?
- How confident are you in using the MCA?
- Why are you confident/not confident in using the MCA? (Explore what will make them more competent).
- Would you like to add any further information to what we have discussed?
According to Creswell (2014), qualitative researchers use open-ended questions so the participants can share their views and the process is largely inductive. Similarly, Edwards et al. (1997) assert that using open-ended questions allows the interviewee to add more information, including their feelings, and understanding about a particular subject. It allows the researcher to gain a better understanding of the true feelings on an issue (Bryman, 2015). Using this approach allowed me to seek the views and opinion of the respondent on their experiences of using the MCA. However, according to Brahier (2013), one limitation of using open-ended questions can be seen in the researcher having limited control over the length of response. Despite this, I found it useful to use open-ended questions because it allowed me to gain as much information as possible on the MCA from the respondent. Information obtained provided insight into the issues important to the respondent and provided rich material for my research.
Sampling in Grounded Theory Research
The research process involved a non-probability sample (purposive sampling). Charmaz (1990; 2009) highlights that GTM examines experiences, creating a theoretical model within a purposely selected population. Within this context, Johnson and Christensen (2008) highlight that elements selected for the sample is chosen by the judgement of the researcher. This approach was used to obtain a representative sample which resulted in saving time. I specified the characteristics of a population of interest using an inclusion criterion to select my respondent. The criteria used was a social worker with over five years of practical experience of using the MCA.
Notwithstanding the advantages of using a purposive sampling approach, Brahier (2013) points out a limitation. In his view, the ability to generalise using this technique is severely limited. But purposive sampling allowed me to enrich the data by including a respondent with a particular type of experience or understanding to share. Besides, the aim of this research was not to have data generalised but it was to evidence a basic understanding of research skills.
Data Generation and Analysis in Grounded Theory Research
Urquhart et al. (2013) highlight four key characteristics of GTM. The first characteristic is that researchers should ensure that no preconceived theoretical ideas are formed before starting the research. Glaser (1998) reports that reviewing literature might contaminate or impede the researcher’s effort to generate categories. However, Andrew (2006) argues that researchers launching into data collection and analysis without first looking at literature is a general misconception. Similarly, Martin (2006) asserts that appropriately using literature in GTM allows the researcher to find the research problem. With this awareness, I ensured that I approached the research with an open mind and carried out a non-committal pre-study literature review to discover the research problem. Data was coded and analysed using the Glaserian paradigm (open, selective and theoretical coding).
Coding in Grounded Theory Research
Schwandt (1997) states that coding involves breaking down data into manageable segments by attaching names to the parts. Transcribed data from the interview was coded analytically by attaching concepts to the data. A bottom-up coding approach was used to code the data line by line to minimise the chance of missing important categories. Urquhart et al. (2013) argue that this approach ensures that codes are suggested by the data, not by the literature. While coding, I was very conscious of any prior knowledge in order not to allow perceptions to be imposed on the data.
By applying the Glaserian approach, I started with open coding the data line by line. For instance, I coded the first sentence from the interview ‘service user’ and ‘user system’. Initially, I noticed the respondent listed some categories of people she works with and coded this ‘service user’ which is a descriptive code and a good place to start. Then I asked myself, ‘why is the respondent referring to these groups?’ It seemed to me that she was trying to indicate a range of groups she works with and I coded this ‘user systems’. Dey (1993) argues that while the dimensions of the research problem emerge from coding, it can be time-consuming. On the other hand, Urquhart et al. (2013) report that although the analysis stage may take longer than other methods, the write-up stage of the work is much quicker because the analysis is so detailed. I share similar views with both Dey (1993) and Urquhart et al. (2013) because although I was coding a small data set, it was time-consuming. Nonetheless, the write up was much quicker.
Open codes in the data were then organised into selective codes which then eventually contributed to the core categories of the theory. Glaser (1978) states that selective coding is a process of scaling up your codes into categories that are important for the research problem. Open codes of ‘assessing capacity’ and ‘difficulty’ ended up as dimensions of a subcategory called ‘decision – making capacity’. I realised that during this process, specific themes were emerging which will comprise the eventual theory. I wrote up some theoretical memos to help me theorise about the categories and to think about the relationships between categories and what might be important to the research question. One category of particular interest to me was “burden of the right outcome” this was an ‘In Vivo’ code, meaning code generated from the sentence or the words of the respondent. Alvita (2008) asserts that in GTM, the researcher seeks to understand what is going on as people resolve their main concern in a substantive area. I wanted to discover if this was the main concern for my respondent so I carried out a second interview to find out more about this (theoretical sampling). The process of theoretical sampling, allowed me to decide, on analytical grounds, where to sample from next.
Theoretical coding is the stage when codes are related to each other. Glaser (1978) states that theoretical coding is establishing new connections that make ideas relevant. Spradley (1979) suggests nine relationships that can exist between domains. The relationship such as ‘is a kind of’ ‘is a characteristic of’ enabled me to decide which of my codes were in fact aspects of others. I used Spradley’s (1979) relationships for the purpose of theory building. To improve its analytic generalisability, theories generated were then related to other theories in the literature. This was to enable me to discover if the emergent theory contradicts the existing literature or if it could suggest new avenues for future research.
These theories emerged using Spradley’s relationship domains.
• Mental capacity is used for supporting and safeguarding service users
• When there is doubt about decision-making capacity or safeguarding issue, this can trigger the use of this framework.
• Service users are supported to make decisions using the framework.
• MCA outcome is based on the balance of probability and intuition.
• There are challenges with the use of this framework especially with the burden of making the right decision.
• It can be a complex piece of framework due to a lack of practical guidance, the need to justify your decision and time limiting factors.
• Access to more practical experience, peer and managerial support will help improve the confidence of practitioners.
In this section, I will be describing the process of data collection using Gibbs reflective cycle and how this shaped data produced.
In hindsight, the research process allowed me to have a very good understanding of the process of qualitative research using GTM. Before data collection, I felt that the interviewee had been provided with a participant information sheet and consent form, which detailed the specific topic area of MCA, so they were, in a sense, preconditioned about how to respond. However, this needed to be done to gain research ethics approval.
Upon reflection, although I consciously tried to put aside what I knew about the MCA and approached the research with an open mind, I recognised more of my own experience in what the practitioner was telling me and recollected so many other instances of similar experiences being described in my professional settings. I was aware of my extensive knowledge around the MCA and this made me hyper-vigilant about personal filters in the analysis. I often found myself battling concerns that I would be making assumptions based on the data set and be accused of “making it all up” (Simmons, 2010, p. 15). To minimise problems of conceptualisation, codes were cross-checked repeatedly through discussions with my colleague and an experienced GTM researcher. According to Urquhart (2013), people must understand the meanings and relationships in the coding process and what a particular concept means. Employing this approach helped to ease my worry regarding my ability to effectively code the data to avoid preconception based on my own experience and knowledge around the MCA.
In GTM, Miles (1984) highlights that interviews should be conducted in settings conducive to open and free discourse: places where both researcher and informant are comfortable enough to be truly present, without fear. The interview for this research was conducted at the close of business in an office environment. I felt that the respondent answered each question with the officially correct answer. However, when I carried out a second interview – theoretical sampling in a home environment, the respondent no longer felt restricted by her official role and communicated more freely. In the future, when carrying out similar research, I will ensure that interviews are conducted in an environment that will not restrict the respondent and encourage them to speak out freely. I will aim to choose a neutral environment and send out a calendar invite to my respondent to ensure readiness and ability to speak freely. Also, this will ensure that time is set aside for the interview to avoid work-related interruptions.
Grounded Theory Method demands more in analysis than a simple inspection of the data (Miles & Huberman, 1984). However, Glaser and Strauss (1967) and later Glaser (1978; 1998) do not instruct a prescribed mechanism for performing the coding. They describe the conceptualisation of coding. I was not sure what I was looking for. I was trying to figure out what a “code” is. Did it refer to an important statement? Did it matter if I had preconceived ideas or not? Was a code a statement of interest? At the onset, I was unsure what was of interest. Both these difficulties were overcome by identifying the key points in the interview data and concentrating the analysis on these. I also considered my research question which helped in identifying key codes and the formation of subsequent theories from the data collected.
In hindsight, another difficulty experienced was in knowing when coding should end. I kept asking myself questions such as did every relevant statement in the text have to be identified and used? Which statement is relevant? Was one statement enough? Was it enough to have more than one statement containing the same code? How often did a code have to occur to be substantive? When performing the constant comparisons between concepts to find emerging categories, how many concepts need to be included to form a category. Glaser (2013) advises that “one is enough if it is significant”. With this in mind, I realised that it is not ‘plenty’ that counts but ‘relevance’. I recognised that one concept can contribute to the emerging theory. However, more than one theory emerged from the data collected and I felt that using Spradley’s relationship domains helped in identifying relationships between different categories which later formed the theories.
GTM is an inductive process and focuses on experiences and perceptions of research participants. Hence, it is important to encourage people to talk freely about their experiences (Alvita, 2008). Glaser (1978) calls this ‘spill’. I felt that by asking pre-planned questions, I did not allow my respondent to ‘spill’ fully. In the future, when carrying out similar research, I will try to develop one question that will trigger a story. I will also consider using more TED (Tell, Explain, Describe) questioning approach to encourage spill and allow theories to emerge.
Although the process of theoretical sampling, allowed me to decide, on analytical grounds, where to sample from next. I felt that as I had good knowledge in the area of MCA, this may have prevented me from delving further into certain aspects of the interview and exploring theoretical sampling further. Glaser (2013) states that “highly trained people well-formed in their field find it hard to transcend their experienced view. They see it everywhere rather than staying open, however much they pretend to be open. (pp. 21-22)”. I agree with the views shared by Glaser and in hindsight, I could have chosen a relatively unknown area for my mini-research. On the other hand, being an expert meant that I used the best codes and categories during the conceptualisation process.
Overall, this mini project on a qualitative research approach using GTM was an enjoyable experience. Although the process was time-consuming, I understood the steps involved in using GTM as a researcher. I found out how one practitioner makes sense of their experiences when using the MCA. I particularly enjoyed the inductive nature of GTM where concepts and theories were built from data. I was engaged with the data throughout the process. In the future, I would like to carry out a self-interview in line with Glaser (1998) approach.
If you are going to carry out a grounded theory research, here are my top resources
Alvita, N. (2008). Eliciting Spill: A methodological note. Grounded Theory Review, 7(1) 61-65
Brahier, D. J. (2013) Assessment in Middle and High School Mathematics. London: Routledge.
Brammer, A. (2010) Social Work Law. 3rd ed. Essex: Pearson Education Limited.
Bryman, A (2015) Social Research Methods. 5th
ed. Oxford: Oxford University Press.
Charmaz, K. (2009) Grounded Theory. London: Sage.
Charmaz, K. (1990) Discovering chronic illness: Using grounded theory. Social Science & Medicine, 30, 11, 1161-1172. doi.org/10.1016/0277-9536(90)90256-R.
Cowley, J. and Graham, M. (2015) A Practical Guide to the Mental Capacity Act 2005. London: Jessica Kingsley Publishers.
Creswell, J. (2014) Qualitative, Quantitative, and Mixed Methods Approaches. London: Sage.
Dey, I. (1993) Quantitative Data Analysis: A user-friendly guide for social scientists. London: Routledge.
Edwards, E. J., Thomas, D. M., Rosenfeld, P. and Booth-Kewley, S. (1997) How to Conduct Organisational Surveys. London: Sage.
Glaser, B. G. (1978) Theoretical Sensitivity. Mill Valley, CA: Sociology Press.
Glaser, B. (1998) Doing grounded Theory: Issues and discussions. Mill Valley, CA: Sociology Press.
Glaser, B. (2013) No preconceptions: The grounded theory dictum. Mill Valley, CA: Sociology Press.
Glaser, B. G. and Strauss, A. L. (1967) The Discovery of Grounded Theory: Strategies for qualitiative research. Chicago, IL: Aldine
Graham, M. (2016) Understanding of the Mental Capacity Act in work with older adults exploring the “unintended consequences” for service users’ emotional wellbeing”. Working with Older People. 20, 3, pp.151-156, https://doi.org/10.1108/WWOP-04-2016-0010
Johnson, B. and Christensen, L. (2008) Educational Research. London: Sage.
Layder, D. (1998) Sociological Practice: Linking theory and research. London: Sage.
Martin, V.B. (2006) ‘The relationship between an emerging grounded theory and existing literature: Four phases for consideration’, The Grounded Theory Review, 5(2/3): 47 – 57.
Miles, M.B. and Huberman, A.M. (1984) Qualitative Data Analysis – A Sourcebook of New Methods. California: Sage
Schwandt, T. (1997) Quantitative Inquiry. London: Sage.
Simmons, O. (2010) Is that a real theory or did you just make it up? Teaching classic grounded theory. Grounded Theory Review, 2(9) 15-35.
Spradley, J. P. (1979) The Ethnographic Interview. Orlando: Winston.
Stevens, E. (2013) The Mental Capacity Act 2005: considerations for nursing practice. Nursing Standard. 28, 2, 35-39. doi: 10.7748/ns2013.09.28.2.35. e7909.
Stevens, E. & Hebblewhite, G. (2014) Empowering Adults under the Mental Capacity Act. Learning Disability Practice. 17. 16-20. 10.7748/ldp.17.8.16. e1571.
Urquhart, C. (2013) Grounded Theory for Qualitative Research. London: SAGE Publication.
Willner, P., Jenkins, R., Rees, P., Griffiths, F. J. and John, E. (2011) “Knowledge of Mental Capacity Issues in Community Teams for Adults with Learning Disabilities.” Journal of Applied Research in Intellectual Disabilities