Contextualización: el centro, el aula los compañeros

This section addresses the process of theory development by describing how coded themes require deconstructing to discover their properties and dimensions. It then describes how coding for overlap (axial) and comparison (selective) encouraged greater depth of information and a wider spread of included information. Furthermore it distinguishes empirical theory, that of a practical nature, from formal theory, that which provides an explanation. The section ends with a reference to the production of information materials for service users and carers. Crucially the information output, described in detail in Chapter 6, constitutes the theory in empirical, or substantive, terms.

Core Themes and the Development of Theory

To facilitate the development of a theory of generalisable proportions grounded theory studies employ comparative analysis. The area in question is researched as a whole rather than focusing on a specific aspect, for example a single group, team or unit. Therefore, grounded theory because of this breadth of data collection and analysis, whilst productive in generating theory, can become extremely complex and appear cumbersome.

This can be due; firstly, to the fact that data analysis does not conclude with a description, moreover it progresses into an explanation with potentially predictive qualities. Secondly, eliciting a broad range of data and analysing for relevance through open, axial and selective coding is a substantial analytical process. And, thirdly, fit and relevance procedures that fail to reinforce or relate to the final theory can cast doubt on its applicability to the subject under study, subsequently defying the essence of a grounded theory – that it is grounded in, and recognisable as, a reflection

of the participants’ contribution. A definition that typifies grounded theory is offered by Kerlinger (1973).

A theory is a set of interrelated constructs (concepts), definitions and proportions that present a systematic view of phenomena by specifying relation among variables, with the purpose of explaining and predicting the phenomena. (Kerlinger 1973, Page 9)

Glaser and Strauss (1967) make a persuasive argument that systematic analysis of empirical data will be more revealing than deduction and speculation. The key, they suggest, is the use of a comparative method of analysis and constant comparison of theoretically sensitive samples.

Constant comparison consists of discovering basic conceptual elements in the data and comparing for similarities, and dissimilarities, of the events or situations (incidents) discovered. It elicits concepts and carefully analyses them using a series of coding techniques, open, axial and selective, enabling substantive theory to develop and propositions or hypotheses to emerge which then form a framework for theoretical comparison.

When categories or concepts are linked, through axial coding, the most significant concepts stand out. Deciding on which of these concepts constitutes the core and major categories requires further analysis. The open coding therefore serves to identify preliminary themes. Axial coding encourages themes to be analysed for overlap and connection (i.e. is there a commonality or axis on which the themes meet or pass). Selective coding, once convinced of the validity of the major category, promotes theoretical sampling to discover the depth and breadth of the category. On fathoming this, theory becomes more prominent.

An example chosen to illustrate a tentative category or variable and how it links to a theory follows. This process is applicable to all salient themes.

Figure 3. A Tentative Core Category

Concept – ‘using drugs to feel good’

Cross-cut with other incidents / categories – ‘avoiding drugs to avoid mental health relapse’

Frequent regular occurrence of concept within several categories denotes tentative core variable

The words of the participants and researcher conceptualisation of the words

“It like chills me out “Self-medicating” of

and takes the edge off” anxiety/stress/tension (Self-Medication Hypothesis) Ready for selective coding and extensive theoretical sampling

What happened?

Where does this happen? Why does this happen? When does this happen? How often has it happened?

Is it a negative or positive experience or both or neither?

Strauss and Corbin (1998) elaborate further and call this organisational scheme for analysis ‘the paradigm’. What happened, for what reason and what reaction resulted contain important information related to the incident or category? Using a paradigm helps with structured analysis. It begins to explain the conditions in which the incident occurred, the actions or interactions of individuals or groups involved and the

Understanding of the structure or conditions in which the incident above occurred (self-medicating, for example) constructs or adds to the explanation. The explanation develops into a theory with why, how, who and when, thus adding the predictive power that potentially translates to practice based validity.

Although grounded theory has a range of established methods and tools (see Figures 4 & 5, Pages 71 & 72) that are systematic in their application, they are not codified to the same high level of specificity as those used in quantitative methods. Remaining open to differences in views and experiences of participants would be difficult if a mechanical codified analysis technique were employed. It is important when applying either Glaser’s philosophy or that of Strauss and Corbin that the researcher is sensitive to theoretical development, samples concepts accordingly, and analyses them within both the overall context and that of the individual participant him or herself. This complex process is simplified by Strauss who advises in an on line interview.

There are three basic elements that should be included in all grounded theory studies,

(i) Theoretical sensitive coding, that is generating theoretically strong concepts from data to explain the phenomenon researched,

(ii) Theoretical sampling, that is deciding whom to interview or what to observe next according to the state of theory generation, and that implies to start data analysis with the first interview and write down memos and hypothesis early and

(iii) the need to compare between phenomena and contexts to make the theory strong.

(Legewie & Schervier-Legewie 2004, on line interview)

Rather than strict constant comparison it is possible to complete data collection and analyse it later, however, that fails to heed the advice of Strauss and Corbin (1998), and despite their later differing views, Glaser’s (1992). Each promotes simultaneous collection and analysis with selective sampling. In most research a sample is identified in advance of data collection whereas grounded theory requires a purposeful sample at the outset that is reflective of the phenomenon with successive samples being influenced by the prominent emerging concepts.

Comparing each data incident is a constant process enabling, through accumulation of similar incidents, a weighty construct to emerge. Further sampling based on the emergent theory is then subjected to selective theoretical sampling. The principle underpinning theoretical sampling is to obtain greater illumination of the theory by matching concepts from older data and new, revisited or fresh, whilst also rescrutinising their dimensions and properties.

Deciding where to collect from was crucial and posed a minor dilemma. Glaser and Strauss (1967) suggest that all information should be considered data including field notes, informal information sources, newspapers, television, conversations and meetings. For both ethical and research quality reasons it is important to cite precisely the data sources, and since my role as practitioner-researcher has potential for overlap it was important to distinguish research interviews and focus groups from clinical activity that may ultimately become research field notes. High volume data collection was therefore confined, in the main, to interviews and focus groups, whilst field observation which was less dense complemented the analysis and theory development rather than underpinning it. In these circumstances the validity of consent was examined, as previously stated, within my research supervision, ensuring only data from service users who had consented to participate could be used, that it remained incidental and was not the prime focus within therapy. Data from clinical activity was informative but did not constitute the themes, rather it reinforced or refined themes emergent from the focus group or interview derived data.

Remaining reflexive was important in this respect particularly if new ideas or thoughts emerged from therapeutic work rather than research data collection processes. Here the significance of new ideas generated in therapy needed examination; were they new ideas or variations on existing ideas, were the ideas too much a deviation from the route my research analysis was taking or perhaps the new ideas were legitimate developments of an idea that had percolated for sometime only to be distilled within another context that contained critical cues? These questions were constant in my development of ideas and concepts, the defining line was that of originality and genesis, only by re-examining transcripts and early coding was I able to differentiate. Even in the absence of transcript information that reflected an idea I did not necessarily abandon it, I was more inclined to reflect on it in supervision and

re-compare several times. My aim was to avoid firstly the unethical inclusion of non research originating data and secondly promote research integrity by avoiding external bias. Ahern (1999) asserts the importance of utilising sources of support such as research supervisors and peers as crucial in the process of reflection and reflexivity. The subsequent exchanges enable research to be scrutinised from wider or alternative perspectives. Although this may be considered by some to introduce bias, on the other hand it encourages deeper analysis and, in my case, was invaluable in delineating my grounded theory ideas from externally generated or reassembled substantive concepts.

Therapy is a dynamic process and combined roles of practice and research in the same therapy field will inevitably lead to overlap. My initial concern that the two aspects would converge and be indistinguishable was unfounded in practice. Moreover the therapy side of my role, from which the inspiration to conduct the research came, provided ongoing inspiration and interesting information often conducive with my results or ongoing analysis. Discovering consistencies in research and practice, if Glaser and Strauss (1967) are to be understood correctly is validational providing that the researcher is aware of the sources of information; I would add that their chronicity is equally important. These measures were strengthened through re-reading transcripts containing the original memos that had identified particular categories or concepts in question.

In conclusion, grounded theory development requires key themes to be identified, then, through systematic analysis, conceptual elements are linked and compared in order to demonstrate their fundamental similarities. These similarities characterise new and old data which are then selected for further coding and theoretical sampling. Substantive and Formal Theory Generation

A concept should be understandable and analysis should reveal its firm character. The characteristics of one concept may exist in other concepts, whilst the concepts in their entirety may be considerably dissimilar. For example, the categories ‘Role of Substances’ and the ‘Level of Knowledge about Drugs’ are two distinct categories which share certain properties, one such property being the sustained use of a psychosis exacerbating substance, like cannabis, to relieve distress from auditory

hallucinations. Glaser (1978) suggests the value of identifying comparable characteristics enables substantive theory to support the development of formal theory. This assertion was encouraging for me since it promoted theory of an empirically substantive nature (what was helpful and unhelpful) which then posed further questions. The development of a formal theory explaining dual diagnosis would be the result of cumulative research rather than a single study such as mine.

The link between substantive and formal theory in dual diagnosis would be satisfying for readers. This study provides substantive theory of immediate and practical relevance whilst also contributing to wider formal theory development beyond. The purpose was to provide useful information to service users, carers and practitioners. The substantive theory was therefore expected to provide an underpinning principle or set of principles on which any information would be based. The substantive theory

Help is discussed later in Chapters 4 and 5. Product Development

Aiming for an outcome of a physical nature from a grounded theory study, such as information materials for service user/carer education, raised challenging questions. Firstly it presupposes that an explanation and accompanying detailed information will emerge. Secondly, additional researcher pressure may occur in order to tailor the explanatory theory in a product format. Thirdly, a process of theory development might be governed by product grounds not for explanatory theory purposes. Glaser (1978) concerns himself less with the verification of theory process from participants and more with explanatory power to the phenomenon as a whole, providing incidents and concepts link adequately. This principle encourages adherence to methodology which in turn decreases the risk of the compromise alluded to above. In addition thorough research supervision, maintaining an awareness of potential practitioner- researcher role conflict and adherence to my research plan enabled the research process to run its scheduled course.

A final problem I encountered and adjusted for was the simplicity that educational or information material required in order to be ‘user friendly’. How a complex phenomenon with multiple incidents can condense into a booklet of some form was

theoretical sampling tested and retested the major concepts, and what they meant in reality to a person taking substances and experiencing mental illness. As a result, checking the accuracy of themes by returning to the same and similar focus groups and presenting the themes in story form with the product (booklet based information materials) in mind served as a user-friendly vehicle on which to locate concepts. This process was planned; however it was unexpected that the corresponding concepts of theory development and information materials would integrate so well.

Over two years, four booklets were developed. A central illustrated character for each booklet was devised who possessed an amalgamation of key issues from within the data. The characters were orientated around common diagnoses and substance types to resemble the participants’ clinical presentations. The illustrated characterised storylines were the vehicle for conveying (i) the essence of help, as defined by the studies Help theory and (ii) the practical and helpful actions, advice and issues contained within the data.

The information materials are presented and discussed in Chapter 6; Outputs.

Method

This section of the chapter sets out the procedures I followed in collecting and analysing data. It describes coding and how coding operated in tandem with the theoretical sampling and constant comparison of both participant groups and data. The coding strategies I employed are illustrated by example and description. The major categories are identified and how they guided theory development is explained.

In keeping with the foundations in pragmatism…grounded theorists aim to develop fresh theoretical interpretations of the data rather than explicitly aim for any final or complete interpretation of it. (Charmaz 1983, Page 111)

Despite the organised structure grounded theory provides, the research process and that of theory development is relaxed and unforced. The fundamental rules of grounded theory deter the researcher from making early interpretations that might lead to inaccuracy. This allows the data to accumulate in greater density and volume and eventually reveal the authentic credible themes.