A number of strategies were employed to ensure the trustworthiness of the data and the transferability of the findings. A grounded theory should be systematically generated, conceptually abstract, have explanatory power for the behaviours noted in the data, be able to accommodate new concepts as they arise and have relevance beyond the substantive area under investigation (Glaser & Strauss, 1967, p. 36). Evaluating the quality of a grounded theory study might therefore be best achieved by using the criteria emphasised by grounded theory’s founders, however other authors disagree, citing the potential for evaluation becoming circular and self- confirming (Elliott & Lazenbatt, 2005). For this reason the researcher evaluated the quality, trustworthiness and transferability of the findings against two sets of criteria. The first set of criteria were those emphasised by Glaser and Strauss who identified
fit, work, relevance and modifiability as essential criteria for a quality grounded
theory (Glaser, 1978, pp. 4-5). The second set of criteria were those of Lincoln and Guba (1985) comprising credibility, transferability, dependability and confirmability. The criteria proposed by Lincoln and Guba (1985) were selected because it is a common framework for evaluating qualitative research and has previously been used
to evaluate grounded theory (Elliott & Lazenbatt, 2005). Each set of criteria will be considered in turn.
2.5.5.1 Fit, relevance, work and modifiability
In their seminal work, Glaser and Strauss emphasised that a quality grounded theory must have fit, relevance and work (Glaser, 1978, pp. 4-5). Glaser later expanded this list to include a fourth criteria, modifiability (Glaser, 1978, pp. 4-5). As these criteria are applied after the theory is generated, the most salient factor in a credible
grounded theory is close adherence to the method described by Glaser and Strauss (1967). To achieve this, the researcher had the benefit of university research
supervisors with extensive experience of grounded theory who provided mentoring consistent with Glaser’s recommendations (Glaser, 1998, p. 5). The researcher also read widely on grounded theory, particularly the seminal text by Glaser and Strauss (1967) and subsequent original texts by Glaser (1965, 1978, 1992, 1994, 1998, 2001, 2002a, 2002b) and Glaser and Holton (2004). Outside of the original sources,
guidance from other authors was limited to those articles and books that were consistent with the original method of grounded theory.
In addition to the measures described above, the emerging theory was constantly evaluated during sequential write-ups for fit, relevance, work and modifiability as described by Glaser (1978, pp. 4-5). According to Glaser fit is synonymous with validity and questions whether “the concept represent(s) the pattern of data it purports to denote” (Glaser, 1998, p. 236). Fit is a function of close adherence to grounded theory methodology, where concepts are generated from data and not ‘forced’ or ‘received’ (Glaser, 1998, p. 236). Relevance flows from fit, as concepts that fit will be highly relevant to participants, in the form of a shared common concern and core process for continually resolving the main concern (Glaser, 1998, p. 236). According to Glaser (1998, p. 237) it is only in the context of fit and relevance that the core category can be integrated and the substantive theory work. That is, a substantive theory that works has meaning to participants and feels familiar (Glaser, 1998, p. 237). The fourth criteria, modifiability is an inherent function of the method of constant comparative analysis and theoretical sampling. The substantive
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theory reported in this thesis was refined and reworked as new concepts were identified, attesting to modifiability.
Future research may seek to test the fit, relevance, workability and modifiability of the substantive theory presented in this thesis. The researcher will also seek
opportunities to share the findings of this study at future meetings with public sector secondary school nurses to confirm if study findings resonate with participants. ‘Checking’ of results or validation processes with participants are not requirements of grounded theory (Cheer et al., 2016) but present future opportunities to expand on the work initiated in this thesis.
2.5.5.2 Credibility, transferability, dependability and confirmability
According to the criteria proposed by Lincoln and Guba (1985), key elements of excellence in qualitative research include credibility, transferability, dependability and confirmability. In the current study, clear evidence that the original method of grounded theory was adhered to is essential to meet the criteria of credibility. Credibility is further enhanced when there is evidence for the application of core processes such as concurrent data collection and analysis, application of the method of constant comparative analysis, theoretical memoing and theoretical sampling. Other strategies to enhance credibility of the current study included the prolonged engagement in the field, checking of interview transcripts against digital audio recordings for errors, joint-coding of interviews with university supervisors for feedback purposes, researcher confirmation that participant quotes were used in their proper context and regular discussions with the researcher’s university supervisors about the emerging findings. Credibility was also enhanced by the achievement of data saturation. Glaser and Strauss defined saturation as meaning that “no additional data are being found whereby the sociologist can develop properties of the category” (Glaser & Strauss, 1967, p. 61). Confirmation that data saturation had been achieved was confirmed by the researcher’s university supervisors.
A grounded theory has inherent transferability owing to its design. Being conceptual in nature, grounded theory transcends specific experiences and is abstract of people,
place and time (Artinian, Giske, & Cone, 2009, p. 12). Dependability is the degree to which there is enough information to replicate a qualitative study (Bitsch, 2005); it is highly reliant on a clear audit trail, detailed research processes, and transparency in relation to methodological decisions. In the current study several factors contributed to the study’s dependability: close adherence to the original method of grounded theory, research supervisors with specialist expertise in grounded theory, and regular supervision meetings with the researcher’s university supervisors. Confirmability is “the degree to which the findings of the research study could be confirmed by other researchers” (Korstjens & Moser, 2018). As with dependability the essential
requirement for meeting confirmability is to use clearly articulated processes with a detailed audit trail to explain methodological decisions. Close adherence to the original method of grounded theory, audio-recorded discussions with the researcher’s university supervisors in relation to methodological decisions and extensive
memoing contribute significantly to this study having a high degree of confirmability.
2.6 Ethical considerations
Prior to conducting field work, the researcher addressed the ethical implications of the study and considered how participants would be protected. The researcher obtained ethics approval for the proposed research from the Child and Adolescent Health Service Human Research Ethics Committee in Perth, Western Australia, as shown in Appendix G with approval number RGS 00056. Reciprocal ethics approval was granted by Curtin University Human Ethics Committee, as shown in Appendix H. The Child and Adolescent Health Service - Community Health and the Western Australia Country Health Service provided governance approval for the conduct of the research in their respective health services, as shown in Appendix I and J. The remainder of this section examines processes for gaining participant consent, provision for withdrawal from the study, considerations in relation to participant privacy, confidentiality and anonymity, minimising the risk of harm to participants, and data storage, access and disposal.
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