Abstract
Constructivist research methodologies are useful in discerning meanings of experience to subsequently inform and improve healthcare practice. For researchers who philosophically align with the constructivist paradigm, numerous methodologies are available from which to choose to address research questions. However, it can be challenging for researchers, especially novice ones, to choose the most appropriate methodology that aligns with the current state of knowledge of the identified topic, proposed research question, and the study purpose. To reduce the confusion faced by health researchers when choosing an appropriate methodology for a specific study, this paper compares two popular qualitative health research approaches: constructivist grounded theory and interpretive phenomenology. Philosophical underpinnings and the epistemological and ontological evolution of each methodology are explored with similarities and differences highlighted. Manifestation of the philosophical foundations of constructivist grounded theory and interpretive phenomenology are described in relation to data collection, analysis, and the research findings. To illustrate distinctions of each approach and support researchers in the navigation of methodological decision-making, a specific healthcare study context is presented: the rural family members’ experiences of a relative’s interhospital transfer for advanced critical care services. This study context is increasingly being recognized as an important area of healthcare research and practice. However, gaps in knowledge persist, specifically in relation to the experiences of rural family members when a critically ill relative requires an interhospital transfer to a distant urban center for advanced critical care services. Improved understanding of such experiences is necessary to inform the care provided to rural family members, potentially mitigating short and long-term negative consequences for these individuals. Within this example, the importance of the research purpose and research question within a specific study context is underscored as central to appropriate methodological decision-making.
Keywords
When choosing a methodology to address a research problem, it is important that the researcher selects an approach that aligns with their philosophical assumptions, the study purpose, the current state of knowledge in the area under investigation, and the desired outcome of the research endeavor (Starks & Brown Trinidad, 2007). However, blurred boundaries between methodologies such as grounded theory and phenomenology, along with the variety of available approaches to each, make choosing an appropriate methodology challenging for researchers, especially novice ones (Green, 2014; Singh & Estefan, 2018; Starks & Brown Trinidad, 2007). In this paper, constructivist grounded theory (CGT) and interpretive phenomenology will be compared with the aim of reducing the confusion faced by health researchers when choosing an appropriate constructivist methodology for a particular study. To illustrate methodological distinctions and appropriate researcher decision-making, a specific study context is described: the rural family members’ experiences of a relative’s interhospital transfer (IHT) for advanced critical care services.
Comparison of Methodologies.
Comparison of Constructivist Grounded Theory and Interpretive Phenomenology
Evolutionary Overview.
Positivist/Post-positivist Origins of Methodologies
Early versions of grounded theory and phenomenology, as first described during the prevailing positivist perspective of the time (Denzin & Lincoln, 2018), subscribed to a realist ontology and were objective in their epistemologies (Charmaz & Bryant, 2010; Koch, 1995). Subsequently, within the realm of qualitative inquiry, significant shifting in paradigmatic foundations resulted in the evolution of these methodologies to include a relativist ontological position and constructivist approach to scientific inquiry (Annells, 1996a, 1996; Charmaz & Bryant, 2010; Denzin & Lincoln, 2018). Below, an overview of the evolution of these two fields of inquiry is offered.
Grounded theory was first described by Glaser and Strauss (1967) as a research methodology for inquiries in the field of sociology (Cutcliffe, 2000). In response to the position of privilege held by quantitative research methods as the only legitimate means to scientific inquiry in sociology, Glaser and Strauss sought to address the resultant marginalization of qualitative research through development of grounded theory as a methodology that was successful in “legitimating inductive qualitative research” (Charmaz et al., 2018, p. 413). The goal of grounded theory is to develop an explanatory theoretical representation of human behavior within a social context that is grounded in data from participants (Creswell & Creswell, 2018; Glaser & Strauss, 1967; Keane, 2015; Wuest, 2012).
Since its inception, grounded theory has been used in many disciplines including nursing (Cutcliffe, 2000) and is, in fact, the most popular qualitative research methodology (Charmaz et al., 2018). This methodology has undergone several evolutionary turns resulting in three main approaches to conducting a grounded theory inquiry: Glaserian or classic, Straussian, and the CGT approach (Berthelsen et al., 2017; Keane, 2015; Wuest, 2012). There is variation across the three approaches to grounded theory with some scholars perceiving objectivist undertones in both the Glaserian and Straussian approaches (Charmaz & Thornberg, 2020), while this is disputed by Wuest (2012) who considers the active engagement of the researcher to be more subjective in nature. Thus, there is debate and confusion in the literature regarding the nature of grounded theory and how it is situated in terms of research paradigm (Cutcliffe, 2000; Keane, 2015; Wuest, 2012).
Generally, it is acknowledged that Glaserian grounded theory is based on the assumption that “the data speaks for itself” (Reay et al., 2016, p. 27), thereby resulting in theory being revealed to the researcher which aligns this methodology within the post-positivist paradigm (Annells, 1996a; Berthelsen et al., 2017; Duchscher & Morgan, 2004; Keane, 2015; Reay et al., 2016). Annells (1996a) notes that the relativist ontology and subjectivist epistemology of Straussian grounded theory places this approach closer to the constructivist paradigm; yet Charmaz et al. (2018) and Keane (2015) identify that the Straussian method is objective in nature and, as such, is underpinned by positivist assumptions.
Broadly speaking, the philosophical underpinnings of grounded theory approaches are linked to pragmatism and symbolic interactionism (Wuest, 2012). Pragmatism is the theoretical position where the useful or practical is privileged over the theoretical (Seigfried, 2000). According to pragmatism, theory is closely connected to practice and the development of knowledge is assessed in terms of its effectiveness to create change (Alvesson & Skoldberg, 2018; Seigfried, 2000; Wuest, 2012). When seeking knowledge from the approach of pragmatism, it is understood that reality cannot be comprehended by deduction from theory; rather, it emerges inductively during the course of investigation of human experience using the method of “constant empirical verification” (Wuest, 2012, p. 228). Through this inductive process, the understanding of human experience is dynamic, evolving, situated within context, and value laden (Wuest, 2012).
Symbolic interactionism is an approach to the study of human living that assumes: (a) individuals act toward things on the basis of the meanings that things have for them; (b) the meaning of such things is derived from or arises out of, the social interaction with other individuals; and (c) these meanings are handled in, and modified through, an interpretive process used by the person in dealing with the thing he [she] encounters (Blumer, 1969, p.2).
Therefore, when undertaking a grounded theory inquiry, symbolic interactionism guides the researcher to see human behaviors as reactions to symbolic meanings that are both created and dynamic in response to social interaction and contexts (Cutcliffe, 2000; Wuest, 2012).
Much like grounded theory, phenomenology has undergone significant evolution and development since it was first described, resulting in phenomenological methodologies that span the continuum of paradigms (Annells, 1999). Husserl, a German philosopher, articulated his philosophy of phenomenology prior to the first World War in response to the dominance of the empiricist philosophy of science of the time (Dowling, 2007; Munhall, 1989). According to Carman (2006), Husserl opposed the philosophical perspective that human experience was irrelevant and ignored in favor of objective pursuits of knowledge associated with naturalism. Rather, Husserl conceived human experience to be the root of knowledge and asserted that this knowledge of human experience could be objectively obtained using the technique of bracketing researcher presuppositions (Carman, 2006; Koch, 1995; Racher & Robinson, 2002). It is through this objective approach to knowledge that the influence of Cartesian duality, or the division between the mind and body, place Husserl’s philosophy of phenomenology within the post-positivist paradigm (Koch, 1995; Lincoln et al., 2018). However, Husserl’s phenomenological philosophy is considered to be a science of subjectivity, where reality as lived experience may be elicited from the consciousness and then objectively described (Carman, 2006; Koch, 1995). In this way, Husserl’s phenomenological philosophy was a departure from the dominant empiricist approach to knowledge (Carman, 2006).
The methodologies of grounded theory and phenomenology are distinct in their origins, yet their methodological evolution within a shared context of philosophy and scientific thought has resulted in commonalities and blurred boundaries (Starks & Brown Trinidad, 2007). Below, these philosophical influences on research method will be explored.
Positivist/Post-positivist Philosophical Underpinnings Manifest in Method
Data Collection and Analysis
While philosophical differences exist between approaches to grounded theory, there are some procedures in the research process that are common to all three grounded theory methodologies including coding, constant comparison, category development, memoing, theoretical sampling, and ongoing conceptualization (Keane, 2015). The components common to all three grounded theory approaches will be briefly described before an exploration of the influences of positivism/post-positivism is offered.
In a grounded theory inquiry, following collection of qualitative data often via interviews or observations, data analysis commences with coding whereby the researcher breaks the data into parts to identify and name concepts perceived to fit with the datum (Duchscher & Morgan, 2004; Mills et al., 2006a; Wuest, 2012). As coding proceeds, the researcher employs the method of constant comparison to compare individual datum and their associated interpretations in relation to how they are theoretically similar or different; as coding and constant comparison continue, relationships between codes emerge and data are gradually grouped together to form categories (Charmaz, 2014; Duchscher & Morgan, 2004; Mills et al., 2006b; Wuest, 2012).
Relationships between categories are considered and theorizing related to the phenomenon of interest continues with the assistance of memoing (Wuest, 2012). Memoing refers to the reflective writing process of the researcher whereby conceptual ideas related to the data are generated (Alvesson & Skoldberg, 2018; Duchscher & Morgan, 2004; Mills et al., 2006a). As the essential process of memoing proceeds, relationships between categories are discerned by the researcher and the core category or central concept to which all concepts relate is identified (Alvesson & Skoldberg, 2018; Charmaz, 2014; Wuest, 2012). Through these processes, a tentative theoretical account of the phenomenon is developed by the researcher (Alvesson & Skoldberg, 2018; Wuest, 2012).
To enhance theoretical saturation, whereby concepts and categories are perceived as complete and ongoing data collection does not elicit additional insights (Charmaz & Thornberg, 2020), and to determine the fit of this initial theoretical rendering with the phenomenon of interest, theoretical sampling is performed (Wuest, 2012). Theoretical sampling involves recruiting additional participants and collecting data from the perspective of the emerging theory (Wuest, 2012). At this stage, if relationships between concepts do not maintain consistency, additional analysis is required, and the theory is abstracted so that all data fit within the emerging theory (Charmaz, 2014; Wuest, 2012). Data are collected until there are no discrepancies noted in the emerging theory (Duchscher & Morgan, 2004; Wuest, 2012). The literature is then reviewed, and comparisons made between existing theory and the theory generated from the grounded theory inquiry (Wuest, 2012). The researcher then proceeds with writing the final report of the grounded theory inquiry (Wuest, 2012).
Specific to the approaches of Glaserian grounded theory, Straussian grounded theory, and descriptive phenomenology, the influence of positivism/post-positivism is evident. For example, in Glaserian and Strausian grounded theory, the researcher, seeking to uncover an unbiased theory of an external reality, maintains a separation between self, the data, and research participants (Charmaz & Thornberg, 2020; Keane, 2015). Similarly, the influence of post-positivism is also manifest in descriptive phenomenology whereby the researcher brackets or sets aside personal beliefs and assumptions in an effort to remove researcher bias (Koch, 1995). As such, descriptive phenomenology, informed by the philosopher Husserl, seeks to objectively describe an external reality (Giorgi, 2009; Koch, 1995).
Research Findings
A Glaserian or Strausian grounded theory inquiry results in the discovery of a theory of a singular reality that is presumed to be verifiable in future studies (Annells, 1996a; Charmaz & Bryant, 2010; Charmaz & Thornberg, 2020). The philosophical underpinnings of post-positivism likewise influence the product of descriptive phenomenology. Upon completion of a descriptive phenomenological study, an acontextual description of the phenomenon of interest is produced, untouched by researcher bias (Dowling, 2007).
Evolutionary Turn to Constructivism
A paradigmatic evolutionary turn in grounded theory was noted when Charmaz, a recognized constructivist grounded theorist, developed an approach flowing from both Glaser and Strauss that sought to address the omission of the subjective nature of individual realities (Charmaz et al., 2018; Mills et al., 2006a). According to the CGT approach, human actions influence and construct both the phenomenon under study and the research inquiry itself (Charmaz at al., 2018). In adopting the CGT methodology, researchers are encouraged to explore values and nurture relationships between the researcher and participant; as such, this grounded theory methodology is relativist in ontology, epistemologically subjective and, thus, is situated within the constructivist paradigm (Mills et al., 2006a; Wuest, 2012).
As with previous grounded theory methodologies, pragmatism and symbolic interactionalism are also foundational for CGT (Charmaz et al., 2018). However, by examining the dynamic connections between meaning and human behavior through an interpretive lens, the influence of pragmatism and symbolic interactionalism are more developed within this methodology (Charmaz et al., 2018). Indeed, the CGT approach considers the perspective of symbolic interactionalism as a lens through which a participant’s view of the world is interpreted, not understood as an exact duplicate of it (Da Graça Oliveira Crossetti et al., 2016).
A similar constructivist turn in the foundations of phenomenology occurred when Heidegger, a student of Husserl and widely considered to be the founder of interpretive phenomenology, built upon the philosophical work of his mentor resulting in a significant philosophical shift in phenomenology (Annells, 1996b; Burns & Peacock, 2019). Heidegger asserted that it is impossible to obtain an unbiased perspective of meaning or knowledge; rather, in the act of understanding, individuals invariably bring personal histories and biases and, therefore, subjectively influence the development of knowledge (Carman, 2006; Guignon, 2006; Koch, 1995). Thus, Heidegger’s philosophy of phenomenology disputes Husserl’s assumption of Cartesian duality whereby a description of lived experience accessed from consciousness could be objectively obtained through the technique of bracketing (Carman, 2006; Koch, 1995; Mackey, 2005). It was these differences in philosophical understandings that led Heidegger to develop a new branch of phenomenology referred to as Heideggerian or interpretive phenomenology (Annells, 1996b; Burns & Peacock, 2019). Distinct from Husserl’s descriptive phenomenology, the philosophical assumptions of this branch of phenomenology firmly place it within the constructivist paradigm (Annells, 1999).
In contrast to Husserl’s descriptive phenomenology that is epistemological in nature and pursues “what can be known… about the world and the objects within it”, Heidegger’s phenomenology is ontological in its approach to understanding (Annells, 1996b; Koch, 1995; Mackey, 2005, p. 181). Understanding is achieved through “being-in-the-world” or what Heidegger refers to as Dasein (Annells, 1996b, p. 706). Heidegger conceptualized individuals as inextricably linked to the world and, as such, they both construct the world and are constructed by the world (Koch, 1995). Thus, Heideggerian phenomenology is unique in its approach to knowledge: the researcher must “seek for understanding of the meaning of Being, rather than for what can be known” (Mackey, 2005, p. 181).
In searching for the meaning of Being, the interpretive phenomenological researcher must consider the nature of human existence in relation to the philosophical notions (also known as the life-worlds) of embodiment, spatiality, temporality, and care (Mackey, 2005; Taylor, 2006). Understandings gained during an interpretive phenomenological inquiry are co-constructed and occur through being-in-the-world and the process of the hermeneutic circle (Koch, 1995; Mackey, 2005). The hermeneutic circle is the phenomenological mode of understanding in which individuals with their existing knowledge gain increasing understanding through being-in-the-world and moving backward and forward from incomplete to more complete understanding (Koch, 1995; Mackey, 2005). Thus, according to interpretive phenomenology, an individual’s preunderstandings are the context within which interpretation occurs (Koch, 1995; Mackey, 2005). It is in this way that the findings of an interpretive phenomenological inquiry are co-constructed (Koch, 1995). These philosophical concepts and their influence on research methods will be described below.
Embodiment, a key tenet of interpretive phenomenology, is noticeably absent from Heidegger’s seminal work Being and Time (1953/2010). However, it is thought that Heidegger’s omission of the influence of the body on Being is intentional in an effort to break the Cartesian assumption that individuals have a body and are “self-contained subjects with no roots to a shared, historical lifeworld” (Aho, 2009, p. 9; Leonard, 1994). This absence was addressed by phenomenologist Merleau-Ponty who described how human existence is experienced through our bodies (Aho, 2005; Taylor, 2006). The mind and body are viewed as inseparably intertwined and “emotions, interpretations, and sensations are interrelated with one another and experienced almost simultaneously” (Orbanic, 1999, p. 142). Through an awareness of emotions and bodily experiences, meaning emerges (Fjelland & Gjengedal, 1994; Orbanic, 1999).
Spatiality is a Heideggerian characteristic of being-in-the-world in which the individual is situated within space and brings elements of concern closer to them while holding others further away (Mackey, 2005). Spatiality must not be misunderstood as a measured or geographical space; rather, it is a concept the researcher must consider when seeking to understand the meaning of a participant’s lived experience within space and recognizing what they bring near to them and what they hold at a distance (Mackey, 2005; Orbanic, 1999).
To understand Being, one must understand that human experiences are temporal where at once, the past, present, and future occur simultaneously and interact with each other (Mackey, 2005; Orbanic, 1999). Consequently, “lived experiences are the culmination of persons’ past, present, and future being-in-the-world” (Orbanic, 1999, p. 142). Thus, when conducting such research and searching for interpretations of meaning, the researcher must consider the experience of time in relation to the participant’s descriptions of their lived experiences (Mackey, 2005).
Care (also known as sorge) refers to the way of Being toward others or things in a way that is relational and meaningful (Mackey, 2005; Orbanic,1999). Indeed, according to Zimmerman (2006), “to be human means to be concerned about things and to be solicitous toward other people” (p. 300). The human caring response occurs in relation to people or things that are perceived to be meaningful; as such, meaningfulness and caring are intertwined and through knowing one, the other becomes known as well (Orbanic, 1999).
Constructivist Philosophical Underpinnings Manifest in Method
Data Collection and Analysis
Philosophically, CGT acknowledges multiple realities, knowledge that is contextual and always incomplete, and the unique subjective positions of the researcher and participant (Charmaz et al., 2018). This is mirrored in interpretive phenomenology, informed by the philosopher Heidegger, which assumes the existence of multiple realities that cannot be fully known, and knowledge generation is a co-construction (Koch, 1995; Mackey, 2005).
Despite some general similarities between the three schools of thought related to grounded theory, there are unique philosophical differences related to CGT. In contrast to the objectivist undertones of earlier grounded theory methodologies noted previously, the relativist ontology of CGT positions the researcher and participant as co-creators of meaning that results in a theory grounded in the experiences of both (Mills et al., 2006a). Methodologically, this requires the researcher to have an awareness of underlying personal assumptions during the course of the inquiry (Charmaz et al., 2018; Mills et al., 2006a). Additionally, during data collection that occurs primarily through interviews, observations, and various forms of media including researcher memos (Keane, 2015; Mills et al., 2006a; Mruck & Mey, 2019), the researcher must be highly engaged to listen attentively to the participant’s experiences with openness (Mills et al., 2006a). The inclusion of reflexivity is important because it brings to the fore an awareness of the multiple and changing realities of both the researcher and participant as the study progresses (Charmaz et al., 2018; Keane, 2015).
According to CGT, the researcher should aim to establish a relationship with the participant to mitigate any perceived power imbalances; this can be achieved by the researcher investing their unique individuality into the course of the research (Mills et al., 2006a). The epistemological foundations of CGT are especially manifest during the interview where the “researcher and participant give and take from each other, the complexity of the area of interest being explored becomes apparent, and in turn gains density as the conversation about meaning ensues” (Mills et al., 2006a, p. 9). Indeed, when using this form of grounded theory, the researcher is directed to focus on the interaction between the researcher and participant as a point of analysis (Charmaz et al., 2018; Mills et al., 2006a).
In addition to the general data analysis procedures that are common to the three schools of grounded theory, the constructivist grounded theorist must ensure that, while memoing and constructing theory, they abstract meaning from the data that remains grounded in the reality of both the researcher and the participants as co-constructors of the data (Charmaz et al., 2018; Mills et al., 2006a). During data analysis, the researcher focuses on meaning, process, and action; furthermore, the researcher strives to delve below superficial meaning to come to know unspoken meaning through the appreciation of participants’ values and beliefs (Charmaz et al., 2018; Keane, 2015; Mills et al., 2006a). Influenced by constructivist origins, the researcher aims to penetrate beyond literal readings of data and instead undertake interpretive readings and reflexive readings whereby, respectively, the researcher actively forms an interpretation of the meaning of the data and reflects on their role in the co-construction of knowledge (Mason, 2017).
Memoing should include the researcher’s reflections on relational aspects encountered during the interview and their influence on the co-creation of meanings (Mills et al., 2006a). The researcher is a part of the research and the researcher’s personal values shape their understanding of meanings (Charmaz et al., 2018; Keane, 2015). Here, the influence of pragmatism is seen: researcher subjectivity informs action undertaken during the research process which then subsequently informs researcher interpretation (Charmaz et al., 2018). It has been noted that CGT is a useful methodology to advance social justice because of its recognition that the resultant theory is co-constructed (Charmaz et al., 2018; Keane, 2015).
Both CGT and interpretive phenomenology are situated within the constructivist paradigm and, as such, methodological similarities are evident and inevitable. To illustrate the philosophical underpinnings of interpretive phenomenology as manifest in method, the interpretive phenomenological method described by Munhall (1994; 2012) will be presented. Munhall’s (1994) interpretive phenomenological methodology is influenced by the work of Heidegger and her experiences as a healthcare provider (HCP) (i.e., nurse), researcher, and professor. According to Munhall (1994; 2012), phenomenology as a research methodology provides the opportunity to better understand the people that HCPs care for as individuals, rather than applying knowledge gained from “theory reflecting aggregates of individuals or the non-existent person” (2012, p. 170). Munhall (1994; 2012) credits the increased interest in interpretive phenomenology to the rise of technology and the desire to offset traditional empiricism in practice with compassion and caring that is informed by meaning, thus enhancing communication between HCPs and their patients.
An interpretive phenomenological study begins with the researcher posing a question that aims to understand the nature of being human in a specific situation and, in doing so, what is hidden may be accessed thereby informing strategies for change (Crowther et al., 2017; Leonard, 1989; Munhall, 1994; 2012). Munhall (2012) acknowledges that all experience is situated within context and meaning is influenced by embodiment, space, time, and relationships. Here, the influence of the phenomenological philosophy of Heidegger is evident. Once a question is asked, the researcher recruits participants who have experienced the phenomenon of interest and are willing to share their experiences (Munhall, 2012). Munhall (1994; 2012) stresses that there are no specific rules related to the number of participants that are recruited; rather, recruitment is guided by the nature of the phenomenon under study.
Data are typically collected from interviews as well as media such as photographs and films (Munhall, 1994; 2012). The researcher’s approach to data collection involves a strategy that Munhall refers to as unknowing. This perspective of unknowing is achieved through the researcher acknowledging preconceptions and biases and, to the best of their ability, setting these aside during data collection so they are open to more clearly understand the unique, distinct perspectives of study participants (Munhall, 2012). Unknowing is facilitated by the use of journaling whereby the researcher documents their preunderstandings and biases (Munhall, 2012). Munhall (2012) emphasizes the importance of unknowing as a form of openness to subjectivity and unique perspectives, whereas knowing is a form of closure. As asserted by Heideggerian phenomenology, Munhall (1994) acknowledges that bracketing as a phenomenological device may not be possible. Instead, she articulates that unknowing may be a better term to describe the attitude assumed by the researcher to allow different meanings to be accessed (Munhall, 1994).
During data collection, Munhall (2012) encourages the researcher to engage in journaling, an activity that overlaps with, yet is distinct from the grounded theory strategy of memoing. As a tool for data analysis, memoing facilitates the generation of ideas and identification of theoretical categories (Alvesson & Skoldberg, 2018; Charmaz, 2014; Duchscher & Morgan, 2004; Mills et al., 2006a; Wuest, 2012) while attending to the inevitable influence of the researcher on understandings during a CGT inquiry (Charmaz et al., 2018; Keane, 2015). Like memoing, journaling includes reflections of researcher preconceptions and the influence of these on the meanings generated during the inquiry (Munhall, 2012). However, journaling in interpretive phenomenology avoids the categorization of themes and instead chronicles the researcher’s evolving understandings, personal growth, and increasing sensitivity to human experience, much like the hermeneutic circle described in Heideggerian philosophy (Koch, 1995; Mackey, 2005). As such, Munhall (2012) notes that the researcher is a co-creator of the findings of the study and as such will be changed by the inquiry.
Data collection and analysis are simultaneous and occur through the researcher listening to their self and others within the context of their life-worlds (Munhall, 2012). Data collected from participants, media, and the researcher themselves is processed through the four life-worlds to enhance the understanding of meaning (Munhall, 2012). These life-worlds, similar to the philosophical notions of embodiment, spatiality, temporality, and care described in Heideggerian philosophy, are identified by Munhall (2012) as corporeality or embodiment, spatiality, temporality, and relationality. These four life-worlds are interconnected and together form the singular life-world of an individual (Munhall, 1994; 2012).
Life-worlds offer a lens through which to consider and contemplate data, within context, when attempting to understand the unique meanings of experience as perceived by individuals (Munhall, 1994; 2012). When considering experiences through the life-world of corporeality, it is understood that the mind and body are not separate, but are as one, and phenomena are experienced by the mind, through the body (Munhall, 2012). The life-world of spatiality offers a lens to consider the environment or space within which an individual experiences phenomenon and thus contributes to unique, individual perspectives of meaning (Munhall, 2012). In addition to considering the physical environment, Mackey (2005) articulates that spatiality includes the metaphysical space where individuals may uniquely pull close or push away elements of experience thus revealing meanings that are more or less important to individuals. The life-world of temporality considers the influence of past experiences and history on meanings that arise during experience; at once, the past and future exist in and influence meanings formed in the present (Munhall, 1994; 2012). Finally, relationality situates meanings of experience within the context of relationships among individuals (Munhall, 2012). When processing data through the life-world of relationality, the researcher is sensitive to and seeks out the unique and individual perception of relationships that are revealed, situated within context (Munhall, 2012).
Research Findings
“Grounded theory leads to ‘why’ questions and can locate the answers in the conditions of their production” (Charmaz, 2017, p. 299). Here, the influence of symbolic interactionalism can be seen where it is assumed that participants experience a common and shared “social psychological problem” that lies beneath the surface of awareness (Wuest, 2012, p. 230); the researcher seeks to access this problem and the means by which it occurs by searching for the meanings in objects, words, or non-verbal ways of communicating and how these meanings influence human behaviors and interactions (Cutcliffe, 2000; Wuest, 2012).
The resulting theory from a CGT inquiry is contextually situated and a compilation of the participants’ stories and the researcher’s interpretation of the meanings (Keane, 2015; Mills et al., 2006a). The research report within which the grounded theory is presented is written so that the voice of the participants and the researcher as author are heard, thereby acknowledging to the reader the shared experience between the researcher and participants and the co-creation of meaning about a phenomenon of importance (Mills et al., 2006a).
In contrast to CGT, Munhall (2012) suggests that interpretive phenomenology and its atheoretical approach to gaining an increased understanding provides a foundation from which to commence theorizing. This in-depth understanding of the meaning of experiences is communicated by the researcher in the form of individual participant narratives that subsequently inform the development of an overarching narrative based on the phenomenon studied (Munhall, 2012). Once data are analyzed or processed and the researcher has engaged in “dwelling with the data” to glean the meaning of being in the phenomenon of interest, they write a narrative using the participant’s language (Munhall, 2012, p. 144). The researcher then returns to the participant(s) to determine if they accurately captured the meaning of being for them. Upon completion of the study, the researcher writes an overarching narrative of the meaning of the experience (Munhall, 2012). It must be emphasized that Munhall encourages the researcher not to seek out and document similarities or differences in participant narratives; rather, the final overarching narrative “tells many different stories of meaning” (Munhall, 2012, p. 145). It is in this way that the individuality of meaning is maintained and aligns with Heideggerian philosophy.
Utility of Constructivist Methodologies to Health Research
While grounded theory techniques (i.e., coding, memo-writing) have been utilized in qualitative inquiries that do not result in the generation of theory (Charmaz, 2017), the main purpose of the grounded theory methodology is to generate a theory (Charmaz & Bryant, 2010; Charmaz & Thornberg, 2020). This product of a grounded theory inquiry aims to explain the behaviors of individuals that manifest within the social context; as such, this methodology is particularly useful to inform both healthcare practice and research that seek to develop and evaluate interventions in social contexts (Reay et al., 2016; Starks & Brown Trinidad, 2007; Wuest, 2012).
The values of HCPs such as nurses and the philosophy of phenomenology are closely aligned, both which are concerned with understanding the nature of being human within context (Dowling, 2007; Leonard, 1989; Mackey, 2005; Munhall, 2012). Furthermore, interpretive phenomenology provides health researchers with the ability to determine meanings of being for patients that can consequently impact understanding and improve healthcare practices (Crowther et al., 2017; Lincoln et al., 2018; Matua & Van Der Wal, 2015; Starks & Brown Trinidad, 2007). Thus, when embarking upon an inquiry, phenomenology is often a logical choice for health researchers (Burns & Peacock, 2019; Leonard, 1989). However, compared to CGT, is interpretive phenomenology a more appropriate research methodology within the context of health research?
Methodological Choice Within a Specific Research Context
Above, two constructivist research methodologies have been explored in relation to their philosophical underpinnings and how these philosophical foundations manifest in method. In addressing a research problem, it is important that the researcher chooses a methodology that is commensurate with their worldview and appropriate for the aim of the study; doing so will enhance the strength of the inquiry (Green, 2014; Mills et al., 2006b; Starks & Brown Trinidad, 2007). To illustrate the distinctions between CGT and interpretive phenomenology, and support researcher decision-making when choosing the most appropriate methodology for a constructivist inquiry, a specific study context and associated methodological considerations are presented.
Understanding Families’ Experiences of Interhospital Transfers for Advanced Critical Care Services
Family members of critically ill patients are significantly affected by a relative’s critical illness experience (Svenningsen et al., 2017). Indeed, a relative’s critical illness can have negative and severe long-term consequences for family members; sequelae may include the development of anxiety, depression, complicated grief, and post-traumatic stress disorder (Davidson et al., 2012). Increasing recognition and concern has motivated the healthcare community to better understand these experiences and address the negative consequences termed post-intensive care syndrome-family (PICS-F) (Davidson et al., 2012; Harvey & Davidson, 2016; Iwashyna, 2010; Marra et al., 2018).
The critical illness experience can increase in complexity if the patient’s needs exceed the healthcare service capacity of the local hospital, thereby necessitating an IHT to an urban center a significant distance away for advanced critical care services. Recently, an integrative review of existing literature produced a conceptual map of this phenomenon that included potentiating and mitigating factors for the central constructs of anxiety and stress as experienced by family members (Burns & Petrucka, 2020). However, it was noted that more research is required in this area of healthcare to inform enhanced family-centered care (Burns & Petrucka, 2020).
While research efforts have investigated PICS-F for nearly a decade, there has been little research conducted about the experiences of rural family members of critically ill patients who require an IHT for advanced critical care services. Existing research indicates that, in addition to the stress experienced during a relative’s critical illness, rural family members may face additional physical, psychological, emotional, and financial burdens as a result of the IHT event (Burns et al., 2018). Yet, as noted by Burns and Petrucka (2020), understanding of this phenomenon remains incomplete with persisting gaps in knowledge related to the experiences of family members unable to travel to the urban center. In addition, little is known about the experience of this phenomenon in cultural contexts outside Australia and the United Kingdom, and potential for development of short-term and long-term consequences for families. As it is important that HCPs care for both the critically ill patient and their family members (McConnell & Moroney, 2015; McKiernan & McCarthy, 2010), this dearth of healthcare knowledge is significant. With enhanced understanding, HCPs may be able to prevent or mitigate the negative consequences experienced by these family members.
Study Specific Rationale for Choosing Interpretive Phenomenology.
Interpretive phenomenology is ontological in its approach and seeks to delve deeply into the meaning of being, therefore, revealing that which is beyond the surface (Crowther et al., 2017; Mackey, 2005). Interpretive phenomenology aims to generate an enhanced understanding of a phenomenon and inspires HCPs to reconsider previously held assumptions of individual life experiences (Crowther et al., 2017; Kleiman, 2004). Where grounded theory generates explanatory theory through the organization and categorization of data, interpretive phenomenology avoids categorization and aims to shed light on the multiple possible meanings of phenomena to enhance the appreciation of new understandings of human experiences (Crowther et al., 2017).
Some methods of interpretive phenomenology result in the generation of an overarching narrative that reveals the many possible meanings of experience (e.g., Munhall, 2012). As noted by Dahlstrom (2014), narratives are a powerful and persuasive mode for communicating study findings to audiences. Through the use of narratives, potentially incorrect assumptions held by HCPs may be altered, healthcare interactions between the HCP and patient or family member enhanced, and healthcare practices improved (Munhall, 2012; Orbanic, 1999; Starks & Brown Trinidad, 2007). This is especially important in critical care because of the documented misunderstanding that some critical care HCPs have in relation to the impact of critical illness on family members. As such, from our perspective, interpretive phenomenology is the most suitable fit for researchers who philosophically align with the constructivist paradigm and aim to gain an increased understanding of the rural family members’ experiences of a relative’s IHT for advanced critical care services.
For researchers who wish to enhance comprehension of the meanings of experiences for family members as understood through being-in-the world rather than developing a theory, interpretive phenomenology would be a more appropriate choice than CGT. Furthermore, phenomenology is an especially useful methodology in situations where the phenomenon of interest is poorly understood (Polit & Beck, 2017), as is the case with IHT. By offering initial understandings of the multiple possible meanings of experiences, interpretive phenomenology subsequently informs and strengthens CGT inquiries guided by research questions seeking to develop theories about the temporal processes of experiences (Munhall, 2012). These considerations provide additional support for the use of an interpretive phenomenological approach when selecting a constructivist methodology to explore the family members’ experiences of critical illness.
Interpretive phenomenology as described by Munhall (1994; 2012) also provides several advantages of fit with regard to the proposed research context. As noted, family members of critically ill patients who undergo an IHT for advanced critical care services describe the additional physical, psychological, emotional, and financial burdens that they experienced (Burns et al., 2018). However, this study also identified unique individual experiences during IHT such as changing family roles, the “difficulty [a participant] had consolidating her known reality to the reality presented to her” (p. 19), the transfer as being “demanding, exhausting, and frightening” (p. 19), and confusion over the past and what the future would hold “not knowing what had happened or what would happen to their loved one” (Burns et al., 2018, p. 19-20). Considering these descriptions of family members’ experiences, it becomes clearer to us the utility of Munhall’s interpretive phenomenology (1994; 2012) in gaining a holistic understanding of the meaning of such experiences. With this foundational, holistic understanding, specific research questions related to how social processes unfold across a group of participants may be generated. In this research context, the perspective of CGT is most appropriate.
Analyzing the experiences of these family members through the four life-worlds of corporeality, spatiality, temporality, and relationality supports a penetrating exploration of that which lies beneath this experience, enhancing understanding of the participant’s being-in-the-world (Munhall, 2012). For example, processing data through the life-world of corporeality may aid in understanding the meaning of being in this experience as sensed through the body as described with the words of exhaustion and demanding. The life-world of spatiality may facilitate the understanding of the meaning of being far from home physically, psychologically, and emotionally. Temporality, when considered as a life-world, may illuminate the meaning of the experience as lived, with the past, present, and future at once influencing meaning. Finally, considering the life-world of relationality may provide a lens to explore the meanings of the experience as arising from changing family roles, relationships with family members and HCPs, relationship with the critically ill relative, and connections to a sense of home. Understanding gained through the four life-worlds of corporeality, spatiality, temporality and relationality is essential to practice in healthcare (Burns & Peacock, 2019).
Although we put forth that interpretive phenomenology is the most appropriate methodology to understand the family members’ experiences in the identified context, CGT should be considered as a useful methodology to extend our knowledge of this experience. The specific lived experiences and associated meanings of IHT identified and understood through an interpretive phenomenological inquiry can then be followed with CGT research to learn about how certain processes occur or are brought about.
Guided by a research purpose and question that focuses on the temporal process of experience, a CGT approach would examine the unfolding of this process, the core phenomenon of the experience, and resultant outcomes. The findings of an interpretive phenomenological inquiry, arrived at though the explicit avoidance of categorizing experiences, reveals the many possible meanings of human experience (Munhall, 2012). We posit that constructivist grounded theory, informed through the findings of an interpretive phenomenological inquiry of the many possible meanings of human experience, may more accurately identify and name the core category or process within a grounded theory inquiry. Informed by meanings accessed during a phenomenological inquiry, future CGT research could examine how IHT brings about disruption to everyday life that requires coping with role changes or how HCP support (or lack of) with specific IHT challenges can result in family members experiencing positive or negative outcomes. Again, it is imperative that the methodology align with the researcher’s values and beliefs and the research question and purpose; in the example presented, interpretive phenomenology was supported. Nonetheless, both constructivist methodologies are valuable for generating healthcare knowledge that facilitates the delivery of care to family members experiencing a relative’s critical illness and subsequent IHT for advanced critical care services.
Conclusion
The methodologies of grounded theory and phenomenology have undergone significant evolution since first described. Paradigm debates and conflicts over the last several decades (Denzin & Lincoln, 2018) have influenced the turn from a philosophical foundation of positivism/post-positivism to constructivism in newer versions of these methodologies. Within the backdrop of shifting paradigms, grounded theory and phenomenology have co-evolved to result in the overlapping yet distinct methodologies of CGT and interpretive phenomenology.
The blurring of boundaries between these constructivist methodologies can make it challenging for researchers, particularly novice researchers, to choose the most appropriate methodologies to guide a study. To support methodological decision-making when choosing a methodology that aligns with a specific research purpose and the researcher’s philosophical assumptions, CGT and interpretive phenomenology were explored and compared. After a detailed exploration of the historical and philosophical foundations of both methodologies and manifestations in method, to additionally support methodological decision-making, a specific study exemplar was presented.
Rural family members of relatives who undergo an IHT for advanced critical care services suffer additional burdens beyond those experienced by family members of critically ill patients not requiring IHT. This experience is currently poorly understood despite being important; HCPs care for both the critically ill patient and their family members. It was determined that interpretive phenomenology would be the most appropriate approach to address gaps in knowledge related to the care of rural family members’ experiencing a relative’s IHT for advanced critical care services. It is acknowledged that CGT is also a useful research methodology to generate healthcare knowledge. However, as noted by Munhall (2012), an enhanced understanding of the meanings of experiences for individuals is an essential first step prior to the commencement of theorizing. Interpretive phenomenology facilitates these initial understandings and, thus, provides an essential first step to the ongoing development of knowledge and theories grounded in experience.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received financial support from College of Nursing Advancement Fund, University of Saskatchewan for the publication of this article.
