Abstract
Advancing our intersectionality-framed program of work, this article positions nursing’s social‑justice mandate within grounded theory (GT). We argue that constructivist grounded theory (CGT), while oriented to social justice, requires further development to address inequities faced by people at intersecting social locations. We integrate intersectionality as critical social theory and analytical tool to institute sustained intersectional thinking that heightens attention to power relations, contextual variation, and researcher positionality. Operationally, intersectionality expands core GT methods: memoing becomes a site for documenting assumptions, emotions, and the (in)visibility of structural forces; theoretical sampling is deliberately oriented to heterogeneity; and constant comparison is tuned to systems of racism, sexism, and classism across data sources. Drawing on our intersectionality‑informed CGT study of public health nurses working with refugee‑mothering women, we offer a practical blueprint of insights for equity‑driven GT and outline future congruence with ecofeminism, queer theory, Indigenous gender frameworks, and transfeminism to further strengthen qualitative methodologies and promote health equity.
Introduction
Nursing researchers worldwide advance science through generating knowledge that addresses the ever-changing needs of public health and well-being (Connor et al., 2025; Redeker, 2021). As described within the International Council of Nurses (ICN) code of ethics, social justice is a professional mandate for nurses to address inequities through activities such as advocating for human rights and ensuring inclusion of populations disadvantaged systemically (ICN, 2021). In fact, the ICN code of ethics explicitly advises nursing researchers to design studies that facilitate exploring human rights issues and health disparities. Shaped by these mandates, nursing researchers have had a longstanding relationship with qualitative methodologies (Birks et al., 2019; Morse, 1991; Stern, 2009). Grounded theory (GT) is one such approach that is historically rooted in nursing as well as centered on discovering new understandings on complex concerns in healthcare delivery contexts (Schreiber, 2001; Singh & Estefan, 2018). Multiple forms of GT exist such as Feminist GT (Bryant, 2019; Mohajan & Mohajan, 2022; Plummer & Young, 2010; Wuest, 1995) and situational analysis (Clarke, 2007). Our specific focus, however, is on three GT methodological strands: Glaserian, Straussian, and Charmaz’s constructivist grounded theory. Constructivist grounded theory (CGT) was developed with social justice-oriented intentions (Charmaz, 2014, 2019). To explore how CGT fits with the specific core ethical values of equity and social justice in nursing, further methodological development is warranted.
In this article, we provide three key contributions that respond to scholarly appeals for advancing equity within qualitative methodologies such as GT (Charmaz, 2014; Denzin & Lincoln, 2018; Wuest, 1995). First, we demonstrate how applying intersectionality as a critical feminist lens and analytical tool with CGT expands central methods such as memoing to explicitly address complexity and heighten analysis to capture power dynamics within basic social problems. Second, we contribute how intersectionality deepens uptake of GT methods by continued “intersectional thinking” throughout the research process to avoid superficial methodological engagement. And third, we demonstrated application of intersectionality reinforces flexibility of CGT as a methodology that is compatible with critical theoretical frameworks. Consequential to this compatibility, future research can more effectively address the needs of populations experiencing complex health inequities and marginalization, including racialized and gender‑diverse groups. Within qualitative nursing research, these contributions respond to pressing needs for applying intersectionality to address persistent health and social inequities within the nexus racism, sexism, and classism (De Sousa & Varcoe, 2022).
We build our contributions upon previous work consisting of two publications that aimed to advance connections between equity-oriented nursing research and GT approaches. Kassam et al. (2020) symbolizes the beginnings of our project where we proposed a study design that demonstrated potential congruence between constructivist grounded theory (CGT) and intersectionality, as described by Collins (1993), Crenshaw (1991), and the Combahee River Collective (1977). To ensure the power, flexibility, and innovation of intersectionality were made visible, we defined intersectionality as both an emergent critical theory and analytical tool. Our second publication, Kassam and Marcellus (2022), reflects the subsequent part of our project where we applied the proposed design through a research study employing intersectionality-informed CGT. In doing so, we continued our contributions to the advancement of GT as a methodology that fits with engaging with equity-oriented nursing research by focusing this article on the insights and reflections we developed while conducting this study. To scaffold and further expand upon our aims of advancing GT, we now focus this third manuscript on the practical insights developed over time that positions intersectionality-informed CGT as a robust methodological avenue for scholars aiming to generate transformative, equity-driven insights within complex health contexts.
We begin by situating this article within our positionalities, with specific focus on the lead author of this article, SK, who has led this project of methodological advancement from the beginning as a doctoral student, and now an emerging scholar. To honor the supervisor-student historical foundations of this project, we present this manuscript as a collaborative team, reflecting a dialogue that continues to this day. Additionally, lead author positionality, personal experiences, and/or reflections, will be addressed in first person for epistemic clarity. Next, we provide a brief overview of the research study where we apply our proposed intersectionality-informed CGT design. We then describe the origins of GT as a qualitative method consisting of a family of approaches. Specifically, rather than understanding GT as a single monolithic method, we situate GT within varying interconnected strands, each with its own epistemological objective and directly stemming from its original form. We then articulate the longstanding connection and philosophical alignment between GT and the nursing discipline, including the social justice values embedded within nursing. To show how intersectionality and CGT worked in tandem in Kassam and Marcellus (2022), we consider how the assumptions outlined in our first publication, Kassam et al. (2020), were either upheld or questioned during implementation. In doing so, we hone in on the lead author (SK) whose doctoral journey consisted of personal memos and reflections that emerged during the process of applying intersectionality to CGT. Finally, we outline anticipated and new limitations raised within our design reflections and how we addressed them. In addition, recommendations are provided for qualitative researchers as a blueprint to advancing the social justice agenda of nursing and GT.
Situating Positionality
Understanding one’s own philosophical positioning as a researcher is among the ways to clearly identify which GT approach to consider (Birks et al., 2019; Ralph et al., 2015; Vander Linden & Palmieri, 2023). It also grounds a researcher in identifying how they analytically think and why they privilege certain concepts over others. We first situate SK, lead author and initiator of the project started in her doctoral studies that aimed to advance GT through her situatedness. We then situate LM as the doctoral supervisor and mentor.
The PhD Student, Mentee, and Colleague: Dr. Shahin Kassam (SK)
As lead author of this work, I (SK) position myself as starting the journey of embracing GT methods as PhD student while also refining my understandings of intersectionality as my analytical lens. Coming from a clinical public health nurse (PHN) background, I have always had a keen interest in how systems of gender, race, class, and additional characteristics interact with health and social systems to marginalize populations experiencing disparately poor health outcomes. Important to my situatedness is how I draw on Collins (1990) to define gender, race, and class as socially and culturally constructed power systems that operate simultaneously rather than in isolation. In this same vein, the biological category of sex is also interconnected with social systems of power to further marginalize populations such as self-identifying women of color and reproduce oppression and power dynamics such as sexism and racism.
Women living with forced migration statuses who also belong to racialized communities and live with limited income has been the center of my practice as a clinician and a researcher. Identifying my pronouns as she/her, and as a cis-gender woman of color, I also experience gendered racism at micro and macro levels which is likely what draws me to the field of intersectionality as described by seminal thinkers like Patricia Hill Collins and Kimberlé Crenshaw. During my doctoral studies I also realized my philosophical positionality. Constructivism became central to how I viewed knowledge creation where, as a PHN, I keenly pursued how my clients made sense of their health. Drawing on Charmaz (2014), I value the unique ways in which people attach meaning to what is shaping their health outcomes. As a nurse, working at the philosophical nexus of an objectivist health system dominated by biomedical frameworks and the subjectivism of human health was both fascinating and troubling. The worry I experienced in leaving social justice-oriented questions unanswered within my nursing practice led to pursuing doctoral studies. It was here that I found GT as a flexible methodology that could hold central tenets of intersectionality while also generate findings relevant to nursing practice.
The PhD Supervisor, Mentor, and Colleague: Dr. Lenora Marcellus (LM)
As SK’s doctoral supervisor and a collaborating author in this work, I brought related previous clinical experience in maternal-infant nursing, experience in teaching and supervising graduate students, and a background in constructivist GT methodology. The philosophy of supervision I offer is relational and grounded in knowing that doctoral journeys are individual and embodied, with both intellectual and emotional work, particularly for nursing students with lived professional experiences of complex patient and community care challenges. As a White settler cis-gender nursing scholar I am mindful of power differentials in the supervisory relationship, the intersecting identities of students and influences on learning experiences, and the value of creating safety in academic relationships.
Study Background
To situate our reflections, we provide a brief overview of the study from which we draw our insights, where we explored how PHNs work with women living with refugee statuses while also transitioning to parenthood (Kassam & Marcellus, 2022). As the PhD student engaging in her dissertation, SK entered into this study with her PHN practice background in the lower mainland of British Columbia, Canada, where she supported women of childbearing age or already parenting who entered the country as refugees. Although half of the world’s refugee population are women (United Nations High Commissioner for Refugees [UNHCR], 2021; United Nations Population Fund [UNFPA], 2016) and are among the many underrepresented populations within research, this population often face disproportionate health experiences resulting from pervasive issues such as gender-based violence and racial discrimination. The following question guided this research: How do public health nurses work with women who are mothering and managing the effects of their refugee status? As described in this published study, ethical approval to conduct this research was received by the Fraser Health Authority and the University of Victoria, British Columbia, Canada Institutional Research Ethics Boards.
Philosophical Foundations
As described in Kassam and Marcellus (2022), the study was philosophically grounded in assumptions that knowledge is co-constructed between researchers and participants through application of CGT methods. Experiences of refugee mothers and public health nurses are also assumed within the study as shaped by social, structural, and power-laden contexts. Employing intersectionality within the CGT research process required “intersectional thinking” across the research process continuum. To summarize how these foundations guided the study design, an adaptation of Weed’s (2017) methodological illustration is provided in Figure 1. In this visual display, commonalities of grounded theory methods are broadly sketched out to demonstrate the essence of most GT variations. In addition, we developed a concentric circular model that demonstrates how each method influences each other. We added a spiral in the center to convey the layered, iterative nature of the GT methods and mapped intersectional thinking as cutting across the research process. While more clearly depicting the continuous interaction of central research methods and movement toward a substantive theory, the adapted illustration also symbolizes the persistent presence and influence of systemic oppression as well as philosophical underpinnings (SI and Pragmatism) as shaping the GT process (see Figure 1).
Visual display of applying intersectionality within CGT methods.
Data Collection
Twelve participants who self-identified as women were provided with the choice of being interviewed one-on-one or as part of a focus group of their PHN peers. Guiding questions explored PHN roles and what informed and/or influenced their work to gain contextual understandings of what shaped interactions with women living with refugee statuses. PHNs shared stories of their own social locations including race and migrant status.
Data Analysis
CGT approaches to analysis included constant comparison of data and three coding techniques of initial, focused, and axial coding. While we centered on any similarities and differences in participant narratives, we also questioned the data for structural forces and power dynamics as recommended in Kassam et al., 2020. Drawing from Kimberlé Crenshaw’s visualisation of intersectionality as overlapping networks driving systemic oppression (Berger & Guidroz, 2009; Collins, 2019), visualization of strategies used by PHNs occurred through diagramming to understand patterns and conceptual relationships.
Findings
Revealing a basic social problem and a core process that addresses this problem is one intention of CGT (Charmaz, 2014; Glaser & Strauss, 1967). The basic social problem affecting PHNs that emerged within data analysis was establishing trusting relationships with women who are mothering and living with refugee statuses while managing broader structural forces. PHNs engaged with this problem through a basic social process of creating safe relational space. Through this study, structural constraints influencing their core process were identified by PHNs as being rooted in organizational, sociopolitical, and economic contexts where PHNs were continuously assessing systemic and population changes as well as managing fluctuations in system priorities.
Implications
Implications of this study included illuminating the need for structural integration of trauma-and-violence-informed systems to support PHNs work with women living at the intersections of gender, race, challenging socioeconomic conditions, and precarious migration statuses. The study also supported action on integrating forced migration as a health determinant in PHN assessment tools to support practice and coordination of health and social services. Lastly, this study addressed the complexity PHNs face within their interactions with the health system and with diverse racialized communities of women living with refugee statuses.
Significant to the background of this study is the focus on nursing as the discipline which both the study participants and SK, the researcher, were situated within. The study provided PHNs opportunity to magnify their main concerns and the strategies used to address them in addition to highlighting the changes occurring within their discipline. The emphasis on making nurses’ real-world clinical experiences more visible thought GT methods reflects the approach’s foundational roots.
The Origins of GT and Connections to Nursing
The original intentions of GT were built to include identifying a basic social problem, or main concern, and generating theory that described social phenomena through exploring human behavior (Charmaz, 2014; Glaser, 1978; Glaser & Strauss, 1967; Strauss & Corbin, 1998). The earliest developments of GT as specified by Glaser and Strauss in 1967 included methods such as constant comparison, theoretical sampling and memo-writing. Significant to these developments is how they emerged within the context of nursing where Glaser and Strauss could directly access human interactions within complex life situations (Connor et al., 2025; Stern & Covan, 2001). A consequence of this contextual origin is how GT has remained a popular research methodology among nurse researchers (Schreiber, 2001; Singh & Estefan, 2018; Stern, 2009).
Pragmatism and symbolic interactionism (SI) underpin all three prominent strands of GT approaches discussed in this manuscript including classic (Glaser, 1978; Glaser & Strauss, 1967), Straussian (Strauss & Corbin, 1998) and constructivist (Charmaz, 2005, 2014). Each strand differs in its historical evolution and onto-epistemological emphases (Vander Linden & Palmieri, 2023). For example, classic GT is driven by objectivist assumptions, whereas Straussian GT is guided by post-positivism and interpretivist thinking (Connor et al., 2025). Constructivism shapes the third strand of GT which was developed by Kathy Charmaz and identified as “constructivist grounded theory” (CGT) (Charmaz & Keller, 2016; Mills et al., 2006). While all three strands lead to theory development, nuances in research question framing and research methods exist.
As a doctoral student, SK explored multiple qualitative methodologies, including GT as taken up by Glaser, Strauss, and Charmaz. With paucities in knowledge on both how PHNs work with complex populations and the experiences of women who are mothering and living with refugee statuses, SK felt that CGT was an optimal methodological choice ideal for expanding areas where little is known (Marcellus, 2017; Schreiber, 2001). While CGT was employed to amplify PHN stories, SK also intentionally chose this approach to focus on experiences of power balance and imbalance throughout the research process (Mruck & Mey, 2007).
Nursing’s Longstanding Relationship and Alignment with Grounded Theory
GT approaches are valued by nurse researchers as they generate findings that are foundational and relevant for practical action (Glaser, 1998; Schreiber, 2001). Among the first nurses to use GT was Juliet Corbin who closely worked with Anselm Strauss and continued building on its application to nursing and health-related research (Strauss & Corbin, 1998). Phyllis Noerager Stern was also a prolific nursing researcher who used classic GT within the nursing discipline to inform major advancements within qualitative methodology and global women’s health and mentored many other researchers in this methodology (Stern, 2009; Stern & Pyles, 1985). Since then, GT approaches have been frequently employed by nurse researchers to identify areas of change needed to promote health as well as support development of user-centered interventions (Charmaz, 2014). Tomm-Bonde et al. (2021) for instance employed GT to reveal contextual triggers which intensified women’s exposure to harm and where interventions were needed to enhance health and well-being.
The ease among nurse researchers in applying a range of ontological and epistemological underpinnings is described as among the central reasons for GT popularity (Mills et al., 2006). The merging of diverse academic backgrounds and philosophical foundations created opportunity for straddling Glaser’s emphasis on quantitative rigor and middle-range theory development with Strauss’s articulations of SI and pragmatism (Charmaz, 2014; MacDonald & Schreiber, 2001). The core belief posited within SI centers on interaction as a primary concept informing human senses of self and how humans construct meaning (Chenitz & Swanson, 1986; Milliken & Schreiber, 2012). For example, language are symbols used verbally and/or nonverbally to communicate shared meanings within a social interaction (Milliken & Schreiber, 2012). These meanings become shared over time through social interaction processes (Blumer, 1969; Milliken & Schreiber, 2012). Symbolic interactionism thereby values the complexity of human interaction and thought, making it a well-suited foundation for nursing research (Milliken & Schreiber, 2012).
Augmenting SI is pragmatism, the second philosophical underpinning informing GT, that posits knowledge as dynamically embedded within interactions between humans with the world (MacDonald, 2001; Shalin, 1991). This philosophy is evident within the inductiveness of GT methods such as memoing and coding driven by constant comparison analysis (Charmaz et al., 2018; Flenady et al., 2017). Additionally, using gerunds as a GT method to express basic social processes captures the presence of constant change over time and illustrates the power and presence of action and the consequences of these actions among participants and context (Glaser, 1996; Schreiber, 2001). Nursing and pragmatism are consequentially deeply connected where nursing practice is perpetually focused on action-oriented thinking and applied science to enhance and improve patient health. Application of evidence-based care provision as a pillar of nursing science is one example of how pragmatism supports nursing knowledge where action-oriented values and practice are linked (Dolan et al., 2022; MacDonald, 2001; Mayumi & Ota, 2023).
Linking Intersectionality to Nursing Science
Situated within the critical social theory family, intersectionality is rooted in feminist thinkers including Black and Latinx thinkers, as well as lesbian, gay, bisexual, transgender, queer and Indigenous scholars (Collins & Bilge, 2016; Kassam et al., 2020). Since its inception, intersectionality has evolved through being employed diversely. Examples include intersectionality as a perspective (Vervliet et al., 2014), as a framework (Lindgren et al., 2017) and as an analytical lens (Haghiri-Vijeh & McDonald, 2022). Through Kassam et al. (2020), Kassam and Marcellus (2022) and now this article, we contribute to this evolution within nursing sciences and focus our application of intersectionality as an emergent critical social theory and analytical tool.
Central Tenets of Intersectionality
Stemming from its origins, intersectionality aims to address injustices and inequities persistent within axes of social locations involving gender, race, and class that are shaped by oppressive and interacting systems of racism, sexism, and classism (Collins & Bilge, 2016; Combahee River Collective, 1977; Crenshaw, 1991). Application of additional social locations such as age, (dis)ability, and migration status (Cho et al., 2013; Collins & Bilge, 2016) within intersectionality-framed projects indicate the flexibility built within its tenets.
A significant central tenet of intersectionality is unearthing the presence of power relations woven into macro level forces. The insidious and diminished visibility of these power relations shape societal thinking and preserve harmful ideologies. Collins (2019) refers to ideologies of neoliberalism, capitalism, and racism as root causes of driving and repeating inequities persistently and deepening marginalization and social injustice. Revealing the contexts within which such processes of power exist toward dismantling inequity among historically marginalized populations is fundamental to this tenet of intersectionality (Collins & Bilge, 2016). Intersectionality is thus well-suited to fit with nursing research through targeting health inequities among priority populations that shoulder disproportionate experiences of poorer health outcomes stemmed by layers of social disadvantage.
The Fit, Work, and Grab of Intersectionality in Nursing Research
Nursing researchers are drawn to intersectionality as a critical social theory. Since 2010, intersectionality has been taken up within nursing research to address health inequities among populations diverse in social locations such as gender, race, religion, and migration status (Siira et al., 2023). Examples of nursing researchers drawn to critical social theory include Qureshi et al. (2020) who applied intersectionality to understand experiences of nurses situated at intersections of male gender and race. Analysis using intersectionality revealed institutional racism as a structural barrier negating progress in these nurses’ careers. Intersectionality was also stressed by Crooks et al. (2021) as foundational to understanding how race, gender, class, and culture shape Black female sexuality. Implications of their analysis advances nursing sciences through demonstrating intersectionality as a conduit for nurses to dispel oppressive stereotype-ridden narratives and amplify Black women’s sexual empowerment and capacity (Crooks et al., 2021).
Calls for applying intersectionality in nursing research exist to generate empirical evidence that address complex population health issues and deepen examination of inequity at the axes of gender, race, and class (De Sousa & Varcoe, 2022; Siira et al., 2023). The philosophical fit between CGT and intersectionality and the nursing discipline provides the opportunity for nursing researchers to respond to this call. Applying intersectionality with CGT also responds and works toward addressing critiques of grounded theory as a methodology often carried out superficially to generate outcomes that are void of an inductive, process-oriented theoretical product (Birks et al., 2019; Clarke, 2007; Glaser, 2019). Researchers that simply draw on GT methods rather than engage in the full research process deliver thin results which Glaser (2019) has referred to as “grounded description” (p. 441) as opposed to generation of new theoretical discovery.
Reflections on Applying Intersectionality to Grounded Theory Methods
As a doctoral student, I (SK) worked closely with my supervisor and mentor, LM, as well as a group of grounded theorists with varying levels of expertise. A co-founder of this Grounded Theory Club (GTC) was Dr. Rita Schreiber, whose objectives included collective exploration and engagement with GT methods and epistemics (Schreiber, 2001). Guided by Phillis Stern’s mentorship, Schreiber’s expertise in applying grounded theory within nursing research pillared the GTC. Stern’s mentorship played a pivotal role in shaping Schreiber’s engagement with grounded theory, providing both conceptual clarity and a model of pedagogical practice in which teaching–learning relationships were understood as dynamic, iterative, and continually evolving (Schreiber, 2001). For example, in their book, Using Grounded Theory in Nursing, Schreiber and Stern (2001) explicitly highlight mentorship as a central mechanism for developing theoretical sensitivity and sustaining grounded theory’s evolution, illustrating how expert–novice relationships become generative sites for methodological innovation. In this way, the GTC reflected the vision of seminal grounded theory scholars, emphasizing mentorship and the exchange of ideas as essential components of conducting qualitative inquiry. (Birks et al., 2019; Glaser, 1978; Morse, 1991). Resulting from these exchanges within the GTC and with my supervisor was solidification of my own situatedness as a PHN, and a clear awareness of my constructivist orientation.
What also became clear was my engagement with critical social theories. Specifically, I was drawn to feminist scholars such as Wuest’s (1995) FGT whose seminal work advanced feminist theory integration with grounded theory, and Plummer and Young (2010) who further magnified equity-oriented intentions of GT. While I recognized gender as the focus of these significant advancements in GT scholarship, I wondered how race and racism interconnected with these aims of revealing inequity. To address this curiosity, I turned to intersectionality as a critical theory situated within feminist thinking. In doing so, a process of “intersectional thinking” developed where my views hinged on how gender, race, socioeconomic status and migration status interacted to affect human health. It was through this clarity I selected CGT as fitting with my personal philosophical and theoretical underpinnings.
We now reflect and provide a blueprint on how this was done during what Glaser and Strauss (1967) describe as among selected essential GT methods: memoing and theoretical sampling (Table 1). Notably, these methods are central to all three strands of GT. To summarize the blueprint, we provide a table highlighting memos demonstrating analytic decision-making informed by intersectional thinking which shaped coding and theoretical sampling.
Intersectionality-Informed Coding and Theoretical Sampling.
Capturing Hunches and Privileging Representation: My Memoing Journey
As a collection of a researcher’s ideas written to inform theory development processes, memos document researcher interactions with concurrent data collection and analysis processes (Charmaz, 2015; Connor et al., 2024; Glaser, 1978; Schreiber, 2001). Three purposes of memoing include (i) ensuring transparency of and engaging with the researcher’s assumptions, (ii) documenting methodological decision-making that occurs across the research process, and (iii) capturing ideas, thoughts, and hunches on the data being collected and analyzed (Charmaz, 2014; Glaser, 1978; Glaser & Strauss, 1967; Schreiber, 2001; Strauss, 1987; Strauss & Corbin, 1998). Guided by Charmaz’s (2014) practical guidance on memo-writing, I started a methodological journal where I both sequentially and iteratively documented any thoughts, dilemmas, and choices I made. To ensure I mitigated superimposing these thoughts which included how central tenets of intersectionality were being described within the data, I engaged with methodological self-consciousness to heighten my awareness of what informed my analytical choices (Charmaz, 2017).
In my quest to understand and engage with this method, I noticed much had been written on memoing as a significant and required process. However, examples of how researchers wrote their memos was limited. In the beginning, methodological journaling informed my selection of CGT through teasing out my own philosophical situatedness and map out methodological fit with my research questions. Journaling progressed organically into my memo-writing journey where I freely documented my thoughts and questions on my smartphone’s digital notes application while in the car after I had interviewed a participant. The process of digitally capturing my reflections was not confined to formal research settings but also emerged during routine activities, such as grocery shopping, when I found myself critically engaging with the data collected. While influenced by Charmaz’s (2014) advice on using memos to organize, code, and interact with data collected, my attention was drawn to the strategies I employed to organize my memos, an aspect that was minimally discussed within the CGT literature. Digital notetaking applications also assisted in tracking the context within which my memos were written. Developing contextual awareness through memoing unexpectedly deepened my understanding of the process, transforming it from a way of capturing ideas into a conceptual space for ongoing analysis and meaning-making.
Memos also became an embodiment of how I was interacting with data being collected and analyzed. While I initially viewed memos as spaces to record thoughts and ideas, as described in the CGT literature, I discovered they also allowed me to capture the feelings and assumptions that arose as I connected participants’ experiences with my own as a public health nurse. Memoing also opened the opportunity to analyze my assumptions as related to the central tenets of intersectionality. These analyses were key to understanding what shaped my methodological decisions while staying closely connected to the data. As an example, the following is a memo: I was thinking about how I should have asked about social locations like gender, race, socioeconomic status, more explicitly, then I realized that the data is guiding me and social location identification occurs within the data already and within my analysis to see which were noted and brought up as important for PHNs,
Memoing ensured my own assumptions would not superimpose on the data being collected or the theory being developed. This awareness of how memoing supported my contributions to knowledge development within the research process and confirmed earlier assumptions made in Kassam et al. (2020). I also realized how memoing expanded these earlier assumptions to involve my interpretations of study participants and their social locations. Attention to this power dynamic between researcher and the data as a distinct feature of intersectionality and CGT thus expanded to incorporate and explicate how study participants were affected by power relations. Memoing was a forum for me to capture the non-verbal reactions of study participants when they discovered their own awareness of power struggles. Some non-verbal reactions were emotional moments that illuminated a shift in a participant’s thinking that moved their focus to the more distal systemic oppressive factors. For example, one memo I wrote during data collection stated: Memo: how PHNs had an ah-ha moment on how barriers to PHNs are what they were talking about rather than barriers for their refugee mothers
I was drawn to this memo during analysis where I witnessed PHNs realizing their interviews were more about the institutional barriers that were constraining their practice which also affected the care being received by women living with refugee statuses. This memo supported my decision to focus on the systemic barriers PHNs faced within processes of working with this population of women.
Memos also helped address questions I had on how racism was talked about implicitly. PHNs addressed systemic racism indirectly through the concept of trauma-and-violence-informed care which was a hunch captured in my memos. As anticipated from my earlier assumptions about using memoing to apply intersectionality within CGT, my reflections increasingly centered on how systemic racism, sexism, and classism were simultaneously represented in the data. The memos also highlighted where these issues were not described, prompting deeper critical analysis of the broader social processes shaping participants’ nursing practice. Memos thus became central to providing a recommendation within the study that addressed institutions to support PHNs in applying trauma-and-violence-informed care principles which include explicating systemic racism and discrimination. Memoing consequently built bridges between data collection and theory construction exemplifying the rigorous nature of GT (Connor et al., 2024; Schreiber, 2001). Through memoing, I learned to acknowledge and trust my intuitive responses and emerging insights which directly informed processes of theoretical sampling and data analysis.
Synergizing Intersectionality with Theoretical Sampling and Constant Comparative Analysis
Often disaggregated into two distinct components of GT, we discuss concurrent theoretical sampling and constant comparative analysis as a non-linear and iterative process that sets GT apart from the various approaches to qualitative research (Charmaz, 2014). The distinctiveness of theoretical sampling includes how it dissuades researchers from creating an a priori sampling plan to initiate and guide theory development. The GT study sample thus emerges alongside the analytical findings to promote and guide inductive theory development (Charmaz, 2014; Glaser & Strauss, 1967; Weed, 2017). Theoretical sampling consequently requires researchers to repeatedly move back and forth between data collection and data analysis (Glaser & Strauss, 1967; Weed, 2017). We drew on Charmaz’s (2014) two-step theoretical sampling process: initial sampling, and constant comparative analysis.
First, our initial sampling phase involved recruiting and interviewing a focus group of PHNs. This was followed by theoretical sampling where analysis of data collected guides what further data was required to address and refine emerging concepts (Charmaz, 2014; Glaser & Strauss, 1967; Schreiber, 2001). Several pieces of data gathered after initial sampling were analyzed including: my memos, the geographical location of the community health clinic, the demographic of populations which this clinic served, and the demographics and interview data generated from the initial sample of PHNs. As I moved through this process, I began to notice that my initial sampling was centered around data that reflected certain interconnections of social constructs, but not others. When I looked more closely, I realized that most participants in my early sample were racially homogenous. There was little to no representation of nurses with diverse racial backgrounds, gender identities, or migration histories. This realization, captured through a memo, became an important turning point in my thinking. It made me question whose voices were being amplified and whose experiences were missing from the story being constructed.
In response, I intentionally sought out nurses who could bring in those absent perspectives. This shift reflected the flexibility of pragmatism underpinning grounded theory, where theoretical sampling allows the researcher to adapt as insights emerge. I found that applying an intersectional lens helped me think more critically about how overlapping social identities shape experiences and how my own decisions as a researcher could either reinforce or challenge patterns of exclusion.
Throughout this process, symbolic interactionism and constructivism provided a foundation for engaging reflexively with the data. The back-and-forth interaction between myself, the participants, and the emerging analysis was a natural and iterative process, rather than forced. It reminded me that research is not static but evolves through conscious, responsive choices. Ultimately, these intentional decisions helped ensure that diverse and intersecting social locations were not only included but meaningfully represented in the developing analysis.
Following initial sampling, we employed constant comparative analysis with memos and additional data sources to provide direction for continued theoretical sampling (Connor et al., 2024; Glaser & Strauss, 1967). This concurrent method of data collection and analysis generates hunches, questions, and codes to capture explanatory processes happening within the data and contribute to developing the basic social problem and core process. However, as Wuest and Merritt-Gray (2001) emphasize, the risk involved during this concurrent phase of GT lies within researchers ignoring heterogeneity and points of intersections where difference exists. Wuest also draws on critical feminist positionings to illuminate social determinants of health as a way of centering social structures where inequities persist (Wuest, 1995; Wuest et al., 2002). Intersectionality, however, highlights how race, gender, and class as well as racism, sexism, and classism, need to be included as part of this centering of social structure process thereby setting the application of intersectionality within CGT apart from earlier critical feminist explorations.
Looking back at memos that documented my data analysis process, ignoring heterogeneity and the axes of social locations was impossible to achieve. Committed to my intentional uptake of intersectionality’s central tenets mitigated the risk of overlooking points of intersections across the research process. In fact, within my memos I see how the analytical process has started before data collection in thinking how I was aligning intersectionality with CGT methods. Through applying intersectionality within constant comparative analysis, I became more critically aware of how inequities were being described (and not described) by participants as being reproduced at the gender, race, and socioeconomic status intersect of the women they were caring for. As I developed explanatory processes, I found myself continually returning to the data and memos to explore what broader influences shaped them, how systemic racism, sexism, and classism were being implicitly or explicitly addressed, and how diverse perspectives were represented.
While intersectionality as a critical social theory may prompt researchers to seek out participants who are diverse in gender, race, and socioeconomic status, my uptake of intersectionality in this study also involved a process of “intersectional thinking” which magnified broader influencing structures (Collins, 2019). For example, demographic analysis of my initial study sample led to questioning how PHNs experiences could be similar or different due to the urban context within which they were situated. The initial data stemmed from a health center that was positioned within a wealthier socioeconomic demographic with some pockets of affordable and government subsidized housing. Resulting from this focus was the decision to collect more data from PHNs working within communities that had more heterogeneity in women who were refugees and living with lower socioeconomic status. Recruitment of participants subsequently turned toward community health centers within different urban and rural geographical regions to further develop the story of how broader influences of community setting and the socioeconomic context of that setting affected PHNs experiences (Charmaz & Belgrave, 2020). Our resulting theory generated through this process was thus a consequence of how certain concepts in the data became illuminated and conceptualized through intersectionality, which is a significant principle of CGT (Charmaz & Belgrave, 2020).
Circling Back: Reflective Insights on Applying Intersectionality with CGT
Looking back at the domains that developed in our process of establishing congruency between CGT and intersectionality (Kassam et al., 2020), we developed a benchmark of quality through identifying four units of analysis. These units described shared assumptions and questions that we anticipated would emerge within a research endeavor such as ours where we applied the intersectionality-framed CGT (Kassam & Marcellus, 2022). While these questions indeed drove the analytical process, they also stimulated further shared assumptions rooted in the combined philosophical synergy of constructivism, SI, pragmatism and intersectionality. For example, questions related to reflexivity as a unit of analysis emerged focusing on data sources included how are social locations, such as coming from a PHN background and being a woman, influencing study participant’s narratives?
While the units of analysis are presented linearly within Kassam et al. (2020), our study also demonstrated reflexivity, complexity, variability, and social justice as influencing and complementing each other. For example, reflections on how SK’s social locations affected participant responses illuminated the openness in dialogue on mutual understandings on complex power relations PHNs were dealing with (Kassam et al., 2020). In this same vein, SK’s situatedness as a woman of color generated conversation with PHNs who also identified as women of color where social justice pillars of racism were raised as undergirding health experiences of women who are refugees she supported within her practice. As a result, SK described her wonder if these same conversations would have taken place if her social locations were different. While resulting outcomes of how the units of analysis would play out in our study were less focused on within Kassam et al. (2020), these units became central to testing, confirming, and advancing CGT as a flexible methodology.
Outcomes of CGT’s flexibility involved generating strategies to tackle health inequities while simultaneously manage broader oppressive forces (Kassam & Marcellus, 2022). The outcomes of the study design consequentially support how CGT as a methodology holds significant capacity to generate social-justice oriented findings that address populations as well as the social context contributing to complex systemic marginalization. Remaining open to what power relations lie within the intersections of experiences and context was an insight that developed through conducting this study. This insight extends our initial recommendations from Kassam et al. (2020) and encourages researchers to expand magnification of power relations into the wider study context as driven by study participants.
Key Contributions
Insights developed and conveyed within this manuscript reveal at least three contributions to advancing CGT. First, intersectionality deepens CGT methods by requiring continuous “intersectional thinking.” Rather than simply adding analytic categories (e.g., gender, race, class), an intentional methodological process of intersectional thinking promoted how social locations emerged, why certain locations became salient according to the emergent data, and which systems of power shaped meaning-making among participants. This contribution expands on earlier assumptions established in Kassam et al. (2020) by demonstrating the how and where intersectionality fits with CGT. In addition, this contribution addresses several calls for clearer and deeper uptake of GT methods which are often thinly and superficially applied (Birks et al., 2019; Connor et al., 2023).
A second central contribution is the expansion of key GT methods to address complexity within basic social problems and heighten analysis of power dynamics contributing to inequity. Memoing, for instance, became a space to process assumptions, emotions, and power relations, extending beyond simple analytic notetaking. Building on Charmaz (2014) and Schreiber (2001), who position memoing as a pivotal engine for moving data into theory, we extend this stance by incorporating intersectionality. As a result, memoing is amplified as a critical method that systematically prompts attention to how power dynamics and structural systems involving racism, sexism, and classism are embedded both explicitly and implicitly within the data. This contribution demonstrates how CGT methods are strengthened by intersectionality to heighten analytic sensitivity including power dynamics that often remain unnamed. This contribution holds capacity of seeing silences within data as exemplified within memoing how PHNs talked around racism through language of trauma-and-violence informed care (Kassam & Marcellus, 2022).
A third contribution involves demonstrating how applying intersectionality reinforces CGT’s flexibility and its compatibility with critical theoretical frameworks. This contribution supports claims of GT as methodologically dynamic where methods are flexible to hold theoretical shaping (Birks et al., 2019). While we initially anticipated challenges in managing analytical complexity, we instead addressed persistent calls for enhanced clarity on how critical theoretical frameworks such as those situated within feminist landscapes can innovatively evolve social justice methodologies (Charmaz, 2014; Denzin & Lincoln, 2018; Olesen, 2007). In doing so, this contribution demonstrated deeper engagement and intentionality to magnify social justice intentions of inclusion and revealing contextual power dynamics.
Highlighting Limitations as Methodological Insights
Now that we have tested the application of intersectionality with CGT, we circle back to our proposal of intersectionality and CGT (Kassam et al., 2020) and reflect on two central limitations we anticipated occurring. First, we had cautioned researchers applying our proposed study design on glossing over researcher situatedness. This limitation continues to firmly stand and was mitigated through explicit identification of researcher philosophical and theoretical positionings throughout the research process promotes study rigor (Birks et al., 2019; Ralph et al., 2015; Vander Linden & Palmieri, 2023). Philosophical and theoretical self-consciousness revealed how intersectionality-informed positionality guided analytic priorities, particularly in attending to processes of “intersectional thinking.” This process engaged with simultaneously examining how gender, race, class, and other social locations were emphasized, and how structural power relations were considered. While philosophical and theoretical self-consciousness avoided glossing over researcher situatedness, this deliberate application of her positionality across methods also deepened SK’s understandings of the compatibility between intersectionality, constructivism, pragmatism, and symbolic interactionism. Although managing multiple orientations might initially seem daunting, it ultimately became a strength and an additional example of GT’s methodological flexibility and congruence with intersectionality.
Our second limitation that we assumed in Kassam et al., (2020) was how attending to complexity through a CGT study can unwittingly be limited by intersectionality’s focus on gender, race, and class. However, our study highlights how intersectionality does the opposite through its historical foundations where new ways of understanding inequities lie along the spectrum of gender-race-class (Collins, 1993; Combahee River Collective, 1977; Crenshaw, 1991). Specifically, how we applied intersectionality to methods of memoing and theoretical sampling-constant comparative analysis privileged alternative ways of addressing systems of oppression. For example, processes PHNs used to create safe relational space included protecting women living with refugee status from re-traumatization. This process acknowledged PHNs understanding of how gender, race, socioeconomic status and refugee status interconnected to expose this population to inequitable forms of racism, sexism, and consequential trauma pre-migration in addition to after arrival to Canada. The study thus refutes the need to disrupt reified intersectional groupings of gender-race-class and rather cements the need to center these locations toward enhancing visibility of additional interconnected power systems and ways in which they are described.
Recommendations When Applying Intersectionality with CGT
In contributing to the expansion of our initially proposed and implemented study design of applying intersectionality to CGT and consequentially advance social justice-oriented research (Kassam & Marcellus, 2022; Kassam et al., 2020), we offer nurse researchers and others a set of two recommendations accompanied by analytical questions that are based on our experiences and reflective analysis (see Table 2). Both recommendations are drawn from reflective insights that occurred during and after the research process. Attaching questions to each recommendation comes from the pragmatic approach to this manuscript involving intentions of advancing social justice oriented-uptake of GT methods in nursing research.
Recommendations and Analytical Questions for Nurse Researcher Consideration.
Recommendation for Nursing Researchers: Conceptualizing Intersectionality as an Analytical Tool That Promotes “Intersectional Thinking”
Our first recommendation advises researchers to conceptualize intersectionality as an analytical tool through magnifying how social locations of gender, race, class and additional social characteristics emerge from data collection and overlap. Pushing this recommendation further addresses analysis of how these locations overlap to exacerbate experiences of systemic inequity. As such, this recommendation highlights the inclusive, non-reductive nature of applying intersectionality with CGT within our study while also expanding on feminist approaches to GT to ensure race and class are integrated analytically. Rationale for this recommendation and the accompanying analytical questions stems from theoretical sensitivity and heightened awareness of power relations within relationships between PHNs and the women they worked with. Further, intersectionality illuminated how these power dynamics were occurring at broader levels resulting in analytical focus on contextual structures constraining PHN practice (Kassam & Marcellus, 2022).
Through this first recommendation, we emphasize identifying systemic structures that are perpetuating inequity within GT processes of analytical decision-making. This includes explicit uptake of how gender-race-class operate simultaneously within macro structures of sexism-racism-classism. Acknowledging and centering theoretical underpinnings within the history of intersectionality is one approach to mitigating implicit and superficial application of intersectionality. This can be done through maintaining philosophical and theoretical self-consciousness as a way of centering one’s positionality throughout analytical priorities. Authentic uptake of an intersectionality’s central tenets should consist of referring to intersectionality as grounded in seminal thinkers including the Combahee River Collective, Kimberlé Crenshaw, and Patricia Hill Collins (Nash, 2018). Staying close to the roots of intersectionality enhances authenticity in the application of intersectionality with CGT and promotes social-justice oriented outcomes that reveal new understandings on health inequities. Within this same vein, we also encourage nurse researchers to acknowledge the historical and philosophical underpinnings of GT methods. Doing so holds capacity to reveal new theoretical knowledge that informs practice, intervention, and new research questions (Schreiber, 2001).
Recommendation for Nursing Researchers: Ensure That Theoretical Sampling and Memo-Writing Intentionally Capture and Account for Contextual Variety
Our second recommendation prompts nursing researchers to shift their gaze internally. Specific to this recommendation are the methods of theoretical sampling and memo-writing where the importance of contextual integration was a reflection that consistently surfaced during SK’s methodological journaling processes. Placing attention on how context is inextricably connected to internal decision-making that occurs within theoretical sampling and memo-writing is promoted through the questions we tied to this second recommendation. An example of how this recommendation manifested can be seen within our study visual where a fragmented line reflected PHNs process of interacting and not interacting with the target community of women who are refugees (Kassam & Marcellus, 2022, p. 1282). This was a significant finding as it highlighted the network of systems perpetuating inequity among a population already marginalized by additional layers of precarious migration status. As a result, we recommend conceptualizing intersectionality as having the power to engage is a process of “intersectional thinking” and amplifying experiences of systemic inequities that lie within the nexus of social locations including gender-race-class.
Unique to this recommendation is the focus on how context shapes inequity (Collins, 2019; Crenshaw, 1991). As described in our first article, Kassam et al. (2020), grounded theory methods also value and guide researchers toward exploring social interactions within varying contexts. However, we specifically encourage nurse researchers to reflect on and memo what context means within the CGT study being implemented. In expanding on analytical questions in Kassam et al. (2020), this includes immersing the researcher into this context and analytical process. In Kassam and Marcellus (2022), one of the contextual aspects considered was geographical location of study participants to capture variations in how PHNs experienced working with women living with refugee statuses. While geographical locations were all urban-centric, our study design magnified focus on what structures within each urban context were being addressed within the data. For example, PHNs from certain geographical areas spoke more about limited transportation, denser communities of affordable and subsidized housing, and more exposure to substance use. In more affluent geographic regions, PHNs spoke less about these health determinants and more about limited awareness of their services among women. Our analysis thereby captured the diversity of urban community demographics as shaped by sociopolitical and economic factors.
Recommendations for Further Inquiry: Expanding the Horizons of Applying Intersectionality
Lastly, while we focused our study design on CGT which stemmed from the seminal works of Glaser and Strauss, the methods highlighted in this manuscript are mandatory across all GT approaches (Connor et al., 2024; Kassam & Marcellus, 2022; Schreiber, 2001). As a result, applying intersectionality across classic and Straussian GT requires further examination for congruency. For instance, while this paper advances an intersectionality-informed CGT approach, we recognize situational analysis as an important, newer strand of grounded theory that maps the social, political, and material arrangements of a research situation and foregrounds power and positionality (Clarke, 2007). Conceptual affinities with intersectionality are clear, however, situational analysis was not employed here and is acknowledged as a direction for future methodological work (Charmaz, 2017; Clarke, 2007).
To undertake this methodological advancement, we also recommend that nurse researchers build upon seminal feminist thinkers including Wuest (1995), Plummer and Young (2010), and Charmaz (2014) to examine the congruence between GT and critical feminist perspectives, such as ecofeminism, queer theory, Indigenous gender frameworks, and transfeminism. Comparative analysis of these approaches can further promote health equity goals and strengthen qualitative methodologies addressing racialized and gender-diverse populations. Our article (Kassam et al., 2020) provides one example of how such an examination can be conducted. In it, we emphasize the importance of philosophical alignment and demonstrate how congruence across multiple units of analysis serves as a foundational principle within GT approaches. Building on methodological innovations in Kassam et al. (2020) and Kassam and Marcellus (2022), which demonstrate the alignment between intersectionality and CGT, we propose that this congruence enables all GT approaches to be effectively integrated and advanced. This integration positions GT not only as a methodological framework but as a transformative engine for advancing equity-driven qualitative inquiry.
Conclusions
Grounded theory is a qualitative research methodology that can make significant contributions to the social justice orientations of nursing and health research worldwide. In reflecting on our experiences of conducting a study that was guided by the integration of intersectionality with CGT, we provided three key contributions to advancing GT as a methodology and practical recommendations for researchers interested in this design. We pragmatically examined how our findings from Kassam and Marcellus (2022) generated a theory that simultaneously addressed the complexities of the PHN role and a population of women systemically marginalized by gender, race, socioeconomic status, and migration status. In focusing on specific methods central to all GT approaches, we addressed Connor et al.’s (2023) calls for clearer guidelines on undertaking GT processes as well as Birks et al.’s (2019) appeals for deeper uptake of GT methods and avoidance of superficial methodological engagement. In addition, we have attended to Denzin and Lincoln’s (2018) bid for innovation in evolving qualitative methodologies to understand complex populations unjustly experiencing perpetual inequity. In doing so, our insights provide an initial blueprint for an approach that advances the GT methodology toward reducing health inequities in healthcare and enhancing inclusion and representation of populations that have historically been marginalized.
Our contributions to methodological advancement involve intentionally and iteratively applying the central tenets of critical theoretical lenses such as intersectionality to inform GT methods. This means continually returning to the data, magnifying how systemic oppression is being described, or being silenced, and generating theory that inductively illuminates health inequities. We encourage other researchers to advance the traction of GT methods, including strands such as CGT, within nursing by engaging in deeper analyses of health inequities and generating social justice-oriented outcomes when paired with intersectionality. In addition, we call for deliberate and thoughtful integration of critical theoretical lenses within GT, recognizing that such depth requires rigorous reflexivity, transparent positionality, and openness to equitable and complex analytical decision-making. Our call is thereby an invitation for researchers to employ while also continue exploring and pushing the boundaries and flexibility of GT’s full emancipatory potential of generating theories that address complex realities, reveal inequity, and meaningfully contribute to real-world health and social challenges.
Footnotes
Acknowledgements
We are grateful to the Grounded Theory Club at the University of Victoria for the scholarly dialogues that provided a deep methodological foundation for this work.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Author Biographies
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