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Kearney et al.'s Study of Pregnant Women Who Use Crack

So, how do you actually build theoretical models and what do they look like? Here’s a step-by-step example.

Margaret Kearney and her colleagues (1995) interviewed 60 women who reported using crack cocaine an average of at least once weekly during pregnancy. The semistructured interviews lasted from 1 to 3 hours and covered childhood, relationships, life context, previous pregnancies, and actions during the current pregnancy related to drug use, prenatal care, and self-care. Kearney et al. coded and analyzed the transcripts as they went. As new topics emerged, investigators asked about the topics in subsequent interviews. In this way, they linked data collection and data analysis in one continuous effort.

Kearney et al. coded the data first for the general topics they used to guide the interviews. Later, they would use these codes to search for and retrieve examples of text related to various interview topics. Next, team members reread each transcript searching for examples of social psychological themes in the women’s narratives. Each time they found an example, they asked: ‘‘What is this an example of?’’ The answers suggested substantive categories that were refined with each new transcript.

Kearney et al. looked at how substantive categories were related. They recorded their ideas about these interactions in the forms of memos and developed a preliminary model. With each subsequent transcript, they looked for negative cases and pieces of data that challenged their emerging model. They adjusted the model to include the full range of variation that emerged in the transcripts.

To begin with, Kearney et al. identified five major categories, which they called: VALUE, HOPE, RISK, HARM REDUCTION, and STIGMA MANAGEMENT. (Capital letters are often used for code names in grounded-theory research, just as in statistical research.) Women valued their pregnancy and the baby-to-be in relation to their own life priorities (VALUE); women expressed varying degrees of hope that their pregnancies would end well and that they could be good mothers (HOPE) and they were aware that cocaine use posed risks to their fetus but they perceived that risk differently (RISK). Women tried in various ways to minimize the risk to the fetus (HARM REDUCTION) and they used various stratagems to reduce social rejection and derision (STIGMA MANAGEMENT).

By the time they had coded 20 interviews, Kearney et al. realized that the categories HARM REDUCTION and STIGMA MANAGEMENT were components of a more fundamental category that they labeled EVADING HARM. After about 30 interviews had been coded, they identified and labeled an overarching psychological process they called SALVAGING SELF that incorporated all five of the major categories. By the time they’d done 40 interviews, Kearney et al. felt they had reached theoretical saturation, which means that they were not discovering new categories or relations among categories. Just to make sure, they conducted another 20 interviews and confirmed the saturation.

FIGURE 19.1.

The relation of themes/categories in Kearney et al.'s analysis of how pregnant drug users viewed their own behavior.

SOURCE: M. H. Kearney et al., ''Salvaging Self—A Grounded Theory of Pregnancy on Crack Cocaine.'' Nursing Research, Vol. 44, pp. 208-13. © 1995, Lippincott Williams & Wilkins. Reprinted with permission.

Figure 19.1 shows the graphic model that Kearney et al. produced to represent their understanding of how the process worked. Kearney et al. described in rich detail each of the major categories that they discovered, but notice how each of the substantive themes in their model is succinctly defined by a quote from a respondent.

When the steps of the grounded-theory approach are followed, models or theories are produced that are, indeed, grounded in the text. These models, however, are not the final product of the grounded-theory approach. In their original formulation, Glaser and Strauss (1967) emphasized that the building of grounded-theory models is a step in the research process. The next is to confirm the validity of a model by testing it on an independent sample of data. Kearney et al. checked the validity of their model by presenting it to knowledgeable respondents (pregnant drug users), to members of the project staff, and to health and social service professionals who were familiar with the population (Further Reading: grounded theory).

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