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Patient Chronic Condition Management: Grounded Theory


Scientists who are new in the field of research can result in grievous mistakes if they adopt certain methods without first identifying the method in the context of a wider methodology concept. This includes an understanding of the philosophy and the related methods of study.

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The Chronic Disease Context

Dealing with a chronic condition can be devastating to the personalities of the patients especially their self-esteem and functionality at work. This is because these conditions sometimes require strict management regimes or their prognosis causes deterioration of the body in a demoralizing manner (MacDonald et al., 2004, p. 242: Robertson, et al., 2006, p. 343). The common chronic ailments that are experienced in developing countries include Rheumatic Fever and Rheumatic Heart Disease, World Health Organization (2005). They are also a serious concern in public health.

Methodology to be used for Study

The Aim of Study

To contribute to the knowledge that is required to improve care or the patients of RF and RHD, this study will seek to identify the factors that affected the decisions of RF and RHD patients to seek treatment and the barriers, challenges, or obstacles that they faced in their endeavors.

Research Question

Rheumatic Fever and Rheumatic Heart Disease are serious health conditions in the developing world despite having the most cost-efficient and suitable management programs that can be incorporated into the health systems of the specific countries (Steer, et al., 2002, p. 231). The main research question is therefore to identify the factors that affect the treatment process of the patients suffering from RF/RHD and their caregivers.

There is a need to have extensive research to increase the understanding of the barriers that these patients face so that recommendations can be made to improve access and services delivery (Koch, et al., 2004, p. 486). Through the use of the principle of the grounded theory, the study will heighten the knowledge of patients seeking treatment and contribute to the entire public health profession.

Selection of the Methodology

Understanding the philosophy and its associated methods provides a map to the methodology choices by a researcher conducting qualitative research (Hollaway, 2005, p. 48). Specifically, I will explore the manner in which different methodologies are underpinned by philosophy or theory to research. This will also entail how a collection of data and their analyses would flow naturally from these methodologies (Holloway & Wheeler, 2010. p. 67). If it is very important for me to understand what qualitative research entails, it is also critical that I get a clear understanding of the ideas that come into play when I chose a certain methodology (Strauss & Corbin, 2005, p. 56).

Philosophy and research methodologies are interlaced and as a matter of fact, the choice of a certain philosophy implies the use of a related method and vice versa (Hollaway, 2005, p. 49). There are numerous methodologies available for qualitative research. They include phenomenology, grounded theory, ethnography, narrative analyses, feminist approaches, case studies, discourse analyses and feminist approaches among others (Hollaway, 2005, p. 53). Each of these methods has different objectives and entails varied research designed and also make use of different research methods. Considering that there are numerous competing methodologies, the way one of them is chosen over the others is very critical (Ashworth, 2003, p. 147). When I integrated down to practicalities, I realized that choices were determined by the instructor’s guidance, personal preferences and ease of using certain methods.

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The following methodologies are important for consideration


This method emerged from a culture developed by social groups like organizations of a certain profession, religious groupings and a group of professionals. The method, therefore, focuses on the particular group rather than on individual subjects of study. The researcher in this case will be interested in finding out the way the subjects in that group interact especially how the culture has shaped communication, socialization (Liamputtong, 2009, p. 121). Christina, (2005, p. 345) in her comparison of various methodologies shows that ethnographic interviews are usually designed to investigate how subjects felt about themselves and their condition. As a researcher, I would be interested in their position in this context. A classical ethnography will examine authorities, privileges and merits, and demerits of the culture. This means that there will be a change in basic assumptions from interpretive to critical assessment (Ashworth, 2003, p. 149).

This method is not suitable for the assessment of the factors influencing the decision to seek the care of RF/RHD in the developing world as per my study design. Essential, this is because, the ethnographic study is set to try and find or understand the culture and characteristics of the process of seeking medication for the subjects themselves (Wilson et al., 2006, p. 812). This is only important to a lesser extent as far as the aim of the study is concerned because as much as the research wants to explore the attitude of a patient as determined by culture, this perception is widely investigated already. What is required here is new information. The objective can be accomplished if the method was able to provide critical viewpoints of how subjects adhere to medication or fail to adhere with reasons beyond factors from their cultural perceptions (Christina, 2005, p. 345). This type of research has a multiplicity of thoughts, and the researcher will be forced to take a relativists stance, which is not fitting in this context.


This study type is based on the concept of existence, life form and having a meaning as Giorgi and Giorgi, 2003, p. 67, describe. A study that utilizes this approach will therefore be implored to search and investigate the experiences and meanings of certain phenomena. This entails looking at what they are, without the use of theories that explain why events happen. In this type of study, it means that using phases, stages, predictions, and the psychological and social process would be principles beyond what entails phenomenology.

Giorgi and Giorgi, 2003, p. 69 affirms that in order to use these concepts, the open would be forced to utilize another methodology and in that case, the Grounded theory would be most appropriate. Wimpenny & Gass 2001, p. 1489, compares the two theories in a study to show critical differences. Their paper shows that phenomenology entailed drawing deeper descriptions of individual experiences while grounded theory takes realist viewpoints. Giorgi & Giorgi, make conclusions from phenomenology research by drawing from the description the participant gives in relation to their lives and their health condition. This however disregards existing theory. Based on the above perspectives of Wimpenny & Gass and Giorgi & Giorgi, phenomenology may not give wide and realistic reasoning of the factors affecting the management of chronic illnesses. The management of RHD is a crucial factor in medicine that should not be addressed with non-realist methods (Kralik, et al., 2004, p. 264).

The researcher will be asking the participants who will be the patients and their caregivers to describe events or encounters they had as a result of living with RF/RHD as Carapetis, 2007, 441 suggests. The researcher will be looking at what that means to the participants at personal levels (Smith & Osborn, 2003. p. 134). That could be important but relating it to external theories related to the subject can compromise the validity of this process.

The underpinning concepts here are the critical-realist assumptions (Smith & Osborn, 2003. p. 134). The researcher assumes that the research subjects are giving accounts that portray or present perception of their subjective discernment of their experience at the same time realizing that, researcher’s own interpretation would inevitably influence the outcomes of the research (Holloway & Todres, 2003, p. 123). Therefore, I consider phenomenology as not suitable for carrying out this research

Grounded Theory

As I had indicated early under the aim of the study that this research will employ grounded theory. I have reasons for considering this methodology over the first two that I have briefly described. The above methodologies are good for qualitative researches but again their limitations come based on, ease of use, preference and the objectives of the research to be conducted (Scott, 2004, p. 119).

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I specifically chose grounded theory because it is underlined by realist presumptions and post-positivist concepts (Schreiber & Stern, 2001). Therefore, my questions of research will be mostly based on the coping process by analytical assessment of the patients and caregivers. This will specifically culminate in issues like how and when does the coping takes place (Ploeg, 1999, p. 36). Which are distractions to the process of survival (Scott, 2004, p. 119)? In this context, I will be considering the responses that participants give me as their honest and truthful account or reflection of their feelings and thoughts.

I will aim to group systematically factors that affect access to care, impede adherence to the medication regime, and those that influenced the decision to seek care in the first-place constraints (Lutfey, 2005, p. 425). These assessments will be followed by a study on how these factors caused the impact like how they hindered access for instance affordability. This is simple when a patient does not have the money to take care of the required medication, they may not seek it in the first place or they may be denied care at the facility of given alternative options that are cheaper and unsuitable or ineffective (Kralik, et al., 2004, p. 263). As I try to analyze the emergent themes, I will stay focused and remain faithful to the responses of the participants so as to get the result analyses without letting personal feelings and beliefs or foreknowledge intrude.

Grounded theory is very appropriate as it offers useful study strategies for the experiences of patients suffering chronic illness. In my study, I will use the methodology which develops social constructionist analyses. These include issues that are usually taken for granted, ideas, descriptions and understanding of the illness (Glaser & Strauss, 2007, p. 103: Charmaz, 2006). From this, I will develop my own sociological construction like feeling that their experiences are true realities and not possible fabrications.

Essentially, sick people will develop constructions that truly reflect their understanding of what they experience as well as the varied conditions that they experience these illnesses. Wimpenny & Gass (2001, p. 1489) have argued that caregivers in most cases support these constructions even when they are possible challenges to the provision of care or even when they contradict the medical profession’s knowledge. Scott, (2004, p. 121) says that this happens sometimes even when the construction cannot be credible or discussed. Therefore, the grounded theory will help my research to offer another perspective of understanding to the caregiver and medical professionals. They will be able to look at the condition from the viewpoint of the patient based on the patient’s behavior and beliefs besides those already known. In this study, I will collect new data based on theoretical development done from the literature review (Christina, 2005, p. 345). A delayed focused theoretical sampling encourages the development of an in-depth understanding of the realities and matters at hand in the study.


As far as chronic illnesses are concerned, the grounded theory will provide the analytical authority and theoretical understanding which will offer synthesized information, provide explanation and interpret the data. The strictness of this method will depend on a range of important concepts and just like quantitative study; my research will vary with the methodological flow. Having the ability to utilize semi-structured interviews and a constant comparative approach, my choice of methodology is suitable for medical research. This is a study that is objective and clearly founded on empirical data.

Reference List

Ashworth, P. (2003). ‘An Approach to Phenomenological Psychology: The Contingencies of the Life world,’ Journal of Phenomenological Psychology, 34(2): 145-56.

Carapetis, JR., (2007), ‘Rheumatic Heart Disease in Developing Countries,’ Engl J Med, 357:439-44.

Charmaz, K., (2006), Constructing Grounded Theory: A Practical Guide through Qualitative Analysis, Thousand Oaks, CA: Pine Forge Press.

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Christina, G., (2005). ‘Grounded Theory, Ethnography And Phenomenology: A Comparative Analysis of Three Qualitative Strategies for Marketing Research,’ European Journal of Marketing, Vol. 39 Issue: 3/4, pp. 294 – 308.

Finlay, L., Chapter 2, “Mapping Methodology” In Findlay, L., & Ballinger, Claire. (2006), Qualitative Research for Allied Health Professionals: Challenging Choices. Chichester, England; Hoboken, NJ: J. Wiley & Sons. Pp. 9-29.

Giorgi, A. & Giorgi, B. (2003). ‘Phenomenology’, In Smith, J.A. (Ed.), Qualitative Psychology: A Practical Guide To Research Methods, London: Sage.

Glaser, B.G., & Strauss, A.L., (2007). The Discovery of Grounded Theory: Strategies For Qualitative Research, New York: Aldine Transaction.

Hollaway, I. (Ed.). (2005). Qualitative Research in Health Care. Berkshire: Open University Press.

Holloway, I. & Todres, L. (2003). ‘The Status Of Method: Flexibility, Consistency and Coherence,’ Qualitative Research 3(3): 345-57.

Holloway, I., & Wheeler, S. (2010). Qualitative Research in Nursing and Healthcare (3rd Ed.). Chichester, West Sussex: Wiley-Blackwell.

Koch, T., Jenkin, P. & Kralik, D. (2004). ‘Chronic Illness Self-Management: Locating the ‘Self,’ Journal of Advanced Nursing, 48(5), pp. 484-492.

Kralik, D., Koch, T., Price, K. & Howard, N. (2004). ‘Chronic Illness Self-Management: Taking Action to Create Order,’ Journal of Clinical Nursing, 13, pp. 259-267.

Liamputtong, P. (2009). Qualitative Research Methods (3rd Ed.). South Melbourne: Oxford University Press.

Lutfey, K., (2005). ‘On Practices Of ‘Good Doctoring’: Reconsidering the Relationship between Provider Roles and Patient Adherence,’ Sociology of Health and Illness, 27(4), pp. 421-447.

MacDonald, M., Currie, B.J., & Carapetis, J.R., (2004). Acute Rheumatic Fever: A Kink in the Chain That Links the Heart to the Throat? Lancet, 4: 240-245.

Ploeg, J., (1999), Identifying the Best Research Design to Fit the Question. Part 2: Qualitative Designs, Evid Based Nurs; 2: 36-37.

Robertson, K.A., Volmink, JA & Mayosi, B.M., (2006). Towards A Uniform Plan For The Control Of Rheumatic Fever And Rheumatic Heart Disease In Africa- The Awareness Surveillance Advocacy Prevention (ASAP), Programme. S Afr Med J, 96 (3 Pt 2): 241-245.

Schreiber, RS & Stern, PN. (2001), Using Grounded Theory in Nursing, New York: Springer Publishing.

Scott, K.W., (2004). ‘Relating Categories In Grounded Theory Analysis: Using A Conditional Relationship Guide and Reflective Coding Matrix,’ The Qualitative Report. 9 (1): 113-126.

Smith, J.A. & Osborn, M. (2003). ‘Interpretative Phenomenological Analysis,’ In Smith, J.A. (Ed.), Qualitative Psychology: A Practical Guide To Research Methods, London: Sage Publications.

Steer, A.C., Carapetis, J.R., Nolan, T.M., & Shann, F., (2002). ‘Systematic Review Of Rheumatic Heart Disease Prevalence In Children In Developing Countries: The Role of Environments Factors,’ J Paediatr Chil Health, 38, pp. 229-34.

Strauss, A., & Corbin, J.M., (2005). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. London: Sage.

Wilson, P.M., Kendall, S., & Brooks, F. (2006). ‘Nurses’ Responses to Expert Patients: The Rhetoric and Reality of Self-Management in Long-Term Conditions: A Grounded Theory Study,’ J Nurs Stud. 43 (7), pp. 803-18.

Wimpenny P., & Gass J., (2001). ‘Interviewing In Phenomenology And Grounded Theory: Is There A Difference?’ Journal of Advanced Nursing, Vol. 31, Issues 6, pp. 1485–1492.

World Health Organization. (2004). ‘Rheumatic Fever and Rheumatic Heart Disease: Report of the WHO Expert Consultation,’ World Health Organization Technical Report Series, 923: 1-122.

World Health Organization. (2005). Preventing Chronic Disease: A Vital Investment. Geneva, Switzerland, Web.

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