Use of Grounded Theory in Cardiovascular Research

By Dunn, Patrick J.; Margaritis, Vasileios et al. | The Qualitative Report, January 2017 | Go to article overview

Use of Grounded Theory in Cardiovascular Research


Dunn, Patrick J., Margaritis, Vasileios, Anderson, Cheryl L., The Qualitative Report


While grounded theory is often cited in the qualitative literature as the methodology, there are few good examples of publications that follow the principles of grounded theory and result in an actual theory. The purpose of this paper is to demonstrate how the Corbin and Strauss (2015) method of grounded theory was used in a study looking at how patients with cardiovascular disease and diabetes develop health literacy skills that are used to manage their condition. The key principles of grounded theory include theoretical sampling, constant comparison, open, axial, and selective coding, the use of memoing, and theoretical saturation. Data collection in this study was in the form of semi-structured interviews of 16 patients with cardiovascular disease and diabetes, and 19 healthcare professionals that care for or educate these patients. Patients were recruited from a primary care medical practice, a cardiology medical practice, patient focused programs provided by the American Heart Association, and social media. Healthcare professionals were recruited from the medical practices, the American Heart Association, and social media. Each interview was recorded, transcribed, and coded. Insights from these interviews led to the development of the health literacy instructional mode, which explores the use of digital tools, instructional approaches, social support, and self-directed learning in the development of health literacy skills, and is an example of the use of grounded theory in cardiovascular research. Keywords: Health Literacy, Grounded Theory, Cardiovascular, Diabetes, Qualitative Research

Medical research is dominated by quantitative, hypothesis driven research methods. According to Krumholtz, Bradley, and Curry (2013) there is a need for more rigorous qualitative research, especially in areas where little is known, such as health literacy. Rather than relying on surveys and statistical analysis of quantitative studies, qualitative and mixed methods research can take an inductive approach to new discovery, which may lead to better hypotheses, better tools and strategies, and ultimately, better outcomes. Qualitative and mixed methods research should be used to investigate complex phenomena that are difficult to measure providing a deeper understanding and leading to better approaches, strategies, instrumentation, hypotheses, and outcomes (Curry, Nembhard, & Bradley, 2009). Qualitative methods can expand and enhance the role of quantitative research methods, especially in complex areas where little information is available, or where there is a high degree of variability in results from quantitative studies. This paper is designed to demonstrate the use of rigorous grounded theory methodology in a qualitative study of the development of health literacy skills in patients with cardiovascular disease and diabetes.

Background on the Study

The knowledge and skills necessary to manage health and prevent disease are known as health literacy (Parker & Ratzan, 2012). An estimated 90 million Americans lack the skills to understand their condition and related numbers, navigate the health system, communicate with their healthcare provider, and make good health related decisions (Kutner, Greengerg, Jin, & Paulsen, 2006). A National Action Plan was developed by U.S. Department of Health and Human Services in 2010 to create a more health literacy society, and a Health Literacy Toolkit was developed to help healthcare providers communicate more effectively with their patients (Dewalt et al., 2010). Since a national assessment of health literacy has not been conducted since 2003 (Kutner et al.), it is unclear how effective the Action Plan, Toolkit, and other strategies have been.

Just as there are many forms of quantitative methods, such as registries, clinical trials, and predictive analytics, there also are several forms of qualitative methods, including narratives, case studies, phenomenology, ethnography, and grounded theory. …

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