Building knowledge and development
of theory with qualitative research
5th Quality of Care Seminar
EMGO+ Institute VUMC
Tuesday 15th April 2014 Amsterdam
Hennie Boeije, Methodology and Statistics
Faculty Social and Behavioural Sciences
University Utrecht
[email protected]
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Role of theory
1. Use previous work and build on the existing
theory in the field
2. Formulate our findings more clearly and
contribute to theory
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
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Contents
 Explain confusion of the use of theory at the
start of our study
 Show different examples of how theory can
be used during the research process
 Demonstrate the theoretical nature of our
findings
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Theory in qualitative research
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
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Background of confusion
 Studying topics from the first person’s perspective
 ‘The goal of qualitative research is the development
of concepts which help us to understand social
phenomena in natural (rather than experimental)
settings, giving due emphasis to the meanings,
experiences, and views of all the participants.’
(Pope & Mays, 1995: 43 in BMJ)
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Background of confusion
 We aim to theorize with our own studies
 Difference in traditions
 Reinventing the wheel
(Before) E. P.
B. C.
GT (After)
(Creswell, J.W. Choosing among five traditions)
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Developing Theory by Hennie Boeije
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No theory at the start?
Theory
Inform the
development of
Data
(Ezzy, 2002)
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Background of confusion
 Systematic reviews and evidence-based practice
What is the underlying intervention theory of each
separate intervention?
 For whom does this intervention work, under what
circumstances?
 Building theory (synthesis) from previous studies
Can it be done?

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How can theory be used in QLR?
 It depends!
 On:


Body of knowledge in a specific field
Research questions
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
How can theory be used in QLR?
Simple model
No theory a priori
Theory as framework
Theory as lens:
sensitizing concepts
Testing theory
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Developing Theory by Hennie Boeije
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Marja de Jong
(Thesis 2013
Master Public
Health)
Simple model
Leader of the
project
Characteristics of
intervention
Cooperation
relevant
stakeholders
Strategy for
sustainability
Research and
communication
about outcomes
Public support
 Topic guide covers these larger themes
 Analysis: exploration within and outside themes
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Developing Theory by Hennie Boeije
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Sensitizing concepts
 Lens
 Give creativity and explanatory power to your findings
 Not to be used restrictive (tunnel vision)
Theoretical sensitivity
Sensitive to thinking about data in theoretical terms
Enables researchers to discover new insights by using
a certain theoretical lens to look at the data
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Sensitizing concepts
Grange and Kerr
et al. (2010)
 Four types of aggression in sports:




Play aggression – part of the game
Power aggression – power, intimidation
Anger aggression – frustration, provocation
Thrill aggression – kick and pleasure
 Topic guide: use the concepts to develop questions
 Analysis: explore relationships between the concepts
to explain and build knowledge
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Theory as framework
Scott-Parker et
al. (2012)
 Explore young driver’s risky behaviour
 Use Social Learning Theory (SLT)




Learn safe and risky driving attitudes and
behaviours
Exposure and imitation of models and
experience of punishments (car crash) and
rewards (shorter journey durations)
Influence of parents, peers, police
Conformation road rules or risky driving
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Scott-Parker et
al. (2012)
Theory as framework
 Topic guide: ‘explore the constructs of
interest’ from the young driver’s perspective
 Exploration only within the themes

E.g., within ‘reward’ > needs being met is
maturational issues, define identity
 Danger of forcing framework on data
 What exactly are the findings?
 Understanding social influences to inform and
guide countermeasures and road use policy
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Example of applied research
 Research objective:

Been-Dahmen & Van
Hooft, in preparation,
Ph.D.-project
Examining effectiveness of nurse-led interventions
for self-management support for chronically ill
patients and the mechanisms that explain
(in-)effectiveness
 Realist review (Ray Pawson)
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A guided self-determination intervention
for self-management support
 The aim of intervention is to enable nurses and
patients to overcome barriers to empowerment
 Patients are administered reflection sheets to reflect
on the position of illness in their lives
 Nurses are trained in communication skills (e.g.,
mirroring, listening) to discuss sheets with patients
 Patients and nurses meet 8 times with flexible contents
Zoffman & Kirkevold, 2012
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Underlying theory of guided selfdetermination intervention for SMS
 Life skills approach for managing the illness and
consistent with philosophy of empowerment
 Grounded theories on nurses being barriers to taking
decisions by patients (self-determination)
 Goals of patients should fit their interests and core
values (disease-oriented, life-oriented)
 In the interaction nurses and patients together should
take care to address the patients’ difficulties and
produce a problem-solving patient-centred interaction
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Developing Theory by Hennie Boeije
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CMO-String (Zoffman & Kirkevold, 2012)
Context
Mechanisms
Outcomes


•



Poorly controlled
patients with
diabetes who
experience a need to
change
Nurses experience
patients as difficult
Nurses involved in
developing
intervention
Patients involved in
developing
intervention





Reflection raises awareness
in patients on real difficulties
with self-management
Patients share unexpected
difficulties life-disease in their
own words
Patients experience they have
an active role to play
Nurses change their image of
the patients as trouble
Nurses talk easily about the
patients’ real difficulties
They co-create knowledge of
person-specific difficulties
•
•
•
Patients are able to identify,
express, and share unique and
unexpected difficulties related to
living with diabetes
Nurses are able to differently
communicate and give
responsibility to patients
Patients and health
professionals engage in shared
decision-making and establish
meaningful and effective
relationships
Patients resolve life-disease
conflict
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Developing Theory by Hennie Boeije
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Role theory in qualitative research
Simple model
No theory a priori
Theory as framework
Theory as lens:
sensitizing concepts
Testing theory
Explorative QL research:
theory development
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Developing Theory by Hennie Boeije
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Theory in qualitative research
Theory
Shapes the general
interpretation of, and
sensitises to
Inform the
development of
Data
(Ezzy, 2002)
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Contribution of Qualitative research
 Use theory in advance
 Explicate the domain of your contribution
 Use existing theory that matches the state of the art
 Be clear about theoretical point of departure
 Contribution of findings
 Formulate findings as concepts and relationships
 Make a creative jump towards explanation = theory
 Think of knowledge in terms of small steps
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Developing Theory by Hennie Boeije
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References
 Boeije, H. (2014) Analyseren in kwalitatief onderzoek. Boom Uitgevers
Den Haag.
 Bowen, G. (2006) Grounded theory and sensitizing concepts.
International Journal Qualitative Methods, 5(3): 12-23.
 Ezzy, D. (2002). Qualitative analysis: practice and innovation. Routledge:
London.
 Pawson R: Evidence-based policy: A realist perspective. London: Sage;
2006
 Sandelowski, M. & Barroso, J. (2003). Classifying the findings in
qualitative studies. Qualitative Health Research, 13(7): 905-923.
 Timmermans, S. & Tavory, I. (2012) Theory construction in qualitative
research: from grounded theory to abductive analysis. Sociological
Theory, 30(3): 167-186.
 Tummers, L. & Karsten, N. (2011). Reflecting on the role of literature in
qualitative public administration research: learning from grounded theory.
Administration & Society, 44(1): 64-68.
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
Thank you for your attention
5th QoC Seminar Qualitative Research 2014
Developing Theory by Hennie Boeije
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