Grounded Theory Method and Symbolic Interactionism: Freedom of Conceptualization and the Importance of Context in Research

Abstract: Symbolic interactionism (SI), a perspective used to understand human conduct, is commonly said to underpin grounded theory methodology (GTM). However, the purpose of GTM is to produce substantive explanatory social theory from data without reliance on prior assumptions. Therefore, some argue that SI is an unnecessary theoretical constraint on the principal aim of GTM—the free conceptualization of data. In this article we use examples from an ongoing constructionist grounded theory study into the negotiation of nurses' roles in general practice in New Zealand, to demonstrate how SI can inform GTM regarding conceptual development and context. We argue that by asking three questions from a symbolic interactionist perspective, at each stage of the research process, freedom of conceptualization may be enhanced and awareness of contextual matters promoted to better bridge world views.

Key words: grounded theory methodology; symbolic interactionism; qualitative research; conceptualization; context; culture; pragmatism

2. General Implications of Conceptualization for Knowledge Generation in the Social Sciences

6. The SI Perspective as an Aid to Conceptualization within Grounded Theory Methods

7. Outcomes of Connecting Symbolic Interactionism and Grounded Theory to Aid Conceptualization and Accommodate Context

Individual beliefs and collective knowledge are developed over time in the light of experience. In everyday life, the conversion of belief to knowledge occurs subliminally but in science highly formalized systems of inquiry are used to justify the transition (DOUGLAS & WYKOWSKI, 2011), giving rise to the argument that scientific knowledge is superior to other ways of knowing on epistemological grounds (WRAY, 2012). This has implications for the status of qualitative social research which is necessarily situated in the realm of everyday human experience, such that quantitative inquiry in the more reified fields of the natural sciences has traditionally been regarded more highly (TOLHURST, 2012). Against this background, grounded theory methodology (GTM) was first developed in the 1960s by Barney GLASER and Anselm STRAUSS (1967), who combined their expertise in qualitative and quantitative sociology, to articulate a new system of inquiry. Motivated by the wish to promote and legitimize empirical theory generation in sociology, they presented a method by which data could be "systematically obtained and analyzed" (p.1). Their introduction of GTM marked a break from the hypothetico-deductive method (HAIG, 1995) and provided greater rigor and structure in the field of qualitative social research at a time when quantitative methodologies were considered superior (BRYANT & CHARMAZ, 2007). The term grounded theory refers not only to the method of inquiry but to the novel explanatory theories that are its intended products (BIRKS & MILLS, 2015). Importantly, such theories are developed directly from the data and not from preconceived theoretical frameworks (BUTLER, COPNELL & HALL, 2018) with free conceptualization of data at the heart of the method (GLASER & HOLTON, 2004). [1]

Over time, despite extensive philosophical debate and methodological variation within GT, free conceptualization has remained central to its appeal (TOLHURST, 2012). However, two difficulties arise. Firstly, conceptualization is a skill (GLASER, 2002) which some researchers struggle to master despite immersion in the methodology (BIRKS, HOARE & MILLS 2019; GLASER, 2011), and abstraction, one of the key tenets of GTM (REICHERTZ, 2009), is often missing. This has given rise to outputs which are merely descriptive, rather than explanatory (GLASER, 2019). Secondly, as conceptualizations are linguistic constructs, used to convey meaning for human purposes (SCHMITTER, 2008), their formation is unavoidably influenced by context, including differing beliefs about the nature of reality and how it may be understood (BANG, MARIN & MEDIN, 2018). Therefore, it is difficult to eliminate preconception and in analyzing data, concerns may arise about data contamination (BIRKS et al., 2019). [2]

Symbolic interactionism (SI) is a leading perspective and method within behavioral sociology, in which interaction is seen as the key to human behavior and the construction of meaning (CARTER & MONTES ALVARADO, 2018), and which has the potential to explicate the process of conceptualization and the place of context in knowledge generation. It has long been associated with GTM (ALDIABAT & LE NAVENEC, 2011; CHAMBERLAIN-SALAUN, MILLS & USHER, 2013), and is almost invariably said to underpin GTM (GLASER & HOLTON, 2004). However, some regard SI as a preconceived theoretical constraint (ibid.; NEWMAN, 2008), and at odds with the stipulation that GT researchers should "take the elevator from the ground floor of raw substantive data and description to the penthouse of conceptualization and general theory. And do this without paying homage to the legacy of extant theory" (GUMMESSON, 2002, p.586). [3]

In this article, we discuss how the understanding and practice of conceptualization in GTM may be aided by framing the study with an SI perspective. We consider the general implications of conceptualization for knowledge generation in the social sciences (Section 2). Recognizing the importance of perspective in this regard, we then address the origins of GT and SI in the Chicago School of Sociology and explain their links to the philosophy of pragmatism (Section 3), before describing the tenets of SI and GTM (Sections 4 and 5). Using examples from an ongoing constructionist GTM study into the negotiation of nurses' roles in general practice in New Zealand, we go on to illustrate how, by asking three questions based on the principles of SI, insight into the process of conceptualization upon which GTM relies may be gained and matters of contextual importance in the situations they study may be identified (Sections 6 and 7). [4]

2. General Implications of Conceptualization for Knowledge Generation in the Social Sciences

Specific language or imagery is required to define, retain and communicate knowledge. As such, knowledge statements are conceptualizations: language assigned to reality, rather than the voice of reality itself (SCHMITTER, 2008). In psychological terms, concepts are created through cognitive activity, prompted by perception of phenomena, and acquire shared meaning through interaction between individuals (SHARIFIAN, 2003). Therefore, knowledge is experiential, and among those with shared experience, similar interpretations of reality develop (KASTANAKIS & VOYER, 2014; SMITH, 1999). Such interpretations are subjective (BERGER & LUCKMANN, 1971) and neither fixed nor "observer-neutral" (KRATOCHWIL, 2008, p.88); rather, they are culturally situated. For example, within established fields of study the definition of concepts and how they should be used to engage with the world is moderated by communities of academics through peer review (KRATOCHWIL, 2008). This creates schools of thought, paradigms (HALL, GRIFFITHS & McKENNA, 2013) or traditions, within which specific theoretical and conceptual frameworks provide criteria against which research assumptions are tested (LYNCH, RAMJAN, GLEW & SALAMONSON, 2020). [5]

In sociological research, confidence in research findings is undermined where assumptions are tested narrowly against institutional values and research practices which privilege particular traditions. Discussing research agendas of indigenous communities in the context of colonialism, SMITH observed, "research is not an innocent or distant academic exercise but an activity that has something at stake and that occurs in a set of political and social conditions" (2021, p.5). Therefore, it is important to be clear about how the chosen system of inquiry is used to generate knowledge (BRYANT & CHARMAZ, 2007) specific to the phenomenon of interest and the philosophical positions of both researchers and participants. Within the institutions of research, outputs are held to be reliable where the system of inquiry, philosophical frameworks and lenses interconnect meaningfully to support the aims of any study and methodological congruence is said to be demonstrated (TRACY, 2010). To be truly meaningful in the world, to promote the public understanding of science and facilitate implementation of research findings, broad context relevant to participants and their communities must be included (CANFIELD et al., 2020). [6]

In the first half of the twentieth century, the Chicago School of Sociology developed under the influence of American Pragmatist Philosophy at Chicago University (CORTESE, 1995). The Chicago School of Sociology is a school of thought based on pragmatist philosophy. Members of the Chicago School developed concepts and research practices which challenged the hypothetico-deductive, or experimental, research paradigm previously dominant within sociology (HAIG, 1995; KENNEDY & LINGARD, 2006). Recognizing the importance of context, they advocated for researchers to go out and study social phenomena in the real world and aimed to generate knowledge through abductive "practical reasoning" (BRINKMANN, 2018, p.11). [7]

Drawing on Charles PIERCE's late nineteenth century writing, pragmatism gained traction with the work of William JAMES, who characterized its effect thus: "It means the open air and possibilities of nature, as against dogma, artificiality, and the pretense of finality in truth" (1907, p.51). In pragmatism, knowledge and theory are viewed as devised tools for living, rather than revealed truths, allowing for change in meaning over time and in the light of experience. Pragmatists focus on human action and the creation of useful knowledge through interaction with the environment and admit ways of knowing beyond science. They acknowledge, for example, the place of values, custom, the arts, and religion and make no categorical distinction between scientific and lay knowledge (SCHEFFLER, 2012). [8]

The works of Chicago's American pragmatist philosophers and psychologists, George Herbert MEAD and John DEWEY in the fields of symbolism and intelligence, concern the nature of interaction and the intimacy between individuals and the circumstances of their existence (HANDBERG, THORNE, MIDTGAARD, NIELSEN & LOMBORG, 2015; SCHEFFLER, 2012). Although GTM was presented as a break from traditional thinking (BRYANT, 2009), these works inform SI and GT, both of which focus on meaning to be found in interactive experience. Thus, a shared foundation in pragmatism links SI and GTM methodologically (CHAMBERLAIN-SALAUN et al., 2013). The term symbolic interactionism was coined by Herbert BLUMER at Chicago, in his interpretation of the work of MEAD and other pragmatists during the 1950s and 1960s (CHARON, 2010). STRAUSS trained in the Chicago School (GERHARDT, 2000), focusing on qualitative research (BRYANT & CHARMAZ, 2007). Prior to his collaboration with STRAUSS at the University of California in San Francisco, GLASER's experience was in positivist quantitative survey analysis and concept-indicator construction at Columbia University (BIRKS et al., 2019; GLASER, 2005). In keeping with GLASER's background and the then dominant scientific paradigm, several assertions in "The Discovery of Grounded Theory" (GLASER & STRAUSS, 1967) reflect positivist ontology; for example, the idea that theory emerges from the data before a detached observer suggests belief in objective discoverable truths (TOLHURST, 2012). However, in recognizing that social phenomena are not static, that human experience is a valid path to knowledge, and by characterizing theories grounded in specific data as useful, in the first articulation of GTM, GLASER and STRAUSS (1967) reflected the influence of pragmatism. Aspects of SI, including the acceptance that human actors behave in accordance with their perception of pertaining conditions, and that their responses are not inevitably pre-determined by fixed sociological and psychological factors, are also apparent in the original version of GTM (CORBIN & STRAUSS, 1990). [9]

BLUMER characterized SI as the formative social process, a distinctive "analytical scheme of human society and human conduct" (1969, p.6), which provides an empirical basis for understanding the social world. He refuted ideas of behavior being pre-determined by culture or social organization in a fixed and fatalistic way and saw SI as a set of principles to be applied when "attempting to come to grips with the obdurate character of the empirical world under study" (p.26). From a symbolic interactionist perspective, meaning is constructed through human group life wherein individuals continuously act, and understand, in the moment, in interaction with themselves, their environment and other human actors. Objects in the environment, which may take any form—physical, human, linguistic, spiritual, indeed anything which may be perceived—acquire meaning for individuals through experience, and interaction occurs within situational contexts that also have acquired meanings (BLUMER, 1969). Meanings associated with objects and situational contexts are constructed and reconstructed over time through human interaction (ibid.), and objects, especially words, symbolize and communicate meaning (BURBANK & MARTINS, 2010). Although their symbology may be interpreted differently by others, for whom they have acquired different meanings through different past interactions, it is nevertheless their meaning in the present, the individuals' current thought processes and their understanding of the perspective of others in the situation, that is the direct cause of behavioral acts (BLUMER, 1969). In this way, collective or group actions are seen as the combination of individual "lines of action" (p.82). As a method, SI is used to provide explanations of social phenomena which, due to their complexity and contextuality, are difficult to explicate by hypothetico-deductive means. It provides a set of principles to apply when "attempting to come to grips with the obdurate character of the empirical world under study" (p.26), a way to:

"gather necessary data through careful and disciplined examination of that world; to unearth relations between categories of such data; to formulate propositions with regard to such relations; to weave such propositions into a theoretical scheme; and to test the problems, the data, the relations, the propositions, and the theory by renewed examination of the empirical world" (p.48). [10]

As in SI, in GTM knowledge about social phenomena is generated by systematically conceptualizing data (BIRKS & MILLS, 2015), rather than by the hypothetico-deductive method (HAIG, 1995). GTM is used with all types of data and epistemologies (HOLTON, 2007) in many fields including construction (SHOJAEI & HAERI, 2019), business (GLIGOR, ESMARK & GÖLGECI, 2016), medical education (KENNEDY & LINGARD, 2006), and nursing (McCANN & POLACSEK, 2018). Over time, three methodological approaches have developed (ibid.), reflecting "contemporaneous interpretation" in the context of changing societal forces (RALPH, BIRKS & CHAPMAN, 2015, p.3) and mirroring adherents' theoretical and conceptual perspectives (CHUN TIE, BIRKS & FRANCIS, 2019). As such, GTM can sit within, across and between paradigms: positivist/realist; constructivist/relativist (BRYANT & CHARMAZ, 2007; CLARKE, FRIESE & WASHBURN, 2018; HALL et al., 2013; RIEGER, 2019); and post-modernist/reflectivist (DENZIN, 2007). Consequently, the approaches differ regarding the positionality of the researcher, which varies on a continuum from detached observer to co-constructor of knowledge (RIEGER, 2019). [11]

Classic GTM is associated with GLASER; evolved grounded theory (EGT) with STRAUSS, CORBIN and CLARKE; and constructivist grounded theory (CGT) with CHARMAZ (CHAMBERLAIN-SALAUN et al., 2013). Regardless of specific approach, there are common GT methods (BIRKS & MILLS, 2015; CHARMAZ, 2012; McCANN & POLACSEK, 2018) and in all cases, the researcher strives to remain grounded in data by recursively comparing empirical instances and research-insights, each with one other. Preconception is militated against through self-reflexivity and the method-specific use of literature (BIRKS & MILLS, 2015; BIRKS et al., 2019). The common methods are: theoretical sensitivity; memo-writing; concurrent data generation; coding and categorizing of data, including the constant comparative method; theoretical sampling; theoretical saturation; and theoretical integration (BIRKS & MILLS, 2015). [12]

6. The SI Perspective as an Aid to Conceptualization within Grounded Theory Methods

Within this section we describe the techniques used within each of the common grounded theory methods and outline examples from our own research where the tenets of SI were connected methodologically to GT as an aid to conceptualization and the accommodation of context. This was achieved by asking, throughout the research, three questions framed from the tenets of SI: Who and what are the actors in this situation? What is meaningful to the actors in this situation and why? and How do actors' individual lines of action interact in this situation over time? Together, these questions allow researchers to point out to themselves, "the things that have meaning" (BLUMER, 1969, p.5) in the situation of inquiry, the interpretation of which guides action. [13]

GT studies begin with the acceptance that researchers, while bringing personal perspectives to the endeavor, claim no concrete knowledge of the case-specific drivers and processes at work. GLASER and STRAUSS stated:

"To be sure one goes out and studies an area with a particular sociological perspective, and with a focus, a general question, or a problem in mind. But he [sic] can (and we believe should) also study an area without any preconceived theory that dictates, prior to the research, ‘relevancies' in concepts and hypotheses" (1967, p.33) [14]

However, to be able to assess the relevance of data and their context, GTM researchers seek, throughout the research process, to develop sensitivity to conceptual possibilities for the exploration and explanation of the phenomena under study (McCANN & POLACSEK, 2018). In SI, the importance of the starting perspective is recognized, and researchers are encouraged to set out and explicate the "initiating picture of the empirical world" (BLUMER, 1969, p.25), from which they engage with the topic and develop the principles to be followed in the research design. From an SI perspective, the researcher's development of theoretical sensitivity is an ongoing process of finding meaning in the situation through interaction with "things that he [sic] encounters" (p.2), including the self. GTM researchers document insights contemporaneously, in memos, allowing the genesis of ideas to be tracked, interrogated, and finessed (CHAMBERLAIN-SALAUN et al., 2013). In SI terms, memo-writing facilitates self-interaction whereby researchers point out to themselves, "the things that have meaning" (BLUMER, 1969, p.5), the interpretation of which guides action. In her version of grounded theory, CLARKE systemized the identification of such meaningful things employing a combination of memos and mapping in a technique called situational analysis (CLARKE, FRIESE & WASHBURN, 2015). Three types of maps are constructed: situational, social worlds/arenas and positional; insights arising from them are captured in memos (CLARKE et al., 2018). SCHATZMAN's technique of dimensional analysis (DA), based in SI thinking, is a further technique sometimes incorporated within GTM (SBARAINI, CARTER, EVANS & BLINKHORN, 2011). In DA situational factors are identified and classified by their theoretical function: process, condition, consequence or context (KOOLS, McCARTHY, DURHAM & ROBRECHT,1996). [15]

In our study, the impetus for research was the perception, indeed the conceptualization, in the mind of the first author, SH, that nurses' role development in general practice was limited by systemic constraints. This positionality was influenced by the first author's personal experience as a nurse in general practice and familiarity with discipline-specific published research literature. However, in GTM extant information, including literature, is subordinate to data from the field under study (RAMALHO, ADAMS, HUGGARD & HOARE, 2015) and SI reinforces this by calling for problems to be defined through "ongoing, flexible, shifting examination of the empirical field, itself" (BLUMER, 1973, p.798). Therefore, when framing the research question, we used the experience of interviewing nurses in general practice for a separate study, to consider other experientially-grounded perspectives and explored them using our three questions. We noted that the concerns of interviewees were expressed in terms of practice-level interpersonal relationships and that differing outcomes were observed under similar macro-level systemic conditions which we identified by looking for non-human actors and their interconnections. Having done so, we decided to begin the research by exploring the negotiation of nursing roles within general practices. Consideration of the several human actors in the situation, what might be meaningful to them and how their "individual lines of action" (BLUMER, 1969, p.82) may interact guided our selection of participants. Consequently, we included those with a range of experience in general practice in our initial sample, including not only nurses, but medical general practitioners, business owners and managers. Using situational analysis to set this issue against the big-picture, our mapping brought together multiple elements including: human actors, individual and collective; non-human actors; culture; symbolic elements and the range of actors' contested viewpoints (CLARKE et al., 2018). By identifying nexus of interaction among these elements, the unit of analysis, which might otherwise have been conceptualized simply as the general practice, as a physical and organizational entity, was conceived more broadly and characterized as the general practice negotiating environment. This expanded our pool of participants to include actors such as regional nursing leaders, with whom general practice staff interact. It also guided data generation by sensitizing SH to recognize and follow potentially significant participant narratives during semi-structured interviews. For example, awareness of symbolic elements, identified as potentially significant through mapping, facilitated exploration of examples given by participants regarding the use of name badges, website content and noticeboards. [16]

In GTM, initial data are collected purposefully from sources representative of the phenomena under study and capable of providing meaningful data; participants may have experiential or observational knowledge (MORSE & CLARK, 2019; PALINKAS et al., 2015). Incrementally, over successive phases of data generation, separated and informed by periods of analysis, grounded theorists seek to identify and explain the main concerns and behaviors of participants regarding the phenomena of interest (GLASER, 2002). However, it is not the aim merely to characterize the concerns of the participants as they describe them; rather the researcher conceptualizes patterns of concern and behavior across multiple data. The first principle of SI reminds us that humans "act towards things on the basis of the meanings that the things have for them" (BLUMER, 1969, p.2). Behaviors are therefore dynamic and responsive to the meaning found in particular situations, at particular times, in interaction with self and others (BLUMER, 1969). In GTM, data can take many forms but to ensure quality, should encompass the variation in the situation of inquiry and be of sufficient depth and detail. It is also important when conceptualizing data and developing categories to be able to determine the relative value to the research aims of discrete empirical instances (BIRKS & MILLS, 2015). We used semi-structured individual interviews to generate participant data and asking ourselves: What is meaningful to the actors in this situation and why?, created a list of questions to be used to probe further into meaning, after first asking participants to describe their experiences of nurses' roles in general practice. These questions included: What are the tasks that have meaning? What does professional autonomy mean to you? and Who supports you to do the things you love? This elicited data regarding values and meaning, and helped to identify additional actors in the situation, bringing into focus, for example, the importance of professional and personal support networks outside of workplaces. Recognizing such meaning as a labile precursor to and driver of action, the GT researcher is able to see behind the empirical instances finding conceptual linkages that transcend the specific behaviors. In our data, for example, one participant strove to provide nurse outreach services to patients, and another to deliver nurse-led preventive care. The recognition that these behaviors arose from the specific meanings attributed to nursing care by individual participants in interaction with actors in their environments facilitated the conceptualization of a variety of such concerns as providing needs-responsive nursing practice. Applying the three SI questions to the analysis of those interactions, the needs responded to were found to include: societal need; professional need; the needs of individual patients and staff members; and the business imperative, which arises from the private business model and funding arrangements in place for New Zealand general practice. [17]

Whilst conceptualization is facilitated by all the common grounded theory methods, it is in coding and categorization that the concepts from which theory will be constructed are formed and theoretically linked (HOLTON, 2007). Both code and category are synonyms of concept but here represent the differing levels of abstraction achieved through phases of analysis. These phases vary with specific approach but address: the coding of empirical data; the development of categories by grouping related codes; and the connecting of categories to explain the data, including the creation of a core category (BIRKS & MILLS, 2015; GLASER, 2011). In a reversal of the concept-indicator model, used in hypothetico-deductive reasoning, whereby a concept is specified, and indicators sought to test it (GLASER, 2005), the logic of discovery in GTM is largely inductive and abductive. That is, there are no predetermined explanations for observed indicators, or empirical instances found in the data; new explanations are created by intellectual effort (REICHERTZ, 2009). The plausibility of all possible hypotheses is considered, and reconsidered, in the light of the data and their analysis to the point of best explanation; other explanations remain possible, and the process is iterative (VON GLASERSFELD, 2001; WARBURTON, 2013). [18]

When coding, the researcher first identifies words, or non-textual evidence appropriate to the type of data, which describe the empirical instances, or indicators, and gives them labels (ELLIOTT, 2018). This is usefully understood from the SI perspective that meaning arises in the moment out of interaction. The labels that the researcher assigns symbolize the meaning they construct in their interaction with the data, with participants and with other objects in the situation, human and non-human. The labels, at this stage codes, mark instances for retrieval and further analysis by focused consideration of groups of similar instances or "interchangeable indicators" (GLASER, 2011, p.1). Over time, groups of indicators are aggregated to form categories, and categories, rather than data, become the principal objects with which the researcher interacts, re-interpreting their meaning and defining them conceptually with properties and dimensions. As concepts then, rather than descriptions, categories become abstracted from time, place and person and can be related one to another hypothetically to explain the data and the grounded theory begins to take shape. It is at this stage that abductive reasoning is used to test the plausibility of the hypotheses by theoretical sampling, as described below. Plausibility-testing may be aided by storyline. A storyline is a narrative description of the categories and how they relate to one another (BIRKS, MILLS, FRANCIS & CHAPMAN, 2009). The process of constructing the storyline is analytical and, again in SI terms, facilitates interaction with the data at a conceptual level. A stilted narrative indicates the need for further analysis. Eventually after sequential testing, reframing and retesting of possible hypotheses, a core category is identified which conceptualizes and embodies the best explanation: the grounded theory. Constant comparative analysis is practiced throughout, considering empirical instances, codes and categories in juxtaposition within and across levels of abstraction (BIRKS & MILLS, 2015). Throughout coding and categorization, questioning from SI tenets reminds the researcher not only to look for the actors' meaning and lines of action among the data but also to recognize herself as an actor in the situation and to take account of her own sense of meaning and action. Depending upon the positionality of the researcher, this may be to decontaminate the data, if taking a classicist view, or to fulfill the role of co-constructor of knowledge as in later GTM variants. [19]

SI can also be informative when considering the naming of categories, as it highlights that the interpretation of specific language, like that of any other object, may differ between individuals or groups (BLUMER, 1969). Sometimes, a category may be named using an in vivo form of words, taken directly from the data (BIRKS & MILLS, 2015). In our study the term leveling up was used by a participant and was constructed as a potential core category, connoting the upskilling of nurses within the practice team. However, this term is in popular use elsewhere symbolizing a range of concepts, including topical political and economic ideas sometimes applied in health settings (JENNINGS, McKAY & STOKER, 2021). Due to the potential for this to disrupt the effective communication of our research, and after further analysis, we renamed the category operationalizing intent and subsequently creating place. [20]

In GTM, data collection occurs episodically and is guided by the products of ongoing analysis. This is termed theoretical sampling and takes various forms, according to the stage of conceptual development (BUTLER et al., 2018). To begin, sources that are broadly representative of the phenomenon of interest are used to gain an initial understanding of the topic. Later, as new facets of the phenomenon are identified, sampling is focused on answering questions relevant to theory development. This may involve seeking new data or re-examining existing data (MORSE & CLARK, 2019) to test linking hypotheses using abductive reasoning. From an SI perspective, it allows the empirical world to "talk-back" (BLUMER, 1969, p.22), through those who have experience with the research topic. The SI perspective also aids understanding of quality assurance criteria in GTM, which include, explanatory power, data-fit, relevance and generalizability (CHARMAZ & THORNBERG, 2020). The measure of each of these is in the data and their representation of the empirical world (BLUMER, 1969) and theoretical sampling is key to data sufficiency in this respect (MORSE & CLARK, 2019). Where analysis ceases to produce new insights, and when categories are fully described, dimensionalized and supported by a suitable number of empirical instances, the category may be considered saturated, and sampling is complete (BIRKS & MILLS, 2015). [21]

Early in our analysis, a provisional hypothesis of the process of negotiating nurses' roles included the sub-category norms of practice, which conceptualized patterns of behaviors seen in the data salient to particular situations and thus subject to contextual variation. Therefore, we identified the need to sample for greater variation of experience of the general practice negotiating environment, our world under study, and subsequently recruited participants from targeted cohorts including new graduates, male nurses, nurse prescribers and those with experience in general practices with a range of ownership, governance, business and care models. One group of participants were Māori nurses with experience of working in Māori Health Service Providers (MHSP), several of whom spoke passionately about their roles in terms of serving their community and giving back, and we coded these instances as meaning of work. Māori are the indigenous peoples of New Zealand and MHSP delivery models focus on reducing health inequity by grounding services in Māori values and practices (GIFFORD, BATTEN, BOULTON, CRAGG & CVITANOVIC, 2018). Māori nurses who integrate kaupapa (first principles) within their clinical practice promote culturally safe care to Māori patients and families (whānau) (SHERIDAN et al., 2011). Sampling within this cultural context highlighted the importance of meaning of work as a driver of nursing behavior and, following the constant comparative method, we reviewed earlier data for other empirical instances relevant to this code. We found references to meaning of work in other settings, there expressed in terms of being part of a team and feeling competent or useful. This allowed us to further develop the code, to test its relevance with further sampling, and to consider its theoretical usefulness as a category to explicate behavior across the data set. [22]

Most grounded theories are substantive in that they explain phenomena within specified conditions (BIRKS & MILLS, 2015). However, their explanatory power may be increased by comparison with compatible theoretical codes from existing knowledge (McCANN & POLACSEK, 2018). To avoid the imposition of concepts not grounded in the substantive area, it is recommended that such extant codes are considered late in the analysis (BIRKS et al., 2009). Some researchers consider the adoption of an SI perspective at the outset of a GT study to be premature and prescriptive (GLASER, 2005; GLASER & HOLTON, 2005; NEWMAN, 2008). We contend that SI sensitizes researchers to possibilities within situations being studied without jeopardizing groundedness. [23]

7. Outcomes of Connecting Symbolic Interactionism and Grounded Theory to Aid Conceptualization and Accommodate Context

As discussed in Section 2, the derivation of all knowledge statements, lay or scientific, relies on the everyday subliminal cognitive process of conceptualization. In explaining the interactional nature of knowledge-construction and SI, BLUMER (1969) explained conceptualization as being an everyday cognitive process invoked to deal with the limits of perception; where experience of a phenomenon is found incomplete or perplexing, explanations are constructed, to render it understandable, or meaningful. GTM is used to look for meaning in the empirical world using inductive and abductive reasoning to provide explanations of social phenomena which, due to their complexity and contextuality, are difficult to explicate by hypothetico-deductive means. In simple terms, when using GTM, the cognitive process of conceptualization is harnessed and operationalized to create scientific meaning, distinguishable from everyday "natural analysis" (KOOLS et al., 1996, p.315) by the purposefulness of the process, the depth of the analysis and the consciousness of the acts of conceptualization. Understanding the everyday process through the application of SI mitigates the difficulty many researchers find in grasping the process of conceptualization once it is raised to the level of a formal analytical technique. [24]

We have described why it is important in sociological research to understand the relevance of context from the point of view of participants. However, sometimes, context is limited to description of the environment within which questions are set or findings presented (ROGERS, DE BRÚN & McAULIFFE, 2020). Conversely, in GTM, it is the intent to look for the "everyday realities" (GLASER & STRAUSS, 1967, p.239) in the situation of inquiry and close attention is paid to the diverse contexts within which data are situated (BAINBRIDGE, WHITESIDE & McCALMAN, 2013). From an SI perspective, contextual factors are objects with which individuals interact to construct meaning, and the real world outside the laboratory is recognised as complex and context dependent (BLUMER, 1969). Accordingly, SI techniques and theories such as STRAUSS' theory of action (1993) and situational analysis (CLARKE et al., 2018), highlight the importance of context in the understanding of human behavior and conceptualization. The former includes as a central theme the idea of trajectory and the effect of temporal influences on actors' interpretations of situations (MILLS, 2009). The maps used in situational analysis promote understanding of the contextual complexities and stress that rather than comprising external circumstances, context is intrinsic and combines with the individual to create the situation of interest (CLARKE et al., 2018). Both draw on the basic tenets of SI which present human behavior (BLUMER 1969) as arising from the diversity meanings to be found in situations and demonstrate how acceptance of SI tenets opens opportunities for conceptualization by increasing receptiveness to the range of perspectives present in the empirical field. However, they represent a further layer of methodological complexity with which researchers must grapple. More simply, by combining SI and GT methodologically, by asking at each decision point in the research process: Who and what are the actors in this situation? What is meaningful to the actors in this situation and why? and How do actors' individual lines of action interact in this situation over time? the researcher is better able to interact with the self, with the data and with the situational context to locate meaning in the situation of inquiry, with or without the application of more prescriptive techniques. [25]

GLASER and HOLTON (2004) cautioned that the relevance of context must be determined through course of analysis not to be considered a preconception. However, the diligent use of constant comparative analysis in conjunction with the three questions ensures that the putative significance of all objects in the situation, contextual or other, are tested for empirical grounding. Moreover, in SI, although the meaning attached to concepts, including that associated with theoretical and conceptual frameworks, may have been constructed from past interactions, it is the meaning of the concept in the present, the individuals' current thought processes and understandings of the perspectives of others in the situation, that drives action (BLUMER, 1969). Therefore, where that act is the conduct of research, an SI perspective supports free conceptualization and need not preclude the use of other perspectives or theoretical codes, the salience of which becomes apparent during analysis. "Symbolic interactionism tells us that things could always be otherwise" (CLARKE et al., 2015, p.14) and prompts us to look for contextual variation in the data. As evidenced by examples in Section 6, attending to context and seeking to understand the various perspectives of those experiencing the phenomenon of interest, enables GT researchers "to correct and adjust the emerging [sic] theory to diverse conditions" (CHARMAZ & THORNBERG, 2020, p.314), potentially enhancing its explanatory power and reach. [26]

The distinction between scientific and lay knowledge, whereby the former is privileged on epistemological grounds, belies the fact that all knowledge relies on human cognition and mental processes of conceptualization, which operate, usually sub-consciously, in response to observed phenomena. In GTM the means of observation and analysis are formalized to facilitate conscious conceptualization within a substantive situation, for the purpose of understanding social phenomena therein, and to militate against concrete pre-conception. The SI perspective aids the understanding and practice of conceptualization by framing it as a continual process, whereby individuals create and re-create meaning in interaction with themselves, with others and with objects in their environment; it explains behavior as an interpretive response to meaning. As such, an understanding of SI means sensitizing to biases and possibilities within the individual and the situations they study, promoting an open attitude to discovery and empowering the researcher to "claim the autonomy given to him [sic] by the method" (GLASER, 2011, p.12) in order to freely conceptualize the data. [27]

In our GT study, the recursive use of three questions based on the tenets of SI effectively raised our research autonomy, guiding decisions regarding research design, including: defining and scoping the situation of inquiry, and selecting research participants and means of data generation. It informed engagement with research participants and interaction with data during the analysis. It improved reflexivity and aided the selection of terminology to convey research findings. [28]

In keeping with their ontological and epistemological origins in pragmatism, GT and SI do not privilege positivist scientific ideas above other philosophical perspectives, practical ways of knowing or cultural interests (SCHEFFLER, 2012); they are said to be "contextually responsive" (BAINBRIDGE et al., 2013, p.277). Their use in combination, as described, has the potential to bridge world views and cultural differences and to remove the otherness of disparate perspectives (ALI et al., 2021). By finding the meaning in situations studied, exchange of ideas across social divisions is facilitated and knowledge is rendered truly useful. [29]

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Sarah HEWITT is a registered nurse and PhD candidate, in receipt of a Massey University Doctoral Scholarship. Working in primary health care in New Zealand, in both clinical and managerial roles, she has an interest in innovation in models of health care delivery and preventive health. Currently researching processes of nurses' role negotiation in general practice, she has previously investigated the effectiveness of primary cardiovascular disease risk assessment.

Massey University
School of Nursing, College of Health
Massey University, Albany
Auckland, 0632, New Zealand

Jane MILLS is one of Australia's most experienced primary health care academics having led and managed teams in both government and tertiary sectors. She is currently the dean of La Trobe Rural Health School. An internationally recognized grounded theorist, in the past decade she co- authored with Professor Melanie BIRKS the popular text "Grounded Theory: A Practical Guide," which has furthered the development of fundamental grounded theory methods of theoretical coding and storyline analysis. The original text has over 3,000 citations and has been reprinted several times since its publication in 2011.

La Trobe University
Office of La Trobe Rural Health
Bendigo, Victoria, 3552, Australia

Karen HOARE is a nurse practitioner and partners with four general practitioners in a practice in South Auckland. Additionally she has an appointment as professor in the School of Nursing at Massey University. Her specialist areas of research are children and young people. She completed her PhD using a grounded theory design to investigate how practice nurses use information in their work in New Zealand. She has written a number of papers relating to grounded theory methods. One of her main interests is building support for children's nursing in low and middle income countries. She is currently coaching senior nurses in Africa as a member of the University of Cape Town's Child Nurse Practice Development Initiative.

Nicolette SHERIDAN is one of Aotearoa New Zealand's most highly regarded nurse academics with tribal affiliations to Ngāpuhi. She has a PhD in public health and nursing, and qualifications in occupational health practice and education. Nicolette has led international research into equity in healthcare and is the lead investigator of a national study into the effectiveness of primary care measuring differences in patient outcomes delivered by different models of general practice. She is head of the school of nursing at Massey University. Her research interests include consumer experiences of long-term conditions and disparities in primary health care services between indigenous and non-indigenous citizens, and Pacific and non-Pacific citizens, as a means of monitoring government commitment to indigenous rights and equity in healthcare.

Massey University
School of Nursing, College of Health
Massey University, Albany
Auckland, 0632, New Zealand

Hewitt, Sarah; Mills, Jane; Hoare, Karen & Sheridan, Nicolette (2022). Grounded theory method and symbolic interactionism: Freedom of conceptualization and the importance of context in research [29 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 23(3), Art. 10, https://doi.org/10.17169/fqs-23.3.3807.

Forum Qualitative Sozialforschung / Forum: Qualitative Social Research (FQS)

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