Introduction

Grounded theory is an approach which was developed in the 1960s by two sociologists, Glaser and Strauss whose theoretical backgrounds were in symbolic interactionism, which focuses on the manner in which people make sense of social interactions and the interpretation they attach to social symbols. They published "the discovery of grounded theory: strategies for qualitative research" (1). Grounded theory as one of the systematic methods of qualitative research has been defined as a qualitative research approach that uses inductive reasoning to generate the theoretical understandings of the research by grounding or basing the theory in the data being collected (2). It is a qualitative research appro-ach for investigating social processes and struc-tures and is also a highly systematic approach for studying social experiences and interactions (3, 4). The primary purpose of grounded theory is to generate theory from observations of real life as these were occurring (5).

Over the past decades, a substantial increase in qualitative research in general and also an increase in the use of grounded theory has been seen. Over the past three decades, the most frequent inquiry within postgraduates has been getting some insight into 'how-to' adopt an appropriate perspective of grounded theory. Considering that applying grounded theory partly depends on an awareness of its philosophical perspectives, gaining knowledge about these various perspectives is required for health care professionals who are interested in studying the social processes. This review was conducted to provide an understanding of the evolution of philosophical and epistemological backgrounds of grounded theory in the recent decades.

Materials and Methods

A review of evidence was conducted on published studies using MEDLINE, ISI and Scopus databases, to identify the literatures relevant to the research objectives.  Searching was carried out using mesh terms including “grounded theory”, “constructivism”, and “objectivism” and it was restricted to English language. Relevant literature focused on constructivist or objectivist grounded theory were retrieved. Due to inaccurate or incomplete indexing in the electronic databases, the reference lists of obtained studies (primary and secondary) were scrutinized to identify further articles. All evidence that studied the different types of grounded theory including constructivist and objectivist in health care research were included in the review. Although there were several types of study designs with different levels of quality, but those which discussed the subject were included. Studies that related to other aspects of grounded theory were excluded. Considering the inclusion and exclusion criteria, all studies were retrieved as well as bibliographies of obtained articles and related books. Among several publications on different types of grounded theory the relevant articles, which met inclusion criteria, were obtained. The identified data were critically reviewed from the viewpoint of the different types of philosophical backgrounds of grounded theory approach.

Results

The philosophical assumptions of qualitative research consist of a stance toward the nature of reality (ontology), how the researcher knows (epistemology), the role of values in the research (axiology), the language of research (rhetoric), and the methods used in the research process (methodology) (6).

In qualitative research, researchers are embracing the idea of multiple realities. When studying individuals, qualitative researchers conduct a study with the intent of reporting these multiple realities. Regarding the epistemological assumption, conducting a qualitative study means that researchers try to get as close as possible to the participants being studied. The longer researchers stay with the participants live, the more they know what they know from firsthand information (7). Crotty has defined that “ epistemology is concerned with providing a philosophical grounding for deciding what kinds of knowledge are possible and how we can ensure that they are both adequate and legitimate” (8). Based on this definition, there are two types of epistemologies “objectivist versus constructivist epistemology” which are underlying the most academic research. The objectivist viewpoint of epistemology claims that it is possible to discover objective truth (8). Therefore, the data already exist in the world and the researcher discovers theory from them (9). The constructivist epistemology typically rejects the objectivists’ view of human knowledge contending that there is no objective truth waiting to be discovered. Truth therefore exists only through interaction with the realities of the world. This view assumes that meaning is constructed rather than discovered (10).Constructionism, by definition, permits the researcher to explore the views and comprehension of the different participants within the subject context and recognizes that each may have experienced a different understanding of the same situation (9).

Philosophical perspectives reflect certain assumptions with respect to the nature of the world and how we come to know about it. The philosophical stance informs the methodology and thus provides a context for the process and grounding its logic and criteria and links the choice and use of methods to the desired outcomes (8). Regarding the philosophical background, there are two theoretical perspectives. The first theoretical perspective is positivism which relates directly to the objectivist epistemology.   Based on this perspective, individuals have direct access to the real world. This worldview is often associated

with quantitative approaches (11). The second philosophical perspective is interpretivism which relates to the constructivist epistemology. This perspective holds that individuals do not have access to the real world, suggesting that their knowledge of the perceived world is meaningful in its own terms and can be understood through careful use of interpretivist procedures (12).

From the viewpoint of constructivist and objectivist epistemologies and their related philosophical perspectives, there are two versions of Grounded theory.  Objectivist grounded theory is rooted in positivist theoretical background; whereas constructivist grounded theory has its roots in an interpretive tradition and relativism. Mills et al. (2006) have argued that “all variations of grounded theory exist on a methodological spiral and reflect their epistemological underpinnings. The form of grounded theory followed depends on a clarification of the nature of the relationship between researcher and participant, and on an explication of the field of what can be known. Constructivist grounded theory is positioned at the latter end of this methodological spiral, actively repositioning the researcher as the author of a reconstruction of experience and meaning” (13).

Figure 1 depicts two different types of grounded theory along with its epistemologies and theoretical perspectives.

Discussion

The Glaserian approach is an objectivist grounded theory and based on etic position, where the researcher is separate from and looks at the social realities. Objectivist grounded theory resides in the positivist theoretical perspective (14). This type of grounded theory attends to data as real facts and assumes that the data already exist in the world. Hence the researcher tries to find them and discover a theory from unbiased observer data. Given these assumptions, objectivist grounded theory remains separate and distant from research participants and their realties (9). Glaser argued that the grounded theory approach is a general methodology of analysis linked with data collection that uses a systematically applied set of methods to generate an inductive theory about a substantive area (15).

However, the Straussian approach is a constructivist grounded theory and based on emic position, where the researchers co-construct the data through adopting a position of mutuality and partnership between participant and researcher.  Mills et al. (2006) have discussed that Strauss and Corbin (1994) have clearly stated that they do not believe in the existence of a “pre-existing reality" (13). Instead, they believe that they create the theory of a social process using their own perspectives, values, privileges, interactions and understanding of the social realities (9,13,16). Strauss and Corbin in 1990 published an alternative view of grounded theory entitled "basics of qualitative research: grounded theory procedures and techniques". This approach involves three types of coding including open, axial, and selective coding (16, 17). This was followed by Glaser (1992) who was disagreeing with some of the procedures advocated by Strauss and Corbin. He published a rebuttal in 1992 entitled "emergence versus forcing: basics of grounded theory analysis" to highlight the differences in what he argued as original grounded theory. He proposed three types of coding including open, selective and theoretical coding. He believed that the outcome of grounded theory is to discover theory rather than conceptual description, which is the outcome of Straussian approach (4; 9).

Following Strauss and Corbin (1990, 1994, 1998) Charmaz was the first researcher who described her work explicitly as constructivist grounded theory. Charmaz has endeavoured to maintain the participants’ presence throughout the research putting an emphasis on keeping the researcher close to the participants through keeping their words intact in the process of analysis. A key point is creative writing as a form of expression that has the potential to communicate how participants construct their worlds (13, 18, 19, 20).

Ultimately, it can be concluded that constructivist grounded theory is distinctly different to the objectivist methodology. Where constructivist grounded theory attempts to interpret how participants construct their realities and present multiple perspectives, it has re-modelled the original purpose of objectivist grounded theory, which tries to conceptualize a latent pattern of behavior (21).

Conclusion

Adopting an appropriate grounded theory approach by health care professionals depends on understanding of the philosophical perspectives and the related epistemologies. It is worth bearing in mind that qualitative analysis is a cognitive process and that each individual has a different cognitive style. A person’s way of thinking, and explanation of analysis, may seem clear to someone with a similar cognitive style and very confusing to another person whose approach is different.The novice researchers should try to discover which approach helps them and will be best to achieve the balance between interpretation and data that produces a grounded theory, although the historical methodological discourse surrounding this research strategy continues to cause initial confusion for inexperienced grounded theorists (13). Researchers who are interested in developing shared understandings of sociological phenomena, especially in the area of mental and social health research, should consider the constructivist position as an appropriate research methodology.

Conflict of Interest

No conflict of interest exists.