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Living well with chronic pain: A grounded theory study

Posted Mar 01 2011 10:19pm

While ‘coping’ with chronic pain has been studied extensively, the people usually studied have been those seeking treatment, and because of this, little is known about how people cope well despite their pain.  A large group of people experiencing ongoing pain do not seek treatment, and while there is speculation that factors such as personality or social support may be associated with this, there is very little known about how this group of people have developed coping skills, or the strategies they employ.

Consequently there is a lack of theory to explain how some people with chronic pain continue with important activities despite their pain.

My PhD study is intended to develop a theoretical understanding (using a grounded theory methodology) of how people cope well despite their pain, identifying the range of coping strategies used by these people, when these skills are used and when they are not, and the relationship between different strategies and how they are used during coping efforts.

Through this research, I will generate theoretical explanations grounded in the data obtained from people who cope well, so that clinicians are supported in their work to develop existing strengths and resources in people who seek treatment to support their pursuit of a ‘normal’ life as they view it. The theory developed within this study may also help to explain how some people live less ‘well’ with their pain, and how clinicians may be able to help this group.

A grounded theory methodology has been chosen to develop an explanatory theory that focuses on strengths, resources and diversity in people who have persistent pain but cope well.

Grounded theory is a method for developing theoretical explanations about social processes developed from qualitative and quantitative evidence gathered from a variety of sources.

The grounded theory process involves:

(1)     obtaining information from participants through interview

(2)     analysing the information using a process called ‘constant comparative analysis’ which involves coding the material obtained, generating mutually exclusive categories and finally, describing the relationships between the categories (usually stemming from a single ‘core’ category)

Analysis begins as soon as the first pieces of data are collected from participants, and further information is obtained to ensure the broadest variability of the phenomenon under investigation is identified. Information may be obtained by interview, but also from questionnaire data, and extant theory from the literature.

The developing theory gradually becomes more abstract through the process of describing relationships between categories.  The research does not start with a theory or hypothesis to prove, disprove or extend. Existing theory is regarded alongside observations taken directly from the data.  This increases the potential for the completed theory to be close to the everyday reality of both participants and clinicians (Elliott & Lazenbatt, 2005). The process requires the researcher to identify as many underlying similarities and diversities as possible within the data.  As a result, new explanations for the patterns that exist are generated, and the widest range of possible patterns or phenomena is integrated (Skeat & Perry, 2008).

Grounded theory is used to develop a model directly from the data obtained from participants, which ensures the resulting theory ‘fits’, ‘works’, is relevant and be modifiable as new data becomes available.

It is a complete methodology and researchers using grounded theory are cautioned to adopt the whole approach rather than selectively use parts of the process (Weed, 2009).

Participants will also be asked to complete three questionnaires, either alone or with the researcher.  Responses from these questionnaires will be entered into analysis in the same way as interview data.

The first participants to be recruited to this study will be people with diagnoses of ankylosing spondylitis or rheumatoid arthritis, working and living in the local community, using medication for disease management but otherwise self-identified as ‘well’.   Between 15 – 40 participants are generally sought for a grounded theory, but the total number and participant characteristics will be dependent upon the emerging theory and data saturation (that is, when no new theoretical constructs are generated).

How can you help?

As you know, Christchurch sustained the second of two major earthquakes one week ago.  I was about to proceed with recruiting participants for this study within the Canterbury region.  In view of our circumstances I don’t think it’s appropriate to proceed with this at this time.  It leaves me with a fairly tight time-frame to identify suitable participants so that I can complete work on this before the end of 2011.

I’m therefore going further afield to identify people who might be interested in being part of this study.

My plea is for anyone reading my blog who might have ideas about how to identify people who live ‘well’ in the community and meet the inclusion criteria above and who are not in Christchurch, to drop me a line.  My original strategy included local swimming pools (with spa and sauna), adverts in local newspapers, GP practices, Rheumatology clinics and libraries.  I also intend to use Arthritis NZ newsletter.  I had been intending to restrict recruitment to Christchurch – but clearly that’s not going to be the best approach, at least right now.

If you have any ideas – please let me know in the comments below, or  fill out this form (it’ll be emailed direct to me and won’t appear in the comments section): [contact-form]

Elliott, N., & Lazenbatt, A. (2005). How to recognise a ‘quality’ grounded theory research study. Australian Journal of Advanced Nursing, 22(3), 48-52.

Skeat, J., & Perry, A. (2008). Grounded theory as a method for research in speech and language therapy. International Journal of Language & Communication Disorders, 43(2), 95-109.

Weed, M. (2009). Research quality considerations for grounded theory research in sport & exercise psychology. Psychology of Sport and Exercise, 10(5), 502-510.

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