Chapter 3: Theory in qualitative research

What is a theory?

In essence, ‘a theory is a big idea that organises many other ideas with a high degree of explanatory power’.^1(p2) Theory has also been defined as ‘an organised, coherent, and systematic articulation of a set of issues that are communicated as a meaningful whole’.^2(p633) Consider the various theories in you may have encountered. These might include scientific theories, philosophical theories, systems theories, psychological theories, conspiracy theories and many more. Each one of these theories enables the person who embodies that theory to ‘explain’ their worldview. Qualitative theories are no different, in that the theory that is adopted in qualitative research enables the researcher to organise their ideas and explain their results. Qualitative theories are usually concerned with explaining the ‘why’ of the complex social world. This is noticeable when examining the locus of control theory, which informs the research question(s), data collection and interpretation. Results from researchers who adhere to this theory are presented within this meaningful whole that revolves around having control over the outcomes of one’s life in some form.

Qualitative theories

This chapter investigates the foundational theories that have come to be associated with qualitative research methods. In Chapter 2, paradigms and, in particular, the interpretivist/constructivist paradigm, were discussed. The interpretivist paradigm is a worldview that uses participants’ perceptions and experiences of the phenomenon that is being investigated to be analysed. It also acknowledges the researcher’s own experiences and background, in terms of how these influence their interpretations and meanings of data.

Reeves and colleagues² discuss how theory can be used to describe how societies work, how organisations operate and why people interact in certain ways. They state that ‘theories give researchers different ‘lenses’ through which to look at complicated problems and social issues, focusing their attention on different aspects of the data and providing a framework within which to conduct their analysis’.^2(p631) Below we describe

There are three levels of theory.

1. Grand theories are broad universal and societal level theories that include many different domains and concepts.³ There are many grand theories and many theorists. Examples include Karl Marx, Friedrich Engels, Max Weber, Emily Durkheim and Michel Foucault. Sylvia IV applied Foucault’s theory of biopolitics to analyse how governments managed populations via technology to enforce social distancing measures to prevent the spread of COVID-19.⁴
2. Middle-range theories are narrower in scope when compared to grand theories, have fewer concepts and are applied at a local level.³ In healthcare improvement, two examples of middle-range theories include diffusions of innovation,⁵ how an idea or product gains momentum and spreads through a system, and normalisation process theory, how a practice or program becomes embedded within a context.^3,6 McEvoy and colleagues applied normalisation process theory to analyse the ‘levers and barriers to the implementation of community participation in primary health care in Ireland.’^7(para10) They conducted an instrumental case study (read more about case studies in Chapter 8) which consisted of two qualitative studies incorporating semi-structured interviews (n=44), focus groups (total number of participants across focus groups was 27) and document analysis (17 documents).⁷ 
3. Micro-level theories are at the individual level and look at relationships and interactions.² Phenomenology is an example of a micro-level theory as the focus is on the individual lifeworld (see Chapter 5). For example, symbolic interactionism explores how social groups and social interactions explain larger social meanings and norms.⁸ The social care article by Basic (2022)^9(p1) applies symbolic interactionism in their study which aims ‘to identify and analyse power relations that contribute to the shaping of young people’s identities and repertoires of action via stigmatisations and social comparisons with different reference groups’. The research demonstrates that ‘narratives about war, escaping war, and post-war life in Sweden, constructing and reconstructing an image of a series of interactive rituals that are both influenced by and influence the power dynamic between the actors’.^9(p1)

Below, three different theories are applied to a qualitative research topic to provide an example of how these different theories can inform the exploration of experiences in qualitative research.

Exploring loneliness and health status of Chinese and Anglo-Australian Manningham Seniors¹⁰ through three different theories

Phenomenology A researcher using a phenomenological approach would study older persons’ perceptions of loneliness by exploring how individuals make sense of their personal and health experiences. The researcher would seek to understand, describe and interpret human behaviour and the meanings the older persons make of their experiences. The approach would be to understand what is being experienced and how it was experienced. This would be done by examining participants’ own statements in the interviews. For example, what is the experience of loneliness and the impact of that experience on an older person’s health? And, what does it mean for older persons to be lonely? The goal is to understand the meanings that the older persons attached to their experiences of loneliness and health.

Interactionism A researcher using interactionist theory would approach the study of older persons’ perceptions of loneliness and health by seeking to understand how the meanings that daily interactions produced. The goal would be to identify and explore the different interactions that contributed to the understanding of loneliness and health in older persons’ daily lives. Thus, the researcher might examine the differences between participants’ experiences (interactions) with family and with friends. Is there a difference and how is that difference manifested?

Critical theory A researcher using critical theory would approach the study of older persons’ interactions by examining power and its relationship to the older persons’ characteristics, such as cultural background or gender identity. For example, critical race theory¹¹ states that institutions such as health systems have laws or procedures that are inherently racist because they lead to different outcomes based on racial factors. The researcher would proceed along the specific critical theoretical lens selected to help them understand how social conceptions of race and ethnicity operate through older persons’ interactions with the health system. Is there a difference between how Chinese and Anglo-Australian seniors are treated within health systems and are these differences due to factors such as ageism or cultural background?

Many theories inform qualitative research, and those presented in this chapter are limited examples. Theories have been developed and modified over many years and have influenced each other’s changes over time. The theories mentioned in this chapter are those that you are likely to encounter in the health domain. Other important theories in the social sciences and humanities, are also used in health-related research, and include (but are not limited to) Marxism and its descendants, feminism, hermeneutics and the post-modernist family of theories.

Willis and colleagues explore theories in their paper The essential role of social theory in qualitative public health research.⁸ They posit that social theory assists researchers to generalise results beyond their particular research group, and that ‘theories provide structured interpretations or models for investigating and understanding a problem’.^8(p439)  Table 1: Types of social theory ^8(p439) provides excellent examples of theorists such as Marx, Durkheim, Foucault and de Beauvoir, along with their key concepts. To provide clarity around the types of social theories, we have included links below to examples of readings that use the social theory type discussed in Willis’ table.

Conflict theory – Campbell B. Social justice and sociological theory. Society. 2021:58:355-364. doi:10.1007/s12115-021-00625-4¹²

Structural functionalism – Adhikari SR. Manu Smriti as the protection of female in Hindu philosophy: in the dimension of structural-functionalism. Philosophy Study. 2020;10(11):706-712. doi:10.17265/2159-5313/2020.11.005¹³

Symbolic interactionism – Basic G. Symbolic interaction, power, and war: narratives of unaccompanied young refugees with war experiences in institutional care in Sweden. Societies. 2022;12(3):90. doi:10.3390/soc12030090⁹

Sociology of knowledge – Messina CB. 2022. Breaking the silence on femicide: how women challenge epistemic injustice and male violence. Br J Sociol. 2022;73(4):859-884. doi:10.1111/1468-4446.12968¹⁵

Feminist theory – Lazarus S, Button M, Kapend R. Exploring the value of feminist theory in understanding digital crimes: gender and cybercrime types. The Howard Journal of Crime and Justice. 2022; 61(3) 381-398. doi:10.1111/hojo.12485¹⁶

This chapter has presented examples of studies using phenomenology, interactionism and critical theory. However, there are many other theories used in qualitative research in health, including queer, intersectionality and colonialism theories. Dr Brene Brown is a grounded theory researcher (more about grounded theory in chapter 10) who writes and presents about how she engages with theory in her work. In the video entitled The anatomy of trust she talks about how her research starts from personal experience with a story about trust, then she investigates the research data she has collected for ideas about trust and engages with theory from John Gottman, who has worked on trust and betrayal. This process is described from about minutes 7–20. The entire presentation illustrates the interplay between research data and theory.

It is important to remember that qualitative research is not an absolute science and that there is no right or wrong theory or framework to guide research. Every researcher has a different worldview and a different perspective to explore; however, all research needs to be guided by a paradigm, theory and/or framework, to ensure full exploration of the experiences of participants.

References

1. Collins CS, Stockton CM. The central role of theory in qualitative research. Int J Qual Methods. 2018;17:1-10. doi:10.1177/1609406918797475
2. Reeves S, Albert M, Kuper A, Hodges BD. Why use theories in qualitative research? BMJ. 2008;337(7670):631-634. doi:10.1136/bmj.a949
3. Davidoff F, Dixon-Woods M, Leviton L, Michie S. Demystifying theory and its use in improvement. BMJ Qual Saf. Mar 2015;24(3):228-238. doi:10.1136/bmjqs-2014-003627
4. Sylvia JJI. The Biopolitics of Social Distancing. Soc Media Soc. 2020;6(3):2056305120947661. doi:10.1177/2056305120947661
5. Dearing JW. Applying Diffusion of Innovation Theory to Intervention Development. Res Soc Work Pract. 2009;19(5):503-518. doi:10.1177/1049731509335569
6. May CR, Cummings A, Girling M, et al. Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implement Sci. 2018;13(1):80. doi:10.1186/s13012-018-0758-1
7. McEvoy R, Tierney E, MacFarlane A. ‘Participation is integral’: understanding the levers and barriers to the implementation of community participation in primary healthcare: a qualitative study using normalisation process theory. BMC Health Serv Res. 2019;19(1):515. doi:10.1186/s12913-019-4331-7
8. Willis K, Daly J, Kealy M, et al. The essential role of social theory in qualitative public health research. Aust N Z J Public Health. 2007;31(5):438-443. doi:10.1111/j.1753-6405.2007.00115.x
9. Basic G. Symbolic interaction, power, and war: narratives of unaccompanied young refugees with war experiences in institutional care in Sweden. Societies. 2022;12(3):90. doi:10.3390/soc12030090
10. Tsindos T. Loneliness and Health Status of Chinese and Anglo-Australian Manningham Seniors. Dissertation (PhD). Monash University; 2014.
11. Ansell A. Critical race theory. In: Schaefer R, ed. Encyclopedia of Race, Ethnicity, and Society Volume 1. SAGE Publications Inc.; 2008:344-346.
12. Campbell B. Social justice and sociological theory. Society. 2021:58:355-364. doi:10.1007/s12115-021-00625-4
13. Adhikari SR. Manu Smriti as the protection of female in Hindu philosophy: in the dimension of structural-functionalism. Philosophy Study. 2020;10(11):706-712. doi:10.17265/2159-5313/2020.11.005
14. Messina CB. 2022. Breaking the silence on femicide: how women challenge epistemic injustice and male violence. Br J Sociol. 2022;73(4):859-884. doi:10.1111/1468-4446.12968
15. Lazarus S, Button M, Kapend R. Exploring the value of feminist theory in understanding digital crimes: gender and cybercrime types. The Howard Journal of Crime and Justice. 2022; 61(3) 381-398. doi:10.1111/hojo.12485