Theory Development from the Results of Content Analysis
7.1 Theory Development in Nursing Science
Scientific research is carried out for various reasons, one of which is the develop- ment of theories. Nursing science is a broad field, and, as such, includes various types of theories. These theories are sometimes borrowed from other sciences, in which case the theories need to be tested to determine whether they are suitable in the context of nursing science [1]. Theories are based on scientific knowledge, but their reliability and validity should nevertheless be tested through established scien- tific and statistical methods.
7.1.1 The Definition of Theory
As theory is a broad concept, it can be expected to have a variety of definitions. A systematic explanation of theory would be a way to demonstrate the relationships between identified constructs and concepts, as well as provide several predictors.
From the structure of theory perspective, it could be defined as a set of concepts, their descriptions and indications of how they are related to each other [1–6]. The next sentences provide an example of concepts, definitions and relationships in a theory of adherence among people with chronic disease [7–10]. The theory includes three concepts: adherence, support, and motivation. An example of a concept defini- tion is: adherence is an active, intentional and responsible process of care in which the individual works to maintain his or her health in close collaboration with health care personnel.
Theory can also be defined based on the purpose of theory. In this case, theory encompasses a description of a phenomenon and explanations of how the studied
phenomenon predicts or influences certain outcomes [1, 2, 4]. A descriptive theory is limited to naming and classifying characteristics of a phenomenon of interest;
hence, its main purpose is to describe something, for example, coping among cancer patients (how they cope, what kind of coping strategies they use). This type of the- ory is also referred to as a factor-isolating theory. An explanatory theory works to clarify a certain observation or dynamic and, as such, will detail the connections between concepts. For example, an explanatory theory of coping among cancer patients could indicate that patients who receive support from family members have an easier time coping with disease. This type of theory is also referred to as a factor- relating theory because it provides indications of how the identified factors are con- nected to each other. Predictive theories will make estimates of an outcome based on scientific evidence, for example, cancer patients who do not have children have a five and a half times higher risk of poor coping relative to patients with children.
This type of theory is also referred to as a situation-relating theory [1, 2, 4, 6, 11].
7.1.2 Levels of Theory
A theory can be classified according to the scope, which refers to complexity and degree of abstraction. In other words, scope dictates the level of specificity and the concreteness of the identified concepts [2, 4, 5]. In one method of classification, theories are organised into metatheories, grand theories, middle-range theories and practical theories (Fig. 7.1). Metatheories are the most abstract and focus on the philosophical basis of science, for example, broad issues such as the process of generating knowledge and theory development. Hence, they will not be applicable to clinical practice. Grand theories—which describe comprehensive conceptual frameworks—can also be positioned at the theoretical level. In terms of nursing theories, grand theories are the most complex and are created to address the nature, mission and goals of nursing care. These theories are focused on nonspecific,
Meta theory
Grand theory
Middle-range theory
Practical theory
Most abstract
Least abstract Fig. 7.1 Classification of
theories according to level of abstraction
abstract concepts and cannot be operationalised. Furthermore, these theories are formulated to provide scholars with an ideal picture of nursing and caring. Middle- range theories describe frameworks that have a more specific focus than grand theo- ries. Therefore, middle-range theories will include a limited number of concepts that are relatively concrete and operationally defined. For this reason, the concepts can be operationalised, and hence, empirically tested. A middle-range theory will present a limited view of nursing reality that is appropriate for empirical testing and directly applicable to nursing practice. Descriptive middle-range theories define several concepts while explanatory middle-range theories present how the included concepts are related to one another. Practice theory, which is often used instead of microtheory or situation-specific theory, is the least complex and most specific type of theory evident in nursing research. This type of theory includes the fewest con- cepts, is characterised by a narrow scope (i.e. a particular aspect of reality), describes strictly defined phenomena, and presents knowledge that is applicable to a specific part of nursing practice. Practice theory is relevant to clinical practice and provides detailed descriptions of the content of contemporary nursing practice [1].
7.1.3 Theory Development Strategies
When theory development is discussed, the terms approach and strategy are com- monly used instead of development. Figure 7.2 shows that theory development is a multi-phase process. It can begin with either an inductive or deductive approach (see Chaps. 1 and 2). Mixed methods can also be used to develop theory [2, 4–6]
(see Chap. 4). An inductive strategy, described in Chaps. 1 and 2, is characterised by
Inductive approach
Starting point is unstructured reality (nursing practice)
The data collection
Creating concepts and their definitions
Creating conclusions and developing hypothetical model or conceptual map
Deductive approach
Starting point is structured reality (models, theories, hypothesis)
Operationalization of concepts and creating statements – data
collection
Setting and testing of hypothesis
Supporting or rejecting of hypothesis
Developing and presenting the theory
Fig. 7.2 Various theory development strategies
an unstructured starting point, which means that there is no, or very limited, earlier knowledge about the study topic, for example, unstructured reality in nursing prac- tice (Fig. 7.2). Qualitative research approaches that include an inductive analysis, for example, content analysis, are used to create concepts. These concepts, when presented along with their respective definitions and relational statements, yield a hypothetical model, sometimes also referred to as a model or conceptual map [6].
These types of models are often called hypothetical models because the included concepts and their structures cannot be verified by statistical methods [6, 12] (see Chap. 9). This means that inductive strategy can be used to develop a hypothetical model rather than a theory. Deductive strategy is the starting point for structured reality. As seen in Fig. 7.2, these models can be hypothetical models or some theo- retical structure, and are usually based on a systematic literature search or estab- lished, existing knowledge. Nevertheless, the concepts must be operationalised if they are to be measured and statistically verified. Statistical methods allow research- ers to test hypotheses and present theory in terms of verified concepts, definitions and relationships.
A researcher must use a mixed methods approach whenever they begin the research process with an inductive approach and later test the hypothetical model with quantitative methods (see Chap. 4). As seen in Fig. 7.2, it is possible that the researcher will need to return back to the inductive strategy and/or data at some point during the theory development process. A relevant example will be presented later in this chapter.
7.1.4 The Structure of Theory
Theory comprises concepts, their definitions and relational statements [2, 4–6].
Hence, a concept is the basic unit of theory. Concepts provide symbolic statements about the observed phenomenon, and are formulated in words that enable people to attach meaning to phenomena that can be directly or indirectly seen, heard, tasted, smelled or touched. In this context of theory, a concept may be a word (e.g. grief, power, pain), two words (e.g. job satisfaction, role strain), or a phrase (e.g. maternal role attachment, health-promoting behaviour). The concepts can be abstract (social support, personality) or concrete (e.g. chair, red colour) depending on the level of theory. However, if a researcher is interested in quantitatively measuring a concept, or verifying their structure, they need to operationalise the concepts so that they can be empirically tested (See Chap. 9).
The concepts presented in a theory must always be defined. However, different levels of definitions exist, for example, theoretical definitions, operational defini- tions, concrete definitions and empirical indicators. Examples of each type of defi- nitions are presented below.
• Theoretical definition
– Adherence is an active, intentional and responsible process in which patients work to maintain their health in collaboration with health care staff.
• Operational definition
– Collaboration means working with health care providers such as physicians and nurses.
• Concrete definition
– Collaboration means that a patient regularly comes to meet physicians. If the patient cannot come, he/she will book a new appointment. The patient and physician plan the care together during these appointments.
• Empirical indicators (which can, for example, be items in an instrument) – (1) I regularly visit my doctor or nurse; (2) My doctor works with me in plan-
ning a treatment that will suit my life; (3) My nurse works with me in plan- ning a treatment that will suit my life.
Statements and hypotheses can indicate the connections between presented con- cepts. Statements provide suggestions of relationships on the general level, while a hypothesis is formulated to test the connections between concepts. The testing of a hypothesis can be extended to the testing of a theory (see Chap. 9). Theories are tested to study the reliability and validity of the theory, assess the usefulness of the theory, or further develop the theory [4, 6, 12].