TIlis research was a qualitative, non-experimental study using a grounded theory approach, as the study attempted to explore the phenomenon of adolescent-friendly maternity care from the points of view of the various stakeholders in adolescent maternity health services, so as to provide constructs of an adolescent-friendly
maternity service for the KwaZulu-Natal province, towards a model of action. Polit and Hungler (1999, p.24) describe a construct as "an abstraction or mental
representation inferred from situations, events, or behaviours". A grounded theory approach was adopted, Glaser (1998) suggests grounded theory as a way to best research substantive areas that relate to life cycle problems. Theaimof collecting this information was towards making the existing maternity services adolescent-friendly, as opposed to creating a separate and new service. Bearing this aim in mind, the study adopted a grounded theory methodology, as it allowed for the researcher to use observations and data collected in order to extract constructs towards developing a model of action (Grbich, 1999).
A grounded theory is inductively achieved from the phenomenon under study. The grounded theory researcher does not have a preconceived theory in mind when setting out with the research. Instead, he or she starts with an area of study and proceeds, allowing all relevant information and ideas to emerge (Babbie, Mouton, Vorster&
Prozesky, 2001). Often grounded theory is used to research areas where there is a dearth of knowledge (Grbich, 1999).Asthe literature review has shown, there is little information on how adolescent maternity clients experience maternity services and on whether these services cater for their specific needs. Even though a grounded theory methodology was used, the intent of this study was not to develop a theory. Burns and Grove (2001, p. 141) define a theory as consisting "of an integrated set of defined concepts, existence statements, and relational statements that present a view of a phenomenon and can be used to describe, explain, predict, or control that
phenomenon". They further qualify a theory as being "directly testable" (Burns&
Grove, 2001, p.141). Since there have been no studies within KwaZulu Natal
examining what would constitute an adolescent-friendly maternity service, grounded theory was used to extract constructs for a model of action, which could in later studies be tested toward a theory of adolescent-friendly maternity services.
For the purposes of this study, the researcher followed the Glaser (1992) approach to grounded theory. It was necessary to identify the school of grounded theory that this research followed, because, according to Babchuk (1997), this differentiation is essential to one's understanding of grounded theory itself. The school ofthought influences how researchers view and use a grounded theory method in research.
Glaser's approach to grounded theory was more in keeping with qualitative research approaches, as opposed to Strauss whose focus on grounded theory retaining aspects of replicability, generalisability, and verification, lend more towards quantitative approaches to research. Glaser on the other hand "seems to view grounded theory as a more inherently flexible type of an operation which is guided primarily by informants and their socially constructed realities. To him, the informant's world should emerge naturally from the analysis with little effort or detailed attention to process on the part of the researcher" (Babchuk, 1997). According to Stem (1994), Strauss brings every piece of information, whether in the data or not, into consideration when developing a theory of the phenomenon under study. However, G1aser pays attention only to the data that is obtained and uses the data to develop the emerging theory. Glaser also views the research problem as emergent and ill defined at the beginning of the study (Babchuk, 1997).Inhis school of thought, the research problem will become obvious as theoretical sampling proceeds, data is collected, coded and constantly compared.
As in the case of adolescent maternity care in KwaZulu-Natal, little was known and hence it was difficult to clearly define the research problem.Itwas hoped, as with this
methodology, that as the study proceeded, the research problem or problems would become more clear and would lead to further questions and information.
A cross-sectional approach was used to collectdata at one point in time from participants. According to Polit and Hungler (1999, p.162), "cross-sectional studies are especially appropriate for describing the status of phenomena or for describing relationships among phenomena at a fixed point in time". For this reason, a cross- sectional approach allowed the researcher to explore the phenomenon of adolescent maternity care across the different stakeholder groups with which this study was concerned. For further in depth data collection, a cohort comparison design wasused, which entailed each stakeholder group comprising of different cohorts as follows:
• Adolescent maternity clients comprising two cohorts, namely antenatal clients, as well as postnatal clients.
• Health care providers comprising three cohorts, namely midwives, doctors and doulas, working in antenatal, labour and delivery and postnatal areas within the maternity services.
• Health care planners comprising three cohorts, hospital/clinic based nursing service managers, doctors in charge of obstetric and gynaecology hospital departments and regional health care planners working for the department of health.
Duringdata collection, constant comparison was "used to develop and refine theoretically relevant categories" (polit and Hungler, 1999, p. 248), that emerged from thedata provided by the different stakeholder groups.