The Courage to Connect: Axial Coding in Grounded Theory and Current Stigma Research

The Courage to Connect: Axial Coding in Grounded Theory and Current Stigma Research

I have been working on my current grounded theory (GT) study regarding the experience of stigma for 15 women diagnosed with bipolar disorder (BD) the first year postpartum. Following collection of raw data, 893 minutes of recorded interviews resulting in 275 pages of single-spaced transcripts, open-coding lifted emerging themes. That's the easy part! I choose to hand code, rather than using computer software,  as I feel it keeps me connected to the participant. Returning over and over to the transcripts reminds me of who the women are that have joined in the research as participants.I enjoy making multiple passes through the transcripts. The iterative process of line by line coding embeds the participant experience in my mind, allowing me to more easily recall their story down the line in axial and selective coding. I also find hand-coding helps develop my theoretical sensitivity as I move back and forth through constant comparison between participants. Open-coding has less pressure. You can lift conceptual data, data that signifies meaning about the phenomenon, freely--knowing that the inductive and abductive process allows for expansion. 

The open-coding for emerging categories through 275 pages of raw data doesn't phase me. It is fun. For this current study, the categories emerged and were noted in memos and schematic representations of the process. Here is an excerpt from my current draft, explaining open-coding:

Open coding, or “breaking data apart and delineating concepts to stand for blocks of raw data” (Corbin & Strauss, 2014, p. 239), was conducted through line-by-line comparative analysis of the raw data. Beginning with comparative analysis, each significant unit of meaning was labeled, and iteratively compared for similarities and differences, and assigned to an early category. A total of 993 significant units of meaning were lifted from the raw data and comparatively analyzed. The labeled thematic content was coded into 5 early categories (a) Getting the Diagnosis; (b) Experienced Stigma; (c) Stereotypes Expressed; (d) Sources of Stigma; and (e) disclosure. The category Getting the Diagnosis presented concepts of meaning regarding how women experienced being diagnosed with a bipolar disorder as relief. Relief resulted from the diagnosis contributing to the understanding of their illness, and understanding regarding previous experiences of psychiatric distress before childbirth. Experienced Stigma included discrimination, social avoidance, and prejudicial attitudes and behaviors described by participants. Participants expressed knowledge of or direct experience with stereotypes of general mental illness (sick, unstable, incompetent, violent, dangerous); depression (emotional, controllable, lazy, not real); mania (erratic, unstable, hospitalization, fun, always happy, running through the streets naked, screaming, drug user); and postpartum mental illness (drowning babies). Sources of stigma reported by participants included medical and psychiatric care providers, spouse/partner, family, employer/coworkers, friends, postpartum depression support groups, social services, and clergy. The last early category, disclosure, included concepts of meaning regarding how women managed the disclosure of their mental illness. Themes generated from the disclosure category included: people don’t understand BD, people avoid what they don’t understand; people fear what they don’t understand, people might not understand me.

 

Having recorded the experience through open coding, the next task has been axial coding. It is axial coding that requires grit. Axial coding requires a comprehensive analysis of the relationships between and among the categories. It is a persistent, disciplined, frustrating, and addictive journey with the data. This is a critical distinction in GTM, we work with data, rather than assuming the data are endpoints that we write up in a report. Axial coding is interacting with data. Sensitizing questions are asked: What are the processes at play? How are the participants defining experiences similarly or differently, and What are the consequences of these events? Theoretical questions are posed: What larger systems are at play? How do concepts relate to each other in properties, qualities, time, or consequence? Recording answers through written memos and schematic diagrams provide an audit trail, markers left throughout the process, helping us know where we are in theoretical development, and how we got there, to begin with! An early memo from my analysis reads,

"How did these women process stigma? I know what stigma looked like, the experienced stigma, the horrific stereotypes, but what did they do with it...it's still there. All women report stigma as part of their everyday lives. What is happening to move them through the initial experience and to develop strategies to avoid stigma currently? Are they engaged in the same process of stigma formation that produced the stigma itself???"

The courage to connect experiences through axial coding is captured by the core category. Axial coding results in discovering a single category representing the overarching (macro) experience, process, and consequence, and individual (micro) experience, process, and consequence. No pressure or anything! Having accomplished the development of a core category through axial coding, I am now engaged in selective coding. I will keep you posted! As a hint, my most recent memo:

"The only people to not stigmatize these women? Their babies".

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Corbin, J., Strauss, A., & Strauss, A. L. (2014). Basics of qualitative research. Sage.

 

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