A Substantive Grounded Theory study to explore the basic social process among women with post partum blues in selected tertiary hospitals at Namakkal- A comparative quantitative and qualitative analysis

Sampoornam. W¹, Nithimathi. K², Manimekalai. P³, Megala. B³, Nithya. S³, Keerthana. A³, Maheshwari. S³, Maryselciya. S³, Lathika. R³

¹Professor, Mental Health Nursing Department, The Tamilnadu Dr. M.G.R. Medical University, Chennai, Dhanvantri College of Nursing, Pallakkapalayam, Namakkal, Tamilnadu, India.

²BSc Nursing IV Year, Dhanvantri College of Nursing, Pallakkapalayam, Namakkal, Tamilnadu, India.

³Dhanvantri College of Nursing, Pallakkapalayam, Namakkal, Tamilnadu, India.

*Corresponding Author E-mail:

ABSTRACT:

Context: Grounded theory has been extensively used in research with women, is a means of generating new knowledge that is situated both within the context of the field and existing theory. Methods: The research design used for our study was substantive grounded theory design. The study was conducted in selected tertiary hospitals at Namakkal. The sample size comprises of 5 women with post partum blues. Based on data saturation, the participants were curtailed and extracted with total 5 women with post partum blues. We recruited participants by adopting purposive typical case sampling technique. Typical participants, who were already experiencing and resolving problems related to post partum blues, were enrolled in our study. Demographic variables were collected. The level of post partum blues were measured by Likert Am I blue? Assessment scale. Observations and semi-structured interviews were conducted. All interviews were recorded and transcribed for the women with post partum blues in order to express core variables (basic social process) related to post partum blues with the help of vignettes. Investigator triangulation strategy was used for collecting the data, coding and making analytic decisions. Results: In our study 3 categories were identified viz biological problems, emotional problems and its ramifications and social network support system. The hypothesis generated from our study is the significant correlation between emotional problems and social support among women with post partum blues.

KEYWORDS: Substantive grounded theory, Basic social process, Women, Post partum blues.

INTRODUCTION:

The suffering associated with postpartum depression (PPD) has been well documented in both quantitative and qualitative literature. Inquiry into the experience of PPD as transformational or producing personal growth does not exist. Future research into the experience of a perinatal mood or anxiety disorder as a traumatic life event expands the understanding of the mechanisms of human potential through suffering and provides insight into treatment, assessment, and prevention.¹

Grounded theory has been extensively used in research with women, is a means of generating new knowledge that is situated both within the context of the field and existing theory.² Moreover, grounded theory (GT) has been widely accepted as an appropriate method for exploring subjective experiences of perinatal mood and anxiety disorders.^3-6

METHODS:

The research design used for our study was substantive grounded theory design. The study was conducted in selected tertiary hospitals at Namakkal. The sample size comprises of 5 women with post partum blues. Based on data saturation, the participants were curtailed and extracted with total 5 women with post partum blues. We recruited participants by adopting purposive typical case sampling technique. Typical participants, who were already experiencing and resolving problems related to post partum blues, were enrolled in our study.

Demographic variables like age, education, occupation, religion, type of family, family support system and family history of post partum blues were collected. The level of post partum blues were measured by Likert Am I blue? Assessment scale.

The clear, detailed and sequential procedural processes in both data collection and analysis ensured rigorous and trustworthy results. Observations and semi-structured interviews were conducted. All interviews were recorded and transcribed for the women with post partum blues in order to express core variables (basic social process) related to post partum blues with the help of vignettes. Investigator triangulation strategy was used for collecting the data, coding and making analytic decisions.

RESULTS:

The core category was analyzed using the Strauss and Corbin (1998) paradigm of conditions, consequences and actions/interactions in the development of a conditional/consequential matrix. After developing category scheme, data was coded with computer-assisted grounded theory analysis.

The description of substantive grounded theory were as follows:

(a) Participant’s demographic variables and levels of post partum blues

(b) Open coding emergent categories

(c) Axial application of the paradigm of conditions, consequences and actions/interactions and the resulting core category

(d) Selective coding application of the conditional/consequential matrix

(a) Participant’s demographic variables and levels of post partum blues:

Distribution of demographic variables according to the age group of women with post partum blues depicts that highest percentage were between 21 and 23 years. Education, delineates that paramount of the participants had completed their schoolings. Majority of the women with post partum blues were home makers. Prevalently most of the participants belonged to Hindu religion. Greater numbers of participants were from extended type of family. Predominantly participants had adequate family support system. Highest number of participants had family history of post partum blues.

Most of the participants had moderate level of post partum blues.

(b) Open coding emergent categories:

Open coding or, “Breaking data apart and delineating concepts to stand for blocks of raw data” (Corbin and Strauss, 2015, 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, iteratively compared for similarities and differences and assigned to an early category. A total of 369 significant units of meaning were extracted from the raw data and comparatively analyzed. A total of 3 categories were identified:

(1) Biological problems;

(2) Emotional problems and its ramifications;

(3) Social network support system.

(1) Biological problems:

The following direct quote by the women with post partum blues illustrates the biological problems related to the basic social process.

Participant 1: I am unable to sleep properly (sighing) and also couldn’t eat well.

Participant 2: After my child birth, I feel so tired. I could sense pricking pain in the sutured area.

(2) Emotional problems and its ramifications:

Rich quotes by the women with post partum blues expressing the emotional issues.

Participant 5: Frequently I am getting tensed and picking quarrel with my family members.

Participant 4: I feel like crying simply without any reason and unable to take care of my son properly.

(3) Social network support system:

Women with post partum blues quoted the following texts.

Participant 3: Initially I felt very bad both physically and emotionally. But, later I could cope myself with the support of husband and family members.

(c) Axial application of the paradigm of conditions, consequences and actions/interactions and the resulting core category:

Thematic data revealed in open coding were then analyzed for intersecting, conflicting, relative connections between thematic content using the analytical tools of questioning and schematic memos to further develop theoretical conceptualization in a core category (Corbin and Strauss, 2015). Specific types of analytical questioning engaged the data, probing for early theoretical connections. Sensitizing questions were asked of the data by the researcher and noted in memos.

(d) Selective coding application of the conditional/consequential matrix:

During selective coding, the use of conditional/consequential matrix and summary memo revealed that the experience of women with post partum blues was deep rooted in sleeplessness, crying spells, conflict with family members and seeking emotional support from spouse.

DISCUSSION:

In our study, in depth and analogue analysis of resolving problems related to post partum blues was carried out. The expression of core variables related to post partum blues identified were quantitative analysis followed by in depth exploration of basic social process of qualitative analysis among women. The comparison was carried out meticulously with ancestry and descendancy literature approaches.

In our study 3 categories were identified viz

(1) Biological problems

(2) Emotional problems and its ramifications

(3) Social network support system. The experience of women with post partum blues was deep rooted in sleeplessness, crying spells, conflict with family members and seeking emotional support from spouse.

The hypothesis generated from our study is the significant correlation between emotional problems and social support among women with post partum blues.

The grounded theory analysis of the data led to the development of a substantive theory describing and explaining the social-psychological process of the experience of postpartum depression. The theoretical model illustrates the relationship among the different phases, as well as the properties that make the phases up. Finally, the implications for further research and practice that stem from the theoretical model that was developed are discussed.

Using the grounded theory method, a substantive theory of postpartum depression was developed. Data were obtained through participant observation in a postpartum depression support group over an 18-month period. In addition, 12 in-depth taped interviews were conducted with mothers who had attended the support group. Analysis of the data by the constant comparative method revealed loss of control as the basic social psychological problem. Women suffering from postpartum depression attempted to cope with the problem of loss of control through the four-stage process of teetering on the edge. The stages that emerged from the data included (a) encountering terror, (b) dying of self, (c) struggling to survive and (d) regaining control.⁷

Psychiatric nurses can help the women with post partum blues to identify the biological problems, emotional problems and its ramifications. Our study findings can be utilized for secondary analysis, meta synthesis to study about substantive grounded theory, in depth and analogue analysis of resolving problems related to post partum blues. Our study is the base for further study to create awareness regarding social network support system in post partum blues among spouse and the family members. Quantitative approach can be initiated to test hypothesis on correlation between emotional problems and social support among women with post partum blues.

REFERENCES:

1. Walker Karraa. 2013. Changing Depression: A Grounded Theory of the Transformational Dimensions of Postpartum Depression. A dissertation submitted to Sofia University Palo Alto, California.

2. McGhee, G., Marland., G., and Atkinson, J. (2007) Grounded Theory Research: literature reviewing and reflexivity. Journal of Advanced Nursing, 60(3) 334 – 342.

3. Abrams, L. S., Dornig, K., and Curran, L. (2009). Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers in the United States. Qualitative Health Research, 19(4), 535-551.

4. Barimani, M., and Hylander, I. (2008). Linkage in the chain of care: A grounded theory of professional cooperation between antenatal care, postpartum care and child health care. International Journal of Integrated Care, 8(4), e77

5. Karraa, W. (2014). Transformed by postpartum depression: Women’s stories of trauma and growth. Amarillo, TX: Praeclarus.

6. Knudson-Martin, C., and Silverstein, R. (2009). Suffering in silence: A qualitative meta-dataanalysis of postpartum depression. Journal of Marital and Family Therapy, 35(2), 145- 158.

7. CT Beck, 1993. Teetering on the Edge: A Substantive Theory of Postpartum Depression. Nursing Research. Volume 42, Pages: 42–48.

Received on 10.01.2022 Modified on 18.02.2022

Int. J. of Advances in Nur. Management. 2022; 10(2):103-105.

DOI: 10.52711/2454-2652.2022.00026