scispace - formally typeset
Search or ask a question

Showing papers on "Grounded theory published in 1998"


Book
01 Jan 1998
TL;DR: Theoretical Foundations and Practical Considerations for Getting Started and Techniques for Achieving Theoretical Integration are presented.
Abstract: Part I: Introduction to Grounded Theory of Anselm Strauss Chapter 1: Inspiration and Background Chapter 2: Theoretical Foundations Chapter 3: Practical Considerations for Getting Started Chapter 4: Prelude to Analysis Chapter 5: Strategies for Qualitative Data Analysis Chapter 6: Memos and Diagrams Chapter 7: Theoretical Sampling Chapter 8: Context Chapter 9: Process Chapter 10: Techniques for Achieving Theoretical Integration Chapter 11: The Use of Computer Programs in Qualitative Data Analysis Part II: Research Demonstration Project Chapter 12 Open Coding: Identifying Concepts Chapter 13: Developing Concepts in Terms of Their Properties and Dimensions Chapter 14: Analyzing Data for Context Chapter 15: Bringing Process Into the Analysis Chapter 16: Integrating Categories Part III: Finishing the Research Project Chapter 17: Writing Theses, Monographs, and Dissertations, and Giving Talks About Your Research Chapter 18: Criteria for Evaluation Chapter 19: Student Questions and Answers

33,113 citations


Book
01 Jan 1998
TL;DR: Creswell as mentioned in this paper explores the philosophical underpinnings, history and key elements of five qualitative inquiry traditions: biography, phenomenology, grounded theory, ethnography and case study.
Abstract: This book explores the philosophical underpinnings, history and key elements of five qualitative inquiry traditions: biography, phenomenology, grounded theory, ethnography and case study. John W Creswell relates research designs to each of the traditions of inquiry and compares each of the research strategies for theoretical frameworks, writing introduction to studies, collecting data, analyzing data, writing the narrative, and employing standards of quality and verifying results. Five journal articles in the appendix offer fascinating reading as well as examples of the five different qualitative designs.

23,020 citations


Book
01 Jan 1998
TL;DR: In this article, the authors present a review of the state-of-the-art in the field of qualitative research, focusing on the state of the art and the future.
Abstract: PART ONE: FRAMEWORK Guide to this Book Qualitative Research: Why And How to Do It Qualitative and Quantitative Research Approaches to Qualitative Research Ethics of Qualitative Research PART TWO: THEORY IN QUALITATIVE RESEARCH Using the Existing Literature Theories Underlying Qualitative Research Texts as Data in Qualitative Research PART THREE: RESEARCH DESIGN Designing Qualitative Research The Qualitative Research Process Research Questions Entering the Field Sampling Triangulation PART FOUR: VERBAL DATA Collecting Verbal Data Interviews Focus Groups Using Narrative Data PART FIVE: DATA BEYOND TALK Collecting Data Beyond Talk Observation and Ethnography Visual Data: Photography, Film & Video Using Documents as Data PART SIX: QUALITATIVE DATA ANALYSIS Qualitative Data Analysis Transcription and Data Management Grounded Theory Coding Thematic Coding and Content Analysis Naturally Occuring Data: Conversation, Discourse, and Hermeneutic Analysis Using Software in Qualitative Data Analysis PART SEVEN: GROUNDING, WRITING AND OUTLOOK Quality of Qualitative Research: Criteria and Beyond Writing Qualitative Research State of the Art and the Future

8,605 citations


Book
01 Aug 1998
TL;DR: In this article, the authors present a survey of case studies, case studies and qualitative data collected from the Internet and from participants' interviews with experts in the field of ethnography and grounded theory.
Abstract: Introduction Part one: Strategies Surveys Case studies Internet research Experiments Action research Ethnography Phenomenology Grounded theory Part two: Methods Questionnaires Interviews Observation Documents Part three: Analysis Quantitative data Qualitative data Writing up the research References Index.

4,213 citations


Book
01 Jan 1998

3,080 citations


Journal ArticleDOI
TL;DR: In this article, a new logic of justification, termed methodological hermeneutics, derived from Margolis's reconciliation of realism and relativism, has been developed by the author.
Abstract: The originators of the grounded theory approach to qualitative research now disagree on certain procedural aspects of the methodology, while agreeing on others, and dispute its epistemological implications. In this article it is argued that the rift can be traced to a conflict over the logic of justification of the approach. Strauss and Corbin endorse Dewey's instrumentalism, including its prizing of the experimental method, and introduce a form of hypothetico-deductivism into the grounded theory method. Alternatively, although subscribing tacitly to the experimental method, Glaser does not tie it in with instrumentalism, and insists that grounded theory properly involves only the inductive phase of inquiry. It is argued that both instrumentalism and induction are inadequate as rationales for the grounded theory method. A new logic of justification, termed methodological hermeneutics and derived from Margolis's reconciliation of realism and relativism, has been developed by the author. When applied to the...

1,469 citations


Journal ArticleDOI
Abstract: Although technological products are unavoidable in contemporary life, studies focusing on them in the consumer behavior field have been few and narrow. In this article, we investigate consumers' perspectives, meanings, and experiences in relation to a range of technological products, emphasizing lengthy and repeated interviews with 29 households, including a set of first-time owners. We draw on literatures spanning from technology, paradox, and postmodernism to clinical and social psychology, and combine them with data collection and analysis in the spirit of grounded theory. The outcome is a new conceptual framework on the paradoxes of technological products and their influences on emotional reactions and behavioral coping strategies. We discuss the findings in terms of implications for theories of technology, innovation diffusion, and human coping, and an expanded role for the paradox construct in consumer research.

1,190 citations


BookDOI
01 Mar 1998
TL;DR: In this article, T.O. Nelson et al. link Metacognitive Theory to Education by linking Metacognition to education and show that it can be used to support monitoring, reflection, and revision.
Abstract: Contents: T.O. Nelson, Metacognitive Food for Thought in Educational Theory and Practice. Preface. D.J. Hacker, Definitions and Empirical Foundations. R.L. Dominowski, Verbalization and Problem Solving. J.E. Davidson, R.J. Sternberg, Smart Problem Solving: How Metacognition Helps. M. Carr, B. Biddlecomb, Metacognition in Mathematics From a Constructivist Perspective. B.M. Sitko, Knowing How to Write: Metacognition and Writing Instruction. R.H. Maki, Test Predictions Over Text Material. J. Otero, Influence of Knowledge Activation and Context on Comprehension Monitoring of Science Texts. D.J. Hacker, Self-Regulated Comprehension During Normal Reading. G.E. Garcia, R.T. Jimenez, P.D. Pearson, Metacognition, Childhood Bilingualism, and Reading. S.M. McGlynn, Impaired Awareness of Deficits in a Psychiatric Context: Implications of Rehabilitation. J. Dunlosky, C. Hertzog, Training Programs to Improve Learning in Later Adulthood: Helping Older Adults Educate Themselves. P.H. Winne, A.F. Hadwin, Studying as Self-Regulated Learning. N.J. Vye, D.L. Schwartz, J.D. Bransford, B.J. Barron, L. Zech, The Cognition and Technology Group at Vanderbilt, SMART Environments That Support Monitoring, Reflection, and Revision. M. Pressley, S. Van Etten, L. Yokoi, G. Freebern, P. Van Meter, The Metacognition of College Studentship: A Grounded Theory Approach. J. Dunlosky, Epilogue. Linking Metacognitive Theory to Education.

1,071 citations


Book
04 Sep 1998
TL;DR: The Links between Theory and Research Elements of the Research Process Analysing Data with Theory in Mind Social Research and Concept-Indicator Links From Theory to Data Starting To Theorize Towards Adaptive Theory Some New Rules of Method as discussed by the authors
Abstract: The Links between Theory and Research Elements of the Research Process Analysing Data with Theory in Mind Social Research and Concept-Indicator Links From Theory to Data Starting To Theorize Towards Adaptive Theory Some New Rules of Method

881 citations


Journal ArticleDOI
TL;DR: In this article, the authors outline the development of the method and explicate the philosophy underpinning its procedures, and suggest that grounded theory if applied in its true sense has scope and potential for the study of consumer behaviour and consumption experiences given its emphasis on context, theoretical emergence, and the social construction of reality.
Abstract: There has been considerable discussion in recent years over the application of interpretive methodologies such as phenomenology, hermeneutics, and semiotics within the field of marketing research, particularly consumer behaviour. However, while these approaches have inspired a wealth of publications, scant attention has been paid to the potential of grounded theory. This is attributed largely to misconceptions regarding both the principles of the method and the two distinct approaches associated with the original authors, Glaser and Strauss (1967). The paper outlines the development of the method and explicates the philosophy underpinning its procedures. Finally, it suggests that grounded theory if applied in its true sense has scope and potential for the study of consumer behaviour and consumption experiences given its emphasis on context, theoretical emergence, and the social construction of realities.

486 citations


Journal ArticleDOI
TL;DR: In this paper, the authors argue for the use of grounded theory as a valid method for research the process of leadership, arguing that mainstream leadership research methodologies have been partially unsuccessful in theorizing about the nature of these processes.
Abstract: The purpose of this article is to argue the case for the use of grounded theory as a valid method for researching the process of leadership. The contention is that leadership is a social influence process, and that mainstream leadership research methodologies have been partially unsuccessful in theorizing about the nature of these processes. Grounded theory is a method which, if applied rigorously, will help to overcome the deficiencies in mainstream leadership research methodology. The underlying criterion driving grounded theory is to generate leadership theory rather than to test theory.


Journal ArticleDOI
Brighid Kelly1
TL;DR: This follow-up study described, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation.
Abstract: The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.

Journal ArticleDOI
TL;DR: In this article, the authors propose a novel theory development process, termed iterative triangulation, for tapping this potential, which employs systematic iterations between literature review, case evidence, and intuition.

Book
01 Dec 1998

Journal ArticleDOI
01 May 1998
TL;DR: A theoretical framework is generated using the paradigm model of grounded theory for the interaction between organizational knowledge and the Intranet and three organizational knowledge strategies taking into account drivers, the context, and intervening conditions are shown.
Abstract: The Intranet phenomenon has been driven by the push of technology standards and the pull of organizational need to (1) communicate across geographic, organizational and functional barriers, and (2) collaborate among sites and with suppliers and customers. The objective of this study is to generate a theoretical framework for the interaction between organizational knowledge and the Intranet. The contribution of this paper is 4-fold. First, we generate a theoretical framework using the paradigm model of grounded theory. We show interactions between the Intranet and three organizational knowledge strategies taking into account drivers, the context, and intervening conditions. Second, previous research on organizational knowledge creation theory is incorporated into the framework. Third, the framework forms the basis for future empirical research on the business value of the Intranet. Finally, the study raises implications for IS developers, IS departments, management and researchers.


Journal ArticleDOI
TL;DR: The study reported here represents the first detailed descriptive field study of GSS application in Africa and suggests that there is potential for applying GSS in Africa to support capacity-building efforts, which tops the agenda of international development agencies.
Abstract: Cross-cultural GSS field studies are scarce. Although the state of knowledge and theory development in this area warrants a focus on descriptive field explorations, most cross-cultural GSS research has taken place in laboratory environments. The study reported here represents the first detailed descriptive field study of GSS application in Africa. A grounded theory approach was used to collect and analyze data on eleven projects in which GSS meetings were organized in Malawi, Zimbabwe, and Tanzania. From the data emerged a model of GSS acceptance in the cultures investigated that extends the Technology Acceptance Model (TAM) in terms of a specification of a number of relevant external factors. These factors include the endorsement of top management, computer literacy, oral communication preference, referent power, and satisfaction with use. Furthermore, the findings suggest that there is potential for applying GSS in Africa to support capacity-building efforts, which tops the agenda of international development agencies.

Journal ArticleDOI
TL;DR: This paper illustrates the way in which a package called NUD facilitated analysis where grounded theory methods of data analysis were also extensively used, and illustrates the limitations of such programs.
Abstract: In the last 15 years there has been a proliferation of computer software packages designed to facilitate qualitative data analysis. The programs can be classified, according to function, into a number of broad categories such as: text retrieval; text base management; coding and retrieval; code-based theory building; and conceptual-network building. The programs vary enormously in the extent to which they can facilitate the diverse analytical processes involved. The decision to use computer software to aid analysis in a particular project may be influenced by a number of factors, such as the nature of the data and the researcher's preferred approach to data analysis which will have as its basis certain epistemological and ontological assumptions. This paper illustrates the way in which a package called NUD.IST facilitated analysis where grounded theory methods of data analysis were also extensively used. While highlighting the many benefits that ensued, the paper illustrates the limitations of such programs. The purpose of this paper is to encourage researchers contemplating the use of computer software to consider carefully the possible consequences of their decision and to be aware that the use of such programs can alter the nature of the analytical process in unexpected and perhaps unwanted ways. The role of the Computer Assisted Qualitative Data Analysis (CAQDAS) Networking Project, in providing up-to-date information and support for researchers contemplating the use of software, is discussed.

Journal ArticleDOI
TL;DR: This paper reviews the contribution of qualitative methods to health services research (HSR) and discusses some of the issues involved in recognizing quality in such work.
Abstract: This paper reviews the contribution of qualitative methods to health services research (HSR) and discusses some of the issues involved in recognizing quality in such work. The place of qualitative work is first defined by reference to Archie Cochrane's agenda for HSR and the limitations of the recent focus on randomized trials as the standard method. Health care practice involves large elements of improvisation which cannot be captured by evidence-based approaches. Qualitative methods offer ways of understanding this improvisation and of identifying more efficient and effective practices, as well as considering the traditional topics of equity and humanity. The methodological procedures of qualitative work reflect a long-established inductive tradition in scientific practice. The logic of grounded theory provides a contemporary specification. In its application, it is quite different from the methodological anarchy of postmodernism. The use of qualitative research and the theoretically stated generalizations which arise from it inform reflective work by health service managers, planners and clinicians.

Journal ArticleDOI
TL;DR: In this paper, the authors investigate students' conceptions of learning in different educational contexts, and analyze to what extent conceptions are contextually dependent, and find that conceptions were to some extent contextually independent.
Abstract: The aim of this study is to investigate students' conceptions of learning in different educational contexts, and analyze to what extent conceptions are contextually dependent. Student nurses and car mechanic students are chosen as two groups, and qualitative similarities and differences between the students are described and explained in terms of the educational contexts: nursing education and car mechanic education. The study is 'qualitative’ by its nature, and the phenomenographic approach and grounded theory are taken as the points of departure. Data for the cross-section study were collected through individual interviews with student nurses (n = 60) and car mechanic students (n = 54). Different groups of students were interviewed at the beginning and at the end of the educational programs. As a result of the analysis, qualitative similarities and differences in students' conceptions were found. Differences among students within a program were, however, fewer than differences among students participating in different programs. In comparing groups of students within the programs, similar trends of development could be identified. Students within both programs used more developed conceptions at the end than at the beginning of the programs. The differences found within and between the student groups could be explained in terms of educational contexts. The results thus showed that conceptions were to some extent contextually dependent.

Journal ArticleDOI
David Edwards1
TL;DR: In this paper, the case-based research process is divided into three genieral phases: descriptive, theoretical-heuristic, and theory testing, and each of these phases is subdivided into two categories.
Abstract: This article describes a conceptual framework for understanding the phases of case-based research. Case-based strategies in research are widely used in case study methodology as well as in a number of qualitative methodologies, including grounded theory development, phenomenological research method, and psychotherapy process research. The epistemological principles on which casebased research is based are fundamentally different from those that inform group-based research using quantitative multivariate statistics. The case-based research process is divided into three genieral phases: descriptive, theoretical-heuristic, and theory testing. Each of these phases is subdivided into two categories. The aims and epistemological principles related to each phase are discussed and illustrated with examples from contemporary research. The principles for establishing validity in case-based research are also reviewed and, to assist research students and supervisors, some common pitfalls are noted. The article shows ...

Journal ArticleDOI
TL;DR: Although grounded formal theories may lack the cultural detail and contextual tailoring of smaller, more focused "designer" analyses, they have the potential to serve as "ready-to-wear" models that fit experiences of individuals in a variety of settings.
Abstract: As qualitative methods have become popular and qualitative reports abundant, researchers have begun to discuss techniques for synthesizing findings about related phenomena from diverse samples. Grounded formal theory analysis is one such approach that can yield higher level, broadly applicable theory from analysis of situation-specific substantive theories. Although grounded formal theories may lack the cultural detail and contextual tailoring of smaller, more focused “designer” analyses, they have the potential to serve as “ready-to-wear” models that fit experiences of individuals in a variety of settings. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 179–186, 1998

Journal ArticleDOI
TL;DR: In this paper, accounting practices as embedded in two religious organisations in Malaysia were investigated, and a grounded theory from the data was developed to produce social theories of accounting practice, which made a contribution towards the need for accounting research to become more explanatory of accounting as social practice wherein theory is both informed and is developed by observation.
Abstract: This paper reports the study of accounting practices as embedded in two religious organisations in Malaysia. The research is an attempt to study accounting practices in a cultural setting that has not been the subject of previous interpretive accounting research. The study also makes a contribution towards the need for accounting research to become more explanatory of accounting as social practice wherein theory is both informed, and is developed by observation. This is achieved by developing grounded theory from the data and is in accordance with recent calls for case studies in accounting research to be more concerned with producing social theories of accounting practice.

Journal ArticleDOI
TL;DR: The findings suggest that international experiences need to include the opportunity to provide direct nursing care and a proposed model for such experiences is presented.
Abstract: As faculty seek creative learning opportunities for students in a changing social, political, and health care environment, knowledge about international learning experiences can provide critical information for decision making. This study sought the answer to two questions: What are the learning outcomes of an international experience for baccalaureate nursing students and what are the similarities and differences in what students learn in developed and developing countries? Using grounded theory methodology, 14 students who had participated in international learning experiences were interviewed. Three major categories emerged from the data analysis: personal and professional growth, empirical knowledge, and the learning experience. More similarities than differences were identified among the students who had traveled to developing versus developed countries. The findings suggest that international experiences need to include the opportunity to provide direct nursing care. A proposed model for such experiences is presented.

Journal ArticleDOI
TL;DR: It was apparent that difficulties existed in satisfying individual requirements for information about treatment options and prognosis and it was concluded that this type of research can contribute to enhancing patient care.
Abstract: The purpose of this study was to explore patient's own descriptive accounts of their experiences of having cancer and undergoing radiotherapy treatment. The respondents involved were suffering from either cancer of the head and neck region or lung cancer. The study focused on "information-giving", in particular eliciting data about misconceptions, missing information and valued information. In addition, material which described another, perhaps unconscious level of communication between health professionals and patients was drawn from the interviews. The methodology employed was of a qualitative nature and predominantly influenced by "grounded theory" (Glaser and Strauss, 1967), where the meanings attached to events are described and explained. However, the "phenomenological" perspective was also influential, in which significance is given to the "lived experience" of the participants (Morse and Johnson, 1991). The method used to obtain data was "interviewing", via semi-structured, audio-taped interviews. Data gathering was approached by way of obtaining "narrative accounts"or stories from the respondents. Thus, the analysis chapters are arranged in a temporal fashion, representing the beginning, middle and "sense of an ending" to the stories (Sarbin, 1986). Three underlying themes emerged from the analysis; hope, fear and uncertainty. The study investigated these themes, and explicated the relation of them to various events. For instance, "hope" occurred in relation to treatment and faith in the hospital staff. "Fear" occurred in relation to recurrence of the cancer and death. "Uncertainty" was noted in connection with prognosis and treatment options. There was also evidence to suggest that health professionals played a role in boosting or decreasing self-esteem (similar to Charmaz, 1983). In particular, this study highlighted that there seemed to be a desire from the cancer sufferers' to obtain a verbal acknowledgement from staff, of the adversity they had overcome.

Journal ArticleDOI
Ann Smith1
TL;DR: A longitudinal study investigating the ways in which undergraduate student nurses reflected about practice as they progressed through a 3-year programme in adult nursing revealed the range of issues students perceived as most important, and to some extent, changes in levels of thinking.
Abstract: An understanding of the nature and function of reflection in recognizing and developing nursing knowledge is a key concern. This paper describes a longitudinal study investigating the ways in which undergraduate student nurses reflected about practice as they progressed through a 3-year programme in adult nursing. The method was qualitative, with data gained from written critical incidents based on practice experiences and classroom discussions, and analysed using the constant comparative method. Findings revealed the range of issues students perceived as most important, and to some extent, changes in levels of thinking. A strong theme occurring throughout related to the complexity of learning what it means to be a professional and, in consequence, what they learn about themselves. Students' preoccupation with emotional aspects of learning and nursing care was evident. They had difficulty in disentangling 'personal' and 'professional' involvement but later data indicates that they had begun to learn to differentiate between involvement as a general characteristic of nursing practice and a overwhelming personal attachment. They generally use their own and each others' experiences to examine meaning, in preference to formal theoretical explanations although there is evidence students moved from acceptance of information to the questioning and critiquing of arguments and professional assumptions, particularly concerning their relevance and appropriateness for practice.

Journal ArticleDOI
TL;DR: Nursing students' views of a supervision programme provided during the second semester of their education, which was their first period of nursing practice, indicate two specific effects of the programme: personal growth and integration of knowledge.
Abstract: This paper describes nursing students' views of a supervision programme provided during the second semester of their education, which was their first period of nursing practice A form with open questions and a 24-item questionnaire were completed by the 28 nursing students The analysis of their responses was a combination of factor analysis and grounded theory approach, based on comparative analysis The results indicate two specific effects of the programme: personal growth and integration of knowledge The process of creating knowledge includes four stages: awareness of concepts and phenomena, development of a 'language of caring', development of a 'model' of communication, and reflection gained as an effect of the intervention The nursing students reported that reflection was a way to bridge the gap between theory and practice Their views of the effect of the supervision showed high values for the following three factors: improved interpersonal skills, improved professional skills, and improved communication skills

Journal ArticleDOI
TL;DR: The social environment has to be considered when applying PDIS in health care and Instructions for nondesigners can be used to introduce them to the design objectives, processes, and ideologies on which PDIS is based and to support them when relating clinical and practical design questions to the existing social constraints and norms.

Journal ArticleDOI
TL;DR: Barriers to the use of guidelines and opportunities for tackling them are identified, from the point of view of the GP, so that future guideline development and policy could be more sensitive to the needs of GPs in the environment in which they work.
Abstract: Background and objectives. Concern about the inadequate take-up of guidelines in general practice has concentrated on problems arising from the process of their development and implementation. However, these perspectives fail to take account of the needs, attitudes and problems of GPs themselves. In this study we aimed to identify barriers to the use of guidelines and opportunities for tackling them, from the point of view of the GP, so that future guideline development and policy could be more sensitive to the needs of GPs in the environment in which they work. Method. Twenty in-depth semi-structured interviews were audiotaped with GPs from within the Avon Health Authority area, representing GPs with different backgrounds and working environments. The transcribed data collected were analysed using a grounded theory approach. Results. Utilization of guideline information is complex. GPs' appraisals of the value of guidelines interact with prior knowledge and beliefs, practicalities of existing information storage and retrieval systems, and individual working practices. Conditions where guidelines are most likely to be referred to may be those either very rarely or very commonly presenting in general practice. Key issues for the uptake of guidelines in the consultation are: general preference for certain formats of presentation; reputability and ownership; use of guidelines in shared decision-making; scope for computer-based systems; and GPs attitudes to time pressures on information-seeking in relation to tolerance of uncertainty. Conclusion. Local initiatives might usefully explore the possibilities of supporting development of guideline-retrieval systems customized for individual GPs or practices. Novel means of stimulating 'ownership' and demonstrating reputability should be sought. The analysis provides a framework for understanding the complexities of the processes of GPs' use of guidelines in practice which can be useful in explaining the results of trials of guideline effectiveness. Guideline implementation occurs in the context of conflicting pressures for clinical autonomy and professional standardization and quality improvement.