USE OF GROUNDED THEORY IN THE EXTRACTION, CODING AND ANALYSIS OF DATA IN LITERATURE META-ANALYSES

ABSTRACT Objective: to describe the conduction of data extraction, analysis and codification using the Straussian perspective of Grounded Theory, in Literature Meta-analysis. Method: this is a theoretical-reflexive study on the data extraction from reviews with meta-anaylses. To design the process of searching for qualitative studies, this study briefly addresses the sequential steps of Preferred Reporting Items for Systematic Review and Meta-Analyses and the Joanna Briggs Institute. The extraction, analysis and codification process were carried out following the assumptions of grounded theory, with the Straussian perspective. They are the theoretical-methodological bases in the first stages of the guidelines of the literature review and Meta-analyses guides, starting with the research question until reaching the review stages, divided into identification, selection, eligibility, and inclusion. Results: the results describe the process of data extraction, analysis and codification from the Straussian perspective, using comparative analysis of data, memoranda, diagrams and possibilities of new sample groups from the detailed analytical reading of the included studies. Finally, theoretical saturation is performed, with an analysis of the findings, with examples of categories and subcategories, the emergence of the central phenomenon and presentation of the paradigmatic model. Conclusion: the essay presents subsidies for the understanding of the conduction of extraction, analysis and codification of data in meta-analyses based on the Straussian perspective, enabling the systematized analysis of qualitative evidence and contributing to the development of models or theories of conceptual character


INTRODUCTION
Technological advances have provided a greater scope of communication services, denoted its informative character and expanded new methods for its technological capacity to store, aggregate and process information.Linked to this, the cultural changes to adapt this emerging advance -often not processed in a simplified way -culminate in the need to make the structure of this information more reputable for the end consumer 1 .
Regarding the vast scientific literature, with numerous articles from research from the most varied universities and public and/or private companies, this information must follow a rigorous method, capable of answering research questions.Systematic Literature Reviews (SLR) have been an effective method for outlining and summarizing information; however, they still face difficulties, especially in the development of effective strategies for data extraction [2][3] .
In addition to dealing with the gaps and necessity of new studies, SLR can assess the relevance of research projects, elucidating important points for the development of a broader understanding of certain topics 2,4 .Systematic methods that outline the literature are considered interactive processes, in which each study is conducted differently, an essential aspect to answer certain questions and/or research gaps [4][5] .
In this context the SLR steps need to follow methodological rigor, to avoid biases that could compromise the synthesis of information.Although SLR is not the place for dubious questions about its synthetic and methodological conduct, the variety of information can look beyond the numerical and purely statistical issue.In this context, the analysis of studies under a qualitative approach is still slowly progressing towards clarifying an adequate and rigorous conduct that contributes to robust results, in addition to those presented in theoretical and empirical research [1][2][3][4]6 .
Research with a qualitative approach has been on the rise in recent decades, being one of the strategies most used by researchers around the world in data analysis and codification, recognizing its potential to add value to quantitative research.Nevertheless, there are controversies about the use of a qualitative approach in RSL research, as it is an activity similar to the quantitative type.However, there is intense debate about the appreciation, legitimation and ideographic strength regarding the attribution of generalization 4,[6][7] .
In this aspect, the synthesis of qualitative research is seen as pertinent to integrating results influenced by postmodern research.Quantitative research and evidence-based research emphasize the outcome, while the qualitative approach seeks the variety of research practices and implausibility at any point in the research, consummating a more interpretive integration [6][7][8] .
Qualitative approaches in Meta-analyses -which assume a more inductive position -are methodological characteristics compatible with Grounded Theory (GT), anchored in the Straussian perspective.These questions are based on the researchers' operationalization to obtain theoretical sensitivity to define objective and subjective concepts.This occurs with the establishment of the cyclical process of collection, extraction and coding, mainly by using open, axial and selective coding and by providing a basis for the development of models and/or theories of a conceptual nature [6][7] .
GT was created in the 1960s in the United States by sociologists Barney Glaser and Anselm Strauss.The authors of the method sought alternatives to generate explanations from the behavior of subjects in various social situations and understand how these behaviors were faced.During the period in which the method was developed, GT was considered innovative, with contributions pertinent to qualitative research and the potential to create theories with existing data or with little scientific documentation [9][10][11] .

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The method allows adaptation according to the objectives of the initial project proposal, as well as the phases of data collection and analysis, according to the conduct of the researcher, their experience and sensitivity to the phenomenon they propose to explain.The differences between Glaser and Strauss culminated in different lines of work.Barney Glaser continued to defend the classic line of GT, while Anselm Strauss, in partnership with Juliet Corbin, developed the Straussian perspective [9][10][11][12] .
The Straussian perspective is based on systematized methodological rigor, with the construction of theory in a pragmatic way.This makes it possible to understand the phenomenon from the perception of meanings, in a process of induction and deduction.Theoretical sensitivity is the fundamental point for the researcher to elaborate concepts and understand how both relate to the questions or gaps of certain study proposals [10][11]13 .
The main points of the perspective begin with planning the proposal, with an adequate research question and delimited objective, but with flexibility and freedom to explore the phenomenon.In addition, it is anchored in theoretical sampling -which takes place throughout the development of the research, establishing new questions or hypotheses that need to be answered.But there must be criticized for not distancing itself from the purpose of the investigation [10][11]14 .
The sources of information or the source of the data can be diversified, such as interviews, documents, literature, videos, photos, observations, and others.The scientific databases, the theme of this study, can be books, articles, theses, dissertations, comments and/or essays [9][10]14 . At his point, attention is paid to the exact descriptors or in association with correlates, which may expand the sample of studies to be included in the review research, for example.
Data analysis from primary and/or secondary studies follows the data coding line, divided into open, axial and selective.Open coding starts from the first reading of the material, performing comparisons and conceptualizing new data that arise during the research.Axial coding is represented by the movement of induction and deduction, with the construction of previous categories, arising from the hypotheses and questions made about the material collected in the first stage of the review [9][10]14 .
At this stage, the paradigmatic model is used as a strategy, consisting of the conditions, a defined reason for the behavior of certain subjects and the facts that arise from these actions; the actions-interactions, which represent the response presented by the hypotheses, verified from the hidden actions of the problem-situations; and the consequences and outcomes, which encompass all aspects of the paradigmatic model.The last stage of analysis is selective coding, in which the previous categories are compared and analyzed continuously, allowing the emergence of the phenomenon [9][10]14 .
To contextualize the methodological process of meta-analyses using GT, an excerpt from the doctoral thesis entitled "Construction and validation of quality indicators for hospital discharge of people care-dependent on home care" 15 was used, which aimed to construct and validate quality indicators for hospital discharge of care-dependent people.The thesis started from the premise of the intrinsic characteristics of the hospital discharge process and the needs of the target audience, as well as the formal and/or informal caregivers and health professionals who are part of the Health Care Network.
For the development of the thesis, the following methodological steps were considered: I) literature review; II) construction; and III) validation of home care quality indicators.The literature review method, anchored in qualitative data extraction considering its application and results, sought a subjective understanding of the phenomena of interest of the theme under study.The literature review also sought to improve the relationship of the main author with qualitative epistemology and the technical domain of the method used 16 .

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For the development of quality indicators for home care, the data collected in the first stage were coded according to the needs of people who were discharged from the hospital, but who need further care at home.The analytical coding of the reviewed studies was based on the contextualization of the population's health needs (object of study of the thesis) and the strategic actions and results evidenced from the process of analysis and coding of data from the reviewed studies.
The literature highlights contributions from the use of GT in meta-analyses research, but does not advance in terms of methodological steps, especially in the extraction, coding, and analysis of data from this framework 14 .In the context of Brazilian nursing, meta-analyses based on GT are incipient, which encourages the need for scientific and rigorous contributions to outline new strategies for synthesizing and extracting data from qualitative research.Thus, the aim of this study was to describe the data extraction, analysis and coding using the Straussian perspective of Grounded Theory in meta-analyses literature.

METHOD
A theoretical-reflective essay on the methodological and analytical stages of GT from the Straussian perspective.To exemplify the realization of meta-analyses in GT, fragments of the doctoral thesis mentioned above are presented 15 .In summary the thesis aimed to build and validate quality indicators through SLR with meta-analyses, Meta-analysis and an integrative approach based on the assumptions of the Donabedian Triad, which deals with health assessment, consisting of structure, process and result 17 , strengthened by the assumptions of the middle-range theory 18 and transitions [19][20] and, later, by the validation of the content by experts using the Delphi method 21 .
The study followed the steps used by the meta-analyses methodology of the Joanna Briggs Institute (JBI) 22 , however, to conduct the extraction, analysis, and codification of the data, using GT, the project was not submitted to JBI as it did not use its sequential process of collecting information, synthesis of findings or for the preparation of the meta-analyses.The methodological process was commenced based on the research question, the first stage described by JBI 22 ,: what are the clinicalcare actions performed by formal caregivers and health professionals upon hospital discharge for people care-dependent on home care?
The second stage of review 22 was the definition of what information would be evaluated in the articles, considering the following notes: definition of home care criteria for people care-dependent after hospital discharge; determination of criteria for the optimization and organization of home care after discharge; establishment of the content of home care; identification of home care domains that require quality indicators.
Subsequently, the inclusion criteria were defined, in which the PICO strategy (Patient -people care-dependent on home care) was used; Interest -home care, home nursing, Quality indicators; and Context -home care). 22Primary and secondary studies, published in national and international journals between 2000 and 2020, in the English, Spanish or Portuguese language and which addressed the structured issues of the PICO strategy were included.Book chapters, editorials, comments, theses, and dissertations were excluded from the study, as well as scientific evidence that was not available in full.
The selection of databases occurred according to the recommendations of JBI 22 , in which the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 5 were adopted in the stages of identifying the databases, descriptors and debugging the products arising from the process from the checklist.The search for studies began, in line with the systematized stages of PRISMA 5 , between 2017 and 2020, through the Capes Journals portal, with access through the Federated Academic Community (CAFe).The studies were selected from the following electronic databases: US National Library of Medicine (PubMed); Web of Science; Scopus

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and Cumulative Index to Nursing and Allied Health Literature (CINAHL).Combinations with the descriptors in Medical Subject Headings (Mesh) were used through actions with Boolean and, OR and/or NOT operators 5,22 .
The decision to use GT at this stage of the review is based on the cyclical process of coming and going, taking a methodological course from the Straussian perspective, considering the insights that arise during the evaluation process of the studies included in the review.JBI has a standardized data tool; however, the methodological framework allows the use of other tools such as software 22 .Thus, the studies found in the identification process were imported from each bank to the EndNote® reference manager, developed by Clarivate Analytics, in its 2013 X7 version and compatible with the 2019 version of Microsoft Word® 2019, being the fourth stage of the review, proposed by JBI 22 .
The articles were filtered to remove duplicate articles, by two independent authors, working in the review from the first stage, and, upon disagreement of opinion, the study under discussion was evaluated by a third member, determining its selection according to the inclusion and exclusion criteria.Despite its international and consensual use, the initial steps of PRISMA are necessary for the dynamics and methodological continuation of the use of GT in the process of data extraction, analysis, and codification due to the need to return to the studies included in the review and/or return the indexing bases with a new descriptor, when a new category or phenomenon is observed.Nevertheless, it is from the eligibility phase that GT begins its process of extracting, analyzing, and encoding the data.
At the first reading, it was verified whether the study contained information relevant to the review, in addition to its methodological quality, evaluated according to the criteria Consolidated criteria for reporting qualitative research (COREQ) 23 and Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) 24 .It was decided not to use the Critical Appraisal Checklist for Interpretive & Critical research (QARI) tool to evaluate the methodological rigor proposed by JBI, but the methodological quality was evaluated, using the instruments described above [23][24] .The stages of information recording collection, synthesis of findings and elaboration of meta-analyses, considering the methodological stages of JBI 22 , adapted to GT are presented in the results.
This research was conducted in accordance with the ethical aspects of resolution 466/2012 and 510/2016 of the National Health Council, whereby the project was forwarded to the Ethics Committee on research with human beings, receiving a favorable opinion for its realization.The review used as an example was filed in the International Prospective Register of Systematic Reviews (PROSPERO), under number CRD42020220894.

Extraction, analysis and codification of data -Straussian perspective
At this stage, the analytical process began, using the stages of GT in 128 studies.The Straussian perspective was used due to its flexibility, which allows us to glimpse the data with meanings about the interactions between the subjects, actors of the research question of the review, besides allowing the integration with the literature during the data analysis process.An essential step to define the theoretical sampling of the review, composed of articles with a qualitative approach and with different theoretical references (Figure 1) 7,9,14 .
The beginning of the data analysis process began with open coding, which was characterized by the thorough process of reading line by line, paragraph by paragraph and incident to incident.In this event, the formation of the first open codes began.From the evaluation, reflection, comparison and conceptualization, a preliminary code was given -called "prior category" -for each raw data analyzed in the articles that comprised the review (Figure 2) [9][10][11] .

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In the methodological follow-up of JBI, the JBI-SUMARI would be used for the qualitative synthesis 22 .However, the tool would limit the process of extracting, analyzing and coding the data in the Straussian perspective of GT.Therefore, it was decided to use software to help organize the data due to the numerous initial codes that emerged from the open coding.For this, version 2020 of the MAXQDA® mixed data analysis program was used, which facilitated the organization of data encodings and allowed an interrelationship between the codes and the construction of memos derived from the methodological approach [25][26] .
This methodological process from the Straussian perspective enhanced the exhaustive reading of all the studies included in the review.The vast majority evoked certain points of the care process of people care-dependent on home care.This step, with the help of memoranda and/or diagrams, enabled the process to go back and forth in the articles included in the review and, when relevant, based on the identification of the necessary articles led to the need to redo the search in the selected databases, inserting new descriptors (Figure 2).

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As shown in Figure 2, in the open and axial coding, the articles that composed the review (units of analysis) generated the first open codes, generating the possibility of returning to the articles when new concepts emerged in the analysis and codification process.In the same open coding process, the codes were analyzed inductive-deductive style, characterizing axial coding from questions to reach the previous categories [11][12][13] .
The two steps were not performed sequentially, but at the same time, considering that in the mentioned codifications it is possible to develop relationships between concepts of conditional character.The raw data had different conjunctures, but were contiguous to previous categories, such as the need to have a professional tool to perform certain activities in the care of care-dependent people cared for at home, but which was also related to the communication capacity between caregiver and health professional, for example.(Table 1) [11][12][13] .
In this stage of selective coding, where the process of integration and refinement of the previously elucidated categories was instituted, the paradigmatic model was used, which helped in the systematization of the previous categories arising from the axial coding from the following components: conditions, actions-interactions, and consequences.These components helped to establish relationships with the phenomenon of the study and the other categories that emerged during the data collection, as well as presenting them in a schematized manner [9][10] .
Selective coding allowed the emergence of categories and subcategories.From the listed categories, the central phenomenon emerged, entitled Unveiling care practices for people caredependent on home care, being the main category of the study, considering the theoretical frameworks of the Donabedian Triad 17 , assumptions of the middle-range theory 18 and the transitions (Figure 3) [19][20] .

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In this process, the relationship and the connection between the conditions that address issues inherent to the need of care-dependent people at hospital discharge were provided, based on the assumptions of the structure 17 , particulate-deterministic paradigm 18 and typology and context [19][20] .Actions-interactions are the responses of the studied public to the events experienced in hospital discharge, considering the quality of the care process 17 , to the interactive-integrative paradigm and its adaptation to the new reality 17 , mediated by conditions and therapy [19][20] .Finally, contemplating the paradigmatic model of the Straussian perspective, we have the consequences based on the quality of the results 17 , which infers in the unitary-transformative paradigm 18 from the response patterns, based on the theory of transitions (Figure 3) [19][20] .
It is worth noting the use of the gerund to represent the actions of the data that are being analyzed and categorized and to aid in the development of the study phenomenon, characteristic of GT (Table 2) [9][10][11]14 . Thecompilation of previous and later categories regrouped, using the MAXQDA® software, enhanced the more comprehensive coding, such as health professionals in general, who were later regrouped according to their specificity (multiprofessional team/nurse/ psychologist).The fact that they have characteristics and similarities between them makes it possible to group codes, reducing the number of analysis units 11 .
The meta-analyses produced themes that were divided according to the assumptions of the Donabedian triad 17 , anchored in the middle-range theory 18 and transitions [19][20] , which addressed nine themes related to the quality of the structure.It was not directed only to the care setting, but to the characters who would act in home care.Six themes were related to the process of performing care in home care, and 10 themes explained the potential results from the interventions and care modes performed from the use of the indicators developed, based on the process and the result, and compiled a diagram summary on the topic addressed.

Analysis Unit
Open codes Previous category "The teams that take care.The teams that care for people with acute infectious conditions -who started intravenous antibiotic therapy in the hospital and were followed at home for another 7 to 10 days to complete the therapeutic regimen." 27entifying the need for nursing services for the administration of complex medicines Skills for medication management in home care. "

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This study presented the description of data extraction, analysis and coding from studies in the literature, using GT.Currently, there are several types of qualitative synthesis methods, such as meta aggregation, a tool used in JBI literature reviews, which corresponds to findings of a descriptive level, of practical use, aiding decision making [28][29] .The ability to develop theories, using meta-ethnography is also used for qualitative synthesis, supported by epistemological assumptions, but it differs from GT on the power of generalization [29][30] .
The qualitative synthesis carried out from the theoretical design of GT has the potential to provide depth and expansion through a central category.From the emergence of the study phenomenon, other conceptual categories are explained, as can be seen in Figure 3.In this context, the Straussian perspective expands contextual processes, actions-interactions, and consequences of a central category, producing a theory about existing concepts and which can be directed to practical utility.Finally, the synthesis of evidence using GT, permeates the reliability strategy of constant comparison, employing other methods to maximize the rigor of the study and theory development and dense description of the categories linked to the central phenomenon 30 .

Category Subcategory
Clinical and psychosocial characteristics of people dependent on technology in home care.

CONCLUSION
In this study, we sought to describe the process of using GT as a theoretical/methodological framework, together with the initial stages of PRISMA and JBI for the development of meta-analyses, using the Straussian perspective.It is worth mentioning that the choice of this perspective does not condition its use in each review, since comparative data analysis, coding, memorandum and diagrams, inherent to the methodological framework, are used.
The use of the Straussian perspective made it possible to construct a meta-analysis with methodological rigor, as it presents systematic follow-up and particular steps of GT, such as open, axial, and selective coding and the emergence of the central phenomenon of the study.It is worth mentioning the use of diagrams and memos, which allowed improving ideas and insights in the analysis coding process, providing the opportunity to return several times to the database to build new codes that emerged during the analysis.
It is reiterated that the steps of GT took place after the PRISMA and JBI steps, but due to its cyclical process of returning to the database with new descriptors due to the emergence of new sample groups.When some code emerged during any coding stage, new searches with the insertion of new descriptors were carried out with the objective of answering the research question and expanding the analysis system.The study contains subsidies for the understanding of conducting SLR research with meta-analyses based on the Straussian perspective of GT, contributing to the scientific rigor of the mentioned methodologies.
The study has the potential to guide researchers in SRL research with meta-analyses, generating codes and conceptual categories according to the Straussian perspective, which, according to the objective of the review, has differentiating characteristics, such as the possibility of using literature in all stages of data extraction, analysis, and codification, in addition to rigor to generate the theory.Moreover, the perspective under discussion is didactic and positions the researcher actively in his methodological process, ensuring a deepening in the theoretical sensitivity and identification of the central category.
The grouping of research results from different countries, with divergent care policies and practices, and qualitative approaches, with different theoretical references, linked to the methodological framework can be pointed out as limitations of the study.Thus, possible particularities may not have been contemplated in this study.Finally, we point out the use of only one perspective of GT, establishing the need for new research that addresses other modalities of the theoretical framework adopted and presented in this theoretical-reflexive essay.

Figure 1 -
Figure 1 -Flowchart of the stages of the initial process of data collection and subsequent analysis and codification of the data.Maringá, PR, Brazil, 2022.

Table 1 -
Arrangement of the units of analysis, open codes and previous categories derived from open and axial coding.Maringá, PR, Brazil, 2022.
• Evaluating the physical and structural condition of the household and support to receive people dependent on technology in home care; • Checking the availability of equipment and instruments to assist people dependent on care in home care, such as beds, chairs, armchairs, etc.

Table 2 -
Example of refinement and arrangement of categories and subcategories derived from selective coding or integration.Maringá, PR, Brazil, 2022.