Introduction

The complexity of the current era, in which political, economic, social, and health phenomena are combined, requires approaches that consider knowledge and data of a quantitative and qualitative order, as well as the introduction of multimethod and various theoretical approaches. (¹)

In this complex context, qualitative research has also presented a renaissance in recent years. Its use has extended to different research spaces, such as nursing, education, health, care, social sciences, arts, literature, and administration. This has allowed a better understanding of the complex phenomena of study. (²)

Among the most used theoretical perspectives in qualitative research is grounded theory. This term first appeared when Barney Glaser and Anselm Strauss published The Discovery of Grounded Theory. Strauss was an expert in symbolic interactionism and Glaser in descriptive statistics, and they worked together in developing the theory. (³)

Grounded theory represents both a research method and a product resulting from that research. It can be defined as a set of integrated conceptual hypotheses systematically generated to produce an inductive theory about a substantive area. (⁴)

Situational analysis (AS), developed by Adele Clarke, is an extension and rethinking of grounded theory. With this development, the author intended to promote the interpretative turn and search for meanings, for which she considered the new theoretical perspectives provoked by the thought of Michel Foucault, Jacques Derrida, and Donna Haraway, among others. (⁵)

According to the author, situational analysis takes the classical grounded theory approach and incorporates constructivist, pragmatism, and interactionist social theory. Elements of Foucault are also incorporated regarding discourse analysis as a central element. (⁵) This methodology innovates with a view from posthumanism by including non-human objects or things in the analysis, such as cultural objects, technologies, animals, media, animated and inanimate non-human pieces of material culture, such as fumigation, architecture, among others. A key argument in science and technology studies has been that the non-human and the human are co-constitutive and constitute the world and each other. (⁶) This overcomes the assumption that only humans "really" matter or "matter more" in a given situation. (⁵)

The situational analysis also brings critical social justice approaches to qualitative research, with feminist, anti-racist, decolonizing, and democratizing commitments. This methodology provides characteristic maps that help analyze power from various perspectives. (⁷)

Collecting information to construct the maps includes various modalities, such as in-depth interviews, ethnographic observation, and discourse analysis. The possible data sources are all kinds of documents, websites, images, material cultural objects, technological devices, scientific or other specialized literature, and social media, among others. (⁶)

When performing situational analysis, the research situation is constructed empirically by making four types of maps and incorporating memos or field notes to document and detail the ongoing analysis. (⁴) Maps are situational, relational, social worlds, and positional.

Methodology

This research aimed to capture the available theoretical and methodological publications about the situational analysis variant of grounded theory in different fields. To achieve this objective, the integrative review methodology was used. This specific review approach aims to synthesize previous theoretical or empirical literature to gain a complete understanding of a particular phenomenon. (¹¹)

The methodology used considers the following stages: 1) identification of the problem, which includes the question and the objective of the research clearly defined; 2) bibliographic search, which follows a comprehensive search strategy; 3) data evaluation; 4) data analysis (data reduction, visualization, comparison, and conclusions); and 5) presentation of the results, as well as implications for practice, public policy and future research. (¹²)

The guiding question of this review was: What is the available evidence on the use of situational analysis in health? The inclusion criteria were articles published in scientific journals indexed in Web of Science, Scopus, and Scielo; complete text online; Keywords: situational analysis, health, grounded theory; available in English or Spanish; Publications from 2018 to 2022.

Results

From the review, 58 investigations were identified in Web of Science, 52 in Scopus, and none in Scielo. Duplicate records and those that were not in the Spanish or English languages were eliminated. We reviewed 93 records and excluded 64 unrelated to the subject investigated. From the reports evaluated for eligibility, two studies not related to the subject of the study were excluded from completing 27 articles (Figure 1) finally.

Figure 1: PRISMA Flowchart: summary of the study selection process 

To organize the data for analysis, a table was designed to include the general background of each article (Table 1). The objective is collected explicitly for an inductive categorization according to the thematic axes in the next phase. t2, t3, t4

Table 1: Characteristics of selected studies 

^Source: Own elaboration (2023)

After the content analysis, four thematic axes were identified in which the situational analysis of grounded theory was used. The different types of maps accompanying the reflective process were considered for this. The categories that emerged from this inductive analysis are:

t10, t11

Table 2: Thematic axes emerging from the selected articles  

^Source: Own elaboration (2023)

Discussion

Situational analysis is considered the last variant developed from grounded theory, which since its creation in 1967 by Glasser and Strauss, has shown a constant evolution. It has enriched studies in various fields, specifically health, due to the complexity of studies in this area, which require a multidimensional and multidisciplinary approach. ⁵

The available evidence shows the possibility of using it in several areas. In this particular research, the areas of health education, health management, public policies, and health care emerge.

In health education, its use stands out in working with patients and training health professionals, incorporating multiple data collection techniques such as in-depth interviews, focus groups, non-participant observation, and content analysis. Discourse analysis is also included in the context that one of the characteristics of situational analysis is to recognize the plots between the positions of power that emerge from the discourses of the different social actors. Another exciting aspect is the relevance to health education studies in their territories and context where individuals, groups, and communities operate, highlighting the multidirectional integration in these spaces. ^13,14,15,16

It has also been used in the area of clinical simulation, specifically in the training of medical professionals in techniques and procedures. This constitutes an innovation and, at the same time, is evidence that supports the use of situational analysis in clinical simulation environments, in which this methodology contributes to the evaluation and improvement of performance in these environments. As a background, it is increasingly challenging to access direct work with patients, especially in the first years of training, so clinical simulation and different evaluation methods take on special prominence. ^13,15

Another interesting aspect of the use of situational analysis lies in the importance that researchers give to the levels of research and triangulation. Although this variant is not framed in the positivist paradigm, in which triangulation is favored from different areas, it is possible to observe that researchers in health triangulate and observe phenomena from various epistemological and ontological positions, thus reinforcing the rigor of qualitative research. ^(13,14,15,16

In the category of health management, situational analysis stands out for its relevance in effective planning, coordination, and communication in different healthcare environments, intending to safeguard patient safety and quality of care. It is also used in strengthening evidence-based practice by critically addressing the diverse stances of health professionals concerning their performance. Triangulation is used in data collection and analysis in the health education category. An example of application is the development of updated profiles of health professionals, specifically nurses in Iran, which contributes to the delimitation of roles and protocols of good practices in their professional practice. ^{17,18,19,20,21,22}

Concerning the use of situational analysis in the field of public policies, it highlights its relevance, especially at the macro-policy level and also from a perspective of description and evaluation of the policies adopted in the various countries. This reflects a critical and complex look at the context in which decisions are made, mainly the projections and improvements that must be implemented to increase equity and social justice. ⁽²³ The importance of collective construction with the participation of all social actors is also emphasized. ²⁴ One reviewed study presents a situational analysis of public policies during the pandemic. The study revealed that the situational analysis map gives visibility to all actors, including silent minorities, and makes explicit the space they demand as demands. According to the work's author, this map observed the presence of men in different categories of decision-making and geographical concentrations, excluding voices from peripheral areas, women, dissidents, minorities, children, people with disabilities, and people with rare or orphan diseases. ²⁵

Finally, in the health care category, there is a majority use of situational analysis with a diversity of epistemological approaches, as well as in information collection techniques, where a melting pot of views and approaches is always presented under the methodological umbrella of this variant of grounded theory. In this axis, it is possible to observe that situational analysis occurs in hospital and community environments, which include both the patient's experience and his family and the health team. Research has been conducted in critical care services, long-stay residences, primary care, and operating rooms. Regarding health conditions, research is observed with older people, the LGBTQ+ community, young people with illicit substance abuse, people with COVID-19, and people suffering from idiopathic falls, among others. ^{26,27,28,29,30,31,32,33,34,35,36,37,38,39}

Despite the reflexivity that involves the look at the various levels and the evidence it can provide on the importance of approaching complex solutions, situational analysis is in the making in health, so readers are invited to immerse themselves in the richness of the variants of grounded theory.

Conclusions

Using situational analysis as a methodological strategy enriches the understanding of the different phenomena of study by incorporating into the traditional method a critical and vindictive look contained in the discourse analysis.

The maps that emerge from the situational analysis can be used to plan research-based interventions and, in this way, implement changes in various areas, such as nursing, health, education, and business.

Situational analysis as a methodological strategy enriches the understanding of study phenomena, promotes research-based planning, and encourages participation and collaborative work. Although its use in the health field is incipient, it has a significant potential that invites us to explore the variants of grounded theory.

On the other hand, the discourse analysis component in the situational map allows an explicit analysis of the power relations between the different actors. It enhances participation and collaborative work, thus strengthening the role of research as an inclusive and democratizing instance.