Category / Health, Wellbeing & Society

Mixed methods: not without its downside?

Prof Edwin van Teijlingen

Conducting mixed-methods research has become very popular over the past decade especially in the health research field.1-4 This development ties in with the growth in inter-disciplinary and multi-disciplinary research. Many grant applications, PhD project and the resulting papers especially in the health field apply a mixed-methods approach, where in the past a single approach would have dominated.   This interest in combining methods seems to be the case even in the more traditional quantitative field of clinical effectiveness and randomised controlled trials. Whilst I find this development encouraging as a mixed-methods social scientist, it also makes me wonder whether the applicants putting forward a mixed-methods project have thought about the disadvantages or at least the opportunity costs of using such approach.

A mixed-methods approach is ‘simply’ combining two or more research methods to address a research question, i.e. what the label suggests. It is often perceived as the combining of qualitative with quantitative methods, but it can technically also be a mix of quantitative methods or a combination of qualitative methods. The advantage of a mixed-methods approach is that the different methods in the mix address different aspects of the research question and that combining these methods offers a synergetic effect. So what are the possible limitations of or barriers to mixed-methods research?

First, using a mixed-methods approach means you need an understanding of two different philosophies and how to bring the findings of these two different methods together.4-6   One requires expertise in two different research approaches, either as individual or in the team as well as someone who can do the combining of the findings. For the latter you really need someone in the team who understand the pragmatic approach commonly used in mixed-methods approaches. Otherwise there is a great risk that the original mixed-methods study will be analysed and reported as two or more separate papers each based on data from one of the methods applied in the mixed-methods study.

Secondly, you can spend your money only once, hence there are opportunity costs. Thus if the maximum grant is £200,000 or £300,000 you can’t spend the full amount on the designing a large-scale quantitative study/survey, as you need to spend a proportion of your money and your attention and time on your qualitative study.

Thirdly, and related the above, both quantitative and qualitative methods have ‘rules’ about sampling and sample-size.5 Just because you have two methods this does not mean you can necessarily do a study with a smaller sample. The sample size calculations will still say you need at least xxx participants. Similarly, although perhaps not so rigidly you need a certain number of interviews or focus groups to do you qualitative study appropriately.

Fourthly, a common mistake seems to be to add a bit of qualitative research to a larger quantitative study, perhaps a bit tokenistic.7 Often it is so obvious in a grant application that the qualitative research is an add-on, an afterthought perhaps from a reviewer in the previous failed grant application.

Finally, not all mixed-methods studies are the same, in fact each mixed-methods study is more or less unique in the way in the way it mixes and matched individual research methods.3 So although mixed-methods may be the best way to address a particular research question, your particular proposed mixed of quantitative and qualitative research might not be the most appropriate to answer the overall research question.8

As with all research methods and research proposals my recommendation is if in doubt go and find an expert for advice.6 If necessary get an expert on your team of researchers to strengthen your application.

 

Professor Edwin van Teijlingen

CMMPH

 

References:

  1.  Barbour, R.S. (1999) The case of combining qualitative and quantitative approaches in health services research. Journal of Health Services Research Policy, 4(1): 39-43.
  2. Simkhada, P., van Teijlingen, E., Wasti, S.P., Sathian, B. (2014) Mixed-methods approaches in health research in Nepal, Nepal Journal of Epidemiology 4(5): 415-416.
  3. Plano Clark, V.L., Anderson, N., Wertz, J.A., Zhou, Y., Schumacher, K., Miaskowski, C. (2015) Conceptualizing Longitudinal Mixed Methods Designs: A Methodological Review of Health Sciences Research, Journal of Mixed Methods Research, 9: 297-319.
  4. MacKenzie Bryers, H., van Teijlingen, E. Pitchforth, E. (2014) Advocating mixed-methods approaches in health research, Nepal Journal of Epidemiology 4(5): 417-422. http://www.nepjol.info/index.php/NJE/article/view/12018/9768
  5. Bryman, A. (1988) Quality and Quantity in Social Research, London: Routledge
  6. Bazeley, P. (2003) Teaching mixed methods. Qualitative Research Journal, 4: 117-126.
  7. Maxwell, J.A. (2016) Expanding the History and Range of Mixed Methods Research, Journal of Mixed Methods Research, 10: 12-27.
  8. Brannen, J. (2005) Mixing methods: The entry of qualitative & quantitative approaches into the research process. International Journal of Social Research Methodology 8(3): 173-85.

 

Congratulations to Dr. Caroline Ellis-Hill

NIHRDr. Caroline Ellis-Hill  has just been accepted as a qualitative methodologist on the NIHR (National Institute for Health Research) panel for Programme Grants for Applied Research (PGfAR).  Caroline from the Centre for Qualitative Research (CQR) in FHSS is the second BU academic to join a NIHR panel this year.  Earlier this year Prof. Edwin van Teijlingen was invited to be a member of the NIHR’s HTA Clinical Evaluation & Trials Board ( http://www.nets.nihr.ac.uk/programmes/hta/our-people ).

Congratulations!

Professors Vanora Hundley & Edwin van Teijlingen

CMMPH

HSS Writing Week 4th-8th January – How can Bournemouth University Clinical Research Unit support you?

bucru identity

The Faculty of Health and Social Sciences is holding a Writing Week between 4th-8th January 2016 aimed at supporting staff to find time in their busy academic diaries to prioritise writing grant applications and papers for publication.

The Bournemouth University Clinical Research Unit offers methodological and statistical collaboration for all healthcare researchers in the area. It supports researchers in improving the quality, quantity and efficiency of research across Bournemouth University and local National Health Service (NHS) Trusts. It incorporates the Dorset office of the National Institute for Health Research (NIHR) Research Design Service who offer free methodological support to researchers who are developing research ideas in the field of health and social care.

BUCRU will be supporting Writing Week in HSS by holding two drop-in sessions on Tuesday 5th January and Thursday 7th January 12-2pm in R508 Royal London House. We would also like to extend the invitation across the other Faculties for anyone who feels we may be able to support them. For those unable to attend the drop-in sessions, we would be delighted to arrange an alternative appointment.

Please see further information here, contact our adminstrator Louise Ward on 01202 961939 / bucru@bournemouth.ac.uk or visit our website. We look forward to seeing you!

Congratulations to FHSS staff on latest KPI publication

Five RiversCongratulations to FHSS Celia Beckett and Jaqui Hewitt-Taylor and colleagues Richard Cross and Pam McConnell based at Five Rivers Child Care, Salisbury. Their first paper describes the exciting process of a Knowledge Transfer Partnership (KTP) project between BU and Five Rivers Child Care which started in 2012 and finished recently in 2015.[1]    The project was established to develop a stepped assessment package that would help to identify the emotional and behavioural needs of children who are looked after to ensure the right services are accessed and to monitor their progress.

 

Congratulations,

Professor Edwin van Teijlingen

CMMPH

 

Reference:

  1. Celia Beckett , Richard Cross , Jaqui Hewitt-Taylor , Pam McConnell (2015) Developing a process for assessment of the emotional and behavioural needs of “looked after” children: the Five Rivers model Journal of Children’s Services, 10(4):  324-38.

New joint AECC and FHSS publication

journal 2015

Congratulations to Joyce Miller, Monica Beharie and Elisabeth Simmenes based at the Anglo-European College of Chiropractic (AECC) and FHSS’s Alison Taylor and Sue Way who just had their paper ‘Parent reports of exclusive breastfeeding after attending a combined midwifery and chiropractic feeding clinic in the UK: A cross sectional service evaluation’ accepted in the journal Journal of Evidence-Based Complementary & Alternative Medicine.

Congratulations!

Prof. Edwin van Teijlingen

CMMPH

 

 

Latest co-creation paper hot off the press! Study investigated the mechanism of spinal manipulation.

Does cervical lordosis change after spinal manipulation for non-specific neck pain? A prospective cohort study

C-spine QF image for Chiro and Man Therapies

The mechanism for spinal manipulation in the treatment of pain is unknown. One mechanism proposed in the literature is that neck pain might be alleviated by changing or ‘correcting’ the alignment of the cervical spine (normal is considered to be a lordosis or lordotic curve – curving in towards the body). We decided to put this idea to the test in an undergraduate student project at AECC. Mike Shilton, a third year chiropractic student at the time, measured the angle of the cervical spine on x-ray images taken of patients and healthy volunteers that I had recruited for my PhD research. In that research, briefly, patients received spinal manipulation over 4 weeks, while healthy volunteers did not. Both groups had motion x-rays taken at baseline and 4-week follow-up. By using the first static image of each motion sequence we were able to investigate whether the cervical spine alignment or lordosis changed in the patient group, and whether such changes were greater than that in the healthy group not receiving treatment.

For the statistical analysis Mike was assisted by another student, Bas Penning de Vries. After the study it was proposed to the two students, by me and Professor Alan Breen, that they have a go at writing up the study for publication, with our assistance of course. Happily, they decided to do so. It might have been at times a painful process for them (most worthwhile things seem to be!), but they persevered and now it is published in a peer-reviewed open access journal! A great achievement for them, a publication already as they begin their clinical careers.

This co-created paper was a valuable exercise for the two undergraduate students, getting to learn about the research process, statistical analysis, publication and dissemination. An obvious benefit of co-creation to academics is that the workload of a project is spread throughout a larger team, albeit the students require support -but the time invested in that support should pay off. For instance, Mike and Bas  brought a fresh perspective to the team, posing well considered questions and suggestions that could be taken on board to improve the robustness of my own work and lines of argument. And of course, we now have a publication that would have taken much longer to get to press had I not had their assistance in writing it. In other words, with co-creation, everyone stands to gain.

Dr Jonny Branney

Report on the Millennium Cohort Study (MCS) Age 17 Survey: Consultative Conference

I recently attended the Millennium Cohort Study (MCS7) Age 17 Survey: Consultative one day conference held at UCL’s Institute of Education in London. Cohort studies are extremely valuable because data is collected over time working with the same sample of people. Longitudinal studies permit to describe the natural history of the same population and can identify risk factors for example, for optimal health, educational attainment chances and/or employment opportunities. Professor Emla Fitzsimons is the Principal Investigator of MCS,m strategically invited leaders of the ‘Activities and Daily Life’, ‘Cognitive Development’, and the ‘Socio-Emotional Development’ to harness conference delegates’ view on what are the important and key issues that society should know when examining 17 year old adolescents’ lives. The leaders provided an overview of their current strategies for capturing participants’ unique style of life. Then through a series of workshops the pros and cons of these were discussed and summarised. I don’t envy their jobs! To study the individual characteristics and the associated environmental factors in such a large sample is a huge undertaking. The attendees were from very varied inter- and multi-disciplinary backgrounds working at a wide range of organisations, including government agencies. The common objective was to create a dataset that can inform many governmental policies on a variety of topics. The process of decision making over every aspects of the 7th sweep of the MCS is extremely complex. The key aspect of longitudinal studies is comparability. Although, each sweep is unique because of the cohort is ageing, there has to be a trend of using the same methodology overtime. Studies like the MCS are facing constant funding crises because they are very expensive to run. There is an ongoing revision of time taken to collect data, finding proxy to gold standard measures and considering cutting expensive data collection methods like, FMRI scans, use of accelerometers to assess physical activity patterns and conducting physical tests. Despite all of these difficulties, data from such studies are invaluable. For example, in the 7th sweep they want to omit interviewing parents about their child’s mental health. I argued to include this data at this sweep, as most adolescents in the study are still living at home and others (like family members) are the ones most likely to identify early signs of mental health problems. Early detection is vital, especially when 1 in 10 adolescents known to develop at least one serious depressive episode in the UK by the time they are 18. Check out the MCS website if you are interested. You can also access all speakers’ slides by following the link (http://www.cls.ioe.ac.uk/Conference.aspx?itemid=4285&itemTitle=MCS+Consultative+Conference&sitesectionid=28&sitesectiontitle=Events). Data from the previous 6 sweeps are available for researchers to interrogate.

HSS Writing Week 4th-8th January – How can Bournemouth University Clinical Research Unit support you?

bucru identity

The Faculty of Health and Social Sciences is holding a Writing Week between 4th-8th January 2016 aimed at supporting staff to find time in their busy academic diaries to prioritise writing grant applications and papers for publication.

The Bournemouth University Clinical Research Unit offers methodological and statistical collaboration for all healthcare researchers in the area. It supports researchers in improving the quality, quantity and efficiency of research across Bournemouth University and local National Health Service (NHS) Trusts. It incorporates the Dorset office of the National Institute for Health Research (NIHR) Research Design Service who offer free methodological support to researchers who are developing research ideas in the field of health and social care.

BUCRU will be supporting Writing Week in HSS by holding two drop-in sessions on Tuesday 5th January and Thursday 7th January 12-2pm in R508 Royal London House. We would also like to extend the invitation across the other Faculties for anyone who feels we may be able to support them. For those unable to attend the drop-in sessions, we would be delighted to arrange an alternative appointment.

Please see further information here, contact our adminstrator Louise Ward on 01202 961939 / bucru@bournemouth.ac.uk or visit our website. We look forward to seeing you!

What do we know about back pain? The Society for Back Pain Research AGM Bournemouth 2015

 

SBPR logo

I was delighted to attend and represent BU at The Society for Back Pain Research (SBPR) Annual General Meeting 5-6 November 2015 which was conveniently held in Bournemouth, at Anglo-European College of Chiropractic, a partner college of BU. SBPR was formed in 1971 to promote the study of all clinical and scientific aspects of spinal pain, including the neck (my area of interest), and to encourage research into its causes, treatment and prevention. There are now over 200 members of the Society, from a wide range of disciplines including all sorts of healthcare professionals and scientists. Suffice to say if there is anything about back pain this audience does not know it is probably not worth knowing! Having said that, attending this meeting reminded me just how much about back pain is still unknown…

Biological Factors in Non-Specific Back Pain

The title of this year’s meeting was ‘Biological Factors in Non-Specific Back Pain’ to place an emphasis on the ‘biological’. It has been over 25 years since the biopsychosocial model was applied to back pain but lately research has tended to be more concerned with psychosocial aspects, such as fear-avoidance behaviour or depression; research into physical findings to diagnose back pain has sadly not been very fruitful. [An important point was made by Professor Maurits van Tulder, that research has actually been largely focused on psychological factors, to the expense of social factors]. While psychosocial factors do seem to be important in influencing patients’ recovery, they don’t get us much closer to a diagnosis, to finding out what is producing and driving the patient’s pain.
However, one of the presentations at SBPR hinted at where the research focus as regards imaging (and MRI specifically) could perhaps go. One of Associate Professor Mark Hancock’s suggestions was that we need studies that focus on changes on MRI, in response to treatment (or no treatment). But how do we best measure such changes? Which treatments and for whom? Could findings on MRI in a person without back pain predict back pain in the future?

Want to know more? For a longer version of this blog, click here.

Many thanks to the Professional Practice Development community, Faculty of Health and Social Sciences, for making my attendance possible.

Dr Jonny Branney

HSS Writing Week 4th-8th January – How can Bournemouth University Clinical Research Unit support you?

bucru identity

The Faculty of Health and Social Sciences is holding a Writing Week between 4th-8th January 2016 aimed at supporting staff to find time in their busy academic diaries to prioritise writing grant applications and papers for publication.

The Bournemouth University Clinical Research Unit offers methodological and statistical collaboration for all healthcare researchers in the area. It supports researchers in improving the quality, quantity and efficiency of research across Bournemouth University and local National Health Service (NHS) Trusts. It incorporates the Dorset office of the National Institute for Health Research (NIHR) Research Design Service who offer free methodological support to researchers who are developing research ideas in the field of health and social care.

BUCRU will be supporting Writing Week in HSS by holding two drop-in sessions on Tuesday 5th January and Thursday 7th January 12-2pm in R508 Royal London House. We would also like to extend the invitation across the other Faculties for anyone who feels we may be able to support them. For those unable to attend the drop-in sessions, we would be delighted to arrange an alternative appointment.

Please see further information here, contact our adminstrator Louise Ward on 01202 961939 / bucru@bournemouth.ac.uk or visit our website. We look forward to seeing you!

Suicide in India: Modelling data

The latest BU research publication used a modelling approach to suicide in India [1].  The paper ‘Time Trend of the Suicide Incidence in India: a Statistical Modelling’ is now online and freely available as it was published in an Open Access journal.  The first author of this paper is BU Visiting Faculty Dr. Brijesh Sathian.  The modelling resulted in some useful predictions of future risk of suicide at a population level, see for example: 10.12691.ajphr-3-5A-17.fig_1

 

Prof. Edwin van Teijlingen

Reference:

Sathian, B. , De, A. , Teijlingen, E. V. , Simkhada, P. et al. (2015). Time Trend of the Suicide Incidence in India: a Statistical Modelling. American Journal of Public Health Research, 3(5A), 80-87.  Online at:  http://pubs.sciepub.com/ajphr/3/5A/17/