Tagged / Mixed-methods approach

The importance of understanding mixed methods

international

Earlier this week ResearchGate alerted us that the paper ‘The Growing Importance of Mixed-Methods Research in Health‘ has been read 900 times on that platform [1].  This methods paper focuses on  the growing importance of mixed-methods research to a wide range of health disciplines ranging from nursing to epidemiology.

Mixed-methods approaches requires not only the skills of the individual quantitative and qualitative methods but also a skill set to bring two methods/datasets/findings together in the most appropriate way. Health researchers need to pay careful attention to the ‘best’ approach to designing, implementing, analysing, integrating both quantitative (number) and qualitative (word) information and writing this up in a way that enhances its applicability and broadens the evidence-based practice. This paper highlights the strengths and weaknesses of mixed-methods approaches as well as some of the common mistakes made by researchers applying mixed-methods for the first time.

Our team in the Centre for Midwifery & Women’s Health (CMWH) has written several other methods papers on the importance of mixed-methods research in community-based health studies [2-5].  We have, of course, conducted and published many mixed-methods studies over the past two decades [see for example 6-10].

 

Prof. Edwin van Teijlingen

 

 

References:

  1. Wasti, S. P., Simkhada, P., van Teijlingen, E., Sathian, B., & Banerjee, I. (2022). The Growing Importance of Mixed-Methods Research in Health . Nepal Journal of Epidemiology, 12(1), 1175–1178.
  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. Mahato, P., Angell, C., van Teijlingen, E., Simkhada, P. (2018) Using Mixed-methods Research in Health & Education in Nepal, Journal of Health Promotion 6: 45-8.
  4. Harvey, O., van Teijlingen, E., Parrish, M. (2022) Mixed-methods research on androgen abuse – a review, Current Opinion in Endocrinology & Diabetes 29(6):586-593.
  5. 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
  6. Pitchforth, E, Watson, V, Tucker, J, Ryan, M, van Teijlingen E, Farmer, J, Ireland, J, Thomson, E, Kiger, A , Bryers, H. (2008) Models of intrapartum care and women’s trade-offs in remote and rural Scotland: A mixed-methods study BJOG: An International Journal of Obstetrics & Gynaecology, 115(5): 560-569.
  7. Wasti, SP, Simkhada, P., Randall, J, van Teijlingen, E, Freeman, J. (2012) Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. PLoS ONE 7(5): e35547. doi:10.1371/journal.pone.0035547.
  8. Simkhada, P., van Teijlingen, E., Devkota, B., Pathak, RS, Sathian, B. (2014) Accessing research literature: A mixed-method study of academics in Higher Education Institutions in Nepal, Nepal Journal of Epidemiology 4(4): 405-14.
  9. Dost, S., Arnold, R., van Teijlingen, E. (2023) Management capacity in the Afghan Ministry of Public Health pre-Taliban: A mixed-methods study of political and socio-cultural issues, Razi International Medical Journal, 3(1): 9–18
  10. Sharma, S., van Teijlingen, E, Hundley, V., Stephens J., Simkhada, P., Angell, C., Sicuri, E., Belizan, J.M. (2013) Mixed-methods evaluation of maternity care intervention in rural Nepal: measuring what works, Poster P.2.3.004(A), Tropical Medicine & International Health 18(Suppl. 1): 183-184.

Congratulation on new interdisciplinary publication

international, Women's Academic Network, writing

Congratulation to Dr. Orlanda Harvey (Social Work), Dr. Terri Cole (Psychology) and Dr. Jane Healy (Criminology) who in collaboration with Jade Levell, a colleague at the University of Bristol, had their article ‘Explorations of attitudes towards accessibility and accessing domestic violence and abuse (DVA) perpetrator support programmes by victim-survivors and perpetrators across five European countries’ accepted by the journal Abuse: An International Impact Journal [1].  This paper reports on an international mixed-methods study exploring victim-survivors and perpetrators’ attitudes towards perpetrator support programmes. The study includes a questionnaire survey of victim-survivors and interviews with male perpetrators conducted in five European countries.

Results showed that of the 93 victim-survivors of domestic violence and abuse, half stated they would have stayed in their relationship with perpetrators if the abuse had stopped, and a similar number reported that they believed their relationships would have been different had there been help for the perpetrator. Analysis of perpetrator interviews showed that they faced barriers to obtaining support, such as being labelled a ‘perpetrator’ which, had they been addressed, may have enhanced their engagement with services. Whilst acknowledging the need for safeguarding and justice, this paper demonstrates the importance of reflecting both victim-survivor and perpetrator needs in order for perpetrators to fully engage with support services. Moreover, it highlighted the need to address the underlying societal issues related to hegemonic masculinity, which can lead to the abuse of women being normalised and the vulnerability of men being stigmatised, through education for young people around healthy relationships.

 

Congratulations

Prof. Edwin van Teijlingen

Centre for Midwifery & Women’s Health

Reference:

Harvey H.,  Cole T., Levell, J., Healy J. (2024) ‘Explorations of attitudes towards accessibility and accessing domestic violence and abuse (DVA) perpetrator support programmes by victim-survivors and perpetrators across five European countries’,  Abuse: An International Impact Journal 5(1): 26-45    https://doi.org/10.37576/abuse.2024.055

New paper BU PhD student Sheetal Sharma

open access, PG research, Publishing, writing

Plos ONE Sheetal 2016Congratulations to FHSS PhD student Sheetal Sharma on her latest paper [1].  The paper ‘Measuring What Works: An impact evaluation of women’s groups on maternal health uptake in rural Nepal’ appeared this week in the journal PLOS One.  Sheetal’s innovative mixed-methods approach was applied to a long-running maternity intervention in rural Nepal.  The paper concludes that community-based health promotion in Sheetal’s study had a greater affect on the uptake of antenatal care and less so on delivery care. Other factors not easily resolved through health promotion interventions may influence these outcomes, such as costs or geographical constraints. The evaluation has implications for policy and practice in public health, especially maternal health promotion.

Reference:

  1. Sharma, S., van Teijlingen, E., Belizán, J.M., Hundley, V., Simkhada, P., Sicuri, E. (2016) Measuring What Works: An impact evaluation of women’s groups on maternal health uptake in rural Nepal, PLOS One 11(5): e0155144 http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0155144

Mixed methods: not without its downside?

REF Subjects

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.

 

Recent methods papers at BU

Publishing

In the past six weeks we saw the publication of three methods papers by BU academics.     BU’s Joanne Mayoh and her colleague Anthony J. Onwuegbuzie in the USA published a paper on mixed-methods approaches in phenomenology.1  They argue that phenomenological research methods work extremely well as a component of mixed-methods research approaches. The purpose of this article is twofold, they provide: (1) a philosophical justification for using what they label mixed-methods phenomenological research (MMPR); and (2) examples of MMPR in practice to underline a number of potential models for MMPR that can practically be used in future research.

In the Faculty of Health & Social Sciences Catherine Angell and Jane Hunt with Professor Emerita Jo Alexander offer methodological insights into the ‘draw and write’ research method. 2   Their literature review identified that the method has been used inconsistently and found that there are issues for researchers in relation to interpretation of creative work and analysis of data. As a result of this, an improvement on this method, entitled ‘draw, write and tell’, was developed in an attempt to provide a more child-orientated and consistent approach to data collection, interpretation and analysis. This article identifies the issues relating to ‘draw and write’ and describes the development and application of ‘draw, write and tell’ as a case study, noting its limitations and benefits.

Finally, BU Visiting Faculty Emma Pitchforth and CMMPH’s Edwin van Teijlingen together with Consultant Midwife Helen MacKenzie Bryers published a paper advocating mixed-methods approaches in health research.3  This paper outlines the different paradigms or philosophies underlying quantitative and qualitative methods and some of the on-going debates about mixed-methods. The paper further highlights a number of practical issues, such as: (1) the particular mix and order of quantitative and qualitative methods; (2) the way of integrating methods from different philosophical stance; and (3) how to synthesise mixed-methods findings.   This paper is accompanied by an editorial in  Nepal Journal of Epidemiology. 4

 

Professor Edwin van Teijlingen

Centre for Midwifery, Maternal & Perinatal Health

 

References:

  1.  Mayoh, J., Onwuegbuzie, A.J.  (2015) Toward a Conceptualization of Mixed Methods Phenomenological Research, Journal of Mixed Methods Research 9(1): 91-107.
  2. Angell, C., Alexander, J., Hunt, J.A.  (2015) ‘Draw, write and tell’: A literature review and methodological development on the ‘draw and write’ research method.  Journal of Early Childhood Research, 13(1): 17-28.
  3. MacKenzie Bryers, H., van Teijlingen, E. Pitchforth, E. (2014) Advocating mixed-methods approaches in health research, Nepal Journal of Epidemiology 4(5): 417-422.
  4. Simkhada, P., van Teijlingen, E., Wasti, S.P., Sathian, B. (2014) Mixed-methods approaches in health research in Nepal (editorial) Nepal Journal of Epidemiology 4(5): 415-416.