Advance Nursing

Research
Mixed Method
Research

Jester B Rafols RN Ma. Lenore G. Pasol RN

DNM

At the end of my presentation, MAN students will be able

to:
1. Recognized the advantages of utilizing the mixed
method type of research
2. Outlines the different application, strategies and
obstacles in using multimethod research design
3. Identify and be familiarized with different
multimethod research design

Mixed Method
Research

Before, nursing research is dominated with

quantitative research.
1980s Qualitative nursing research starts to be
evident.
Some people argue that qualitative and
quantitative research are based on totally
incompatible paradigms.

Multimethod (or mixed-method) Research is the judicious

blending of qualitative and quantitative data.
One argument for blending qualitative and quantitative data in a
study is that they are complementary; they represent words and
numbers,
the
two
fundamental
languages
of
human
communication.

By integrating different methods and modes of analysis, the weaknesses of a single

approach may be diminished or overcome.
Quantitative has strong in generalizability, precision, and control over extraneous
variable but, sometimes the validity of such research is called into question.
By introducing tight controls, quantitative studies may fail to capture situational
context. By reducing complex human experiences, behavior, and characteristics to
numbers, such studies sometimes seem superficial.
The use of tightly structured methods can sometimes lead to biases in capturing
constructs under study. All these weaknesses are aspects of the studys ability to yield
valid, meaningful answers to research questions.

Qualitative research has strengths and weaknesses that are opposite.

The strength of qualitative research lies in its flexibility and its potential to yield
insights into the true nature of complex phenomena through in-depth scrutiny.
However, qualitative research is almost always based on small, unrepresentative
samples.
It is often undertaken by a single researcher or small research team, using data
collection and analytic procedures that rely on subjective judgments. Thus,
qualitative research is sometimes criticized for problems with reliability and
generalizability.

Neither of the two styles of research can fully deliver on its promise to establish the truth
about phenomena of interest to nurse researchers. However, the strengths and weaknesses
of quantitative and qualitative data are complementary.

Combined shrewdly in a single study, qualitative and quantitative data can supply each
others lack. By using multiple methods, researchers can allow each method to do what it
does best, with the possibility of avoiding the limitations of a single approach.

Why Use
Multi
Method?

Enhanced Theoretical Insights

Qualitative and quantitative research constitute

alternative ways of viewing and interpreting the
world.
These alternatives are not necessarily correct or
incorrect; rather, they reflect and reveal different
aspects of reality.
Denzin (1989)coined the term triangulation to refer to
the use of multiple sources to converge on the truth.
He expressed the value of triangulation eloquently.

 Incrementality
Qualitative methods are well suited to exploratory or hypothesisgenerating research early in the development of a problem area.
Quantitative methods are needed as the problem area matures for the
purposes of verification.
However, the evolution of a theory or problem area is rarely linear and
unidirectional.
The need for exploration and in-depth insights is rarely confined to the
beginning of an area of research inquiry, and subjective insights may
need to be evaluated early and continually.

Progress in developing a body of evidence for nursing practice tends to be

incremental and to rely on multiple feedback loops.
It can be productive to build a loop into the design of a single study,
potentially speeding the progress toward understanding.

Bargagliotti and Trygstad (1987) conducted two separate studies of

job stress among nurses, on nursing quantitative procedures and the
other using qualitative procedures.
The quantitative study identified discrete events as sources of stress,
and the qualitative study revealed stress-related processes over
time.
The discrepant findings, because they were derived from different
samples of nurses working in different settings, could not be easily
integrated and reconciled.
The investigators noted, Comparison of findings from the two
studies suggests that the questions raised by the findings in each
study might have been more fully addressed by using a combined
quantitative/qualitative methodology

Enhanced Validity

When researchers hypotheses or models are supported by multiple

and complementary types of data, they can be more confident about
the validity of the results.

Brewer and Hunter (1989), Although each type of method is

relatively stronger than the others in certain respects, none of the
methods is so perfect even in its area of greatest strength that it
cannot benefit from corroboration by other methods findings.

The integration of qualitative and quantitative data can provide

better opportunities for testing alternative interpretations of the
data, for examining the extent to which the context helped to shape
the results, and for arriving at convergence in tapping a construct.

For example, Ersek, Ferrell, Dow, and Melancon (1997), in their study
of quality of life in women with ovarian cancer, used qualitative data
to validate their quantitative quality-of-life measures.

Creating New Frontiers

This lack of congruity can lead to insights that can push a

line of inquiry further that would otherwise have been
possible.

When separate investigations yield inconsistent results,

the differences are difficult to reconcile and interpret

By probing into the reasons for any observed

incongruities, researchers can help to rethink the
constructs under investigation and possibly to redirect the
research process.
The incongruent findings, in other words, can be used as a
springboard for exploring reasons for discrepancies and
for a thoughtful analysis of the studys methodologic and
theoretical underpinnings.

APPLICATIONS
OF
MULTIMETHOD
RESEARCH

Instrument Development

Qualitative data are sometimes collected for the development

and validation of formal, quantitative instruments for research
or clinical purposes.
When researchers become aware of the need for a new
measuring tool, they sometimes derive the questions for a
formal instrument from clinical experience, theory, or prior
research.

When a construct is new, however, these mechanisms may be

inadequate to capture its full complexity and dimensionality.

Thus, many nurse researchers have begun to use data

obtained from qualitative inquiries as the basis for generating
questions for quantitative instruments that are subsequently
subjected to rigorous quantitative assessment.

Example of qualitative inquiry on a quantitative instrument:

Barroso and Sandelowski (2001) recorded qualitatively the problems
experienced in administering the widely-used Beck Depression
Inventory (BDI) to a sample of human immunodeficiency virus
infected patients. The researchers concluded that their experiences
with the BDI show the importance of incorporating qualitative
techniques of interviewing and observation in all phases of the
process of instrument utilization

 Explicating and Validating

Constructs
Multimethod research is often used to develop a
comprehensive understanding of a construct, or to
validate the constructs dimensions.
Such research may be undertaken when a littleresearched phenomenon has been identified as worthy
of further scrutiny (usually in an in-depth qualitative
study), or when there is a body of existing research in
which some serious gaps have been identified or
doubts have been raised about the prevailing
conceptualization.

Example of validating constructs:

Reece and Harkless (1996) conducted a multimethod
study to examine the maternal experiences of women
older than 35 years. The researchers administered an
existing quantitative measure of maternal experience,
the revised What Being the Parent of a Baby is Like
(WPL-R) scale, which involves three subscales: SelfEvaluation in Parenting, Centrality, and Life Change.
The researchers also asked respondents broad,
probing questions about their motherhood experience
and qualitatively analyzed the themes that emerged.
The investigators found that several new dimensions
arose in the qualitative portion of the research,
including loss of control, fatigue and the need to heal,
and the sense of mortality and the passage of time.

 Hypothesis Generation

In-depth qualitative studies are often fertile with insights about

constructs or relationships among them. These insights then can be
tested and confirmed in quantitative studies, and the generalizability
of the insights can be assessed.

This most often happens in the context of discrete investigations.

One problem, however, is that it usually takes years to do a study
and publish the results, which means that considerable time may
elapse between the qualitative insights and the formal quantitative
testing of hypotheses based on those insights.

A research team interested in a phenomenon might wish to

collaborate in a research program that has hypothesis generation
and
testing
as
an
explicit
goal.

Example of hypothesis generation:

Wendler (2001) described how the use of a metamatrix can be used to facilitate pattern recognition
across data from different sources, including
qualitative and quantitative sources, and to generate
hypotheses and new research questions. In Wendlers
example of a mixed-method study of Tellington touch
(t-touch), use of a meta-matrix led to a discovery of
the relationship between the administration of t-touch
and the practitioners physical state (e.g., caffeine
intake).

 Illustration, Clarification, and

Amplification

Qualitative data are sometimes combined with quantitative data to

illustrate the meaning of constructs or relationships.
Such illustrations often help to clarify important results or to
corroborate the understandings gleaned from the statistical analysis.
In this sense, these illustrations often help to illuminate the analyses
and give guidance to the interpretation of results.

Qualitative materials can be used to illustrate specific statistical

findings or can also be used to provide more global and dynamic
views of the phenomena under study, often in the form of illustrative
case studies.

 Understanding Relationships and

Causal Processes
Quantitative methods often demonstrate that variables are
systematically related to one another, but they often fail to provide
insights about why variables are related. This situation is especially
likely to occur with correlational research.

The discussion section of research reports typically is devoted to an

interpretation of the findings. In quantitative studies, interpretations
are often speculative, representing researchers best guess (a guess
that may, of course, be built on solid theory or prior research) about
what the findings mean. In essence, the interpretations represent a
new set of hypotheses that could be tested in another study.

When a study integrates both qualitative and quantitative data,

however, researchers may be in a much stronger position to derive
meaning immediately from the statistical findings through the
analysis of qualitative material.

The most ambitious application of multimethod research is in the area of

theory development.
The use of multiple methods provides greater opportunity for potential
disconfirmation of the theory.
If the theory can survive these assaults, it can provide a substantially
stronger context for the organization of our clinical and intellectual work.
Brewer and Hunter (1989), in their discussion of the role of multimethod
research in theory development, made the following observation:

Theory building and theory testing clearly require variety. In building

theories, the more varied the empirical generalizations to be explained,
the easier it will be to discriminate between the many possible theories
that might explain any one of the generalizations. And in testing theories,
the more varied the predictions, the more sharply the ensuing research
will discriminate among competing theories

Theory Building, Testing, and

Refinement

MULTIMETHO
D RESEARCH
DESIGNS

Green and Caracelli (1997) have

identified
several
types
of
research designs that involve a
multimethod
approach.
The
designs cluster into two broad
categories
that
they
label
component
designs
and
integrated designs.

1.
Multimethod Component Designs

Component design- the qualitative and quantitative aspects are

implemented as discrete components of the overall inquiry, and remain
distinct during data collection and analysis. Combining the qualitative and
quantitative components occurs during the interpretation and reporting
phases of the project.

Complementarity designs, the results from one method type are

enhanced or clarified by results from the other type. Polit and her colleagues
(2000) used a complementarity design in their previously described study of
food insecurity.

Triangulated design, both qualitative and quantitative methods are used

to capture the same phenomenon, with a focus on convergence and
increased validity. This design fits the application described in the previous
section as explicating and validating constructs.

Expansion design, in which different methods are used for distinct inquiry
componentsas might be the case in an evaluation that involved both a
process and impact analysis. The results from such studies are often
presented in a side-by-side fashion, rather than woven together into a single
story.

2. Multimethod Integrated Designs

Integrated design, there is greater integration of the method types at all phases of
the project, from the development of research questions, through data collection and
analysis, to the interpretation of the results. The blending of data occurs in ways that
integrate the elements from the different paradigms and offers the possibility of yielding
more insightful understandings of the phenomenon under study.
Four Types of Integrated Designs

1. Iterative designs involve a dynamic in which the findings from one method are
used as a basis for moving forward with further research using the alternative
method (as is typically the case with instrument development and refinement).
2. Embedded designs (or nested designs), one methodologic approach is
embedded in the other, interlocking contrasting inquiry characteristics in a
framework of creative tension
3. Holistic designs feature the essential interdependence of alternative methods for
gaining a full understanding of complex phenomena. In holistic designs, the methods
are integrated simultaneously rather than hierarchically.
4. Transformative designs, the emphasis is on blending the value commitments of
different research traditions to arrive at a better representation of the multiple
interests in the larger social context.

In general, integrated designs are better suited to theory building and

testing than are component designs.

Timing and Design

Sandelowski (2000) has offered an alternative typology of multimethod designs. Her
scheme focuses on which approach (qualitative or quantitative) has priority, and how the
approaches are ordered in a study.
She developed a useful matrix that indicates the kinds of objectives that can be addressed
with alternative design configurations. For example, in her Template Design #1, the
qualitative approach is the dominant one and quantitative data are viewed as an adjunct.
The quantitative data, which are collected concurrently with or after the qualitative data,
are used to provide measured description, validation, and formal generalizations.
Template Design #4, by contrast, involves qualitative data occurring before (and as an
adjunct to) the quantitative portion of the study. Such a design is used when the aim is to
generate questions for a quantitative instrument, or to generate hypotheses to be tested
formally.

Sandelowskis scheme makes clear that most multimethod studies involve decisions about
how to order data collection. In some cases (especially in component studies), data
collection for the two approaches occurs more or less simultaneously.
In others, however, there are important advantages to timing the approaches so that the
second phase builds on knowledge gained in the first.

TIP: Many multimethod studies are conducted in two or more phases, such as conducting indepth interviews with a subsample of patients from whom biophysiologic data were
obtained after analysis of those data has been done. If there is a possibility that you might
go back to study participants to obtain more data, be sure to structure your consent form in
such a way that they are aware of any potential future demands on their time. Also, be sure
to obtain contact information to facilitate finding them at a later date.

STRATEGIES
FOR
MULTIMETHO
D RESEARCH

The ways in which researchers might choose to combine qualitative

and quantitative methods in a single study are almost limitlessor
rather, are limited only by the researchers ingenuity, and by their
views about the value of multimethod research.

Researchers who do primarily quantitative research tend to be more

likely to see the value of incorporating qualitative approaches into
their designs than vice versa.
Phenomenological researchers, in particular, seldom build a
quantitative component into their studies. Indeed, a number of
qualitative researchers argue that true integration is not even
possible.

Mass (2000), for example, believes that the quest for meaning and
the quest for measurement are incommensurable Nevertheless,
examples of multimethod research abound. Although it is not
possible to develop a catalog of multimethod strategies,

 Clinical Trials

Although phase III clinical trials almost always use an experimental

design with structured quantitative outcome measures, qualitative
inquiries embedded in the trials can prove valuable in all phases. For
example, in phase I, when the intervention is being fine-tuned, indepth discussions with clinical staff and with patients can provide
critical insights into how to develop the best possible intervention.
Sandelowski (1996) has argued that qualitative methods used as a
component of quantitative research can increase the meaningfulness
of experimental studies by placing them more firmly in the real world
(Sandelowski, 1996). Even in a formal phase III evaluation of a
clinical trial, many questions can be addressed qualitatively. Why did
some patients drop out of the study? How did staff and patients feel
about the intervention? Why didnt certain patients improve as a
result of the intervention? What contextual factors constrained (or
enabled) the interventions success?

Example of a multimethod clinical trial:

Whittemore, Rankin, Callhan, Leder, and Carroll (2000) were involved

in a clinical trial of alternative social support interventions,
administered by nurse versus peer advisors, for patients who have
had a myocardial infarction. Subjects, who were randomly assigned
to three groups (nurse advisors, peer advisors, or control group),
were compared in terms of health outcomes. The qualitative part of
the study, which was designed to understand better the experiences
of the peer advisors, was based on written logs and individual and
group interviews.

Evaluation Research

Evaluation research often involves both quantitative components (e.g., impact

analyses and cost analyses) and qualitative components (e.g., process analyses). In
some cases, the components are stand-alone features of the study and are not
linked in a systematic fashion. However, the most powerful and useful evaluations
do use data from one component to inform findings in other components.

Qualitative data collection methods are especially useful when the researcher is
evaluating complex interventions. When a new treatment is straightforward (e.g., a
new drug), it is usually easy to interpret the results: post-treatment group
differences usually can be attributed to the intervention.

However, many nursing interventions are not so straightforward. They may involve
new ways of interacting with patients or new approaches to organizing the delivery
of care. Sometimes, the intervention is multidimensional, involving several distinct
features. At the end of the evaluation, even when hypothesized results are
obtained, people may ask,

What was it that really caused the group differences? (If there were no group
differences, then the important question would be, Why was the intervention
unsuccessful?) In-depth qualitative interviews with subjects could help to address
these questions. In other words, qualitative data may help researchers to address
the black box question understanding what it is about the complex intervention
that drove observed effects.

Example of a multimethod evaluation:

Hecker (2000) collected both qualitative and quantitative data in an
evaluation of a communitywide health fair held in a suburb of Mexico
City. A collaborative research team gathered qualitative information
about the planning and implementation of the health fair, and
quantitative data about the outcomes of the fair. The researchers
used both types of data to develop recommendations for program
replication and modification.

 Surveys

The most common data collection method currently used by nurse

researchers is structured self-reports,
The qualitative portion might involve such approaches as in-depth
individual or group interviews or unstructured observations in a
naturalistic environment such as a hospital or nursing home. From a
practical point of view,
it is efficient to collect both types of data simultaneously. For example,
researchers could administer a structured questionnaire and then conduct
an in-depth interview on the same day to a subsample of survey
respondents.

In some studies, this procedure is likely to work well, but a two-stage

(iterative) approach has two distinct advantages. First, if the second-stage
data collection can be postponed until after the quantitative data have
been collected and analyzed, researchers will have greater opportunity to
probe deeply into reason for any obtained results.

A second reason for using an iterative approach is that researchers can

use information from the first stage to select a useful subsample for the
second.

Example of a qualitative study after a survey:

Wilson and Williams (2000) were involved in a three-phase study on
telephone consultation among community nurses in England. The
first phase involved a national survey of community nurses by
mailed questionnaire.

In the second phase, which involved in-depth interviews with a

subset of 14 survey respondents, nurses were probed about their
experiences with telephone consultations. The third phase involved a
survey of clients from the interviewees caseload who had used
telephone services.

 Ethnographies

The methods used in ethnographic field studies usually yield a rich array
of data amenable to qualitative analysis, such as notes from qualitative
observations, indepth interviews, and narrative documents such as diaries
and letters.
Ethnographers can, in some cases, profit from the collection of more
structured information from a larger or more representative sample than is
possible in collecting the qualitative data.

The secondary data might be in the form of structured self-reports from a

survey, or quantifiable records.

As field work progresses, ethnographers typically gain considerable insight

into the cultures under study.
Alternatively, the quantitative portion of the study could be used to gather
descriptive information about the characteristics of the community or
organization so that qualitative findings could be understood in a broader
context. In either case, having already gained entre into the community
and the trust and cooperation of its members, ethnographers may be in an
ideal position to pursue a survey or record-extraction activity.

Example of a multimethod ethnography:

Clark (2002) conducted a focused ethnography of Mexican-origin
mothers experiences of obtaining and using health services for their
children in an urban Latino community in the United States. In
addition to gathering in-depth ethnographic data through multiple
interviews and participant observation, Clark gathered and analyzed
quantitative information from the childrens medical records (e.g.,
number of emergency department visits, number of well-child visits).

OBSTACLES
TO
MULTIMETHO
D RESEARCH

1. Epistemologic biases
2. Costs.
3. Researcher training.
4. Analytic challenges.
5. Publication biases.

1. References:

I believe in innovation and

that the way you get
innovation is you fund
research and you learn the
basic facts.
-Bill Gates

THANK YOU AND

GODBLESS!!!