By Milou Fredrix
This year at the EHPS/ DHP conference in Aberdeen, a number of our NUIG health psychologists attended the 18th CREATE pre-conference workshop. This year, the workshop was facilitated by Dr. Irina Todorova and Dr. Rachel Shaw and was designed around mixed methodology in health psychology. The workshop addressed what exactly mixed methods research is, and highlighted some of the advantages as well as the challenges and dilemmas associated with this approach. In this blog I will discuss some of the content covered in this workshop, and hopefully leave you with a better idea of what ‘mixed methods research’ entails.
Qualitative vs Quantitative
For decades, the field of psychology has been the stage of a passionate debate between supporters of quantitative and qualitative research paradigms. This “qualitative-quantitative debate”, is one of those highly charged subjects that can trigger a heated discussion at any research convention. As most people will know, quantitative methodology typically refers to the collection and analysis of numerical data. This type of data is usually collected through measures such as rating scales, performance instruments and observation checklists. Qualitative methods on the other hand, tend to refer to methods of data collection and analysis that focus on understanding and meanings. Researchers usually collect this type of data through observations, interviews and focus groups. Analyses for these types of data are very different and require different skills and expertise. For decades, qualitative and quantitative approaches were considered to be incompatible paradigms, underpinned by fundamentally different assumptions (Dures, Rumsey, Morris, & Gleeson, 2011).
Mixed Methods Research
Over recent years however, the two fields have been coming together. One doesn’t necessarily exclude the other anymore. And it seems that we have found a nice compromise in the form of mixed methodology research paradigms. Thinking in categories, mixed methods are sitting on a new third chair, with qualitative research sitting on one side of it and quantitative research sitting on the other (Johnson & Onwuegbuzie, 2004).
So what exactly are mixed methods? Mixed methods research (MMR) is usually defined as a type of research where the researcher mixes or combines quantitative and qualitative research techniques into a single study. The qualitative and quantitative findings should be mixed or integrated to get a better understanding of a concept than could be gained by using just one method (Johnson & Onwuegbuzie, 2004).
From a theory perspective, MMR is based on the idea that there are various ways of making sense of the social world and that there are multiple positions on what is important (Greene, 2008). Mixed methods say that no single method, be it quantitative or qualitative, is superior to the other when it comes to understanding behaviour and social phenomena. Using mixed methods designs can help you overcome the weaknesses of both quantitative and qualitative research. Quantitative research for example, is often accused of lacking an understanding of the context in which people behave. Qualitative methods however, are often criticised for including biased interpretations made by the researcher. By using both kinds of methods, the strengths of each approach can complement the limitations of the other. In addition to creating a more robust study design, these mixes provide a more complete and holistic understanding of the research question. In other words, it can be easier to explain your findings and add more meaning to them.
Sounds ideal right? Well, yes and no. In recent years, MMR has become the ‘hot’ method. However, the facilitators of the CREATE workshop stressed that doing it right is not easy. While the combination of research methods can certainly add value, there are some things to consider before you start. The major downside to conducting MMR is the fact that it takes much more resources and time. When dealing with limited funding and time to complete a project, this can be particularly daunting.
Using mixed-methods approaches means that you will need sufficient knowledge of two different research philosophies. In other words, you will need skills in collecting and analysing quantitative as well as qualitative data. In addition to that, you also need to know how to bring different types of data together. For this so called ‘integration process’, you really need someone in your team who understands the challenging ‘mixing of data’ approach used in mixed-methods studies. Bringing together the findings from the qualitative and quantitative work is the most important part of mixed methods research. Here you really bring the findings together to create a more complete understanding of a research question. Without integration, the knowledge gained is equivalent to that from a qualitative study and a quantitative study undertaken independently, rather than achieving a knowledge that is “greater than the sum of the parts”. Therefore lacking expertise can often lead to the original mixed-methods study being reported as separate papers, each based on data from one of the methods used in the mixed-methods study. However, if you do find yourself in a position where you have sufficient time and expertise to conduct MMR, these approached can really help create a more complete understanding of a research question.
Mixed Methods Research Design
Designing your mixed methods study is an important step and can be done in many ways. How you wish to incorporate the different methodologies very much depends on what your research question is. You can make the design as complex as needed. An often used, relatively basic design would be a convergent parallel design. This would mean collecting quantitative and qualitative data parallel to each other while integrating the results in the end. For example, when examining barriers to exercise, you could distribute questionnaires, and alongside it conduct a number of in-depth interviews to get a broader understanding of the issue. In other instances, you might like to use qualitative measures to explain your previously collected quantitative results. In this case the two methods would be part of an explanatory sequential design. These are just 2 examples of the many different forms in which MMR might take place. The important thing to remember is that mixing and integrating results to get a better understanding of the issue, is a crucial part of the process. Just using qualitative and quantitative measures in a study without integrating the results is not enough (Creswell, Klassen, Plano Clark, & Smith, 2011)!
Integration of data
When it comes to integrating the data, unfortunately there does not seem to be a golden rule. We were all hoping to be guided through a step by step approach through data integration in the workshop. Unfortunately, what seems to be the hardest part of MMR, also seems to be part that lacks some guidance. The integration of data is a challenge, as it is led by the data and there is no manual for it. It is important to carefully review your data and listen to what it tells you. This can be particularly challenging when the qualitative and quantitative findings are contradicting each other. While this can be a frustrating result, the CREATE facilitators encouraged us to look at this with a positive attitude. Contradicting results make for great research questions and they open doors for more investigation. When integrating results, reading examples from previous articles can help immensely. A journal dedicated to mixed-method research, aptly named, ‘The Journal of Mixed Method Research’. will hold examples of articles using mixed methods designs with proper integration of the findings. With regards to the quality of MMR, especially in the context of systematic reviews, quality assessments tools for such research are limited. However, Dr Shaw did introduce us to the Mixed Methods Appraisal Tool (MMAT). This tool can guide the quality appraisal of mixed methods study and help judge the quality of MMR studies.
Mixed methods in health psychology
In recent years, health science research has started prioritising methodological diversity. The use of mixed method approaches to investigate complex health issues are becoming increasingly popular (Creswell et al., 2011). After all, we are looking at a diverse range of complicated health problems; intuitively it makes sense to study these problems using varied approaches. Mixed methods have become particularly popular in health intervention development. In fact, qualitative research is rapidly becoming a key component in developing effective health promotion strategies and interventions. In many stages of intervention development, using a mix of methodological approaches is thought to improve effectiveness and uptake of the intervention. Looking at the MRC framework for designing and evaluating complex interventions, mixed methodology can be beneficial to the process at multiple stages.
For example, in the development stage of the intervention, qualitative research can provide important insights into processes of change, and it can be a great way to involve users from the start. Furthermore in a feasibility and piloting stage of development, using a mixture of qualitative and quantitative methods makes it more likely to understand barriers to participation and to estimate response rates (Anderson, 2008). Many research funders are even expecting some form of mixed methodology when calling for research proposals in health research. This is great for the uptake of mixed methodologies. However we do need to be careful not to just add a bit of ‘tokenistic’ qualitative research into larger quantitative projects. It is important to refrain from treating qualitative research as an add-on or an afterthought to meet funding needs. It can be a very substantial addition and should be a significant part of the research process when incorporated. More importantly, the use of mixed methods should add meaning and value to the research, and it should help answer questions that otherwise would remain unanswered (Dures et al., 2011).
The CREATE workshop gave us some great insights into a complicated process. Mixed methodology research is a great way of getting a broad and complete understanding of a research question. However it should not be underestimated and it should be given the amount of thought and time that it requires.