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      Combining qualitative and quantitative research within mixed method research designs: A methodological review

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          Abstract

          Objectives

          It has been argued that mixed methods research can be useful in nursing and health science because of the complexity of the phenomena studied. However, the integration of qualitative and quantitative approaches continues to be one of much debate and there is a need for a rigorous framework for designing and interpreting mixed methods research. This paper explores the analytical approaches (i.e. parallel, concurrent or sequential) used in mixed methods studies within healthcare and exemplifies the use of triangulation as a methodological metaphor for drawing inferences from qualitative and quantitative findings originating from such analyses.

          Design

          This review of the literature used systematic principles in searching CINAHL, Medline and PsycINFO for healthcare research studies which employed a mixed methods approach and were published in the English language between January 1999 and September 2009.

          Results

          In total, 168 studies were included in the results. Most studies originated in the United States of America (USA), the United Kingdom (UK) and Canada. The analytic approach most widely used was parallel data analysis. A number of studies used sequential data analysis; far fewer studies employed concurrent data analysis. Very few of these studies clearly articulated the purpose for using a mixed methods design. The use of the methodological metaphor of triangulation on convergent, complementary, and divergent results from mixed methods studies is exemplified and an example of developing theory from such data is provided.

          Conclusion

          A trend for conducting parallel data analysis on quantitative and qualitative data in mixed methods healthcare research has been identified in the studies included in this review. Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings, help researchers to clarify their theoretical propositions and the basis of their results. This can offer a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and develop new theory.

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          Most cited references 21

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          Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods study

          Background Recently, there has been a surge of international interest in combining qualitative and quantitative methods in a single study – often called mixed methods research. It is timely to consider why and how mixed methods research is used in health services research (HSR). Methods Documentary analysis of proposals and reports of 75 mixed methods studies funded by a research commissioner of HSR in England between 1994 and 2004. Face-to-face semi-structured interviews with 20 researchers sampled from these studies. Results 18% (119/647) of HSR studies were classified as mixed methods research. In the documentation, comprehensiveness was the main driver for using mixed methods research, with researchers wanting to address a wider range of questions than quantitative methods alone would allow. Interviewees elaborated on this, identifying the need for qualitative research to engage with the complexity of health, health care interventions, and the environment in which studies took place. Motivations for adopting a mixed methods approach were not always based on the intrinsic value of mixed methods research for addressing the research question; they could be strategic, for example, to obtain funding. Mixed methods research was used in the context of evaluation, including randomised and non-randomised designs; survey and fieldwork exploratory studies; and instrument development. Studies drew on a limited number of methods – particularly surveys and individual interviews – but used methods in a wide range of roles. Conclusion Mixed methods research is common in HSR in the UK. Its use is driven by pragmatism rather than principle, motivated by the perceived deficit of quantitative methods alone to address the complexity of research in health care, as well as other more strategic gains. Methods are combined in a range of contexts, yet the emerging methodological contributions from HSR to the field of mixed methods research are currently limited to the single context of combining qualitative methods and randomised controlled trials. Health services researchers could further contribute to the development of mixed methods research in the contexts of instrument development, survey and fieldwork, and non-randomised evaluations.
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            Revisiting the Quantitative-Qualitative Debate: Implications for Mixed-Methods Research.

            Health care research includes many studies that combine quantitative and qualitative methods. In this paper, we revisit the quantitative-qualitative debate and review the arguments for and against using mixed-methods. In addition, we discuss the implications stemming from our view, that the paradigms upon which the methods are based have a different view of reality and therefore a different view of the phenomenon under study. Because the two paradigms do not study the same phenomena, quantitative and qualitative methods cannot be combined for cross-validation or triangulation purposes. However, they can be combined for complementary purposes. Future standards for mixed-methods research should clearly reflect this recommendation.
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              The value of combining qualitative and quantitative approaches in nursing research by means of method triangulation.

              The article contributes to the theoretical discussion of the epistemological grounds of triangulation in nursing research. In nursing research, the combination of qualitative and quantitative methods is being used increasingly. The attempt to relate different kinds of data through triangulation of different methods is a challenging task as data derived through different methodologies are viewed as incommensurable. Epistemological questions become a vital issue in triangulation of different methods, as qualitative and quantitative methods are built on philosophical differences in the structure and confirmation of knowledge. The epistemology of nursing is manifold, complex and multifarious in character. Contemporary nursing research should be developed on the bases of an epistemology that reflects this multiplicity. The benefits and problems of triangulation are discussed on basis of an epistemological position that acknowledges the need for various types of knowledge and that does not attempt to rank them in a hierarchical order or place different values on them. We conclude that the complexity and diversity of reality provides the ontological basis for an alternative epistemological position. The various methods used should be recognized as springing from different epistemological traditions which, when combined, add new perspectives to the phenomenon under investigation. The different types of knowledge should not be seen as ranked, but as equally valid and necessary to obtain a richer and more comprehensive picture of the issue under investigation.
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                Author and article information

                Contributors
                Journal
                Int J Nurs Stud
                Int J Nurs Stud
                International Journal of Nursing Studies
                Pergamon Press
                0020-7489
                1873-491X
                16 November 2010
                March 2011
                16 November 2010
                : 48
                : 3
                : 369-383
                Affiliations
                [a ]Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
                [b ]Institute for Applied Health Research/School of Health, Glasgow Caledonian University, United Kingdom
                [c ]Division of Nursing, Department or Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
                [d ]Public Health Sciences, University of Edinburgh, United Kingdom
                Author notes
                [* ]Corresponding author. Tel.: +46 8 524 836 57. ulrika.ostlund@ 123456ki.se
                Article
                S0020-7489(10)00363-9
                10.1016/j.ijnurstu.2010.10.005
                7094322
                21084086
                Copyright © 2010 Elsevier Ltd. All rights reserved.

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