The nature of mixed methods studies

Mixed methods research (MMR) means the use of both qualitative and quantitative approaches in one empirical study. (It must be noted, however, that mixed methods (MM) can also be conducted within qualitative research itself when several approaches are employed. See later in this chapter.) MMR has become fashionable – O’Cathain et al. (2007) state that some writers even call it a fad. MMR is more difficult than mono-method research for several reasons: First, traditionally writers proposed that qualitative and quantitative research come from different world views and each has a distinct epistemological stance and conceptual framework (the debate is discussed in the introduction of this book). While Punch (2005: 3) claims that not all research questions are ‘driven by paradigm considerations’, others, such as some of the authors in the text edited by Tashakkori and Teddlie (2003) see it as a third paradigm (see also Johnson and Onwuegbuzie, 2004). Secondly, some authors maintain that technically and operationally it might be difficult to use both approaches in one single study (for instance Sandelowski, 2000). In spite of its complexity, MMR in nursing and healthcare has been frequently carried out in a pragmatic and practical way throughout the last decade. Researchers who pursue this type of inquiry need an understanding of both qualitative and quantitative research and realisation that this type of inquiry is more time-consuming.

Qualitative and quantitative methods are often used together in one single study for practical purposes only, or to satisfy members of grant-making bodies who believe that a research study can be strengthened through using both methods. MMR is used to illustrate different aspects of a phenomenon or to illuminate a problem from different angles, gaining a variety of different types of information. Many approaches used in nursing and healthcare researches employ MM occasionally, for instance ethnography and – mainly in the early days – grounded theory.

Mason (2006) gives two main reasons for MMR:

MMR is particularly useful for translational research (where basic research and scientific discoveries are applied to clinical or practice settings). Tripp-Reimer and Doebbeling (2004) state that the use of qualitative research in a quantitative study adds ‘human dimensions’ to the care of patients; policy changes too might be more easily put into place as a result of this strategy.

Mixed methods and pragmatism

Mixed methods (mixed methodologies) research has its roots in pragmatism, a direction in philosophy with its origin in the work of Charles Peirce (1839–1914), William James (1842–1910) and John Dewey (1859–1952) in the nineteenth and early twentieth century. Seeing the world as a reality of diverse experiences, they considered mainly the practical consequences and effects of actions and their expedience. In the view of pragmatists, theory and practice are not only related, but theory is just an abstraction from reality (this is a very simplistic description of some elements of pragmatism, but there is no place for discussing the whole of pragmatism here. Researchers who are interested can pursue this themselves). Johnson and Onwuegbuzie (2004: 16) stress ‘workable solutions’ to problems and hence pragmatism as the ‘philosophical partner’ for MM which are seen as instrumental in achieving the research aims. The practical consequences of actions are seen as important and the research should be meaningful. The ‘paradigm wars’ and the dichotomy or dualism of qualitative and quantitative research have no place here. Clinical and applied research often gain from the practical and instrumental approach. Practice has priority over theory in pragmatism, although pragmatists are by no means a-theoretical. It is interesting however, that Giddings and Grant (2007) suggest that pragmatism is not the preserve of MMR alone but can play a part in any type of research. Pragmatists, so these writers observe (p. 53): ‘rather than focusing on epistemological integrity, emphasise the importance of getting ‘‘the job done’’.’ Many researchers see MM as a way of improving, enhancing or extending a research study. In the words of Johnson et al. (2007: 113):

‘Mixed methods research is generally speaking an approach to knowledge (theory and practice) that attempts to consider multiple viewpoints, perspectives, positions and standpoints (always including the standpoints of qualitative and quantitative research).’

Flemming (2007) defends MMR in nursing specifically, by stating that many nursing questions need input from both quantitative and qualitative perspectives to provide the broad knowledge in the field. These types of knowledge, she maintains, are neither incompatible nor mutually exclusive. The effectiveness of care or interventions can be measured by a randomised controlled trial (RCT) while patient perceptions and experience are more likely to be elicited by qualitative methods. Both contribute to practical use in clinical practice regardless of their ontological and epistemological base.

Doing mixed methods research

Types of mixed methods research

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