An overview of mixed methods research

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An overview of mixed methods research

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An overview of mixed methodsresearch

Louise DoyleLecturerSchool of Nursing & Midwifery Studies, Trinity College Dublin,24 D’Olier St, Dublin 2, Ireland

Anne-Marie BradyLecturerSchool of Nursing & Midwifery Studies, Trinity College Dublin,24 D’Olier St, Dublin 2, Ireland

Gobnait ByrneLecturerSchool of Nursing & Midwifery Studies, Trinity College Dublin,24 D’Olier St, Dublin 2, Ireland

Abstract Mixed methods research is viewed as the third methodologicalmovement and as an approach it has much to offer health and social science research.Its emergence was in response to the limitations of the sole use of quantitative orqualitative methods and is now considered by many a legitimate alternative to thesetwo traditions. Purists’ view of the dichotomy between positivist and non-positivistphilosophies is prevalent; however, mixed methods afford researchers an opportunityto overcome this ‘false dichotomy’. The philosophical underpinning of pragmatismallows and guides mixed methods researchers to use a variety of approaches toanswer research questions that cannot be addressed using a singular method. Inparticular, healthcare researchers may benefit from the opportunity to use such adynamic approach to address the complex and multi-faceted research problems oftenencountered in the health care sector.

Key words mixed methods; paradigm; pragmatism; qualitative research;quantitative research; typology of mixed methods

IntroductionMixed methods research is emerging as a dominant paradigm in health care researchin recent years with an increase in health care researchers using this method.A review of research commissioned by the Health Research and DevelopmentProgramme in the United Kingdom showed that 17% (n = 22) of the studies

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commissioned before 1995 were mixed methods in comparison to 30% (n = 33)funded between 2000 and 2004 (O’Cathain, et al., 2007). It is clear therefore thathealth service researchers are increasingly identifying the benefits of using a mixedmethods design in their research studies. As this is a relatively new area, debate andconfusion persist as to what exactly constitutes mixed methods research and whatare the benefits to researchers and funders in health care. This paper defines mixedmethods research and charts the emergence of mixed methods research as a result ofthe paradigm wars. The proposed benefits of utilising such a research approach areidentified, and the criticisms of mixed methods research are outlined. Two recentclassification systems developed by Creswell and Plano Clark (2007) and Leech andOnwuebuzie (2007) are also outlined.

Definition of mixed methods designMixed methods may be defined as ‘research in which the investigator collects andanalyses data, integrates the findings and draws inferences using both qualitativeand quantitative approaches or methods in a single study’ (Tashakkori and Creswell,2007:4). Research is not restricted by the use of traditional approaches to data collec-tion but is guided by a foundation of enquiry that underlies the research activity(Creswell, 1994). A mixed methods study is one that includes a qualitative andquantitative dimension, but difficulties often arise when the researcher attempts toarticulate how the two elements relate to one another (Tashakkori and Creswell,2007). There is an inconsistency among researchers about what constitutes mixedmethods research (Sandelowski, 2001; Bryman, 2007; Tashakkori and Creswell,2007). Some interpretations view mixed methods as the collection and analysis ofquantitative and qualitative data. More contemporary writings in this area had soughtto develop an understanding of the importance of complete integration of the twoapproaches (Hanson, et al., 2005; Bryman, 2007; Creswell and Plano Clark, 2007).Tashakkori and Creswell (2007) argue that as mixed methods research is still evolv-ing, the discussion of what it actually is should be kept open. Similarly, Johnson, et al.(2007) suggest that the definition of mixed methods research will change over timeas this research approach continues to grow.

Paradigm debate and mixed methods researchResearchers are urged to locate their research in a selected paradigm. Morgan (2007:47) defines a paradigm as ‘the set of beliefs and practices that guide a field,’ and itcan be used to summarise the beliefs of researchers. The world view, theoretical lensand paradigm are all terms used interchangeably in the literature. Paradigm is a worldview that is defined by distinct elements including epistemology (how we knowwhat we know), ontology (nature of reality), axiology (values) and methodology(the process of research) (Hanson, et al., 2005). In other words, paradigm differencesinfluence how we know, our interpretation of reality and our values and methodol-ogy in research. Paradigm will influence the questions that researchers will pose andthe methods they employ to answer them (Morgan, 2007). The world view of theresearcher is greatly influenced by the positivist (quantitative) paradigm or naturalis-tic or constructivist (qualitative) tradition to which they align themselves. Tradition-alists would argue that these paradigms are different and a combination of the twois not possible (Sandelowski, 2001). There is an assumption that the research

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paradigms are not compatible because it is not possible to combine the ontologicaland epistemological stances of both traditions (Guba and Lincoln, 1988).

Traditionally, researchers have made a forced choice between the positivist scien-tific model of research associated with quantitative methods and the interpretativemodel associated with qualitative ones (Howe, 1985). Historically, the approach inhealth care research was nearly exclusively of the quantitative or positivist traditionwhich was predicated on the necessity for the researcher to be objective and unbi-ased, and for many, it is considered to be the ‘gold standard.’ Positivism contendsthat there is a single reality and therefore seeks to identify causal relationshipsthrough objective measurement and quantitative analysis (Firestone, 1987). In thepositivist paradigm, the researcher is considered independent and objective usinglarger samples to test carefully constructed hypothesis. The prevailing wisdom isthat the researcher in the positivist tradition can put aside values to avoid bias in aprocess of inquiry.

Constructivism or qualitative research emerged as an alternative to the positivistform of inquiry as researchers sought to examine the context of human experience(Schwandt, 2000). The qualitative paradigm is receiving greater attention in recentyears and is sometimes described as the naturalistic inquiry, post-positive, construc-tivist or interpretative approaches (Creswell, 1994). Constructivism proposes thatthere are multiple realities and different interpretations may result from any researchendeavour (Appleton and King, 2002). Those interpretations are shaped by particularcircumstances that exist as a study unfolds. Researchers who work within theconstructivist paradigm seek to illuminate the reality of others through the processof detailed descriptions of their experiences (Appleton and King, 2002). In theinterpretative paradigm, the researcher is subjective with the focus directed at deeperunderstanding of what is happening with a smaller sample.

The positivist viewpoint is that the research outcomes are not biased by the valuesof the detached positivist researcher unlike in the constructivist paradigm where theresearcher is immersed in the research (Firestone, 1987). The assumption is thatlogical positivism is objective, whereas the naturalistic inquiry is subjective. Howe(1985) argues strongly that no research endeavour is free from value judgmentsand an ‘attempt to bracket values’ (p. 12) only produces more insidious bias. Thedetached researcher in the positivist inquiry results in the production of detachedevidence and will not succeed in capturing the true context of health service work(Stevenson, 2005). One of the key ways that qualitative and quantitative researchmay be differentiated is the distinction between induction and deduction (Morgan,2007). The simplistic view of quantitative research is that it is an objective processof deduction whereas the qualitative process is subjective and a process of inductionthat can only be viewed in context (Morgan, 2007).

The field of mixed methods and language used to describe it is relatively new.Considerable debate exists in the literature around the issues of compatibility in com-bining qualitative and quantitative methods (Howe, 1985; Smith and Heshusius, 1986;Yanchar and Williams, 2006; Bryman, 2007; Morgan, 2007). Quantitative versusqualitative debates have resulted in an illusion that the two approaches are mutuallyexclusive (Sandelowski, 2001). The practice disciplines are sometimes overly concernedwith ‘methodological acrobatics’ (Sandelowski, 2001: 335). Some researchers believethat competition between paradigms is not helpful, and focus on ways in which tradi-tional rivalries may be usefully combined (Sale, et al., 2002; Stevenson, 2005). It is pro-posed that mixed methods may be the third paradigm, capable of bridging the gapbetween the quantitative and qualitative positions (Johnson and Onwuegbuzie, 2004).

Doyle et al. Mixed methods research

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Mixed methods research is guided by philosophical assumptions that enable themixing of qualitative and qualitative approaches throughout the research process(Hanson, et al., 2005). The philosophy of pragmatism advanced the notion that theconsequences are more important than the process and therefore that ‘the end justi-fies the means’. It advocates eclecticism and ‘a needs-based or contingency approachto research method and concept selection’ (Johnson and Onwuegbuzie, 2004: 17),so that researchers are free to determine what works to answer the research questions.The pragmatic approach to research is informed by the belief that the practicalities ofresearch are such that it can not be driven by theory or data exclusively and a processof abduction is recommended which enables one to move back and forth betweeninduction and deduction through a process of inquiry (Morgan, 2007).

Johnson and Onwuegbuzie (2004) share their aspirations that the field of mixedmethods research will move beyond quantitative versus qualitative arguments andwill instead focus on recognising the usefulness of both paradigms and identifyinghow these approaches can be used together in a single study to maximise thestrengths and minimise the weaknesses of each other. They further contend that tak-ing a non-purist position allows researchers to design research studies that combinemethods that will offer the best chance of answering their specific research questions.Maxcy (2003: 86) suggests that pragmatic researchers’ “…unique contribution is toopen up inquiry to all possibilities while tying that search to practical ends”. Morgan(2007: 48) supports this and views a pragmatic approach as a new guiding paradigmthat can act “as a basis for supporting work that combines qualitative and quantitativemethods and as a way to redirect our attention to methodological rather than meta-physical concerns”.

The rationale for mixed methods researchMany reasons have been identified for conducting a mixed methods research study.Following a review of theoretical and empirical literature, Greene, et al. (1989) iden-tified five purposes for conducting mixed methods research designs. These are trian-gulation, complementarity, development, initiation and expansion. Bryman (2006)in a later review of 232 social science mixed methods papers identified 16 reasonsfor conducting mixed methods studies. Many of the rationales identified in Bryman’s(2006) analysis are similar to those identified by Greene, et al. (1989) althoughsomewhat more detailed in manner. The main rationales or benefits proposed forundertaking a mixed methods study are as follows:

Triangulation: this allows for greater validity in a study by seeking corroborationbetween quantitative and qualitative data.

Completeness: using a combination of research approaches provides a more completeand comprehensive picture of the study phenomenon.

Offsetting weaknesses and providing stronger inferences: many authors argue that utilising amixed methods approach can allow for the limitations of each approach to be neutra-lised while strengths are built upon thereby providing stronger and more accurateinferences (Bryman, 2006; Creswell, et al., 2003).

Answering different research questions: Creswell and Plano Clark (2007) argue that mixedmethods research helps answer the research questions that cannot be answered byquantitative or qualitative methods alone and provides a greater repertoire of toolsto meet the aims and objectives of a study. Furthermore, Sale, et al. (2002) identifyhow a combination of research approaches is useful in areas such as nursing becauseof the complex nature of phenomena and the range of perspectives that are required.


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Explanation of findings: mixed methods studies can use one research approach (i.e.,quantitative or qualitative) to explain the data generated from a study using the otherresearch approaches. This is particularly useful when unanticipated or unusual find-ings emerge. For example, findings from a quantitative survey can be followed upand explained by conducting interviews with a sample of those surveyed to gain anunderstanding of the findings obtained.

Illustration of data: using a qualitative research approach to illustrate quantitative find-ings can help paint a better picture of the phenomenon under investigation. Bryman(2006) suggests that this is akin to putting ‘meat on the bones’ of dry quantitativedata.

Hypotheses development and testing: a qualitative phase of a study may be undertaken todevelop hypotheses to be tested in a follow-up quantitative phase.

Instrument development and testing: a qualitative study may generate items for inclusionin a questionnaire to be used in a quantitative phase of a study.

These points identify the usefulness that a mixed methods research approach canhave in answering a particular research question(s). However, it has been noted thatmixed methods research may have more practical benefits in terms of attractingresearch funding (Giddings, 2006). Increasingly, agencies funding large researchprojects are showing an interest in interdisciplinary research which involves collabo-ration between various disciplines in a certain field. This is particularly so in healthsciences where collaboration on large research projects between nursing, medical andparamedical professionals is increasingly promoted and encouraged. Different disci-plines bring with them different research histories with medicine more traditionallyassociated with positivist or quantitative paradigms and methods and nursing moreassociated with more interpretivist or qualitative ones. Therefore, the utilisation of amixed methods research approach can help meet the requirements of funding agen-cies that look for interdisciplinary research using a variety of methods.

Typology of mixed methodsIn an attempt to clearly identify the types of mixed methods research, many authorshave developed typologies or classification systems of mixed methods designs(Greene and Caracelli, 1997; Creswell, et al., 2003; Teddlie and Tashakkorri, 2006;Creswell and Plano Clark, 2007; Tashakkori and Creswell, 2007; Leech and Onwueg-buzie, 2007). Tashakkori and Teddlie (2003: 680) state that the determination ofa typology is “among the most complex and controversial issues in mixedmethodology.” The main advantages of having a typology of mixed methods includethe conveying rigor regarding the methodology, providing guidance and assisting inthe development of language for mixed methods research (Bryman, 2006; Teddlieand Tashakkorri, 2006). In this paper, two recent classification systems developedby Creswell and Plano Clark (2007) and Leech and Onwuegbuzie (2007) will beoutlined.

The first question when deciding on methodology is to ascertain which approachwill best suit the research question. This is a fundamental issue that all researchersneed to address, and Creswell and Plano Clark (2007) have stressed the importanceof justifying the selection of a mixed methods approach to conduct research. Themain rationale for choosing a mixed methods design has been previously outlinedin this paper, however, there are a number of methodological issues that a researchermust consider before undertaking a mixed methods study. Creswell and Plano Clarke(2007) suggest that there are three major decisions to make before selecting a


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particular type of mixed methods design, and Figure 1 outlines a decision tree thatidentifies the main issues that need to be considered.

The first decision to be made is regarding conducting the qualitative and quantita-tive stages concurrently or sequentially. Deciding whether both the methods aregiven equal priority is another key decision. The third issue is to ascertain wherethe mixing of the qualitative and quantitative methods will occur. O’Cathain, et al.(2007) reporting on a review of mixed methods studies identified that two-thirdswere sequential, the majority gave priority to the quantitative methodology and inte-gration occurred largely at the interpretation stage (81%, n = 39) in comparison tothe analysis phase (17%, n = 8).

Creswell and Plano Clark (2007) have developed a typology of mixed methodsdesigns, which they describe as being functional and parsimonious, and which iden-tifies four main types of mixed methods research (Figure 2).

The triangulation design is the most common and well-known design, and thiswas previously known as the concurrent triangulation design (Creswell, et al.,2003). The quantitative and qualitative phases occur at the same time, and both themethods are usually given equal weighting. The traditional model of triangulationmixed methods design is the convergence model where integration occurs duringthe interpretation phase. Within the data transformation model, the quantitative andqualitative data are collected concurrently, and after the initial analysis, the data aretransformed either by quantifying qualitative data or by qualifying quantitativeresults. Creswell and Plano Clark (2007) describe the use of open-ended qualitativequestions on a survey instrument as a validated quantitative data triangulation mixedmethods design. The multi-level research model variation of the triangulation designis used when the focus of the study is on a system and different methods are used toaddress the different levels. For example, qualitative methodology may be used toascertain the views of nurse managers on a particular issue, and this is comparedwith a survey of staff nurses’ views. Triangulation is viewed as the most challenging

Figure 1 Decision tree for mixed methods design (Creswell, et al., 2003; Creswell andPlano Clark, 2007).


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design of the four main research designs, and research teams are often used to imple-ment this form of research design.

The embedded design, first described by Caracelli and Greene (1997), is charac-terised by having one dominant method, whereas the other data set provides a sec-ondary or supportive role. The embedded experimental model is the most commonvariant of the embedded design, and the priority is given to the quantitative method-ology, and the qualitative data set is subservient (Creswell and Plano Clark, 2007).One of the purposes of the qualitative component may be to examine the process ofthe intervention. The embedded experimental model has been previously known asthe concurrent nested mixed methods design (Creswell, et al., 2003). The lastvariation of the embedded design is the correlational model where the qualitativedata are embedded within a quantitative design to help explain the outcomes of thecorrelation model. Within the embedded designs, the methods may be conductedconcurrently or sequentially.

The explanatory design previously described by Creswell, et al., (2003) as sequen-tial explanatory design consists of two phases, beginning with the quantitative phaseand then the qualitative phase, which aims to explain or enhance the quantitativeresults. Figure 2 outlines the two variants of the explanatory design—the follow-upexplanatory model and the participant selection model. Within the follow-up explan-atory model, the researcher identifies specific quantitative findings, such as unex-pected results, outliers or differences between groups that need further explorationusing qualitative methodology. In contrast, the qualitative phase has priority in theparticipant selection model, and the purpose of the quantitative phase is to identifyand purposefully select participants. The explanatory design requires a longer imple-mentation time due to the sequential nature but is regarded as the easiest of the fourmethods to implement.

The exploratory design is a sequential design where the first phase, qualitative,helps in the development of the quantitative phase. Creswell, et al. (2003) describedthis design as sequential exploratory design. This design (see Figure 2) is usedfor developing and testing instruments (Instrument Development Model) or for

Figure 2 Creswell and Plano Clark (2007) typology of mixed methods research.


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developing a taxonomy (Taxonomy Developmental Model). Priority is given to thequantitative entity in the instrument development model.

Leech and Onwuegbuzie (2007) use three criteria to develop their threedimensional typology of mixed methods design, and these include the level ofmixing, time orientation and emphasis of approaches. Partially mixed studies aredescribed as those studies where both the qualitative and quantitative phases areconducted independently before mixing occurs at the data interpretation stage. Incontrast, fully mixed methods designs have mixing occurring in either one or all ofthe following: the research objective(s), the types of data, analysis and inference.Figure 3 outlines the Leech and Onwuegbuzie (2007) typology of mixed methodsdesign. The first layer differentiates the studies into either partially or fully mixeddesigns, the second decides on the timing of the different phases of data collection,and finally whether each methodology is given equal status within the chosen design.This classification system results in six mixed methods designs (see Table 1).

This classification system is simple and easy to understand and avoids the use ofthe word triangulation. The term triangulation is one to which many meanings areattributed, and Sandelowski (2003) argues that it has been used so much that it hasno meaning at all. The major limitation to this classification system is the division of

Figure 3 Leech and Onwuegbuzie (2007) typology of mixed methods design.

Table 1 List of Leech and Onwuegbuzie (2007) mixed methods designs

1) Partially mixed concurrent equal status design2) Partially mixed concurrent dominant status design3) Partially mixed sequential equal status design4) Partially mixed sequential dominant status design5) Fully mixed concurrent equal status design6) Fully mixed concurrent dominant status design


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mixed methods into partially mixed and fully mixed studies. Leech and Onwuegbuzie(2007:3) describe partially mixed designs as ‘occupying regions somewhere betweenmonomethod designs and fully mixed methods designs.’ The authors would suggestthat the use of phrases such as ‘partially mixed’ and ‘fully mixed’ may be avoided andthat the phrase ‘integration at the interpretation phase only” may be substituted forpartially mixed research designs.

As identified, choosing the most appropriate design for a mixed methods studydepends on a number of factors including deciding which approach is best suited toanswering a particular research question and the overall rationale for using a mixedmethods approach. The typologies identified in this paper offer a system of classifica-tion of mixed methods research designs, which allow researchers to choose a designmost appropriate to meet the aim and objectives of their research.

The limitations of mixed methods researchAlthough it is clear that a mixed methods approach has much to offer a researcher,there have been criticisms of its use. Many of these criticisms focus on the incompat-ibility thesis, that is, the belief that quantitative and qualitative research methodscannot be mixed in a single study as they have such different ontological and episte-mological origins. Methodological purists believe strongly in the dichotomy of worldviews and research methods (Creswell and Plano Clark, 2007) and therefore argueagainst the combination of quantitative and qualitative approaches. Guba (1987: 31)had clearly identified the extent of the dichotomy between the paradigms by statinghow “the one precludes the other just as surely belief in a round world precludesbelief in a flat one.” Consequently, Sale, et al. (2002) caution against the uncriticalacceptance of mixed methods research by a new generation of researchers who haveoverlooked the underlying assumptions and incommensurate differences between thetwo paradigms. However, Onwuegbuzie (2002) argues that the purists’ view of thedichotomies between positivist and post-positivist philosophies are in fact falsedichotomies. Rather, Onwuegbuzie (2002) suggests that positivist and non-positivist philosophies lie on an epistemological continuum with mixed methodsresearch occupying the middle ground. Similarly, Howe (1988) argues against theincompatibility thesis and instead suggests that researchers should adopt a pragmaticapproach and forge ahead with ‘what works.’

Mertens (2003) who herself is an avid believer in mixed methods research posessome questions about the pragmatist philosophy upon which most mixed methodsresearch is based. She argues that basing methodological choices solely on pragmaticsor ‘what works’ is inadequate as it does not answer the question ‘practical for whomand to what end?’ However, many authors would suggest that the practicality inher-ent in pragmatism is concerned with finding the most appropriate method to answera research question or set of research questions. Tashakkori and Teddie (2003) arguethat researchers within the pragmatist tradition abide by what they term ‘the dictator-ship of the research question’, meaning they consider the research question to bemore important than either the method or the paradigm that underlies it.

Other criticisms or weaknesses of a mixed methods approach are more practical innature. Johnson and Onwuegbuzie (2004) suggest that it may be difficult for oneresearcher to carry out a mixed methods study if the qualitative and quantitativephases are to be undertaken concurrently. In this case, a research team may berequired. Ivankova, et al. (2006) identify that sequential studies also have drawbacksas it may take considerable time and resources to undertake distinct phases of a study.


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Within a mixed methods study, there is also a requirement that the researcher has atleast a sufficient knowledge of both quantitative and qualitative methods indepen-dently and how to mix these methods appropriately to achieve good study outcomes.As highlighted, there are drawbacks to using a mixed methods research approach.Therefore, it is essential that mixed methods researchers can anticipate the questionsor criticisms of their chosen approach to design appropriate studies and defend thesestudies when required.

ConclusionMixed methods research is now viewed as the third methodological movement and asan approach that has much to offer health and social science researchs. The purposeof mixing approaches is to afford opportunity to gain a more complete understandingof research problems (Creswell and Plano Clark, 2007). Researchers anticipate thatmixing methods will enable them to capture the complexity of human phenomena(Sandelowski, 2001). Mixed methods research responds to the interests and needsof diverse stakeholders in research. This is clearly identified by Greene (2005: 209)who suggests that ‘a mixed method approach offers greater possibilities than a singlemethod approach for responding to decision makers agenda, as well as to the inter-ests of other legitimate stakeholders.’ In health care, the selection of mixed methodsas a methodology seeks to provide hard data for the decision makers who seek todetermine health care policy. Mixed method research responds to the pressures foroutcomes in healthcare, but it can also report on the context of those outcomes. Cres-well and Plano Clark (2007) have identified that within the nursing discipline, mixedmethods research has been discussed and used extensively. Similarly, Twinn (2003:553) suggests that “there is growing acceptance that the design provides an appropri-ate methodology to address the complex health problems frequently faced by thenursing discipline”. By building on the strengths, acknowledging and limiting theweaknesses of mixed methods research, nurse researchers can address these ‘complexhealth problems’ in a creative and imaginative way.

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Louise Doyle (RPN, BNS, RNT, MSc) is a lecturer in mental health nursing at theSchool of Nursing and Midwifery Studies, Trinity College Dublin. She is currentlyundertaking a mixed methods PhD study of adolescent help-seeking for suicidalbehaviour.Email: [email protected]

Anne-Marie Brady (RGN, BSN, MSN, PG Dip Clinical Health Sciences Education,RNT) is a lecturer and Research Fellow at the School of Nursing and Midwifery Stud-ies, Trinity College Dublin. She is undertaking a PhD study exploring transitionexperiences and intent to stay of degree graduate nurses, using a mixed methodsapproach.Email: [email protected]

Gobnait Byrne (RGN, RNT, BNS, MPH, PG Dip Statistics) is a lecturer in generalnursing at the School of Nursing and Midwifery Studies, Trinity College Dublin. Sheis currently undertaking a PhD study of migrant health in Ireland using mixedmethods.Email: [email protected]


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Documents

An overview of mixed methods research