Best Practices for Mixed Methods Research in the Health Sciences John W. Creswell,Ann Carroll Klassen,Vicki L. Plano Clark,Katherine Clegg Smith for the Office of Behavioral and Social Sciences Research;Qualitative Methods Overview Jo Moriarty

Reviewed by: Dawn Dowding University of Leeds, UK

Qualitative research and mixed methods research have an important role in the generation of knowledge for health and social care practice. Alongside more quantitative approaches to research that produce measurable evidence, qualitative approaches can provide in-depth insights into the context and meaning of experiences and provide possible explanations for the relationships between variables measured using more quantitative approaches. Both of the above papers have been developed to provide researchers with guidance on the use of mixed methods and qualitative research in the fields of health and social care, with the intention of helping to improve the quality of such research and the underlying evidence base.

Mixed methods research is defined by Cresswell et al. as ‘the intentional collection of both quantitative and qualitative data and the combination of the strengths of each to answer research questions' (p. 5). The focus of their overview is to provide guidance to researchers applying to the National Institute for Health (NIH) in the US with advice on what a ‘good quality’ mixed methods research study should consider. It also provides guidance on what a reviewer of a mixed methods research proposal should look for in order to evaluate its quality. It consequently provides a succinct, detailed and thorough overview of the nature of mixed methods research, together with a comprehensive reading list, that leaves the reader in no doubt about what they should be producing in order to provide a good quality research study.

In their overview Cresswell et al. discuss the basic tenets of mixed methods research; its underlying theoretical position, the strengths of combining quantitative and qualitative data and an overview of ways in which data from multiple methods of data collection can be integrated. Through their discussions of integrating data through merging (where the results of different study elements are presented together), connecting (where data from one data set is used to help inform the collection of data using different methods) and embedding (where data from one element of a study is embedded within another study design) they provide a useful guide to the range and complexity of the different possible designs in mixed methods research. They also provide a useful insight into the types of research questions that would be suitable for the use of a mixed methods study design (and by implication those types of study where they would not be appropriate).

I would recommend that individuals read both the section on how a mixed methods study should be designed (pp. 6–9) and the chapter on developing an R-series plan (pp.16–26) concurrently. The first provides a methodological overview on considerations for designing a mixed methods study, the second, practical advice and insights into how to write a mixed methods study proposal. Although the focus is on the NIH investigator R-series research grant application, the basic principles are the same for any good quality research proposal. If their advice and guidance is followed (and the reader makes use of the further reading lists) they should be able to produce a high quality, well argued and thought out research proposal which can provide an argument for the benefits of using mixed methods research, a rationale for the design chosen and an overview of the methods that are to be used (and why).

Further sections consider the type of research team that is necessary in order to deliver a mixed methods research study and guidelines for reviewers of mixed methods study applications. Consideration of the multi-disciplinary nature of a research team that is often required to deliver on a mixed methods research study provides valuable advice to novice researchers. By their nature mixed methods research studies are often collaborative ventures, and being explicit at the beginning about the skills that are required on a project team, ensures that individuals with those skills are identified appropriately. The checklists that are provided on pages 31–33 which outline the quality criteria used to evaluate a mixed methods study are equally as useful for individuals developing their study, to ensure that all the criteria are adequately addressed in the research proposal. Although this paper is not a textbook on mixed methods study designs, it provides a detailed and thoughtful analysis of mixed methods research, which could be a useful resource for individuals assessing the quality of mixed methods studies that have been completed. It could also be a useful introductory resource for students carrying out research studies in the areas of health and social care.

In contrast to the paper by Cresswell et al., it is unclear exactly what the purpose (and therefore who the potential audience may be) of the paper by Moriarty. The introduction suggests that it will provide an overview of qualitative research in social care, with a view towards helping improve the evidence base in the future. However, as it does not explicitly provide guidance to researchers on how to design (or write) a high quality research proposal (as covered by the Cresswell et al. paper), it is not exactly clear how this might be achieved. The paper covers issues such as what qualitative research methods are, when and how they may be appropriate, and different theoretical perspectives on qualitative research. One of the strengths of Moriarty’s review is the references to research studies that have been carried out in social care using qualitative methods, which can provide a useful resource for readers to explore how such research can be carried out in practice.

The paper begins by providing an overview of the nature of qualitative research methods, why they are relevant and how such methods have developed in social care research. Through this discussion a clear rationale for why qualitative approaches might be beneficial in social care research is presented, but there is little analysis of how they complement other methods, and the types of questions that may be addressed by well designed qualitative studies.

Following on from this, the paper then briefly discusses theoretical approaches in qualitative research, before discussing approaches to sampling and methods of collecting qualitative data (focusing on interviews, focus groups and observation data). These sections are very descriptive – basically outlining what theoretical approaches there are, what methods of sampling there are, and what the different types of data collection are. There is little evaluation of the strengths and limitations of different approaches, or any consideration of what a ‘well designed’ study using specific types of sampling method or data collection method would look like.

Following from this there is discussion of different approaches to qualitative research; grounded theory, case study approaches, conversation analysis, ethnography and life history and narrative inquiry research. For each approach there is an overview of the origins and characteristics of the approach, areas where the approach could be used in social care research, advantages of the approach and disadvantages. As part of the discussion for each research approach, examples of studies that have been carried out in the field of social care are provided, which gives the reader some insights into the types of questions that have been addressed and the types of findings that have been produced from such studies. It is also helpful to have a summary of the limitations and critique of each approach, as this provides insights into the limitations that researchers need to be aware of when designing studies. However, as with the previous sections the overviews are by necessity brief and descriptive, and there is little detail on what a ‘good’ study using the different approaches might look like.

Having discussed different qualitative approaches, ethical issues that may arise in carrying out qualitative research in social care are discussed. This is a useful section that highlights areas of ethical concerns that researchers need to be aware of and provides some guidance on the things that you would need to think about and address in an ethics committee application. The paper ends with a discussion of how to consider the resources available to a researcher when considering an appropriate study design and recommendations for future research in social care. As with other areas in this paper the review highlights important areas for consideration, but does not really offer any in-depth analysis of them, or guidance on how a researcher might want to address them to ensure that any study they carry out is as well designed as possible.

My evaluation of the paper by Moriarty is that in attempting to provide an overview of qualitative research approaches specifically for social care researchers, it has in effect provided a broad overview with little real analysis or specific guidance. I felt reading it that there was little in the paper that I could not have learned by reading a good qualitative research textbook, complemented by an overview of the types of qualitative research that has been carried out previously in social care fields.

The contrast between these two papers when read together is an interesting one. By specifically providing guidance to researchers on how to write a good mixed methods research proposal, Cresswell et al. have in effect produced an extremely useful resource for health and social care researchers on what constitutes a ‘good’ mixed methods study, which can be used by a number of audiences to assess the quality of proposed or already conducted research. This is not the case for the Moriarty paper, which came across as less a useful resource for researchers, and more a review paper useful for students new to the field. At the end of the review of qualitative research I was not clear what a well designed study would look like, meaning that it is also not clear how it would be able to add to the evidence base for social care research. I would be very happy to suggest that the Cresswell publication be part of the recommended reading for both experienced and novice researchers alike. From it the reader will learn a lot about both mixed methods research designs and how to write a good research proposal. I would suggest that researchers interested in the field of qualitative research might be better off reading the original texts in the reference list for the Moriarty paper and considering papers that try to explore how to evaluate the quality of qualitative research (e.g. Daly et al., 2007; Hannes et al., 2010). This would be a better approach in terms of learning what a well designed qualitative study might look like, in order to assist both with proposal writing and research study evaluation.