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A nurses’ guide to mixed methods research

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A nurses’ guide to mixed methods research

AUTHOR
Rebecca (Becky) Ingham-Broomfield, JP.
RN (NSW), ENB249 Cardio-thoracic Nursing (London), CertEd,
DipNurs (London), BSc (Hons), MSc (Health Psychology).
Lecturer in Nursing
Armidale Rural Referral Hospital, Armidale, NSW, Australia
[email protected]

KEY WORDS
research methodology, qualitative research, quantitative research, mixed methods, triangulation, evidence based
practice (EBP).

ABSTRACT
Objective
This article provides a breakdown of the components of mixed methods research methodology. The intention of the
article is to simplify the terminology and process of mixed methods research to enable novice readers of research to
have a better understanding of the language and concepts involved. The Survey method, using both qualitative and
quantitative research methods, will be used to explain the principles of mixing methods.

Primary Argument
Australian nurses work in an environment where evidence-based practice is mandatory. Understanding the research
process and terminology used may benefit nurses to implement research in their day-to-day practice. Gaining
knowledge of the different approaches used in mixed methods research is paramount if nurses are to base their
care on research which has utilised this style.

Conclusion
As mixed methods are used in nursing, social and behavioural research it is essential that nurses understand the
methodology. The main components of mixed methodology will, therefore, be discussed in a systematic, logical
order.

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INTRODUCTION
Currently the Nursing and Midwifery Board of Australia include a requirement for nurses to evaluate and
implement research in their care (Borbasi and Jackson 2012, p.22; Nursing and Midwifery Board of Australia
2013a). All nurses are expected to be actively involved in implementing or undertaking research (Borbasi and
Jackson 2012, p.22) as a major goal of nursing research is to improve health care and outcomes (Moxham
2015; Benner 1984). Evidence based or ‘best practice’ nursing in Australia is supported by the Joanna Briggs
Institute (Chang and Daly 2012). As evidence based practice and research are threaded through professional
work and study in the health sciences (Wright-St Clair et al 2014, p.5) nurses, particularly novice nurses, may
benefit from a discussion that helps them understand the sequence of a research paper (Moxham 2015)
using mixed methods.

The emergence of mixed methods, which was considered a third methodological movement, began during
the 1980’s (Tashakorri and Teddie 2003). The first and second movements were quantitative methodology
and qualitative methodology. Mixed methods are also known as ‘multi-methodology’ or ‘triangulation’ and
are considered to have high validity due to the variation in data collection (Bulsara 2015; Taket 2013). Mixed
methods research is further defined by Jirowong et al (2014, p.360) as research that ‘systematically combines
the collection and analysis of both qualitative and quantitative data in the same study’. This style of research
allows investigators to combine both numeric and narrative data in their analysis (Lewis, 2013 p.166). Mixing
methods offers a richer explanation than single use of either qualitative or quantitative methods as it can draw
on the strength of each approach and overcome their weaknesses (Lewis 2013, p.167; National Institutes
of Health 2011). The range and description of how methods can be mixed is extremely wide (Wurtz 2015;
Taket 2013) therefore this paper will address mixed methods very broadly.

THE MIXED METHODS RESEARCH PAPER

The rationale behind using a mixed methods approach
Many authors and investigators have discussed the rationale behind combining qualitative and quantitative
research methodology. The following discussion provides a breakdown of the main reasons for using mixed
methods.

Mixed methodology can answer a research question from a number of perspectives and ensures there are no,
or fewer, ‘gaps’ to the information collected (Bulsara 2015; Jirojwong et al 2014). Pre-existing assumptions
from the researcher are less likely to occur, and inferences made stronger, as different approaches can
yield broader information given that one method may not be able to provide all the information required
(Bulsara 2015; Jirojwong et al 2014). As Wurtz (2015) explains, using mixed methods can provide a deeper
understanding of behaviour, or a better idea of the meaning behind what is occurring. Most significantly mixed
method research can include culture in the design by giving a voice to everyone involved in the behaviour
being examined (Wurtz 2015). As Taket (2013) further explains, mixed methods can empower research
participants by providing appropriate means for them to choose how and whether to participate. For example,
a self-completion questionnaire excludes those who do not have the ability to read or write (Taket 2013),
however, if an interview is also included in the methodology, they may be able to participate with greater
autonomy (Liamputtong 2013, p.326).

There are six categories of Mixed Method Designs (Wurtz 2015) described in the grid at the end of this paper.
Creswell and Plano Clark (2011, pp.69 - 101) agree there are six major designs but attribute several differing
names to those given by Wurtz (2015).

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In brief, a mixed methods study is not two separate studies addressing a specific issue but one study that
employs different methods to address a specific research question or hypothesis (Jirojwong et al 2014, p.281).

Survey Method
The Survey Method will be used as an example of how qualitative and quantitative frameworks can be used
together to research subjects. A survey is defined as a data collection tool to gather information about
individuals (Privitera 2014). It may aim to collect factual information (quantitative data) and/or opinions of
individuals through interviews (qualitative data). Surveys may be wholly quantitative but using mixed methods
allows for greater depth. It is one of the most commonly used methods in social science research (Hamer
and Collinson 2014).

Abstract/Summary
An abstract or summary of a mixed methods paper using survey technique will provide a brief objective
summary of the research report. The rationale and background of the study should be provided and also
include the theoretical and methodological processes for gathering information (Borbasi and Jackson 2012).

Identifying the problem

Survey designs can use a hypothesis (Privitera 2014) or research question (Jirojwong et al 2014, p.273). A
hypothesis is defined by Johnson and Hengstberger-Sims (2014, p.35) as a statement about the relationship
between two or more variables (also known as factors or characteristics).Whilst a survey can be used as
a measurement tool in many research designs, survey research specifically refers to the use of surveys to
quantify, describe or characterise an individual or group (Privitera 2014).

Literature Search
The literature review is generally found in the introductory section of a research paper (Polit and Hungler
2013). The function of a literature search in mixed method research varies depending on the classification of
the study. As a survey consists of many questions, or statements, to which participants respond, the literature
may be used to inform the researcher of questions or approaches previously used.

METHODOLOGY
Design
The survey research design can be administered either in written form and/or through interview. The survey
will include a series of questions or statements, called items, used in a questionnaire and /or interview to
measure responses (Privitera 2014, p.226).

There are three types of questions or statements used in a survey, namely open-ended items, partially open-
ended and restricted items (Privitera, 2014). The open-ended questions can be used in interviews on an
individual basis, or within a focus group, to glean qualitative information. A focus group is based on group
discussion to elicit the respondent’s perceptions, opinions, beliefs and attitudes (Jirojwong et al 2014, p.359).
The participants are able to express their views by interacting within a group discussing an issue or number
of issues (Liamputtong 2013). Partially open questions have several set answers but allow the researcher to
ask extra questions (Jirojwong et al 2014; Liamputtong 2013). An example of a restricted item, also known as
a closed-ended item, includes restricted answer options and commonly uses a Likert scale (Privitera 2014).
The Likert scale usually has between three and seven columns with options such as strongly agree, agree,
not sure, disagree and strongly disagree. Whilst the Likert scale can be used to elicit responses regarding
attitudes and beliefs, statistics can be produced from the responses as the responses can be assigned a
numerical value (Jirojwong et al 2014, p.360).

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Other response formats may include verbal rating scales where a range of verbal responses are provided
and the participant circles the one that most closely mirrors their view, or visual analogue scales, which asks
the respondent to mark a position on a line between 0 and 10 or 0 and 100 depending on the nature of the
question (Liamputtong 2013, p.212)

Sample
The sample population is very variable in mixed methods research. It can vary from small groups to huge
populations. Subjects of survey research may be called participants, informants or subjects. Samples may
be selected using convenience (purposive) or probability (random) techniques which means the sample was
specifically chosen to ensure the data gathered is ‘information-rich’ (Borbasi and Jackson 2012, p.135).
The quantitative element will mean the sample can be larger but sampling decisions need to be based
on the research question. As Lewis (2013 p.277) further explains, mixed methods research has at least
two components, elements or phases which means drawing a sample is hard to specify but, very generally
speaking, a qualitative (purposive) sample would be less than 30 and a quantitative (probability) sample
would be greater than 50.

Concurrent designs (merging qualitative and quantitative research) include the need for adequate sample
sizes and being consistent in analysis whereas sequential designs (one phase of qualitative research which
then builds on quantitative research or vice versa) results in decisions needing to be made on choosing
appropriate sampling and sample sizes for both phases (National Institutes of Health 2011). To put it simply,
it is very hard to match qualitative data to quantitative data as investigators, who hold different philosophical
positions, may find mixed methods research to be challenging because of the tensions created by their differing
beliefs (National Institutes of Health 2011).

Ethics
Consent should be obtained after full explanation of the study’s intent (Borbasi and Jackson 2012). All nursing
research should consider ethics and potential harm (Nursing and Midwifery Board of Australia 2013b). For
example, data collection from web surveys should be undertaken so identities cannot be accessed. Participants
should be de-identified (Liamputtong 2013, p.30). The investigator is obliged to consider the implications
of the proposed research for the participating subjects, their families and society (Burns and Grove, 2009).
Permission for nursing research is sought from an ethics committee appropriate to the situation (Jirojwong et
al 2014, pp.63-66; Elliott et al 2013, p.93). The ethical principles of autonomy, beneficence, non-maleficence
and justice are widely acknowledged in contemporary regulatory research ethics frameworks (Liamputtong
2013, p.27).

Pilot Study
A pilot study as a trial run of the research which is conducted on a small number of participants (Polit and
Hungler 2013; Nieswiadomy 2012). The pilot study allows the researcher to assess the adequacy and feasibility
of the intended research (Moxham 2015, p.35). With mixed methods research, using a survey technique,
is important to identify problems or ‘flaws’ and strengthen the combination of qualitative and quantitative
methodology by identifying practical and methodological issues (Bulsara 2015). Modifications can be made
prior to the main study (Kim 2011).

Main Study
Issues of validity are challenging as qualitative and quantitative research have developed through different
pathways (Jirojwong et al 2014, p.279). The essential component for the researcher is to ensure the research
demonstrates the established research rigour required by each method (Teddie and Tashakkori 2009, cited
in Jirojwong et al 2014). It is generally accepted that the qualitative or quantitative elements in a mixed
methods study can have equal status or that one approach may be dominant.

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In mixed methods research the investigators intentionally integrate and combine both qualitative and
quantitative data rather than separate it. The challenge is how to integrate it (National Institutes of Health
2011). As Liamputtong (2013, p.339) states the combination of qualitative and quantitative data can produce
a richer understanding of a number of different factors within a piece of research.

Analysis and Results

Investigators may use codes or colour coding to identify common themes. The codes can be counted and
totals given for a response frequency (Bulsara 2015). This works well with survey questions and responses
which generate figures but the data can also be considered qualitative if the researcher is seeking opinions
and attitudes (Bulsara 2015). The main findings will be discussed according to which design was used (refer
to GRID below). Issues may arise when analysing the data because of the combination of the qualitative and
quantitative designs. This may mean the researcher has to gather more data or revisit databases (National
Institutes of Health 2011).

Two articles in this series discuss this section in more depth, namely, A nurses’ guide to Quantitative research
(Ingham-Broomfield 2014) and A nurses’ guide to Qualitative research (Ingham-Broomfield 2015).

Discussion/Recommendations
Whatever method is used in research papers, this section usually tries to clarify what the results mean. There
should be an interpretation of the results, the study limitations and possible implications for further research
to advance knowledge (Polit and Hungler 2013; Nieswiadomy 2012). The researcher will discuss problems
encountered including the methodology chosen.

Conclusions of the research paper using mixed methods

Any research study design and findings need to be critiqued by the author(s) in the research study’s discussion
section. The investigators may discuss the complexity of the mixed methods approach. Most conclusions
summarise the main points, review the research method, repeat the findings, discuss the limitations and
offer suggestions for future research related to the subject researched (Nieswiadomy, 2012).

Reference list
The Reference List will contain research papers including books and other journal articles which may contain
a selection of qualitative, quantitative and mixed methods sources to support the concepts outlined (Ingham-
Broomfield 2014).

CONCLUSION
The methodological approach used in this paper has discussed mixed methods, using the survey method
as an example, in a logical and systematic order. This paper has discussed the main components of mixed
methods research for nurses who are new to this process and its terminology.

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GRID
Quantitative (QUAN) and Qualitative (QUAL)
Category Sequential Sequential Sequential Concurrent Concurrent Concurrent
Explanatory Exploratory Transformative Triangulation Nested Transformative
Design Design design Design Design Design

Collection QUAN stage 2 stages 2 distinct stages QUAL and QUAN QUAL and QUAN Guided by
and analysis followed by -Priority –theoretical data collection data collection a specific
of data QUAL stage given to perspective used is concurrent – is concurrent theoretical
QUAL data to guide the study only one data perspective.
followed by collection phase QUAL and QUAN
QUAN collected during
the same phase

Priority given QUAN QUAL Whichever serves Ideally equal Either QUAL or Ideally equal
to which data the theoretical priority to both QUAN dominate priority to both
perspective best QUAL and QUAN the design QUAL and QUAN

Integration of Interpretive Interpretive Interpretive phase Interpretive Analysis phase Analysis phase
data occurs phase phase phase mixes both but can also
during this QUAL and QUAN occur in the
research data interpretive
phase stage

Purpose QUAL results QUAN data Whichever serves Focuses on QUAL used to The purpose
used to used to help the theoretical similarities and better explain is to use
help explain interpret perspective best differences, QUAN data methods that
QUAN QUAL phase with the primary will best serve
results purpose to the theoretical
support each perspective of
other the researcher

(Wurtz 2015; Lewis 2013)

REFERENCES
Benner, P. 1984. Benner’s Stages of Clinical Competence 13-34. Retrieved from http://www.health.nsw.gov.au/nursing/projects/
Documents/novice-expert-benner.pdf (accessed April 2016).
Borbasi, S. and Jackson, D. 2012. Navigating the Maze of Research. Mosby Elsevier: Chatswood, Sydney.
Bulsara, C. 2015. Using a Mixed Method Approach to Enhance and Validate your Research. Retrieved from http://www.nd.edu.au/
downloads/research/ihrr/using_mixed_methods_approach_to_enhance_and_validate_your_research.pdf (accessed April 2016).
Burns, N. and Grove, S.K. 2009. The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence. Saunders Elsevier:
Maryland Heights, Missouri.
Chang, E. and Daly, J. 2012. Transitions in Nursing (3rd edn). Churchill Livingstone, Elsevier: Sydney.
Creswell, J.W. and Plano Clark, V.L. 2011. Designing and Conducting Mixed Methods Research. SAGE Publications Inc: Thousand Oaks,
California.
Elliott, D., Aitken, L. and Chaboyer, W. 2013. ACCCN’s Critical Care Nursing. Mosby Elsevier: Chatswood, Sydney.
Hamer, S. and Collinson, G. 2014. Achieving Evidence-Based Practice - A Handbook for Practice Retrieved from http://bookdirectory.
net/?p=312122 (accessed April 2016).
Ingham-Broomfield, R.M. 2014. A nurses’ guide to Quantitative Research. Australian Journal of Advanced Nursing, 32(2):32-38.
Ingham-Broomfield, R.M. 2015. A nurses’ guide to Qualitative Research. Australian Journal of Advanced Nursing, 32(3):34-40.
Jirojwong, S., Johnson, M. and Welch, A. 2014. Research Methods in Nursing and Midwifery (2nd ed). Sydney: Oxford University Press.
Johnson, M. and Hengstberger-Sims, C. 2014. Introducing the Research Process. In S. Jirojwong, M. Johnson and A. Welch (ed), Research
Methods in Nursing and Midwifery. Oxford University Press: Sydney, Australia.
Kim, Y. 2011. The Pilot Study in Qualitative Inquiry. Retrieved from http://qsw.sagepub.com/content/early/2010/04/21/1473325010362001
(accessed April 2016).

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Lewis, J. 2013. Mixed Methods Research. In S. Jirojwong, M. Johnson and A. Welch (ed), Research Methods in Nursing and Midwifery
(1st ed). Oxford University Press: Sydney, Australia
Liamputtong, P. 2013. Research Methods in Health. Oxford University Press: South Melbourne, Australia
Moxham, L. 2015. Nurse Education, Research and Evidence-Based Practice. In A. Berman, S. J. Snyder, T. Levett-Jones, M. Hales, N.
Harvey, Y. Luxford, L. Moxham, T. Park, B. Parker, K. Reid-Searl and D. Stanley (ed). Kozier & Erb’s Fundamentals of Nursing (3rd ed, Vol.
1). Pearson Australia: Frenchs Forest, Sydney.
National Institutes of Health. 2011. Best Practices for Mixed Methods Research in the Health Sciences. Retrieved from http://obssr.
od.nih.gov/scientific_areas/methodology/mixed_methods_research/pdf/Best_Practices_for_Mixed_Methods_Research_the_nature_
and_design_of_mixed_methods_research.pdf (accessed April 2016).
Nieswiadomy, R.M. 2012. Foundations of Nursing Research. Pearson: Boston, MA.
Nursing and Midwifery Board of Australia. 2013a. Code of Professional Conduct for Nurses in Australia. Retrieved from http://www.
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Taket, A. (2013). The Use of Mixed Methods in Health Research. In P. Liamputtong (Ed.), Research Methods in Health. South Melbourne:
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presentations/other/0809-mixedmethods.pdf (accessed April 2016).

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