Question

Briefly describe how you would conduct a mixed methods study that focuses on the association between Mental Distress and HIV infection in an adult population. Address what type of mixed methods study and the level of Mixing.

Answer 1

Introduction:

Mixed methods research is the use of quantitative and qualitative methods in one study. Research is often dichotomized as quantitative or qualitative. Quantitative research, such as clinical trials or observational studies, generates numerical data. On the other hand qualitative approaches tend to generate non-numerical data, using methods such as semi-structured interviews, focus group discussions and participant observation. Historically, quantitative methods have dominated health research. However, qualitative methods have been increasingly accepted by the health research community in the past two decades, with a rise in publication of qualitative studies.

As the value of qualitative approaches has been recognized, there has been a growing interest in combining qualitative and quantitative methods. A recent review of health services research within England has shown an increase in the proportion of studies classified as mixed methods from 17% in the mid-1990s to 30% in the early 2000s.

The core characteristics of a well-designed mixed methods study / Level of Mixing:

1. Collecting and analysing both quantitative (closed-ended) and qualitative (open-ended) data.
2. Using rigorous procedures in collecting and analysing data appropriate to each method’s tradition, such as ensuring the appropriate sample size for quantitative and qualitative analysis.
3. Integrating the data during data collection, analysis, or discussion.
4. Using procedures that implement qualitative and quantitative components either concurrently or sequentially, with the same sample or with different samples.
5. Framing the procedures within philosophical/theoretical models of research, such as within a social constructionist model that seeks to understand multiple perspectives on a single issue—for example, what patients, caregivers, clinicians, and practice staff would characterize as “high quality treatment”.

How to Conduct Mixed methods study that focuses on the association between Mental Distress and HIV infection in an adult population:

Mixed methods can be an ideal technique to assess complex interventions. Evaluators can choose from five primary mixed methods designs depending on the research questions they want to answer and resources available for the evaluation.

Validate findings using quantitative and qualitative data sources. Evaluators can use a convergent design to compare findings from qualitative and quantitative data sources. It involves collecting both types of data at roughly the same time; assessing information using parallel constructs for both types of data; separately analysing both types of data; and comparing results through procedures such as a side-by-side comparison in a discussion, transforming the qualitative data set into quantitative scores, or jointly displaying both forms of data. For example, the investigator can gather qualitative data to assess the personal experiences of patients while also gathering data from survey instruments measuring the quality of care. The two types of data can provide validation for each other and also create a solid foundation for drawing conclusions about the intervention.

Use qualitative data to explore quantitative findings. This explanatory sequential design typically involves two phases:

(1) an initial quantitative instrument phase, followed by

(2) a qualitative data collection phase.

In which the qualitative phase builds directly on the results from the quantitative phase. In this way, the quantitative results are explained in more detail through the qualitative data. For example, findings from instrument data about costs can be explored further with qualitative focus groups to better understand how the personal experiences of individuals match up to the instrument results. This kind of study illustrates the use of mixed methods to explain qualitatively how the quantitative mechanisms might work.

Develop survey instruments. Yet another mixed methods study design could support the development of appropriate quantitative instruments that provide accurate measures. This exploratory sequential design involves first collecting qualitative exploratory data, analysing the information, and using the findings to develop a psychometric instrument well adapted to the sample under study. This instrument is then, in turn, administered to a sample of a population. For example, A study could begin with a qualitative exploration through interviews with primary care providers to assess what constructs should be measured to best understand improved quality of care. From this exploration, an instrument could be developed using rigorous scale development procedures that is then tested with a sample. In this way, researchers can use a mixed methods approach to develop and test a psychometric instrument that improves on existing measures.

Use qualitative data to augment a quantitative outcomes study. An outcomes study, for example a randomized, controlled trial, with qualitative data collection and analysis added, is called an embedded design. Within this type of an outcomes study, the researcher collects and analyses both quantitative and qualitative data. The qualitative data can be incorporated into the study at the outset; during the intervention (for example, to explore how participants experience); and after the intervention (for example, to help explain the results). In this way, the qualitative data augment the outcomes study, which is a popular approach within implementation and dissemination research.

Involve community-based stakeholders. A community-based participatory approach is an example of a multiphase design. This advanced mixed methods approach involves community participants in many quantitative and qualitative phases of research to bring about change. This design would involve primary care providers and staff, patients, and other providers and individuals in the community in the research process. Key stakeholders participate as co-researchers in a project, providing input about their needs, ways to address them, and ways to implement changes.