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Achieving integration in mixed methods designs-principles and practices.

ABSTRACT: Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs-exploratory sequential, explanatory sequential, and convergent-and through four advanced frameworks-multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods.

SUBMITTER: Fetters MD

PROVIDER: S-EPMC4097839 | biostudies-other | 2013 Dec

REPOSITORIES: biostudies-other

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Achieving integration in mixed methods designs-principles and practices.

Fetters Michael D MD Curry Leslie A LA Creswell John W JW

Health services research 20131023 6 Pt 2

Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs-exploratory sequential, explanatory sequential, and convergent-and through four advanced frameworks-multistage, intervention, case study, and participatory. ...[more]

PMID: 24279835

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Project description:BACKGROUND:Dignity Therapy (DT) is a short-term intervention to reduce psychological suffering in end-of-life care. Its strength lies in evidenced-based development and investigation. The aim of the present study is to investigate the feasibility of DT at German palliative care units (PCU), as well as the acceptability and adaption of a German version of the DT question protocol (DTQP). METHOD:A clinical multicentre mixed methods study, whereby patients and relatives provided quantitative (feedback questionnaires) and qualitative (cognitive interviews) data on the DT intervention. Before using the DTQP on patients, healthcare professionals (HCP) were invited to participate in cognitive interviews to provide input on DT. Therefore 360° feedback was achieved. Finally, the conducted DT interviews were examined. The study took place at two German PCUs (Mainz and Würzburg). Participating HCPs were physicians, psychologists, nurses and chaplains. Patients admitted to the PCUs were eligible to participate if they had a terminal illness and a life expectancy ranging from 2 weeks to 12 months. RESULTS:Out of 410 admitted patients, 72 were eligible and 30 (7.3% of all patients and 41.7% of eligible patients) participated. On average, 9 questions from the DTQP were used per DT interview. Subsequent cognitive interviews with patients produced four main categories of feedback (on the title, the question protocol, wording, and the questions actually asked). Finally, of the 30 participants, 19 completed the feedback questionnaire, as did 26 relatives. Of those, 18 patients and 24 relatives evaluated DT as helpful. CONCLUSIONS:DT is feasible for German PCUs. Our research yielded a validated German translation of the DTQP following EORTC guidelines and findings were reported according to the COREQ checklist for qualitative design. TRIAL REGISTRATION:The study was registered retrospectively on the 22nd of December 2017 at the German Clinical Trials Register ( DRKS00013627 ).

Project description:BackgroundLiterature suggests an increasing trend towards more screening tests, while awareness of potential harms of screenings has been reported to be sub-optimal. This paper aimed to characterize ANC screening practices within the 53 countries of the WHO Europe Region and compare these to evidenced-based recommendations from WHO and from other key reference sources.MethodsFrom January 2019 to July 2019 we conducted a survey among key informants (KIs) in the 53 countries of the WHO European Region and a systematic review of literature. KIs were invited to answer an online structured questionnaire, available both in English and Russian. Published and unpublished guidelines, policies or cross-sectional studies on ANC screening practices were searched for in four electronic databases (MEDLINE, Global Health Library, Web of Science, Google) and also sent by KIs. Data obtained from both methods were analysed and triangulated by two independent authors.ResultsOverall 42 countries participated in the survey. Among these, 36 (86%) reported national guidelines on ANC screening, but only 26 (61.9%) reported up-to-date and comprehensive guidelines. All countries reported supplemental use other guidelines, with 19 (45.2%) using more than three. When looking at current evidence-based recommendations, only one (ultrasound before 24 weeks) was reported to be implemented in all countries. Overall, 35 (83.3%) countries reported using at least five not-recommended ANC screening practices, with 21 (50%) implementing ≥10 not-recommended ANC screening practices. The systematic review resulted in 11871 records, with 111 (90 guidelines, 4 policies, 17 cross-sectional studies) matching inclusion criteria. Findings from the systematic review were largely consistent with those of the online survey: among the most comprehensive national guidelines identified, only six (24%) had a concordance ≥75% with the reference recommendations, independently from their publication date, while the few existing cross-sectional studies highlighted large heterogeneity in the implementation of ANC practices among countries.ConclusionsGuidance on and implementation of evidenced-based recommendations on ANC screening is suboptimal in the WHO European Region. It is necessary to increase the availability of evidence-based high-quality national guidelines and their concrete use in routine practice.

Project description:Mixed methods are commonly used in health services research; however, data are not often integrated to explore complementarity of findings. A triangulation protocol is one approach to integrating such data. A retrospective triangulation protocol was carried out on mixed methods data collected as part of a process evaluation of a trial. The multi-country randomised controlled trial found that a web-based training in communication skills (including use of a patient booklet) and the use of a C-reactive protein (CRP) point-of-care test decreased antibiotic prescribing by general practitioners (GPs) for acute cough. The process evaluation investigated GPs' and patients' experiences of taking part in the trial.Three analysts independently compared findings across four data sets: qualitative data collected view semi-structured interviews with (1) 62 patients and (2) 66 GPs and quantitative data collected via questionnaires with (3) 2886 patients and (4) 346 GPs. Pairwise comparisons were made between data sets and were categorised as agreement, partial agreement, dissonance or silence.Three instances of dissonance occurred in 39 independent findings. GPs and patients reported different views on the use of a CRP test. GPs felt that the test was useful in convincing patients to accept a no-antibiotic decision, but patient data suggested that this was unnecessary if a full explanation was given. Whilst qualitative data indicated all patients were generally satisfied with their consultation, quantitative data indicated highest levels of satisfaction for those receiving a detailed explanation from their GP with a booklet giving advice on self-care. Both qualitative and quantitative data sets indicated higher patient enablement for those in the communication groups who had received a booklet.Use of CRP tests does not appear to engage patients or influence illness perceptions and its effect is more centred on changing clinician behaviour. Communication skills and the patient booklet were relevant and useful for all patients and associated with increased patient satisfaction. A triangulation protocol to integrate qualitative and quantitative data can reveal findings that need further interpretation and also highlight areas of dissonance that lead to a deeper insight than separate analyses.

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Achieving integration in mixed methods designs-principles and practices.

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Achieving integration in mixed methods designs-principles and practices.

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