Exploiting the potential of mixed methods studies in health services research
Mixed methods studies, where qualitative and quantitative methods are used together in a single study, are undertaken in health services research (HSR). The question addressed here is whether researchers in HSR are fully exploiting the potential of mixed methods studies, and if not, then how they might maximise the potential of this approach. Methods used to examine this question included a review of the literature on mixed methods research; a quantitative documentary analysis of the research proposals, reports and publications of 75 mixed methods studies funded by ten Department of Health programmes in the period 1994 - 2004; and a qualitative study involving semi-structured face-to-face interviews with 20 researchers. It was evident from the documentary analysis that researchers are mixing methods in a range of different ways, with quantitative methods dominating, thus reflecting the conventional hierarchy of evidence in HSR. However, researchers could further exploit this approach by being clear about the purpose and practice of mixing methods when planning their studies, exploiting the contribution of qualitative components of studies, engaging with a wider range of ways of integrating data and findings from different components of a study, and being explicit in peerreviewed journal articles about any unique contribution made by this approach. Findings from the interviews with researchers suggest that researchers can contribute to fully exploiting the potential of mixed methods research by learning more about the different ways of integrating data and findings, respecting and understanding the strengths of the different methodological approaches, communicating with team members, and valuing integration. In HSR a multidisciplinary approach to team working is the norm whereby study components are undertaken separately. An interdisciplinary approach to team working is less common but may be associated with exploiting more of the potential of mixed methods studies. The external research environment appears to be conducive to interdisciplinary endeavour but not to interdisciplinary outputs. Structural change, as well as change in researcher behaviour, will be necessary if health services researchers are to fully exploit the potential of using mixed methods research.