Using mixed methods research in medical education: basic guidelines for researchers

Context  Mixed methods research involves the collection, analysis and integration of both qualitative and quantitative data in a single study. The benefits of a mixed methods approach are particularly evident when studying new questions or complex initiatives and interactions, which is often the case in medical education research. Basic guidelines for when to use mixed methods research and how to design a mixed methods study in medical education research are not readily available.
Methods  The purpose of this paper is to remedy that situation by providing an overview of mixed methods research, research design models relevant for medical education research, examples of each research design model in medical education research, and basic guidelines for medical education researchers interested in mixed methods research.
Conclusions  Mixed methods may prove superior in increasing the integrity and applicability of findings when studying new or complex initiatives and interactions in medical education research. They deserve an increased presence and recognition in medical education research.     

A process for the inclusion of Aboriginal People in health research: lessons from the Determinants of TB Transmission project

The Determinants of TB Transmission (DTT) project, a federally-funded study covering the period April 1, 2006-March 31, 2013, and examining the determinants of TB transmission amongst the Canadian-born population (Aboriginal and non-Aboriginal) in the prairie provinces of Canada, took a novel approach to health research involving Aboriginal people. The methodology aligned itself with the recently published Canadian Institutes of Health Research (CIHR) Guidelines for Health Research Involving Aboriginal People and the established principles of Ownership, Control, Access, and Possession (OCAP). This article details the process by which collaboration with Aboriginal peoples was achieved, including the involvement of Aboriginal researchers, the development of Provincial Network Committees (PNCs), and communications with First Nations Chiefs and Council. Strengths of this methodology included Aboriginal organizational and community support with a high rate of participation; PNC leadership, which brought together Aboriginal stakeholders with provincial and federal TB program planners; and the exploration of both on and off-reserve transmission factors. Challenges of the methodology included meeting funding agency timelines and expectations given the gradual process of trust development and PNC-reviewed publication; respecting both community and individual participants' autonomy regarding study participation; and political discomfort with strong Aboriginal involvement. While the methodology required a dedicated investment from researchers and funding agencies alike, the process was worthwhile and achieved a high degree of support from its major collaborators: the Aboriginal peoples.     

试论个案研究方法在卫生政策分析中的应用

个案研究是社会科学中常见的研究复杂社会系统的方法之一,对于研究卫生政策过程有着很强的适用性。本文在回顾相关方法学与个案研究文献的基础上,从个案研究的特点、类别、设计与实施等方面初步介绍了个案研究方法的总体思路和手段,并结合卫生政策过程的特点,从研究设计、个案选择、研究推广等方面,初步探讨了个案研究方法在卫生政策研究中的应用。     

A Typology of Health Marketing Research Methods–Combining Public Relations Methods with Organizational Concern

Research plays a critical role throughout virtually every conduit of the health services industry. The key terms of research, public relations, and organizational interests are discussed. Combining public relations as a strategic methodology with the organizational concern as a factor, a typology of four different research methods emerges. These four health marketing research methods are: investigative, strategic, informative, and verification. The implications of these distinct and contrasting research methods are examined.     

A new inter-professional course preparing learners for life in rural communities

The 'Professionals in Rural Practice' course was developed with the aim of preparing students enrolled in professional programs in Canada to become better equipped for the possible eventuality of professional work in a rural setting. To match the reality of living and working in a rural community, which by nature is interprofessional, the course designers were an interprofessional teaching team. In order to promote group cohesiveness the course included the participation of an interprofessional group of students and instructors from the disciplines of medicine, nursing, occupational therapy, physical therapy, teacher education, and theology. The format of the course included three-hour classes over an eight-week period and a two-day field experience in a rural community. The course utilized various experiential and interactive teaching and learning methods, along with a variety of assessment methods. Data were collected from student participants over two iterations of the course using a mixed methods approach. Results demonstrate that students value the interprofessional and experiential approach to learning and viewed this course as indispensable for gaining knowledge of other professions and preparation for rural practice. The data reveal important organizational and pedagogical considerations specific to interprofessional education, community based action research, and the unique interprofessional nature of training for life and work in a rural community. This study also indicates the potential value of further longitudinal study of participants in this course. Key words: Canada, community based action research, education, interdisciplinary, interprofessional.     

Policy and organizational implications of gender imbalance in the NHS

PURPOSE: The purpose of the paper is to examine the policy and organizational implications of gender imbalance in management, which research suggests exists in the NHS. DESIGN/METHODOLOGY/APPROACH: The research in this paper involved a qualitative approach with an analysis of elite interviews conducted with a non-random sample of officials involved in health policy and interviews with a random sample of senior managers in NHS Scotland. The research formed part of a larger study, which explored the enablers and inhibitors to female career progression in various Scottish sectors. FINDINGS: The paper finds that gender imbalance in management exists in the NHS. This is manifested in a masculine organizational context, leadership and policy decision-making process, which have implications for female career advancement opportunities and subsequently access to macro policy decisions. RESEARCH LIMITATIONS/IMPLICATIONS: The paper involved a sample (30 percent) of senior managers and examined policy processes in NHS Scotland. To improve the external validity of the findings further research should be conducted in NHS organizations in England and Wales. PRACTICAL IMPLICATIONS: The findings in the paper suggest that gender imbalance in management and a masculine organizational context and leadership style within the NHS create a less than conducive environment for female employees. This has practical implications in terms of levels of part-time employment, career progression and attrition rates. ORIGINALITY/VALUE: The paper adds to the debate of gender and organizational studies by examining the health sector, which has high levels of female employment but low levels of female representation at senior management levels. The paper therefore adds to an often-neglected area of study, women in leadership and senior managerial positions. The paper is original in its approach by examining the micro and meso organizational dimensions which impact on women's ability to influence macro health policy.     

Researching sexual and reproductive behaviour: a peer ethnographic approach

In recent years, ethnographic research has challenged the notion within demography that fertility-related behaviour is the outcome of individualistic calculations of the costs and benefits of having children. Anthropology has further criticised the abstraction in demographic analysis of sexual behaviour and fertility decision-making from the socio-cultural and political context in which the individual or couple is located. Within demography itself, institutional and political-economic analyses have argued strongly that sexual and reproductive behaviour must be understood within locally specific social, cultural, economic and political contexts. Positivist and empiricist research methods, such as the sample survey and focus groups, which continue to dominate demographic inquiry and applied research into sexual and reproductive behaviour, have been shown to be limited in their ability to inform about the process of behaviour change and contexts within which different behaviours occur. The article introduces a new methodology for researching sexual and reproductive behaviour, called the peer ethnographic approach, which the authors have developed in an attempt to address some of the limitations of the methods which currently dominate research into sexual and reproductive behaviour. The peer ethnographic methodology is discussed in detail and the results of recent field-testing are reported, which show that, although the approach has limitations, it also has the potential to make a significant contribution to our understanding of sexual and reproductive behaviour.     

Applying Lean principles and Kaizen rapid improvement events in public health practice

This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.     

Q‐ING FOR HEALTH—A NEW APPROACH TO ELICITING THE PUBLIC'S VIEWS ON HEALTH CARE RESOURCE ALLOCATION

The elicitation of societal views about healthcare priority setting is an important, contemporary research area, and there are a number of studies that apply either qualitative techniques or quantitative preference elicitation methods. However, there are methodological challenges in connecting qualitative information (what perspectives exist about a subject) with quantitative questions (to what extent are those perspectives ‘supported’ in a wider population). In this paper, we present an integrated, mixed‐methods approach to the elicitation of public perspectives in two linked studies applying Q methodology. In the first study, we identify three broad viewpoints on the subject of health priorities. In the second study, using Q‐survey methods, we describe and illustrate methods to investigate the distribution of those views in the wider population. The findings of the second study suggest that no single viewpoint dominates and none of the three views represents a ‘minority perspective’. We demonstrate the potential of Q methodology as a methodological framework that can be used to link qualitative and quantitative questions and suggest some advantages of this over other approaches. However, as this represents the first applied study of this kind, there are methodological questions that require further exploration and development. Copyright © 2013 John Wiley & Sons, Ltd.     

Retracted: Determinants of project success among HIV/AIDS nongovernmental organizations (NGOs) in Rakai,Uganda

The aim of the study was to identify the main determinants of grassroots project success among HIV/AIDS NGOs operating in Rakai, Uganda. It was a cross‐sectional study using face‐to‐face interviews in a mixed‐methods approach among community members and NGOs involved in providing HIV/AIDS and related health services. The study found that the success of grassroots projects of HIV/AIDS NGOs essentially relies on adequate financial resources, competent human resources, strong organizational leadership, and NGO networking. These data suggest that to increase grassroots project success, HIV and AIDS NGOs in Rakai need to improve not only the budget base and human capacities but as well decision‐making processes, organizational vision, mission and strategies, gender allocation in staffing, and beneficiary involvement. Copyright © 2010 John Wiley & Sons, Ltd.     

Planning and budgeting in the crippled children''s sector through goal programming.

This article describes how the goal programming methodology was applied to a state level Crippled Children's Program. The various organizational goals are incorporated into the programming model to indicate the trade-offs associated with the resource allocation process. Alternative allocations are presented in terms of a "what if" approach to programming.     

The application of large gaussian mixed models to the analysis of 24 hour ambulatory blood pressure monitoring data in clinical trials

We propose the use of Gaussian mixed models to analyse statistically 24 hour ambulatory blood pressure data from clinical trials. We develop specific models and apply them to data from a clinical study that compares two angiotensin-converting enzyme inhibitors. We investigate and discuss computing issues related to the implementation of such methods. We conclude that this methodology provides a sophisticated but practical approach to the analysis of such data.     

Using Mixed Methods Effectively in Prevention Science: Designs,Procedures, and Examples

There is growing interest in using a combination of quantitative and qualitative methods to generate evidence about the effectiveness of health prevention, services, and intervention programs. With the emerging importance of mixed methods research across the social and health sciences, there has been an increased recognition of the value of using mixed methods for addressing research questions in different disciplines. We illustrate the mixed methods approach in prevention research, showing design procedures used in several published research articles. In this paper, we focused on two commonly used mixed methods designs: concurrent and sequential mixed methods designs. We discuss the types of mixed methods designs, the reasons for, and advantages of using a particular type of design, and the procedures of qualitative and quantitative data collection and integration. The studies reviewed in this paper show that the essence of qualitative research is to explore complex dynamic phenomena in prevention science, and the advantage of using mixed methods is that quantitative data can yield generalizable results and qualitative data can provide extensive insights. However, the emphasis of methodological rigor in a mixed methods application also requires considerable expertise in both qualitative and quantitative methods. Besides the necessary skills and effective interdisciplinary collaboration, this combined approach also requires an open-mindedness and reflection from the involved researchers.     

Working Relationships and Outcomes in Multidisciplinary Collaborative Practice Settings

A multidisciplinary research team of academics and community practitioner partners worked together to design and conduct an investigation into the purposes, processes, and outcomes of multidisciplinary collaborative practice. A review of the literature revealed a confusing array of terminology while also pointing to potential benefits and challenges, models for practice, and suggestions for research. The pilot research study consisted of six case studies set in three different programs. The principal finding was that no single model can be applied to all multidisciplinary collaborative endeavors. The appropriate approach depends on the context and goals of the work and on the organizational structure. This study highlights the process for collaboration and its prerequisites: Shared physical space, opportunities for formal and informal communication, consensual decision-making, team/group coordination, and organizational support. Additionally, the role of specific disciplines appears to be less predominant in the process of multidisciplinary collaboration than the commitment of individuals to collaborating. The benefits reported by practitioners were suggested to far outweigh the challenges associated with the approach to practice. Future research should incorporate a stronger client voice, include investigation of inter-group and interagency collaboration, and extend to a wider variety of practice settings.     

Rejection of an innovation: health information management training materials in east Africa

A shift towards decentralization in many low-income countries has meant more skills are demanded of primary health care managers, including data and information handling at all levels of the health care system. Ministries of Health are changing their central reporting health information systems to health management information systems with emphasis on managers utilizing information at the point of collection. This paper reports on a research study to investigate the introduction of new information management strategies intended to promote an informational approach to management at the operational health service level in low-income countries. It aims to understand the process taking place when externally developed training materials (PHC MAP), which are intended to strengthen health management information systems, are introduced to potential users in an east African country. A case study has been undertaken and this research has demonstrated that the dynamic equilibrium approach to organizational change is applicable to the introduction of new information management strategies and management approaches in low-income countries. Although PHC MAP developers envisaged a technical innovation needing implementation, potential users saw the situation as one of organizational change. Contributions to theory have been made and many implications for introducing new information systems or the informational approach to management are identified. This theoretical framework could also facilitate the introduction of future information management innovations and would allow practitioners to perceive the introduction of information management innovations as one of organizational change that needs to be managed. Consequently, issues that may facilitate or inhibit adoption could be identified in advance.     

The impact of managers' perceptions of learning organizations on innovation in healthcare: sample of Turkey

Organizational learning is the process of increasing effective organizational activities through knowledge and understanding. Innovation is the creation of any product, service or process, which is new to a business unit. Significant amount of research on organizational learning place a central meaning on the fact that there is a positive relationship between organizational learning and innovation. Both organizational learning and innovation are essential for organizations to prepare for change. The aim of this study is to determine to what extent the identified learning organization dimensions are associated with innovation. The study used a quantitative non‐experimental design employing statistical analysis via multiple regression and correlation methods to identify the relationships between the variables examined. Because the research was conducted in a non‐experimental way, learning organization dimensions are referred to as predictor variables, and innovation is referred to as the criterion variable. Watkins and Marsick's Dimensions of the Learning Organization Questionnaire was used in the study. Questionnaires were distributed to 498 hospital managers and, 243 valid responses were used in this study. Therefore, 243 hospital managers working at 250 Ministry of Health (public) hospitals across Turkey participated in the study. Results demonstrate that there are significant and positive correlations between learning organization dimensions and innovation. Intercorrelations between learning organization dimensions and correlations between learning organization dimensions and innovation were average and high, respectively. Results further indicate that the dimensions of the learning organizations explained 66.5% of the variance for the innovation. Copyright © 2012 John Wiley & Sons, Ltd.     

Seeing health and illness worlds – using visual methodologies in a sociology of health and illness: a methodological review

Abstract This review starts from the premise that the visual has been, until recently, a neglected dimension in our understanding of social life, despite the role of vision in other disciplines, including medicine itself. The potential for a visual approach will be analysed drawing on a range of studies, broadly within the sociology of health and illness, which have used visual approaches. I highlight the value of visual methodology projects within qualitative approaches to research more generally, and assess the difficulties as well as the advantages. It is suggested that using visual methodologies does not necessarily lead to greater reactivity in the research process as has sometimes been proposed; and that visual worlds are themselves unique topics of sociological study which may be enhanced by using visual techniques rather than written and spoken language. A combination of visual and traditional methods can also be fruitful. Painting and drawing, video, film, and still photography are included as examples which researchers have used and can use.     

Unpacking capacity to utilize research: A tale of the Burkina Faso public health association

One of the most important challenges in addressing global health is for institutions to monitor and use research in policy-making. In low- and middle-income countries (LMICs), civil society organizations such as health professional associations can be key contributors to effective national health systems. However, there is little empirical data on their capacity to use research. This case study was used to gain insight into the factors that affect the knowledge translation performance of health professional associations in LMICs by describing the organizational elements and processes constituting capacity to use research, and examining the potential determinants of this capacity. Case study methodology was chosen for its flexibility to capture the multiple and often tacit processes within organizational routines. The Burkina Faso Public Health Association (ABSP) was studied, using in-depth, semi-structured interviews and key documents review. Five key dimensions that affect the association's capacity to use research to influence health policy emerged: organizational motivation; catalysts; organizational capacity to acquire and organizational capacity to transform research findings; moderating organizational factors. Also examined were the dissemination strategies used by ABSP and its abilities to enhance its capacity through networking, to advocate for more relevant research and to develop its potential role as knowledge broker, as well as limitations due to scarce resources. We conclude that a better understanding of the organizational capacity to use research of health professional associations in LMICs is needed to assess, improve and reinforce such capacity. Increased knowledge translation potential may leverage research resources and promote knowledge-sharing.     

Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation

Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.