Combining quantitative and quaiitative research

In the research investigating FS screening I have utilised both quantitative and qualitative research methods and sought a compromise between the realist quantitative and constructivist qualitative position, as have other researchers in the field of health (Huberman & Miles, 1994; Miles & Huberman, 1984; Miller & Crabtree, 1992; Pope & Mays, 1995). Using this approach, the combination of qualitative and quantitative research is conceived as providing a richer picture of the phenomenon rather than seeking to obtain an objective or verifiable ‘truth’ (Smith, 1996).

The combination of quantitative and qualitative research can be a difficult path to tread. The positivist, realist tradition which underpins much of social research is often dismissive of qualitative methods whilst at the same time, qualitative researchers have been equally dismissive of quantitative methods. In combining methods one lays oneself open to criticism from both sides of the philosophical debate, from those who question the value and utility of a qualitative approach and those who believe that the theoretical and philosophical position of quantitative research is untenable. In this critical environment, many social researchers have been dominated by one approach or another without utilising the benefits both (Bullock, 1992). However, Hammersley (1996) contends that combining qualitative and quantitative research has the advantage of emphasising the practical character of research. Structured data collection and statistical analysis can be concerned with exploring patterns in the data and developing theoretical ideas, and qualitative methods can be used to test theories. There is no fixed relationship between the use of quantitative and qualitative methods and Hammersley (1992; 1996) describes this approach as methodologically aware eclecticism, in which the full range of options is kept in mind in terms of methods and theoretical assumptions. He suggests that quantitative and qualitative methods each have their place depending on the research question (Hammersley, 1996).

From a constructivist perspective there is no reason why phenomena should not be described using numbers as well as words (Yardley, 1997). Scientific terminology, quantitative measures and statistical procedures can be viewed as a language or form of rhetoric which is very powerful in modern society (John, 1992). In order to put an argument across to policy makers and the general public or to a community of medical scientists, it may be necessary to adopt this language for the purpose of communication (Griffin & Phoenix, 1994, Stenner & Eccleston, 1994). Hence quantitative methods are not incompatible with qualitative principles. As Yardley (1997) points out, a characteristic of a

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post-modern qualitative ('new paradigm') approach is the self-conscious use of previous scientific and cultural traditions, knowledge and methodology which are transformed, reinterpreted and reinvigorated by adopting a different epistemological framework (Kvale, 1992). By using quantitative methods alongside qualitative analysis, the rigour and credibility of both forms of research may be enhanced.

The tradition of using both quantitative and qualitative methods has a long history in the research literature {e.g. Zelditch, 1962; Sieber, 1973). This eclectic tradition has in the past taken three broad forms:

1. Triangulation - where findings obtained from quantitative and qualitative methods are compared with the assumption that together they represent a more accurate picture of events (Denscombe et al., 1986; Denzin, 1970). This approach has been criticised as naïve as it assumes that the findings of different methodologies should converge, whereas in fact research using different methodologies may well produce different findings which may not be readily integrated into one picture. Importantly, the concept that a single, unitary picture of the truth that is valid is a positivist assumption which does not sit readily with the epistemological position of constructivist researchers (Fielding & Fielding, 1986; Bryman, 1988). However, it has been suggested that researchers should instead try to relate each set of data to the theory underpinning it to see how the data complement and contradict each other. Smith (1996) maintains that triangulation may be seen as a way of getting a richer picture which captures multiple voices or truths that exist in relation to any phenomenon not a route to absolute truth. As such, triangulation can be a viable research strategy whether you subscribe to a realist or relativist view of inquiry.

2. Facilitation - where one approach acts as a source of hypothesis or as the basis of developing research strategies for the other approach. For example, qualitative interviewing can be used as a preliminary to a research survey or vice versa, when a survey identifies a key area of interest which is examined in-depth using qualitative interviews.

3. Complementarity - two approaches provide different sorts of information that complement each other and are of equal value. Qualitative approaches may sometimes be seen as better at producing information about interactional processes and

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participants’ perspectives whereas quantitative strategies are presumed to be better at documenting frequencies and causal patterns.

Some research has sought a compromise between quantitative and qualitative methodologies {e.g. Pope & Mays, 1995). Qualitative methods may be used to collect observational, textual or biographical data. Content analysis may then be used to assign numerical codes to observations or text segments according to a set of classification rules which can be verified by assessing inter-rater reliability {i.e. the reliability with which two or more raters can independently code the material in the same way). The codes are treated as a summary of empirical observations and can in principle be statistically analysed if drawn from a large random sample. This method has been used by Borkan etal. (1991) to examine patients' beliefs about the cause of their hip fractures. Extensive inter-rater comparisons were used to ensure the reliability of the coding and the outcome measure was assessed using analysis of variance. This type of research has been labelled 'soft-nosed positivist' or 'qualitative positivism' (Miles & Huberman, 1984; Huberman & Miles, 1994; Miller & Crabtree, 1992) and is promoted as a way of combining the advantages of qualitative and quantitative methods. In contrast to questionnaires that are tightly controlled and require the researcher to define in advance of the data collection, which variables are important and which must be ignored, qualitative data collection allows the researcher to adopt a more 'inductive', data driven approach. This allows the researcher to build and extend hypotheses and explanations from the data as they emerge through the data collection process. It also allows the researcher to use naturally occurring language, investigate different meanings and concepts and use rich interpretative coding. Temporal and causal relations between variables can be coded enabling description of interaction and change. At the same time the rigour of the coding process serves as a guarantee that the interpretation of the data was consistent and explicit while the semi-quantitative analyses can give an indication of the generality or uniqueness of the particular findings.

Although there are advantages in this approach, there are also limitations associated with this method. Yardley (1997) points out that the procedure of rigorous numerical coding may encourage a realist view of the data as a set of empirical facts which can be verified or disconfirmed by using multiple observers and observations. Rather than constructing an agreed description of reality, qualitative researchers often consider it more important to obtain insight into different personal perspectives, understandings or interpretations of a phenomenon. However, Hammersley (1992) suggests that there are no universally superior research designs or methods, and the critical issue is the appropriateness of the research

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design or method for the research question. He suggests that we need to think about the circumstances in which integrated research is appropriate and the advantages and disadvantages of combining methods to answer particular research questions.

However, some researchers are critical of the use of quantitative research in any form and argue that this approach creates spurious and unhelpful impressions of objectivity (Filstead, 1970). Yardley (1997) suggests that from a constructivist perspective it is important to avoid reifying the results of quantitative research - Le. treating figures as facts, and statistical analyses as precise representations of reality. The tendency towards reification can be counteracted by making the process of the research itself a focus of the study and an explicit part of the process of validation (Bannister et al., 1994). The strategy is known as reflexivity, and ranges from disclosure of the researcher's personal perspective and motives for undertaking the research, to a self-conscious reflection on how the context of the research has shaped the material obtained and how theoretical standpoints may have shaped the analysis or the manner in which the conclusions presented have been constructed and justified {e.g. Steier, 1991; Wynne, 1988). Reflexivity has been discussed mainly in relation to qualitative research, however, it is equally applicable to quantitative approaches and may bring considerable benefits to quantitative research.

It has also been suggested that the combination of qualitative and quantitative research is particularly useful where investigations are being carried out in social groups whose material and situational perspectives have been under or misrepresented in social research, such as among women, socio-economically deprived groups and/or ethnic minority groups. The qualitative approach may overcome some of the problems of giving a voice and language to such groups through which they may better express their experiences, whilst the quantitative approach serves to indicate the extent and patterns of their inequality. Oakley (1981) argues that in the case of women, using qualitative approaches such as the semi or unstructured interview helps to mitigate some of the inequality which exists between the researcher and researched and avoids reinforcement of inequality among those who are already exploited. In the context of investigating socio-economic variation it is important to select a methodology that enables expression of the views of those who are most socio­ economically deprived as well as more affluent groups. A qualitative method grounded in respondents’ interpretations and experience serves this purpose.

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