Design evolution

The research design was modified at two stages during the research process. The first change occurred when the theoretical assumption underlying the quantitative analysis was found to be inadequate. Preliminary quantitative analysis found no relationship between changes in health and alcohol consumption over time. Given that the qualitative research was initially conceived to generate a fuller understanding of the significant findings of the quantitative research, the absence of any significant quantitative results affected the purpose of the qualitative research. The qualitative research was developed into an exploration of the alcohol consumption of older adults who had been diagnosed with a long-term condition. The interviews were designed to explore both alcohol consumption habits and health over time, and probe how older adults view the relationship between their health and their drinking. The Figure 3.1: Follow-up explanations model (adapted from Creswell & Plano Clark 2007)

qual

sampling strategy is detailed in Chapter 5, but the aim was to recruit a diverse sample of older men and women from different socioeconomic groups with whom to explore these concepts.

The second, more significant change to the research design occurred during the early thematic analysis of in-depth interviews when the variety of motivations to change drinking over time became evident. Health was cited as a driving factor for behaviour change, as well as social, financial and psychological factors. The range of stimuli for drinking change evident in the interviews prompted a re-examination of additional variables around social and financial change within the ELSA data. Within the mixed methods literature the potential for this type of design modification during a project is recognised: new conditions or information that emerges may cause the researcher to adapt their design (Johnson & Onwuegbuzie 2004), or researchers may add another phase of data collection or analysis to explore dissonance (Creswell et al. 2008). In addition to examining some new variables, at this stage the decision was made to modify the statistical analysis technique from change score analysis to chi-squared analysis of the association between life changes and different patterns of drinking change because using an aggregate change score measure concealed the diversity of drinking behaviour changes within the ELSA sample (see Section 9.3.2 p.209 for a more detailed explanation of this decision).

The final mixed methods design is illustrated in Figure 3.2. This design is most like what Teddlie and Tashakkori (2009, p156-157) call a ‘Fully Integrated Mixed Design’ (FIMD). Similar to the FIMD, this project uses the data in a dynamic and reciprocal manner to inform collection, analysis and interpretation of further data. The range of data collected with ELSA facilitated this recursive element, because a number of questions on social and financial circumstances were asked during data collection and so it was possible to identify relevant variables to examine, at a population level, the relationships between non-health factors and alcohol consumption that were evident within the qualitative data.

Although the research design has evolved over time in terms of priority and sequence, the justification for mixing methods has remained constant: to provide a fuller picture of alcohol consumption behaviour and change over time in older adults who have experienced health deterioration. In particular, the project aimed to improve understanding of the mechanisms that resulted in a change in drinking behaviour after disease diagnosis in older adults. However, given the paucity of knowledge on drinking change after a change in health in this population the quantitative research was necessary to first test the initial theoretical assumption of the current research by identifying patterns of drinking change that could then inform the qualitative sampling strategy. The reciprocal nature of the final design increases

comprehensiveness through a more detailed probing of emergent findings to understand the broader patterns of and individual motivations for change.

The objectives and research questions set out at the end of Chapter 2 are presented below, identifying which research questions are answered by the quantitative and which are answered by the qualitative data (see Figure 3.3).

Figure 3.2: Diagrammatic representation of mixed methods design

What factors affect alcohol consumption in older adults and what are the processes of drinking change or

maintenance over time?

Change score analysis: do people who report a change in health or non-health

changes modify drinking differently to those reporting no change in health (or

non-health factors)?

Meta-inferences

Quantitative Research Qualitative Research

Chi-squared analysis and post-hoc tests to explore the association between life changes and changes in drinking over

time. Used qualitative findings to identify additional factors that may influence drinking change over time.

Design qualitative research using findings from preliminary ELSA

analysis. Explore health and drinking over time in older adults.

Figure 3.3: Quantitative and qualitative research questions

Objective III: To explore the processes underlying change or maintenance of drinking behaviour in older adults who have been diagnosed with a long-term condition, using in-depth interviews.

Objective I: To examine the alcohol consumption behaviour of older adults, including socio-demographic variations in consumption and reasons for drinking alcohol, using data from ELSA and interviews with older adults.

Quantitative

Qualitative

What are the current alcohol consumption patterns of older adults and how do they vary by socio-demographic

characteristics?

What purpose(s) does drinking serve for older adults?

Objective II: To describe how alcohol consumption changes over time in older adults and explore differences in behaviour change between older adults who experience life changes (e.g. changes in health) and those who experience no changes, using data from ELSA.

Quantitative

What are the patterns of change over time in alcohol consumption?

What is the relationship between changes in health and alcohol consumption change in older adults?

What is the relationship between non-health changes and alcohol consumption change in older adults?

Qualitative

What level of knowledge do older adults have of the relationship between health and alcohol consumption?

What mechanisms lead to a change or maintenance of alcohol consumption behaviour in older adults after a change in health?