Justification for using mixed methods

To achieve the value added by a mixed methods approach, use of an

appropriate design is a methodological imperative. Options are well documented and validated within the literature (Creswell, 2015; Creswell and Plano Clark, 2011; Johnson

79 & Onwuegbuzie, 2004; Onwuegbuzie et al, 2009; Teddlie & Tashakkori, 2009). Creswell (2015a) contended that the rationale for choosing a mixed methods approach should be part of the methodological discussion. Design options are varied and can be tailored to the particular inquiry. Some design options are classified as being sequential (where qualitative data collection is followed by quantitative data collection for example), or simultaneous (where data is collected by quantitative and qualitative data collection methods and the results of each are integrated). The type of data collected in each phase of a study foreshadows the world viewpoint being taken and therefore the data type being generated for interpretation. In this study, a sequential design was used since the aim was to explain nurses’ decisions to participate in PDRP. In order to explain the problem, the current baseline of understanding and attitude must be measured. Data to support this part of the inquiry was collected by quantitative means.

Explanation of the data using a qualitative approach followed. Had the nature of the inquiry been to explore nurses’ decisions to participate in PDRP, the design phases would have been reversed. The essential ingredient of any mixed methods design is that ‘mixing’ the methods is purposeful and clear.

In order to ensure clarity of decision making for the purposes of this study, the key decision points and questions indicated by Creswell and Plano Clark (2011) citing the work of Bryman (2006 p. 98) were used. The questions were:

1. What is the reason for choosing mixed methods?

2. What is the priority of the quantitative and qualitative phases?

3. What is the level of interaction between the qualitative and quantitative

phases?

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5. Where and how will there be mixing of the quantitative and qualitative phases?

In the context of this study, answers to the questions were as follows:

1. What is the reason for choosing mixed methods?

The application of both quantitative and qualitative methods in research studies provides the opportunity to answer questions posed in a more comprehensive way than could perhaps be expected using a single approach (Creswell & Plano Clark, 2011; Tariq & Woodman, 2010). The approach has been determined to be especially useful where the phenomena under investigation are interwoven and multifaceted; mixed methods

research design assists the researcher to address complexity. It was clear from the literature review that the question of nurses’ engagement with CPD was indeed complex. Therefore, answering the research questions in this study using both qualitative and quantitative approaches was assessed as being more likely to result in a comprehensive understanding of NZBS nurses’ decisions to participate in PDRP.

2. What is the priority of the quantitative and qualitative phases?

In this study, the priority of phases was quantitative/qualitative. This choice was made because ultimately, the aim of the study was to explain nurses’ engagement with PDRP. Quantitative data collection methods were used to generate data on what nurses knew about the NZBS PDRP including factors that affected their decision-making about participation. The qualitative phase of the study provided the opportunity to ask nurses to explain key findings from the quantitative data where topics had appeared sufficiently important that participation with the NZBS PDRP had been affected.

81 3. What is the level of interaction between the qualitative and quantitative

phases?

Questions for the qualitative data were generated from analysis of the data gathered in the quantitative phase of the study. The participants in the quantitative phase were invited to volunteer to participate in the qualitative phase and thus, the data and the participants interacted between the phases. The qualitative data added greater depth, richness and meaning to the data generated in the quantitative phase of the study and importantly, assisted in the explanation of nurses’ decisions to participate in PDRP.

4. What is the timing of the quantitative and qualitative phases?

The quantitative phase took place prior to the qualitative phase. Hence, the study was explanatory.

5. Where and how will there be mixing of the quantitative and qualitative phases?

Quantitative data analysis informed the questions to be explored in the qualitative phase. Participants in the qualitative phase explained the data generated in the quantitative phase. A subset of the participants who took part in the quantitative phase participated in the qualitative phase meaning there was mixing of the participants. In other words, the sample was nested between the phases of the research which further supported an explanatory design (Creswell, 2015b).

The answers to Bryman’s (2006) questions are summarised in Table 3-1 overleaf. Figure 3-1 shows the overall design of the study (Creswell & Plano Clark, 2011; Tariq &

82 Woodman, 2010). Application of the justified design including a research plan is shown in Table 3-2. Appendix B provides a timeline of the work as it was completed.

Table 3-1 Decision Questions and rationale for choosing mixed methods design Decision Questions Answer/Rationale

Reason for choosing mixed methods Questions to be asked in the qualitative phase are dependent on findings from the quantitative phase

What is the level of interaction between the qualitative and quantitative phases?

There is an independent level of interaction between the phases. The two phases are separate from each other and will be analysed separately.

What is the priority of the quantitative and qualitative phases?

The two phases have equal priority. However, they are administered in the order QUAN-QUAL because this order allows for explanation to occur.

What is the timing of the quantitative and qualitative phases?

Timing is sequential and the phases are implemented in two distinct phases. Where and how will there be mixing of the

quantitative and qualitative phases?

In this case, the mixing occurs because the questions developed for the qualitative phase are dependent on the findings from the quantitative phase.

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Table 3-2 Research Plan

Step Activity Tools

Design and implement the Quantitative phase

Step 1

Development of questionnaire or negotiate access to use existing

questionnaire to identify factors affecting engagement with continuing education from the literature review

Seek any permissions required including ethical approval

Pilot study

Distribute PDRP Knowledge and Attitude

Questionnaire to all eligible nurses at NZBS

Analysis of returned questionnaires Volunteers for phase 2 (semi-structured interviews) self-select as part of questionnaire

Questions developed from the literature which identify areas of interest related to factors affecting engagement with continuing education

Massey University Human Ethics Committee

New Zealand Blood Service Tools selected or developed for questionnaire. Adjust as necessary

Excel and statistical analysis Respond to volunteers and identify likely date of interviews

Use strategies to follow from the quantitative results

Step 2

Development of semi-structured interview schedule designed to explain the findings from the quantitative phase in more depth

Areas of interest for follow-up and fuller explanation identified through data analysis of the quantitative phase Design and implement the qualitative phase

Step 3

Semi-structured Interviews with

participants who self-selected from Step 1 General inductive analysis

Semi-structured interviews developed in step 2 undertaken with volunteers NVIVO

Interpret the connected results

Step 4

Discuss to what extent and in what ways the qualitative results help to explain the quantitative results

Interpretation of quantitative and qualitative findings and presentation

In summary, use of an explanatory sequential design (QUAN-QUAL) allowed areas of interest found in the analysis of data from the quantitative phase to be followed-up adding detail and explanation of the phenomena. In this study, the

84 the quantitative phase and hence, the methods were mixed. The research aim

remained as previously indicated and the phasing of the questions was developed as follows:

Aim:

To explain NZBS nurses’ decisions to participate in PDRP.

Quantitative Phase Questions:

 What do NZBS nurses understand about PDRP?

 What are NZBS nurses’ attitudes to PDRP?

 What affects NZBS nurses’ decisions to participate in PDRP?

Qualitative Phase Question:

 How do NZBS nurses explain key findings from the quantitative data which

appear to affect their decision to participate in the NZBS PDRP?

Justification for each data collection method will be made later in the chapter including procedures that were followed.