Mixed methods: rationale

In addition to the theoretical perspectives discussed in Section 3.2, Nastasi, Hitchcock and Brown (2010) identify research purpose as a key precursor to research design decisions. Similarly, Gorard (2010) stresses that the research purpose and questions

A

C

E

Qualitative _{Mixed Quantitative}

118 drive decisions about methodology. These decisions are perhaps best understood in the context of a research study’s key stages, as described by Teddlie and Tashakkori (2009), and the general purposes of mixed methods research, as described by Greene, Caracelli and Graham (1989).

Teddlie and Tashakkori (2009) describe three key stages in a research study: conceptualisation; experiential; and inferential. Together, these three key stages constitute what Teddlie and Tashakkori (2009) identify as a “strand” of a study; strand being defined as any phase of a study that contains each of three stages. At the first stage – conceptualisation – the research purpose and questions, together with theoretical perspectives, are considered (Teddlie and Tashakkori, 2009). The second stage – experiential – concerns the study’s methods of data collection and analysis (Teddlie and Tashakkori, 2009, p. 146). During the third and final stage – inferential – the findings are explained, and understanding is developed. In addition, in an exploratory sequential study of this type, the inferences of each strand will be integrated to generate a “meta-inference” (Teddlie and Tashakkori, 2009, p. 152). As discussed in Section 3.2, this study’s theoretical framework was pragmatism, and its purpose was to explore nursing students’ perspectives on dignity in care. The research questions were:

1. What meaning do nursing students attach to the term ‘dignity in care’?

2. What are nursing students’ perspectives on the personal and environmental influences on the preservation of dignity in care?

3. What are nursing students’ perspectives on the nurse’s role in preserving dignity in care?

Regarding the conceptualisation stage of the current study, the research purpose and questions reflect the exploratory and inductive nature of the study, the researcher’s qualitative orientation, and the gap existing around what is known of nursing students’ perspectives on dignity in care. These considerations of orientation and available evidence are identified as reasons to choose an exploratory research design (Creswell

119 and Plano Clark, 2011). The methods identified at the experiential stage as the most appropriate to answer the research questions of this study were Nominal Group Technique (NGT) embedding photo-elicitation, and Q-methodology. These are detailed in Chapter 4, but, regarding the integration stage, both NGT and Q- methodology are characterised by their mixing of qualitative and quantitative techniques.

Carney, McIntosh and Worth (1996) and Gallagher et al. (1993) argue that, while NGT is essentially qualitative, its results can be presented quantitatively. This dual nature is underlined by Potter, Gordon and Hamer (2004), who describe NGT as a “mixed methods approach” because it provides both qualitative and quantitative information. NGT was used, in part, to develop the second, Q-methodology, strand of the study. Similarly, Q-methodology – which uses statistical analysis to reveal individual and collective viewpoints (Valaitis et al., 2011) – has also been described as both a qualitative and a mixed methods approach (Ernest, 2011; Newman and Ramlo, 2010; Watts and Stenner, 2012). The exploratory and inductive nature of the study, along with the use of these, arguably, mixed methods, situates the study in Zone B of the qualitative-quantitative continuum illustrated in Figure 3-1.

Greene, Caracelli and Graham (1989) identify the following reasons for choosing a mixed methods research design: triangulation; initiation; development; expansion; and complementarity. Relating the stages of the research study to these varied purposes helps provide the rationale for choosing a mixed methods research design, particularly in relation to the experiential and inferential stages.

One rationale for using a mixed methods design is triangulation (Creswell, 2014; Doyle, Brady and Byrne, 2009; Jick, 1979; Teddlie and Tashakkori, 2009). Archibald (2015, p. 2) explains that the “triangulation metaphor” has its origins in navigation and the use of two known points to locate a third unknown point. Similarly, Flick (2015, p. 218) describes triangulation as the use of “at least two vantage points” to scrutinise a research problem. These different vantage points are usually provided by the use of

120 multiple research methods (Flick, 2015), but may also be provided by the involvement of different researchers (Archibald, 2015; Teddlie and Tashakkori, 2009). Streubert and Carpenter (1999) argue that the latter is particularly important if a researcher lacks expertise in any of the methods being employed. Tracing its roots back to the ancient Greeks and Galileo, Maxwell (2015) disputes the view that ideas about triangulation began in the late 1950s with the growing recognition of mixed methods as a distinct research approach. Denzin (2012) also argues that contemporary ideas about triangulation are rooted in qualitative research; growing out of the combination of multiple qualitative approaches rather than the combination of qualitative and quantitative approaches.

Greene, Caracelli and Graham (1989) advocate the use of multiple research methods as a means of reducing variance and bias to enhance the validity of the findings. This stance is supported by Robson (2011), who comments that the use of multiple methods can improve the rigour of an inquiry. With reference to mixing qualitative methods only, Polit and Beck (2014) identify triangulation as a key strategy for enhancing the credibility and dependability of findings. In a similar way, Bryman (2006) identifies credibility as a reason for deciding to mix qualitative and quantitative methods in a single study. In the context of this study’s location in Zone B of the qualitative- quantitative continuum, the use of triangulation to enhance credibility and dependability seemed most appropriate.

However, in an examination of over 200 mixed method research studies in social science, Bryman (2006) found that triangulation was not widely identified as a rationale for the use of mixed methods. In addition, Bryman (2007) argues that triangulation is much more than a means of confirming findings. Instead, the different methods should be “mutually informative” and integrated to generate a deeper understanding (Bryman, 2007, p. 21). The idea that the whole is greater than the sum of its parts is supported by Denzin (2012, p. 82), who argues that triangulation is “not a tool or a strategy of validation”, but a means of enriching inquiry. Archibald (2015) agrees and suggests that viewing it only as a means of confirming findings is

121 “positivist” and limits its potential contribution to the enrichment of inquiry. This seems to be closely related to the remaining four other reasons identified by Greene, Caracelli and Graham (1989) for choosing a mixed methods design.

Firstly, one of these other reasons is initiation; a term used by Greene, Caracelli and Graham (1989, p. 127) to capture the use of mixed methods to enrich the “breadth and depth” of inquiry. This is achieved by seeking out and responding to contradictory or paradoxical findings (Bryman, 2006; Greene, Caracelli and Graham, 1989). Both consistent and divergent findings from the different methods are welcomed because of their potential to generate “fresh insights” (Greene, Caracelli and Graham, 1989, p. 128). To accommodate such insights, research questions are likely to evolve as the inquiry progresses (Bryman, 2006; Greene, Caracelli and Graham, 1989). Tashakkori and Creswell (2007a) identify this as a key approach to writing research questions for mixed methods studies. Therefore, the notion of initiation as a rationale for the use of mixed methods seemed relevant to this study because of the flexibility offered to respond to new or surprising insights emerging as the study progressed.

Secondly, development is another rationale, and this is defined by Greene, Caracelli and Graham (1989) as using mixed methods with the purpose of using one method to help develop the other. In this context, development refers to decisions about sampling as well as data collection and analysis (Greene, Caracelli and Graham, 1989). Bryman (2006) also highlights the use of mixed methods to facilitate sampling and develop instruments for data collection. As detailed in Chapter 3, the current study consisted of two strands, with the second being informed by the first.

Thirdly, ‘expansion’ is the term used by Greene, Caracelli and Graham (1989) to describe the selection of a mixed methods design because it allows for multiple components – such as processes and outcomes – to be incorporated into a single inquiry. This rationale is also highlighted by Bryman (2006), who notes that a decision to mix methods may be based on a desire to combine the quantitative study of structures with the qualitative study of the processes underpinning these structures.

122 Furthermore, expansion seems to correspond with the term ‘completeness’ used by Bryman (2006) to describe the use of mixed methods to enhance, explain and illustrate findings. In this way, it is argued that mixed methods will enrich findings, which is especially important in the study of complex problems (Creswell and Plano Clark, 2011; Doyle, Brady and Byrne, 2009; Muncey, 2009; Östlund et al., 2011). Again, this seemed especially appropriate to the study of perceptions and a complex concept such as dignity in care.

Fourthly, Greene, Caracelli and Graham (1989) also identify complementarity as a rationale. They explain that this term refers to the use of mixed methods as a means of remedying the limitations of one method with the strengths of another (Greene, Caracelli and Graham, 1989). This seems to correspond with what Bryman (2006, p. 106) refers to as the use of mixed methods to “offset” the strengths and weaknesses of qualitative and quantitative methods. It has been described as the most frequent rationale provided for the use of mixed methods (Bryman, 2006; Greene, Caracelli and Graham, 1989). It is argued that this enables findings to be elaborated, clarified and interpreted with greater ease and accuracy (Greene, Caracelli and Graham, 1989). These benefits were particularly relevant to this study of nursing students’ perceptions because it was anticipated that enriching findings in this way would make them more amenable to analysis and more comprehensible, interesting, and accessible to others. It was anticipated that this in turn would aid the dissemination of the findings, especially to the student nurse participants and population. In addition, it seemed reasonable to suggest that this would improve the usefulness of the findings, especially in “applied” disciplines (Bryman, 2006, p. 106).