Mixed methodology, commonly referred in this chapter as MM is currently regarded as one of the emerging and leading research methods where mixing methods and types of data requires new sets of skills and sensibilities (Creswell and Plano Clark, 2007; Bergman, 2011). However, in order to comprehend MM, it is important to offer a brief definition/description of qualitative and quantitative research methodologies and concepts as used throughout this thesis.
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Quantitative research is often contrasted with qualitative research (and vice versa), which often turned into a `paradigm war,' resulting in apparently incompatible worldviews underlying the two methodologies (Pope and Mays, 2006; Pearson et al., 2007; Manning & McMurray, 2010). Researchers view each methodology differently with some claiming dominance of either methodology. On one hand, Cohen (1980) views quantitative research methodology as a social research that employs empirical methods and empirical statements, whereby the latter are descriptive and relate to what ‘is’ the case in the ‘real world’ rather than what “ought” to be the case. On the other hand, quantitative research methodology is viewed as a type of research that explains a particular phenomenon by collecting numerical data that are analysed using mathematical methods, in particular statistics (Creswell, 1994) or adhering ‘to a set of sequential steps to acquire dependable
data’ (Pearson et al.., 2007:43). Data collected from this methodology are used to control the phenomenon with the focus on theory testing (derived from previous research to formulate a hypothesis or testable idea), prediction and control (Pearson et al., 2007). In addition, the hypothesis is then tested using objective methods, a process called deduction. Approaches related to this methodology include experimental research, survey research, and cohort research studies. Quantitative research attempts to answer questions such as, ‘how big is X or how many X’s are there?’ (Pope and Mays, 2006: 3)’ The General Practice Survey proposed in this research (Chapter Five) will attempt to use this method to investigate diabetes primary care service provision to EMGs in a typical ethnically mixed medium-sized city.
In the traditional sense, quantitative research methodologies continue to be the driving force behind evidence-based practice and research, with the ability to measure and quantify a phenomenon, as well as the relationships between phenomena numerically,
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whether the phenomenon is health, biological, behavioural, economic, or emotional in scope (Vance et al., 2013). Bourgeault et al. (2010) demonstrated that each methodology (quantitative and qualitative) has benefits in its own right in health and social sectors. In this research, this researcher will employ both quantitative methods to understand, for example, the prevalence of diabetes rates in EMGs as well as qualitative methods to uncover staff’s lived perspectives of the cultural barriers faced in their day-to-day interactions with the patients from EMGs. In addition, quantitative researchers have focused on determining cost-effectiveness, looking at the number of patients with specific chronic diseases, such as diabetes and the cost of treating these patients on an annual basis. This approach is widely valued by most healthcare organisations. For example, the National Institute for Health and Care Excellence (NICE), uses quantitative evidence to develop guidelines and make recommendations on the effectiveness of treatments and medical procedures for different diseases taking into consideration both desired medical outcomes and also economic arguments regarding different treatments (NICE, 2009). However, quantitative approaches do not often take into account the patient perspective; therefore, qualitative research methodologies are required to understand the patient perspectives, their satisfaction level and coping strategies with the disease and treatment regimens to ensure concordance (Creswell and Plano Clark, 2007; Mayberry and Osborn, 2012). For instance, cultural barriers such as commitments to religious beliefs cannot be fully understood by quantitative methods alone. Qualitative research is also needed to enrich understanding in this area, and mixed method could do even better, which further supports the rationale for choosing MM for this research.
In contrast, Roberts and Priest (2010:151) view qualitative research methodology as ‘a
means of exploring an area of human experience, in order to try to understand how humans make sense of their world. It allows us to identify and describe topics or
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phenomena about which little is known, and explore and explain the scope and meaning of such phenomena.’ This is concurred by Pope and Mays (2006), who add that qualitative researchers strive to interpret social phenomena (such as interactions and behaviours) in terms of the meanings people attach to them. They refer to this as interpretative research methodology and conclusions are drawn from the information obtained from participants, which may generate new hypotheses or theories, a process termed induction (Roberts and Priest, 2010). Qualitative research is mostly used to study people, human phenomena and the process of carrying out the research itself. The type of questions usually answered by this methodology include: ‘what is X, and how does X vary in different circumstances, and why?’
(Pope and Mays, 2006:3). Examples of methods used in qualitative methodology include: participant observation, interviews, case studies, and ethnographic research. Qualitative methodology has been seen as a vital instrument for evaluating policies, reforms and programs, analysing how healthcare professionals deal with profound changes in their work, exploring people’s unique experiences, views, opinions, studying different cultures, grasping the complexity of the phenomenon, and understanding issues in their natural settings. In addition, randomised controlled trials (RCTs) can also be carried out using nested qualitative studies aimed at understanding different research results being produced, the why and how they worked or did not (Sturt et al., 2008).
Quantitative and Qualitative research methodologies tend to differ in major steps in every research process (Table 4.1), such as the intent of the study, review of the literature, use of the questions or hypotheses, data collection and analysis, researchers’ roles, and validation of the data (Creswell and Plano Clark, 2007).
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Table 4.1: Elements of quantitative and qualitative research in the process of research adapted from Creswell and Plano Clark (2007:29)
Elements of qualitative
research tend towards… Process of research Elements research tend towards… of quantitative
Understands meaning individuals give to a phenomenon inductively
Intent of the
research
Test a theory deductively to support or refute it Minor role Justifies problem How literature is used Major role Justifies problem
Identifies questions and hypotheses
Ask open-ended questions
Understand the complexity of a single idea (or phenomenon)
How intent is
focused
Ask closed-ended questions
Test specific variables that form hypotheses or questions
Words and images
From a few participants at a few research sites
Studying participants at their location
How data are
collected
Numbers
From many participants at many research sites
Sending or administering
instruments to
participants
Text or images analysis
Themes
Larger patterns or generalisations
How data are
analysed
Numerical statistical analysis
Rejecting hypotheses or determining effect sizes
Identifies personal stance Reports bias Role of the researcher Remains in the background
Takes steps to remove bias
Using validity procedures that rely on the participants, the researcher or the reader
How data are
validated
Using validity procedures based on external standards, such as judges, past research, statistics.