Effectiveness of Mixed-Method Studies in Health Care Research
                     EFFECTIVENESS OF 
MIXED-METHOD 
STUDIES IN HEALTH 
CARE RESEARCH
An Academic presentation by
Dr. Nancy Agnes, Head, Technical Operations, 
Pubrica
Group: www.pubrica.com
Email: [email protected]
IN BRIEF
• The majority of studies were effectively finished, but there was a 
lack of rationale for the  mixed methods design  in both 
applications and results. This had implications for making quality 
assessments about individual components in the context of the 
technique used. 
• There was also a lack of openness regarding the unique methods 
regarding a clear explanation of data gathering and analysis, 
which was more of an issue for the qualitative component than 
the quantitative, with 42% (19/45) versus 18% (8/45) of proposals 
experiencing from this. 
• Due to the lack of an effort to integrate data and findings from 
various components within a study, judgments about integration 
could rarely be made. This blog addresses the quality of mixed 
methodologies studies in  health care research.  
INTRODUCTION  
•  In health care studies, mixed methods studies are prevalent (HSR). Within a single research, 
they comprise two distinct data collection and analysis components: at least one quantitative 
method with statistical analysis and structured data collection and at least one qualitative 
method with thematic analysis and less structured data collection. 
• Researchers, research commissioners, and consumers must evaluate whether a mixed methods 
study was conducted well or poorly, determining whether it is appropriately mixed methods 
research and good quality research. 
• The quality of mixed methods research has been formally addressed in health, educational, and 
social,  clinical research writing, as well as implicitly when scholars reviewed the difficulties in 
planning and implementing these studies. 
• However, the issue has received little attention overall, with a current search for quality criteria 
for mixed methods research revealing that none were accessible, despite efforts to create 
them.   

IDENTIFYING MIXED METHODS STUDIES
A methodical review of summaries of studies sponsored by the Department of Health, a significant 
commissioner of health services research in England at the time, produced mixed methods studies 
in 2004. The techniques have previously been explained and are summarized here. The programs 
were as follows: 
• Health Technology Assessment;  
• Service Delivery and Organization;  
• New and Emerging Applications of Technology;  
• Policy Research Programme; and  
• Primary and secondary care interface,  
• Forensic mental health,  
• Immediate dental care, and  
• Promoting implementation of research findings.  
• There were 118 mixed methodologies papers found. A request for the research plan, the final 
report for finished studies, and a summary of any published papers were sent to each study's 
primary researcher. 
APPLICATION OF QUALITY 
QUESTIONS 
•  A  data extraction  form was created that included quality 
queries with check box choices of 'yes, but enhancements are 
feasible,' 'no,' 'not enough information (NEI),' and 'not relevant 
(N/A). 
• Alongside each query, there was space for open remarks, 
where the evaluator (AOC) could document specifics of good 
and bad practices.
• For example, one researcher applied the data gathering form 
to each study, first to the plan and then to the report. Finally, 
any discrepancies between the plan and the writing were 
identified.  
MIXED METHODS DESIGN 
•  Only one-third of proposals and reports justified the use of mixed methods study. A few studies 
clearly defined the design in terms of method priority, purpose, sequence, and point at which 
integration would or did occur. 
• If scientific research support  researchers were clear about the importance of methods and the 
function of any less dominant method, it would benefit the following quality evaluation of 
individual components. 
• For example, having 40 in-depth interviews as an early help to develop a questionnaire seemed 
wrong but appropriate if these discussions were also to be used as the primary means of 
exploring the problem under study. 
• In the setting of outstanding descriptions of individual components, there may be a lack of 
transparency in the general designing and conducting of mixed methods research.  
QUANTITATIVE COMPONENT 
• The responsibilities of quantitative methods were typically well 
explained within proposals and reports. However, adequate 
information about these methods was not always provided. 
• Some parts of the  original research article's  quantitative 
methods were not explained, particularly the analysis and 
numbers involved. This was less of an issue for reports, but 
there were still issues with vague general descriptions or little 
or no explanation of the analysis. 
• This absence of transparency made assessing other elements 
of quality challenging.  
QUALITATIVE COMPONENT 
• The functions of qualitative methods were typically well 
explained in proposals and reports. 
• However, qualitative methods were frequently inadequately 
explained, which happened more regularly than quantitative 
components, both within recommendations (p ¼ 0.011) and 
reports (p ¼ 0.08).   
LIMITATIONS 
•  The research is based on mixed methods research that a 
specific commissioner in a single nation sponsored. Although 
the answer rate to queries for documentation for mixed 
methods studies was high, non-responders may have been 
more likely to be biased, problematic studies the results toward 
better quality studies. 
• A single researcher (AOC) developed and implemented the 
questions in the context of team discussions, which meant that 
the data-gathering process was unassailable by an outside 
source. 
• To improve clarity and minimize intra-rater variability, a coding 
procedure was developed to complement the data capture 
form. However, another researcher may have evaluated the 
findings differently.  
CONCLUSION 
• This is the first effort to assess the quality of HSR mixed 
methods research. We are not offering this as a definitive 
method for others to use but rather to initiate a discussion 
about evaluating and enhancing quality. 
• If we use mixed methods studies in HSR, we should be 
more open about the design and the individual components 
within the design framework and try to combine data and 
results from qualitative and quantitative methods.  
ABOUT PUBRICA 
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• Using the reader to inform them of the gaps in the chosen 
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• Our specialists are conscious of the order in which the 
general topic, the issue, and the background are followed 
by the narrow subject where the hypothesis is stated. 
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