Art & science science research series: 6
Mixed methods research Halcomb E, Hickman L (2015) Mixed methods research. Nursing Standard. 29, 32, 41-47.
Date of submission: February 11 2014; date of acceptance: June 26 2014.
Abstract Mixed methods research involves the use of qualitative and quantitative data in a single research project. It represents an alternative alternat ive methodological approach, combining qualitative and quantitativee research approaches, which enables nurse researchers quantitativ to explore complex phenomena in detail. This article provides a practical overview of mixed methods research and its application in nursing, to guide the novice researcher considering a mixed methods research project.
Authors Elizabeth Halcomb Professor Halcomb Professor of primary health care nursing, School of Nursing, University of Wollongong, Australia. Louise Hickman Director Hickman Director of postgraduate nursing, Faculty of Health, University of Technology Sydney, Australia. Correspondence to: ehalcomb@uow
[email protected] .edu.au
Keywords Mixed methods research, multi-method research, nursing research, qualitative qualitat ive research, quantitativ quantitativee research, research design, research methodology, rigour
Review All articles are subject to external double-blind peer review and checked for plagiarism using automated software.
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HEALTHCARE HEA LTHCARE SYSTEMS ARE AR E becoming becoming more complex in response to people living longer, the rise in chronic and complex diseases and finite healthcare budgets. Social, political, environmental, cultural and economic forces may also add complexity to healthcare issues (Lavelle 2013). As healthcare systems increase in et al 2013). complexity, so do the research problems faced by health researchers rese archers (Glogowska 2011). 2011). Therefore, researchers are challenged to find investiga investigative tive methods that encompass multidimensional multidimensional aspects of health issues (Andrew and Halcomb 2006, Creswelll and Plano Clark 2011). Creswel 2011). In response to this challenge, there has been an increased focus
on mixed methods research in social science, education and health (Glogowska 2011, Bowers 2013). Mixed methods research offers nurse et al 2013). researchers a methodology to address complex issues, which is more comprehensive than could be achieved by either qualitative or qualitative research methods alone (Simons and Lathlean 2010, Andrew and Halcomb H alcomb 2012). Paradigm differences have sometimes prevent prevented ed the mixing of qualitative and quantitative research in nursing inquiry, but such differences have generally been overcome, with most researchers adopting a pragmatic approach and implementing whichever research methodologies are most appropriate to answer their research question (McEvoy and Richards 2006, Simons and Lathlean Lathle an 2010, Glogowska 2011, Maudsley 2011). 2011). In addition, there has been a steady rise in the t he number of mixed methods manuscripts published in nursing journals in recent years (Lipscomb 2008, Simons and Lathlean 2010). Definition of mixed methods research
Essentia lly, quantitative research involves the Essentially, collection and analysis of numerical data, while qualitative research considers narrative or experiential data (Hayes et al 2013). 2013). Mixed methods research refers to research that integrates both qualitative qual itative and quantitative data within a single study (Creswell and Plano Clark 2011, Wisdom et al 2012). 2012). The mixing mix ing of the qualitative and quantitative components within a study is an important aspect of mixed methods research (Simons and Lathlean Lathlea n 2010, Maudsley 2011). 2011 ). Qualitative and quantitative elements are interlinked during mixing mix ing to provide an integrated response to the research question quest ion that is deeper than would be possible pos sible by either either method alone (Glogowska 2011, 2011, Zhang and Creswell Cres well 2013).. Integration may occur 2013) occu r at any stage or stages of the research process, process , but is central to ensuring rigour in mixed methods research (Glogowska 2011). There is some discrepancy in the definitions of mixed methods research and a nd multi-method research, and the differences between them. However, there is general agreement that mixed methods research differs subtly from
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Art & science research series: 6
multi-method research (Johnson et al 2007). Mixed methods research combines qualitative and quantitative research in a single study, while multi-method research involves data collection using two methods from the same paradigm, for example interviews and focus groups, or quantitative surveys and medical record audit (Andrew and Halcomb 2009). Mixed methods research capitalises on the strengths of both qualitative and quantitative research in combining qualitative and quantitative data collection, while compensating for their limitations, to provide an integrated understanding of the research topic (Andrew and Halcomb 2009, Wisdom et al 2012, Scammon et al 2013). Multi-method research has the advantage of collecting data using multiple methods. Mixed methods research, in contrast, has the potential to combine qualitative and quantitative characteristics throughout the research process, from its philosophical underpinnings through to data collection, analysis and interpretation.
Core considerations Mixed methods research involves more than the collection of qualitative and quantitative data within a single study. The methodological approach to mixed methods research requires various considerations to be addressed to ensure methodological rigour. This article presents eight core considerations for the novice researcher in planning and undertaking mixed methods research (Box 1).
Rationale for using mixed methods Research questions should reflect the rationale for undertaking mixed methods research and demonstrate the qualitative and quantitative aspects of the project (Lavelle et al 2013). A mixed methods study should not be undertaken simply because it is possible to collect both numerical and narrative data in relation to a research question. The researcher should consider which methodological approach would be the most
BOX 1 Core considerations of mixed methods research Rationale
for using mixed methods. approach. Mixed methods designs. Skills required. Project management. Integrating qualitative and quantitative aspects. Demonstrating rigour. Dissemination of mixed methods research findings. Philosophical
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appropriate to address his or her specific research questions. The decision to use a mixed methods design should be based on the additional value that using both qualitative and quantitative methods of data collection would provide, above that using a single method of data collection, in answering the research question (Creswell and Plano Clark 2011, Scammon et al 2013). The feasibility of undertaking a mixed methods study should also be considered in terms of balancing the benefits of a mixed methods research design against the increased skills and resources required (Halcomb and Andrew 2009). The research problems that are best suited to mixed methods designs are those in which multiple perspectives on the research problem may be able to provide a more detailed understanding than could be obtained from a single perspective (Simons and Lathlean 2010, Andrew and Halcomb 2012). For example, a study that developed an overall impression of a health service using quantitative data might overlook factors that affect individuals accessing the service. Adding a qualitative component, investigating the experiences of individuals accessing the service, would be likely to add significant insights to such a study. Reasons for using mixed methods research designs are provided in Box 2.
Philosophical approach A philosophical approach or world view is the lens through which one views the world. A range of philosophical approaches may be used in mixed methods research (Mesel 2013). The researcher should explore a philosophical approach, to understand how it fits with their personal perceptions and with the proposed project, before using it. Creswell and Plano Clark (2011) advocate four stances on using world views in mixed methods research. First, a single world view may be selected to underpin the entire study. Generally, this would be either pragmatism, a transformative (emancipatory) approach or critical realism (Andrew and Halcomb 2006, Creswell and Plano Clark 2011, Maudsley 2011, Andrew and Halcomb 2012, Walsh and Evans 2014). A pragmatic approach involves the researcher using ‘what works’ to seek answers to the research question (Creswell and Plano Clark 2011). Pragmatism views the research problem as the most important issue, valuing both subjective and objective observations to reveal the answers (Andrew and Halcomb 2006, Feilzer 2010, Creswell and Plano Clark 2011). In contrast, a transformative approach involves recognising cultural differences and injustices throughout
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the research process (Mertens 2003, Creswell and Plano Clark 2011). Critical realism holds that reality is best understood by investigating multiple outlooks (McEvoy and Richards 2006, Creswell and Plano Clark 2011, Maudsley 2011). A critical realist world view is well suited to mixed methods research, since critical realists undertake research to explore multiple outlooks and develop deeper understanding (McEvoy and Richards 2006). Second, multiple world views may be used to underpin different aspects within mixed methods research, depending on how the researcher seeks to understand the social world (Creswell and Plano Clark 2011). Using this approach emphasises tensions and oppositions that reflect various ways of understanding the world. Researchers using this approach need to clearly articulate the ways in which the various world views are being used. Third, multiple world views may be combined relating to the design of the mixed methods study (Creswell and Plano Clark 2011). For example, a sequential mixed methods study that commences with interviews followed by an online survey would begin the study with a naturalistic (qualitative) perspective and then move towards a positivist (quantitative) world view. In this approach, mixed methods is purely a method of collecting data, and the respective world view guides each methodological approach (Creswell and Plano Clark 2011). Finally, world views may be dependent on the shared beliefs within a scholarly community (Creswell and Plano Clark 2011). In this perspective, researchers within a given field have shared beliefs about meaningful research questions and appropriate procedures for answering these questions. Regardless of which philosophical stance is chosen for a mixed methods study, the study methods should be consistent with the chosen philosophy, and the tenets of the chosen philosophy should inform all aspects of the research process.
Mixed methods designs There are various typologies (classifications according to general type) of mixed methods designs in the research literature. The researcher should understand the implications of the various designs, and the principles that underlie them, before embarking on their research. Table 1 provides a summary of mixed methods designs commonly used in nursing research, with an example of how each design was used in a recent published study. Four main characteristics define mixed methods research designs (Creswell and Plano Clark 2011).
The first design characteristic is the extent to which qualitative and quantitative data interact or are independent. For example, does one set of data inform the other? Or may the two data sets be collected independently of each other? The second design characteristic is the implementation sequence for data collection. In a simultaneous or concurrent design, both qualitative and quantitative data are collected at the same time. This has the advantage of reducing the duration of the data collection period, but has the disadvantage of being resource intensive and not allowing collection of either data set to inform the collection of the other (Halcomb and Andrew 2009). A sequential design involves qualitative and quantitative data being collected separately, with the findings from one type of data collection, for example interviews, providing the basis for the collection of the second set of data, for example a survey. The disadvantage of sequential designs is that it takes longer for the data collection to be completed (Halcomb and Andrew 2009). Third, designs may vary in the relative priority given to qualitative and quantitative data. Exploratory studies usually prioritise qualitative data because little information is already known. However, explanatory studies where researchers seek complementarity often prioritise quantitative data (Andrew and Halcomb 2006). It is particularly important that the relative priority of each type of data is established before commencing the study. Finally, mixed methods designs may vary in the timing of integrating qualitative and quantitative data. Such integration may occur at
BOX 2 Reasons for using mixed methods research designs Corroboration –
using the results of one method to substantiate the findings of another, about a single phenomenon. Complementarity – using the results of one method to elaborate, enhance or clarify the results from another method. – Process: quantitative results provide outcomes, qualitative results provide the processes. – Unexpected results: surprising results obtained from one method, the other method provides explanation. – Confirmation: quantitative results test hypotheses generated by qualitative findings. Development – using the results of one method to inform another method. – Instrument development: qualitative results used to design a quantitative instrument, then the quantitative instrument is tested. – Sampling: one approach enables sampling for the other approach. Initiation – using one method to uncover the paradoxes and contradictions in findings from another method. Expansion – expanding the depth and breadth of the study using different methods for various components of the research. (Greene et al 1989, Bryman 2006, Wisdom et al 2012)
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Art & science research series: 6
any point in the research process. For example, various philosophical approaches may be used to support the study; research questions may include both qualitative (why?) and quantitative (how often?) questions; data collection may combine open-ended questions that collect narrative data and rating scales; or the data analysis may cross-tabulate themes and participant demographics (Andrew et al 2008).
Skills required Mixed methods research is seldom a solo endeavour (Bowers et al 2013, Lavelle et al 2013). Establishing a team to undertake a mixed methods project should be carefully thought out (Creswell and Plano Clark 2011). A broad range of skills is required to undertake mixed methods research and this should be considered
when establishing a research team (Halcomb and Andrew 2009). Limited attention has been paid to optimal models of teamwork or the optimal composition of mixed methods research teams, and they should include individuals with both quantitative and qualitative skills and knowledge, as well as those with experience in conducting mixed methods research (Bowers et al 2013). Skills should be a particular consideration when mixed methods designs are used by postgraduate students (Halcomb and Andrew 2009). Undertaking a mixed methods research project as a postgraduate project requires the student to gain a broader range of research skills than would be required for a project using either qualitative or quantitative methods alone. Care should be given to the composition of
TABLE 1 Mixed methods designs Research design
Process
Purpose
Level of interaction
Priority
Example
Convergent parallel
Qualitative and quantitative (concurrent)
To obtain different but complementary data to answer a single research question.
Data collected and analysed independently.
Equal
Peters and Cotton (2013) collected postal surveys and undertook unstructured interviews with women with a physical disability to gain a broad understanding of the barriers and enabling factors associated with accessing and experiencing screening services for breast cancer and cervical cancer.
Sequential explanatory
Quantitative then qualitative
Qualitative data are collected to explain the quantitative findings.
Quantitative data frame qualitative data collection.
Quantitative dominant
Pfaff et al (2014) used a postal survey to measure perceived confidence in interprofessional collaboration among new graduate nurses. Following analysis of the survey data, they conducted interviews with 16 new graduate nurses to explain the quantitative findings and expand on them.
Sequential exploratory
Qualitative then quantitative
Quantitative data builds on qualitative findings to provide generalisability.
Qualitative data frames quantitative data collection.
Qualitative dominant
Hamshire et al (2013) conducted a series of interviews with nursing students to explore their experiences and expectations of their nursing course. The interview findings informed the development of an online survey that was completed by 1,080 students in nine UK universities.
Embedded or nested
Quantitative within qualitative or qualitative within quantitative
To obtain different data to answer a complementary research question.
Embedded data set provides answers to a complementary research question.
May be either qualitative or quantitative dominant.
Kinser et al (2013) conducted a randomised controlled trial of an eight-week yoga intervention for women with major depression. Outcomes measured included depression severity, stress, anxiety and rumination. Qualitative interviews were embedded in the trial to explore the feasibility and acceptability of the intervention.
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supervision panels for postgraduate students undertaking mixed methods research, to ensure the panel has the range of skills needed to support a mixed methods project (Halcomb and Andrew 2009).
Project management The practical implications of the chosen mixed methods design should be considered carefully. The main issues in project management are: resources and financial costs, time and management of data (Halcomb and Andrew 2009). Collecting two sets of data, rather than one, requires additional resources. Qualitative and quantitative data are also collected differently, so the range of resources needed for a mixed methods project will be greater than for one that is either qualitative or quantitative alone. Therefore, a clear justification should be provided for the use of a mixed methods design, to substantiate the case for additional resources from funding bodies. Time may be an issue in mixed methods research, particularly when the study is conducted in fulfilment of a postgraduate degree (Halcomb and Andrew 2009). It is essential to allocate sufficient time for the project to be conducted successfully. A sequential project requires adequate time to collect and analyse the first data set, before commencing collection of the second data set (Halcomb and Andrew 2009). The second data set may not address important matters arising from the first data
set if insufficient time is allowed for analysis of the first data set. Similarly, resources for a concurrent project must enable collection of two sets of data at the same time (Halcomb and Andrew 2009). Collecting both qualitative and quantitative data leads to a larger, more complex data set than would be gathered in a purely qualitative or quantitative project (Andrew and Halcomb 2009). The complexity is further increased when qualitative and quantitative data are integrated within the analysis phase. Such complexity affects the time required for data analysis, the range of skills required to manage the data and the resources required for data storage.
Integrating qualitative and quantitative aspects The mixing of data within a mixed methods study is an important stage in the research process, but has received scant attention in the literature (Bryman 2006, Andrew et al 2008, Zhang and Creswell 2013). Zhang and Creswell (2013) identified three distinct procedures for mixing – integration, connection and embedding – in their review of how mixing occurs in health services research. Table 2 provides a definition of the three procedures for mixing, with examples of each. These approaches are not mutually exclusive and some projects may combine different methods of mixing within their design (Zhang and Creswell 2013). Evaluating which of these procedures is appropriate for an investigation and incorporating
TABLE 2 Procedures for mixing qualitative and quantitative data Procedure
Definition
Example
Integration
Qualitative and quantitative data are collected concurrently and analysed separately. Integration occurs during the interpretation phase.
Rickard et al (2011) conducted a study to explore the roles of research nurses and possible career pathways. Data were collected via a 104-item survey tool that combined three previously validated instruments and a series of semi-structured interviews. The qualitative and quantitative data were collected separately and only integrated during the reporting phase.
Connection
One approach is based on the findings of the other approach.
Meixner et al (2013) surveyed providers of brain injury services within a region, asking about the barriers to accessing crisis intervention services. A second phase of the study involved a series of focus groups who investigated the survey findings to develop greater levels of understanding.
Embedding
The analysis of one type of data is embedded within the other. Generally, this involves a small qualitative component nested within a quantitative study.
Zwar et al (2010) conducted a cluster randomised controlled trial to test the uptake and effectiveness of a package of smoking cessation support provided primarily by the practice nurse. Qualitative interviews were conducted with patients, nurses and general practitioners who participated in the trial to evaluate the implementation, feasibility and acceptability of the intervention.
(Adapted from Zhang and Creswell 2013)
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Art & science research series: 6 this into the research design before commencing the study is important when planning mixed methods research. The strategies used for mixing should be clearly articulated in publications and research reports (Maudsley 2011).
Demonstrating rigour Methods of demonstrating rigour in studies that use mixed methods are still poorly defined, despite the increasing popularity of mixed methods research. While the use of mixed methods may enhance validity, the researcher should still demonstrate rigour in the research (Lavelle et al 2013). Creswell and Plano Clark (2011) advocate that mixed methods investigations should demonstrate rigour using the criteria that would be seen in a quantitative or qualitative investigation, in addition to specific mixed methods criteria. Rigour in mixed methods research involves providing the reader with a clear audit trail and with well-considered, justified rationales for the decisions made throughout the research process, regardless of the specific tool or method used (Lavelle et al 2013). Dissemination of mixed methods research findings Disseminating mixed methods research is a significant challenge for researchers (Glogowska 2011). An increase in mixed methods publications has led to improved acceptance of mixed methods research articles. However, reviewers’ lack of familiarity with mixed methods, as well as audience expectations, word limits for journal articles and the decision to publish in a mixed methods or clinical journal are potential barriers to publication that should be considered (Wisdom et al 2012). Two models of dissemination, the segregated and integrated models, have been proposed
BOX 3 Good Reporting of A Mixed Methods Study amework 1. Describe the justification for using a mixed methods approach to the research question. 2. Describe the design in terms of the purpose, priority and sequence of methods. 3. Describe each method in terms of sampling, data collection and analysis. 4. Describe where integration has occurred, how it has occurred and who has participated in it. 5. Describe any limitation of one method associated with the presence of the other method. 6. Describe any insights gained from mixing or integrating methods. (O’Cathain et al 2008) 46
for mixed methods publications and theses (Halcomb and Andrew 2009, O’Cathain 2009). In the segregated model, qualitative and quantitative components of a study are kept separate, devoting separate chapters or articles to each. Any integration between qualitative and quantitative components of the study occurs only in the discussion of the report or in a separate article. In contrast, in the integrated model, findings from qualitative and quantitative methods are interwoven within a series of articles or chapters, each of which is focused on a single aspect of the research question or theme. The choice of presentation method should reflect the nature of the research study to be disseminated (Halcomb and Andrew 2009). Many publications reporting mixed methods research lack sufficient detail of the methods used (Wisdom et al (2012). Several frameworks have been developed to improve dissemination of mixed methods research and to guide authors in writing mixed methods articles for publication. One such framework is the Good Reporting of A Mixed Methods Study framework (O’Cathain et al 2008) (Box 3). Use of such frameworks may improve the quality of reporting research significantly; however, authors should also be aware of the manuscript submission guidelines for the relevant journal.
Conclusion Mixed methods research provides significant opportunities for researchers to gain a deeper understanding of complex health issues than would be possible with the use of either quantitative or qualitative data alone. Researchers who use mixed methods should plan their study from a qualitative, quantitative and mixed methods perspective. The main considerations outlined in this article should be deliberated on before the mixed methods study commences. All phases of the research process should flow logically and be clearly compatible. Reports and publications stemming from mixed methods research should explicitly detail the essential methodological components of the project. Mixed methods articles have the potential to extend nursing knowledge and to inform professional nursing practice in a wide range of complex healthcare issues NS
Acknowledgement Nursing Standard wishes to thank Leslie Gelling, reader in nursing at Anglia Ruskin University, for co-ordinating and developing the Research series.
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References Andrew S, Halcomb EJ (2006) Mixed methods research is an effective method of enquiry for community health research. Contemporary Nurse. 23, 2, 145-153. Andrew S, Halcomb EJ (Eds) (2009) Mixed Methods Research for Nursing and Health Sciences. Wiley-Blackwell, Oxford. Andrew S, Halcomb EJ (2012) Mixed methods research. In Borbasi S, Jackson D (Eds) Navigating the Maze of Research: Enhancing Nursing and Midwifery Practice. Third edition. Elsevier, Marrickville NS W, 147-166. Andrew S, Salamonson Y, Halcomb EJ (2008) Integrating mixed methods data analysis using NVivo ©: an example examining attrition and persistence of nursing students. International Journal of Multiple Research Approaches. 2, 1, 36-43. Bowers B, C ohen LW, Elliot AE et al (2013) Creating and supporting a mixed methods health services research team. Health Services Research. 48, 6 Pt 2, 2157-2180. Bryman A (2006) Integrating quantitative and qualitative research: how is it done? Qualitative Research. 6, 1, 97-113. Creswell JW, Plano Clark VL (2011) Designing and Conducting Mixed Methods Research. Sage, Thousand Oaks CA. Feilzer MY (2010) Doing mixed methods research pragmatically: implications for the rediscovery of pragmatism as a research paradigm. Journal of Mixed Methods Research. 4, 1, 6-16. Glogowska M (2011) Paradigms, pragmatism and possibilities: mixed-methods research in speech and language therapy. International Journal of Language and Communication Disorders. 46, 3, 251-260.
Greene JC, Caracelli VJ, Graham WF (1989) Toward a conceptual framework for mixed-method evaluation designs. Educati onal Evaluation and Policy Analysis. 11, 3, 255-274.
Maudsley G (2011) Mixing it but not mixed-up: mixed methods research in medical education (a critical narrative review). Medical Teacher . 33, 2, e92-e104.
Halcomb EJ, Andrew S (2009) Practical considerations for higher degree research students undertaking mixed methods projects. International Journal of Multiple Research Approaches. 3, 2, 153-162.
McEvoy P, Richards D (2006) A critical realist rationale for using a combination of quantitative and qualitative methods. Journal of Research in Nursing. 11, 1, 66-78.
Hamshire C, Willgoss TG, Wibberley C (2013) What are reasonable expectations? Healthcare student perceptions of their programmes in the North West of England. Nurse Education Today . 33, 2, 173 -179. Hayes B, Bonner A, Douglas C (2013) An introduction to mixed methods research for nephrology nurses. Renal Society of Australasia Journal . 9, 1, 8-14. Johnson RB, Onwuegbuzie AJ, Turner LA (2007) Toward a definition of mixed methods research. Journal of Mixed Methods Research. 1, 2, 112-133. Kinser PA, Bourguignon C, Whaley D, Hauenstein E, Taylor AG (2013) Feasibility, acceptability, and effects of gentle Hatha yoga for women with major depression: findings from a randomized controlled mixed-methods study. Archives of Psychiatric Nursing. 27, 3, 137-147. Lavelle E, Vuk J, Barber C (2013) Twelve tips for getting started using mixed methods in medical education research. Medical Teacher . 35, 4, 272-276. Lipscomb M (2008) Mixed method nursing studies: a critical realist critique. Nursing Philosophy . 9, 1, 32-45.
Meixner C, O’Donoghue CR, Witt M (2013) Accessing crisis intervention services after brain injury: a mixed methods study. Rehabilitation Psychology . 58, 4, 37 7-385. Mertens DM (2003) Mixed methods and the politics of human resaech: the transformative-emancipatory perspective. In Tashakkori A, Teddlie C (Eds) Handbook of Mixed Methods in Social and Behavioral Research. Third edition. Sage, Thousand Oaks CA, 193-214. Mesel T (2013) The necessary distinction between methodology and philosophical assumptions in healthcare research. Scandinavian Journal of Caring Sciences. 27, 3, 750-756. O’Cathain A (2009) Reporting mixed methods projects. In Andrew S, Halcomb EJ (Eds) Mixed Methods Research for Nursing and Health Sciences. Wiley-Blackwell, Oxford, 135-158. O’Cathain A, Murphy E, Nicholl J (2008) The quality of mixed methods studies in health services research. Journal of Health Services Research and Policy . 13, 2, 92-98. Peters K, Cotton A (2013) ‘They treat you with respect’: Nurses providing optimal breast and cervical screening services for women with physical disability. HNE Handover for Nurses and Midwives. 6, 1, Special Issue.
Pfaff KA, Baxter PE, Jack SM, Ploeg J (2014) Exploring new graduate nurse confidence in interprofessional collaboration: a mixed methods study. International Journal of Nursing Studies. 51, 8, 1142-1152. Rickard CM, Williams G, Ray-Barruel G et al (2011) Towards improved organisational support for nurses working in research roles in the clinical setting: a mixed method investigation. Collegian. 18, 4, 165-176. Scammon DL, Tomoaia-Cotisel A, Day RL et al (2013) Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation. Health Services Research. 48, 6 Pt 2, 2 181-2207. Simons L, L athlean J (2010) Mixed methods. In Gerrish K, Lacey A (Eds) The Research Process in Nursing. Sixth edition. Wiley-Blackwell, Oxford, 331-344. Walsh D, Evans K (2014) Critical realism: An important theoretical perspective for midwifery research. Midwifery . 30, 1, e1-e6. Wisdom JP, Cavaleri MA, Onwuegbuzie AJ, Green CA (2012) Methodological reporting in qualitative, quantitative, and mixed methods health services research articles. Health Services Research. 47, 2, 721-745. Zhang W, Creswell J (2013) The use of ‘mixing’ procedure of mixed methods in health services research. Medical Care. 51, 8, e51-e57. Zwar N, Richmond R, Halcomb E et al
(2010) Quit in general practice: a cluster randomised trial of enhanced in-practice support for smoking cessation. BMC Family Practice. 11, 59. doi:10.1186/1471-2296-11-59.
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