In health and social care, we often think about research methodology in one of two ways – qualitative or quantitative. But what if we use both?
Mixed-methods research involves both quantitative and qualitative research methodologies. So, on a quantitative side, this can involve big data analysis, using existing databases such as the ELSA or the SAIL databank, conducting questionnaires or surveys. These are just examples. On a qualitative side, this can involve interviews or focus groups for example.
Specifically, there are four types of mixed-method design (Shorten & Smith, 2017):
- Explanatory sequential: Quantitative data collected first, followed by qualitative data collection to try and explain the quantitative findings.
- Exploratory sequential: Qualitative data collection is followed by quantitative data collection to test findings.
- Parallel: When you collect data for both studies at the same time.
- Nested: This can have either a qualitative or quantitative approach as a key focus, with the other approach answering a side question and nested into the main approach.
The aim and benefit of mixed-methods research is that you can explore one topic – say health inequalities in dementia – from different angles.
This can be particularly useful when there is little known about a topic area. Indeed, mixed-methods research is becoming ever more prominent in health research, as it allows exploring and understanding complex issues which just cannot be answered by only taking one approach.
Let’s take the example of inequalities in dementia care. If we just look at whether there are any inequalities, what is the benefit of this knowledge? It would probably leave far more questions than answers. But if we just spoke to people about whether they experience any barriers to care, we would not know the scale of the problem. So, you can see how both angles and approaches complement one another.
That’s precisely what we have done in a recent cross-country study between England and the Netherlands, funded by the Alzheimer’s Society. We took a parallel mixed-methods approach, by conducting a survey for unpaid dementia carers and semi-structured interviews with unpaid carers and people living with dementia. The aim of this study was to explore inequalities in accessing and using post-diagnostic dementia care and how these may vary between England and the Netherlands.
Together with a consultation group of health care professionals, and two carers and one person living with dementia, I co-produced the carer survey, and co-produced the interview topic guide with the carers and person with dementia. Both the survey and topic guide were then culrtually adapted and translated into Dutch.
We found that carers and people with dementia experience too many barriers in accessing and using care, in both countries, with some barriers including lack of finances, lack of awareness, and lack of trust into existing services. However, one key facilitator which emerged were dementia care navigators. These appear to be much better integrated in the Netherlands, enabling carers and people with dementia to navigate the maze of dementia care much easier, and be signposted to vital care. In England, dementia care navigators were sparse and failed to provide the same effect.
Whilst mixed-methods research is not suitable for addressing all types of research questions, it can certainly provide a more complex approach, enabling asnwering a research question better and more nuanced. So, next time you think of conducting a specific research project, a mixed-methods approach might be worth thinking about?
Dr Clarissa Giebel is a Senior Research Fellow at the University of Liverpool and NIHR ARC North West Coast. Clarissa has been working in dementia care research for over 10 years focusing her research on helping people with dementia to live at home independently and well for longer, addressing inequalities that people with dementia and carers can face. Outside of her day work, Clarissa has also organised a local dementia network – the Liverpool Dementia & Ageing Research Forum, and has recently started her own podcast called the Ageing Scientist.