Exploiting the potential of mixed methods studies in health services research.

Mixed methods studies, where qualitative and quantitative methods are used together in a
single study, are undertaken in health services research (HSR). The question addressed here is
whether researchers in HSR are fully exploiting the potential of mixed methods studies, and if
not, then how they might maximise the potential of this approach. Methods used to examine
this question included a review of the literature on mixed methods research; a quantitative
documentary analysis of the research proposals, reports and publications of 75 mixed methods
studies funded by ten Department of Health programmes in the period 1994 - 2004; and a
qualitative study involving semi-structured face-to-face interviews with 20 researchers.
It was evident from the documentary analysis that researchers are mixing methods in a range of
different ways, with quantitative methods dominating, thus reflecting the conventional
hierarchy of evidence in HSR. However, researchers could further exploit this approach by being
clear about the purpose and practice of mixing methods when planning their studies, exploiting
the contribution of qualitative components of studies, engaging with a wider range of ways of
integrating data and findings from different components of a study, and being explicit in peerreviewed
journal articles about any unique contribution made by this approach. Findings from
the interviews with researchers suggest that researchers can contribute to fully exploiting the
potential of mixed methods research by learning more about the different ways of integrating
data and findings, respecting and understanding the strengths of the different methodological
approaches, communicating with team members, and valuing integration.
In HSR a multidisciplinary approach to team working is the norm whereby study components
are undertaken separately. An interdisciplinary approach to team working is less common but
may be associated with exploiting more of the potential of mixed methods studies. The external
research environment appears to be conducive to interdisciplinary endeavour but not to
interdisciplinary outputs. Structural change, as well as change in researcher behaviour, will be
necessary if health services researchers are to fully exploit the potential of using mixed methods
research.