Chapter 12 Understanding Mixed Methods Research, Quality Improvement, and Other Special Types of Research

Question 1

Mixed Methods Research

Answer 1

Research that integrates quantitative and qualitative
data and strategies in a single study or coordinated
clusters of studies

Question 2

Advantages of Mixed Methods Research

Answer 2

Complementarity

Practicality

Enhanced validity

Question 3

Purposes and Applications of Mixed Methods Research

Answer 3

Instrument development

Intervention development

Hypothesis generation and testing

Explication

Question 4

Concurrent Approach

Answer 4

Qualitative and quantitative data are collected at the same time

Question 5

Sequential Approach

Answer 5

Qualitative and quantitative data are collected in phases

Question 6

Convergent Parallel Design

Answer 6

Obtain different, but complementary, data about the central phenomenon under study—i.e., to triangulate data sources

Question 7

Explanatory Design

Answer 7

Sequential designs w/ quantitative data collected in the 1st phase, followed by qualitative data collected in the 2nd phase

Question 8

Exploratory Design

Answer 8

Sequential MM designs, with qualitative data being collected first

Question 9

Quality Improvement (QI)

Answer 9

Involves assessments of a problem in patient care
with the aim of improving clinical care and patient
outcomes within a healthcare organization to
develop improvement science

Question 10

QI Interventions

Answer 10

Quality Improvement Interventions include:
- Provider education (teaching healthcare teams how
best to manage situations)

- Provider reminders (providing decision support materials to prompt healthcare professionals to undertake some action)

- Patient education (increasing patient’s understanding of a prevention or treatment strategy)

- Patient reminders (reminding patients to keep appointments or adhere to regimens)

- Structural changes (creating care coordination or case management systems)

Question 11

Root Cause Analysis (RCA)

Answer 11

” 5 Whys”

Question 12

Plan-Do-Study-Act (PDSA) Approach

Answer 12

Plan: Develop strategies or interventions
Do: implement interventions and collect data
Study/Check: run analysis on collected data
Act: dissemination of outcome results as appropriate for practice changes

Question 13

Which type of research involves an intervention?

A) Survey research
B) Clinical trials
C) Secondary analyses
D) Methodological research

Answer 13

B) Clinical Trials

Rationale: Studies that involve an intervention include
clinical trials, evaluation research, and nursing
intervention research. Outcomes research, surveys,
secondary analyses, and methodological research do
not involve an intervention.

Question 14

Clinical Trials

Answer 14

Studies that develop clinical interventions and test
their efficacy and effectiveness

Undertaken to evaluate an innovative therapy or
drug are often designed in a series of phases

Question 15

Phase I of Full Clinical Trial

Answer 15

Designed to establish safety, tolerance, and dose

Question 16

Phase II of Full Clinical Trial

Answer 16

Seeks preliminary evidence of effectiveness—a pilot test often using a quasi-experimental design

Question 17

Phase III of Full Clinical Trial

Answer 17

Fully tests the efficacy of the treatment via a randomized clinical trial (RCT), often in multiple sites
- Sometimes called an efficacy study

Question 18

Phase IV of Full Clinical Trial

Answer 18

Focuses on external validity (effectiveness) of an intervention in the general population
- Emphasis on generalizability

Question 19

Practical/Pragmatic Clinical Trials

Answer 19

Help in making decisions in real-world application

Question 20

Pragmatism

Answer 20

A paradigm often associated w/ MM research, which provides a basis for a position that has been stated as the “dictatorship of the research question”

Question 21

Evaluation Research

Answer 21

Examines how well a specific program, practice,
procedure, or policy is working

Question 22

Process Analysis

Answer 22

Often undertaken to obtain descriptive
information about the process by which a
program gets implemented and how it actually
functions

Question 23

Economic Analysis

Answer 23

Assess whether program benefits outweigh its monetary costs

Question 24

During which phase of a full clinical trial would an
efficacy study be done?

A) Phase I
B) Phase II
C) Phase III
D) Phase IV

Answer 24

C) Phase III

Rationale: Phase III fully tests the efficacy of the treatment via a randomized clinical trial (RCT), often
in multiple sites; this phase is sometimes called an
efficacy study.

Phase I finalizes the intervention; phase II seeks preliminary evidence of effectiveness, usually via a pilot test; and phase IV focuses on long-term consequences of the intervention and on generalizability (sometimes called an effectiveness
study).

Question 25

Nursing Intervention Research

Answer 25

Describes an approach distinguished by a distinctive
process of planning, developing, & testing interventions—especially complex interventions

Question 26

Comparative Effectiveness Research (CER)

Answer 26

Involves direct comparisons of two or more
health interventions

Seeks insights into which intervention works
best for which patients

Sometimes referred to as patient-centered
outcomes research

Question 27

Health Services Research

Answer 27

Designed to document the quality and effectiveness
of health care and nursing services

Question 28

Focus of Health Services Research

Answer 28

Often focuses on parts of a healthcare quality model developed by Donabedian
Key concepts:
o Structure of care (e.g., nursing skill mix)
o Processes (e.g., clinical decision making)
o Outcomes (end results of patient care)

Question 29

Outcomes Research

Answer 29

Subset of health services research

Comprises efforts to understand the end results of
particular health care practices and to assess the
effectiveness of health care services

Represents a response to the increasing demand
from policymakers and the public to justify care
practices in terms of improved patient outcomes and
costs

Question 30

Survey Research

Answer 30

Obtains quantitative information (via self-reports)
on the prevalence, distribution, and interrelations of
variables in a population

Used primarily in correlational studies and to gather
information from nonclinical populations

Secures information about people’s actions, intentions, knowledge, characteristics, opinions, and attitudes

May be cross-sectional or longitudinal

Question 31

Modes of Collecting Survey Data

Answer 31

Personal (face-to-face) interviews: Tend to yield the highest quality data but are very expensive

Telephone interviews

Self-administered questionnaires
 Distributed by mail or the Internet

Question 32

Tell whether the following statement is True or False.

Telephone interviews provide the best quality data for
survey research.

A) True
B) False

Answer 32

B) False

Rationale: Personal interviews used with survey
research tend to provide the highest quality data, but
they are very expensive.

Question 33

Secondary Analysis

Answer 33

Study that uses previously gathered data to address
new questions

Can be undertaken with qualitative or quantitative
data

Cost-effective; data collection is expensive and
time-consuming.

Secondary analyst may not be aware of data quality
problems and typically faces “if only” issues (e.g., if only there was a measure of X in the dataset).

Question 34

Delphi Surveys

Answer 34

Developed as a tool for short-term forecasting

The technique involves a panel of experts who are
asked to complete several rounds of questionnaires
focusing on their judgments about a topic of
interest.

Multiple iterations are used to achieve consensus.

Question 35

Methodological Research

Answer 35

Studies that focus on development, validation, and
evaluation of research tools and instruments

Can involve qualitative or quantitative data

Question 36

Examples of Methodological Research

Answer 36

Developing and testing a new data collection
instrument

Testing the effectiveness of stipends in
facilitating recruitment

Question 37

Guidelines for Critical Appraisal of Mixed Method Studies

Answer 37

Was the study exclusively qualitative or exclusively quantitative? If so, could the study have been strengthened by incorporating both approaches?

If the study used an MM design, did the inclusion of both approaches contribute to enhanced validity? In what other ways (if any) did the inclusion of both types of data strengthen the study & further the aims of the research?

In a QI project, were adequate methods used to identify the root cause of the problem being addressed? Was PDSA (or another QI model) used to guide the process, and was it used appropriately? Was a good research design used to assess the effects of the QI changes?