Chapter 12 Understanding Mixed Methods Research, Quality Improvement, and Other Special Types of Research Flashcards
Mixed Methods Research
Research that integrates quantitative and qualitative
data and strategies in a single study or coordinated
clusters of studies
Advantages of Mixed Methods Research
Complementarity
Practicality
Enhanced validity
Purposes and Applications of Mixed Methods Research
Instrument development
Intervention development
Hypothesis generation and testing
Explication
Concurrent Approach
Qualitative and quantitative data are collected at the same time
Sequential Approach
Qualitative and quantitative data are collected in phases
Convergent Parallel Design
Obtain different, but complementary, data about the central phenomenon under study—i.e., to triangulate data sources
Explanatory Design
Sequential designs w/ quantitative data collected in the 1st phase, followed by qualitative data collected in the 2nd phase
Exploratory Design
Sequential MM designs, with qualitative data being collected first
Quality Improvement (QI)
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
QI Interventions
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)
Root Cause Analysis (RCA)
” 5 Whys”
Plan-Do-Study-Act (PDSA) Approach
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
Which type of research involves an intervention?
A) Survey research
B) Clinical trials
C) Secondary analyses
D) Methodological research
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.
Clinical Trials
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
Phase I of Full Clinical Trial
Designed to establish safety, tolerance, and dose
Phase II of Full Clinical Trial
Seeks preliminary evidence of effectiveness—a pilot test often using a quasi-experimental design
Phase III of Full Clinical Trial
Fully tests the efficacy of the treatment via a randomized clinical trial (RCT), often in multiple sites
- Sometimes called an efficacy study
Phase IV of Full Clinical Trial
Focuses on external validity (effectiveness) of an intervention in the general population
- Emphasis on generalizability
Practical/Pragmatic Clinical Trials
Help in making decisions in real-world application
Pragmatism
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”
Evaluation Research
Examines how well a specific program, practice,
procedure, or policy is working
Process Analysis
Often undertaken to obtain descriptive
information about the process by which a
program gets implemented and how it actually
functions
Economic Analysis
Assess whether program benefits outweigh its monetary costs
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
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).
Nursing Intervention Research
Describes an approach distinguished by a distinctive
process of planning, developing, & testing interventions—especially complex interventions
Comparative Effectiveness Research (CER)
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
Health Services Research
Designed to document the quality and effectiveness
of health care and nursing services
Focus of Health Services Research
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)
Outcomes Research
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
Survey Research
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
Modes of Collecting Survey Data
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
Tell whether the following statement is True or False.
Telephone interviews provide the best quality data for
survey research.
A) True
B) False
B) False
Rationale: Personal interviews used with survey
research tend to provide the highest quality data, but
they are very expensive.
Secondary Analysis
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).
Delphi Surveys
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.
Methodological Research
Studies that focus on development, validation, and
evaluation of research tools and instruments
Can involve qualitative or quantitative data
Examples of Methodological Research
Developing and testing a new data collection
instrument
Testing the effectiveness of stipends in
facilitating recruitment
Guidelines for Critical Appraisal of Mixed Method Studies
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?
