Identifying a method of appropriately answering research questions and hypotheses is challenging and in part will be determined by a researcher’s philosophical world view. An inquirer’s views of the ideas they are studying are influenced by their understandings and beliefs (Greene and Caracelli 2003). Beliefs are no doubt founded on experiences and reflection of those experiences. In this case my beliefs and experiences as a trained and practicing physiotherapist have had an impact on my view of the world and the focus and the choice of methodology for this study. I see a
requirement to collect evidence that can be quantified and acknowledge that within the context of health and social care research qualitative enquiry is also important. Qualitative data within a quantitative study enables the researcher to enrich the information collected and can be employed to add to or explain the numerical findings.
I am an advocate of lifespan development described by (Datan and Reese 1977; Baltes et al 1980). Within this context there is an understanding that an individual is constantly changing and that these changes occur as a result of the circumstances in which they live. An individual’s life time development is influenced by changes from conception to death involving the interaction of
biological, psychological, historical and sociological factors. These changes are as a result of the individual interacting within their environment and adjusting to both internal and external influences occurring sequentially. This world view which arises out of actions, situations and consequences is best described as a pragmatic world view (Creswell 2009). Within this context it is acknowledged that the data collected for this study only captures a snap shot of the lives of the participants and is therefore a limitation. However, resources for research are not finite and researchers need to identify the best use of resources within methodological and ethical limitations. The considerations discussed above have contributed and influenced the pragmatic approach taken by the researcher for this study.
Pragmatism as a paradigm in research supports the use of both qualitative and quantitative research in the same study, presenting the researcher with a practical approach to answering research questions while allowing the researcher to study a topic pertinently (Teddlie and
Tashakkorie 2003). In this study the quantitative data collected in the questionnaire contributes to understanding relationships. The qualitative data collected in the open questions in the
questionnaire enable a deeper sense of appreciation of those relationships. Pragmatism belongs to a culture of commonsense (Sleeper 1986) and supports the use of mixed methods research. Mixed methods as a research concept is there to facilitate the researcher to gain a more superior
comprehension of a topic than would be possible if only one methodology was used.
Having stated my world view, within this project I understand that my experiences may contribute to biases and therefore trustworthiness in this study. Trustworthiness is a term used in qualitative research and relates to the reliability and validity of the research and includes the terms credibility transferability, dependability and confirmability (Rolfe 2006). Credibility and transferability
correspond to the concepts of internal and external validity and are discussed later (See 6.3). Dependability and confirmability are aspects which deal with the consistency and objectivity of the study.
Dependability is defined as the reliability of the data findings (Rolfe 2006; Taylor 2007) and relies on the researcher clearly defining the methodology and data analysis involved in the study. This chapter provides evidence of the methodology utilised in this study and the data analysis strategies. Confirmability is defined and relates to the presentation and objectivity of the data (Rolfe 2006; Taylor 2007). This relies on the researcher identifying and putting strategies in place to limit bias. To limit bias involves the researcher documenting their stance in the research and showing continuing dialogue with colleagues, supervisors and field experts through the research process and
documenting presentations of the research findings. In the introductory chapter I discussed my stance in this study in addition a field diary was kept and referred to when analysing the data. All
the qualitative data was peer reviewed by an expert in the field of JHS. Qualitative data analysis was discussed with supervisors who were informed of the overall research progress in regular meetings (See appendix 4) and presentations of the research findings are documented (See appendix 5).
The overall study objective was to explore the multi-factorial nature of JHS. Details of the
hypotheses and questions have been previously presented within a mixed methods context and can be viewed (See 2.6).
3.2.1 Mixed methods research
Mixed methods research as a methodology requires an explanation, because the mixing of the methods is particular for each study. It is not the intention in this chapter to discuss this topic in detail but to give the reader an overall picture of mixed methods as it has been used in this study.
Mixed methods research has been referred to as the third paradigm or third methodological movement (Teddlie and Tashakkori 2003; Johnson and Onwuegbuzie 2004). The other research movements are defined as quantitative and qualitative. It is suggested that the term mixed methods designs (MMD) (which is the term that will continue to be used in this thesis) is used as a general term to cover mixed method research and mixed model research (Teddlie and Tashakkori 2003). Mixed method research studies involve the collection and analysis of quantitative and qualitative data either sequentially or concurrently. They are often only marginally mixed but both sets of data are required to answer the research hypotheses and questions and there is often a single
paradigm. Alternatively the mixing may be more global. In the case of mixed model research where there is mixing in many or all of the stages of the study, to enable the answering of each research question depending on the paradigms and inferences corresponding to different world views. This study utilised mixed method research within a MMD.
3.2.2 Mixed methods design
It was anticipated that by utilizing MMD in which both quantitative and qualitative data were collected, analysed and integrated would enable the answering of questions that the other methodologies on their own may not be able. It was also anticipated this method would provide stronger inferences if the data converged, or the opportunity to offer diversity if the data were divergent as has previously been discussed within the mixed methods literature (Tashakkori and Teddlie 1998). The use of triangulation has been reported as a method by which to combine sources and to add to the usefulness of MMD (Jick 1979; Greene et al 1989). Creswell (2002) described the method and usefulness of triangulation and suggested collecting quantitative and
qualitative data, merging the data and then using the integrated results to answer the research questions. In this study triangulation was used to enable the discussion of inferences that confirmed or refuted each other. Further analysis of the data may be facilitated by transformation. Transformation of data is referred to using the terms ‘qualitising’ and ‘quantitising’. These terms were defined by Tashakkori and Teddlie (1998) although the idea ‘to convert data into primitive quantities’ was previously described by Miles and Huberman (1994p11). Qualitised data is data collected quantitatively, converted into narratives and analysed qualitatively. Quantitsed data is data collected qualitatively and converted into numerical codes that can be statistically analysed.
For this study the benefits of using MMD were to confirm a quantitatively derived hypothesis and explore features that were important to patients with JHS. This method of conducting research is similar to a clinical examination in which both subjective (qualitative) and objective (quantitative) information is collected, analysed and from which inferences are made.
3.2.3 Choosing a mixed methods design
There are many ways of designing a MMD study, some of which incorporate practical decisions. For example data collected in phases (sequentially) will take longer to gather than data collected at the same time (concurrently). Another factor will be the weighting given to each methodology. This may be equal or it might be preferred for one method to dominate another. A more complex issue arises when considering how the questions and the data analysis are to be mixed. This consists; a) connecting the data, this means mixing quantitative and qualitative in the first and second phases of the data collection, b) integrating the data by merging the different data sets; and c) embedding the data in which the researcher uses the secondary form of data to support data from the larger primary study.
With these designs in mind it seemed appropriate to use a concurrent nested strategy because the secondary (smaller) qualitative method was to be nested in the primary (larger) QUANTITATIVE method and the mixing of the two methods were to be used to integrate information and compare between the data sets in order to gain perspectives at different levels. There were five stages for this study. Within each stage there was an element of development, analysis or integration of either or both the quantitative and qualitative aspects (see figure 3-1).
Figure 3-1 Overview of the stages of the mixed methods process and relationship of the methodologies