This section discusses the potential for the ‘mixed methods’ research tradition to
enable a more appropriate, ‘less secure’, and ‘integrated’ methodological position in
research and clinical contexts. In the present multi‐methods study I have combined
both survey (‘general’ and largely quantitative) and interview (‘particular’ and
qualitative) data in order to establish fuller understanding. Methodologically, a
mixed methods approach could have been utilised to integrate these diverse
approaches. Indeed that was where my ‘methodological thinking’ originally lay.
However, after initially considering mixed methods I came to embrace an
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data sets. Nevertheless, important understandings can be gained by considering
mixed methods.
3.2.1. The potential of mixed methods inquiry
Rogers and Apel (2010, p. 94) argue that embracing methodological diversity is an
important step in revitalising suicidology, and is preferable to merely shifting the
current quantitative / (post)positivist bias towards qualitative / interpretive
approaches. Robinson et al. (2008), Niner et al. (2009) and Goldney (2002, p. 70) also
agree that considering the nexus between qualitative and quantitative methods may
be vital in relation to suicide and its prevention in Australia. Furthermore,
suicidology does have a contemporary (e.g. Wong et al. 2011; Walls 2007) and
historical (e.g. Durkheim 1951 [1897]) tradition of combining qualitative and
quantitative data. Thus, for some (Rogers and Apel 2010, p. 94; Kral et al. 2012),
mixed methods research may provide the methodological basis necessary to
progress suicidology by exploiting the qualitative and quantitative ‘nexus’.
There is a parallel assertion that the mixing of different methods of inquiry and data‐
types in clinical practice may help evolve care beyond some of the limitations noted.
It has been argued, for example, that because nursing may be considered both ‘art’
and ‘science’ it may be ‘an ideal context for the use of mixed methods approaches’
(Carr 2008, p. 25). This position is based on the belief that mixed methods may
enable a combination of both general and particular data, and may do justice to
explaining the complexity of human behaviour and relationships. In this sense mixed
methods inquiry may represent a framework for moving beyond reductive,
objectifying modes of inquiry.
3.2.2. The limitations of mixed methods inquiry
Employing mixed methods approaches in domains such as suicidology and nursing
may be of value. Upon closer examination, however, there are potential limitations.
Limitations arise not in respect to the broad notion of ‘mixing’ different methods and
data, but rather in the ways the mixed method tradition may be understood and
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paradigmatic incompatibility (Denzin 1997), the possible promotion of a
(post)positivist agenda (Giddings 2007), and the potential to constrain research
within the ‘walls’ of a new tradition in what might otherwise be a more liberated
post‐paradigmatic era (Bergman 2008, p. 13; Kincheloe 2001).
The notion of paradigmatic incompatibility relates to the association of qualitative
research methods (e.g. interview) with constructivism / interpretivism and
quantitative research methods (e.g. survey) with positivism / post‐positivism
(Bergman 2008, p. 11). In the positivist / post‐positivist tradition reality is ‘out there’,
objective, and knowable in so much as possibly flawed human apprehension of it
allows. Alternatively, in the constructivist / interpretive paradigm knowledge is very
much seen as a product of human consciousness. Usually (but not always) mixed
methods embraces the notion that different paradigms can be combined to explore
that which is ‘both socially constructed and yet real’ (Hacking 1999, p. 119) – both
‘subjective’ and ‘objective’, or ‘particular’ and ‘general’. Thus it may be argued that
mixed methods presents a satisfactory solution to incompatibility (Birembaum‐
Carmeli et al. 2008, p. 435).
However, others argue strongly that it is not possible to reconcile multiple paradigms
because ‘qualitative’ and ‘quantitative’ represent distinct, mutually exclusive
worldviews (Denzin 1997) in which ‘one precludes the other just as surely as belief in
a round world precludes belief in a flat one’ (Guba 1987, p. 31). Additionally, it is
argued that one paradigm may guide mixed methods (e.g. critical realism or
pragmatism), or that, regardless of potential paradigmatic incompatibility, methods
may be combined at the ‘technique level’ (Sandelowski 2000, p. 248). Clearly, a
diversity of positions regarding paradigmatic compatibility exist (for further
explication see Teddlie & Tashakkori 2010, p. 13‐15; Creswell & Plano‐Clark 2007, p.
26‐27; Greene & Caracelli 2003, p. 96‐103) and the legitimacy of combining
qualitative and quantitative approaches aligned with different paradigms is the
subject of ongoing debate (Tashakkori & Creswell 2007; Teddlie & Tashakkori 2010).
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While the mixed methods tradition does not always assert the need to mix
paradigms (Symonds & Gorard 2008, p. 6; Haase & Myers 1988; Sale et al. 2002, p.
46; Bergman 2008, p. 13) its tendency to do so may be problematic as it,
paradoxically, reinforces a false dichotomisation. Such paradigmatic dichotomisation
is argued to be ‘misleading’ and seriously limiting in relation to suicidology
(Fitzpatrick 2011, p. 29), and this may also be the case in broader clinical contexts
which seek to move beyond unhelpful dichotomies (which, as noted, may assert that
medical and social psychiatry, mental health and psychiatric nursing, or observation
and engagement, are incompatible which each other). More broadly, it is noted that
in a post‐paradigmatic research landscape, the ‘either‐or’ distinction may hamper
research which seeks to combine different data types (Bergman 2008, p. 13). Rather
than freeing research from the restrictions of paradigms, dichotomisation may
actually obscure a more fundamental reintegration and may strip from researchers
power to design their own studies to best meet research needs (Symonds & Gorard
2008, p. 15). Therefore, in the present study the interpretive tradition was favoured
over mixed methods in order to limit the view that interview and survey methods
inherently rest upon different (and potentially incompatible) paradigmatic
(methodological) foundations. Furthermore, this may be seen to have important
parallels in the clinical context, particularly in respect to the fuller integration of
diverse approaches to care.
Another related factor rendering mixed methods less attractive is that when multiple
paradigms are assumed to be present there may be a tendency to presume ‘a
methodological hierarchy’ which prioritises the (post)positivist paradigm over the
interpretive (Denzin & Lincoln 2005, p. 9). In suicidology, for example, it is argued
that often ‘mixed methods’ is merely a quantitative study of qualitative data that
reinforces positivistic concepts of validity and generalisability (Fitzpatrick 2011). This
claim reflects the broader concern that the mixed methods movement may conceal
the ‘continued hegemony of positivism’ (Birenbaum‐Carmeli et al. 2008, p. 436;
Giddings 2007). In this regard it is argued that by being guided by the mixed methods
tradition one may be responding to the ‘disciplinary implosion’ with a reductionist
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Again, this may be seen to have parallels in clinical contexts, which arguably involve
the dominance of medicalised approaches over other alternate or complementary
approaches. Thus it is appreciated that, for some, mixed methods presents a
satisfactory solution to paradigmatic incompatibility (Morgan 2007 in Birembaum‐
Carmeli et al. 2008, p. 435). For others, including myself however, mixed methods
represents a limiting ‘truce’ (Bergman 2008) and something of a ‘Trojan horse’ for
positivism (Giddings 2007).
3.2.3. Summary
The mixed methods research tradition is useful in that it promotes the importance of
combining different methods, ‘perspectives’ and data types in single projects.
However, issues of methodological incompatibility and competition render it
currently a somewhat problematic tradition. While combining methods can clearly
be valuable and necessary for understanding complex human phenomena (Sale et al.
2002, p. 46), preoccupation with paradigmatic incompatibility may not be resolvable
at present. Indeed the question of incompatibility may be based on false premises
and stand in the way of getting research ‘done’ (Sale et al. 2002, p. 46). Furthermore,
given the positivistic bias in relation to suicidology (and arguably nursing and mental
health care more broadly), there is good cause to consider how multiple methods
can be combined within an interpretive framework, rather than using mixed
methods which may reinforce a positivistic bias.