SCI Nursing Journal

Matthew R. Sorenson, PhD, RN

In the last several years, we have seen an increase in studies, particularly those with a clinical focus that employ research methods from differing traditions, a mixing or blend of research methodologies. The use of mixed methodology in answering research questions is a form of what has been referred to as “triangulation.” In mixed-method studies, a qualitative research strategy is often used in combination with a quantitative strategy.

Qualitative studies have been viewed as providing a sense of the meaning of a phenomenon, whereas quantitative studies provide a means of comparing scores across populations and settings. An integration of both approaches may provide a new sense of the concept under investigation. This blending of approaches can provide a new understanding of concepts of relevance to spinal cord injury (SCI).

Triangulation
Definitions of triangulation in the nursing literature tend to utilize four categories developed by Denzin (1989). These categories are: (1) data, (2) investigator, (3) theoretical, and (4) method. In data triangulation, the investigator collects data from more than one source, for example from nursing staff and family members. Investigator triangulation involves having more than one researcher involved in data collection. Theoretical triangulation employs more than one theoretical perspective to analyze the data or may involve the collection of data using different research tools developed from differing theoretical perspectives. Method triangulation concerns the use of multiple means of collecting data, whether two separate qualitative/quantitative strategies, or the use of a qualitative and a quantitative technique within the some investigation (Denzin).

Method triangulation can involve either “within-method” or “between-method” approaches. Within-method triangulation involves use of more than one approach in collection of data (e.g., two different qualitative approaches to data collection). Here, research methods are not chosen from both the qualitative or quantitative tradition, the investigator employs multiple methods with one tradition. The between-method approach reflects the mixing of methods, utilizing both quantitative and qualitative approaches in gathering data. This technique provides the opportunity to expand beyond the limitations of one particular approach and gain a broader picture of the concept under study.

Should an investigator mix approaches throughout several aspects of the research process in terms of theoretical approaches or multiple investigators, in order to maintain some clarity across definitions it has been suggested that this be referred to as mixed model research (Teddlie & Tashakkori, 2003), with the term mixed methods referring more to the process of data collection.

Mixed-Method Research
As with other research traditions, there are several research designs possible with mixed-method research depending on whether the researcher is interested in exploring or confirming a research question. The collection of data using these approaches may occur in a sequential or simultaneous fashion. Examples of design approaches in the conduct of mixed-method studies include:

(1) The use of a qualitative strategy along with a quantitative strategy. An aspect of this design is commonly seen in clinical studies in which the participant is asked to complete a standardized question followed by a series of open-ended questions. A commonly employed approach in mixed-methods studies appears to be the adding of open-ended questions to a quantitative research instrument, typically a self-report questionnaire. This approach provides the investigator with the opportunity to move past the quantitative score generated by the questionnaire and investigate respondent feelings and concerns regarding the particular concept under investigation. This approach, however, could lead the investigator into playing little attention to the conduct of the qualitative aspects, leading to questions of qualitative rigor. More formal designs fully incorporate both methodologies.

(2) The findings from one study could be used to develop instruments used in another. A qualitative study could be done to investigate the perceptions surrounding quality of life in individuals with spinal cord injury. Afterward, the extracted themes could be used in the development of a standardized questionnaire. A similar approach was used in developing a quality of life measure for use with adolescent populations. In that work, qualitative studies served as the basis for model creation, with a series of quantitative studies conducted afterward to establish the instruments’ psychometric properties (Haase, Heiney, Ruccione, & Stutzer, 1999).

(3) Another variant can find one investigator administering a standardized questionnaire to a population, while another investigator conducts a qualitative interview with a comparison of the results afterward. This methodology was seen in a study of individuals with chronic fatigue syndrome, where a quantitative questionnaire was used to assess quality of life, with a subsample qualitatively interviewed (Anderson & Ferrans, 1997).

Relevance for Spinal Cord Nursing
Spinal cord research can involve non-random, purposive samples or samples that are readily accessible. This approach to sampling is less likely to generate the large numbers of subjects necessary to achieve the standard distribution pattern desired for the use of parametric statistics. A researcher could use non-parametric statistics to test for significance with smaller samples and purposive sampling approaches. Yet, this does not bring the same wealth of information that the concomitant use of a quantitative and a qualitative research method could bring. Mixing methods can bring a further dimension to spinal cord research, providing the richness of qualitative description along with standardized quantitative scores that can be compared with other studies. This approach can work well with smaller studies, and those descriptive investigations that are attempting to describe a concept with a SCI study population.

Conclusion
There seems to be an ongoing debate within the nursing literature regarding the philosophical basis of quantitative and qualitative research, such that a mixed-method approach may appear incommensurate. It has been proposed that applied research disciplines should avail themselves of a more pragmatic approach to research. With a pragmatic approach, the research question is considered the primary issue of concern, with less concern for a particular philosophical framework. The pragmatic approach argues that researchers should feel free to ask the questions that interest them and employ the methods that are appropriate to answering the question. This approach states a belief that qualitative and quantitative approaches are not incompatible with one another and argues for a middle ground between constructivist and positivist paradigms (Maxcy, 2003; Teddlie & Tashakkori, 2003). While there are still many questions to be answered regarding the use of mixed-method studies, these approaches may be of value to those conducting research with SCI and deserve a further look.

References

Anderson, J. S. & Ferrans, C. E. (1997). The quality of life of persons with chronic fatigue syndrome. Journal of Nervous and Mental Disease, 185(6), 359-367.

Denzin, N. K. (1989). The research act: A theoretical introduction to sociological methods (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.

Haase, J. E., Heiney, S. P, Ruccione, K. S., & Stutzer, C. (1999). Research triangulation to derive meaning-based quality-of-life theory: Adolescent resilience model and instrument development. International Journal of Cancer, 12, S125-S131.

Maxcy, S. J. (2003). Pragmatic threads in mixed methods research in the social sciences: The search for multiple modes of inquiry and the end of the philosophy of formalism. In A. Tashakkori & C. Teddlie (Eds.), Handbook of mixed methods in social and behavioral research (pp. 51-89). Thousand Oaks, CA: Sage.

Teddlie, C., & Tashakkori, A. (2003). Major issues and controversies in the social and behavioral sciences. In A. Tashakkori & C. Teddlie (Eds.), Handbook of mixed methods in social and behavioral research (pp. 3-50). Thousand Oaks, CA: Sage.

Matthew R. Sorenson, PhD, RN, is an assistant professor of nursing at DePaul University in Chicago, Illinois. Questions, comments, or suggestions regarding Research Corner may be addressed to msorenso@depaul.edu.

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