SummaryMixed methods research is the use of quantitative and qualitative methods in a single study or series of studies. It is an emergent methodology which is increasingly used by health researchers, especially within health services research. There is a growing literature on the theory, design and critical appraisal of mixed methods research. However, there are few papers that summarize this methodological approach for health practitioners who wish to conduct or critically engage with mixed methods studies. The objective of this paper is to provide an accessible introduction to mixed methods for clinicians and researchers unfamiliar with this approach. We present a synthesis of key methodological literature on mixed methods research, with examples from our own work and that of others, to illustrate the practical applications of this approach within health research. We summarize definitions of mixed methods research, the value of this approach, key aspects of study design and analysis, and discuss the potential challenges of combining quantitative and qualitative methods and data. One of the key challenges within mixed methods research is the successful integration of quantitative and qualitative data during analysis and interpretation. However, the integration of different types of data can generate insights into a research question, resulting in enriched understanding of complex health research problems.

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Highlights Older women’s experience of intimate partner violence (IPV) is an important public health concern. Globally, the reported prevalence of intimate partner violence experienced by older women ranges from 16.5% to 54.5%. The precipitants and consequences of intimate partner violence may be different for older than for younger women.. Older women experiencing intimate partner violence face unique barriers to accessing help. Older women’s experience of intimate partner violence is under-researched, especially in terms of interventions.

ObjectivesUK guidance advises HIV-positive women to abstain from breast feeding. Although this eliminates the risk of postnatal vertical transmission of HIV, the impact of replacement feeding on mothers is often overlooked. This qualitative study examines, for the first time in the UK, decision-making about infant feeding among African women living with HIV.MethodsBetween 2010 and 2011, we conducted semistructured interviews with 23 HIV-positive African women who were pregnant or had recently given birth. We recruited participants from three HIV antenatal clinics in London.ResultsWomen highlighted the cultural importance of breast feeding in African communities and the social pressure to breast feed, also describing fears that replacement feeding would signify their HIV status. Participants had significant concerns about physical and psychological effects of replacement feeding on their child and felt their identity as good mothers was compromised by not breast feeding. However, almost all chose to refrain from breast feeding, driven by the desire to minimise vertical transmission risk. Participants’ resilience was strengthened by financial assistance with replacement feeding, examples of healthy formula-fed children and support from partners, family, peers and professionals.ConclusionsThe decision to avoid breast feeding came at considerable emotional cost to participants. Professionals should be aware of the difficulties encountered by HIV-positive women in refraining from breast feeding, especially those from migrant African communities where breast feeding is culturally normative. Appropriate financial and emotional support increases women's capacity to adhere to their infant-feeding decisions and may reduce the emotional impact.

IntroductionAdvances in antiretroviral therapy have transformed HIV into a long-term condition with near-normal life expectancy for those in whom viral replication is well controlled on treatment. This means that age-related events, including menopause, is of increasing importance in the care of people living with HIV. The PRIME (Positive Transitions Through the Menopause) Study aims to explore the impact of the menopause on the health and well-being of women living with HIV (WLHIV).Methods and analysisThe PRIME Study is a multicentre, mixed-methods observational study deploying a multiphase sequential design with explanatory and exploratory phases. Phase 1 comprised three focus group discussions with WLHIV. In phase 2 we aimed to administer questionnaires comprising detailed assessment of menopausal status and symptoms to 1500 WLHIV aged 45–60 attending HIV clinics in England. Phase 3 comprised semistructured interviews with a subsample of phase 2 participants. Ongoing quantitative follow-up of 100 participants is planned between October 2018 and September 2019. Qualitative and quantitative data will be kept analytically distinct and analysed using appropriate methods. We will integrate quantitative and qualitative findings using coding matrices.Ethics and disseminationThe PRIME Study has ethical approval from the South East Coast-Surrey Research Ethics Committee on behalf of all National Health Service (NHS) sites, and approval from University College London Research Ethics Committee for qualitative work conducted in non-NHS sites. In conjunction with the study Expert Advisory Group (which includes WLHIV), we have drafted a dissemination strategy that takes into account a wide range of stakeholders, including patients, policy makers and healthcare providers. This includes at least five empirical research papers to be submitted to peer-reviewed journals, as well as an accessible report aimed primarily at a non-technical audience (published in May 2018 and launched at a live-streamed event). Both quantitative and qualitative data are held by the PRIME Study team and are available by request.

Improvements in survival due to advances in antiretroviral therapy (ART) have led to a shift in the age distribution of those receiving HIV care, with increasing numbers of women living with HIV (WLWHIV) reaching menopausal age. We present a narrative literature review of 26 studies exploring the menopause transition in WLWHIV, focusing on: (1) natural history (2) symptomatology and management, and (3) immunologic and virologic effects.Data are conflicting on the association between HIV and earlier age at menopause, and the role of HIV-specific factors such as HIV viral load and CD4 count. There are some data to suggest that WLWHIV experience more vasomotor and psychological symptoms during the menopause than HIV-negative women, and that uptake of hormone replacement therapy by WLWHIV is comparatively low. There is no evidence that menopause affects either CD4 count or response to ART, although there may be increased immune activation in older WLWHIV.We conclude that menopause in WLWHIV is a neglected area of study. Specific information gaps include qualitative studies on experiences of reproductive ageing; data on the impact of the menopause on women's quality of life and ability to adhere to health-sustaining behaviors; as well as studies investigating the safety and efficacy of pharmacological and psychosocial interventions. There is likely to be a burden of unmet health need among this growing population, and better data are required to inform optimal provision of care, supporting WLWHIV to maintain their health and wellbeing into their post-reproductive years.Word count: 2065

Resulting from treatment advances, the Human Immunodeficiency Virus (HIV) is now a long-term condition, and digital solutions are being developed to support people living with HIV in self-management. Sharing their health data with their peers may support self-management, but the trust, identity, privacy and security (TIPS) considerations of people living with HIV remain underexplored. Working with a peer researcher who is expert in the lived experience of HIV, we interviewed 26 people living with HIV in the United Kingdom (UK) to investigate how to design a peer data sharing platform. We also conducted rating activities with participants to capture their attitudes towards sharing personal data. Our mixed methods study showed that participants were highly sophisticated in their understanding of trust and in their requirements for robust privacy and security. They indicated willingness to share digital identity attributes, including gender, age, medical history, health and well-being data, but not details that could reveal their personal identity. Participants called for TIPS measures to foster and to sustain responsible data sharing within their community. These findings can inform the development of trustworthy and secure digital platforms that enable people living with HIV to share data with their peers and provide insights for researchers who wish to facilitate data sharing in other communities with stigmatised health conditions. CCS CONCEPTS • Human-centered computing~Human computer interaction (HCI) • Security and privacy~Social aspects of security and privacy

Third-sector organizations, an important support for people living with HIV, increasingly use digital technology to improve service efficiency and reach.However, there is limited empirical evidence on this use by women living with HIV. The 4M Network (4MNet) is a peer-run UK-wide network of trained Mentor Mothers (MMs) living with HIV; it uses the WhatsApp platform as its primary digital communication tool. We report on a qualitative study about 4MNet MMs' experiences of using WhatsApp, to inform the design of future digital support services. Seven telephone interviews were conducted with five MMs and two project management team (PMT) members in February 2019.Interviews were analyzed using Interpretive Phenomenological Analysis (IPA).WhatsApp was found to have several key features that provided both positive and negative use considerations. WhatsApp eased communication among MMs and supported participation in group activities despite differing schedules and geographic locations. Challenges encountered with WhatsApp included: financial restrictions to data storage and continual access; self-confidence using technology; and security and privacy concerns. Peer-led digital communication is found to be acceptable and effective for women living with HIV. Understanding barriers and valued features of existing digital platforms increasingly used among potentially marginalized groups is vital for informing inclusive innovation.