Using mixed methods in health services research: A review of the literature and case study

Haan, Maarten de; Eijk-Hustings, Yvonne van; Vrijhoef, Hubertus J. M.

doi:10.1177/1355819620955223

Cited by 8 publications

(5 citation statements)

References 38 publications

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“…Disagreements in convergence coding were discussed by all team-members. More details of the triangulation approach are published elsewhere [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study

Haan

Eijk-Hustings²,

Bessems-Beks³

et al. 2023

PLoS ONE

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Background Expected rise in the demand for healthcare and a dropping supply of healthcare professionals, has generated an increased interest in the most effective deployment of healthcare professionals. Consequently, task shifting has become a common strategy to redistribute tasks between established professional groups, however, little is known about the effects of shifting tasks to emerging professional groups. The aim of this study was to evaluate a legal amendment to facilitate task shifting to an emerging profession in Dutch healthcare: Clinical Technologists (CTs). CTs were introduced and provided an Extended Scope of Practice (ESP) to perform nine ‘reserved procedures’ independently. Methods A concurrent multi-phase mixed methods study was used to evaluate whether a legal amendment to facilitate task shifting to CTs was effective and efficient. Results The results show that CTs use their ESP frequently to perform five categories of reserved procedures independently and suggest that the ESP increased the efficiency of care delivery for those procedures. Additionally, the findings highlight that task shifting was influenced by the setting in which CTs worked, time allotted to patient-contact as well as external factors (e.g., financing). Conclusions This study provides tentative lessons for policymakers on how task shifting to emerging professional groups can be improved. Providing a legal amendment to facilitate task shifting to CTs seems to be effective and efficient. However, it also poses multiple challenges. While established professional groups can face similar challenges, it is likely that these are exacerbated for emerging professional groups, particularly when shifting tasks occurs horizontally.

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“…Disagreements in convergence coding were discussed by all team-members. More details of the triangulation approach are published elsewhere [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study

Haan

Eijk-Hustings²,

Bessems-Beks³

et al. 2023

PLoS ONE

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“…In this research, we adopt ‘Triangulation’ to analyse the quantitative and qualitative data and illustrate it by the communal display table. The triangulation steps 49 is as follows ( figure 3 ).…”

Section: Methods and Analysismentioning

confidence: 99%

Exploring the relationship between self-management behaviour, family function and health information adoption behaviour in Chinese diabetic foot patients: a mixed-methods study protocol

Wang,

Tang,

et al. 2023

BMJ Open

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IntroductionDiabetic foot is a major burden and threat to individuals, families and society, making it imperative to promote good self-management behaviour. However, although nurses have provided these patients with excellent health knowledge, their self-management remains unsatisfactory. Although researches have shown that self-management requires family involvement, no research has been conducted in China on family function, specifically in the diabetic foot. Therefore, this study aimed to explore the relationship between self-management, family functioning, and health information adoption behaviour and explain the formation’s reason.Method and analysisWe will conduct a mixed-methods study using an exploratory sequential study design in Zhejiang, China. In the first phase, cross-section research will be conducted using a convenient sampling strategy on 225 diabetic foot patients. SPSS V.26 was used for correlation and multiple stepwise regression analyses. Structural equation modelling will be performed by using AMOS V.24. The researchers will conduct a semistructured interview to collect qualitative data and use NVivo to analyse. Ultimately, we will ‘triangulate’ to integrate quantitative and qualitative data.Ethics and disseminationThis study received ethical clearance from the Ethics Review Committee, the affiliated Sir Run Run Shaw Hospital of Medicine School, Zhejiang University (approval no: 2023-0145). All data collection processes will abide by health and safety measures required by the national government. Written informed consent will be obtained from all participants. The study will produce one paper that will be disseminated, to local stakeholders and participants, via local and international conferences and publications in peer-reviewed journals.

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“…Results were grouped into themes and mapped to the effectiveness and implementation RE-AIM domains by 2 study team members. We used mixed methods to investigate the possible convergence of qualitative and quantitative findings, through data triangulation [ 22 ]. Through this analysis, we sought to corroborate and expand quantitative findings using qualitative data.…”

Section: Methodsmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on the Implementation of Mobile Health to Improve the Uptake of Hydroxyurea in Patients With Sickle Cell Disease: Mixed Methods Study

Badawy¹,

DiMartino²,

Brambilla³

et al. 2022

JMIR Form Res

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Background Hydroxyurea therapy is effective for reducing complications related to sickle cell disease (SCD) and is recommended by National Health Lung and Blood Institute care guidelines. However, hydroxyurea is underutilized, and adherence is suboptimal. We wanted to test a multilevel mobile health (mHealth) intervention to increase hydroxyurea adherence among patients and improve prescribing among providers in a multicenter clinical trial. In the first 2 study sites, participants were exposed to the early phases of the COVID-19 pandemic, which included disruption to their regular SCD care. Objective We aimed to describe the impact of the COVID-19 pandemic on the implementation of an mHealth behavioral intervention for improving hydroxyurea adherence among patients with SCD. Methods The first 2 sites initiated enrollment 3 months prior to the start of the pandemic (November 2019 to March 2020). During implementation, site A clinics shut down for 2 months and site B clinics shut down for 9 months. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate the implementation and effectiveness of the intervention. mHealth implementation was assessed based on patients’ daily app use. Adherence to hydroxyurea was calculated as the proportion of days covered (PDC) from prescription records over the first 12 and 24 weeks after implementation. A linear model examined the relationship between app usage and PDC change, adjusting for baseline PDC, lockdown duration, and site. We conducted semistructured interviews with patients, health care providers, administrators, and research staff to identify factors associated with mHealth implementation and effectiveness. We used a mixed methods approach to investigate the convergence of qualitative and quantitative findings. Results The percentage of patients accessing the app decreased after March 15, 2020 from 86% (n=55) to 70% (n=45). The overall mean PDC increase from baseline to week 12 was 4.5% (P=.32) and to week 24 was 1.5% (P=.70). The mean PDC change was greater at site A (12 weeks: 20.9%; P=.003; 24 weeks: 16.7%; P=.01) than site B (12 weeks: −8.2%; P=.14; 24 weeks: −10.3%; P=.02). After adjustment, PDC change was 13.8% greater in those with increased app use after March 15, 2020. Interview findings indicated that site B’s closure during COVID-19 had a greater impact, but almost all patients reported that the InCharge Health app helped support more consistent medication use. Conclusions We found significant impacts of the early clinic lockdowns, which reduced implementation of the mHealth intervention and led to reduced patient adherence to hydroxyurea. However, disruptions were lower among participants who experienced shorter clinic lockdowns and were associated with higher hydroxyurea adherence. Investigation of added strategies to mitigate the effects of care interruptions during major emergencies (eg, patient coaching and health navigation) may “insulate” the implementation of interventions to increase medication adherence. Trial Registration ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167 International Registered Report Identifier (IRRID) RR2-10.2196/16319

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Using mixed methods in health services research: A review of the literature and case study

Cited by 8 publications

References 38 publications

Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study

Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study

Exploring the relationship between self-management behaviour, family function and health information adoption behaviour in Chinese diabetic foot patients: a mixed-methods study protocol

Impact of the COVID-19 Pandemic on the Implementation of Mobile Health to Improve the Uptake of Hydroxyurea in Patients With Sickle Cell Disease: Mixed Methods Study

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