Mixed methods grant applications in the health sciences: An analysis of reviewer comments

Systematic Development of Standards for Mixed Methods Reporting in Rehabilitation Health Sciences Research

OBJECTIVE

Mixed methods research (MMR) integrates quantitative and qualitative methods throughout the research process to answer complex research questions. MMR designs align with the guiding frameworks of patient-centered care and social determinants of health by effectively examining the role of contextual factors and human experiences in influencing health and rehabilitation outcomes. Reporting standards and critical appraisal tools ensure the quality and transparency of the research process. MMR standards exist; yet, there is a need for reporting guidelines and an appraisal tool that meets field standards, is applicable across rehabilitation fields of study, and can accommodate the range of possibilities for combining research approaches and methods.

METHODS

Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) was developed using a systematic consensus-building process in accordance with published guidance and was preregistered with the Enhancing the Quality and Transparency of Health Research Network. MMR-RHS evolved through a sequence of steps, including extensive literature review, expert consultation, stakeholder feedback, pilot testing, and tool refinement.

RESULTS

MMR-RHS consists of 20 criteria that align with field standards for rigor and transparency, with an emphasis on integration throughout the research process, a key component of MMR.

CONCLUSIONS

A systematic process was utilized to develop the reporting standards and an appraisal tool for MMR in rehabilitation and health science. The tool is comprehensive, includes a set of criteria grounded in MMR literature, and is flexible for application to a range of MMR designs commonly seen in rehabilitation research.

IMPACT

The MMR-RHS may improve the quality and transparency of MMR by supporting investigators, authors, reviewers, and editors during project development, manuscript preparation, and critical review. The tool may assist readers in critical appraisal, knowledge translation, and application of published MMR findings. Ultimately, the MMR-RHS may help legitimize mixed methods in rehabilitation and health research, an important step toward understanding the complexities of health care, patient outcomes, and evolving societal health needs.

Music in the acute preoperative nursing care - A mixed-method pilot study

AIM

The aim was to (1) examine the feasibility aspect of a music intervention, (2) examine the association between music and pain, relaxation and well-being and (3) explore patients' experience of listening to music while waiting for acute surgery.

DESIGN

The design was a mixed-method study.

METHODS

Participants were offered a music pillow for 30 min. Before and after the intervention, participants reported their pain, relaxation and well-being using a visual analogue scale ranging from 0 to10. The qualitative part was based on field observation followed by a semi-structured interview.

RESULTS

The quantitative part included 30 participants. The Wilcoxon signed-rank test showed a positive significant association between music and pain, relaxation and well-being (p < 0.001). The qualitative part included 15 participants. Two themes derived from the analysis: (1) feelings of physical and mental well-being and (2) a break from the acute preoperative context.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach

The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.

Brain and spinal cord paired stimulation coupled with locomotor training affects polysynaptic flexion reflex circuits in human spinal cord injury

Neurorecovery from locomotor training is well established in human spinal cord injury (SCI). However, neurorecovery resulting from combined interventions has not been widely studied. In this randomized clinical trial, we established the tibialis anterior (TA) flexion reflex modulation pattern when transcranial magnetic stimulation (TMS) of the primary motor cortex was paired with transcutaneous spinal cord (transspinal) stimulation over the thoracolumbar region during assisted step training. Single pulses of TMS were delivered either before (TMS-transspinal) or after (transspinal-TMS) transspinal stimulation during the stance phase of the less impaired leg. Eight individuals with chronic incomplete or complete SCI received at least 20 sessions of paired stimulation during assisted step training. Each session consisted of 240 paired stimuli delivered over 10-min blocks for 1 h during robotic-assisted step training with the Lokomat6 Pro^®. Body weight support, leg guidance force and treadmill speed were adjusted based on each participant's ability to step without knee buckling or toe dragging. Both the early and late TA flexion reflex remained unaltered after TMS-transspinal and locomotor training. In contrast, the early and late TA flexion reflexes were significantly depressed during stepping after transspinal-TMS and locomotor training. Reflex changes occurred at similar slopes and intercepts before and after training. Our findings support that targeted brain and spinal cord stimulation coupled with locomotor training reorganizes the function of flexion reflex pathways, which are a part of locomotor networks, in humans with varying levels of sensorimotor function after SCI.Trial registration number NCT04624607; Registered on November 12, 2020.

Age, sex, and inflammatory markers predict chronic conditions, cardiac disease, and mortality among captive western lowland gorillas (Gorilla gorilla gorilla)

In humans, inflammatory markers predict health risks. As great apes experience many similar conditions, measuring inflammation may provide valuable health information. We examined four serum inflammatory markers in zoo-housed gorillas (n = 48): albumin, CRP, IL-6, and TNF-α. We first analyzed age- and sex-associated patterns, then used multimodel inference to evaluate models with age, sex, and inflammatory markers as predictors of all-cause morbidity, cardiac disease, and mortality. Older gorillas had lower albumin and higher IL-6, and males had higher albumin, lower CRP, and lower TNF-α. All-cause morbidity was best predicted by age, sex, and TNF-α, but the second model containing only age and sex was equivalent. Cardiac disease was best predicted by TNF-α alongside age and sex, with lower levels associated with increased risk. When outliers were removed, the model with TNF-α was second to the model containing only age and sex. Finally, mortality risk was best predicted by the model with only age and sex. Other models containing individual inflammatory markers were within top model sets for each health outcome. Our results indicate that age and sex are robust for predicting all-cause morbidity and mortality risk in gorillas; while models which include individual inflammatory markers also predict risk, they may not improve predictions over age and sex alone. However, given the prevalence of cardiac disease in great apes, these results suggest that TNF-α warrants further investigation. With their potential to provide valuable health information, data on inflammatory markers may contribute to the care and management of gorillas in human care.

Taking a critical stance towards mixed methods research: A cross-disciplinary qualitative secondary analysis of researchers' views

Recent growth and institutionalization in the field of mixed methods research has provided fertile ground for a wide range of thoughtful criticism of how this research approach has been developed and conceptualized by some members of the mixed methods community. This criticism reflects the increasing maturity of the field as well as the different theoretical perspectives and methodological practices of researchers in different disciplines. While debates addressing these criticisms are likely to lead to valuable insights, no empirical studies have been carried out to date that have investigated researchers' critical views on the development and conceptualization of mixed methods research. This study examines the criticisms of the mixed methods field raised by a cross-national sample of researchers in education, nursing, psychology, and sociology. We carried out a secondary analysis of semi-structured interviews with 42 researchers and identified 11 different criticisms, which we classified in four domains: essence of mixed methods, philosophy, procedures, and politics. The criticisms related to the procedures domain were equally distributed among the four disciplines, while those related to the essence, philosophy and politics domains were more common among sociologists. Based on our findings, we argue that the divergence of views on foundational issues in this field reflects researchers' affiliation to different communities of practice, each having its own principles, values, and interests. We suggest that a greater awareness of this divergence of perspectives could help researchers establish effective collaboration and anticipate potential challenges when working with researchers having different methodological approaches.

Advancing discussion of ethics in mixed methods health services research

BACKGROUND

To describe the ethical issues and experiences of scientists conducting mixed methods health services research and to advance empirical and conceptual discussion on ethical integrity in mixed methods health research.

METHODS

The study was conducted with 64 scholars, faculty and consultants from the NIH-funded Mixed Methods Research Training Program (MMRTP) for the Health Sciences. This was a cross-sectional study. Survey results were analyzed using descriptive statistics to characterize responses and open coding to summarize strategies about eight ethical mixed methods research issues. Respondents completed an online survey to elicit experiences related to eight ethical issues (informed consent, confidentiality, data management, burden, safety, equitable recruitment, communication, and dissemination) and strategies for addressing them.

RESULTS

Only about one-third of respondents thought their research ethics training helped them plan, conduct, or report mixed methods research. The most frequently occurring ethical issues were participant burden, dissemination and equitable recruitment (> 70% endorsement). Despite occurring frequently, < 50% of respondents rated each ethical issue as challenging. The most challenging ethical issues were related to managing participant burden, communication, and dissemination. Strategies reported to address ethical issues were largely not specific or unique to mixed methods with the exception of strategies to mitigate participant burden and, to a lesser degree, to facilitate equitable recruitment and promote dissemination of project results.

CONCLUSIONS

Mixed methods health researchers reported encountering ethical issues often yet varying levels of difficulty and effectiveness in the strategies used to mitigate ethical issues. This study highlights some of the unique challenges faced by mixed methods researchers to plan for and appropriately respond to arising ethical issues such as managing participant burden and confidentiality across data sources and utilizing effective communication and dissemination strategies particularly when working with a multidisciplinary research team. As one of the first empirical studies to examine mixed methods research ethics, our findings highlight the need for greater attention to ethics in health services mixed methods research and training.