Mixed Methods in Biomedical and Health Services Research

Mixed-methods studies, in which qualitative1 and quantitative methods are combined in a single program of inquiry,2 are increasingly common and can be valuable in biomedical and health services research, in which the complementary strengths of each approach can characterize complex phenomena more fully than either approach alone.3,4 To effectively address complex problems in health and healthcare delivery, including heterogeneous and dynamic systems of care, a multilevel approach is needed to capture the perspectives of patients, providers, and organizations. Mixed methods offer enhanced capabilities to this end. Consequently, interest in mixed-methods studies is growing among funders, as evidenced by recent calls for proposals using these methods from the National Institutes of Health (NIH),5 the Agency for Healthcare Research and Quality,6 and independent research organizations (eg, Patient Centered Outcomes Research Institute)7 and foundations (eg, The Robert Wood Johnson Foundation).8 Training in mixed methods is also sponsored by NIH,9 the Agency for Healthcare Research and Quality,10 and professional associations.11 Nevertheless, written guidance on how to conduct rigorous mixed-methods research is not readily available to the general readership of peer-reviewed biomedical and health services journals, a group who may be less familiar with this approach. Accordingly, in this article, we describe applications of mixed methods in biomedical and health services research and provide a concise overview of key principles to facilitate best practices. First, we define mixed-methods approaches and present illustrations from published literature, including cardiovascular care. Second, we summarize standards for the design and conduct of rigorous mixed-methods studies. Third, we highlight 4 central considerations for investigators interested in using these methods. Mixed methods can be useful in the pursuit of a broad range of focal topics and study aims in the biomedical and health services research arenas, including, but not …