Lessons learned from mixed method research when designing and evaluating an education intervention in nursing homes – a retrospective reflection

Abstract

Background: Several interacting factors, such as the evidence, modes of delivery, and care recipients and their contexts influence the success or failure of implementation and practice development in health services. Mixed-methods research has the potential to unpack these elements and clarify their effect. However, mixed-methods approaches embedded in different worldviews may challenge both the designing and conducting of such studies.

Aims and objectives: To share lessons learned in a research team whose members were novices in mixing methods situated in different paradigms within the same study. By sharing insight gained from reflecting on the advantages and challenges the team experienced, this article hopes to inspire researchers and practice developers to create and conduct innovative mixed-methods research, and also to help them avoid challenges that may hamper collaboration in such research and practice development teams.

Methods: A retrospective reflection on lessons learned when designing, conducting and evaluating a facilitated education intervention in 24 Norwegian nursing homes from 2012 to 2015. The intervention aimed to help staff reduce the use of restraint in residents living with dementia, while the research study mixed a cluster-randomised controlled trial with participatory action research and ethnography to evaluate both the effect of the implementation process and the factors influencing it. The study findings prompted the retrospective reflection on lessons learned. Field notes from the first and third authors, as well as published advice and reports from experienced mixed-methods researchers were used in the reflection processes between the three authors.

Lessons learned: Qualitative data enriched the causal explanations based on trial findings and provided explanatory contextual illuminations of how implementation succeeded or failed in different nursing homes. However, conducting mixed-methods research in a multidisciplinary team with members anchored in either qualitative or quantitative traditions was challenging due to different paradigmatic positions, as well as the team’s reluctance to address openly the resulting difficulties.

Conclusions and implications for practice:

Mixing research methods may illuminate the powerful influence of context on the implementation and effectiveness of studies. As part of the preparation, researchers should allocate sufficient time to discuss potential differences in values and underlying ontological and epistemological assumptions, and demonstrate mutual methodological respect. The implications for practice are: Theoretically informed mixed-methods evaluation offers the potential to identify and systematically evaluate the key components and outcomes of practice development endeavours Results from rigorous mixed-methods research may enable more precision illumination of the complex interaction between the staff’s skills and intentions to perform person-centred care, and the contextual conditions employers offer them in which to practice their care Thus, mixed-methods research results may be useful, in terms of accountability and value for money, to health leaders, who are increasingly challenged to apply evidence-informed, person-centred approaches to care