Advancing mixed methods in mental health research

Advancing mixed methods in mental health research

Given the inherent complexity and multifaceted nature of mental health, the evolving field of mental health research needs methodological approaches effectively matching this. Following a twentieth-century positivist surge in psychiatry, recent decades saw significant advancement in robust qualitative methods. This has paved the way for a growing application of mixed methods across the field, yet ongoing challenges limit capacity to realise their potential. Here, we highlight the value of mixed methods in mental health research, examine ongoing challenges, and outline pathways to advancing mixed methods in the field.

Mixed methods research formally integrates qualitative and quantitative methods in a single study or project (often understood to differ from approaches that include, but do not actively integrate, these methods). We believe that mixed methods offer a powerful approach, facilitating a holistic, complex understanding of mental health, a greater understanding of breadth and depth of phenomena and opportunity to build and refine conceptualisations. Mixed methods approaches have been increasingly applied within mental health research, especially in service and intervention research1 2 and nursing.3 4 However it is our view that mixed methods approaches are not yet routinely embedded across the field, and frequently suffer from a range of ongoing limitations where implemented. Indeed, many challenges noted in earlier writings on mixed methods in the mental health research field continue to resonate today.1 5 This includes communication challenges within teams, undervaluing of qualitative methods, and under-rationalisation and explanation of the use and design of mixed methods,2 5 the latter of which was noted as a critical issue in a 2021 review of community-based participatory mixed methods mental health research.6

Mixed methods research is typically undertaken within a pragmatist epistemology. Pragmatism is a school of thought concerned with meaning and action and conceptualises truth and knowledge as provisional rather than absolute. As a paradigm, it rejects dualist approaches and instead emphasises a pluralistic blending of perspectives to develop meaningful understanding. Thus, a pragmatic mixed methods approach challenges the premise that the differing epistemologies underpinning qualitative and quantitative methods make them incompatible. Within a pragmatist lens, there is instead a focus instead on finding workable approaches to combining methods in order to best make sense of a given phenomenon as needed.7 8

Mixed methods research can function towards different purposes, leading to various conceptualised design types, including Greene et al’s seminal typology9 of:

• Triangulation, where a study seeks convergence across methods;

• Complementarity, where findings of each method enhance those of the other;

• Development, where findings from one method inform the other;

• Initiation, where the study aims to stimulate new perspectives or interpretations; and

• Expansion, where mixed methods increase the breadth of inquiry.

Accordingly, there are various characteristics within one’s design that should be given consideration, which inform and link to these different design types. Here, we briefly cover some fundamental considerations, rather than offering an exhaustive or detailed ‘how-to’; for further reading, we suggest conceptual and practical texts from the Journal of Mixed Methods Research’s virtual special issues on integration and quality, respectively.10 11 There are features of timing and degree of independence across strands; for instance, one might have a sequential design where one strand directly informs another, or a concurrent one where both methods are implemented entirely independently of one another. A further consideration is status; strands can be equal, or more weight may be given to one strand, which would likely translate into the balance of each strand’s respective contribution to integrated conclusions. The method of integration is a further decision, which should correspond to the specific design type adopted; for instance, in a sequential development design, integration would occur perhaps primarily through study-building, while in a concurrent triangulation design, integration might function through a comparative process across the findings.

We offer our own worked examples (table 1), not as exemplary but as insights into some of the design types, rationales, processes and our own reflections, to highlight the potential of mixed methods in, for instance, facilitating a holistic understanding of mental health, integrating breadth and depth of phenomena, and refining conceptualisations. As authors at varying stages of the early career researcher (ECR) journey, some reflections speak to this, which might be valuable for ECRs and for those supervising and mentoring them.