Mixed methods in health service research : where do we go from here?

In the 21st century, it is more obvious than ever before that healthservices research and its practitioners exist in an extremely complexcontextual environment. Consequently, at the heart of understandinghow to deliver an evidence base for safe and effective care in a set-ting characterised by multifaceted health care demands, is the real-isation that no one research method in isolation will suffice. Thisrealisation, together with the REWARD group’s contention that 85 %of health service research conducted–and most importantly mainlyfunded by public money–is‘waste’, is one of the reasons whyframeworks such as the MRC guidance on complex interventions,and mixed methods designs are subject to intensified attention. Thisplenary address aims to discuss the contribution of mixed methodsto researching complex interventions within the MRC framework andto consider its place in contemporary health service research. The MRCframework for researching complex interventions has highlighted the importance of research designs including both qualitative and quantita-tive approaches. However when reviewing the literature prior to writingmy chapter in our recent textbook, it was clear that designing andconducting truly mixed methods research presents health service re-searchers with a number of challenges. Predominant amongst theseare the selection of designs from suggested typologies, methodologicalreporting, critical evaluation and most importantly ensuring that thecore feature in true mixed methods (as opposed to multi-methods) de-signs–analytical and methodological integration–is implemented. Tobe able to conduct mixed methods approaches that are rigorously de-signed, logically executed, and transparently reported, we need tomove to a position where funders, researchers, journal editors and re-search consumers demand methodological integration of methods anddata from study outset, rather than as a mere afterthought in the dis-cussion section of research reports