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Exploring ‘obstetric violence’ and ‘birth rape’

trauma hiding.jpg

Recently, the wonderful Ibone Olza (Perinatal Psychiatrist and Childbirth Activist from Childbirth is Ours, Spain) contacted me about her work on obstetric violence, birth rape and professional trauma. After reading her papers and watching her present her work, I was compelled to document and reflect upon some of the issues raised, here.

The following points are made within the paper: Fernández, Ibone Olza. “PTSD and obstetric violence.” Midwifery today with international midwife 105 (2013): 48-9.

Birth trauma has been defined as “Actual or threatened injury or death to the mother or her baby” (Beck 2008). Yet such trauma lies in the eye of the beholder, therefore, any trauma experienced by either the mother, newborn or the birth attendant may be due to a subjective experience of stress which does not need to fit any particular criteria necessarily. This means that some traumatic events may be subjective in their nature, and as such, we cannot judge what may or may not cause another person trauma. It is a personal interpretation or perception.

A meta-ethnographic analysis of studies about women’s perceptions and experiences of a traumatic birth reported that women are often traumatized as a result of the actions or inactions of midwifery staff (Elmir et al. 2010). Whatever, such inactions or actions may be…women often use words such as ‘barbaric’, ‘intrusive’, ‘horrific’ and ‘degrading’ to describe their mistreatment (Thomson and Downe 2008).

For Hodges, drugging or cutting a pregnant woman with no medical indication is an act of violence, even when performed by a medical professional in a hospital. Inappropriate medical treatment is also clearly abusive, although few women are aware that this is deliberate mistreatment (Hodges 2009).

The term ‘birth rape’ has been used by women who feel that their bodies have been violated. Kitzinger highlighted that many women who have experienced a traumatic birth display similar symptoms to rape survivors (Kitzinger 2006). The video below explores these issues in greater detail, as we can hear the lovely  Ibone Olza  sharing this work.

 

One of the things I was most encouraged about, was that  Ibone Olza  considers the wellbeing of the midwifery staff in her work. Birth attendants are often also traumatized by these acts, and may feel powerless to intervene. In a recent study by Beck, 26% of obstetric nurses met all the diagnostic criteria for screening positive for PTSD due to exposure to their patients who were traumatized (Beck and Gable 2012). Being present at  abusive deliveries can magnify staffs’ exposure to birth trauma.

staff use phrases such as…

“the physician violated her”

“a perfect delivery turned violent”

“unnecessary roughness with her perineum”

“felt like an accomplice to a crime”

“I felt like I was watching a rape.”

….to describe the guilt that ensued when they felt like they had failed women or they did not speak up and challenge/question…

Article 51 establishes that: The following acts implemented by health personnel are considered acts of obstetric violence:

  1. Untimely and ineffective attention of obstetric emergencies
  2. Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available
  3. Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breastfeeding immediately after birth
  4. Altering the natural process of low-risk delivery by using acceleration
    techniques, without obtaining voluntary, expressed and informed consent of the woman
  5. Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman

(D’Gregorio 2010)

trauma

Yet whilst people do bad things, it is important to remember that they are not necessarily bad people…

This work explains how professionals may exert obstetric violence due to:

  • Lack of technical skills to deal with emotional and sexual aspects of childbirth.
  • Unsolved trauma. The medicalization of childbirth produces more severe iatrogenic
    complications (Johanson, Newburn and Macfarlane 2002; Belghiti et al. 2011). If the
    professionals do not have a supportive space to reflect or to deal with this aspect of iatrogenic care, they may fall into a spiral of continuously increased medicalization as a defensive strategy. Childbirth is then perceived as a very dangerous event, “a bomb ready to explode,” without realizing that interventions cause more unnecessary interventions and pain.
  • Professional burnout in birth attendants will lead to increased dehumanized care and therefore never-ending figures of women experiencing childbirth as very traumatic.

..and so the challenge will be to identify and address these root causes to ensure that maternity staff are able to provide excellence in midwifery care. My work explores how we might support the psychological wellbeing of health care staff may increase levels of humanity and compassion in care. I hope to keep in touch with Ibone Olza and many others around the world who share the same passion for this work. Together we may collectively work towards a time where maternity workers are psychologically safer, and therefore better able to provide the excellence in care they strive to give.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

References and further reading

  • Soet JE, Brack GA, DiIorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 2003 Mar;30(1):36-46.
  • Creedy DK, Shochet IM, Horsfall J. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 2000 Jun;27(2):104-111.
  • Ayers S, Pickering AD. Do women get post traumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 2001 Jun;28(2):111-118.
  • Beck CT, Gable RK, Sakala C, Declercq ER. Post traumatic stress disorder in new mothers: results from a two stage U.S. national survey. Birth 2011 Sep;38(3):216-227.
  • Allen S. A qualitative analysis of the process, mediating variables and impact of traumatic childbirth. Journal of Reproductive and Infant Psychology 1998;16(2-3):107-131.
  • Beck CT, Watson S. Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res 2008 Jul-Aug;57(4):228-236.
  • Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004 Jul-Aug;53(4):216-224.
  • Beck CT. Birth trauma: in the eye of the beholder. Nurs Res 2004 Jan-Feb;53(1):28-35.
  • Ayers S. Delivery as a traumatic event: prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clin Obstet Gynecol 2004 Sep;47(3):552-567.
  • Olde E, van der Hart O, Kleber R, van Son M. Posttraumatic stress following childbirth: a review. Clin Psychol Rev 2006 Jan;26(1):1-16.
  • Elmir R, Schmied V, Wilkes L, Jackson D. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs 2010 Oct;66(10):2142-2153.
  • Nicholls K, Ayers S. Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol 2007 Nov;12(Pt 4):491-509.
  • Ayers S. Thoughts and emotions during traumatic birth: a qualitative study. Birth 2007 Sep;34(3):253-263.
  • Thomson G, Downe S. Widening the trauma discourse: the link between childbirth and experiences of abuse. J Psychosom Obstet Gynaecol 2008 Dec;29(4):268-273.
  • Goldbort JG. Women’s lived experience of their unexpected birthing process. MCN Am J Matern Child Nurs 2009 Jan-Feb;34(1):57-62.
  • Sawyer A, Ayers S. Post-traumatic growth in women after childbirth. Psychol Health 2009 Apr;24(4):457-471.
  • Hodges S. Abuse in hospital-based birth settings? J Perinat Educ 2009 Fall;18(4):8-11.
  • Kitzinger S. Birth as rape: There must be an end to ‘just in case’ obstetrics. British Journal of Midwifery 2006;14(9):544-545.
  • Beck CT. The anniversary of birth trauma: failure to rescue. Nurs Res 2006 Nov-Dec;55(6):381-390.
  • Beck CT, Gable RK. A Mixed Methods Study of Secondary Traumatic Stress in Labor and Delivery Nurses. J Obstet Gynecol Neonatal Nurs 2012 Jul 12.
  • Perez D’Gregorio R. Obstetric violence: a new legal term introduced in Venezuela. Int J Gynaecol Obstet 2010 Dec;111(3):201-202.
  • Callister LC. Making meaning: women’s birth narratives. J Obstet Gynecol Neonatal Nurs 2004 Jul-Aug;33(4):508-518.
  • Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ 2002 Apr 13;324(7342):892-895.
  • Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open 2011 Dec 21;1(2):e000514.

 

 

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How to conduct research: A dummy’s guide to conducting research

Image result for quote "I do research because"

Seminars held by the worlds top universities generally present the most up to date and respected ideas in relation to conducting research. Recently, I was lucky enough to attend a conference where several seminars were held over a one week period…How very convenient!…These seminars in combination were able to map out a broad blue print of how to conduct research for their audiences (myself and other chums).

As a result of attending these wonderful seminars, I am now able to translate what was shared into this dummy’s guide to conducting research. I write here not only to refresh my own knowledge in this area, but also in the hope that it may be of use to the readers of this post. Wish me luck!…

research

So why do we do research?…Because we have an idea?, a problem to solve?, or an area where a lack of knowledge resides?..(See ) …These are all valid reasons to conduct research within reason, but…What is research?…

Image result for quote on research is formalised curiosity

OK, so we need to define a research question…What question, need or idea are we trying to answer?..What itch do we have to scratch? We need to formulate a research question….and also formulate a research problem.

How to formulate a research problem

  • Explore the nature of the problem. Why is it a problem?..who does it affect?
  • Explore the context of the research problem. Where does it ‘sit’ among other things?
  • Define your variables. What would vary?…what can’t you control?…what would be the impact of that?
  • Think about what would happen if you didn’t address this problem. What would be the consequences of doing something else?
  • Define your objectives? What are you trying to achieve by doing this research?

How to formulate a research question

Think first…is your research question:

  • Interesting
  • Relevant
  • Focused
  • Answerable

Then…narrow your ideas down to develop a great research question.

Broad topic  Narrowed topic      Focused topic   Research Question
Children’s
health →
 Children and diabetes → School meals and sugar content→ Is there an association between sugar content in school meals and diabetes risk?
Walking → Walking related injury → Walking related injury and
adults→
How does Walking related injury affect
adults?
Bullying → Teenagers and
bullying →
Teen peer
pressure and aggressive behavior→
What role, if any, does
peer pressure play in the development of aggressive behavior
among teens?

                                          Image result for hypothesis

Image result for hypothesis

  1. Non directional hypothesis = Pregnant women will experience some change in their pattern of urination.
  2. Directional hypothesis = Pregnant women will urinate less frequently.
  3. Null hypothesis = A statistical assumption. e.g: There will be no difference in the frequency of urination for pregnant women who swim compared with those who do not swim.

And to test this theory…..(quasi-experimental or experimental study design)..we must ascertain the relationship between variables.

Components

Experimental group = Pregnant women swimming

Expected result = e.g Pregnant women will urinate less frequently

Comparison group = Pregnant women who do not swim

Image result for which research design

 

Image result for methods

Quantitative and qualitative research characteristics….

Characteristic Quantitative research Qualitative research
Philosophical origin Logical positivism Naturalistic/Interpretive
Focus

Reasoning

Concise and objective Broad and objective
Reasoning Logistic and deductive Dialectic and inductive
Basis of knowing Cause and effect relationships Meaning, discovery and understanding
Theoretical focus Tests theory Develops theory
Researcher involvement Control Shared interpretations
Methods of measurement Structured interviews, questionnaires, observations, scales or measurements Unstructured interviews and observations
Data Numbers Words
Analysis Statistical analysis Individual interpretations
Findings Generalisation, accept or reject theoretical propositions Uniqueness, understanding of new phenomena and/or theory

Image source and further reading = Crowe, Michael, and Lorraine Sheppard. “Qualitative and quantitative research designs are more similar than different.” Internet Journal of Allied Health Sciences and Practice 8.4 (2010): 5.

Image result for research designs

Image result for data analysis

Quantitative data analysis methods Qualitative data analysis methods
Involve statistics/number analysis Text analysis
Seek deductive interences Seek inductive inferences
Focus on quantifiable phenomena (comparisons, differences, trends and relationships) Focus on meanings (themes)
Involve data clustering analysis for relationships in non-hypothesis testing Involve data structuring and coding into themes and groups.
Involve systematic predetermined analysis Involve in-depth fluid analysis
Value-free enquiry Considers the impact a researcher may have on others’ values
Objective Subjective
Narrow and specific General and broad

Image result for variables

Variable = Anything that varies

Independent variable = does not depend on that of another. Can be introduced or withdrawn by the researcher

Dependent variable = Depends on the independent variables and it’s out come variable e.g: Trauma, bleeding, symptom changes.

Extraneous variable = Unwanted influence that may interfere with either the dependent and/or independent variables.

Demographic variable = Age, gender, race etc.

Top tips:

  • We can ask..’What is the relationship between two or more variables?’ However, we cannot infer ’cause and effect’.
  • Experimental study designed (hypothesis testing) is considered to be the ‘Gold standard’ for evidence. However, you can gather a multitude of this type of evidence via systematic review and/or meta analysis (See more information on these here or in the image below).
  • Ethical considerations should be revisited throughout the study, as well as before commencement.
  • Take control of any extraneous variables by random sampling (from a larger sample base), random assignment (into either a control or experimental group), selecting a homogeneous (similar on an important variable) sample and by matching the control to the experimental group on important variables.

In conducting a systematic review, you can also arrive at new research problems and questions…meaning that the possibilities of conducting research are endless!..

 

But why do all of this hard work if you are not going to share what you have found, analysed, discussed and then concluded?

Image result for publish

It is important to publish and share your work at both a high and low level, so that new knowledge is available to everyone!…Students and professors alike should publish. It is never too soon or early in your career to get started on this. If you are not confident about writing or publishing your work, contact me and I will be happy to partner with you throughout the process.

Image result for methods of research data analysis

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Debunking Midwifery Myths

New article published here: Oh baby: seven things you probably didn’t know about midwives

…please share it widely!

dad with baby

As I am now coming to the end of my PhD (With lot’s of new and exciting things on the horizon I hope), I have been delving into the depths of the largest global online survey of midwives to date – the voices of over 2470 midwives in 93 countries!

Not only is this really an awesome and very important piece of work… it also holds some quite harrowing findings for our beloved midwifery profession. Yet this report also indicates that – if the voices of midwives are listened to, and if midwives are enabled to overcome gender inequalities and assume positions of leadership – quality of care can be improved for women and newborns globally. Wow….OK…we had better get to work then!

ALSO…

“Professionally, 89% of respondents reported that a clear understanding of what midwifery involves is critical for change to take place. Concerns were also expressed over the perceived devaluing of midwifery combined with the increasing medicalisation of birth.”

 

baby on blue

Professionally, the participants expressed concern about a lack of understanding of what “midwifery” is, the devaluing of the midwifery profession combined with the increasing medicalisation of birth, and the underlying weakness in midwifery education and regulation.

Now, I don’t claim to be able to fix the world in a day..but there was one thing that I thought I may be able to do from behind my PC. I could get an article published in @ConversationUK about the midwifery profession…perhaps I could even debunk some myths and set the record straight!…

I had my article published…please share it widely via the link below:

Oh baby: seven things you probably didn’t know about midwives

Now I was limited in this article. Limited in words and in how many points I was able to make in one article…editors need to keep their publications engaging!..and so yes…I did not manage to publish everything in this article as I would have liked to…and yes there are many many more myths about midwives that need to be debunked. But I am hoping that this will the a start of a new conversation.

Midwifery is defined as “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life” and it should be celebrated at every opportunity.

Let’s keep the conversation going around the importance of the midwifery profession. Midwives are crucial to the delivery of high quality maternal and newborn care and subsequent reductions in maternal and newborn mortality around the world. Yet they must be celebrated, respected and supported.

The core characteristics of midwifery include “optimising normal biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with and referral to other services, respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families” – Can we start to spread the word on this now please?

baby on back

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Making Birth better: How research shapes practice #bbresearch17

Indulging in my passion for research, I am today reflecting on my time at  …an intimate conference made into a delightful day thanks to  & …More specifically …    &   …

I personally enjoyed this as a more intimate conference, where deeper conversations could get the brain working on what was really needed in maternity services and health research…Another reflection of the day can be seen on Steller here…

As you can see, we had a great line up for the day, and a fish and chip lunch no less!

Highlights for me include:

Stop sexualising breastfeeding!!!! The great presentation by

Learning about associated with at with

Learning so much about at with Prof. Soo Downe

Getting a wave from miles away from  across the miles sending & midwifery love to us all …..❤️

Powerful words from at …. how do we cope as midwives, & ensure excellence in maternity care?

And of course.. # learning all about making sure that blood goes to baby with  with ❤️

Learning about the barriers to identifying poor shared by prof at  with 🎓

Yet there were a couple of overarching themes that came from the day…including….

 

Thank you to everyone who came to see these wonderful presentations (including those who came to see my own presentation of course – you gave me lots to think about!)!…and thank you all for such an intimate and heartwarming day discussing my favorite topic…Research in Midwifery 😍…

 

And a last word from the Head of Midwifery at Hinchingbrooke  Hospital….(Heather Gallagher)…..

bbresearch

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

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Mindfulness and Self-Care in Midwifery

As my main research interests are firmly rooted within supporting a positive staff experience for healthcare workers, especially midwives in work-related psychological distress, I am always looking for new opportunities to share knowledge with others in this area. …The Global Alliance for Nursing and Midwifery (GANM) is a joint project sponsored by the Pan American Health Organization (PAHO) and the World Health Organization (WHO) Collaborating Center for Nursing Knowledge, Information Management & Sharing at the Johns Hopkins School of Nursing. This blog post provides an overview of a webinar session hosted by GANM entitled “Mindfulness and Self-Care in Midwifery:  Review of Current Evidence and Guided Mindfulness Practice.

For a preliminary introduction to this topic – check out an earlier blog post on this topic entitled “Midwife Burnout: A Brief Summary“.

downtimes

Erin Wright, DNP, CNM, APRN-BC, led the conversation…Participants were diverse, and originated from Canada, Peru, US (Baltimore, Urbana, Birmingham, Atlanta, Buffalo), Ireland, UK (Coventry University and School of Healthcare Sciences Cardiff), Brazil, Montserrat, and Trinidad.

The full webinar can be accessed here.

Much of the research covered, has also been captured within my earlier narrative review: Pezaro, Sally, et al. “‘Midwives Overboard!’Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.” Women and Birth 29.3 (2016): e59-e66.

However, there were some new and interesting comparisons made with more recent research here…

“Four common themes have been identified that traverse the different models of care. The NZ study provides insight into how case load midwifery can be sustainable enabling long term sustainability. The UK study highlights healthy resilient practices that enable practice. What remains uncertain is how models of care enable or disable sustainable long term practice and nurture healthy resilient behaviours within the different models of care”.

comparisons

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking as the notion may be interpreted as expecting midwives ‘to toughen up’ in a working setting that is socially, economically and culturally challenging.”

Sources (Crowther, Susan, et al. “Sustainability and resilience in midwifery: A discussion paper.” Midwifery 40 (2016): 40-48.)

So we are now much enlightened as to how and why midwives are experiencing distress, we also have some insights into how they try to cope (or not)…and where this distress may affect maternity services…but what we are yet to learn, is what may be most effective in supporting midwives in work-related psychological distress…although a few clues are emerging….

Mindfulness is coming forward as a potential tool of support..stress management, education and clinical supervision may also be of benefit to midwives in distress…But how, why and how much is not yet clear.

After exploring the literature in relation to psychological distress in midwifery populations, we were all invited to join in some mindfulness practice..What is mindfulness?

Image result for mindfulness

 

Feeling overwhelmed?…TRY….R.A.I.N

RRecognize What’s Going On

AAllowing: Taking a Life-Giving Pause

I—Investigating with Kindness

NNatural Loving Awareness

Source: Mindful.org

relation-ships

Recommended further reading

Youtube presenters:

  • Jon Kabat Zinn
  • Elisha Goldstein
  • Tara Brach
  • Sharon Salzberg

Websites/Audio Links:

Books: 

  • A Mindfulness Based Stress Reduction Workbook (Goldstein and Stahl)
  • Everyday Catastrophe Living (Jon Kabat Zinn)
  • Wherever you go there you are (Jon Kabat Zinn)
  • Mindfulness for Beginners (Jon Kabat Zinn)
  • Real Happiness (Sharon Salzberg)
  • The Mindful Nurse (Carmel Sheridan)

For more mindfulness exercises, visit the UCLA Mindfulness Awareness Research Center.

book-mark

Thanks for a very insightful and informative session!

Until next time…Look after yourselves & each other 🦄💫🎓

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An exploration of mixed-methods research

What is Mixed-methods research?…. a mixture of methods? …or a multitude of methods in either one study or a succession of research?….Yes….it is a pickle.

What is mixed methods research?

I am on a learning curve (as always)…and I have been refining my understanding of mixed methods research…so what is mixed-methods research as I understand it now?

Firstly…what is a method?

I like to think of it as a recipe. Everyone knows a recipe for making a Victoria sponge…Eggs, sugar, butter, jam…and cream….But perhaps my method is different from your method..I add vanilla essence….you prefer yours with blackcurrant jam….We are both using a recipe or ‘method’ for making a Victoria sponge…

It’s just that the recipe or ‘method’ has both agreed standards… and modified versions.

Image result for victoria sponge

So…in research terms, I used to think of mixed-methods as literally a mixture of methods used in a single study….perhaps questionnaires and interviews…or a focus group and a literature review…But there are others who have defined it differently. Basically…we are actually looking at a mixture of both qualitative and quantitative research in one study/paper…Here are some other definitions below from leaders in the field..

Pat Bazeley: I tend to distinguish between mixed methods and multimethod, although if I need a generic term, I used mixed methods. Multimethod research is when different approaches or methods are used in parallel or sequence but are not integrated until inferences are being made. Mixed methods research involves the use of more than one approach to or method of design, data collection or data analysis within a single program of study, with integration of the different approaches or methods occurring during the program of study, and not just at its concluding point. Note that I am not limiting this to a combination of qualitative and quantitative research only, but more broadly, combinations of any different approaches/methods/data/analyses.

 

Valerie Caracelli: A mixed method study is one that planfully juxtaposes or combines methods of different types (qualitative and quantitative) to provide a more elaborated understanding of the phenomenon of interest (including its context) and, as well, to gain greater confidence in the conclusions generated by the evaluation study.

 

Huey Chen: Mixed methods research is a systematic integration of quantitative and qualitative methods in a single study for purposes of obtaining a fuller picture and deeper understanding of a phenomenon. Mixed methods can be integrated in such a way that qualitative and quantitative methods retain their original structures and procedures (pure form mixed methods). Alternatively, these two methods can be adapted, altered, or synthesized to fit the research and cost situations of the study (modified form mixed methods).

 

John Creswell: Mixed methods research is a research design (or methodology) in which the researcher collects, analyzes, and mixes (integrates or connects) both quantitative and qualitative data in a single study or a multiphase program of inquiry.

 

Steve Currall: Mixed methods research involves the sequential or simultaneous use of both qualitative and quantitative data collection and/or data analysis techniques.

 

Marvin Formosa: Mixed methods research is the utilitization of two or more different methods to meet the aims of a research project as best as one can. The research project may be conducted from either one or two paradigmatic standpoints (mixed methodology study).

 

Jennifer Greene: Mixed method inquiry is an approach to investigating the social world that ideally involves more than one methodological tradition and thus more than one way of knowing, along with more than one kind of technique for gathering, analyzing, and representing human phenomena, all for the purpose of better understanding.

 

Al Hunter: Mixed methods is a term that is usually used to designate combining qualitative and quantitative research methods in the same research project. I prefer the term multimethod research to indicate that different styles of research may be combined in the same research project. These need not be restricted to quantitative and qualitative; but may include, for example, qualitative participant observation with qualitative in-depth interviewing. Alternatively it could include quantitative survey research with quantitative experimental research. And of course it would include quantitative with qualitative styles.

 

Burke Johnson and Anthony Onwuegbuzie: Mixed methods research is the class of research where the researcher mixes or combines quantitative and qualitative research techniques, methods, approaches, concepts or language into a single study or set of related studies.

 

Udo Kelle: Mixed methods means the combination of different qualitative and quantitative methods of data collection and data analysis in one empirical research project. This combination can serve for two different purposes: it can help to discover and to handle threats for validity arising from the use of qualitative or quantitative research by applying methods from the alternative methodological tradition and can thus ensure good scientific practice by enhancing the validity of methods and research findings. Or it can be used to gain a fuller picture and deeper understanding of the investigated phenomenon by relating complementary findings to each other which result from the use of methods from the different methodological traditions of qualitative and quantitative research.

 

Donna Mertens: Mixed methods research, when undertaken from a transformative stance, is the use of qualitative and quantitative methods that allow for the collection of data about historical and contextual factors, with special emphasis on issues of power that can influence the achievement of social justice and avoidance of oppression.

 

Steven Miller: Mixed methods is a form of evolving methodological inquiry, primarily directed to the human sciences, which attempts to combine in some logical order the differing techniques and procedures of quantitative, qualitative and historical approaches. At present mixed methods must devote itself to resolving a set of issues, both epistemological and ontological. The first must devote itself to what Miller and Gatta (2006) call the “epistemological link,” that is the rules and rationales which “permit” one to proceed mixed methodologically. The second must adhere to some form of “minimal realist” ontology, where either social reality is “One” but can be accessed by different methods separately or working in conjunction, or social reality is multiple in nature and can ONLY be accessed through mixed methods. Present day attempts to couch mixed methods within some broad notion of pragmatism are not satisfactory.

 

Janice Morse: A mixed method design is a plan for a scientifically rigorous research process comprised of a qualitative or quantitative core component that directs the theoretical drive, with qualitative or quantitative supplementary component(s). These components of the research fit together to enhance description, understanding and can either be conducted simultaneously or sequentially.

 

Isadore Newman: Mixed methods research is a set of procedures that should be used when integrating qualitative and quantitative procedures reflects the research question(s) better than each can independently. The combining of quantitative and qualitative methods should better inform the researcher and the effectiveness of mixed methods should be evaluated based upon how the approach enables the investigator to answer the research question(s) embedded in the purpose(s) (why the study is being conducted or is needed; the justification) of the study. (See Newman, Ridenour, Newman & DeMarco, 2003.)

 

Michael Q. Patton: I consider mixed methods to be inquiring into a question using different data sources and design elements in such a way as to bring different perspectives to bear in the inquiry and therefore support triangulation of the findings. In this regard, using different methods to examine different questions in the same overall study is not mixed methods.

 

Hallie Preskill: Mixed methods research refers to the use of data collection methods that collect both quantitative and qualitative data. Mixed methods research acknowledges that all methods have inherent biases and weaknesses; that using a mixed method approach increases the likelihood that the sum of the data collected will be richer, more meaningful, and ultimately more useful in answering the research questions.

 

Margarete Sandelowski: First, I think of this in terms of either a single primary research study or as a program of research. Then, I see mixed methods as something of a misnomer as mixing implies blending together. Mixed methods research, though, is more the use of different methodological approaches TOGETHER in a single study or single program of research. One cannot blend methods in the sense of assimilating one into the other. I use methods here to refer to larger inquiry approaches (e.g., experiments and grounded theory) which are themselves based in distinctive theoretical perspectives. Yet this sets up a problem too, as grounded theory, for example, can be “positivist” (a la Strauss & Corbin), “constructivist” (a la Charmaz), or “postmodern” (a la Clarke) in sensibility or influence. So, if a researcher is doing grounded theory (positivist style) and an experiment (positivist influence), are any methods actually being mixed? In other words, mixed methods research can be defined at the technique level as the combination of, e.g., purposeful & probability sampling, open-ended and closed-ended data collection techniques, and narrative and mutivariable analyses—i.e., in which anything can be used together (linked or assimilated into each other)—or it can be defined at a larger theoretical/paradigmatic level as using divergent approaches to inquiry together. I would not define mixed methods research as constituting ANY combination of 2 or more things, as any research involves the use of 2 or more of something and the use of experiment and survey is 2 things, but they are informed by one mind (typically positivist/objectivist/realist). We get tangled in words, do we not?

 

Lyn Shulha: By collaborative mixed method research, we will mean the purposeful application of a multiple person, multiple perspective approach to questions of research and evaluation. Decisions about how methods are combined and how analyses are conducted are grounded in the needs and emerging complexity of each project rather than in preordinate methodological conventions. . . . Within this context, methods can be “mixed” in a variety of ways. Sometimes, one method serves another in validating and explicating findings that emerge from a dominant approach. On other occasions, different methods are used for different parts of the issues being investigated, and in an independent way. In more complex cases, the methods and perspectives are deliberately mixed from the beginning of the process. The resulting interaction of problem, method, and results produce a more comprehensive, internally consistent, and ultimately, more valid general approach. What sets the most complex forms of collaborative mixed method research apart from other forms of inquiry is that findings depend as much on the researchers’ capacities to learn through joint effort and to construct joint meaning as on their expertise in conventional data collection and analysis techniques.

 

Abbas Tashakkori and Charles Teddlie: Mixed methods research is a type of research design in which QUAL and QUAN approaches are used in type of questions, research methods, data collection and analysis procedures, or in inferences.

 

Note: QUAL = qualitative research; QUAN = quantitative research

Source for quotes = Toward a Definition of Mixed Methods Research R. Burke Johnson University of South Alabama, Mobile Anthony J. Onwuegbuzie University of South Florida, Tampa Lisa A. Turner University of South Alabama, Mobile

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There are also now reporting guidelines emerging for Mixed Methods studies (O’Cathain, Alicia, Elizabeth Murphy, and Jon Nicholl. “The quality of mixed methods studies in health services research.” Journal of Health Services Research & Policy 13.2 (2008): 92-98.)

Good Reporting of A Mixed Methods Study (GRAMMS)…Guidelines as follows…

(1) Describe the justification for using a mixed methods approach to the research question

(2) Describe the design in terms of the purpose, priority and sequence of methods

(3) Describe each method in terms of sampling, data collection and analysis

(4) Describe where integration has occurred, how it has occurred and who has participated in it

(5) Describe any limitation of one method associated with the present of the other method

(6) Describe any insights gained from mixing or integrating methods

Mixed methods research is more specific in that it includes the mixing of qualitative and quantitative data, methods, methodologies, and/or paradigms in a research study or set of related studies. One could argue that mixed methods research is a special case of multimethod research.

 

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So until next time… look after yourselves & each other…then …in the words of Bob Marley…go ahead and stir it up….🎓💜🌟