The late inclusion of qualitative researchers can create some of the technical challenges described above and can lead to communication problems among team members. Indeed, our discussions suggested that many difficulties in mixed-methods research are not the result of misunderstandings or points of confusion but rather emerge from different worldviews that are deeply rooted in the philosophies of knowledge that researchers bring to their work. Left unresolved—or worse, unaddressed —these differences can significantly complicate the implementation of a study, as illustrated in the following example.
A community mental health clinic and multidisciplinary research team collaborated on a project to improve the relevance of the clinic's services to community members. The study proposal described a project that would involve community members in exploring how services could be modified. Early in the project, however, it became clear that researchers had different interpretations of “community participation.” The quantitative researchers interpreted it to mean that front-office clinic staff would recruit potential participants (clinic users) who in turn would act as key informants on community issues; consumer surveys and interviews would round out the data collection. For the qualitative team members, however, the term encompassed service users and potential service users (that is, anyone in the clinic service area)—the understanding being that both of these groups would participate in discussions about improving the clinic's relevance to the community.
Would the contributions of front-line staff, consumer surveys, and consumer interviews be sufficient to represent the community perspective? Or as the qualitative researchers envisioned, did the study require input from the community at large (for example, persons who lived in the clinic's catchment area who were not receiving services there)? The different assumptions about the meaning of “community” and “community participation” were not discussed by team members at the outset of the study, resulting in significant impediments to collaboration and effective implementation of the study design.
Researchers have long recognized the fact that qualitative and quantitative research methods are based on different philosophies of knowledge, but little attention has been paid to how these differences can bring about real-world dilemmas for a mixed-methods research team. For example, quantitatively trained services researchers, following the lead of their counterparts in clinical trials research, define their task as discovering “truths” about the natural and social worlds. Unbiased collection of objective data provides the researcher with “just the facts” in which statistically meaningful differences offer insights into empirical phenomena. By contrast, many qualitative researchers come from a social constructionist perspective wherein the social and natural worlds are perceived only through a culturally given lens. Within this framework, the goal of qualitative research is not to seek “truth” but to gain an understanding of how individuals' worldviews affect their behaviors.
As anthropologist Clifford Geertz (15
) argued, culturally given models provide people with a way to make sense of others' behaviors (“models of”) and, at the same time, offer people blueprints for acting on the world around them (“models for”). As a consequence, conflicts emerge along such fundamental fault lines as the investigator's role in data collection. The qualitative researcher who is “always in the field” may be regarded as “overengaged” with subjects, leading to suspicion that his or her results are “biased” (16
). Conversely, the quantitative researcher who administers a survey to study subjects through a third party may be regarded as “detached from” the study population. Conflict among the team members is sure to result when these fundamental—and fundamentally different— research behaviors are judged on the basis of very different philosophical perspectives.
The “flow” of the research process also differs significantly in these two worlds. The randomized controlled trial, which serves as the model for many funded mental health services research projects, operates in a distinctly linear fashion: baseline measurement, then application of an intervention (versus a comparison group), which is followed by a second set of measurements to assess group-level changes. Intermediate measurements, when they are taken, are intended to serve as additional documentation of the overall linear movement of the randomized controlled trial. In contrast, many contemporary qualitative researchers ascribe to hermeneutic philosophy, in which coming to understand the Other (that is, the worldview of the individuals who are the focus of the study), involves rethinking the Self (that is, the taken-for-granted worldview of the research team). This self-reflection, in turn, provides new insights into the Other—and so on in an iterative fashion. In this recursive framework, researchers anticipate learning, understanding, assessing, and then reapproaching the object of study from a slightly new perspective (17
). The following example illustrates how a “linear” study design may veer off course when some fundamental assumptions by the research team (in this case, the assumed meanings of “culture”) are called into question in the course of the research process.
One research team developed a “culturally relevant” intervention in which community health workers collaborated with physicians to address the mental health needs of local community members. Initially, the intervention was considered culturally relevant precisely because the community health workers shared the same ethnicity as patients and could communicate with them in their native language. Through the ethnographic evaluation of the intervention, however, it became apparent that the community health workers, who had grown up in the United States, did not always share the social and cultural backgrounds of their largely immigrant clientele. Other cultural factors not related to ethnicity also affected the intervention. For example, the clinical milieu in which the intervention was implemented presented unanticipated challenges for the community health workers, who had to learn “on the job” how to “fit in” with fellow staff members and providers. In addition, the community health workers lacked formal training and experience in mental health services research but were expected to serve as full participants in the research team. This expectation intimidated some of the community health workers—who were reluctant to express their unease to other team members—and also contributed to low morale.
Insights gleaned from qualitative data may be shunted aside when the study design is unable to accommodate a “midcourse correction.” Grounded theory—a long-standing and important approach to qualitative analysis (18
)—uses a constant comparison method that allows for ongoing refinement throughout the research endeavor. In the above example, the research team has continued to build on ethnographic insights into the meaning of cultural relevance to adapt and tailor the intervention to other populations. In particular, the team has since committed itself to conducting formative ethnographic research pertaining to the target population and the clinical milieu in which the intervention is to be implemented to help ensure that subsequent intervention planning proceeds in a culturally responsive manner. Other contemporary studies have used similar emergent insights to appropriately modify the course of the research processes (19
Contemporary researchers who intend to undertake mixed-methods studies maintain that the worldviews that motivate qualitative and quantitative investigation are not an “either-or” proposition. In fact, the careful combination of approaches may prove to be far more fruitful than either methodological approach alone. We agree that bridging the two cultures of research can enlarge the knowledge base: together we can ask questions that affect what and how much we can learn from a particular phenomenon. However, sound services research designs require qualitative investigators to participate in the discussion during the study planning stages to help determine which data collection methods are best suited to a particular investigation and how the study will incorporate emergent findings from the qualitative work. Inclusion of qualitative researchers from the outset is not just good practice; it will lead to more robust mixed-methods designs that maximize the contributions of all members of the research team.