Applying the WHO recommendations on health-sector response to violence against women to assess the Spanish health system. A mixed methods approach

This methodological note describes the development and application of a mixed-methods protocol to assess the responsiveness of Spanish health systems to violence against women in Spain, based on the World Health Organization (WHO) recommendations. Five areas for exploration were identified based on the WHO recommendations: policy environment, protocols, training, accountability/monitoring, and prevention/promotion. Two data collection instruments were developed to assess the situation of 17 Spanish regional health systems (RHS) with respect to these areas: 1) a set of indicators to guide a systematic review of secondary sources, and 2) an interview guide to be used with 26 key informants at the regional and national levels. We found differences between RHSs in the five areas assessed. The progress of RHSs on the WHO recommendations was notable at the level of policies, moderate in terms of health service delivery, and very limited in terms of preventive actions. Using a mixed-methods approach was useful for triangulation and complementarity during instrument design, data collection and interpretation.

Using multilevel modeling and mixed methods to make theoretical progress in microfoundations for strategy research

The microfoundations research agenda presents an expanded theoretical perspective because it considers individuals, their characteristics, and their interactions as relevant variables to help us understand firm-level strategic issues. However, microfoundations empirical research faces unique challenges because processes take place at different levels of analysis and these multilevel processes must be considered simultaneously. We describe multilevel modeling and mixed methods as methodological approaches whose use will allow for theoretical advancements. We describe key issues regarding the use of these two types of methods and, more importantly, discuss pressing substantive questions and topics that can be addressed with each of these methodological approaches with the goal of making theoretical advancements regarding the microfoundations research agenda and strategic management studies in general.

The effects of quality and environmental management on competitive advantage: A mixed methods study in the hotel industry

This paper reports results derived from a mixed methods study where 13 hotel managers were initially interviewed, followed by a quantitative study of 355 additional managers. Data were analysed using partial least squares path modelling. The research question related to the relationship between quality and environmental management and the competitive advantage sought by hotels. The results indicate that quality management and environmental management permit the improvement of competitive advantage in terms of both costs and differentiation. Moreover, hotels implementing quality programmes find fewer obstacles in implementing environmental management.

Large scale experiments on gravel and mixed beaches: Experimental procedure, data documentation and initial results

This paper provides information on the experimental set-up, data collection methods and results to date for the project Large scale modelling of coarse grained beaches, undertaken at the Large Wave Channel (GWK) of FZK in Hannover by an international group of researchers in Spring 2002. The main objective of the experiments was to provide full scale measurements of cross-shore processes on gravel and mixed beaches for the verification and further development of cross-shore numerical models of gravel and mixed sediment beaches. Identical random and regular wave tests were undertaken for a gravel beach and a mixed sand/gravel beach set up in the flume. Measurements included profile development, water surface elevation along the flume, internal pressures in the swash zone, piezometric head levels within the beach, run-up, flow velocities in the surf-zone and sediment size distributions. The purpose of the paper is to present to the scientific community the experimental procedure, a summary of the data collected, some initial results, as well as a brief outline of the on-going research being carried out with the data by different research groups. The experimental data is available to all the scientific community following submission of a statement of objectives, specification of data requirements and an agreement to abide with the GWK and EU protocols. (C) 2005 Elsevier B.V. All rights reserved.

Foundations of an intervention package to improve communication in residential care settings:a mixed methods study

Background: The prevalence of hearing loss is considerably higher in individuals in residential care than in people within the community-dwelling population, and yet hearing aids and hearing services are relatively underused. Care staff have a key role in supporting access to services. Objectives: This study identifies staff perspectives on hearing loss and their views about potential hearing service improvements. Study design: A four-stage mixed methods study was used, made up of qualitative interviews, observation, a survey and a stakeholder involvement meeting. Results: The qualitative stages indicated that staff were concerned about their levels of interaction with residents. Staff considered maximizing communication as part of their professional role. The quantitative survey indicated that these views were widely held by staff, and the stakeholder stage identified the need for social support and dedicated staff training opportunities. Conclusion: Care home staff regard communication as a shared issue. Future interventions could enhance access to hearing services and provide care home staff with training in hearing loss and hearing aid management. © 2013 Informa Healthcare.

Mixed methods research:don't "just do it"

Purpose The purpose of this paper is to identify some of the dilemmas involved in the debate on the how, when and why of mixed methods research. Design/methodology/approach The authors' starting point is formed by developments in the philosophy of science literature, and recent publications on mixed methods research outside of the management accounting domain. Findings Contrary to recent claims made in the management accounting literature, the authors assert that uncovering points of disagreement between methods may be as far as researchers can go by combining them. Being reflexive can help to provide a deeper understanding of the research process and the researcher's role in this process. Research limitations/implications The paper should extend the debate among management accounting researchers about mixed methods research. One of the lessons drawn is that researchers are actively immersed in the research process and cannot purge their own interests and views. Accepting this lesson casts doubt on what the act of research may imply and achieve. Practical implications The paper shows that combinations of research methods should not be made based on a "whatever works" attitude, since this approach ultimately is still infused with ontological and epistemological considerations that researchers have, and should try to explicate. Originality/value The value of this paper lies in the provision of philosophical underpinnings that have not been widely considered in the management accounting literature on mixed methods to date. © 2011 Emerald Group Publishing Limited. All rights reserved.

A mixed methods investigation of parental factors in non-attendance at general paediatric hospital outpatient appointments

Non-attendance at paediatric outpatient appointments results in delayed diagnosis and treatment, putting children at risk of avoidable ill health, and incurring considerable health service costs. Links between missed appointments and clinical, socio-demographic, and access-related factors have been indicated, but parental cognitions associated with non-attendance have yet to be investigated. The aims of this project were to evaluate the effectiveness and theoretical bases of existing interventions designed to reduce non-attendance; to consider the ways in which missed appointments are managed by healthcare providers; to explore parents’ beliefs and experiences of attending and missing appointments; and to investigate the factors underlying these beliefs. A systematic literature review focusing on non-attendance interventions was conducted Within a mixed methods framework, interviews were conducted with healthcare professionals, subsequent interviews were conducted with parents who had attended or missed a General Paediatric outpatient appointment, and a cross-sectional questionnaire study of parents’ beliefs was implemented. The systematic review revealed that text message appointment reminders are effective at reducing non-attendance rates, but that no interventions have thus far been developed using theories of behaviour. Healthcare professionals recognised both barriers and parents’ beliefs as influences on attendance, but also believed there were ‘types’ of families who miss appointments. Healthcare professionals disagreed somewhat about how non-attendance should best be managed. The parent interview study found six themes. The findings reflect parents’ perceptions about the importance of attending and of their ability to attend. The results of the questionnaire study corroborate this structure of beliefs as the analysis produced two factors, the perceived ‘worth’ of attending and anticipated ‘worry’ when attending. This thesis demonstrates an original approach to investigating non-attendance at children’s outpatient appointments, using mixed methods and adopting a psychological rather than service-use perspective. The findings contribute to Health Psychology theory and offer recommendations for healthcare providers.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

Broadening the evidence base and the mind when thinking about mixed methods research

On behalf of my coauthors, Dr Michael Larkin and Professor Paul Flowers, and I would like to thank Dr Pierre Pluye for his letter in response to our article.1 Dr Pluye supported our argument that a broader evidence base is needed in evidence-based healthcare. He provided the readers of this journal with important additional information which updates them on the progress in the area of mixed studies reviews and further detail about the Mixed Methods Appraisal Tool (MMAT).2 Since writing our …

Formal methods for the development and verification of autonomic IT systems

This chapter explores ways in which rigorous mathematical techniques, termed formal methods, can be employed to improve the predictability and dependability of autonomic computing. Model checking, formal specification, and quantitative verification are presented in the contexts of conflict detection in autonomic computing policies, and of implementation of goal and utility-function policies in autonomic IT systems, respectively. Each of these techniques is illustrated using a detailed case study, and analysed to establish its merits and limitations. The analysis is then used as a basis for discussing the challenges and opportunities of this endeavour to transition the development of autonomic IT systems from the current practice of using ad-hoc methods and heuristic towards a more principled approach. © 2012, IGI Global.

Navigating health sources on the Internet: A mixed-methods examination of online consumer reviews and expert text on psychotropic drugs

Purpose. The Internet has provided an unprecedented opportunity for psychotropic medication consumers, a traditionally silenced group in clinical trial research, to have voice by contributing to the construction of drug knowledge in an immediate, direct manner. Currently, there are no systematic appraisals of the potential of online consumer drug reviews to contribute to drug knowledge. The purpose of this research was to explore the content of drug information on various websites representing themselves as consumer- and expert-constructed, and as a practical consideration, to examine how each source may help and hinder treatment decision-making.^ Methodology. A mixed-methods research strategy utilizing a grounded theory approach was used to analyze drug information on 5 exemplar websites (3 consumer- and 2 expertconstructed) for 2 popularly prescribed psychotropic drugs (escitalopram and quetiapine). A stratified simple random sample was used to select 1,080 consumer reviews from the websites (N=7,114) through February 2009. Text was coded using QDA Miner 3.2 software by Provalis Research. A combination of frequency tables, descriptive excerpts from text, and chi-square tests for association were used throughout analyses.^ Findings. The most frequently mentioned effects by consumers taking either drug were related to psychological/behavioral symptoms and sleep. Consumers reported many of the same effects as found on expert health sites, but provided more descriptive language and situational examples. Expert labels of less serious on certain effects were not congruent with the sometimes tremendous burden described by consumers. Consumers mentioned more than double the themes mentioned in expert text, and demonstrated a diversity and range of discourses around those themes.^ Conclusions. Drug effects from each source were complete relative to the information provided in the other, but each also offered distinct advantages. Expert health sites provided concise summaries of medications’ effects, while consumer reviews had the added advantage of concrete descriptions and greater context. In short, consumer reviews better prepared potential consumers for what it’s like to take psychotropic drugs. Both sources of information benefit clinicians and consumers in making informed treatment-related decisions. Social work practitioners are encouraged to thoughtfully utilize online consumer drug reviews as a legitimate additional source for assisting clients in learning about treatment options.^

“Mind the gap”: Qualitative Researchers and Mixed Methods Research

This paper presents a heuristic investigation of mixed methods organized around three pairs of opposing standpoints: methods (qualitative vs. quantitative), paradigms (constructivist vs. post positive), and inquiry approaches (dialectical vs. pragmatic).

Pedagogical Perceptions of Classroom Performance in the Teacher Evaluative Process: A Mixed Methods Study

This sequential explanatory, mixed methods research design examines the role teachers should enact in the development process of the teacher evaluation system in Louisiana. These insights will ensure teachers are catalysts in the classroom to significantly increase student achievement and allow policymakers, practitioners, and instructional leaders to direct as learned decision makers.