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Title
Theoretical and methodological considerations in mixed methods studies: Before design theoretical placement
1st submission date: 03/07/17
Accept date: 26/01/18
AUTHORS: Mousa Alavi, Mandy Archibald, Rose McMaster, Violeta Lopez, Michelle ClearyMousa Alavi (corresponding author), Ph.D. Associate professor, Nursing & midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan university of Medical Sciences, Isfahan, Iran. Hezar Jereb Avenue, Isfahan, IRAN. Email: [email protected] , [email protected] Phone: +98 9138936489Short bio: Dr Alavi is a faculty member of Isfahan University of Medical Sciences, Iran and his research area of interest is mental health nursing, qualitative and quantitative research methods, and psychometric evaluation.Mandy Archibald, BScN, PhD ,University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, Edmonton, AB, CAN T6G 1C9. Email: [email protected] Short bio: Dr Archibald is a senior executive board member for the Mixed Methods International Research Association (MMIRA). Her research skills include qualitative and mixed methods research approaches; scoping, narrative and systematic reviews; knowledge translation (particularly collaborative approaches and arts-based knowledge translation), and arts-based research methodologies. Rose McMaster, RN, PhD. Professor of International Nursing, Yamaguchi University, Ube, Japan, and Adjunct Professor, School of Health Sciences, University of Tasmania, Australia. Email: [email protected] bio: Professor McMaster is a registered general nurse, with psychiatric qualifications, who has worked in a variety of areas. She has more than 25 years’ experience in tertiary education, including various teaching, leadership and management roles.Violeta Lopez, RN, PhD Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Email: [email protected] bio: Professor Lopez research interest is in chronic and long term care psychoeducational interventions using mixed methods
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approach to examine their effectiveness. She has expertise in translating and psychometric evaluations of research instruments.Michelle Cleary, RN PhD, Professor, School of Health Sciences, University of Tasmania, Sydney, NSW, Australia. Email: [email protected] bio: Professor Cleary has led research in a large number of areas in healthcare and mental health generally; these areas include outcome measurement, assessment of need, research and publishing processes, clinical innovation and health service evaluation, leadership, education, and consumer and carer issues.Conflict of Interests: NilAcknowledgements
We would like to thank all authors who we have sited their work in our
manuscript.
Aligning Theory and Methodology in Mixed Methods Research:
Before Design Theoretical Placement
When the theoretical framework (and its components) is not clearly linked to the
methods, researchers risk designing flawed studies, wherein the stated research
question is inconsistent with the research design. Explicitly identifying one’s
theoretical orientation can provide an orderly schematic for linking observations
from separate investigations (i.e. qualitative, quantitative) thereby facilitating
understandings and guiding research designs particularly in fields of social and
health sciences where complex phenomena are an aspect of the subject of
inquiry. Although this has been established, how researchers might position their
research theoretically to guide mixed methods research is less clear. In this
paper, we propose the Before Design Theoretical Placement (BDTP) as a
general guide for specifying and locating studies in a broader theoretical
grounding, and discuss how it may inform overall study considerations. We
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then use this approach to illustrate how theories and methods can work together
to facilitate professional knowledge development from a relational perspective.
Keywords: health science, knowledge generation, mixed methods
research
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Background
Two major aims of scientific research are enlarging disciplinary specific knowledge and
solving practical problems (Hox, 1997). Developing a strong professional knowledge
base (i.e., knowledge of use to a specific profession), particularly in fields where
complex phenomena are an aspect of the inquiry (Rose, 2015) requires strong
theoretical and methodological grounding (Tashakkori & Teddlie, 2010). With
increasing frequency, researchers, particularly those in the social (Tashakkori & Teddlie,
2010) and health sciences (Curry & Nunez-Smith, 2014), are looking to mixed methods
research (MMR) as being valuable in responding to such complexities (Creswell, 2014;
Hesse-Biber & Johnson, 2013; Mertens, 2011; Saint Arnault & Fetters, 2011). In this
paper, we propose the Before Design Theoretical Placement (BDTP) as a general guide
for specifying and locating studies in a broader theoretical grounding, and discuss how
it may inform overall study considerations within MMR studies.
MMR, as defined by Johnson, Onwuegbuzie and Turner (2007), is a “type of
research in which a researcher or team of researchers combines elements of qualitative
and quantitative research approaches … for the broad purposes of breadth and depth of
understanding and corroboration.” (p. 123). The benefits of integration and its potentials
in providing synergistic understandings while attending to the shortcomings of
qualitative and quantitative research approaches has contributed to a proliferation of
MMR literature across disciplines (Archibald, Radil, Zhang, & Hanson, 2015; Bergman,
2008; Fetters & Freshwater, 2015ab; Hesse-Biber, 2010). Despite this popularity, using
even a well-designed MMR study does not guarantee trustworthy results (Creswell,
Plano Clark, Gutmann, & Hanson, 2007; De Lisle, 2011).
Researchers often look towards design typologies as a means to conceptualize
the relationship between the qualitative and quantitative study components. These
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typologies have been, in one form or another, accepted and modified by a number of
researchers (Creswell, 2003; Creswell & Plano Clark, 2011; Kettles, Creswell & Zhang,
2011; Leech & Onwuegbuzie, 2007; Teddlie & Tashakkori, 2009). Examples of such
typologies include:
Sequential explanatory: Quantitative data are collected and analysed first followed
by qualitative data, which are used to help explain and interpret quantitative
findings.
Sequential exploratory: Qualitative data are collected and analysed followed by
quantitative collection and analysis, and integrated at the level of intepretation.
Sequential transformative: Either qualitative or quantitative data are collected first
and then results are integrated in the interpretation phase.
Concurrent triangulation: Also known as parallel convergent design (previously
known as triangulation design) where qualitative and quantitative data are collected
and analysed at the same time within one study.
Concurrent nested: one method is given priority over the other method and guides
the study, while the other method is embedded or nested within the dominant
method / larger study design.
Concurrent transformative: the methodological choices are guided by theoretical
framework(s) which are seen in the research question(s).
Although there has been an emphasis on establishing design typologies in MMR,
approaches to MMR is still evolving. Writers in MMR have forwarded a number of
pragmatic approaches to assist researchers in choosing the appropriate model to answer
their queries (Creswell & Plano Clark, 2011; Johnson et al., 2007; Hesse-Biber, 2015;
Morgan, 2007; Östlund, Kidd, Wengström, & Rowa-Dewar, 2011). Yet examining the
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literature on research methodologies suggests that less attention has been placed on
understanding the foundational constructs which comprise research questions. It follows
that understanding which concepts comprise a construct is foundational to research
question formulation, which consequently directs the majority of design decisions,
including how constructs are to be observed or measured. Identifying how these
foundational elements (i.e., concepts and constructs) are embedded in theory can
faciltiate a systematic view of phenomena under study (Hox, 1997). Despite this, there
is a tendency to overlook the relationships between theoretical concepts, constructs, and
general theory. When the theoretical framework (and its components) is not clearly
linked to the methods, researchers risk designing flawed studies, wherein the stated
research question is inconsistent with the research design.
Creswell and Plano Clark (2011) emphasize the value of explicitly identifying
one’s theoretical orientation while Tashakkori and Teddlie (2010) see the merit of early
theoretical identification in explicating the research problem. In addition to providing a
schematic framework for linking observations and findings (Evans, Coon, & Ume,
2011), this practice can provide a structured method for describing study phenomena
while guiding design decisions (Evans et al., 2011; Tashakkori & Teddlie, 2010 ).
Given that drawing upon one or more theoretical frameworks to inform all phases of a
MMR study may occur (Creswell, Klassen & Smith, 2011; Evans et al., 2011),
understanding the foundational theoretical aspects embedded in theories, and how these
can be conceputalized to uniformly guide a MMR study, increases the likelihood of
theoretical soundness – a necessary attribute for sound and meaningful research
(Llahana, 2005).
Current theoretical frameworks informing MMR
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Although the importance of identifying the theoretical orientation of a study is well
recognized, researchers do not always explicitly delineate their theoretical orientations
and frameworks, or how these have been used to inform design decisions (Evans et al.,
2011). This is particularly true in the health sciences where few mixed methods original
articles report and adhere to theoretical frameworks. Given this apparent lack of use
and clear lack of explicit reporting, how researchers might position their research
theoretically within the scientific process is even less clear.
Frameworks have the potential to guide researchers towards pertinent
methodological and design considerations, and assist researchers in positioning their
studies theoretically. However, guidance is lacking on how researchers can identify and
position their theoretical orientations, As such, an integrated approach to incorporating
both theoretical and design considerations is needed. Such an explicit approach may be
particularly useful for beginning researchers seeking to develop theoretical soundness
and a methodologically cohesive MMR study.
In this paper, we propose the Before Design Theoretical Placement (BDTP) as a
general guide for specifying and locating studies in a broader theoretical grounding, and
discuss how it may inform overall study considerations. We then use this approach to
illustrate the symbiosis of theories and methods, specifying how theories and methods
can work together harmoniously to facilitate professional knowledge development. We
have focused on the BDTP as a guide for researchers of mixed methods studies;
however, its application is not limited to these types of studies. Moreover, our focusing
on “before design” emphasizes the need to specify and place the study in a broader
theoretical grounding before any design decision. However, theoretical placement is an
ongoing process made throughout the course of a study.
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At the outset we would like to acknowledge that seasoned colleagues,
researchers and academics are likely familiar with some of the ideas discussed in this
paper. However, knowing that many less established researchers – such as health
science practitioners not necessarily trained in research – as well as early career
academics are being called upon to conduct research (Cleary, Hunt & Horsfall, 2011).
This paper may provide useful guidance. We also acknowledge that the examples we
provide are in no way comprehensive and from the author’s research, to some, may
appear naive and introduce unnecessary jargon but the purpose of this article is to
introduce BDTP.
The Authors’ Standpoint of Before Design Theoretical Placement
Central to BDTP is the reciprocal and dialectic relationship between research and theory
(Llahana, 2005). Research relies on theory and theory, in turn, relies on research to be
developed; as such, empirical research can be considered an intentional endeavour
oriented towards theoretical and scientific knowledge development. The purposes of the
BDTP are to assist researchers in locating and developing theoretical positioning and
reciprocally using these understandings to design rigorous mixed methods studies. The
BDTP offers three cyclical levels to knowledge development, including: (1) developing
concept(s), (2) developing statement(s), and (3) developing theory (Figure 1), which
correspond with the interrelated foundational components of the theory building process
as identified by Walker and Avant (2005). When using Walker and Avant’s (2005)
approach, the researcher moves from developing concepts at an elementary level, to
developing a theory at a more advanced and abstracted level. Concepts refer to an
abstract general notion. Researchers approach research problems with a set of ideas they
wanted to explore (Denzin & Lincoln, 2005). Concept development is a necessary step
in theory building. Theory, however, relates to scientifically accepted general principles
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that are used to explain phenomena, and underpin research design decisions
(Sandelowski, 1993). The role of theory in the field of social science research
determines where it situates in the research framework (Garner, Wagner, & Kawulich,
2009; Tavallaaei & Abu Talib, 2010).
A research design is a set of methods and procedures used to collect, analyze and
measures variables
in the research problem being explored or examined. It provides a detailed outline how
an investigation will be carried out which includes how a theoretical framework will be
used to guide the study (Leedy & Ormond, 2016). In this case, the research design in
this study is what classification of MMR will be used to investigate the research
problem with the proposed BDTP. The BDTP offers guidance in specifying the
researcher’s theoretical standpoint in an ongoing process of theory building by
delineating corresponding tasks for each level of this theory building process.
Moreover, it illustrates how such processes can be used to inform design decisions in
MMR. For this purpose, we have illustrated the use of BDTP to data from the
following two mixed methods studies conducted by author 1 (published and
unpublished data) I) evaluation of nursing students’ clinical competency (Alavi &
Irajpour 2011, 2014), and, II) investigation of inter-professional collaboration (IPC) in
mental health services (Irajpour, Alavi, Abdoli, & Saberizafarghandi, 2009, 2012;
Alavi, Irajpour, Abdoli, & SaberiZafarghandi 2012)
Insert figure 1 near here
Metatheoretical Orientations
Theory building suggests a qualitative orientation associated with inductive or abductive
reasoning, interpretive and naturalistic paradigms, and qualitatively affiliated research
approaches such as grounded theory (Glaser & Strauss, 1967). Conversely, theory
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testing is generally regarded as quantitative in nature, often associated with a positivistic
orientation (Glaser & Strauss, 1967). Such conventions reflect metatheoretical bases
(i.e., overarching theories that define how theory is constructed) rooted in modernism
and postmodernism, respectively (Overton, 2007).
An ontological and epistemological grounding in modernism claims certainty
and objectivity as desirable outcomes of inquiry. This posits that certain types of
knowledge (e.g., value free) can be obtained only by way of certain methodological
approaches, often characterized by rigidity (e.g., randomized controlled trials).
Conversely, the interpretive turn offered by postmodernism valued uncertainty, while
prioritizing absolute subjectivism and rejecting ideal realism (Overton, 2007). While
research activities within each binary have produced knowledge useful to the
bricklaying knowledge-building characteristic of professional knowledge development,
our position is that neither alone is sufficient for MMR.
The BDTP approach is perhaps best aligned with a modern approach, one that
embraces a relational metatheory. Distinct from modern and postmodern approaches
which treat qualitative and quantitative as mutually exclusive and opposing categories, a
relational metatheory moves away from such diametrics, recognizing that while
qualitative and quantitative have distinctive qualities, they are equal and co-acting
constituents of a whole (e.g., a whole understanding) (Overton, 2007). A holistic
metatheoretical approach is most congruent with research efforts seeking a holistic, or
unified, understanding of phenomena. Thus, a relational metatheoretical stance positions
the BDTP in alignment with the pragmatic nature of MMR (Feilzer, 2010; Johnson &
Onwuegbuzie, 2004). The BDTP uses terminology both from qualitative (e.g.,
emerging) and quantitative (e.g., observed variables) vocabulary to communicate the
unity of knowledge and ways of acquiring it (i.e., research continuum rather than
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research polarities of qualitative and quantitative), particularly through use of
nomological networks (Masterson & Rainer, 2009). The evolution of MMR has
questioned the stronghold of traditional paradigms and their research outlooks
comprising of positivist/postpositive (quantitative) or constructivist/interpretive
(qualitative) models (Johnson et al., 2007; Denscombe, 2008). Both qualitative and
quantitative researchers use empirical observations to address research questions for a
comprehensive, meaningful and credible understanding of a phenomenon (Johnson &
Onwuegbuzie, 2004; Patton, 2002).
Applying the BDTP
As previously mentioned, the BDTP approach includes three levels: 1) developing
concept(s), 2) developing statement(s), and 3) developing theory, which correspond to
levels of Walker and Avant’s (2005) theory building process. There are three tasks (3
Ds) subsumed under each level:
Level 1 - Define concept(s), Demonstrate the concept(s), and Design the study
Level 2 - Define statement(s), Demonstrate the statement(s), and Design the
study
Level 3 - Define theory, Demonstrate the theory, and Design the study.
Level 1: Developing Concept(s)
The first level in the BDTP process attends to concept development, which is the first
level of the theory building process. The researcher undertakes three key tasks (3 Ds) in
this level.
DI - Define Concept(s)
Concepts are understood as “mental images of phenomenon, an idea, or a construct
about a thing or an action … (that) allows us to classify our experiences in a meaningful
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way both to ourselves and to others” (Walker & Avant, 2005, p. 26). The superordinate
(overarching) concept is “the broad constellation of meanings and understandings
associated with a given concept” (Adcock & Collier, 2001, p. 531). Operationalizing
concepts involves understanding the defining features of concepts and subordinates and
positioning them within a broader theoretical context (Luyt, 2012; Nevid, 2012). To
facilitate specifying concepts, the researcher is encouraged to ask “what is my scientific
work about?”, “what are the main concepts that I aim to deal with?”, “how have these
concepts been conceptualized within theories” and “how might this inform my research
methods?”
The researcher(s) then detect the current status of concept development and
associated operationalization, which requires that a literature review be completed. It is
well established that the literature review is foundational to creating substantial and
usable research, in part because it enables a clearer delineation of the research problem
and study objectives, and prevents researchers from unneeded study replication to make
a unique knowledge contribution (Amaratunga & Haigh, 2005; Everest, 2014;
Pathirage, Amaratunga & Haigh, 2005; Onwuegbuzie, Leech & Collins, 2012). If
through the literature review, the researcher finds the concepts and subordinates to be
well developed, the decision can then be made to either complete the study, progress to
the second task of study design, or proceed to the next level of theory building process.
During the literature review, researchers are encouraged to not only identify the
status of concept development, but to question which metatheoretical basis contributed
to the current conceptualization and operationalization. Have particular research
approaches been privileged in previous research of the concept of interest? Which
conceptual approach to knowledge building has been favored in these research
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endeavors? Such questions may help researchers assume a critical stance not only of the
status of the construct, but of the underlying meta-theoretical position.
In the evaluation of nursing students’ clinical competency, researchers first
identified “clinical competency” as a superordinate concept. They started an extensive
search of the nursing literature to find the current status of the concept’s
operationalization. They found a list of core practices as defining features of clinical
competency (i.e. assessment skills, communication skills, management skills, and caring
skills), and identified pertinent contextual factors (i.e. teacher, students, program and
environmental characteristics), imperative to understanding the superordinate construct
of clinical competency. However, the literature review revealed an insufficiently
organized set of contextual information, suggesting that further demonstration of the
concept was necessary.
Similarly, in another study, authors took inter-professional collaboration (IPC)
as the core superordinate concept and agreed upon a common definition of IPC as “the
process of developing and maintaining effective interprofessional working relationships
with learners, practitioners, patients/clients/ families and communities to enable optimal
health outcomes” (Orchard et al., 2010, p.8) as an initial guide to their further review
and study considerations. They then reviewed relevant mental health services literature
to understand the current status of IPC in local mental health services. They located no
published articles on the current status of IPC, and no local assessment tools measuring
the IPC in mental health services. However, they located a non-local framework (i.e.,
the Canadian Interprofessional Health Collaborative (CIHC) framework (Orchard et al.,
2010)) which could be used as a theoretical guide to further study considerations. The
CIHC framework provided an integrative approach to describing the competencies
required for effective interprofessional collaboration, and highlighted the role of
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contextual issues in the process of IPC. Having an agreed general definition of the
superordinate concept and an agreed theoretical orientation, the authors then conducted
a second literature review to identify important features of IPC in the mental health
services, newly informed by the adapted theoretical framework. Identifying the contexts
of development of associated concepts was important to understanding what was
represented and what was missed in previous research of the concepts.
D 2 - Demonstrate the Concept(s)
To demonstrate the concept(s) and subordinates, a representational model is created as
a simplified way of organizing complex phenomenon; a diagrammatic representation
that is also a conceptual device for organizing thinking about the phenomenon under
study (McKenna, 2006). A well-known approach of representing theory components is
nomological networking, developed by Cronback and Meehl (1955). A nomological net,
or network, known as a “lawful network”, (Nichols, 2011) could be considered as a
subset of a theory in that it explains the interrelationships between how numerous
network components relate. Cronbach and Meehl (1955) define the nomological net as
“the interlocking system of laws which constitute a theory” (p. 290).
Based on the nomological networking guide, there are distinct subtypes of
theory building elements, each possessing distinct characteristics. Various subtypes are
represented using different shapes, which allow researchers to differentiate between
subtypes and depict hypothesized sets of relationships between concepts. Measured or
observed concepts, also known as observed variables, indicators, or manifest variables,
are represented by squares or rectangles. Latent variables, also known as unobserved
variables, are illustrated using circles or ovals. Lines indicate the relationship between
concepts; the absence of a line between concepts signifies that no direct relationship has
been hypothesized. Lines have either one arrow, which represents a hypothesized direct
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relationship between two concepts, or two arrows, which represents a bilateral
relationship between two variables with no implied direction of effect. An arrow
pointing to a concept is representative of the dependent or effect variable (Ullman,
2006). Nomological networks are used as conceptual representation devices, which
either help researchers organize and communicate their thinking about phenomena
under study or guide them to develop an empirically testable model of the respective
phenomenon. In the second level of the BDTP, the nomological networks are used for
their former usage, so that the existing and/or hypothesized subordinates of concept(s)
are demonstrated to facilitate understanding of the concepts and subordinates of interest
to a particular study. Therefore, we have not been concerned about meeting any
assumptions that have been suggested to use nomological networking as a quantitative
tool by researchers.
We illustrate the respective nomological networks of our case examples in
Figure 2. With case example 1 (i.e., evaluating the nursing students’ clinical
competency, represented in part A of Figure 2), the superordinate concept of “clinical
competency” was considered a latent variable that surrounds a set of identified
indicators (i.e., rectangle I), and a set of hypothesized indicators (i.e., rectangle II). The
arrows connecting the superordinate concept of clinical competency to its indicators are
pointed from the superordinate concept to the indicators, assuming them as reflective
indicators of the concept.
Regarding the second example, IPC in the mental health services (please see the
part B of Figure 2), as was seen with the first example, the latent variable of IPC
surrounds a set of identified indicators and hypothesized indicators, represented in
rectangles I and II respectively. However, unlike case example 1, the arrows are
pointed from the indicators to the superordinate concept of IPC, assuming them as
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formative indicators of the concept. Deciding on the nature of the concept (i.e. latent
and observable) and connections between them is based on the researchers’ theoretical
orientation, the current status of concept development and the associated
operationalization.
Insert figure 2 near here
D 3 - Design the Study
If the concept of interest is found to be underdeveloped during task D1, the
researcher(s) may decide to devise a new study. For this purpose, the researcher
specifies a research question(s), devises a research design to best address the research
question(s) and to develop the respective concept(s). Critically, the nomological
network developed during the second task (D2) is used to inform design, and to
illustrate what might be conceptually lacking dimensions about phenomena. A
nomological network suggests sources of data (including qualitative or quantitative),
stipulates the relationships between diverse sources of data, as well as methods of data
collection and analysis (Newman, Ridenour, Newman, Smith, & Brown, 2013).
In reference to case example 1, the theoretical grounding and development status
of the superordinate concept of clinical competency identified during the first task
suggested a need for identifying context dependent indicators of the nursing students'
clinical competency beyond what had been identified through the literature review. The
reflective nature of these indicators, as represented by nomological network during the
second task, suggested a need to continue exploring the important features (i.e.
reflective indicators) of nursing students' clinical competency, rather than its
constituents (i.e. formative indicators). This directly informed the researchers’ decision
to adopt a qualitative approach to identifying the important features or indicators of the
nursing students' clinical competency. The researchers then conducted several
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interviews with nursing students, clinical teachers, and nursing staff to understand the
context-specific nature of nursing students’ clinical competency. After comprising a list
of indicators, identified first from the literature review and built upon during the
qualitative study, the researchers conducted a quantitative study to understand how
clinical evaluators ranked the relevance, applicability and importance of each indicator.
As a final step, a quantitative survey was administered to investigate the status of the
nursing students' clinical competency. Findings from this work signified the completion
of the study.
Regarding the second example, there was a similar need to explore
complementary context dependent indicators of IPC in the mental health services.
However, contrary to the first example, the researchers planned to explore the formative
indicators of the superordinate concept. To do this, they first conducted a qualitative
study to explore context specific constituent elements of the superordinate concept. The
researchers then applied the indicators identified through the literature review and
qualitative study to develop a native assessment tool to measure IPC in mental health
services.
Study completion may occur naturally after the respective concepts have been
developed and operationalized through the three tasks outlined above. Alternatively,
researchers seeking to proceed beyond this level and advance their scientific work can
use the BDTP as a guide to Develop Statements – the next level of the theory building
and knowledge development process
Level 2: Developing Statement(s)
After concepts have been developed and operationally defined, the researcher(s) can
progress towards developing statements, which involves understanding if and how
concepts relate to one another. Here three consecutive tasks (i.e., defining statements
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and determining status of statement development, demonstrating statements, and
designing a study) are completed to delineate the relationships between concepts (i.e.,
superordinate concept and other hypothesized concepts).
D 1 -Define Statement(s)
Understanding if and how concepts are related (and if so, determining the nature and
direction of relationship) is a hallmark of theory building and a cornerstone of cohesive
scientific knowledge development (Walker & Avant, 2005). While typically associated
with statistical research, researchers affiliated with qualitative approaches also seek this
form of understanding, but tend to use different language (e.g., themes, subthemes). To
define statements, the researchers detect the current status of statement development.
This is accomplished through a literature review. If the literature review reveals that the
hypothesized statement(s) have already been investigated, the researchers need to
consider how the present study contributes to extant understanding: is there reason to
stop or redirect the current study, or establish a new study to investigate different
relationships? Alternatively, should the literature review reveal that further
understanding of the concepts and statements are needed, the researcher(s) may rightly
re-focus on the first level of the theory development process.
D 2 - Demonstrate the Statement (s)
Modeling the relational structure of concepts through nomological network can help
prevent researchers from erroneous design by providing a directive picture of the
phenomena under study. Given that mistakes of misspecification are relatively common
in health and social sciences’ research (Bollen, 2002; Bollen & Bauldry, 2011) and that
the same set of concept(s) can assume diverse relationships, visually depicting the
nature of these relationships is a useful aid to understanding.
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As demonstrated by the example of IPC in mental health services, the
hypothesized relationships between IPC and associated concepts (i.e. IPC management
system, IPC potentials, interprofessional competencies, professional competencies,
interprofessionalism, client-centered care, and contextual determinants) were
represented by nomological networks (refer to Figure 3). This helped direct the
research study and has the additional advantage of providing a visualization tactic,
thereby facilitating communication and mutual understanding between diverse members
of the research team.
Insert figure 3 near here
D 3 - Design the Study
This approach enables additional insights beyond the nature of the concept(s) and the
respective statement(s). The research design and associated methods are designed to
address the research question(s). As demonstrated in case example 1, researcher(s)
recognized that a qualitative follow up study was required to understand the extent of
support for the hypothesized statements developed during tasks D1 and D2 . Because
the qualitative findings supported the hypothesized associations, the researchers
progressed to develop theory.
Level 3: Developing Theory
After statements have been developed, researcher(s) may proceed to the most abstract
level of the theory building process. Developing theory enables a more complete
picture of phenomena of interest and if positioned relationally, can more aptly reflect
the holistic complexity of phenomena.
D 1 - Define theory
To define a meaningful whole, or a comprehensive conceptual understanding, necessary
for approaching complexity (Alavi 2013; Boateng & Foundation, 2014; Sokolowski &
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Banks, 2012), the researcher begins his or her study with a set of hypothesized concepts
and relationships derived from a critical review of literature and extant theory. If theory
is unavailable, the researcher may consider re-visiting earlier levels to ensure that
concepts are sufficiently defined and statements are adequately established, as these are
integral to building a meaningful and comprehensive understanding of the respective
phenomena under study. After the hypothesized set of concepts and statements has
been established, the researcher is to detect the current status of theory development,
which metatheoretical positions influenced this perspective, and whether further
investigation is needed. A well-developed respective theory may well signify the end of
the need for further empirical work in that area.
In the example of investigating IPC in the mental health services, the researchers
found no empirically supported theory establishing multifaceted complex relationships
between the IPC and associated concepts (e.g., IPC management system,
interprofessional competencies). In this case, the results of the literature review were
instrumental in setting up hypothesized relationships between the concepts. The
resulting depiction gave the researcher(s) a holistic sense of the IPC in mental health
services.
D2 - Demonstrate the Emerging Theory
Using nomological networks to demonstrate a meaningful whole of the study subject
facilitates understanding of pertinent concepts, respective statements and their
relationships, thereby enabling insight into the overall model. Researchers may employ
an existing theory or extract a nomological network from a broader background theory.
In the example of ICP in mental health services, the researchers used the nomological
network guidelines to configure multiple hypothesized relationships among a set of
stablished concepts (see figure 3).
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Insert figure 3 near here
D3 - Design the Study
The researcher specifies research question(s) derived from the hypothesized
theoretical structure. This in turn guides research design and methods selection. A
single qualitative or quantitative approach or a typological MMR design (e.g.,
explanatory sequential), may be selected. Or, as an alternative to typology (Guest,
2013), a study design may be constructed to reflect the complexity of the phenomena
under study. Theory development studies that reflect the third level of the knowledge
development process have been undertaken. For example, Lavery (2014) used MMR to
empirically test a theoretical framework on factors influencing party leaders' decision-
making priorities in relation to ethic balancing versus polarization in governmental
party establishment. A three level process progressing from concept development to
theory development was undertaken, mirroring the case examples wherein researchers
empirically examined and expanded upon a hypothesized model (i.e. nomological
network) of the IPC in mental health services using MMR. Characteristic of this process
is the iterative movement between levels, and the use of diverse and conceptually
coherent methods selected to develop and understand concepts, their nature, and their
relationships to internal and external, contextually relevant factors impacting
understanding.
Discussion
The BDTP can advance researchers’ understanding of the role of theories as one of the
linchpins that connects qualitative and quantitative components into mixed methods
studies (Newman et al., 2013) and guide research designs in the study of complex
phenomena. It has potential to advance understandings of how pragmatic and pluralistic
selection of research methods can help establish a unified theoretical basis for empirical
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work. The BDTP provides guidance for how researchers can use a three-level approach
to position their own research in a common theory building and knowledge generation
process. Critically positioning theory could facilitate qualitative and quantitative
integration on an interactive continuum rather than on diametric opposites
(Onwuegbuzie & Leech, 2005), consistent with a modern or relational metatheoretical
stance (Overton, 2007).
Despite the linearity of presentation, the BDTP is in itself a cyclical process. Each step
is predicated on reflection and scrupulous investigation of the extent of knowledge
about concepts, their relationships, and how the current state of knowing impacts design
decisions. In contrast to taking a theoretical framework and making data “fit” within
that framework, the BDTP offers a ground-up approach to understanding the dialectical
and complementary relationships between theory and MMR, wherein all mixed methods
classification can be considered a step towards theory building that informs future
research decisions (Byrne, 2010; Hesse-Biber & Johnson, 2015; Kline, 2011; Llahana,
2005; Walker & Avant, 2005). As Silverman posited (2013, p.107), “Without theory,
research is impossibly narrow. Without research, theory is mere armchair
contemplation.” Although the BDTP emphasizes the dialectical relationship between
theory and research, it assumes that theory precedes any research and design decision
(Tashakkori & Teddlie, 2010). Examining the conceptual elements of phenomena
under study can contribute to cohesion in the design process (McKenna, 2006). In this
way, the BDTP is a toolkit to configure underlying theory components in a logical
manner (Byrne, 2010), forming a solid foundation by which to inform future design
decisions.
New approaches to investigation constantly evolve as a way of gaining a better
understanding of the human experience (Polit & Beck, 2014; Morse, 1994, 2012). When
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the research inquiry is in a ‘real world setting [where] the researcher does not attempt to
manipulate the phenomenon of interest’, the research approach needs to be naturalistic,
flexible and individualistic (Patton, 2001, p.39; Patton, 2005). Thus, the premise that all
research should be preceded by “theory” is somewhat contentious. The reality is
however that in many settings studies start with a policy question that has to be
translated into a set of questions that are ‘researchable’. Moreover, concepts are drawn
upon and jettisoned at different stages of the research process and at times particular
concepts may only enter the research process during analysis. Whilst we have
endeavoured to be inclusive it is beyond the scope of this paper to include all relevant
concepts in this discussion (such as ‘sensitising concepts’, see Blumer 1954).
Conclusion
To summarise, well-executed MMR studies offer a uniquely holistic perspective of
research phenomena, reflecting the complexities of inquiry subjects. Such
understandings are essential to developing robust professional knowledge particularly in
fields of social and health sciences where complex phenomena are often the subject of
inquiry. Increasingly, researchers are challenged to undertake MMR and grapple with
the intersection of theoretical and methodological considerations from diverse data
sources. Often, theories are adopted as afterthoughts, selected to make sense of data.
Alternatively, theories are selected to guide inquiry, but may lack sufficient direction for
researchers seeking to examine the nature of concepts and their relationships. Further,
how research studies can be sequentially designed to answer research questions that
reflect deliberate theoretical and methodological cohesion from relational perspectives
is not well attended to. We offer the BDTP as an approach to help researchers position
their research in a common theory building and knowledge generating process. Guided
by complementary tasks varying in level of abstraction, mixed methods researchers may
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better understand the theoretical foundations of their research in a manner more explicit
than what is common practice.
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Walker, L.O., & Avant, K.C. (2005). Strategies for Theory Construction in Nursing:
Pearson New International Edition (4th ed.). New Jersey: Pearson Education, Inc.
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1
2
3
Figure 1. The levels and the corresponding tasks of the BDTP
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
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A B
Figure 2. Nomological network of the superordinate concepts of nursing students’
clinical competency (A) and IPC in mental health services (B)
Note. Oval indicates latent variable and rectangle indicates observable variable
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Formative indicators Superordinate
concept
I: Identified IndicatorsTeam working skillsConflict management skillsOrganizational culture
IPCII: hypothesized indicators that need to be identified by further study
Superordinate
concept
Reflective indicators
I: Identified IndicatorsAssessment skillsCommunication skills Management skillsCaring skills
Clinical
competency
II: hypothesized indicators that need to be identified by further study
1
2
3456789
1011121314
15
16
17
18
1920212223242526272829303132
Figure 3. Nomological network of the associations between superordinate concept of
IPC in mental health services and other important concepts
Note. Unidirectional arrow indicates hypothesized causal relationship (e.g. management
system is influential on IPC in mental health services) and bidirectional arrow indicates
bilateral association or causal relationship between concepts (e.g. professional
competency improves IPC and IPC improves professional competency)
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12
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4
5
6
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8
9