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Consequently, the study uses a mixed methods design where the variable-oriented data occupy a secondary role to the case-oriented methodology (Creswell & Plano Clark, 2007). Quantitizing, defined as the process of assigning numerical values to non-numerical data, enables the transformation and merging of data sets and therefore, qualifies as mixed methods (Sandelowski, 2000b; Sandelowski, Voils, & Knafl, 2009). Designing and conducting mixed methods research. Hierarchies of life histories and associated health risks. The concept of time from life course perspective appeared in our study both as clock time associated with caregiving events and as personally, socially and culturally constructed time, expressed in caregiver narratives (Sandelowski, 1999, p. 81) elicited through interviewing. Inter-rater agreement was established at the 90% level among the research team (Miles & Huberman, 1994). These constructs reflect cultural and contextual influences from our theoretical framework (Figure 2), which are defined as historical or individual events from childhood or young adulthood that shape the caregiving trajectory, and the cumulative advantages or disadvantages of socioeconomic status (years of education, current income and occupation), race, age, and gender (Elder, 1995; Elder, 2003; McDonough & Berglund 2003; Hertzman, 2004). Learn more Caregivers choose the start date of the trajectory, naming events that later influenced care and their dates, so that researchers could further explore and understand culturally and socially constructed notions about transitions and turning points (Scanlon-Mogel & Roberto, 2004). Fontana A, Frey J. Some of these themes validated the sparse caregiver literature, such as the notion of a reckoning point (life course perspective: caregiver turning point; Clark & Huttlinger, 1998), the first recognition and acceptance of the role of caregiver, which we heard commonly expressed by Mexican American families. Critical perspectives in racial and ethnic differences in health in late life. Bronwynne C. Evans, College of Nursing & Health Innovation, Arizona State University, 500 N. Third St., Phoenix, Arizona 85003, Phone: (602) 496-0766, Fax: (602) 496-0886, ude.usa@snave.ennywnorb. Utilization of such frameworks could, then, fit snugly into Tashakkori and Creswells recent definition of mixed methods: Research in which the investigator collects and analyses the data, integrates the findings, and draws inferences using both qualitative and quantitative approaches or methods in a single study or program of inquiry (2007, p. 4). Also, the phenomenon of collective caregiving (life course perspective: cultural and contextual/caregiving in la familia) is a new addition from our study to the literature. Utility of the life course perspective in research with Mexican American caregivers of older adults. Its just like cleaning a baby, its the same thing, he said. The purpose of the timeline was to visually augment data about the caregiving experience derived from the interview on contiguous series of 8 11 sheets of paper marked with a horizontal life course line, with the left end representing the start of the caregiving trajectory, progressing toward the right end across time. Life course perspective also provided an opportunity for us to quantify the breadth and depth of data collection over time for other researchers. Mixed methods studies can be difficult to locate because the methodology is so new that many researchers fail to use consistent terms to describe their research. Do inquiry paradigms imply inquiry methodologies? Johnson R, Onwuegbuzie A, Turner L. Toward a definition of mixed methods research. We tag team it between all three of us. Life course perspective helped us pose and answer our research questions because the theory itself contained the concepts of burden/strain, cultural and contextual variables, caregiving trajectory, and transitions and turning points. How might we utilize a framework to navigate the uncertainty in mixed methods and help answer our questions? Clark M, Huttlinger K. Elder care among Mexican American families. We used a demographic questionnaire and the General Acculturation Index to collect those data. Using narrative in social research: Qualitative and quantitative approaches. Of these 28, 11 came from the discipline of nursing; 10 of these used theoretical frameworks from other disciplines, pointing up the interdisciplinary nature of mixed methods. Major issues and controversies in the use of mixed methods in the social and behavioral sciences. Before Many other practice disciplines, both in and out of health sciences (e.g., architecture, law, engineering, social work, nutrition, medicine, education, business, agronomy, and epidemiology), also are fertile ground for mixed methods research. The aims of the study were to describe the level, circumstances, and consequences of caregiver burden/strain in Mexican American caregivers; determine the impact of cultural and contextual variables on caregiving in such families; and determine the events that lead to nursing home admission for older Mexican Americans. Moreover, are these studies accessible to other researchers who seek to use them as models for their own work? When needed, we converted case-oriented interview data into items, ranks, scales, or concepts that could be represented numerically to facilitate comparison with variable-oriented data. Without careful consideration, a theoretical framework could be chosen that has a poor fit with the study, distorts the data, or fails to describe the reality under study (Sandelowski, 1993b; 2000b). A manual of start codes derived from life course perspective, enabling initial examination of the data, was revised and tested across 60 cases, and was considered complete when no additional new codes could be identified. Even recruitment is tied to life course perspective in our IRB-approved study because we targeted agencies that serve Mexican-American families needing support with transitions and turning points in their caregiving trajectories. Are there limits to its utility? In an effort to increase utilization/application of our findings for other researchers, we attempt to enhance external validity/transferability/fittingness by attending to congruency with life course perspective theory, considering cultural and linguistic accuracy in translation and interpretation, and making the findings intellectually accessible to other researchers by working iteratively between life course perspective and thorough, specific, detailed descriptions of data collection and analytic procedures. Reflecting back to our inductive theoretical drive, we decided to enroll them because, although they complicated our research protocol, they are an integral part of uncovering the phenomenon of caregiving in Mexican American families. Researchers waged paradigm wars in which they questioned whether or not qualitative and quantitative data could be combined (e.g., Guba & Lincoln, 1988). Interviews were transcribed verbatim and checked for accuracy. Sometimes more than one primary caregiver provides care to a single care recipient. Data reduction procedures throughout our study rely on the life course perspective emphasis of temporality. For instance, a caregiving daughter and her son both act as primary caregivers for Tata (Grandfather) and her other son comes over to help when he can. What family transitions and turning points in the caregiving trajectory are related to nursing home admission? It is expected that we will be able to distinguish different social and cultural factors influencing caregiving trajectories and nursing home admission within these typologies, define distinct categories of change in caregiving, and describe patterns for families who continue to provide informal care as compared to those who do not. Life Course Perspective: Caregiving Trajectory. First of all, establishing significance or impact of a proposed study is one of the most crucial aspects of grantsmanship. In: Tashakkori A, Teddlie C, editors. Following procedures as outlined in Happ et al. David W. Coon, College of Nursing & Health Innovation, Arizona State University. In: Tashakkori A, Teddlie C, editors. Since I cant lift him off the bed, one of my sons will sit him in the wheelchair to bring him in to eat.. Pearce N, Davey Smith G. Is social capital the key to inequalities in health? We also knew that our intensive case- and variable-oriented analysis would enable early detection of problematic transitions and turning points where family caregiving is threatened, and lead to future culturally-responsive, patient-centered, customized interventions to keep elders in their homes. The term mixed methods is a recent one. Borkan J, Quirk M, Sullivan M. Finding meaning after the fall: Injury narratives from elderly hip fracture patients. Sandelowski M. Theory unmasked: The uses and guises of theory in qualitative research. If practice is thought to take the lead (Greene, 2008), are health science studies actually using theoretical frameworks to help guide complex mixed methods studies? In: Mortimer E, Shanahan M, editors. Acting as maps, theoretical frameworks can help researchers return home to aims/research questions after forays into triangulation seeking convergent validity and facilitate identification of the next path to explore. There will be some opportunity for statistical generalization of quantitative data results, based on multilevel modeling, during the initial analytic phase before the two data sets are combined. Evans B, Crogan N, Belyea M, Coon DW. Dummy codes for different types of turning points could be subjected to analysis to study their effects on admitting care recipients to nursing homes. Sandelowski M. Rigor or rigor mortis: the problem of rigor in qualitative research. Demographic and variable-oriented data were collected and entered into SPSS. We do continue to carefully monitor issues of informed consent in secondary analyses, many of which will spring from our large, complex data set, and consonant with our transformative philosophy, we make a conscious effort to understand and value the stories of our caregiving families. Nursing research: Principles and methods. In our mixed methods study currently funded through the National Institute of Nursing Research, a theoretical framework was of incalculable worth during the search for funding because it provided a vehicle for discussing significance and innovation in methods, identification of gaps in research, and foreshadowing of project outcomes and future research plans. For example, the next phase of this inquiry will be an intervention to support Mexican-American families in their efforts to care for older family members at home. PMC legacy view Our advice is, Dont leave home without one!, This work was supported by the National Institute of Nursing Research, National Institutes of Health [grant number 5R01NR010541-02]. Our analysis emphasized the descriptive/exploratory phase of inquiry, identifying the full spectrum of transitions, turning points, and adaptive strategies and their influence on caregiver burden/strain and its consequences. Handbook of mixed methods in social and behavioral research. We did not include studies that generated a theory, only those that relied from the beginning on a theory for conceptual guidance. I said, You have to watch them more. Journal of Nutrition Education and Behavior. Using the results of both the case- and variable-oriented analyses, we will map two typologies: one for caregiver burden/strain and one for caregiver gain or rewards, in relation to trajectory events. We used stories of these trajectories, told in telenovela style, as a culturally-appropriate, powerful recruitment tool in Spanish language media, including print, radio, and television. This article uses a funded National Institutes of Health study as an example to explain the utility of a theoretical framework in conceptualizing a study, making design decisions such as sampling and recruitment, collecting and analyzing data, and data interpretation. Careers, The publisher's final edited version of this article is available at, Communal caregiving: a single primary caregiver provides care to more than one care recipient. In regard to transferability, we ask how knowledge created through action and reflection can be used in a new setting and examine our evidentiary warrant for doing so. The call has gone out for practice disciplines to use more fully the full armamentarium of concepts, techniques, and terminology associated with mixed methods in order to manage the increasing complexity of research (Twinn, 2003). official website and that any information you provide is encrypted The evolving of mixed methods could be construed as constituting a third methodological movement, following quantitative and qualitative approaches (Teddlie & Tashakkori, 2003), that is composed of distinctive mixing of practices from these other methodologies (Greene, 2008). Rather than limiting the study, the theoretical framework was critical to the design (as a theoretical framework is for all studies, according to Hesse-Biber, 2010) because it provided a guiding structure that kept the study well-bounded but did not preclude discovery. [I felt] good and then bad because Ive never lived with my husband and my kids, [alone]. Is mixed methods social inquiry a distinctive methodology? Federal government websites often end in .gov or .mil. Pragmatically, then, how does a theoretical framework provide structure for a complex investigation of health behaviors, social determinants of health, or patient and family-focused health care, and facilitate translation of research findings into practice (Forthofer, 2003)? We relied on congruency of our research design with life course perspective as a guiding framework to tackle the maze of mixed methods. Happ M. Mixed methods in gerontological research: Do the qualitative and the quantitative data touch? They provide an orderly, efficient scheme for bringing together observations and facts from separate investigations; assist in summarizing and linking findings into an accessible, coherent, useful structure; guide understanding of phenomena both the what and the why of their occurrence; and provide a basis for prediction (Polit & Beck, 2004). My brother was watching [my parents] at his house but he started leaving them more and more. Hertzman C. The life-course contribution to ethnic disparities in health. We used constructs drawn directly from life course perspective (Figure 2) to focus our inquiry. We also created a series of matrices reflecting constructs from life course perspective, such as burden/strain, where case- and variable-oriented data could be displayed together to enable such comparisons. College of Nursing & Health Innovation, Arizona State University, 500 N. Third St., Phoenix, Arizona 85003, Phone: (602) 496-0766, Fax: (602) 496-0886, Mixed methods, theoretical framework, conceptual framework. While the perceived dichotomies between the inductive-subjective-contextual approach and the deductive-objective-generalizing approach (described in Morgan, 2007) still continue today in some camps, other researchers have chosen to integrate these methodologies. 8600 Rockville Pike A mixed methods way of thinking is an orientation toward social inquiry that actively invites us to participate in dialogue about multiple ways of seeing and hearing, multiple ways of making sense of the social world, and multiple standpoints on what is important and to be valued and cherished (Greene, 2008, p. 20). Such descriptions will enable confirmability/objectivity of the research by demonstrating neutrality in interpretations. The spouse struggled to meet the care recipients needs, saying With her hurting and everything, shes just like Jell-O. There is a growing acceptance of the utility of mixed methods in addressing complex health problems among health science researchers (Forthofer, 2003) and, beginning with the use of triangulation in the 1980s, mixed methods have slowly gained ground in nursing (Twinn, 2003). HHS Vulnerability Disclosure, Help Teddlie C, Tashakkori A. Pragmatism also addresses how our values and ethics, our politics and epistemologies, and our world-views as researchers directly influence our actions and our methodologies (Morgan, 2007). The purpose of this paper is to explore the worth of a theoretical framework in guiding the design and implementation of mixed methods studies. Johnson R, Onwuegbuzie A. As we coded the 660 interviews using a manual derived from the constructs of life course perspective (described above), new themes emerged that enriched the theoretical framework. Nursing often uses explicit theoretical frameworks from nursing or other disciplines as conceptual and organizational hooks upon which to hang a project (Sandelowski, 1999). Life course perspective aids in this endeavor by focusing the researcher on relevant constructs and their interrelationships; we use it as a series of chronological hooks upon which to hang sequential and concurrent events in time (Sandelowski, 1999).

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