Mixed Methods: An Example
Mixed Methods: An Example Program Transcript
NARRATOR: Dr. Debra Rose Wilson’s study provides an excellent example of a mixed method research design. Note why this is the case, as she explains her research question and study.
DEBRA ROSE WILSON: My background’s in health care, and my PhD is in health psychology. And I teach in the School of Psychology, as well as in the School of Nursing. I’m a nurse as well, so I come into this with a health perspective, looking at research from a holistic perspective, but recognizing that if we’re examining any phenomena within health that we have to look at it from many angles. That isn’t always just cause and effect.
For example, in cardiovascular disease, it isn’t just genetics that causes the disease. It’s diet. It’s whether they had an angry personality. It’s how much social support they had. It’s even whether they were breastfed or not as an infant. All of those factors contribute to the disease. And from a health care perspective, it was important to look at all those factors.
When you look at quantitative data, that’s very valid for health care. We need to know those hard numbers. We need to know the biomarkers, or the results of blood tests, or the results of EEGs and blood pressure and pulse. Those are all important in health care.
But so is the subjective perception of pain, for example. While we can measure blood pressure and pulse during pain and look at the objective science of pain, it’s really difficult to express and understand the patient’s perspective of pain. That’s why it’s so important to look at health care from a mixed methodology approach.
My area of expertise is working with adult survivors of childhood sexual abuse. I also had a background in relaxation techniques and complementary and alternative therapies. And for me, it made sense to combine the two areas of expertise in my area of research.
The research area that I look at, consequently, is mind-body, the influence that our attitudes, our beliefs, our perception of stress has on our biology. And this was important to apply to the population of adult survivors of childhood sexual abuse.
We didn’t really know how adult survivors dealt with stress. We knew that they tended to overreact to stress. They tended to use more denial and inappropriate maladaptive coping mechanisms when they were stressed. And they tended to
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Mixed Methods: An Example
perceive more stress in their environment as well. We really didn’t know if stress management was effective for this population.
The study I’m talking about is a mixed method approach to examining the effectiveness of stress management. My study explored the experience of stress management from a holistic perspective. 35 adult survivors of childhood sexual abuse participated in four weeks of stress management training. And so from a holistic perspective, I wanted to gather as much data as possible, both quantitative and qualitative. And I did this from a holistic approach so that I gathered objective data, which are those biomarkers, those hard numbers.
And for that, I examined their salivary immunoglobulin A. Saliva was collected from the participants, and we sent it to a lab and looked at how much immunoglobulin A they had in their saliva. Immunoglobulin A is the immunoprotector of our mucus membranes of our digestive system and our respiratory system, for example. And it was an easy way to get a sample that I didn’t have to draw blood and stress them again.
Another parameter that I wanted to check was subjective data. How did they interpret their ways of coping? And I used Folkman and Lazarus’ Ways of Coping Questionnaire, which is a subjective measure of coping. And I also examined that before and after the intervention, as I did the salivary IgA before and after the four week intervention of stress management classes.
The third part of my study, I gathered intersubjective data. When doing qualitative interviews, you can’t really take the researcher out of the research. There’s something that happens between the participant and the researcher that’s relevant. And that interview process is intersubjective. So for this study, I gathered objective data, subjective data, and intersubjective data.
It’s really important when you’re gathering intersubjective data to recognize that it is intersubjective, that the researcher’s bias is involved. And so when you’re doing any kind of qualitative piece of research, you have to recognize what your biases are.
I wasn’t sexually abused as a child. I had to recognize that I had bias, that I had pre-assumptions about what it was like to be sexually abused as a child. But I had not experienced it. When I was able to put those ideas down and recognize them as my bias and then set them aside, it was much easier to gather intersubjective data.
Another really important point about intersubjective data, and when you’re doing any kind of qualitative interview, is to be truly present with the person that you’re with. True presence means that you’re consciously and intentionally setting aside all those running thoughts that are running at the back your head, and focusing on what your participant is saying. Your participant knows when you’re in true
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Mixed Methods: An Example
presence with them. They know that you’re focused on them. And you get a better rapport, and you get a better understanding of what their experience is when you’re truly focused on what they’re saying, and what their body is saying as well. That you’re being objective and looking at their responses, and matching their body language to what they’re saying.
So to summarize, the objective data gathered was that salivary immunoglobulin A, a lab test, quantitative data. The subjective data was the Ways of Coping Questionnaire by Folkman and Lazarus, which really examined their interpretation of how they were coping. And thirdly, the intersubjective data was the interview at the end of the four weeks where you consciously recognized your bias, but interviewed them and asked these participants, what was their experience? Which tools worked for them? What were those stress management classes like?
The design of this study was a pre-intervention and post-intervention data was collected. Before the intervention of four weeks of stress management training, I collected the salivary IgA, the objective data, as well as the Ways of Coping Questionnaire, the subjective data, and collected them again post-intervention. After the intervention, I also did the qualitative interviews, which set up a pre-post intervention design study.
Adult survivors of childhood sexual abuse are a vulnerable, at-risk population. So for the university’s Review Board of Human Subjects, the IRB, I had to make sure they were protected. Sitting in a room, closing their eyes, doing relaxation therapy with dim lights in a group setting can be frightening for an adult survivor of childhood sexual abuse. So I had to make sure there were people there to help them if they had some sort of an adverse reaction to the experience.
So for IRB approval, I had therapists in the room with me for all of the classes, and they were in group sessions. But if they needed help afterwards, those therapists who were trained in working with adult survivors of childhood sexual abuse would be available to the participants. That way if anything happened, they could have some follow-up. I was blessed that experience was positive for all of the survivors and all my participants.
As far as results go, what I found first from the objective data, I found that the salivary IgA, immunoglobulin A, improved over the four weeks significantly. Therefore, stress management is effective in improving our immune system. The second thing I found was that the ways of coping improved as well. And this is profound, because I was able to influence the consequences of childhood sexual abuse. The participants were able to heal and transcend some of those consequences or sequelae of childhood sexual abuse.
The third thing I found when I did the qualitative interviews was that they recognized hypervigilance as one of the big problems that they had with stress.
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Mixed Methods: An Example
Now hypervigilance is this always aware of the environment, always looking, always expecting something bad to happen. What they also recognized was that they didn’t do anything about it. They were just hypervigilant for more. So they weren’t using appropriate coping mechanisms.
Another theme that I found that ran throughout the qualitative piece is a somatic detachment. What I mean by that is because they were so externally focused, they weren’t aware of their body’s responses to stress. So they were almost detached from their body, which is not surprising, because that was an appropriate coping mechanism when they were abused. That tended to become a common coping mechanism in adulthood. And that wasn’t an appropriate mechanism. When they became aware of their somatic detachment, I started to do exercises like relaxation, body scans, being aware of different parts of their body. They recognized not only the somatic detachment, but were able to heal and focus a little bit more inward.
The third theme that I recognized is that they all see themselves on a pathway to healing. That they all identified themselves in different places on the process, but that these stress management tools, they could use these on their pathway to healing. And that gave them some power.
So it’s important when you’re doing mixed methodology that you bring those three pieces of data together. It’s called triangulation. And for my study, that was easy. They all pointed in the same direction, that stress management was effective for adult survivors of childhood sexual abuse from all three parameters. Their immunity improved, their ways of coping improved, and they had tools from which they could use to heal.
One of the important social change implications of this study is that the consequences of childhood sexual abuse can be transcended. That means adult survivors can heal and lead a more whole life.