Mixed Methods

Mixed Methods: An Example

Mixed Methods: An  Example Program Transcript

[MUSIC PLAYING]

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.

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