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Open Access Research article

Structural issues affecting mixed methods studies in health research: a qualitative study

Alicia O'Cathain1*, Jon Nicholl1 and Elizabeth Murphy2

Author Affiliations

1 Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Regent Street, Sheffield, UK

2 School of Sociology and Social Policy, Law and Social Sciences Building, University of Nottingham, Nottingham, UK

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BMC Medical Research Methodology 2009, 9:82  doi:10.1186/1471-2288-9-82

Published: 9 December 2009



Health researchers undertake studies which combine qualitative and quantitative methods. Little attention has been paid to the structural issues affecting this mixed methods approach. We explored the facilitators and barriers to undertaking mixed methods studies in health research.


Face-to-face semi-structured interviews with 20 researchers experienced in mixed methods research in health in the United Kingdom.


Structural facilitators for undertaking mixed methods studies included a perception that funding bodies promoted this approach, and the multidisciplinary constituency of some university departments. Structural barriers to exploiting the potential of these studies included a lack of education and training in mixed methods research, and a lack of templates for reporting mixed methods articles in peer-reviewed journals. The 'hierarchy of evidence' relating to effectiveness studies in health care research, with the randomised controlled trial as the gold standard, appeared to pervade the health research infrastructure. Thus integration of data and findings from qualitative and quantitative components of mixed methods studies, and dissemination of integrated outputs, tended to occur through serendipity and effort, further highlighting the presence of structural constraints. Researchers are agents who may also support current structures - journal reviewers and editors, and directors of postgraduate training courses - and thus have the ability to improve the structural support for exploiting the potential of mixed methods research.


The environment for health research in the UK appears to be conducive to mixed methods research but not to exploiting the potential of this approach. Structural change, as well as change in researcher behaviour, will be necessary if researchers are to fully exploit the potential of using mixed methods research.