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Clipping is a handy way to collect and organize the most important slides from a presentation. Mixed methods research is the integration of quantitative and qualitative components in a research project. Mixed methods research is increasingly being recognized for its ability to bring multiple points of view to a research project, taking advantage of the strengths of each of the quantitative and qualitative components to explain or resolve complex phenomena or results. Mixed methods researchers need to carefully consider both why they are integrating quantitative and qualitative research in their studies and how they are going to accomplish this integration in practice. Broadly speaking, scientific research involves systematically and methodically following a recognized research protocol to answer a specific question. When viewing a given phenomenon from a constructivist paradigm, there is no single underlying truth, but rather there are as many experiences of the phenomenon as there are people experiencing it. Quantitative methods measure the difference between the before and the after states of a research object of interest or take a “snapshot” (such as a survey questionnaire) to quantify the state at that moment of the object being studied. Data collection for quantitative methods generally falls into two categories: survey “instruments” or “tools” (special-purpose questionnaires) and biological measurements.
How do successful male massage therapists overcome perceived gender barriers in the massage profession?
What value do occasional and regular therapeutic massage users ascribe to their treatments? How do therapeutic massage practitioners conceive of and use evidence in the context of their practice? As mentioned at the beginning, mixed methods research brings together quantitative and qualitative methods within a single study. This section will begin with current examples of therapeutic massage mixed methods projects. Searches for studies using “mixed methods” or “combined methods” and “massage” in PubMed, Ovid, and the Massage Therapy Foundation database did not locate any studies. A poster presentation describing early results of research still under way in patients in the Washington, DC, area of the United States. Quantitative questionnaires were used to monitor outcomes of massage treatments on patients of massage therapist trainees.
The quantitative component documented the training and practice demographics of therapeutic massage practitioners in Alberta, Canada.
Patients from a locale in Washington State, United States, were randomized to either a body-oriented therapy treatment approach or a massage therapy–only routine. In this study, participants in Vancouver, British Columbia, Canada, who received the intervention exhibited negative effects according to the quantitative measures.
Taking the time to consider the category of a project’s purpose will provide insight into what the project is meant, and not meant, to achieve. We wanted the option of using the interviews to clarify any unexpected questionnaire results. Larger studies may have multiple sequential components within which there may be single (quantitative or qualitative) or concurrent research projects.
The progression of a research study can be visualized as a sequence of project steps; integration can occur at any of these sequence points. Fully integrated studies begin with conceptualization of the study, because issues of design, research question development, and literature review should also be developed from a mixed methods perspective.
The research components of purpose, sequencing, priority, and integration will now be identified within the mixed methods research examples previously listed. Menard’s quantitative results indicated that clients “reported statistically significant reductions in symptom severity” from having received massage. More than 90% of questionnaire respondents were trained in multiple therapies, with little similarity in training patterns.
Patients were randomized to either a body-oriented therapy approach or a massage therapy–only routine. In this study, the participants who received the intervention exhibited negative and stressful effects according to the quantitative measures. Qualitative studies are often used to help refine a questionnaire so as to increase questionnaire response and accuracy. This process would be followed by a quantitative process of implementing the questionnaire. The subsections that follow provide brief introductions to two areas of considerable and ongoing debate in mixed methods research. The generally accepted mixed methods definition is “qualitative and quantitative components in a single study.” Therefore, what is a project called that uses only multiple quantitative or only multiple qualitative methods?
Another issue is what to call a study process that shows no integration of its quantitative and qualitative research components. The important point is that every mixed methods study should carefully explain its definition of mixed methods by describing how the mixing or combining is achieved. The most contentious theoretical discussions during the development of the mixed methods research framework have addressed the question of whether post-positivist and constructivist research can coexist within a study or whether those approaches are incommensurate—that is, a researcher cannot use both paradigms simultaneously. Therapeutic massage is a particularly appropriate area of research for mixed methods designs because, using such designs, researchers can examine more than one facet of an issue in the same study. The goal of much of clinical research design in therapeutic massage is to verify the value of a treatment, usually isolating a single effect of interest for a particular treatment goal, such as the four examples given earlier at the end of the “Quantitative Research” subsection. In clinical trials, a placebo treatment (no actual therapeutic content) is typically used to provide a baseline measurement that accounts for some of the nonspecific treatment effects, such as those mediated by the receiver’s perceptions.

Standard trials assume consistency in treatment application, which may be difficult to achieve in therapeutic massage because of practitioner variability. When the results of a therapy are likely produced by one or more nonspecific treatment effects, choosing the appropriate outcome measures may be difficult. The values or beliefs of the patient and how they relate to physical or physiologic outcomes may be more easily and fully captured using a mixed methods approach, because the two components being related are likely qualitative and quantitative data. Mixed methods research involves understanding and applying knowledge of quantitative and qualitative research components alike. The fact that therapeutic massage research currently shows few mixed methods examples does not mean that mixed methods lack value to the field of therapeutic massage research. Corresponding author: Antony Joseph Porcino, CAMEO Project, BC Cancer Agency, 912–750 West Broadway, Vancouver, British Columbia V5Z 1H1 Canada.
The authors are not aware of any conflicts of interest or potential conflicts of interest regarding the material in this manuscript.
Whether you are reading or designing a mixed methods research project, it is important to be familiar with both qualitative and quantitative research methods and the specific purposes for which they are brought together in a study: triangulation, complementarity, expansion, initiation, or development. This ability becomes critical when complex healing systems such as therapeutic massage are being studied.
We also explore why mixed methods may be particularly important within therapeutic massage research. The question can be focused on an idea, a process, or a theory about the origin or manifestation of a subject of interest. Quantitative analysis of the measurements usually involve statistics, and the study results are usually also communicated using statistics. There are many outcome questionnaires, all carefully developed and researched so that their strengths and weaknesses are known. Small-scale projects may use research designs such as case studies and case series, and also single-subject research designs and pilot projects, both of which use methods from larger studies, but apply them to only one person or a small group of people. The results are shared in written descriptions and summaries supported by examples taken from the data sources. While theoretically it can involve any combination of the above methods, the qualitative methods used are often more simple, like the description methods.
The next sub-sections will detail the purpose and structural design considerations of mixed methods research.
Qualitative interviews explored the individual (patient) and community effects of providing a massage therapy training program for Aboriginals in Hopevale, Australia. Practitioners with training in multiple therapies were interviewed, exploring the many influences of multiple training on daily practice.
Interviews were planned to gain an understanding of the effects and value of the program from participants. The five categories—triangulation, complementarity, expansion, development, and initiation—are common in today’s mixed methods literature.
He recognized sixteen different reasons for studies to be undertaken, but acknowledged that those categories simply provided a more nuanced understanding of the five categories outlined by Greene et al. Although the mismatching may partly reflect a lack of readily available mixed methods guidance at the time of the studies, it likely also reflects how a research project may become more complex than originally planned. Projects with development, complementarity, and triangulation purposes may begin integration at the data collection stage (such as from comments on questionnaires). For each study we have listed the sequencing, priority, and purpose in the first boxes of each table. The interviews documented that, in normal practice, treatment decisions are made throughout practice and draw on all the clinical skills, training, and experience that the practitioner has amassed. At the end, although both groups showed similar positive outcomes, the qualitative component indicated that “the groups differed on perceived experience of the intervention and its influence on therapeutic recovery” (p. Yet those effects were fully explained and understood to be positive experiences through the qualitative component.
Studies achieve this result by ensuring that the language in the questionnaire is both relevant to, and best understood by, the population being studied.
This article uses “mixed methods” for all degrees of integration of quantitative and qualitative methods within a single study.
Researchers using a pragmatic approach comfortably encompass the integration of qualitative and quantitative methodology and meaning, using them to mutually augment one another, moving beyond the issue of whether the theoretic paradigms are incommensurate.
For example, Menard was able both to assess the therapeutic reductions in severity of symptoms achieved by massage therapy treatment and to garner an understanding of the value of the treatment, beyond just symptom reduction, to the person.
Many of the foregoing goals, treatment routes, and physical and psychological responses are interrelated. Mixed methods may help both to chose outcomes and to capture a broad range of relevant outcomes in the physical and psychological realms alike. It is therefore more complex than using either of those approaches on their own, involving more work, increased resources and time, and complexity in design, implementation, and evaluation. As has been shown here, mixed methods have great value in the field of therapeutic massage research, and the potential of the approach should be considered more often. Inflammatory bowel disease patients’ decisions to use complementary therapies: links to existing models of care. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. Paradigms lost and pragmatism regained: methodological implications of combining qualitative and quantitative methods.

Evaluating a massage therapy training and treatment programme in a remote Aboriginal community.
Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Culture, ritual, and errors of repudiation: some implications for the assessment of alternative medical traditions.
Paradigms of health and disease: a framework for classifying and understanding complementary and alternative medicine.
The spectrum of therapeutic influences and integrative health care: classifying health care practices by mode of therapeutic action. Complementary and alternative medicine whole systems research: beyond identification of inadequacies of the RCT. In: Committee on the Use of Complementary and Alternative Medicine by the American Public, Board on Health Promotion and Disease Prevention.
In addition, decisions need to be made about the sequencing and the priority or importance of each qualitative and quantitative component relative to the other components, and the point or points at which the various qualitative and quantitative components will be integrated. Complex healing systems may have multiple physiologic effects, often reflected in changes throughout the patient’s body. Quantitative methods can be found in all forms of science in which measurement is involved. To expand the examples available, we have included as well the Brazier study and our own project, which is currently being written up for publication, We are introducing these examples of mixed methods research in therapeutic massage here. Comments written on the questionnaires provided qualitative detail about the context of the questionnaire answers. One questionnaire had open-ended questions in response to which participants could write descriptive answers.
Surprising results may encourage a change to a mixed methods design to help understand the results, as in the Brazier study. The title “Like a Burden Has Been Lifted” was drawn directly from that source and points to a significant quality-of-life factor that is often secondary to the cancer outcome focuses of radiation, surgery, and chemotherapy. Revealing and comprehending this broad framework shows the power of mixed methods research. Integrating the two at analysis and interpretation highlights some of the difficulties in assuming that a standardized treatment occurs during research, even with explicit treatment protocols. Qualitative studies may also be used to decide which issues are most important to address through a questionnaire sent to a larger population. An expanded perspective of this kind is important when researching CAM therapies such as therapeutic massage, because the foundational premises of health and illness underlying these therapies often do not reflect a purely biomedical perspective. Therefore, treatment focused on one goal or one tissue area will also likely have effects elsewhere.
The use of multiple methods to monitor a range of treatment inputs (from practitioner, patient, and environmental sources) and treatment results (biologic, mental, emotional, and spiritual) may help to capture or resolve important components of this practice research issue. In planning or reporting a mixed methods study, the purpose, sequence, priority, and point or points of integration should be clearly identified. By using the full gamut of research methods, researchers can achieve a greater understanding of the significance and reality of the practice of therapeutic massage. Develop questions within each of these major areas, shaping them to fit particularkinds of respondents. Biological measurements include levels of chemical markers that can be obtained from body fluids such as saliva, blood, or urine, from movement measurements such as range of motion, and from other measurements such as weight, density, temperature, or shape. We will return to them again for analysis of their design details and the studies’ results. A focus group to explore some results or issues was pending at the time of the poster presentation. In preplanned mixed methods projects, results from one component may change a planned research component or analysis.
Concurrent studies are more able to integrate at any point along the sequence; sequential studies begin integration when the results or interpretation from the first component are used to begin the next. The rewards of mixed methods research come from surmounting the limitations imposed by the use of a single research method and paradigm framework, thereby gleaning a broader and more insightful perspective that can be helpful in understanding complex phenomena. The lack of studies appears to suggest the use of mixed methods research for therapeutic massage is very limited, but likely simply represents a lack of familiarity with mixed methods research.
As we will point out, this approach may be the best for capturing the essence of therapeutic massage interventions. Take care to word questions so that respondents are motivated to answer ascompletely and honestly as possible.5. It doesnt have to pertaindirectly to what you are trying to find out (although it might), but this initialrapport-building will put you more at ease with one another and thus will make therest of the interview flow more smoothly.8. Difficult or potentially embarrassing questions should be asked toward the end ofthe interview, when rapport has been established.10.
The last question should provide some closure for the interview, and leave therespondent feeling empowered, listened to, or otherwise glad that they talked toyou.

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