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Journal of Research in Nursing

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An overview of mixed methods research


Louise Doyle, Anne-Marie Brady and Gobnait Byrne
Journal of Research in Nursing 2009; 14; 175
DOI: 10.1177/1744987108093962
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ORIGINAL PAPER

An overview of mixed methods


research
Louise Doyle
Lecturer
School of Nursing & Midwifery Studies, Trinity College Dublin,
24 DOlier St, Dublin 2, Ireland

Journal of Research
in Nursing
2009
SAGE PUBLICATIONS
Los Angeles, London,
New Delhi and Singapore
VOL 14 (2) 175185
DOI: 10.1177/
1744987108093962

Anne-Marie Brady
Lecturer
School of Nursing & Midwifery Studies, Trinity College Dublin,
24 DOlier St, Dublin 2, Ireland

Gobnait Byrne
Lecturer
School of Nursing & Midwifery Studies, Trinity College Dublin,
24 DOlier St, Dublin 2, Ireland

Abstract Mixed methods research is viewed as the third methodological


movement and as an approach it has much to offer health and social science research.
Its emergence was in response to the limitations of the sole use of quantitative or
qualitative methods and is now considered by many a legitimate alternative to these
two traditions. Purists view of the dichotomy between positivist and non-positivist
philosophies is prevalent; however, mixed methods afford researchers an opportunity
to overcome this false dichotomy. The philosophical underpinning of pragmatism
allows and guides mixed methods researchers to use a variety of approaches to
answer research questions that cannot be addressed using a singular method. In
particular, healthcare researchers may benefit from the opportunity to use such a
dynamic approach to address the complex and multi-faceted research problems often
encountered in the health care sector.
Key words mixed methods; paradigm; pragmatism; qualitative research;
quantitative research; typology of mixed methods

Introduction
Mixed methods research is emerging as a dominant paradigm in health care research
in recent years with an increase in health care researchers using this method.
A review of research commissioned by the Health Research and Development
Programme in the United Kingdom showed that 17% (n = 22) of the studies
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commissioned before 1995 were mixed methods in comparison to 30% (n = 33)
funded between 2000 and 2004 (OCathain, et al., 2007). It is clear therefore that
health service researchers are increasingly identifying the benefits of using a mixed
methods design in their research studies. As this is a relatively new area, debate and
confusion persist as to what exactly constitutes mixed methods research and what
are the benefits to researchers and funders in health care. This paper defines mixed
methods research and charts the emergence of mixed methods research as a result of
the paradigm wars. The proposed benefits of utilising such a research approach are
identified, and the criticisms of mixed methods research are outlined. Two recent
classification systems developed by Creswell and Plano Clark (2007) and Leech and
Onwuebuzie (2007) are also outlined.

Definition of mixed methods design

Mixed methods may be defined as research in which the investigator collects and
analyses data, integrates the findings and draws inferences using both qualitative
and quantitative approaches or methods in a single study (Tashakkori and Creswell,
2007:4). Research is not restricted by the use of traditional approaches to data collection but is guided by a foundation of enquiry that underlies the research activity
(Creswell, 1994). A mixed methods study is one that includes a qualitative and
quantitative dimension, but difficulties often arise when the researcher attempts to
articulate how the two elements relate to one another (Tashakkori and Creswell,
2007). There is an inconsistency among researchers about what constitutes mixed
methods research (Sandelowski, 2001; Bryman, 2007; Tashakkori and Creswell,
2007). Some interpretations view mixed methods as the collection and analysis of
quantitative and qualitative data. More contemporary writings in this area had sought
to develop an understanding of the importance of complete integration of the two
approaches (Hanson, et al., 2005; Bryman, 2007; Creswell and Plano Clark, 2007).
Tashakkori and Creswell (2007) argue that as mixed methods research is still evolving, the discussion of what it actually is should be kept open. Similarly, Johnson, et al.
(2007) suggest that the definition of mixed methods research will change over time
as this research approach continues to grow.

Paradigm debate and mixed methods research


Researchers are urged to locate their research in a selected paradigm. Morgan (2007:
47) defines a paradigm as the set of beliefs and practices that guide a field, and it
can be used to summarise the beliefs of researchers. The world view, theoretical lens
and paradigm are all terms used interchangeably in the literature. Paradigm is a world
view that is defined by distinct elements including epistemology (how we know
what we know), ontology (nature of reality), axiology (values) and methodology
(the process of research) (Hanson, et al., 2005). In other words, paradigm differences
influence how we know, our interpretation of reality and our values and methodology in research. Paradigm will influence the questions that researchers will pose and
the methods they employ to answer them (Morgan, 2007). The world view of the
researcher is greatly influenced by the positivist (quantitative) paradigm or naturalistic or constructivist (qualitative) tradition to which they align themselves. Traditionalists would argue that these paradigms are different and a combination of the two
is not possible (Sandelowski, 2001). There is an assumption that the research
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Doyle et al. Mixed methods research


paradigms are not compatible because it is not possible to combine the ontological
and epistemological stances of both traditions (Guba and Lincoln, 1988).
Traditionally, researchers have made a forced choice between the positivist scientific model of research associated with quantitative methods and the interpretative
model associated with qualitative ones (Howe, 1985). Historically, the approach in
health care research was nearly exclusively of the quantitative or positivist tradition
which was predicated on the necessity for the researcher to be objective and unbiased, and for many, it is considered to be the gold standard. Positivism contends
that there is a single reality and therefore seeks to identify causal relationships
through objective measurement and quantitative analysis (Firestone, 1987). In the
positivist paradigm, the researcher is considered independent and objective using
larger samples to test carefully constructed hypothesis. The prevailing wisdom is
that the researcher in the positivist tradition can put aside values to avoid bias in a
process of inquiry.
Constructivism or qualitative research emerged as an alternative to the positivist
form of inquiry as researchers sought to examine the context of human experience
(Schwandt, 2000). The qualitative paradigm is receiving greater attention in recent
years and is sometimes described as the naturalistic inquiry, post-positive, constructivist or interpretative approaches (Creswell, 1994). Constructivism proposes that
there are multiple realities and different interpretations may result from any research
endeavour (Appleton and King, 2002). Those interpretations are shaped by particular
circumstances that exist as a study unfolds. Researchers who work within the
constructivist paradigm seek to illuminate the reality of others through the process
of detailed descriptions of their experiences (Appleton and King, 2002). In the
interpretative paradigm, the researcher is subjective with the focus directed at deeper
understanding of what is happening with a smaller sample.
The positivist viewpoint is that the research outcomes are not biased by the values
of the detached positivist researcher unlike in the constructivist paradigm where the
researcher is immersed in the research (Firestone, 1987). The assumption is that
logical positivism is objective, whereas the naturalistic inquiry is subjective. Howe
(1985) argues strongly that no research endeavour is free from value judgments
and an attempt to bracket values (p. 12) only produces more insidious bias. The
detached researcher in the positivist inquiry results in the production of detached
evidence and will not succeed in capturing the true context of health service work
(Stevenson, 2005). One of the key ways that qualitative and quantitative research
may be differentiated is the distinction between induction and deduction (Morgan,
2007). The simplistic view of quantitative research is that it is an objective process
of deduction whereas the qualitative process is subjective and a process of induction
that can only be viewed in context (Morgan, 2007).
The field of mixed methods and language used to describe it is relatively new.
Considerable debate exists in the literature around the issues of compatibility in combining qualitative and quantitative methods (Howe, 1985; Smith and Heshusius, 1986;
Yanchar and Williams, 2006; Bryman, 2007; Morgan, 2007). Quantitative versus
qualitative debates have resulted in an illusion that the two approaches are mutually
exclusive (Sandelowski, 2001). The practice disciplines are sometimes overly concerned
with methodological acrobatics (Sandelowski, 2001: 335). Some researchers believe
that competition between paradigms is not helpful, and focus on ways in which traditional rivalries may be usefully combined (Sale, et al., 2002; Stevenson, 2005). It is proposed that mixed methods may be the third paradigm, capable of bridging the gap
between the quantitative and qualitative positions (Johnson and Onwuegbuzie, 2004).
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Mixed methods research is guided by philosophical assumptions that enable the
mixing of qualitative and qualitative approaches throughout the research process
(Hanson, et al., 2005). The philosophy of pragmatism advanced the notion that the
consequences are more important than the process and therefore that the end justifies the means. It advocates eclecticism and a needs-based or contingency approach
to research method and concept selection (Johnson and Onwuegbuzie, 2004: 17),
so that researchers are free to determine what works to answer the research questions.
The pragmatic approach to research is informed by the belief that the practicalities of
research are such that it can not be driven by theory or data exclusively and a process
of abduction is recommended which enables one to move back and forth between
induction and deduction through a process of inquiry (Morgan, 2007).
Johnson and Onwuegbuzie (2004) share their aspirations that the field of mixed
methods research will move beyond quantitative versus qualitative arguments and
will instead focus on recognising the usefulness of both paradigms and identifying
how these approaches can be used together in a single study to maximise the
strengths and minimise the weaknesses of each other. They further contend that taking a non-purist position allows researchers to design research studies that combine
methods that will offer the best chance of answering their specific research questions.
Maxcy (2003: 86) suggests that pragmatic researchers unique contribution is to
open up inquiry to all possibilities while tying that search to practical ends. Morgan
(2007: 48) supports this and views a pragmatic approach as a new guiding paradigm
that can act as a basis for supporting work that combines qualitative and quantitative
methods and as a way to redirect our attention to methodological rather than metaphysical concerns.

The rationale for mixed methods research


Many reasons have been identified for conducting a mixed methods research study.
Following a review of theoretical and empirical literature, Greene, et al. (1989) identified five purposes for conducting mixed methods research designs. These are triangulation, complementarity, development, initiation and expansion. Bryman (2006)
in a later review of 232 social science mixed methods papers identified 16 reasons
for conducting mixed methods studies. Many of the rationales identified in Brymans
(2006) analysis are similar to those identified by Greene, et al. (1989) although
somewhat more detailed in manner. The main rationales or benefits proposed for
undertaking a mixed methods study are as follows:
Triangulation: this allows for greater validity in a study by seeking corroboration
between quantitative and qualitative data.
Completeness: using a combination of research approaches provides a more complete
and comprehensive picture of the study phenomenon.
Offsetting weaknesses and providing stronger inferences: many authors argue that utilising a
mixed methods approach can allow for the limitations of each approach to be neutralised while strengths are built upon thereby providing stronger and more accurate
inferences (Bryman, 2006; Creswell, et al., 2003).
Answering different research questions: Creswell and Plano Clark (2007) argue that mixed
methods research helps answer the research questions that cannot be answered by
quantitative or qualitative methods alone and provides a greater repertoire of tools
to meet the aims and objectives of a study. Furthermore, Sale, et al. (2002) identify
how a combination of research approaches is useful in areas such as nursing because
of the complex nature of phenomena and the range of perspectives that are required.
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Explanation of findings: mixed methods studies can use one research approach (i.e.,
quantitative or qualitative) to explain the data generated from a study using the other
research approaches. This is particularly useful when unanticipated or unusual findings emerge. For example, findings from a quantitative survey can be followed up
and explained by conducting interviews with a sample of those surveyed to gain an
understanding of the findings obtained.
Illustration of data: using a qualitative research approach to illustrate quantitative findings can help paint a better picture of the phenomenon under investigation. Bryman
(2006) suggests that this is akin to putting meat on the bones of dry quantitative
data.
Hypotheses development and testing: a qualitative phase of a study may be undertaken to
develop hypotheses to be tested in a follow-up quantitative phase.
Instrument development and testing: a qualitative study may generate items for inclusion
in a questionnaire to be used in a quantitative phase of a study.
These points identify the usefulness that a mixed methods research approach can
have in answering a particular research question(s). However, it has been noted that
mixed methods research may have more practical benefits in terms of attracting
research funding (Giddings, 2006). Increasingly, agencies funding large research
projects are showing an interest in interdisciplinary research which involves collaboration between various disciplines in a certain field. This is particularly so in health
sciences where collaboration on large research projects between nursing, medical and
paramedical professionals is increasingly promoted and encouraged. Different disciplines bring with them different research histories with medicine more traditionally
associated with positivist or quantitative paradigms and methods and nursing more
associated with more interpretivist or qualitative ones. Therefore, the utilisation of a
mixed methods research approach can help meet the requirements of funding agencies that look for interdisciplinary research using a variety of methods.

Typology of mixed methods


In an attempt to clearly identify the types of mixed methods research, many authors
have developed typologies or classification systems of mixed methods designs
(Greene and Caracelli, 1997; Creswell, et al., 2003; Teddlie and Tashakkorri, 2006;
Creswell and Plano Clark, 2007; Tashakkori and Creswell, 2007; Leech and Onwuegbuzie, 2007). Tashakkori and Teddlie (2003: 680) state that the determination of
a typology is among the most complex and controversial issues in mixed
methodology. The main advantages of having a typology of mixed methods include
the conveying rigor regarding the methodology, providing guidance and assisting in
the development of language for mixed methods research (Bryman, 2006; Teddlie
and Tashakkorri, 2006). In this paper, two recent classification systems developed
by Creswell and Plano Clark (2007) and Leech and Onwuegbuzie (2007) will be
outlined.
The first question when deciding on methodology is to ascertain which approach
will best suit the research question. This is a fundamental issue that all researchers
need to address, and Creswell and Plano Clark (2007) have stressed the importance
of justifying the selection of a mixed methods approach to conduct research. The
main rationale for choosing a mixed methods design has been previously outlined
in this paper, however, there are a number of methodological issues that a researcher
must consider before undertaking a mixed methods study. Creswell and Plano Clarke
(2007) suggest that there are three major decisions to make before selecting a
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particular type of mixed methods design, and Figure 1 outlines a decision tree that
identifies the main issues that need to be considered.
The first decision to be made is regarding conducting the qualitative and quantitative stages concurrently or sequentially. Deciding whether both the methods are
given equal priority is another key decision. The third issue is to ascertain where
the mixing of the qualitative and quantitative methods will occur. OCathain, et al.
(2007) reporting on a review of mixed methods studies identified that two-thirds
were sequential, the majority gave priority to the quantitative methodology and integration occurred largely at the interpretation stage (81%, n = 39) in comparison to
the analysis phase (17%, n = 8).
Creswell and Plano Clark (2007) have developed a typology of mixed methods
designs, which they describe as being functional and parsimonious, and which identifies four main types of mixed methods research (Figure 2).
The triangulation design is the most common and well-known design, and this
was previously known as the concurrent triangulation design (Creswell, et al.,
2003). The quantitative and qualitative phases occur at the same time, and both the
methods are usually given equal weighting. The traditional model of triangulation
mixed methods design is the convergence model where integration occurs during
the interpretation phase. Within the data transformation model, the quantitative and
qualitative data are collected concurrently, and after the initial analysis, the data are
transformed either by quantifying qualitative data or by qualifying quantitative
results. Creswell and Plano Clark (2007) describe the use of open-ended qualitative
questions on a survey instrument as a validated quantitative data triangulation mixed
methods design. The multi-level research model variation of the triangulation design
is used when the focus of the study is on a system and different methods are used to
address the different levels. For example, qualitative methodology may be used to
ascertain the views of nurse managers on a particular issue, and this is compared
with a survey of staff nurses views. Triangulation is viewed as the most challenging

Figure 1 Decision tree for mixed methods design (Creswell, et al., 2003; Creswell and
Plano Clark, 2007).

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Doyle et al. Mixed methods research

Figure 2 Creswell and Plano Clark (2007) typology of mixed methods research.

design of the four main research designs, and research teams are often used to implement this form of research design.
The embedded design, first described by Caracelli and Greene (1997), is characterised by having one dominant method, whereas the other data set provides a secondary or supportive role. The embedded experimental model is the most common
variant of the embedded design, and the priority is given to the quantitative methodology, and the qualitative data set is subservient (Creswell and Plano Clark, 2007).
One of the purposes of the qualitative component may be to examine the process of
the intervention. The embedded experimental model has been previously known as
the concurrent nested mixed methods design (Creswell, et al., 2003). The last
variation of the embedded design is the correlational model where the qualitative
data are embedded within a quantitative design to help explain the outcomes of the
correlation model. Within the embedded designs, the methods may be conducted
concurrently or sequentially.
The explanatory design previously described by Creswell, et al., (2003) as sequential explanatory design consists of two phases, beginning with the quantitative phase
and then the qualitative phase, which aims to explain or enhance the quantitative
results. Figure 2 outlines the two variants of the explanatory designthe follow-up
explanatory model and the participant selection model. Within the follow-up explanatory model, the researcher identifies specific quantitative findings, such as unexpected results, outliers or differences between groups that need further exploration
using qualitative methodology. In contrast, the qualitative phase has priority in the
participant selection model, and the purpose of the quantitative phase is to identify
and purposefully select participants. The explanatory design requires a longer implementation time due to the sequential nature but is regarded as the easiest of the four
methods to implement.
The exploratory design is a sequential design where the first phase, qualitative,
helps in the development of the quantitative phase. Creswell, et al. (2003) described
this design as sequential exploratory design. This design (see Figure 2) is used
for developing and testing instruments (Instrument Development Model) or for
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Figure 3 Leech and Onwuegbuzie (2007) typology of mixed methods design.

developing a taxonomy (Taxonomy Developmental Model). Priority is given to the


quantitative entity in the instrument development model.
Leech and Onwuegbuzie (2007) use three criteria to develop their three
dimensional typology of mixed methods design, and these include the level of
mixing, time orientation and emphasis of approaches. Partially mixed studies are
described as those studies where both the qualitative and quantitative phases are
conducted independently before mixing occurs at the data interpretation stage. In
contrast, fully mixed methods designs have mixing occurring in either one or all of
the following: the research objective(s), the types of data, analysis and inference.
Figure 3 outlines the Leech and Onwuegbuzie (2007) typology of mixed methods
design. The first layer differentiates the studies into either partially or fully mixed
designs, the second decides on the timing of the different phases of data collection,
and finally whether each methodology is given equal status within the chosen design.
This classification system results in six mixed methods designs (see Table 1).
This classification system is simple and easy to understand and avoids the use of
the word triangulation. The term triangulation is one to which many meanings are
attributed, and Sandelowski (2003) argues that it has been used so much that it has
no meaning at all. The major limitation to this classification system is the division of

Table 1 List of Leech and Onwuegbuzie (2007) mixed methods designs


1)
2)
3)
4)
5)
6)

Partially mixed concurrent equal status design


Partially mixed concurrent dominant status design
Partially mixed sequential equal status design
Partially mixed sequential dominant status design
Fully mixed concurrent equal status design
Fully mixed concurrent dominant status design

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mixed methods into partially mixed and fully mixed studies. Leech and Onwuegbuzie
(2007:3) describe partially mixed designs as occupying regions somewhere between
monomethod designs and fully mixed methods designs. The authors would suggest
that the use of phrases such as partially mixed and fully mixed may be avoided and
that the phrase integration at the interpretation phase only may be substituted for
partially mixed research designs.
As identified, choosing the most appropriate design for a mixed methods study
depends on a number of factors including deciding which approach is best suited to
answering a particular research question and the overall rationale for using a mixed
methods approach. The typologies identified in this paper offer a system of classification of mixed methods research designs, which allow researchers to choose a design
most appropriate to meet the aim and objectives of their research.

The limitations of mixed methods research


Although it is clear that a mixed methods approach has much to offer a researcher,
there have been criticisms of its use. Many of these criticisms focus on the incompatibility thesis, that is, the belief that quantitative and qualitative research methods
cannot be mixed in a single study as they have such different ontological and epistemological origins. Methodological purists believe strongly in the dichotomy of world
views and research methods (Creswell and Plano Clark, 2007) and therefore argue
against the combination of quantitative and qualitative approaches. Guba (1987: 31)
had clearly identified the extent of the dichotomy between the paradigms by stating
how the one precludes the other just as surely belief in a round world precludes
belief in a flat one. Consequently, Sale, et al. (2002) caution against the uncritical
acceptance of mixed methods research by a new generation of researchers who have
overlooked the underlying assumptions and incommensurate differences between the
two paradigms. However, Onwuegbuzie (2002) argues that the purists view of the
dichotomies between positivist and post-positivist philosophies are in fact false
dichotomies. Rather, Onwuegbuzie (2002) suggests that positivist and nonpositivist philosophies lie on an epistemological continuum with mixed methods
research occupying the middle ground. Similarly, Howe (1988) argues against the
incompatibility thesis and instead suggests that researchers should adopt a pragmatic
approach and forge ahead with what works.
Mertens (2003) who herself is an avid believer in mixed methods research poses
some questions about the pragmatist philosophy upon which most mixed methods
research is based. She argues that basing methodological choices solely on pragmatics
or what works is inadequate as it does not answer the question practical for whom
and to what end? However, many authors would suggest that the practicality inherent in pragmatism is concerned with finding the most appropriate method to answer
a research question or set of research questions. Tashakkori and Teddie (2003) argue
that researchers within the pragmatist tradition abide by what they term the dictatorship of the research question, meaning they consider the research question to be
more important than either the method or the paradigm that underlies it.
Other criticisms or weaknesses of a mixed methods approach are more practical in
nature. Johnson and Onwuegbuzie (2004) suggest that it may be difficult for one
researcher to carry out a mixed methods study if the qualitative and quantitative
phases are to be undertaken concurrently. In this case, a research team may be
required. Ivankova, et al. (2006) identify that sequential studies also have drawbacks
as it may take considerable time and resources to undertake distinct phases of a study.
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Within a mixed methods study, there is also a requirement that the researcher has at
least a sufficient knowledge of both quantitative and qualitative methods independently and how to mix these methods appropriately to achieve good study outcomes.
As highlighted, there are drawbacks to using a mixed methods research approach.
Therefore, it is essential that mixed methods researchers can anticipate the questions
or criticisms of their chosen approach to design appropriate studies and defend these
studies when required.

Conclusion
Mixed methods research is now viewed as the third methodological movement and as
an approach that has much to offer health and social science researchs. The purpose
of mixing approaches is to afford opportunity to gain a more complete understanding
of research problems (Creswell and Plano Clark, 2007). Researchers anticipate that
mixing methods will enable them to capture the complexity of human phenomena
(Sandelowski, 2001). Mixed methods research responds to the interests and needs
of diverse stakeholders in research. This is clearly identified by Greene (2005: 209)
who suggests that a mixed method approach offers greater possibilities than a single
method approach for responding to decision makers agenda, as well as to the interests of other legitimate stakeholders. In health care, the selection of mixed methods
as a methodology seeks to provide hard data for the decision makers who seek to
determine health care policy. Mixed method research responds to the pressures for
outcomes in healthcare, but it can also report on the context of those outcomes. Creswell and Plano Clark (2007) have identified that within the nursing discipline, mixed
methods research has been discussed and used extensively. Similarly, Twinn (2003:
553) suggests that there is growing acceptance that the design provides an appropriate methodology to address the complex health problems frequently faced by the
nursing discipline. By building on the strengths, acknowledging and limiting the
weaknesses of mixed methods research, nurse researchers can address these complex
health problems in a creative and imaginative way.
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Louise Doyle (RPN, BNS, RNT, MSc) is a lecturer in mental health nursing at the
School of Nursing and Midwifery Studies, Trinity College Dublin. She is currently
undertaking a mixed methods PhD study of adolescent help-seeking for suicidal
behaviour.
Email: Louise.doyle@tcd.ie
Anne-Marie Brady (RGN, BSN, MSN, PG Dip Clinical Health Sciences Education,
RNT) is a lecturer and Research Fellow at the School of Nursing and Midwifery Studies, Trinity College Dublin. She is undertaking a PhD study exploring transition
experiences and intent to stay of degree graduate nurses, using a mixed methods
approach.
Email: Anne-marie.brady@tcd.ie
Gobnait Byrne (RGN, RNT, BNS, MPH, PG Dip Statistics) is a lecturer in general
nursing at the School of Nursing and Midwifery Studies, Trinity College Dublin. She
is currently undertaking a PhD study of migrant health in Ireland using mixed
methods.
Email: Gobnait.byrne@tcd.ie

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