1. Challenges of Using a Mixed Methods Design to
Study a Complex Health Intervention
in Burkina Faso
Authors: Anne-Marie Turcotte-Tremblay,
Manuela De Allegri, Valéry Ridde
November 16, 2016

2. PLAN
1. Research topic
2. Mixed methods design
3. Challenges encountered
4. Strategies to counteract these challenges

3. RESEARCH TOPIC
• Intervention: Performance-based financing in
Burkina Faso
• Gap: Potential unintended consequences but little
empirical research.
• Objective: to increase the scientific knowledge on
unintended consequences of intervention
Ridde, Turcotte-Tremblay et al., 2014

4. SEQUENTIAL EXPLORATORY
MIXED METHODS DESIGN
Creswell & Plano Clark, 2007
QUAL quan
• Explore in depth
• Multiple case study in 6
facilities using observation,
interviews & discussions
• Test hypotheses to
confirm & generalize
• Interrupted time series
using routine data

5. CHALLENGE 1
BECOMING A "JACK OF ALL TRADES"
• Defending both QUAN and QUAL approaches at the
SAME TIME in front of a doctoral committee
• Differences: worldviews, methodology
(inductive vs deductive ), techniques for
data collection & analyses, criteria for rigor,
softwares, language, etc

6. CHALLENGE 2
NAVIGATING IN UNCERTAINTY
• Sequential design: QUAL informs QUAN
– Grey areas in protocol but tentative hypotheses &
analyses with routine data
• QUAL phase led to unexpected hypotheses for which
QUAN data are not readily available
– Develop a QUAN survey but limited time
– Match hypotheses with the data available

7. CHALLENGE 3
MANAGING TIME & RESOURCES
• Doctoral students have limited time
• Reach a compromise b/w QUAL & QUAN phases
Anthropological approach but difficult to do 1
year of field work and then launch a new
quantitative phase

8. ANTICIPATED CHALLENGES
• Conflicting results between QUAL & QUAN
may raise more question than it answers
• Presentation of QUAL & QUAN phases in a
6 000 word article or 10 min presentation

9. POTENTIAL STRATEGIES
1. Don’t hesitate to collaborate with other
experts (bio statistician, etc)
2. Gain experience in both of these approaches
before undertaking a mixed methods study
3. Get supervisors with experience using MMR
4. Training opportunities in MMR (e.g., McGill
University, University of Heidelberg )

10. Conclusion
• Numerous challenges that can be overcome!
• Useful to develop
– into a well rounded researcher with complementary
skills
– scientific knowledge on the unintended
consequences of a complex intervention in global
health

11. Bibliography
• Creswell, J. W., & Plano Clark, V. L. (2007). Designing
and Conducting Mixed Methods Research (SAGE).
Thousand Oaks, California.
• Ridde, V., Turcotte-Tremblay, A.-M., Souares, A.,
Lohmann, J., Zombré, D., Koulidiati, J. L., … Allegri, M.
D. (2014). Protocol for the Process Evaluation of
Interventions Combining Performance-Based Financing
with Health Equity in Burkina Faso. Implementation
Science, 9(1), 149.
• Tariq, S., & Woodman, J. (2013). Using mixed methods
in health research. JRSM Short Reports, 4(6).