Mixing Methodologies:

Can Bimodal Research be a Viable Post-Positivist Tool?

by Douglas S. Nau

The Qualitative Report, Volume 2, Number 3, December, 1995
(http://www.nova.edu/ssss/QR/QR2-3/nau.html)


Introduction

The field of systemic family therapy has often taken the view that qualitative research is a more appropriate research methodology for that field than is quantitative research. In fact, it is almost heretical in some institutions to suggest that quantitative research is a legitimate domain for understanding. It is this author's opinion that such a view severely limits the scope the field and may lead to a description of the subject or family which is monocular.

In a recent commentary, Fraenkel (1995) urges family therapy clinicians and researchers to consider using both "knowledge about patters of adjustment" (p. 113) as well as considering that "each family [i]s utterly unique" (p. 113). In the debate between nomothetic and ideographic ways of understanding commented that "virtually every field of intellectual endeavor has struggled with this tension between the general and the unique" (p. 116). This same tension exists in the debate between research modalities as well. He comments that "no matter how statistically powerful a nomothetic [read quantitative] finding, it can never definitively predict the experience and action of the individual person [qualitative research]." The research community has historically seen these two modes of research as historically opposite. Instead, he argues, why not use the strengths of both to gain a greater perspective on families. A research paradigm which utilized both qualitative and quantitative methodologies could be productive.

In good family therapy, general knowledge of how many families respond to frequently occurring situations and challenges...[can be] used as a backdrop with which to begin rather than conclude a clinical inquiry and treatment. (Fraenkel, 1995, p. 118)

Blending qualitative and quantitative methods of research can produce a final product which can highlight the significant contributions of both. The studies mentioned below combine both methodologies to produce contributions to the field of research. The first is a description of physician-patient conversations and the second looks at how traditional beliefs fade with each subsequent generation.

The Waitzkin and Britt Study

Waitzkin and Britt (1993) use data collected in an earlier long-term quantitative study (Waitzkin, 1984) to determine how physicians communicate about "self-destructive behaviors" with their patients. In this study, the authors used a method of qualitative inquiry which was somewhat of a hybrid of several accepted methodologies: literary criticism, critical theory, and narrative analysis. Their journey into the world of the doctor-patient encounter attempted to contextualize the conversations around what was happening in the lives of the two patients they used as case examples. Such dialogues helped the reader to understand why the attempts of physicians to curb those "behaviors" may have had little impact.

The authors began their inquiry from questions which arose from an earlier quantitative study (Waitzkin, 1984). That study identified certain assumptions that quantitative research placed the physician "as the central figure in the interview" (p. 1123). Therefore, the authors wanted to put back the sociocultural contexts of the physician-patient discourse to rediscover "the crucial ways that contextual issues pattern the meaning of words exchanged by patients and doctors" (p. 1123).

The rationale for the qualitative research method employed in their subsequent study was that a richer description was needed in order to understand the ways in which the physician's "speech genre" (Bakhtin, 1986) seemed to clash with the experiences of the patient in the context of his or her daily life. Such different ways of communicating, they theorized, might be at odds with each other. As it turned out, their transcripts of over 50 encounters proved just that.

The authors reviewed the works of Mishler (1984), Riessman (1990), Viney and Bousfield (1991) in social psychology, Kleinman (1988) in the field of cultural anthropology, Cicourel (1985) in the field of cognitive studies, and several from the field of medical humanities. They supported their research with the writings of Bakhtin (1986) in literary theory and Foucault's (1977) critiques of medicine and social control.

The authors' analysis of their data led them to conclude that there was an inherent "medically phrased moralism" (p. 1127) in the dialogue between patient and doctor. They found that physicians paid little attention to the contextual issues in a patient's life or the social context of their coming to see their physician. The authors found that attention to socially relevant details were "marginal in medical encounters" (p. 1134).

The original plan for this study was a quantitative one. The authors later realized the limitations of that methodology. The voices of the participants were never heard by anyone outside the research team. To correct this, they embarked on a subsequent effort to let their research participants speak and when they did, they discovered new information. The Waitzkin and Britt (1993) study offered the research community one example of how qualitative depth can be linked with quantitative breadth. The authors offered personal stories and transcripts of actual conversations between physicians and their patients which centered around health and health maintenance. The conclusions the authors drew suggested that physicians may benefit from letting their patients tell their own stories without placing a veneer over the encounter that is loaded with medicalese or technical terminology. By listening more attentively, physicians may be able to achieve greater "success" (p. 1135).

While the Waitzkin and Britt (1993) study was a more distinct two-step process, others have streamlined the process. One such two-step process which is more refined and integrated is a combined qualitative-quantitative study of an immigrant population. The following study demonstrates a method for research which illustrates how qualitative research and quantitative research can be joined together.

The Tripp-Reimer Study

Tripp-Reimer (1985) has suggested that an ethnomethodological research study can be enhanced by simultaneously combining qualitative and quantitative methodologies. In her ethnographic research study of the "evil eye" (Greek: matiasma) in Greek immigrants to the United States, she encouraged health care workers to become more culturally sensitive. Such sensitivity would, she argued, better equip practitioners to offer "holistic or comprehensive health care" (p. 191). The author convincingly argued for a combined research method using qualitative and quantitative techniques.

The author believes that Tripp-Reimer (1985) may offer another way of mixing methods by first using qualitative questions to inform the scope of the quantitative ones. Qualitative and quantitative methods used in conjunction "may provide complementary data sets which together give a more complete picture than can be obtained using either method singly" (p. 197). This author believes this reasoning to be sound because both methods provide a different lens through which to view data.

Tripp-Reimer (1985) suggested that both research methods have strengths which can be used effectively. Qualitative research methods often provide "rich descriptive and documentary information about a topic or a phenomenon" (p. 197). She believes that it is best to use qualitative research first to generate "important questions" (p. 197) to ask research participants. The author contended that qualitative research, when used first in what might be termed a bimodal process, could help to "facilitate serendipitous findings, raise unexpected questions, and identify topics the investigator might not have otherwise considered" (p. 197).

Quantitative research methods, on the other hand, are most appropriately used to "test hypotheses with the goal of predicting or explaining" (p. 180). Tripp-Reimer (1985) suggested that quantitative methods tend to be more number-driven when the researcher wished to know how often or how much of a phenomenon is present. These numbers usually are able to serve as a base for explaining or predicting what has occurred or what will occur in the future.

Tripp-Reimer (1985) used this methodology to study the Greek immigrant population of the Columbus, Ohio metropolitan area between 1976 and 1977. Her methods of data collection began with a questionnaire to the population identified by the Greek community. From this, she was able to select five individuals to participate in a pilot study. The author and her research team used semi-structured interviews and participant observation to "obtain descriptive data concerning the practice of matiasma" (p. 184). During these interviews, data was simultaneously collected and later analyzed using quantitative research methods and a computer-assisted analytical tool. The results of her research revealed that first generation Greek-Americans were 34% more likely to believe in the concept of the evil eye than were fourth generation Greek-Americans. Tripp-Reimer (1985) believed that such a combined research method was able to allow her to see in ways she may not have been able to see with either qualitative or quantitative research method alone.

Tripp-Reimer (1985) wrote that such bimodal research permitted a "full understanding of the situation" (p. 192). Such a statement is difficult to prove and reflected a positivist viewpoint. Such a perspective could severely limit any postmodern study because it posits that objective reality can be known.

Is Bimodal Research Viable?

Denzin and Lincoln (1994) write that "objective reality can never be captured" (p. 2). To assume that even with binocular vision one can "have" all the information, or even "know" what is true is a dangerous positivistic position. The rub between the two methodologies comes when we analyze the assumptions behind each one. These are clearly spelled out in detail by Denzin and Lincoln (1994, pp. 4-6) and can be summarized as follows. The differences between quantitative and qualitative research is that the first is positivist, limiting, unable to capture the subjects' perspective, abstract, and based on flat descriptions. Qualitative research, the critics claim, tends to be unscientific and based on slipshod methodologies. It's proponents claim that it offers a postmodern and post-positivist view more in keeping with prevailing social attitudes. They also claim that such a research method is able to capture the voices of many and provide what Geertz (1973) called a "thick description" of everyday life.

Can the Marriage be Saved?

There is ongoing contention surrounding whether or not the two research methods mentioned above are suitable partners given their broad theoretical discrepancies. Such a position which proposes a "marriage" between them is, no doubt, a post-positivist one. However, the field of family therapy itself encourages multiple perspectives and different ways of knowing. Perhaps one solution out of the potential gridlock might be to approach the union of potentially conflicting methods from a therapeutic stance. This is what Steinglass (1995), using a similar metaphor, calls "the wedding of family therapy and family research methods" (p. 126).

Fraenkel (1995) urges that "the tension between nomothetic and ideographic approaches should come to have more the form and flavor of a healthy dialectic, rather than that of an acrimonious debate" (p. 120). In fact, Sells, Smith, and Sprenkle (1995) have argued convincingly for what they termed a multi-method, bidirectional research model. They suggest that ethnographic content analysis, for example, "lends itself to both qualitative and quantitative research goals and combines what are usually considered antithetical modes of analysis" (p. 202). Adding yet another twist to this discussion, Janet Beavin Bavelas (1995) suggests that we should challenge this dichotomy way of viewing the two approaches, and instead, replace it with a continuum way of discussing and using qualitative and quantitative research methods.

What these recent evocations suggest is that there are many questions to be pondered regarding the two approaches to inquiry. Can qualitative research be viewed with a quantitative lens? Can quantitative research be viewed with a qualitative lens? If common ground can be found on which to build a new relationship, perhaps differences which separate the two can be strategically minimized. "Qualitative and quantitative methods build upon each other and offer information that neither one alone could provide" (Sells, Smith, & Sprenkle, 1995, p. 203). Just as two members of a family might be encouraged to see the world through the eyes of the other, perhaps research purists can be encouraged to see how listening to another voice may serve to broaden our understanding of ourselves in a way heretofore obscured.

References

Bavelas, J. B. (1995). Quantitative versus qualitative? In W. Leeds-Hurwitz (Ed.), Social approaches to communication (pp. 49-62). New York: Guilford Press.

Bakhtin, M. M. (1986). Speech genres and other late essays. Austin: University of Austin Press.

Cicourel, A. (1985). Text and discourse. Annual Review of Anthropology, 14, 159-185.

Denzin, N. K., & Lincoln, Y. S. (1994). Introduction: Entering the field of qualitative research. In N. K. Denzin and Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 1-17). Thousand Oaks, CA: Sage.

Foucault, M. (1977). Discipline and punish. New York: Pantheon.

Fraenkel, P. (1995). Commentary: The nomothetic-ideographic debate in family therapy. Family Process, 34(2), 113-121.

Geertz, C. (1973). The interpretation of cultures. New York: Basic Books.

Kleinman, A. (1988). The illness narratives. New York: Basic Books.

Mishler, E. G. (1984). The discourse of medicine: The dialectics of medical interviews. Norwood, NJ: Ablex.

Riessman, C. K. (1990). Strategic uses of narrative in the presentation of self and illness. Social Science & Medicine, 30, 1195-1200.

Sells, S. P., Smith, T. E., & Sprenkle, D. H. (1995). Integrating qualitative and quantitative research methods: A research model. Family Process, 34(2), 199-218.

Steinglass, P. (1995). Editorial: The clinical power of research. Family Process, 34(2), 125-126.

Tripp-Reimer, T. (1985). Combining qualitative and quantitative methodologies. In M. M. Leininger (Ed.), Qualitative research methods in nursing (pp. 179-194). Orlando, FL: Grune & Stratton.

Viney, L. L., & Bousfield, L. (1991). Narrative analysis: A method of psychosocial research for AIDS-affected people. Social Science Medicine, 32, 757-765.

Waitzkin, H., & Britt, T. (1993). Processing narratives of self-destructive behavior in routine medical encounters: Health promotion, disease prevention, and the discourse of health care. Social Science Medicine, 36(9), 1121-1136.


Douglas S. Nau is a third-year doctoral candidate in the School of Social and Systemic Studies' Department of Family Therapy at Nova Southeastern University, Fort Lauderdale, Florida 33314, USA. His e-mail address is nautilus@ssss.nova.edu.
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