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Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation

Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation
Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation
Background: Mixed methods are commonly used in health services research however data are not often integrated to explore complementarity of findings. A triangulation protocol is one approach to integrating such data. A retrospective triangulation protocol was carried out on mixed methods data collected as part of a process evaluation of a trial. The multi-country randomised controlled trial found that a web-based training in communication skills (including use of a patient booklet) and the use of a C-reactive protein (CRP) point of care test decreased antibiotic prescribing by general practitioners (GPs) for acute cough. The process evaluation investigated GPs’ and patients’ experiences of taking part in the trial.

Methods: Three analysts independently compared findings across four data sets: qualitative data collected view semi-structured interviews with 1) 62 patients and 2) 66 GPs and quantitative data collected via questionnaires with 3) 2886 patients and 4) 346 GPs. Pairwise comparisons were made between data sets and were categorised as agreement, partial agreement, dissonance or silence.

Results: Three instances of dissonance occurred in thirty-nine independent findings. GPs and patients reported different views on the use of a CRP test. GPs felt the test was useful in convincing patients to accept a no-antibiotic decision, but patient data suggested this was unnecessary if a full explanation was given. While qualitative data indicated all patients were generally satisfied with their consultation, quantitative data indicated highest levels of satisfaction for those receiving a detailed explanation from their GP with a booklet giving advice on self-care. Both qualitative and quantitative data sets indicated higher patient enablement for those in the communication groups who had received a booklet.

Conclusions: Use of CRP tests does not appear to engage patients or influence illness perceptions and its effect is more centred on changing clinician behaviour. Communication skills and the patient booklet were relevant and useful for all patients and associated with increased patient satisfaction. A triangulation protocol to integrate qualitative and quantitative data can reveal findings that need further interpretation and also highlight areas of dissonance that lead to a deeper insight than separate analyses.
1-26
Tonkin-Crine, S.
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Anthierens, S.
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Hood, K.
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Yardley, L.
64be42c4-511d-484d-abaa-f8813452a22e
Cals, J.
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Francis, N.
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Coenen, S.
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van der Velden, A.
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Godycki-Cwirko, M.
49c96dba-8729-4f32-8ee9-fb43f1285b8f
Llor, C.
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Butler, C.
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Verheij, T.
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Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Tonkin-Crine, S.
65679835-9bdc-48b6-92f3-cc6322cccc4f
Anthierens, S.
f237b5ac-203d-4ae0-b02c-a696e357614b
Hood, K.
12e14eb3-2c75-409f-a69d-add733644d89
Yardley, L.
64be42c4-511d-484d-abaa-f8813452a22e
Cals, J.
c269ba90-56e3-48f2-98a2-ea7e05ccef31
Francis, N.
7e3c0c61-da54-491a-bca9-bc9ddc4f9f12
Coenen, S.
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van der Velden, A.
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Godycki-Cwirko, M.
49c96dba-8729-4f32-8ee9-fb43f1285b8f
Llor, C.
823fedef-4996-4d45-837b-d448368b6163
Butler, C.
7fb510dd-3e7b-4a9a-809c-5c1549b1e7f1
Verheij, T.
cc355b92-ba85-4102-98a0-cee55f0504f6
Goossens, H.
533640f7-b568-4d95-a7c1-28158d154ba8
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777

Tonkin-Crine, S., Anthierens, S., Hood, K., Yardley, L., Cals, J., Francis, N., Coenen, S., van der Velden, A., Godycki-Cwirko, M., Llor, C., Butler, C., Verheij, T., Goossens, H. and Little, P. (2016) Discrepancies between qualitative and quantitative evaluation of randomised controlled trial results: achieving clarity through mixed methods triangulation. Implementation Science, 11, 1-26. (doi:10.1186/s13012-016-0436-0).

Record type: Article

Abstract

Background: Mixed methods are commonly used in health services research however data are not often integrated to explore complementarity of findings. A triangulation protocol is one approach to integrating such data. A retrospective triangulation protocol was carried out on mixed methods data collected as part of a process evaluation of a trial. The multi-country randomised controlled trial found that a web-based training in communication skills (including use of a patient booklet) and the use of a C-reactive protein (CRP) point of care test decreased antibiotic prescribing by general practitioners (GPs) for acute cough. The process evaluation investigated GPs’ and patients’ experiences of taking part in the trial.

Methods: Three analysts independently compared findings across four data sets: qualitative data collected view semi-structured interviews with 1) 62 patients and 2) 66 GPs and quantitative data collected via questionnaires with 3) 2886 patients and 4) 346 GPs. Pairwise comparisons were made between data sets and were categorised as agreement, partial agreement, dissonance or silence.

Results: Three instances of dissonance occurred in thirty-nine independent findings. GPs and patients reported different views on the use of a CRP test. GPs felt the test was useful in convincing patients to accept a no-antibiotic decision, but patient data suggested this was unnecessary if a full explanation was given. While qualitative data indicated all patients were generally satisfied with their consultation, quantitative data indicated highest levels of satisfaction for those receiving a detailed explanation from their GP with a booklet giving advice on self-care. Both qualitative and quantitative data sets indicated higher patient enablement for those in the communication groups who had received a booklet.

Conclusions: Use of CRP tests does not appear to engage patients or influence illness perceptions and its effect is more centred on changing clinician behaviour. Communication skills and the patient booklet were relevant and useful for all patients and associated with increased patient satisfaction. A triangulation protocol to integrate qualitative and quantitative data can reveal findings that need further interpretation and also highlight areas of dissonance that lead to a deeper insight than separate analyses.

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More information

Accepted/In Press date: 5 May 2016
e-pub ahead of print date: 12 May 2016
Published date: 12 May 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 393982
URI: https://eprints.soton.ac.uk/id/eprint/393982
PURE UUID: a8142bb4-d24a-41cd-8348-3d4ea35ccd11
ORCID for L. Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 10 May 2016 10:39
Last modified: 19 Nov 2019 06:48

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