Exploratory Sequential Design
In an exploratory sequential design, qualitative data are collected prior to the collection of quantitative data (Figure 11.1). This type of design is likely to be familiar to many investigators as it is commonly used as a strategy to design an instrument or questionnaire or to gather information to guide the content of an intervention (e.g., focus group: a guided discussion that systematically investigates what a diverse group of people thinks of a set of research questions). The qualitative component helps “discover” or “uncover” the range of domains and the words people use to express constructs; the goal is not to generalize the study results to the larger population. In other words, the salience of ideas (or themes) comes from the meaning participants ascribe to constructs, not from counting the number of persons or calculating proportions of persons who express a particular idea. Although qualitative methods do not use a standardized set of questions for every respondent, participants are able to express attitudes, beliefs, feeling, and constructs that are most important to them. For instance, in the northern region of Australia, Nagel and others initially qualitatively interviewed local aborigines to understand their perspective of mental health, then incorporated an aboriginal concept of mental health in a randomized controlled study of a brief motivational intervention (Nagel, Robinson, Condon, & Trauer, 2009).
In the context of behavioral intervention development, an exploratory sequential design with an initial qualitative exploration of patients’ perceptions of an intervention can guide the adaptation and administration of a larger scale intervention that is then based on quantitative methods of assessment (i.e., outcomes assessed with standardized questionnaires). Pilot studies of a new intervention need to incorporate ways for participants to provide feedback about how to make recruitment and informed consent procedures effective as well as to gauge feasibility and acceptability of the intervention, and for making modifications to the intervention to be more palatable to participants (Audrey, 2011). The active incorporation of patient feedback resembles a patient-centered design process commonly used in research and systems designs, and the NIH recognizes the needs for research development centered around the patients’ perspectives (Office of Disease Prevention, 2015). Mixed methods provide a tool to systematically integrate quantitative and qualitative approaches so that interventions and care systems are consistent with patients’ experiences and concepts.