Toward Integrating Qualitative and Quantitative ‘ Methods: An Introduction Allan Steckler, DrPH Kenneth R. McLeroy, PhD Robert M. Goodman, PhD, MPH. Sheryl T. Bird, MA, MPH. . Lauri McCormick, MSPH ‘Both the qualitative and quantitative paradigms have weaknesses which; to a certaln extent, are compensated for by the strengths of the other. As indicated in this article, the strengths of quantitative methods are that they produce factual, reliable outcome ata that are vavally generalizable to some larger population. The strengths of qualitative methods are that they generate rich, detailed, valid process data that usualy leave the study participants’ perspectives in tact. This article discusses how qualitative and quan- Thative methods can be combined and ft introduces the articles included in ths issue, INTRODUCTION In designing their studies, health education practitioners, evaluators, and researchers have commonly followed one of two paradigms.' The quantitative paradigm uses methods adopted from the physical sciences, including appro- priate statistical techniques, to study health behavior or other related social Phenomena to determine if and to what extent predetermined study “variables” fre causally related. In this paradigm, experimental and quasi-experimental tative paradigm distance themselves from the people and social phenomenon they are studying in Srder to maximize objectivity. They administer survey questionnaires with predetermined response categories through in-person inter- eee ‘Alan Stecter, Shen! T. rd, and Laurl McCormick are with the of Health Behavior tnd Health Education, School of Public Heal, University of Nogth «Kenneth R, Mc 4 with the of Public Health Education, University . P McLeroy Department: Robert M. Goodman is School of Pubic Healt, Univesity of “Address reprint request 10 ~ and Health | 1, School of Public Health, Hil, NC.27599-7400," ‘Heath Education Quirterly, Vol. 191): 1-8 (Spring BE a ‘Published by John Wiley & Sons, Ine. CCC0195-6402/92/010001-06504.00 © 9a oy SOPH.2 Heabh Bdvenion Quarry ( views, telephone interviews, or mailings. The goal in collecting quanti te see prtigmeonthe abet asd opps entvoploge ‘The qualitative paradigm, on a So “methods immerse themselves In a culture by observing its people Interactions; participating in activities; interviewing key people; taki: toves consretingease fcies and/or analysing exstng documents i eects yen trom study2 For a health education or health promotion program, an insi provides an understanding of how people perceive a program, why pc to it the way they do, why the program has specific effects, and wk anticipated consequences of a program are. By examining why and how work or do not work (Le., process evaluation) health educators a improve future programs, e : + STRENGTHS, WEAKNESSES, AND PURPOSES OF EACH APPROACH Both the qualitative and quantitative paradigms have weaknesses acertain extent, are compensated for by the strengths of the other. At in Table 1, the strengths of quantitative methods are that they produ reliable outcome data that are usually generalizable to some IargerP qualitative methods.atsthatthe) datcthassvallcleayesthe study pacts nertfh Itative methods also provide contextual understanding of health bet Program results, : ‘Some authors refer to quantitative approaches as “the dominant ‘because the purposes, procedures, and benefits of quantitative methoc Known and accepted? In contrast, the purposes, procedures, and & qualitative methods are unfamiliar to many. We, ‘emphas «itive methods in this introduction because we believe that fn order 4 the practice of health education and health promotion, program e- ‘Table 1. A Typology of Attributes of Quantitative and Qualitative Evatuatic ‘Quantitative Qualitative Deductive Indoctive= ‘Verification and outcome oriented ‘Discovery and process ‘Measirement tends to be objective Measurement tends to be Reliable aan Vaid4 Heal Education Quarry (Spring 1992) “ection but deciphering the meaning of social phenomena. This usually implies Gfempting to understand and define the culture of the individu and groups attemping my atudied. Tn program evaluation terms obtaining “nteligibiiy” ‘usually means seeing & program from ‘the participants’ perspectives, and under daa ching that partcipans attribute to the program. Within the {ualltaive paradigm, some have argued that the purpose of evaluation and aqualtasPavraie oF improve the fvel of dilogue,” That i, the porpose of ‘Guillttive research is not to provide answers to empirical questions, but rather seat arate various lewpoins on important issues.* For example, ina study of ew administrative procedures in a school system, it was teachers) sponses {0 _ Tee open-ended qualitative questions, and not the closed-ended quantitative ‘questions, that convinced the school board that the new procedures were strongly SRiiked by some school personnel and should be studied further’! rg PY Bo argue against integrating qualitative and quantitative methods tuk ihe postion thatthe to paradigms are so diferent that any reconeision {ake the Phem is bound to destroy the epistomological foundations of each! eeeyretgument is thatthe purpose of research is ether predicion or intelig- ‘gs teangot be both, As Rosenberg suggests, “the extreme views are PrP: ably beyond serious adjudication. No one is going to convince = proponent of aay pay ree that the view all the way across onthe other side ofthe continuum isright. The reason is thatthe differences between them reston very fundamental Saar sf ptlosophy, claims about epistemology, metaphysics, and ethiessemoes saree ene not been settled in philosophy since they were first ralsed by Plato twenty-four hundred years ago” (p. 18). Meet ee Trough we recognize the importance ofthe philosophical debate for ie future development of socal scence methodology, our postion is a pragmatic one. As suggested by Reichardt and Cook,! we think it i possible to subscribe 19 the Stllosophy of one paradigm but also employ the methods ofthe other, Ne s6re Paneseahy Criment that “each method is based on different yet compli: Wa iy assumptions and each method has certain strengths that can be weed Tar comensate forthe limitations of the other" (p. 118). In fact, our position 1 samPtnat stronger, we believe that social Interventions, such as health eda- a torr and health promotion programs, are complex phenomena which require ‘he application of multiple methodologies in order to properly understand oF Cearebte them, We agree withthe sentiment that,“ . today the Issue nalongst er ethether to use quantitative or qualitative methods, but rather how they can Hoaaerpiaed to produce more effective evaluation strategies." We also believe oe corer the qualitative nor quantitative paradigms ar in jeopardy of being efiniatd by the ober. — ieee otras four ways that qualitative and quantitative methods might be HE ted in beth education research and program evalatons. nthe fst Posie approach (model 1) qualitative methods are used fnitally vo hep Go: Peror aosediive measres, For example, it snow common practice fo condoct a ‘in the second ap-okME aT H ._ tridngulation of Steeber et als Integrating Qualtathe and Quanthatve Methods s 7 ‘Qualitative meibods are used to help develop quantitative measures and bostroments. | Go) : “meta ‘QuaSative methods are sed to help ean quaniative dings, [ovantrarive | — : [penueaive] Meda’s ‘Quaotiadve esethods are used to enbelish a primarily quaitative stedy, Mosae (Quatiuthe aod quentiave metbods ase used equal and parallel, that qualitative and quantiutive methods might be poldgists often use this approach at the conclusion of an in-depth ethnography When they conduct a survey of members of the community they have been studying: The final possible approsch (model 4) is when the two $ are, used equally and parallel, When both methods are used equally, often the resilts from each determine pens are the more vali, This procedure lsometinest6 Hess Education Quorerly (Spring 1992) STATE OF THE ART __ We initiated this theme issue of Health Education Quarterly because we were ‘urious about the state of the art of integrating qualitative ‘and quantitative ‘methods fn health education research and evaluation, We wondered if other researchers and evaluators were struggling with the same methodologeal issues that we were and, if so, how they were attempting to resolve them. In particular, ‘we wondered which, if any, of the possible models of integration were currently being used, and which one(s) might predominate. ‘Table 2 characterizes the seven manuscripts that are inclided im this theme Issue. A variety of health problems, settings, and qualitative and quantitative methods are illustrated in these seven manuscripts. The health problems studied or programs evaluated include chronic diseases, acquired immunodeficiency syn- drome (AIDS) prevention, antimalarial chemoprophylaxis during pregnancy, ‘occupational stress, smoking policy, smoking prevention, and substance abuse prevention. The settings in which the studies occurred are both domestic and international and include commonites, clinics, worksites, and schools. Qualf- tative methods used in these studies include ethnographic interviews, open-ended and in-depth interviews, ethnographic field notes, focus groups, open-ended questions on surveys, and participant observation. The most frequently used quantitative method was closed-ended questionnaires, other quantitative meth+ ods include epidemiological data collected through aclosed-ended questionnaire, ical examinations, attendance logs, clinical tests (blood and urine), and closed-ended interviews. Each of the seven selected manuscripts illustrates at least one of the four possible models of integration depicted in Figure 1. Model 1 is ilustrated by the Bauman and Greenberg Adair, Hugentobler et al., and de Vries et al. articles; model 2 is illustrated by the Hugentobler et al. and Goutieb et al. articles; model 3 is illustrated by the Dorfman et al. and Buchanan articles; and model 4 is illustrated by the Helitizer-Allen and Kendall article. The variety of health problems, settings, and research methods illustrated in these f suggests that methodological integration is currently being attempted and strug sled with at least by some health education researchers and evaluators. In reviewing all the rianuscripts that were submitted for this theme issue, it appears to us that a weakness seems to be that when qualitative and quantitative methods are both used in the same project they each tend to be reduced to their ‘lementary forms, With all due respect to the authors of the manuscripts included * in this theme issue, and to the other authors who submitted for review, it appears that one of the improvements needed when m Integration is attempted is to increase the level of sophistication of each of the __ “methods. On the qualitative side, none of the manuscripts included in this issue . (er those submitted for review) illustrate complex qualitative case study meth- ~ edalogy, such asthe type of methodology described by Yin,’ nor do they illustrate ~‘ethnographies as described by Fetterman.” On the quantitative side, anslyses tend to employ simple descriptive statistics, With a few notable exceptions (Hu- gentobler et al., Gottlieb et al.), the quantitative data and results tend not to include advanced inferential statistical applications, nor the quantitative testing ~ of complex hypotheses. In studies which employ both qualitative and quantitative methods, mores Heal Edacition Quarterly (Spring 192) advanced applications are therefore warranted. This may not occur for several _ reasons: lack of sufficent fands, time, and/or expertise. Seldom do reseatchers “or evaluators have the necessary resolices to employ both advanced qualitative tand quantitative methods. Alternatively, because It takes many years of learning and practice of each method in order to be able to conduct sophisticated studies, by attempting to be experts in two broad paradigms and methodologies, inves- tigators may not learn the intricacies and finer points of either and, thus, lack, ~ the necessary expertise, - sea : ‘Uf methodological integration is going'to progress, the use of each paradigm, within a given study or intervention project, must become both more accepted. and more refined, No single solution can be offered for this complex method~ ological problem, but a number of steps could be taken. First, funding agencies ‘faust recognize the need for both perspectives and be willing to allocate sufficient resources $0 that the use of qualitative and quantitative methods in the same project is supported. Second, health educators, evaluators, and researchers Should be trained in both paradigms. Presently, graduate training programs emphasize quantitative methods; only rerely are qualitative methods included. A third approach to enhancing methodological integration is teamwork. In ‘ven project, it would be better to utilize teams of investigators composed of ‘experts in the application of each paradigm, rather than having oaly one or two Investigators who employ methods representing both paradigms. Finally, a potential hindrance to the continued development of methodolog- {cal integration is the animosity towards each paradigm by the adherents of the ‘Alternative approach. Until such time as there is mutual acceptance and respect, prospects for advancing integration will remain limited. It is our hope that the franuscripts included in this theme issue will serve to illustrate the value of methodological integration in health education evaluation and research, and will bring the adherents of each paradigm closer together. 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