Paper
Thursday, 20 July 2006
This presentation is part of : Research Theoretical and Methodological Strategies
Mixed Methods in Clinical Trials: Understanding the Effects of Guided Imagery for Chronic Pain Using a Concurrent Nested Design
Wendy Lewandowski, PhD, APRN, BC, College of Nursing, Kent State University, Kent, OH, USA
Learning Objective #1: Describe two strengths of using concurrent nested designs in experimental research.
Learning Objective #2: Describe two weaknesses of using concurrent nested designs in experimental research.
Mixed methods designs in intervention studies are gaining popularity, as they can provide a broader understanding of the phenomenon of interest.  A mixed method, concurrent nested design (experimental + descriptive) was used to study the effects of a guided imagery intervention with persons experiencing chronic pain.  Participants were randomly assigned to treatment or control group.  Participants in the treatment group (n=21) used guided imagery over a 4-day period; those in the control group (n=21) were monitored.  Measures of pain (VAS; MPQ; Verbal descriptions) were obtained simultaneously at five repeated daily intervals for participants in both groups.  Social desirability, imaging ability, and analgesic intake were measured but did not meet criteria for use as covariates. 

Quantitative and qualitative data were analyzed separately, and combined during the integration phase. First, a RM-MANCOVA was performed. There was a significant interaction for treatment by trials, F(3,117) = 2.717, p < .05.  Post hoc testing showed significant differences between the two groups for pain during the last two days of the study, F(1, 41) = 6.297, p < .01 and F(1, 41) = 3.802, p < .05.  Second, content analysis was performed on qualitative pain descriptions.  Six categories emerged:  pain is never-ending, pain is relative, pain is explainable, pain is torment, pain is restrictive, and pain is changeable.  For participants in the treatment group, pain became more changeable and less tormenting; also, their descriptions of pain as never-ending ceased.  

While this mixed methods study allowed for the rigors of a RCT, it also offered a way to collect in-depth qualitative data that supported a more detailed explanation of findings, a fuller understanding of the conceptual links in the research model, and a more sensitive measure of pain.  However, because the two methods received unequal priority in the study, a disadvantage may have existed when the final results were interpreted.

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