The Qualitative Report Volume 16 Number 3 May 2011 635-656

http://www.nova.edu/ssss/QR/QR16-3/jeanty.pdf

Mixed Methods Research of Adult Family Care Home

Residents and Informal Caregivers
Guy C. Jeanty
Carlos Albizu University, Miami, Florida, USA

James Hibel
Nova Southeastern University, Ft. Lauderdale, Florida, USA

This article describes a mixed methods approach used to explore the

experiences of adult family care home (AFCH) residents and informal
caregivers (IC). A rationale is presented for using a mixed methods
approach employing the sequential exploratory design with this poorly
researched population. The unique challenges attendant to the sampling
strategy with this population, and an iterative approach of data collection
and data analysis are discussed. A summary of the data integration
process and outcome is presented. Key Words: Adult Family Care Home,
Sequential Explanatory, Sequential Exploratory, Mixed Methods
Paradigm, Exclusion Criteria, Inclusion Criteria, and Grounded Theory

Robbins (2001), a noted ethnographer, argued that “rigorous qualitative research

can provide the ‘why’ behind statistically significant differences” (p. 27). Noted
quantitative researchers, Crawley et al., (2000) stated that “qualitative research is needed
to clarify and improve the knowledge of health care professionals of the demographic,
socioeconomic, psychosocial, and medical factors that influence decisions regarding end-
of-life care” (pp. 2522-2523).
In gerontology, although quantitative methods have been used most widely,
numerous studies provide a rationale for the use of qualitative research in gerontology
(Easton, 1999; Ekblad, Marttila, & Emilson, 2000; La Veist, 1996; Mays & Pope, 2000;
Nuwaha, Faxelid, Neema, Erikson, & Hojer, 2000; Sofaer, 1999; Williams, 1994; Yin,
1999). Keith (1994) suggested that aging research, with its emphasis on meaning and
perspective of research subjects, most clearly calls for qualitative methods. However,
mixed qualitative and quantitative research methodologies can provide the best of their
respective traditions, the naturalistic and positivist paradigms.
Mixing quantitative and qualitative methods can enhance a study that is suitable
to both paradigms (Tashakkori & Teddlie, 1998). Johnson and Onwuegbuzie (2004)
aptly state, “A tenet of mixed methods research is that researchers should mindfully
create designs that effectively answer their research questions” (p. 20). In this research, a
qualitative method was the central approach used to explore meanings associated with
living in, or supporting someone who lives in, an adult family care home (AFCH). A
quantitative approach was also employed to elaborate on these meanings and to assess the
effects of living in an AFCH on both residents and their relatives (or informal
caregivers).
636 The Qualitative Report May 2011

Mixed Qualitative and Quantitative Methods

Research questions or hypotheses have historically dictated whether a qualitative

or quantitative method would be best to answer the central questions of a study. For
example, according to Morse and Field (1995), sound research requires two important
components; using the most appropriate method at the appropriate time and applying the
appropriate method, according to the type of research questions that are being explored.
Qualitative research has been increasingly used as a methodology due largely to
its ability to generate rich descriptions of complex phenomena (Chenail & Maione, 1997;
Crabtree & Miller, 1992; Golander, 1992; Kaufman, 1994). Qualitative research also
helps to illuminate the experience and interpretation of events by research participants
(Gubrium & Sankar, 1994). Sofaer (1999) argued that qualitative inquiry allows for
“initial explorations to develop theories and to generate and even test hypotheses while
moving towards explanations” (p. 1101). As Denzin and Lincoln (1994) put it,
qualitative researchers “seek answers to questions that stress how social experience is
created and given meaning. In contrast, the quantitative approach emphasizes the
measurement and analysis of causal relationships between variables, not processes” (p.
4).
In recent years mixed method approaches have arisen, due in part to recognizing
some inherent limitations and strengths of both qualitative and quantitative approaches
(Teddlie & Tashakkori, 2003). Quantitative research has been regarded by some as the
standard of “quality” research (Ayer, 1959; Maxwell & Delaney, 2004; Schrag, 1992).
Quantitative purists have argued that “social observations should be treated as entities in
much the same way that physical sciences treat physical phenomenon” (Johnson &
Onwuegbuzie, 2004, p. 14). A number of limitations of the quantitative paradigm have
been acknowledged, primarily centering on the awareness that the researcher cannot be
assumed to be separate from the object of observation (Creswell, Plano-Clark, Gutman,
& Hanson, 2003; Miles & Huberman, 1994). That said, the quantitative paradigm has
several strengths: “testing and validating already constructed theories; generalize a
research finding when it has been replicated on many different populations and
subpopulations; research results are relatively independent of the researcher” (Johnson &
Onwuegbuzie, p. 19). Qualitative research is limited in its ability to generate predictive
models or to create findings that generalize to larger populations, though it benefits from
its ability to bring forward meaning and accounts of lived experience that typically do not
arise from quantitative research. The unique strengths of both qualitative and
quantitative paradigms can be effectively combined to minimize their respective
limitations while accentuating their strengths in a mixed method design.

Mixed Method Paradigm

The primary objective of mixed methods is to obtain a more complete

understanding of human behavior and experience by using more than one method within
a research study (Morse, 1991). Although mixed methods research is being employed
across several disciplines, it is still evolving conceptually as a research method (Johnson
& Onwuegbuzie, 2004).
Creswell et al. (2003) define a “beginning point” of mixed methods study:
Guy C. Jeanty and James Hibel 637

A mixed methods study involves the collection or analysis of both

quantitative and/or qualitative data in a single study in which the data are
collected concurrently or sequentially, are given a priority, and involve the
integration of the data at one or more stages in the process of research. (p.
212)

Johnson and Onwuegbuzie (2004) suggest that the definition of mixed methods study will
continue to evolve as the philosophical underpinnings of this method emerge.

Philosophical Underpinnings

The mixed methods paradigm has risen, in part, from the distinctions drawn
between the “positivist/empiricist approach and the constructivist/phenomenological
orientation” (Tashakkori & Teddlie, 1998, p. 3). The positivist view is the basis for
quantitative methods, and the constructivist philosophy underlies qualitative methods
(Johnson & Onwuegbuzie, 2004). While these philosophical distinctions have, in the
past, led researchers to view the two paradigms as fundamentally incompatible, other
researchers have taken a more moderate stance and argued that quantitative and
qualitative methods are in fact compatible (Howe, 1988; Reichardt & Rallis, 1994). This
paradigm shift has been dubbed “pragmatism” (Johnson & Onwuegbuzie, 2004).
Tashakkori and Teddlie (1998) identified several key points regarding
pragmatism and mixed methods:

(a) Pragmatism supports the use of both qualitative and quantitative

research methods in the same research study and within multistage
research programs. Pragmatism rejects the either/or dichotomy.
(b) Pragmatist researchers consider the research question to be more
important than either the method they use or the paradigm that
underlies the method. The research question predominates.
(c) Decisions about the use of mixed methods, qualitative methods, or
quantitative methods depend on the research question and the stage of
the research process.
(d) Pragmatism avoids the use of metaphysical concepts such as “truth”
and “reality” that have caused much debate and at times divisions. (pp.
22-30)

In regard to pragmatism, Johnson and Onwuegbuzie (2004) state that “the bottom
line is that research approaches should be mixed in ways that offer the best opportunities
for answering important research questions” (p. 16). Similarly, Johnson and Turner
(2003) argue that a fundamental principle of mixed method research is that “methods
should be mixed in a way that has complementary strengths and nonoverlapping
weaknesses” (p. 297). This principle heightens a researcher’s awareness of the inherent
limitations of both qualitative and quantitative methods.
The use of mixed methods serves at least three objectives: “(a) to obtain
convergence or corroboration of findings, (b) to eliminate or minimize key plausible
638 The Qualitative Report May 2011

alternative explanations for conclusions drawn from the research data, and (c) to
elucidate the divergent aspects of a phenomenon” (Johnson & Onwuegbuzie, 2004, p.
299). As such, utilizing mixed methods provides the researcher with multiple
perspectives from which to analyze a topic, and represents an effective method for
triangulating data (Creswell, 1994; Creswell et al., 2003; Johnson & Onwuegbuzie, 2004;
Tashakkori & Teddlie, 2003).
In this study a qualitative design was used to obtain residents’ views of everyday
life in an AFCH and the views of informal caregivers (IC). In addition, quantitative
methods provided a means of assessing the emotional states of AFCH residents and ICs
using previously validated instruments (Johnson & Onwuegbuzie, 2004) in order to
elaborate on the qualitative data.

Mixed Method Designs

Morse (1991), a nursing researcher, created a notation system that has gained
broad acceptance by researchers conducting mixed method studies. As shown in Table 1,
Morse’s system presents four kinds of mixed method approaches. A plus (+) sign,
indicates simultaneous collection of quantitative and qualitative data. An arrow (→) is
used to denote that one form of data collection follows another. Uppercase letters (e.g.,
QUAN, QUAL) indicate major emphasis on the form of data collection, and lowercase
letters (e.g., quan, qual) suggest less emphasis. Additionally, Morse describes two types
of designs, simultaneous and sequential. Simultaneous designs are implemented at the
same time. In the sequential design, one form of data, either the qualitative or
quantitative, is collected before the other.

Table 1. Mixed Method Approaches 1

Approach Type
QUAL + quan Simultaneous
QUAL → quan Sequential
QUAN + qual Simultaneous
QUAN → qual Sequential

Creswell et al. (2003) identified six different types of mixed method designs that a
researcher might employ. The designs are Sequential Explanatory; Sequential
Exploratory; Sequential Transformative; Concurrent Triangulation; Concurrent Nested,
and Concurrent Transformative. There are four criteria—implementation, priority,
integration, and theoretical perspective—that can be used to assist the researcher in using
these designs effectively. Relevant to the study presented here, overviews of two of the
designs, Sequential Explanatory Design and Sequential Exploratory Design, are
illustrated in Table 2 and Table 3. The major characteristics of each design are presented
as well as the strengths and weaknesses of each.

1
Types of Designs Using Morse’s (1991) Notation System
 Guy C. Jeanty and James Hibel 639

Sequential Explanatory Design

According to Creswell et al. (2003), the sequential explanatory design is

“characterized by the collection and analysis of quantitative data followed by the
collection and analysis of qualitative data” (p. 223). The steps in this design are
illustrated in Table 2. In this design, priority is generally given to the quantitative data,
and then the two methods are integrated during the interpretation phase of the study.
The objective of the sequential explanatory design is “typically to use qualitative
results to assist in explaining and interpreting the findings of a primarily quantitative
study” (Creswell et al., 2003, p. 227). Morse (1991) stated that this method can be
particularly useful when unexpected results arise in a quantitative study. The qualitative
data are useful in examining unexpected results in greater detail. The simplicity of this
design is one of its main strengths (Creswell et al.).

Table 2. Sequential Explanatory Design 2

Sequential Explanatory Design

QUAN → qual
QUAN QUAN qual qual
Data → Data → Data → Data → Interpretation of Entire Analysis
Collection Analysis Collection Analysis

Sequential Exploratory Design

The sequential exploratory design has several features that are similar to the
sequential explanatory design. The sequential exploratory design is also conducted in
two phases. However, this design is characterized by an initial phase of qualitative data
collection and analysis followed by quantitative data collection and analysis (Creswell et
al., 2003). Priority is given to the qualitative aspect of the study, and the findings of the
two phases are then integrated in the interpretation phase.
Creswell et al. (2003), state that “the purpose of this design is to use quantitative
data and results to assist in the interpretation of qualitative findings” (p. 227). In contrast
to the “sequential exploratory design, which is better suited to explaining and interpreting
relationships, the primary focus of this design is to explore a phenomenon” (p. 227). The
sequential exploratory design is appropriate to use when testing elements of an emergent
theory, and it can also be used to generalize qualitative findings to different populations
(Creswell et al.; Johnson & Onwuegbuzie, 2004; Tashakkori & Teddlie, 1998).
The Sequential Exploratory Design was used in this study. The exploratory
emphasis of this design was a good fit in this study because of its congruency with the
qualitative aspect of this study. The goal of capturing the lived experiences of AFCH
residents and informal caregivers was tremendously enhanced as a consequence of
thickening the qualitative reports with the quantitative data through this design.

2
Creswell et al. (2003) Major Designs
640 The Qualitative Report May 2011

Additionally, the exploratory design allowed for a gradual and recursive emergence of
overarching theories about the lived experiences of residents and informal caregivers.
Hence, the decision to make the qualitative elements of the mixed methods design the
major emphasis of this study proved to be a sound decision.

Table 3. Sequential Exploratory Design 3

Sequential Exploratory Design

QUAL → quan
QUAL QUAL quan quan
Data → Data → Data → Data → Interpretation of Entire Analysis
Collection Analysis Collection Analysis

Methodology of the Study

Qualitative Methodology

The qualitative part of this research was guided by the grounded theory method,
developed by Glaser and Strauss (1967) to generate explanatory theories of human
behavior. According to Strauss and Corbin (1990),

Grounded theory is one that is inductively derived from the study of the
phenomenon it represents. That is, it is discovered and provisionally
verified through systematic data collection and analysis of data pertaining
to that phenomenon. Therefore the data collection, analysis, and theory
stand in reciprocal relationship with each other. One does not begin with a
theory and then prove it. Rather, one begins with an area of study and
what is relevant to that area allowed to emerge. (p. 23)

Thus, grounded theory provides a research methodology that is creative, dynamic,

and flexible yet rigorous within a set of procedures. It is especially useful for developing
theories where little is known about the phenomenon. Hence, it was appropriate for this
study because there has been little exploration of AFCHs (Spencer, Hersch, Aldridge,
Anderson, & Ulbrich, 2001). The methods employed within grounded theory included
interviews, participant observation, and document analysis which contributed to the
development of theories about the experiences of AFCH residents and informal
caregivers (Strauss & Corbin, 1990).

3
Creswell et al. (2003) Major Designs
Guy C. Jeanty and James Hibel 641

Quantitative Methodology

Measurement is central to quantitative research because it provides the essential

connection between empirical observation and mathematical expression of quantitative
relationships (Tashakkori & Teddlie, 2003). However, Williams (1992) aptly stated,
“Just because a study has used statistics is no guarantee of its worth. In fact, statistics can
be misused either intentionally or unwittingly, and it is not difficult to locate quantitative
studies where statistics were not really needed at all” (p. 3). Quantitative research
methods are no better or worse than its qualitative counterparts (Creswell, 1994;
Tashakkori & Teddlie, 2003). However, when used appropriately quantitative techniques
can be very valuable (Williams, 1992). In this study, standardized quantitative tests were
used to obtain measurements in particular categories to obtain relevant descriptions of
each participant’s perspective and experiences.
Greene, Caracelli, and Graham (1989) identified several general objectives of
mixed methods studies: “(a) triangulation (i.e., seeking convergence and corroboration of
findings from different methods that study the same phenomenon); (b) complementarity
(i.e., seeking elaboration, illustration, enhancement, and clarification of the results from
one method with results from the other method)” (as cited in Onwuegbuzie & Leech,
2006, p. 480). In this study the purpose of using quantitative data was to thicken (i.e.,
augment, enrich, and enhance) the findings of the qualitative data. Since the quantitative
data added depth to more fully understand the experiences of AFCH residents and ICs
than would be possible using either qualitative or quantitative methods alone, quantitative
techniques were a valuable complement in this study.

Sampling Strategies

Rationale

Kemper and Teddlie (2000) provide guidelines in choosing a sample. First, the
sampling technique should stem logically from the conceptual framework and the
research questions. Second, the sample should generate sufficient data on the phenomena
being studied. Third, the sample should reasonably lead to the possibility of making clear
inferences or credible explanations from the data.
Sampling techniques can be divided into two types: probability sampling and
purposive sampling. Quantitative studies generally use “larger samples selected through
probability techniques, while qualitative studies typically use smaller samples selected
through purposive techniques” (Kemper & Teddlie, 2000, p. 277). These sampling
techniques are often blended in mixed method studies (Creswell et al., 2003; Tashakkori
& Teddlie, 1998), and this is the approach used in this study.
In this study the probability sampling technique, simple random sampling, was
employed in selecting participants from a pool of forty (40) AFCHs in Broward County,
Florida. In this technique each person in a clearly defined population had an equal
chance of being included in the sample (Kemper & Teddlie, 2000). The advantage of the
simple random sampling method is that the research data can be generalized to other
populations (Tashakkori & Teddlie, 1998).
642 The Qualitative Report May 2011

The sample size for this particular study (N=14), to the quantitative purist, may be
considered insufficient for generalizability, but proponents of mixed methods research
argue that adding a quantitative component that surveys a randomly selected sample is
likely to lead to generalizability (Johnson & Christensen, 2004; Johnson & Onwuegbuzie,
2004; Johnson & Turner, 2003). Onwuegbuzie and Collins (2007) argue:

Virtually all researchers (whether qualitative, quantitative, or mixed

methods researchers) make some form of generalization when interpreting
data. Typically, they make statistical generalizations, analytical
generalizations, and/or generalizations that involve case-to-case transfer
… Specifically, because all findings are context-bound; (a) any
interpretations stemming from these findings should be made only after
being appropriately aware of the context under which these results were
constructed, (b) generalizations of any interpretations to another context
should be made only after being adequately cognizant of the new context
and how this new context differs from the context from which the
interpretations were generated; and (c) generalizations should occur only
after the researcher has reflected carefully on the consequences that such a
generalization may have. (pp. 307-308)

The objective of using quantitative data in this inquiry was to gain additional
insights about research participants but not for the purpose of generalization to the larger
population of AFCH residents. The quantitative data were, however, expected to be
useful in assessing the emotional state of AFCH residents and informal caregivers. Once
participants were identified, qualitative techniques such as semi-structured questions and
direct observation were implemented. In the qualitative phase of this study, the
purposive sampling technique was used. This technique “involves taking opportunities as
they come along and following up on leads as they arise within fieldwork” (Kemper,
Stringfield, & Teddlie, 2003, p. 283).

Participants

The participant residents were older adults of diverse backgrounds with a variety
of medical problems. Adult family care homes in multi-ethnic neighborhoods were
contacted to insure varied socio-economic, gender, age, and ethnic participation. The
AFCH residents required assistance with at least three activities of daily living (ADL).
The ICs of these residents lived in the state of Florida.
Adult family care home residents lived in the primary residence of an AFCH
provider and the provider’s family members. The AFCHs were for-profit entities. Those
with two or fewer residents are permitted by the State of Florida to provide care for the
frail elderly without a license, but unlicensed AFCH providers had to comply with the
state laws governing the operation of AFCHs. Providers with three to five residents were
licensed by the State of Florida. Local governments had additional requirements such as
an occupational license.
The gatekeepers in AFCHs were the AFCH providers. As such they determined
who gained access to both residents and ICs. Contact information about AFCH providers
Guy C. Jeanty and James Hibel 643

was obtained from the State of Florida’s website. My professional experience in hospice
care resulted in contact with several AFCH providers. The relationship that I developed
with those providers was valuable in gaining access to residents and ICs. The initial
contact with the providers was by telephone.
Once access was granted to enter the setting, AFCH providers, residents, and ICs
were provided written requests for participation in this study.

Inclusion or Exclusion Criteria

In the sampling process some individuals were not appropriate candidates for this
particular study. Inclusion or exclusion of individuals in the target population was based
upon the ability of the potential participant to meaningfully participate in the study.
Table 4 delineates the inclusion or exclusion criteria.

Table 4. Inclusion or Exclusion Criteria

Inclusion Criteria
Item Description
General Cognition Cognitively normal, based on an absence of significant
impairment in cognitive functions or activities of daily
living.
Age of AFCH Resident Age 65 plus.
Informal Caregiver Informal caregiver is biologically related to resident or
designated as the caregiver of the AFCH resident.
Visual and Auditory Acuity Adequate visual or auditory ability to complete
assessment and participate in interviews.
General Health Good general health with no additional diseases expected
to interfere with the study.

Exclusion Criteria
Item Description
Memory Complaints Persistent memory complaints and memory difficulties
that are verified by an informal caregiver and or adult
family care home (AFCH) provider.
Significant Neurological Any significant neurological disease such as Alzheimer’s,
Disease Stroke victims, or history of significant head trauma etc.
Psychiatric Disorders with History of schizophrenia with psychotic features,
psychotic features agitation, or behavioral problems within the last 3 months
which could lead to difficulty complying with the
protocol.
Significant Medical Illness Any significant illness or unstable medical condition
which could lead to difficulty complying with the
protocol.
644 The Qualitative Report May 2011

The sample population consisted of fourteen (14) individuals, residents, and

informal caregivers (ICs), drawn from forty (40) adult family care homes (AFCHs) in
Broward County, Florida. The criteria for selecting participants from the sample pool
were as follows: (a) Each participant who met criteria was assigned a number; (b) the
number was written on a slip of paper; (c) the slip of paper was placed into a box and
mixed; (d) then the numbers were drawn from the box.
Residents who had the capacity to give consent were asked for consent to
participate in the study. When it was appropriate, ICs of residents were asked to give
consent. Once signed consents were obtained, faced-to-face interviews were scheduled.
A subsequent interview was scheduled to ensure the accuracy of the data.

Sites

There are slightly over forty (40) AFCHs in Broward County, Florida. The
criteria for site selection were as follows: an AFCH licensed by the State of Florida, a
well-established AFCH, that is, no major infraction had been issued by the Agency for
Health Care Administration, and the AFCH had at least two residents.
Interviews were conducted in the AFCH where each resident lived. Interviews of
ICs were conducted in a variety of settings. All testing materials, such as pens and tests,
were provided by the researcher. Each resident, IC, and AFCH provider were sent an
introductory letter, explaining the nature of the study during and after the study.

Ethics

The researcher followed ethical standards to ensure that the research did not harm
participants or abuse the privilege of access to participants or ICs (Gubrium & Sankar,
1994; Kayser-Jones & Koenig, 1994; Lyman, 1994; Reaves, 1992). The research was
approved by the Nova Southeastern University Institutional Review Board on June 18,
2008. Elements included in the protocol were assessment of the risk to participants,
informed consent, and the right to privacy or confidentiality (Kayser-Jones & Koenig).
In order to protect the informants’ rights and to provide participants with a
description of these procedures: (a) the research objectives were explained verbally and
in writing, (b) each informant was informed of all data collection devices and activities,
(c) written permission to proceed with the study as described was received from each
participant, (d) test results, verbatim transcriptions, written interpretations, and reports
were stored in a locked cabinet and available to each informant upon request, (e) the
informants’ rights and preferences were the researcher’s chief consideration, and (f) each
informant was assigned a code and all other identifiable data was changed to protect the
identity of each participant.

Qualitative Data Collection Strategies

In the qualitative paradigm, data collection is not typically separate from data
evaluation; data collection and theory development in qualitative research often occur
simultaneously. In Lincoln and Guba’s (1985) view, the naturalistic method which
maintains that “truth” is context-bound, functions best when theory emerges from data
Guy C. Jeanty and James Hibel 645

that reflect the participants’ perspective. In this part of the study, data collection and
theory development evolved simultaneously. As theoretical constructs emerged during
this process, conceptual categories were recorded and refined during the course of the
study.
Data collection occurred in stages. Two semi-structured interviews were
conducted with each resident at the AFCH where the resident lived. The interview
involved techniques such as participant-observation, open-ended questions, and
collaboration between the researcher and informants (Kaufman, 1994; Rowles &
Reinharz, 1988). Interviews were recorded using a tape recorder, and detailed field notes
were taken. The length of interviews varied depending on each resident’s physical ability
and desire.
In the first interview, the areas of inquiry included the views of each AFCH
resident and IC. The central question of this study was “What constitutes a meaningful
life for an AFCH resident?” Several related questions were asked. The interviews of
residents and ICs were conducted separately. Time was reserved at the end of the first
interview to administer one quantitative measure. The second interview provided an
opportunity for participants to review the major themes in the first interview.

Qualitative Data Analysis Strategies

Qualitative data collection and analysis are distinct but related processes.
According to Marshall and Rossman (1995), the two procedures “go hand in hand to
promote the emergence of substantive theory grounded in empirical data” (p. 112).
Participant interviews were transcribed verbatim as interviews were completed. In
Patton’s (1990) view, “The first decision to be made in analyzing interviews is whether to
begin with case analysis or cross case analysis” (p. 376). The process began with case
analysis of transcribed audio taped interviews, leading to intimate familiarity with the
words, descriptions, meanings, and personal narrative of participants (Miles &
Huberman, 1994).
Following individual analysis of the cases, cross-case analysis was conducted by
developing descriptive meta-matrices of the cases and using the constant comparison
method (Miles & Huberman, 1994). The constant comparison method allowed categories
to emerge directly from the data by coding, categorizing, and comparing bits of data
within individual cases as well as among different cases (Glaser & Strauss, 1967). Each
participant’s transcript was coded by gender, marital status, race, ethnicity, education,
age, religion, and employment.
Through the process of sifting the data, a series of themes and patterns emerged
embodying both personal and social aspects of each individual’s experience (Gubrium &
Sankar, 1994). Grouping the data required organizing it by developing a set of categories
so that each category expressed a criterion (or a set of criteria) for distinguishing some
observation from others (Dey, 1993).
Since the principal researcher is primarily a visual learner, a method that
accentuated his strength was employed. First, similar bits of data and themes were
highlighted by color-coding each data bit. Second, preliminary rules of inclusion were
written, and preliminary category names were established. Category refinement was an
ongoing process. Some of the tentative categories that appeared similar were combined;
646 The Qualitative Report May 2011

sub-categories were created and the rules of inclusion were revised. Third, each color-
coded data bit was read several times, paying attention to the various themes. Each
category was then coded with its own symbol and corresponding descriptive phrase.

Quantitative Data Collection Strategy

Geriatric Depression Scale. There are several quantitative data collection

techniques, and among them are questionnaires, interviews, focus groups, tests, and
observation (Tashakkori & Teddlie, 1998). According to Johnson and Turner (2003),
“Tests are commonly used in quantitative research to measure attitudes, personality, self-
perceptions, and performance of research participants” (p. 310).
The AFCH residents in this study were administered the Geriatric Depression
Scale (GDS). The GDS has been used successfully with older adults who are physically
healthy or ill (Corcoran & Fischer, 2000). Geriatric Depression Scale was used to
measure depression in residents. This test was useful in this study for several reasons.
First, it has excellent reliability; its internal consistency is 0.94. Second, “The GDS also
has good known-groups validity in distinguishing significantly among respondents
classified as normal, mildly depressed, and severely depressed” (Corcoran & Fischer, p.
315). Third, the GDS is effective and easy to administer. It is a 30-item instrument
written in simple language and can be administered in oral or written format (Corcoran &
Fischer). Assessing for depression was important because depression level may have
influenced how some AFCH residents viewed themselves and described their experiences
in the AFCH. The GDS was administered during the initial interview.

Zarit Burden Interview. The IC participants in this study were administered the
Zarit Burden Interview (Zarit, 1990). Karlikaya, Yukse, Varlibas, and Tireli (2005)
stated, “Different questionnaires have been developed to quantify the largely subjective
domain of caregiver burden, but the Zarit Caregiver Burden Scale is one of the most
widely used scales” (p. 2). This test was particularly valuable in this study because it is
designed to measure the physical, emotional, and financial strain of being a caregiver.
Additionally, the ZBI measures the strain experienced by caregivers of physically ill and
functionally impaired older adults. The internal reliability for the ZBI has been estimated
at 0.91. The test-retest reliability is reported at 0.71. Validity has been estimated by
correlating the total score with a single global rating of burden (r = 71; Zarit, 1990).
The ZBI can be completed by caregivers themselves or as part of an interview. In
this study the ZBI was administered by asking caregivers to complete the questionnaire.
Caregivers were asked to respond to 22 questions about the impact of the patient’s
disabilities on their on their life (Zarit, 1990).
The GDS and ZBI substantially augmented the descriptions of the qualitative
data. Using these two instruments revealed important characteristics that are common
among research participants. These instruments made it possible to thicken
understandings of the ways the AFCH residents found meaning living in an AFCH. The
tests yielded alternative ways of analyzing the qualitative data and understanding the
experiences of AFCH residents and ICs.
Guy C. Jeanty and James Hibel 647

Quantitative Data Analysis Strategy

Onwuegbuzie and Teddlie (2003), state that mixed methods data analysis includes
the use of quantitative (and qualitative) analytical techniques, either concurrently or
sequentially, followed by data interpretation in either a parallel, an integrated, or in
iterative manner.
As mentioned above, the sequential qualitative-quantitative data analysis design
was employed in this study. According to Tashakkori and Teddlie (1998),

One of the main data analytic strategies in mixed methods is to convert the
data that are collected in one of the traditions into the other tradition such
that alternative techniques can be used with analyzing the same data. Two
aspects of this type of transformation are (a) converting qualitative
information into numerical codes that can be statistically analyze and (b)
converting quantitative data into narratives that can be analyzed
qualitatively. (pp. 125-126)

In this study the initial qualitative data analysis was followed by quantitative data
analysis.
The quantitative data analysis process consisted of the following stages: data
reduction (Stage 1), data display (Stage 2), and data integration (Stage 3; Onwuegbuzie &
Teddlie, 2003). Stage 1, data reduction, involved reduction of the data gathered in the
collection phase. For quantitative data, data reduction includes computation of
descriptive statistics (e.g., measures of central tendency measures of dispersion and
variability). Stage 2, data display, involved reducing the information into appropriate and
simplified tables and graphs which are the two most common ways of displaying
quantitative data. Stage 3, data integration, was the last link in the data analysis process.
In this stage, all data were integrated into a coherent whole or two separate sets of
coherent wholes (Onwuegbuzie & Teddlie). Upon completion of the three stages, the
data were interpreted and conclusions were presented.

Integration of Qualitative and Quantitative Methods

According to Creswell et al. (2003), integration can be defined as “the

combination of quantitative and qualitative research within a given a stage of inquiry” (p
220). Integration is a fluid process that might occur

… within the research questions (e.g., both quantitative and qualitative

questions are presented), within data collection (e.g., open-ended
questions on a structured instrument), within data analysis (e.g.,
transforming qualitative themes into quantitative items or scales), or in
interpretation (e.g., examining the quantitative and qualitative results for
convergence of findings). (Creswell et al., p. 220)

Similarly Onwuegbuzie and Johnson (2006) suggest that data integration “occurs
via techniques such as quantitizing data … or qualitizing data” (p. 53). Quantitizing and
648 The Qualitative Report May 2011

qualitizing data involve a process “wherein quantitative data are converted into narrative
data that can be analyzed qualitatively … and/or qualitative data are converted into
numerical codes that can be represented statistically” (Onwuegbuzie & Leech, 2006, p.
491).
Tashakkori and Teddlie (1998) emphasize the importance of identifying the
stage(s) of integrating qualitative and quantitative data. Onwuegbuzie and Leech (2006)
state that “data integration is the final stage, whereby both quantitative and qualitative
data are integrated into either a coherent whole or two separate sets (i.e., qualitative and
quantitative) of coherent wholes” (p. 491). In this study integration of the two methods
occurred during data analysis and data interpretation.
Integration occurred on many levels. First, the research questions contained both
qualitative and quantitative questions aimed at exploring the lived experiences of AFCH
residents and informal caregivers. Second, integration occurred during the data
collection process, data analysis, and interpretation of the data. These three dynamic
processes unfolded in a reciprocal manner; each influencing and enriching the data.
Third, integration also occurred by quantitizing portions of the qualitative data. For
example, a thematic analysis of critical incidents involving residents revealed that
frequency of falls was a factor that influenced informal caregivers’ preference for
AFCHs. Additionally, qualitative themes such as family conflicts (e.g., between siblings
and caregiving spouses), employment stress, and the risks of informal caregivers become
ill or injured were also quantitized.
Integration also revealed some key findings between male and female informal
caregivers. Consistent with previous studies (Brody, Hoffman, Kleban, & Schoonhover,
1989; Chappell & Reid, 2002; Cox, 2005) six out of eight informal caregivers in this
study were female. However, the males in this study reported higher levels of emotional
strain. Possession of the qualitative and quantitative data was valuable for interpreting
the higher level of emotional strain reported by the male informal caregivers. Integration
of the data was modestly successful.

Evaluation in a Mixed Design

It is imperative that researchers make every effort to be methodologically sound

in data collection, analysis, and interpretation, and most quantitative and qualitative
researchers agree that rigor is needed in research (Creswell et al., 2003; Lincoln & Guba,
1985; Miles & Huberman, 1994; Tashakkori & Teddlie, 1998). Onwuegbuzie and
Teddlie (2003) noted that accountability implies that researchers strive to assess and
document the legitimacy (e.g., credibility, trustworthiness, and dependability) of their
findings.
Credibility in naturalistic research is based upon the rigor of the process and
particularly the trustworthiness of the findings (Denzin & Lincoln, 1994).
Trustworthiness provides credibility that one’s findings are worthy of attention and
provides clear procedures for researchers who may want to replicate a study (Denzin &
Lincoln).
Guy C. Jeanty and James Hibel 649

Credibility and Trustworthiness

Credibility of the data is particularly important in this study because of the

idiosyncratic nature of participants’ experiences, the meanings attributed to living in an
AFCH, and the journey that lead to the selection of an AFCH as a long term care setting.
Most previous studies of older adults have employed a quantitative perspective (Burrs,
1995; Garret, Harris, Norburn, Patrick, & Danis, 1993; Gordon, 1995, 1996; La Veist,
1994; Neubauer & Hamilton, 1990). While the quantitative approach has confirmed a
number of hypotheses about the placement of older adults in institutional settings, it has
not produced a deeper understanding of the meaning of aging in these settings. One way
of obtaining a deeper understanding is by mixing the qualitative and quantitative
paradigms.
To insure quality control and trustworthiness of the study, several methods were
employed. Results were presented in such a way that anyone, whether or not he or she
has had the experience, can recognize the phenomenon described. The principal
researcher recorded and transcribed the participants’ in-depth interviews. A log was kept
in the form of an audit trail, which described the chronology of the primary investigator’s
impressions, and perceptions.
In order to establish trustworthiness, both data sources, qualitative and
quantitative, were triangulated. As Denzin (1978) noted, “Bias inherent in any particular
data source, investigators, and particular methods will be canceled out when used in
conjunction with other data sources, investigators, and methods” (p. 14). The goal of
triangulating different methods and data sources in this study was to test for consistency
in the data.
The qualitative data revealed several notable factors among the research
participants. There were striking similarities in their narratives about life before and after
a moving into an AFCH. Residents uniformly stated a preference for living a private
home rather than an institution. Informal caregivers reported feeling more tranquil with a
family member living in the AFCH.
The quantitative data enriched the qualitative data in that the quantitative data
reflected the emotional state of the participants. For example, the resident whose level of
depression according to the GDS was in the severe range was consistent with the
qualitative data collected on that resident. Similarly, the ZBI scores of informal
caregivers reflected their narratives about numerous events that caused them a great deal
of emotional strain.
The researchers also reviewed the emerging themes separately then discussed
their impressions. This process was essential in refining the themes further, and
additional insights were considered and incorporated. After this, we proceeded with the
more comprehensive data analysis.
In addition, the researcher’s prolonged engagement in the informants’ setting is
“relevant to the quality of information and the quality of the investigators inferences and
conclusions that are based on such information” (Tashakkori & Teddlie, 1998, p. 90). In
order to accomplish this, in addition to interviewing participants, the principal researcher
made subsequent visits to the AFCHs and made additions to the field notes about
participants’ interactions in their AFCH. In order to provide peer debriefing, during this
650 The Qualitative Report May 2011

study several experienced colleagues, including those in the field of gerontology,

provided constructive feedback.

Member Checking

To utilize member checking as a means of determining credibility and

trustworthiness, all participants were given the opportunity to review their transcriptions
to ensure accuracy; however, only the AFCH residents agreed to do so. Of the eight
informal caregivers, two agreed to read the transcript. Informal caregiver two stated
simply, “I like it, and I hope more people learn about adult family care homes because it
made a big difference in my life.” The informal caregivers’ feedback confirmed the
interpretation of their respective views.

Summary of the Findings

This study explored the experiences of AFCH residents and informal caregivers
using mixed methods approach. Through the use of a sequential exploratory design,
emphasizing the qualitative method, insights about the experiences of AFCH residents
and informal caregivers were gained. The findings revealed important insights about
residents’ preference for AFCHs and informal caregivers’ emotional state after a family
member became a resident of an AFCH.
Residents in this study reported a preference to live in an AFCH rather than
nursing homes or large adult facilities. Their preference was primarily associated with
their perception of greater opportunities for meaningful social interaction in a household
(e.g., being around children and participating/observing the routine events of daily life).
Residents also perceived a greater ability to influence the social environment of the
AFCH because of their immediate and frequent access to AFCH providers, in contrast to
a nursing home where they might little or no access to an administrator.
Informal caregivers reported less emotional strain after a relative moved into an
AFCH. They also reported a greater sense of “trust” of AFCH providers and perceived
the providers as a surrogate family.

Strengths of the Study

The mixed methods design was effective in our quest to capture the views and
experiences of AFCH residents and informal caregivers. The works of many researchers
provided excellent examples of mixed methods research as well as inspiration (Crawley
et al., 2000; Creswell, 1994; Johnson & Christensen, 2004; Onwuegbuzie & Teddlie,
2003; Reichardt & Rallis, 1994; Teddlie & Tashakkori, 2003). The works of Creswell et
al. (2003), Johnson and Onwuegbuzie (2004), and Tashakkori and Teddlie (2003) were
especially helpful in determining which mixed methods design would be best for this
study.
The sequential exploratory design provided a clear sequence of the necessary
steps in data collection and data analysis. As aforementioned, priority was given to the
qualitative aspect of the study. As such, the quantitative data was used to enrich the
Guy C. Jeanty and James Hibel 651

findings of the qualitative data by adding depth to more fully understand the experiences
of AFCH residents and informal caregivers.
The Geriatric Depression Scale and the Zarit Burden Interview substantially
enriched the descriptions of the qualitative data. The instruments revealed important
characteristics among research participants (such as the differences in burden strain
among male and female informal caregivers). These instruments were useful in
demonstrating the ways that AFCH residents found meaning living in an AFCH. The
tests both supported the qualitative data and added an additional element from which to
view the experience of AFCH residents and informal caregivers.
By and large, the mixed methodology employed in this study was an appropriate
fit given the objectives of the study. While the prospect of using mixed methods was at
times intimidating and time consuming, this approach did in fact provide the best
elements of the qualitative and quantitative traditions.

Limitations of the Study

The limitations of this study include methodological limits, sample size, and
investigator bias. While the methodology was effective in identifying and describing
crucial experiences of research participants, it is possible that the questions asked did not
identify all the important aspects of these residents and informal caregivers’ experience.
Additionally, the qualitative questions were kept to a minimum for the benefit of AFCH
residents in order to minimize possible physical and or emotional distress.
Also, conducting multiple interviews (longitudinal study) could have achieved
greater depth and breadth of understanding. The disadvantage of multiple interviews,
however, is finding participants who are willing to commit to multiple meetings as well
as completing pre and post tests. Those options were beyond the scope of this study.
However, future investigators might do well to explore these possibilities.
The study was restricted to the investigation of AFCH residents in Broward
County, Florida. Exploring the experiences of AFCH residents in northern Florida and
other states might be worthwhile because South Florida is distinct in numerous ways,
including cultural diversity. Additionally, the sample size was very modest; a larger pool
of participants might yield results that could be generalized to other groups. The sample
was also limited to one sexual orientation (i.e., heterosexual). These limitations may
provide opportunity for other researchers to study more stratified samples.
Each investigator brings a preconceived set of ideas and beliefs to the research
process. Throughout this investigation, we tried to limit the degree to which our
assumptions and beliefs influenced the findings. We are aware that it is quite possible
that through the questions we asked, or not asked, we swayed the data. To counter this
possibility, quantitative measures were used to evaluate the views and experience of
participants.

Recommendations for Future Investigators

Caution should be taken in interpreting the results of this study. Because this
study had a limited focus, a number of issues remain for future researchers. While there
are similarities between AFCHs, nursing homes, and assisted living facilities, there are
652 The Qualitative Report May 2011

important distinctions. The acuity level between nursing home and AFCH residents and
cost of delivering care are significantly different. Additionally, each AFCH is unique and
should be evaluated individually. Therefore, we wish to offer three recommendations for
future researchers.
The first recommendation is for the replication and expansion of this study.
Replication might yield new insights about aging in an AFCH, the meaning of family, the
reasons that AFCH providers choose to open their homes to older adults who are not
related to them. The use of a larger sample size might reveal additional common and
uncommon experiences of participants.
The second recommendation is to redirect the research question to include
specific aspects of the experience of specific subpopulations such as Asians, non-
Hispanic people of Caribbean descent, and gay, lesbian, and transgender individuals.
Such inquiries into the experiences of this subset of the population might reveal richer
data and findings. It is quite possible that there is variation in the experiences of different
subpopulations. Redirecting the research questions to older adult gay, lesbian and
transgender groups that are rarely represented might be particularly enlightening.
A final recommendation is to explore the characteristics of AFCH providers.
Although the focus of this inquiry was not about AFCH providers, our observation was
that all of the providers were female. Additionally, three of the five providers were Black
women; two were from the Caribbean, and the other an African-American. Similarly,
Hedrick, Sullivan, Sales, and Gray, (2009) noted that in their study most of the providers
were born outside of the United States. The characteristics of AFCH providers merit
further inquiry.
We are thankful for the contributions of the participants. The insights gained
from this study were possible because of the AFCH providers who were willing to open
their homes to an almost perfect stranger. The AFCH residents and informal caregivers
were very generous with their time; they were all altruistic in sharing their stories about
the chain of events that brought them to an AFCH.

References

Ayer, A. J. (1959). Logical positivism. New York, NY: The Free Press.
Brody, E., Hoffman, C., Kleban, M., & Schoonhover, C. (1989). Caregiving daughters
and their local siblings: Perceptions, strains, and interactions. Gerontologist,
29(3), 529-538.
Burrs, F. A. (1995). The African-American experience: Breaking the barriers to hospices.
The Hospice Journal, 10(3), 15-18.
Chappell, N. L., & Reid, R. C. (2002). Burden and wellbeing among caregivers:
Examining the distinction. The Gerontologist, (42)6, 772-780.
Chenail, R. J., & Maione, P. (1997). Sensemaking in clinical qualitative research. The
Qualitative Report, 3(2), 1-9.
Corcoran, K., & Fischer, J. (2000). Measures for clinical practice (3rd ed., Vol. 2). New
York, NY: The Free Press.
Cox, C. B. (2005). Community care for an aging society: Issues, policies, and services.
New York, NY: Springer Publishing Company, Inc.
Guy C. Jeanty and James Hibel 653

Crabtree, B. F., & Miller, W. L. (Eds.). (1992). Doing qualitative research. Newbury
Park, CA: Sage.
Crawley, L., Payne, R., Bolden, J., Payne, T., Washington, P., & Williams, S. (2000).
Palliative and end-of-life care in the African-American community. The Journal
of the American Medical Association, 284(19), 2518-2529.
Creswell, J. W. (1994). Research design: Qualitative and quantitative approaches.
Thousand Oaks, CA: Sage.
Creswell, J. W., Plano-Clark, V. L., Gutman, M. L., & Hanson, W. E. (2003). Advanced
mixed methods research designs. In A. Tashakkori & C. Teddlie (Eds.),
Handbook of mixed methods in social & behavioral research (pp. 209-240).
Thousand Oaks, CA: Sage.
Denzin, N. K. (1978). The logic of naturalistic inquiry. In N. K. Denzin (Ed.),
Sociological methods: A sourcebook (pp. 1-32). New York, NY: McGraw Hill.
Denzin, N. K., & Lincoln, Y. S. (1994). Introduction: Entering the field of qualitative
research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative
research (p. 17). Thousand Oaks, CA: Sage.
Dey, I. (1993). Qualitative data analysis. London: Routledge.
Easton, K. L. (1999). Using focus groups in rehabilitation nursing. Rehabilitation
Nursing, 24(6), 212-215.
Ekblad, S., Marttila, A., & Emilson, M. (2000). Cultural challenges in end-of-life care:
Reflections from focus groups’ interviews with hospice staff in Stockholm.
Journal of Advanced Nursing, 31(4), 623-630.
Garrett, J. M., Harris, R., Norburn, J., Patrick, D., & Danis, M. (1993). Life sustaining
treatments during terminal illness: Who wants what? Journal of General Internal
Medicine, 8(3), 361-368.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for
qualitative research. Hawthorne, NY: Aldine.
Golander, H. (1992). Under the guise of passivity: We can communicate warmth, caring,
and respect. In J. M. Morse (Ed.), Quantitative health research (pp. 192-201).
Newbury Park, CA: Sage.
Gordon, A. K. (1995). Deterrents to access and service for Blacks and Hispanics: The
medicare hospice benefits, healthcare utilization, and cultural barriers. The
Hospice Journal, 10(2), 65-83.
Gordon, A. K. (1996). Hospice and minorities: A national study of organizational access
and practice. The Hospice Journal, 11(4), 49-70.
Greene, J. C., Caracelli, V. J., & Graham, W. F. (1989). Toward a conceptual framework
for mixed-method evaluation designs. Educational Evaluation and Policy
Analysis, 11(3), 255-274.
Gubrium, J. F., & Sankar, A. (Eds.). (1994). Qualitative methods in aging research.
Thousand Oaks, CA: Sage.
Hedrick, S. C., Sullivan, J. H., Sales, A. & Gray, S. L. (2009). Mom and pop versus
the big boys: Adult family homes as providers of Medicaid-funded residential
care. Journal of Aging and Social Policy, 21(1), 31-51.
Howe, K. R. (1988). Against the quantitative-qualitative incompatibility thesis or dogmas
die hard. Educational Research, 17(3), 10-16.
654 The Qualitative Report May 2011

Johnson, R. B., & Christensen, L. B. (2004). Educational research: Quantitative,

qualitative, and mixed approaches. Boston, MA: Allyn and Bacon.
Johnson R. B., & Onwuegbuzie, A. J. (2004). Mixed methods research: A research
paradigm whose time has come. Educational Researcher, 33(3), 14-26.
Johnson, R. B., & Turner, L. A. (2003). Data collection strategies in mixed methods
research. In A. Tashakkori & C. Teddlie (Eds.), Handbook of mixed methods in
social and behavioral research (pp. 297-319). Thousand Oaks, CA: Sage.
Karlikaya, G., Yukse, G., Varlibas, F., & Tireli, H. (2005). Caregiver burden in dementia:
A study in the Turkish population. The Internet Journal of Neurology, 4(2), 12-
26.
Kaufman, S. (1994). In-depth interviewing. In J. F. Gubrium & A. Sankar (Eds.),
Qualitative methods in aging research (pp. 123-136). Thousand Oaks, CA: Sage.
Kayser-Jones, J., & Koenig, B. A. (1994). Ethical issues. In J. G. Gubrium & A. Sankar
(Eds.), Qualitative methods in aging research (pp. 15-32). Thousand Oaks, CA:
Sage.
Keith, J. (1994). Consequences for research procedure. In J. F. Gubrium & A. Sankar
(Eds.), Qualitative methods in aging research (pp. 105-119). Thousand Oaks, CA:
Sage.
Kemper, E. A., Stringfield, S. & Teddlie, C. (2003). Mixed methods sampling strategies
in social science research. In A. Tashakkori and C. Teddlie (Eds.), Handbook of
mixed methods in social and behavioral research (pp. 273-296). Thousand Oaks,
CA: Sage.
Kemper, E. A., & Teddlie, C. (2000). Mandated site-based management in Texas:
Exploring implementation in urban high schools. Teaching and Change, 7(2),
172-200.
La Veist, T. A. (1994). Beyond dummy variables and sample selection: What health
services researchers ought to know about race as a variable. HSR: Health Services
Research, 29(2), 1-16.
La Veist, T. A. (1996). Why we should continue to study race … but do a better job: An
essay on race, racism and health. Ethnicity & Disease, 6(4), 21-29.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage
Publications.
Lyman, K. A. (1994). Fieldwork in groups and institutions. In J. G. Gubrium & A.
Sankar (Eds.), Qualitative methods in aging research (pp. 155-170). Thousand
Oaks, CA: Sage.
Marshall, C., & Rossman, G. B. (1995). Designing qualitative research (2nd ed.).
Thousand Oaks, CA: Sage.
Maxwell, S. E., & Delaney, H. D. (2004). Designing experiments and analyzing data.
Mahwah, NJ: Lawrence Erlbaum.
Mays, N., & Pope, C. (2000). Qualitative research in health care: Assessing quality in
qualitative research. British Medical Journal, 320(7), 7226-7250.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: A source book of
new methods. Beverly Hills, CA: Sage.
Morse, J. M. (1991). Approaches to qualitative-quantitative methodological triangulation.
Nursing Research, 40(3), 120-123.
Guy C. Jeanty and James Hibel 655

Morse, J. M., & Field, P. A. (1995). Qualitative research methods for health professions
(2nd ed.). Thousand Oaks, CA: Sage.
Neubauer, B. J., & Hamilton, C. L. (1990). Racial differences in attitudes toward hospice
care. The Hospice Journal, 6(2), 37-48.
Nuwaha, F., Faxelid, E., Neema, S., Erikson, C., & Hojer, B. (2000). Psychosocial
determinants for sexual partner referral in Uganda: Qualitative results.
International Journal of STD & AIDS, 11(2), 156-161.
Onwuegbuzie, A. J., & Collins, M. T. (2007). A typology of mixed methods sampling
designs in social science research. The Qualitative Report, 12(2), 281-316.
Onwuegbuzie, A. J., & Johnson, R. B. (2006). The validity issue in mixed research.
Research in the Schools, 13(1), 48-63.
Onwuegbuzie, A. J., & Leech, N. L. (2006). Linking research questions to mixed
methods data analysis procedures. The Qualitative Report, 11(3), 474-498.
Onwuegbuzie, A. J., & Teddlie, C. (2003). A framework for analyzing data in mixed
methods research. In A. Tashakkori & C. Teddlie (Eds.), Handbook of mixed
methods in social and behavioral research (pp. 351-383). Thousand Oaks, CA:
Sage.
Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury
Park, CA: Sage.
Reaves, C. C. (1992). Quantitative research for the behavioral sciences. New York, NY:
John Wiley & Sons.
Reichardt, C. S., & Rallis, S. F. (1994). Qualitative and quantitative inquiries are not
incompatible: A call for a new partnership. In C. S. Reichardt & S. F. Rallis
(Eds.), The quantitative-qualitative debate: New perspectives (pp. 85-92). San
Francisco, CA: Josey-Bass.
Robbins, M. (2001). MFT researchers gain crucial skills, feedback, support. Family
Therapy News, 32(4), 1-27.
Rowles, G. D., & Reinharz, S. (1988). Qualitative gerontology: Themes and challenges.
In S. Reinharz & G. D. Rowles (Eds.), Qualitative gerontology (pp. 3-33). New
York, NY: Springer.
Schrag, F. (1992). In defense of positivist research paradigms, Educational Researcher,
21(5), 5-8.
Sofaer, S. (1999). Qualitative methods: What are they and why use them. HSR: Health
Services Research, 34(2), 1101-1118.
Spencer, J., Hersch, G., Aldridge, J., Anderson, L., & Ulbrich, A. (2001). Daily life and
forms of “communitas” in a personal care home for elders. Research on Aging,
23(6), 611-632.
Strauss, A., & Corbin, J. (1990). Basics of qualitative research-grounded theory
procedures and techniques. Newbury Park, CA: Sage.
Tashakkori, A., & Teddlie, C. (1998). Mixed methodology: Combining qualitative and
quantitative approaches. Thousand Oaks, CA: Sage.
Tashakkori, A., & Teddlie, C. (Eds.). (2003). Handbook of mixed methods in social and
behavioral research. Thousand Oaks, CA: Sage.
Teddlie, C., & Tashakkori, A. (2003). Major issues and controversies in the use of mixed
methods in the social and behavioral sciences. In A. Tashakkori & C. Teddlie
656 The Qualitative Report May 2011

(Eds.), Handbook of mixed methods in social & behavioral research (pp. 3-50).
Thousand Oaks, CA: Sage.
Williams, D. R. (1994). The concept of race in health services research: 1966 to 1990.
HSR: Health Services Research, 29(2), 261-274.
Williams, F. (1992). Reasoning with statistics: How to read quantitative research. New
York, NY: Harcourt Brace Jovanovich College Publishers.
Yin, R. K. (1999). Enhancing the quality of case studies in health services research. HSR:
Health Services Research, 34(3), 1211-1224.
Zarit, S. H. (1990). Interventions with frail elders and their families: Are they effective
and why? In M. A. P. Stephens, J. H. Crowther, S. E. Hobfoll, & D. L.
Tennenbaum (Eds.), Stress in coping in later life families (pp. 3-27). Washington,
DC: Hemisphere.

Author Note

Guy C. Jeanty is adjunct professor in the Department of Marriage and Family

Therapy at Carlos Albizu University’s in Miami, FL. He is also a faculty member in the
Harold Abel School of Social and Behavioral Sciences at Capella University. Dr. Jeanty
serves on the Advisory Board for Persons with Disabilities in Broward County, Florida.
He has worked in a variety of social service agencies, conducting clinical evaluation of
emotionally disturbed children. He was the Program Director for a Florida Assertive
Community Treatment serving adults with co-occurring disorders. Prior to working in
community mental health, he worked as a hospice chaplain. Correspondence regarding
this article can be addressed to: Dr. Guy Jeanty at Phone: 954-533-5905 or by E-mail:
gcesarj@yahoo.com
James Hibel is Associate Professor of Family Therapy and Senior Director of
Institutional Assessment, Planning and Relations in the Graduate School of Humanities
and Social Sciences at Nova Southeastern University. His recent research interests
include pedagogy, supervision and clinical practices in narrative therapy and
enhancement of institutional assessment practices. Correspondence can also be
addressed to: Dr. James Hibel, Graduate School of Humanities and Social Sciences, Nova
Southeastern University, 3301 College Avenue, Ft. Lauderdale, FL 33314; Phone: 954-
262-3067; E-mail: hibelj@nova.edu

Copyright 2011: Guy C. Jeanty, James Hibel, and Nova Southeastern University

Article Citation

Jeanty, G. C., & Hibel, J. (2011). Mixed methods research of adult family care home
residents and informal caregivers. The Qualitative Report, 16(3), 635-656.
Retrieved from http://www.nova.edu/ssss/QR/QR16-3/jeanty.pdf