Search

A mixed methods study has the potential to produce knowledge that is unavailable to a qualitative study and a quantitative study undertaken independently. Any unique insight or "yield" from a mixed methods study may be difficult to assess in practice. However, given that integration of data or findings from different components of a study is a core characteristic of mixed methods research, two possible indicators of yield can be used: first, the extent to which researchers exploit the potential for integration in mixed methods studies; and second, the way in which this integration is communicated in peer-reviewed journal articles. Here, the authors apply these indicators to mixed methods studies in health services research in the United Kingdom. (Contains 6 tables and 1 note.)

NHS Direct is a 24 h telephone helpline established in England and Wales, UK to offer advice and information for people about health, illness and the National Health Service (NHS) so that they are better able to care for themselves and their families. In 2001/2002 we undertook in-depth home interviews with 60 users of the service in two NHS Direct sites in England. In this paper we consider the extent to which NHS Direct facilitates patient empowerment in terms of helping people to be in control of their health and health care interactions. Our research suggests that NHS Direct facilitates patient empowerment by enabling patients to self care and to access health advice and services. It is also seen to offer the prerequisites for empowerment perceived to be lacking in the wider NHS, including time, respect, listening, support, and information. The service also functions by offering an alternative contact point for people seeking to avoid being labelled 'time wasters' by other busy health care providers. In the context of a wider health service which appears to problematise individuals' ability to make decisions about the appropriateness of seeking health care, NHS Direct legitimises help-seeking actions. Empowerment in the context of NHS Direct has been associated with self care as a way of reducing 'unnecessary' demand on health services. However, health professional and patient perspectives on what is considered necessary demand differ, and in certain contexts, patient empowerment may involve service use as well as self care. Further, our data reveal the context-dependent nature of a concept like empowerment. For example, when people are ill, in pain, or anxious about a loved one, they may value being cared for more than being empowered. Our research suggests that, in addition to its other functions, NHS Direct is also valued as contributing to a sense of being cared for. Keywords. NHS Direct; UK; Patient empowerment; Self-care; Legitimacy

In a move towards a more informed understanding of the concept of satisfaction, this paper aims to explore how 30 dermatology patients describe what it meant to them to be either satisfied or very satisfied with their healthcare. This was undertaken using in-depth interviews and the findings suggest that participants clearly differentiated between being satisfied or very satisfied with healthcare. While for some participants, being satisfied with healthcare was described in terms of care being adequate or average, for others it meant that there were aspects of healthcare that could be improved, or that something was missing and that optimal care was not achieved. Care and management had been 'acceptable' or 'sufficient' but not 'outstanding.' In contrast, being very satisfied with particular aspects of healthcare was described in ways that suggested that the service was not only more than adequate, but ranged from 'better than average' to 'outstanding', i.e. optimal care had been provided. This observation of a 'continuum of satisfaction' has specific and important implications for the future analysis and presentation of patient satisfaction surveys. It is suggested that attention to the differences between the two constructs provides a useful means to highlighting areas of patient concern and that researchers reporting the results of patient satisfaction surveys should cease to collapse them.