A structured, eleven-step reporting guideline for mixed-methods research in the health sciences
Explore the 11 Steps How to CiteAbout the Framework
Mixed-methods research integrates quantitative precision with qualitative depth, offering a richer understanding of complex health phenomena. Yet clinician-researchers — especially in low- and middle-income settings — receive little formal training in designing or reporting such studies.
Krishna Raj's Framework for Mixed-Methods Protocol addresses this gap by providing eleven logically sequenced, mutually reinforcing steps — each explained through familiar clinical analogies — to make mixed-methods protocol writing accessible to every medical researcher, irrespective of their prior methodology training.
The framework is applicable across mixed-methods design typologies including Explanatory Sequential, Exploratory Sequential, and Convergent Parallel designs, and is particularly suited to community medicine, public health, health systems research, and implementation science.
Medical researchers • Public health professionals • Postgraduate students • Research supervisors • Journal reviewers • Funding bodies evaluating mixed-methods proposals
Every abstract methodological concept is paired with a clinical analogy — a familiar medical procedure or diagnostic reasoning pattern — so the framework feels intuitive to clinicians from day one.
The Framework
Each step represents a distinct, essential component of a mixed-methods research protocol. The steps are sequenced to guide the researcher from philosophical grounding through to complete documentation, mirroring the logical progression of clinical diagnostic reasoning.
Select and justify the theoretical lens guiding both quantitative and qualitative strands. Analogous to selecting the diagnostic paradigm before ordering investigations.
Narrate the research problem, establish the gap in existing evidence, and justify why integration of both data types is necessary. Like a detailed clinical history that justifies the workup.
Define Specific, Measurable, Achievable, Relevant, and Time-bound objectives that span both data strands. Equivalent to setting clear treatment targets before initiating therapy.
Formulate a primary integrated research question and sub-questions that link quantitative and qualitative components. Like a clinical question that requires both lab values and patient narratives to answer.
Declare the philosophical stance (pragmatism, transformative, etc.) that underpins the mixed-methods design. Comparable to the clinician's epistemological approach to diagnosis — evidence-based versus narrative-centred.
Systematically map gaps in both quantitative and qualitative literature, demonstrating that integration is the only approach to fill the identified gap. Like a differential diagnosis supported by prior case evidence.
Specify the mixed-methods design type, sampling strategy, data collection instruments, integration point, and joint display plan. The core of the protocol — equivalent to a detailed procedure note.
Plan for interpreting integrated findings, addressing discordance between strands, and situating conclusions within existing theory. Like the clinical formulation that reconciles conflicting signs and symptoms.
Synthesise the anticipated contribution to knowledge, policy implications, and call to action. Analogous to the management plan and follow-up recommendation in a clinical summary.
Document all cited sources in APA 7th edition format with a minimum of 30 sources spanning both methodological and substantive literature. Like the evidence base underpinning a clinical practice guideline.
Include all instruments (quantitative tools, qualitative guides), informed consent forms, ethical clearance, and a Gantt chart. The complete investigator's toolkit — like the surgical tray laid before the procedure.
Validation & Registration
A formal multi-round Modified Delphi consensus validation is being conducted in accordance with the CREDES (Conducting and REporting DElphi Studies) reporting standard. International and national experts in mixed-methods research, health systems research, and medical education are participating. Consensus threshold: ≥80% agreement and Content Validity Index (CVI) ≥0.78 per step.
The framework has been submitted for registration with the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network, the international body for health research reporting guidelines. Registration number will be published here upon confirmation.
How to Cite
Researchers using, discussing, teaching, or applying this framework should cite it using the following format (APA 7th edition):
This framework is made available under a Creative Commons Attribution (CC BY 4.0) licence. You are free to share and adapt the material for any purpose, provided appropriate credit is given, the licence is indicated, and changes are noted.
Get in Touch
For enquiries about the framework, collaboration opportunities, Delphi expert panel participation, or citation permissions, please reach out.