A mixed methods exploratory design optimising both quantitative and qualitative approaches was identified to achieve the study aims.
Creswell describes mixed methods as gathering quantitative (close-ended) and qualitative (open-ended) data, integrating the two, and drawing interpretations based on the combined data sets’ [9,10]. This method allows for mixing of both paradigms of deduction (which explores a hypothesis by testing it- an approach frequently used in a quantitative research) and induction (which involves open ended observations to logically explain findings; an approach frequently used in a quantitative research) in a holistic way [11]. The intent was that using a combination of methods would be more translatable and better inform modern day health education for future preceptorship programmes.
A sequential mixed method study design was used:
1. An online self-completed cross-sectional survey questionnaire (via Microsoft forms) aimed at qualified AHPs working within the SSOT ICS.
2. Consenting survey respondent were recruited to participate in two subsequent focus groups with current SSOT newly qualified AHPs (preceptees) and experienced AHP preceptors/ managers (preceptors).
In this design, survey responses informed the subsequent interview topic guide used for the focus groups, which enabled greater understanding of preceptor and preceptee experiences in SSOT. For example, barriers to participation in preceptorship programmes and participants’ recommendations for improvements for newly qualified AHP staff could be explored in more detail.
Focus group findings and identified themes facilitated triangulation of survey results. Using a mixed methods approach enabled all results and findings to be considered, including those not falling clearly within the quantitative and qualitative boundaries and greater insights to be gained [12].
Some authors have highlighted inconsistencies, uncovered using a mixed method approach, thereby strengthening the research by providing information that would not necessarily be discovered using a single method approach [13]. Consideration was given to how contradictory views would be managed to ensure transparency of reporting [14,10]. The McGill Mixed methods Appraisal Tool (MMAT) guided the reporting of this research.
Some suggest mixed method approaches place a high demand on individual researchers to have skills in both qualitative and quantitative analyses which might be difficult to achieve [15], especially as typically, researchers will have a foundation of either a qualitative or quantitative research. To mitigate this, one of the research team had a background in qualitative research (AOB), another a background in quantitative methods (ES), thus, as recommended, working collaboratively [16], which authors anticipated would strengthen the overall quality of the study.
Quantitative component – Survey questionnaire
The survey was designed by a sub-group of the SSOT AHP Faculty Committee and piloted by five newly qualified AHPs/ ‘critical AHP friends’ outside SSOT ICS across England’s West Midlands region. A Microsoft form was selected as the online platform supported by all UK NHS systems, to optimise responses.
The survey included 65 questions in six sections: demographic and profession related details; (including where the AHP was currently practicing, banding of post and whether they were a newly qualified); details of preceptorship programs and supervisory support, questions relating to delivery, usefulness, and finally AHP personal experiences of preceptorship.
Most answer options were multiple choices, with subsequent branching to increase speed of completion. Likert scales were used to facilitate speed of completion and 21 free text answer opportunities given to allow respondents to clarify their responses e.g., listing adaptations made due to COVID and requesting results and/ or participation in focus groups.
Sample size:
No organisation was able to provide a complete inventory of AHP employees by grade or discipline, but estimates were identified for the proportion of AHPs in the four NHS providers in 2021 (Table 1).
Given the exploratory nature of the survey a formal sample size was not calculated. No current data exists to accurately identify the number of AHPs working in Stafford and Stoke on Trent ICS.
Inclusion criteria:
The eligibility criteria for survey respondents to be included in the analysis were: -
i) Self–reported as qualified Health and Care Professionals Council (HCPC) registered Allied Health Professionals [1].
ii) Employed in the Integrated Care System of Staffordshire and Stoke on Trent
Exclusion criteria:
- Support worker/ un-qualified health professional assistant
- Registered AHP working outside of SSOT ICS
Recruitment:
The project team used a snowball method of recruitment using social media, emails and AHP networks, and NHS Trust communications (briefings and screen savers). Every effort was made to recruit AHPs working in the private, independent, and voluntary organisational sectors.
The survey was open for 19 days in May 2021 and the response rate monitored throughout. Due to poor initial response from newly qualified AHPs, so additional reminders were sent on Microsoft chat, as well as daily posts on social media. Some Trusts were targeted specifically via email and via AHP Faculty members to enhance response rate. Survey data were analysed in Excel version 2016 and summarised using descriptive statistics.
Qualitative Component – Focus Groups
Two online focus groups were scheduled to optimise participation, with minimal disruption to clinical services. The research team were mindful that during the COVID-19 pandemic most AHPs were familiar with virtual discussions via Microsoft Teams platform. Consequently, this format was chosen, with additional benefit of ensuring compliance with pandemic social distancing measures and convenience; enabling busy clinicians, across the four main NHS provider organisations maximum opportunity to participate.
Sample:
All Focus Group (FG) participants were consenting survey respondents, purposively sampled and invited by email to participate by the project manager to obtain gender, ethnicity, AHP profession and workplace balance between newly qualified AHP preceptees and senior AHP preceptors. If an expression of interest followed, interested parties were sent the FG Participant Information Sheet and a consent form. On successful completion and email return, participants were sent the calendar invitation link to participate in the relevant MS Teams focus group.
Focus group preparation:
Each FG aimed to further explore and gain additional insights relating to the survey results. The pre-determined topic guide was used to facilitate the discussion and included open questions, with follow up prompts as necessary. Prior to each FG the lead facilitator (ES or AOB) and observer (KJ) independently documented their preconceptions and expected outcome of the discussions, to proactively identify project team assumptions and limit potential bias.
Procedure:
Each group was led by an experienced facilitator and observed by an independent observer who made additional notes. Consent was reiterated at the start of each FG which was audio-recorded on MS Teams. To promote honest candid responses, participants were reminded that anonymity would be guaranteed and any quotes subsequently used would be non-identifiable to an individual or their employing organisation.
The first focus group for preceptees (newly qualified AHPs) was held on 23.06.21.; the second for Preceptors (experienced clinicians/ managers) on 24.06.21. Prior to the second focus group the project team met to share provisional thoughts on how discussions from the preceptee focus group should influence the second discussion. Initial key discussion topics identified in the preceptee group were subsequently further explored with the preceptors.
Audio recordings from both focus groups with the verbatim MS Stream transcripts were analysed and subsequently themes identified as per [17] thematic analysis approach. Semantic and latent coding was undertaken independently by all three authors (AOB, ES & KJ). Sub-themes and final themes were then agreed, and any discrepancies resolved through consensus agreement.
Data Integration
The results were brought together using ’joint displays’ (Figure 1). Consistency and inconsistency are highlighted in the integration phase (third column on the joint display tables). The joint displays are a frequently used approach to provide a structure from which conceptual similarities can be identified in a transparent and meaningful way [18]. Triangulation with previously published preceptorship data is detailed in the discussion.