Table 1.

Studies using MMR to examine children with T1D

Authors, date, and origin	Study purpose	Sample	MMR definition	MMR rationale	MMR design and other methods	Methods	Integration
Disease management
Lehmkuhl et al., 2009 USA	To assess perceptions of disease management in children with T1D and their peers	N = 70 adolescents ages 11–16 attending a diabetes camp (45 had T1D; 25 were peers)	“Mixed methods (qualitative and quantitative data) approach”	“This type of mixed methods approach provides the most comprehensive picture of children’s attitudes and opinions about sensitive topics such as having a chronic illness like diabetes” Heary & Hennessy (2002) cited	Mixed method, concurrent approach Quan + Qual	Surveys that included multiple choice and open-ended questions with constant comparative analysis	Integration of data occurred after individual analysis of strands “the present study incorporated quantitative data about children’s perceptions in order to augment the qualitative”
Patton et al., 2016 USA	To examine knowledge of and perceived barriers to dietary management in parents of young children with T1D	N = 23 families with a child 1–6 years old with T1D	“The mixed methods design of this study integrated parents’ qualitative perceptions of healthful eating and a quantitative assessment of their child’s diet and mealtime behavior to identify specific targets for nutrition-focused components of diabetes education programs for families of young children.” Not cited	“A significant contribution of this study is its presentation of both quantitative and qualitative data, allowing for integration of parents’ reported beliefs and behaviors and their personal narratives, perceptions, and opinions related to diet and mealtimes.”	Concurrent Quan + QUAL	Demographic questionnaire, surveys, 3-day food diary with measured servings, semi-structured interview	“integrated parents’ qualitative perceptions of healthful eating and a quantitative assessment of their child’s diet and mealtime behavior”
Erie et al., 2018 USA	To explore continuous glucose monitoring practices in homes and schools in caregivers of children with T1D	N = 33 parents and 17 daytime caregivers of children 2–17 (x = 9.1, sd = 4)	Uses “mixed methods” terminology but does not define or cite with MMR literature	No rationale for using mixed methods design provided	Concurrent Quan + Qual	Surveys with multiple choice and open-ended questions. Grounded theory was used to analyze qualitative data	Used mixed methods analysis to examine data
Oser et al., 2020 USA	To understand barriers and facilitators, including self-management challenges and successes, to raising a child with autism spectrum disorder (ASD) and T1D	Phase 1: N = 1398 blog posts Phase 2: N = 12 caregivers of children with T1D and ASD	Uses “mixed methods” in the title but does not explicitly define or cite in the article	“This 2-step approach allowed further exploration of initial themes identified from the secondary data analysis of web-based content, with the advantage of being able to ask follow-up questions.” “utilizes a qualitative component to allow further exploration of the lived experience of raising a child with both T1D and ASD. We also sought to gather some exploratory information.”	Sequential QUAL ↓ QUAL + quan	Phase 1: thematic analysis of blog and forum posts Phase 2: Semi-structured interviews with thematic analysis and demographic surveys	“The themes generated from this study were used to create an interview guide that was used in phase 2”
Stanek et al., 2020 USA	To examine the impact of stressful life events on diabetes management in the first year of diagnosis	N = 128 families of children 5–9 years old with recent-onset T1D	Uses “mixed methods” terminology but does not define or cite	No rationale for using MMR; “The objectives of this study were to examine the impact of stressful life events on T1D characteristics of school-age children with recent-onset T1D, and to identify family psychological stressors correlated with greater numbers of stressful life events using a mixed methods design.”	Longitudinal, MMR design QUAN + qual	Surveys, open-ended questions No clear qualitative methodology	No clear integration
Faulds et al., 2021 Faulds et al., 2020 USA	To understand adolescents’ self-management behaviors, including barriers and facilitators, when using diabetes technologies	Phase 1: N = 80 children ages 10–18 with T1D Phase 2: N = 10 children ages 10–18 with T1D	Uses “mixed methods” terminology but does not define or cite	Cites Happ et al. (2006) to justify the approach used in the MMR study	Sequential, mixed method study Quan → Qual	Phase 1: Surveys; health outcomes data Phase 2: Semi-structured interviews with a qualitative descriptive approach	Phase 1 findings were used to recruit participants for phase 2 “Selected quantitative outcomes from the larger descriptive study were contrasted and compared to further dimensionalize main themes and patterns”
Morone et al., 2021 USA	To understand social determinants of health that act as barriers to diabetes management, especially in single-parent black households	Phase 1: N = 4/16 parents Phase 2: 9 parents Phase 3: 105 parents	Uses “mixed methods” terminology but does not define or cite with MMR literature	“sequential, exploratory design... to ensure that parents generated, prioritized, and explained their own study ideas.”	Sequential, exploratory, 3-phase mixed methods study Qual → Quan	Phase 1: Focus group and NGT sessions Phase 2: semi-structured interviews Phase 3: Survey development and administration	Each phase of data informed subsequent phases Qualitative data from phases 1 and 2 were used to develop the survey administered in phase 3
Support
Rearick et al., 2011 USA	To explore peer support in parents of children newly diagnosed with T1D following the Social Support to Empower Parents (STEP) intervention	N = 21 parents completed interviews N = 11 parents completed surveys	Uses “mixed methods” terminology but does not explicitly define “concurrent nested mixed-methods study—with qualitative inquiry as the core component (ie, the interview) and with quantitative inquiry as the nested component” Flemming (2007) cited	“The use of a mixed-methods approach can provide a more balanced perspective of experience, moving toward holism”	Concurrent, nested QUAL(quan)	Framework-informed interviews with content analysis, survey (family measurement measure)	Integration during interpretation of qualitative and quantitative data
Hayes et al., 2017 UK	To understand what creates a supportive school environment and how school environments may contribute to diabetes management; specifically looked at perceived stress, resiliency, and perceived social support	Phase 1 = 54 students 11–16 years old with T1D Phase 2 = 6 children	Uses “mixed methods” terminology but does not explicitly define Creswell et al. (2002) & Robson (2011) are cited	Not explicitly explained but appears to be confirmatory with emphasis placed on one strand to highlight and strengthen findings of the other strand “The qualitative data built on the findings of the quantitative data and pupils’ views highlighted important themes related to resilience and managing T1D in a UK school setting”	Sequential, explanatory strategy QUAN → qual	Phase 1: Surveys including the Resiliency Scale for Children & Adolescents Phase 2: semi-structured interviews with thematic analysis	Scores from the Resiliency Scale for Children & Adolescents in phase 1 were used to select participants to complete phase 2
Development and evaluation of interventions/measures
Carroll et al., 2007 USA	To evaluate user satisfaction with a pilot study using an integrated phone system	N = 10 adolescents 13–18 years old	Refers to mixed methods in abstract but does not define, cite, or use terminology in the article	“...mixed quantitative and qualitative methods to evaluate user satisfaction with the integrated system”	Qual—> QUAN	focus groups, surveys	Qualitative findings were used in intervention design/feedback; the quantitative sample was a subsample of the qualitative sample
Monaghan et al., 2011 USA	To assess parent satisfaction of a 5-session intervention to enhance parent mastery of diabetes management	Phase 1: N = 12 parents of children ages 1–6 years with T1D Phase 2: N = 4 parents of children ages 1–6 years with T1D	“Mixed-methods research strategies can be employed to learn both to what degree and how and why an intervention works (Teddlie & Tashakkori, 2009).”	“Program evaluation, an integral component of clinical trial research, incorporates quantitative and qualitative methods, with qualitative methods being particularly useful in modifying existing interventions, evaluating intervention delivery, determining for whom the intervention is most beneficial, and assessing what components may be downsized or enhanced” Sandelwoski (2000) cited	Sequential, MMR design QUAN → qual Program evaluation	Phase 1: Surveys Phase 2: in-depth interviews with thematic analysis	“Results from qualitative analyses were integrated with quantitative findings to identify possible program enhancements and maximize effectiveness of an intervention program for parents of young children with T1D.”
Frøisland et al., 2012 Norway	To pilot test 2 mobile phone applications to explore how mobile phones can be used for follow-up with adolescents with T1D, and guide future interventions	N = 12 adolescents ages 13–19 years old with T1D	Uses “mixed methods” in the title but does not explicitly define or cite in the article	Triangulation: “This study used triangulation of methods to provide details about the phenomenon studied that would not be available with the use of one method alone.”	QUAL + quan	Surveys and semi-structured interviews with field notes were performed at completion of the 3-month intervention	Integration of data took place after individual analysis of strands Quantitative data were used to support qualitative findings
Barnard et al., 2014 UK	To explore experiences of adolescents and their parents who participated in a pilot closed-loop insulin delivery study	N = 15 adolescents (12–18 years old) N = 13 parents	“Mixed methods psychosocial evaluation... using qualitative and quantitative research methods.”	“A mixed methods psychosocial evaluation was conducted to determine the utility of the device in terms of participants’ perceptions of lifestyle change, diabetes management, and fear of hypoglycemia.”	Concurrent Qual + Quan	Pre- and post-intervention surveys, semi-structured interviews	Quantitative and qualitative strands were analyzed individually and integrated in discussion findings
Jaser et al., 2014 USA	To develop and test feasibility of a positive psychology intervention	N = 39 adolescents 13–17 years old and their parents	Does not define, cite, or use mixed method terminology, but uses “quantitative and qualitative data”	“...used quantitative and qualitative methodology to evaluate the intervention”	Longitudinal, pilot study QUAN (multiple timepoints) ↓ quan + qual (evaluation)	Clinical data, surveys, semi-structured interviews	For evaluation, quantitative and qualitative strands were analyzed individually and integrated in discussion findings
Cooper et al., 2014 UK	To develop and test the Adolescent Diabetes Needs Assessment Tool	N = 171 children 12–18 years old	Uses “mixed methods” terminology but does not define or cite	No rationale for using mixed methods design provided	Qual—> QUAN	Literature search w/ secondary framework analysis, item review, reliability, and validity testing	Themes elicited from qualitative literature review were used to develop items
Cooper et al., 2018 UK	An evaluation study to assess feasibility of using an app, the Adolescent Diabetes Needs Assessment Tool	While there were 89 adolescents aged 12–18 years old with T1D who participated in the intervention, evaluation measures were completed with providers in the clinic	Uses “mixed methods” terminology but does not explicitly define or cite	No explicit MMR rationale but suggest that MMR is helpful to determine methodological recommendations for a future, large-scale study and to assess for overlap between strand findings to help explain outcomes	Non-randomized, mixed method design Quan + Qual	Data collected from the app, and surveys and 3 focus group interviews at the completion of the intervention	Integration of data took place after individual analysis of strands
Mitchell et al., 2018 Mitchell et al., 2016 UK	To examine feasibility of an intervention to improve physical activity in children with T1D	N = 20 children aged 7–16 years with T1D (10 in the RCT group/10 in the control group). 16 children completed qualitative interviews	Uses “mixed methods” terminology but does not define or cite	No explicit MMR rationale; “The Medical Research council (MRC) framework for developing and evaluating complex interventions strongly advises carrying out feasibility and pilot work prior to running a full-scale trial; therefore, in keeping with phases 1 and 2 of the MRC framework, the aim of this study was to use a mixed-method study design”	Pilot RCT with mixed method study design Quan + QUAL Qualitative interviews followed intervention completion	Surveys, anthropometric measures, accelerometer data, and semi-structured interviews analyzed with 6-stage thematic process	Integration of data took place after individual analysis of strands and qualitative data was used to explain quantitative findings
Whittemore et al., 2018 USA	To understand experiences of parenting adolescents with T1D and develop a prototype for an eHealth program	Phase 1: N = 21 parents of adolescents ages 12–18 Phase 2: N = 16 providers Phase 3: N = 53 parents and 27 providers	“multiphase method was used generating both qualitative and quantitative data at multiple time points”	No clear rationale, but states “mixed-methods evaluation”	Phase 1: (Qual) Phase 2: prototype development Phase 3: mixed methods evaluation (QUAL + quan)	Semi-structured interviews, focus groups, surveys	Findings from phase 1 used to inform Phase 2. Phase 3 evaluated the prototype developed in Phase 2. Some of the sample from Phase 1 also completed Phase 3
Albanese-O’Neill et al., 2019 USA	To design and evaluate online, mobile diabetes education for fathers of children with T1D to improve diabetes knowledge and self-efficacy	Phase 1: N = 30 fathers of children ages 6–17 with T1D Phase 3: N = 33 fathers who did not participate in Phase 1	Uses “mixed methods” terminology but does not explicitly define Cites Creswell (2008)	Rationale provided for the use of the evaluation design, but not for specific MMR methodology: “...study design was informed by the small but growing field of literature on the best practices for eHealth tool development.”	Multiyear, mixed method study with 3 phases Quan + Qual ↓ Website design ↓ QUAN + qual	Phase 1: Exploratory research with semi-structured interviews and surveys Phase 2: Website/subdomain development Phase 3: Evaluation	Integration of data at each phase of data collection. Findings from individual phases used to inform subsequent phases
Connan et al., 2019 Canada	To design, develop and refine an online education module	N = 18 children N = 15 caregivers *in children < 8 parent-report only & in children > 16 child-report only	Uses the phrase “mixed-methods usability testing approach,” but does not define or cite	“...to determine usability and further refine the e-module prototype”	Quan + Qual	2 iterative cycles: semi-structured interviews, observation, surveys	Quantitative and qualitative strands were analyzed individually and integrated in discussion findings
Kaya Meral & Yildirim, 2020 Turkey	To assess the effects of psychodrama group therapy on quality of life, depression, and adaptive skills in mothers of children with T1D	N = 14 mothers of children with T1D	“A mixed research method that included qualitative and quantitative data collection and analysis process. The design classification of the research was a convergent parallel design.” Not cited	The rationale for using MMR design was not explicitly stated	Convergent, parallel, MMR design Concurrent Quan + Qual *Fig. 1 details the research design	Randomized pre and posttest control group design with surveys Phenomenological methods with group records, Moreno’s social atom directive	Integration of data took place after individual analysis of strands
Versloot et al., 2021 Canada	To describe the implementation and evaluation of a 4-step care model related to quality of life in adolescents with T1D	N = 236 adolescents 13–17 years old	“mixed quantitative and qualitative methods”	“...a mixed quantitative and qualitative evaluation of a pilot implementation project to gain insights into the concerns reported by adolescents with T1D on...”	4-step iterative process followed with evaluation Quan + Qual	Focus groups, semi-structured interviews, medical records, surveys, HbA1c	For evaluation, quantitative and qualitative strands were analyzed individually and integrated in discussion findings
Hilliard et al., 2022 USA	To develop and test a family behavioral intervention	Phase 1: N = 500 + families of children < 7 with T1D; N = 79 families with children < 8 years old Phase 2 and 3: N = 50 (intervention group) N = 40 (crossover group)	“mixed methods (i.e., survey data, qualitative research)”	No clear rationale provided, but mixed methods used to inform intervention development	3 phases with mixed methods assessment Quan—> Qual ↓ Intervention delivery ↓ QUAN + qual	Analysis of data from T1D database, semi-structured interviews, surveys with open-ended questions	“Experts in behavioral health and diabetes ... designed the FBI targets, materials, and protocol based on these mixed-methods results.”
Education/communication
Howe et al., 2015 USA	To understand and explore health literacy and communication experiences with diabetes educators in parents of children with T1D	N = 162 parents that completed surveys N = 24 parents that completed interviews	Uses “mixed methods” terminology but does not define or cite	“We used a mixed methods design with the intention that the quantitative and qualitative data sets would be complementary to more fully explain the communication processes between parents and diabetes educators.”	Sequential Quan—> Qual	Surveys, semi-structured interviews with content analysis	Survey findings for health literacy were used to select parents with high and low literacy scores to participate in interviews Mixing occurred in the interpretation phase