A sequential mixed-methods design for role extension research in radiography: Methodological Insights from a framework development study in Ghana

AbstractIntroduction Radiographer role extension into image interpretation has gained global attention, particularly in low-resource settings where radiologist shortages hinder timely diagnosis. However, limited methodological guidance exists to support the design of complex, context-specific implementation research in this area. This paper outlines and reflects on a four-phase sequential mixed methods design employed to develop and validate a framework for Preliminary Image Evaluation (PIE) by radiographers in Ghana. Method This methodological paper presents a reflective account of the design decisions and integration strategies that guided a multi-phase mixed methods study on radiographer role extension. Rather than reporting new empirical data, the focus is on the philosophical positioning, analytical choices, and integration logic that shaped the study. Key methods included qualitative interviews, a validated online survey, performance-based image interpretation tests, curriculum document analysis, and a Delphi consensus process. Results Sequential integration of qualitative, quantitative, documentary, and performance-based data generated meta-inferences that supported cumulative knowledge building and iterative refinement of research tools. The design enabled alignment across data strands, enhanced interpretive trustworthiness, and culminated in a validated PIE framework tailored to resource-constrained environments. Stakeholder engagement throughout the process reinforced contextual relevance and legitimacy. Conclusion This study demonstrates the methodological strength and contextual value of methodological diversity and purposeful method integration in addressing complex workforce issues. It shows how mixed methods designs can move beyond isolated findings to inform sustainable education reform, workforce development, and policy alignment in radiography. Implication for practice This work offers a methodological model that can guide educators, researchers, and policymakers in designing contextually responsive workforce research. By showcasing how integrated mixed methods can generate policy-relevant and actionable insights, it supports the development of strategic approaches to radiographer role extension.