title: A complementary marriage of perspectives: understanding organizational social context using mixed methods.
abstract: BACKGROUND
  Organizational factors impact the delivery of mental health services in community settings. Mixed-methods analytic approaches have been recommended, though little research within implementation science has explicitly compared inductive and deductive perspectives to understand their relative value in understanding the same constructs. The purpose of our study is to use two different paradigmatic approaches to deepen our understanding of organizational social context. We accomplish this by using a mixed-methods approach in an investigation of organizational social context in community mental health clinics.
  
  
  METHODS
  Nineteen agencies, representing 23 sites, participated. Enrolled participants included 130 therapists, 36 supervisors, and 22 executive administrators. Quantitative data was obtained via the Organizational Social Context (OSC) measure. Qualitative data, comprised of direct observation with spot sampling generated from agency visits, was coded using content analysis and grounded theory. The present study examined elements of organizational social context that would have been missed if only quantitative data had been obtained and utilized mixed methods to investigate if stratifying observations based on quantitative ratings from the OSC resulted in the emergence of differential themes.
  
  
  RESULTS
  Four of the six OSC constructs were commonly observed in field observations (i.e., proficiency, rigidity, functionality, stress), while the remaining two constructs were not frequently observed (i.e., resistance, engagement). Constructs emerged related to organizational social context that may have been missed if only quantitative measurement was employed, including those around the physical environment, commentary about evidence-based practice initiatives, leadership, cultural diversity, distrust, and affect. Stratifying agencies by "best," "average," and "worst" organizational social context impacted interpretation for three constructs (affect, stress, and leadership).
  
  
  CONCLUSIONS
  Results support the additive value of integrating inductive and deductive perspectives in implementation science research. This synthesis of approaches facilitated a more comprehensive understanding and interpretation of the findings than would have been possible if either methodology had been employed in isolation.
authors.affiliation: Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA. rbeidas@upenn.edu.
authors.forename: Rinad S
authors.initials: RS
authors.lastname: Beidas
authors.affiliation: Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA. cbenja@upenn.edu.
authors.forename: Courtney L Benjamin
authors.initials: CL
authors.lastname: Wolk
authors.affiliation: Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA. luwalsh2296@gmail.com.
authors.forename: Lucia M
authors.initials: LM
authors.lastname: Walsh
authors.affiliation: Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA. Arthur.C.Evans@phila.gov.|Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Philadelphia, PA, 19104, USA. Arthur.C.Evans@phila.gov.
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Evans
authors.affiliation: Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Floor 3, Philadelphia, PA, 19104, USA. Matthew.Hurford@phila.gov.|Department of Behavioral Health and Intellectual disAbility Services, 1101 Market Street, Philadelphia, PA, 19104, USA. Matthew.Hurford@phila.gov.|Community Behavioral Health, 801 Market Street, Philadelphia, PA, 19107, USA. Matthew.Hurford@phila.gov.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Hurford
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA. bargf@uphs.upenn.edu.
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003155:Community Mental Health Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D018864:Cultural Diversity; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D004522:Educational Status; D004526:Efficiency; D005260:Female; D006282:Health Personnel / Q000193:education / Q000706:statistics & numerical data; D006280:Health Workforce / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D007857:Leadership; D008297:Male; D015143:Philadelphia; D012111:Residence Characteristics; D013315:Stress, Psychological / Q000209:etiology; D035502:Trust