This article explains why ontology, epistemology, and research paradigms matter in health research. Its central message is that researchers can combine methods. However, they still need to work from a coherent paradigm. Assumptions about reality shape the research question, methods, analysis, and interpretation.

Journal Club Article: Disbeschl, S., Checkland, K., Stutchbury, K., & Payne, R. (2026). ‘You can mix your methods, but you can’t mix your paradigms’: a guide to ontology and epistemology for the confused researcher. British Journal of General Practice, 76(762).

Key Points

Why ontology and epistemology matter

All research is shaped by a paradigm. The article argues that research is never neutral. It is always guided by assumptions about what reality is. It is also influenced by how knowledge is produced and how it should be studied.

All research is shaped by a paradigm. The article argues that research is never neutral. It is always guided by assumptions about what reality is. It considers how knowledge is produced. It also reflects on how it should be studied.

The paper outlines four major paradigms in healthcare research:

• Positivism: seeks objective truth, prioritises measurement, objectivity, and replicability.
• Constructivism/interpretivism: sees knowledge as co-constructed, values context, meaning, and researcher positionality.
• Critical realism: assumes an underlying reality exists but can only be partially known; focuses on explaining underlying causal mechanisms.
• Pragmatism: prioritises what is most useful in solving a real-world problem and often supports mixed methods.

Different paradigms suit different research questions. A paradigm should be chosen because it fits the purpose of the study, not simply because a particular method is preferred.

Methods can be mixed, but paradigmatic inconsistency is a problem. The authors stress that combining quantitative and qualitative methods is acceptable, but researchers still need clarity about the philosophical position guiding the study.

Quality criteria differ across paradigms. What counts as rigour in positivist research is not the same as what counts as rigour in interpretivist or critical realist research.

The article encourages researchers to be explicit and reflective. Being clear about assumptions helps with study design, peer review, collaboration, and producing credible findings.