Pre-hospital mixed methods research: An updated methodological review

Mixed methods research, a methodology that integrates both qualitative and quantitative data in order to gain a more comprehensive understanding through drawing upon the strengths of each method, is increasingly used in the pre-hospital context. Despite its growing prevalence, little is known about how mixed methods research is conducted and reported in this unique setting. This methodological review builds on our prior systematic review and examines mixed methods studies in the pre-hospital context, mapping and describing how mixed methods research is conducted and reported. We searched MEDLINE, CINAHL Complete, Embase and Scopus bibliographic databases from 1 January 2012 to 3 June 2025, using an updated pre-hospital search strategy. Study screening was undertaken in duplicate. Articles reported in English, explicitly stating the use of ‘mixed methods’ in the pre-hospital ambulance setting were included, Data related to underpinning philosophical or theoretical framework, rationale for utilising mixed methods, background of the corresponding author, mode of data integration, model of publication and adherence to reporting standards, utilising the good reporting of a mixed methods study (GRAMMS) guidelines, was extracted and analysed. A range of pre-hospital mixed methods research was identified (n = 110). Reporting standards varied, with some studies demonstrating strong integration of qualitative and quantitative data, while others lacked clarity in methodological rationale. Diversity in subject and design reflects the need for flexibility in dynamic pre-hospital environments. This methodological review highlights opportunities for improvement in mixed methods research in pre-hospital care. While the approach supports comprehensive inquiry, it is largely not underpinned by philosophical frameworks which may support methodological rigour. In many cases, mixed methods research in the pre-hospital context is used for practical reasons, and the influence of the pre-hospital setting is observed in adaptable methodologies and a diverse range of subject matter. Our findings offer new insights and guidance for future research design and reporting in this field.