Q-methodological Study Research Articles

The Attitudes of Midwives Towards NHS Fee-Charging and Data-Sharing Policies for Migrant Mothers in the UK: A Q-Methodology Study

As part of the UK’s “hostile environment”, individuals who are not “ordinarily resident” within the state are subject to fee-charging and data-sharing practices when accessing maternity care. This Q-methodological study aimed to capture and analyze attitudes towards these practices, by asking 21 midwives to rank a range of statements by level of agreement. A factor analysis of these rankings identified four distinct attitudes towards fee-charging within maternity care, with some supporting these policies as a means of protecting the institution, while others rejected them as discriminatory or difficult to implement. Consequently, this paper presents recommendations to improve efficiency and alleviate conflict around the implementation of these practices within maternity care..

Challenge or threat? A Q-methodological study into nursing students' perceptions on learning to collaborate under stress.

Nursing students will come across stressful situations during their internships and will continue to do so in future practice. Because of the impact stress can have on performance, nursing students need to be equipped to work and collaborate in such situations. Careful consideration of the needs and desires of nursing students should be taken in account, in order to create a training environment that fosters students' ability to learn to collaborate under stress. The aim of this study is to identify viewpoints of undergraduate nursing students towards the learning of collaboration in stressful situations, to understand their needs and desires, and to improve educational designs for training to collaborate in stressful situations. We conducted a Q-methodology study, a mixed methods approach that studies and charts subjectivity, and uses a by-person factor analytical procedure to create profiles of shared viewpoints. The process of our Q-study is based on the following five steps: Q-set development (54 statements), participant selection (n=29), Q-sorting procedure, data analysis, and factor interpretation. Q-factor analysis resulted in two prevailing factors that answer our research question. Twenty-five students loaded on these two factors, and factor interpretation resulted in Profile 1 "Practice makes perfect, so let's do it" and Profile 2 "Practice is needed, but it scares me". Whereas Profile 1 regarded learning to collaborate in stress mainly as a challenge, Profile 2 appeared anxious despite feeling the necessity to learn this. An overarching consensus factor revealed the importance of a learning environment in which mistakes can be made. The two described profiles align with the biopsychosocial model of challenge and threat, and could help to recognize and address the individual needs of nursing students when learning to collaborate in stressful situations. Incorporating these profiles in training may guide students towards a more challenge-like appraisal of stressful situations.

Pregnant women's informational needs prior to decisions about prenatal diagnosis for chromosomal anomalies-A Qmethodological study.

To study pregnant women's subjective viewpoints on what is important when receiving information prior to decision-making regarding prenatal testing for chromosomal anomalies. Data were collected using Q methodology. During January 2020-October 2021, 45 pregnant women in Sweden completed a 50-item Q sort. Statements regarding what is important when receiving information about prenatal screening and diagnosis were prioritized through ranking in a fixed sorting grid on an 11-point scale, from "most important" to "least important." Socio-demographics and coping styles were surveyed through questionnaires. Three groups represented different viewpoints on what pregnant women consider important when receiving information about prenatal screening and diagnosis. Factor 1: Stepwise information and decision-making: viewing information and decision-making as a step-by-step process. Factor 2: Decision-making as a continuous process based on couple autonomy: Striving for an informed decision as a couple about tests, test results and conditions screened. Factor 3: As much information as early as possible-the importance of personal autonomy in decision-making: Prioritizing autonomous decision-making based on non-directive information early in the pregnancy. This study highlights the complexities involved when providing information. As shown by the differing viewpoints in this study, pregnant women's informational needs differ, making individual and personalized information preferable.

Supervision as a mechanism in teacher wellbeing: A Q-methodological study of school staff viewpoints

AimsThe study aimed to explore the viewpoints held by school staff regarding the topic of supervision.RationaleDespite recognition of the potential benefits of supervision for school staff, supervision remains largely uncommon within schools. Barriers relating to terminology and potential connotations, suggest low uptake may in part relate to perceptions of supervision. Thus, it seems important to further understand how the topic of supervision is construed by school staff.MethodOnline Q-methodology was utilised. Twenty-one school staff members, working in a range of roles and settings, with varying experiences of supervision, completed a Q-sort activity and a post-sort questionnaire.FindingsTwo viewpoints were identified. Viewpoint 1 perceived supervision to be necessary, achievable within school resources, and of benefit to the whole-school system. Viewpoint 2 was more cautiously optimistic, perceiving barriers to implementation but highlighting the importance of embedding supervision within school systems.LimitationsThe viewpoints cannot be generalised, and the viewpoints identified in the current study are not exhaustive. Adaptations to the design, particularly relating to online Q-methodology, are suggested.ConclusionsThe findings reiterate the need to avoid a ‘one-size-fits-all’ approach to supervision and to develop a shared understanding and a culture of supervision in schools. To support Educational Psychologists developing, implementing, and evaluating supervision structures in schools, a Staff Supervision Development Protocol was developed.

How service users envision their engagement in processes of collaborative innovation: A Q-methodological study on user involvement in eHealth collaborations

Involving users in innovating public services is an increasingly common, but challenging practice, as users often have different viewpoints on their own role in the process. Particularly in complex innovation arrangements such as public-private collaborations, governments and service innovators need to be aware of users’ perceptions of their involvement to maximally exploit the advantages of including them. This article theorizes and tests four different roles of user-provider interaction on co-innovation processes: users as (1) legitimators, (2) customers, (3) partners, and (4) self-organizers. These theoretical roles are tested through Q-methodology on service users in 19 public-private eHealth collaborations from five European countries. Our findings suggest the existence of three hybrid empirical profiles of user involvement: (1) users as ‘service consultants’, (2) users as ‘co-designers’, and (3) users as ‘hands-off supporters’. The discovery of these profiles suggests the existence of different viewpoints on user involvement, which can influence the expectations and behavior of the users in innovation processes.

Mental health professionals’ views of the borderline personality disorder diagnosis for children and young people: a Q-methodological study

PurposeBorderline personality disorder (BPD) is a controversial psychiatric diagnosis. Despite an increasing amount of research looking at the BPD diagnosis when applied to young people, there is limited understanding of the key viewpoints of mental health professionals working with young people in the UK. This research aims to use Q-methodology to contribute to understanding the multiple views of the diagnosis.Design/methodology/approachQ-statements about views of the BPD diagnosis were selected from relevant journals, internet sites and social media platforms and were validated by a Q-methodology research group, the research supervisors and an online group of individuals with BPD. Q-sorts were then used to explore the viewpoints of 27 mental health professionals in the UK working with children and adolescents. Analysis of the data was completed using Q-methodology analysis software.FindingsThree main factors emerged from the data, explaining 66% of the variance. Of the 27 participants, 24 loaded onto these three factors, defined as: harmful not helpful; language and optimism; and caution and specialist services. Three Q-sorts did not load significantly onto any one factor.Originality/valueThere appears to be at least three ways of understanding the BPD diagnosis for young people. It may be useful for clinicians to consider and share their own viewpoint, be open to difference and formulate difficulties from an individual perspective.

A Q-methodological Study of High School Students’ Perceptions of Self-love

목적 본 연구의 목적은 고등학생의 자기사랑에 관한 인식 유형 및 유형별 특성을 파악하는데 있다. 방법 본 연구의 목적을 이루기 위해 Q 방법론을 활용하였는데, Q 모집단은 고등학생 6명과의 심층면담 및 관련 문헌고찰을 통해 구성했으며, 최종 33개의 Q 표본이 선정됐다. Q 분류는 고등학생 37명에 의해 시행됐으며, 분류된 자료는 PC-QUANAL 프로그램을 활용해 분석하였다. 결과 분석결과, 고등학생의 자기사랑에 관한 인식은 5개 유형으로 분류되었다. 각 유형은 첫째, ‘주도적인 성장지향형’, 둘째, ‘타인을 의식하는 자기돌봄형’, 셋째, ‘현실적인 즐거움추구형’, 넷째, ‘정서적인 자기친절형’, 다섯째, ‘자기를 신뢰하는 관계지향형’으로 명명되었다. 결론 본 연구는 고등학생의 자기사랑에 관한 인식 유형 및 유형별 특성을 탐색함으로써 고등학생의 자기사랑 인식에 관한 이해를 도모하였다. 나아가, 각 유형별 특성을 반영한 교육 및 방안을 마련함으로써 향후 학생들의 자기사랑을 향상시키기 위한 기초자료를 마련하는데 도움이 될 것으로 사료된다.

Changes in student appreciation of small-group active learning: A follow-up q-methodological study

BackgroundDifferences in students’ epistemic beliefs and approaches to learning influence how they appreciate small-group active learning methods. As students develop and advance through their study program, it is likely that their epistemic beliefs and approaches to learning change. However, it is unclear how these changes influence their appreciation of small-group active learning, and what this means for teachers who want to motivate and engage students at various stages of their study program. In a previous paper, we published findings of first-year medical students. In the present study, we followed up on the original student sample as they entered their fourth year. MethodsWe repeated the Q-methodological study procedure from the previous study to explore change in appreciation of small-group active learning. Participants rank-ordered 54 statements, answered open-ended questions about their rank-ordering, and completed a demographic questionnaire. We also invited participants to take part in a subsequent interview to reflect on changes in their beliefs about small-group active learning since their start of medical training. ResultsTwenty students participated (38.5% of the original sample). We decided on a 2-profile solution. Profile 1 students were ‘success-oriented’, while profile 2 students were ‘development-oriented’. Students’ appreciation of small-group active learning remained fairly stable over time, although key aspects related to students’ epistemic beliefs and approaches to learning developed. Seven students took part in the subsequent interview and reported personal, group, tutor, and medical program reasons for changes in their appreciation of small-group active learning. DiscussionThis study showed how and why medical students’ appreciation of small-group active learning changed over time along with development of their epistemic beliefs and approaches to learning. These findings contribute to the study of active learning in (medical) education because they highlight the development of students as they advance through their studies. What motivates and engages first-year students is not necessarily motivating and engaging for students in later stages. Our findings support the development of interventions that can help teachers to teach in active learning settings.

An Analysis of the Perception Types of Distance In-Service Teacher Training for Elementary School Teachers: A Q-Methodological Study

An Analysis of the Perception Types of Distance In-Service Teacher Training for Elementary School Teachers: A Q-Methodological Study

Q methodology: An underutilised tool in pharmacy practice research

Pharmacy practice research is often concerned with opinions, perspectives, values, or a variety of other subjective domains, whether that be in regard to the experiences of patients, views of stakeholders about innovative pharmacy services, or culture in pharmacy practice. This article offers a brief introduction to Q methodology, which is a philosophical, conceptual, and technical framework well-suited to shed light on such subjective views. Q methodology combines qualitative and quantitative processes to uncover distinct viewpoints present about any given topic. While other textual analyses focus on identifying the constituent themes about a topic, Q methodology instead detects and interprets holistic and shared perspectives. The introduction covers key theoretical principles, as well as the logistics and procedures involved in completing a Q-methodological study. Example data from a study investigating views on pharmacist integration into general practice in New Zealand are presented to highlight the potential of Q methodology for pharmacy practice research.

Family's Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study

This study aimed to distinguish and describe the types of perceptions of do not resuscitate (DNR) proxy decisions among families of elderly patients in a long-term care facility. This exploratory study applied Q-methodology, which focuses on individual subjectivity. Thirty-four Q-statements were selected from 130 Q-populations formed based on the results of in-depth interviews and literature reviews. The P-samples were 34 families of elderly patients in a long-term care hospital in Busan, Korea. They categorized the Q-statements using a 9-point scale. Using the PC-QUANL program, factor analysis was performed with the P-samples along an axis. The families' perceptions of the DNR proxy decision were categorized into three types. Type I, rational acceptance, valued consensus among family members based on comprehensive support from medical staff. Type II, psychological burden, involved hesitance in making a DNR proxy decision because of negative emotions and psychological conflict. Type III, discreet decisions, valued the patients' right to self-determination and desire for a legitimate proxy decision. Type I included 18 participants, which was the most common type, and types II and III each included eight participants. Families' perceptions of DNR proxy decisions vary, requiring tailored care and intervention. We suggest developing and providing interventions that may psychologically support families.

How practitioners between bench and bedside evaluate biomedical translation?

AbstractWhile translational research (TR) aims at changing regulatory and organizational practices in the biomedical field, surprisingly little is known about how practitioners in the lab or the clinic think about translation. Addressing this gap, we present results from a Q-methodological study on the meanings and values associated with translation held by researchers, clinicians, and clinician scientists at two major German biomedical research institutions implementing TR strategies. We identify eight different collective understandings of translation, with respect to both where primary translational problems are located and what the most immediate and effective measures should be. Our findings suggest that there may not be a one-fits-all solution for improving translation and that general regulatory and organizational measures may be less effective than measures addressing specific audiences and their specific viewpoints. TR does, however, work well as an umbrella term in stimulating and orchestrating a productive interaction between various viewpoints, practices, and contexts.

A Q-Methodological Study on the Radiologist's Image of Radiology College Students Experienced Clinical Practice

A Q-Methodological Study on the Radiologist's Image of Radiology College Students Experienced Clinical Practice

Exploring subjective constructions of health in China: a Q-methodological investigation

BackgroundWith an increasing awareness of people’s satisfaction and feeling, health-related quality of life (HRQoL) has become an essential aspect of measuring health. HRQoL is fundamentally a foreign concept introduced to China from the West. While a growing number of studies applied western HRQoL measures, few content validity tests examined the legitimacy of applying Western developed HRQoL measures in a Chinese cultural setting. If there are distinct differences in health conceptualisation between China and the West, it can be argued that those western measures may fail to ask the most appropriate and important questions among a Chinese population in assessing health. As a limited number of studies have investigated Chinese people’s understandings of health, this study aimed to explore how health is defined and described in China.MethodsA Q-methodological study was conducted to explore subjective constructions of health among Chinese participants. A scoping review of Chinese generic HRQoL measures, supplemented by a series of qualitative interviews conducted in China, produced a list of 42 statements representing aspects of health considered as being important in a Chinese cultural setting. Chinese participants in face-to-face interviews ranked and sorted these statements. Data were analysed to identify clusters of participants who shared a similar perspective, using a by-person factor analysis procedure.Results110 Chinese participants with various demographics characteristics completed sorting interviews. Five independent factors emerged: (I) “Physical independence and social interaction skills”; (II) “Physical health”; (III) “Sensations and feelings”; (IV) “Lifestyles”; (V) “Learning and working abilities”.ConclusionsThe Q-study showed that many health statements were rated highly as most important by a diverse range of Chinese participants but were not covered in the commonly used Western HRQoL measure EQ-5D. It then suggests that the EQ-5D descriptive system might need modification to improve its capacity to measure health status in China. The study thus raises a general question as to how appropriate the Western-developed HRQoL measures are when used to assess health in a significantly different cultural setting.

Lessons Learned: Some Guidelines to Factor Interpretation

Data Interpretation is an essential process in understanding the results of a Q-methodological study. Employing a team approach to provide further practice of the interpretation process, we used an earlier study of values preferred in adolescent friendship to highlight the lessons discovered in our interpretative work. The uniqueness of this research was the iterative team interpretation of a staged process and the faculty mentor relationship in the teamwork. Lessons learned included the time it takes to develop understanding, the importance of mentorship and the use of abduction, intuition, and holistic interpretation. Further lessons focused on the development of an ability to take the role of the hypothetical person, learning strategies to overcome novice researcher status, how to use the PQMethod report and the use of all the reported data in the analysis and interpretation.

Clinical psychologists’ views about talking to people with psychosis about sexuality and intimacy: a Q-methodological study

Sexual and relationship needs of people with psychosis are generally overlooked despite established psychosocial benefits and reduced risk of relapse. Despite mental health professionals’ reluctance to initiate conversations about sexuality and intimacy with service-users, people with psychosis and their support networks have indicated their desire for professionals to address intimate topics. Clinical psychologists are specifically trained to address complex psychological issues; however, no research to date has explored their views around discussing sexuality and intimacy. Q-methodology was used to explore clinical psychologists’ personal and professional views about discussing sexuality and intimacy with people with psychosis. 27 clinical psychologists completed Q-sorts. Varimax rotation revealed three factors with distinct views; a majority perspective that highlighted the normality of sexuality and intimacy for people with psychosis and the acceptability of such conversations in clinical work for practitioners, a view focused on concerns about the appropriateness of discussing sexuality and the possibility that conversations could lead to increased risk, and a view that related to concerns about competency in addressing intimate subjects. The practical and clinical implications are discussed in terms of training need and limited access to sexual health services.

Profiles of family caregivers of patients at the end of life at home: a Q-methodological study into family caregiver\u2019 support needs

BackgroundFamily caregivers of patients at the end of life often experience care-related burden. To prevent caregiver burden and to enhance the capacity to provide care it is important to have insight in their support needs. The purpose of this study was to identify profiles of family caregivers who provide care to patients at the end of life at home.MethodsA Q-methodological study was conducted in which family caregivers ranked 40 statements on support needs and experiences with caregiving. Thereafter they explained their ranking in an interview. By-person factor analysis was used to analyse the rankings and qualitative data was used to support the choice of profiles. A set of 41 family caregivers with a variety on background characteristics who currently or recently provided care for someone at the end of life at home were included.ResultsFour distinct profiles were identified; profile (1) those who want appreciation and an assigned contact person; profile (2) was bipolar. The positive pole (2+) comprised those who have supportive relationships and the negative pole (2-) those who wish for supportive relationships; profile (3) those who want information and practical support, and profile (4) those who need time off. The profiles reflect different support needs and experiences with caregiving.ConclusionsFamily caregivers of patients at the end of life have varying support needs and one size does not fit all. The profiles are relevant for healthcare professionals and volunteers in palliative care as they provide an overview of the main support needs among family caregivers of patients near the end of life. This knowledge could help healthcare professionals giving support.

Nurses' intentions to respond to requests for legal assisted-dying: A Q-methodological study.

To explore the intentions of nurses to respond to requests for legal assisted-dying. As more Western nations legalize assisted-dying, requests for access will increase across clinical domains. Understanding the intentions of nurses to respond to such requests is important for the construction of relevant policy and practice guidelines. Mixed-methods. A total of 45 Australian nurses from aged, palliative, intensive, or cancer care settings surveyed in November 2018. Q-methodology studying nurses' evaluations of 49 possible responses to a request for a hastened death. Data consisted of rank-ordered statements analysed by factor analysis with varimax rotation. Four distinct types of intentions to respond to requests for assisted-dying: a) refer and support; b) object to or deflect the request; c) engage and explore the request; or d) assess needs and provide information. The findings underscore the complexity of intentionality in assisted-dying nursing practice and differences from other forms of end-of-life care, particularly regarding patient advocacy and conscientious objection. This study enables further research to explore determinants of these intentions. It can also assist the development of professional guidance by linking policy and clinical intentions. Identified a basic range of nurses' intentions to respond to requests for assisted-dying, as there was no evidence at present. Developed a fourfold typology of intentions to respond with most nurses intending to engage in practices that support the requestor and sometimes the request itself. A minority would object to discussing the request. The relatively low level of advocacy within the intended responses selected also is distinctly different from other end-of-life care research findings. This research could assist nursing associations in jurisdictions transitioning to legal assisted-dying to develop guidance ways nurses can frame their responses to requests.

The role of rehabilitation care workers in South African healthcare: A Q-methodological study.

BackgroundThe South African Department of Health identified the need to train a new cadre of community health worker (CHW) in the field of rehabilitation as part of their 2030 Health Plan that aims to improve primary healthcare (PHC) and community-based rehabilitation (CBR). Community health workers can be effectively utilised in CBR if their role is understood and their potential is not limited by professional protectionism and scepticism. A clear understanding of the scope of practice of a new cadre will minimise resistance by health professionals.ObjectivesThe aim of this study was to explore rehabilitation health professionals’ perception of the role of the new cadre, called rehabilitation care workers (RCWs), in South African healthcare.MethodsQ-methodology was used to gather and interpret the data. A convenient sample of 16 health professionals participated in the study. Participants ranked statements about the role of the RCWs from strongly agree to strongly disagree. Data were entered into PQMethod software program for statistical and factor analysis.ResultsTwo factors emerged. Participants loading onto Factors 1 and 2 were of the opinion that RCWs’ role would be to strengthen PHC and CBR and to promote participation of people with disabilities (PWD) in intermediate care and community.ConclusionRehabilitation health professionals’ positive perception of the new cadre is encouraging so that it could ensure their effective utilisation in CBR. Rehabilitation care workers were perceived as capable of enhancing the lives of PWD by ensuring inclusive development.

Young people’s beliefs about psychological therapy for psychosis: a Q-Methodological study

Background: The evidence base for the use of psychological therapies in the treatment of psychosis is growing, however engagement can be difficult and outcomes are variable. Beliefs, attitudes and expectations may have an important influence on whether individuals engage with therapy and on clinical outcomes, however, these beliefs have not been adequately explored.Aims: To examine what young people in Early Intervention Services (EIS) think about psychological therapies for psychosis.Method: Thirty participants were recruited from EIS across five NHS trusts to examine young people’s beliefs about psychological therapy.Results: Four distinct factors, or sets of beliefs, about therapy emerged: (1) Therapy is helpful and gives hope for the future; (2) Therapy is just talking, people need medication; (3) Therapy is useful but stigmatising; (4) Therapy is better than medication. Positive views towards different aspects of therapy were present in all four accounts. Other important issues were raised, including concerns about stigma and opposing beliefs about medication.Conclusion: These four factors provide useful insights into young people’s beliefs about psychological therapy. Individuals’ beliefs and expectations should be recognised and explored in order to promote greater engagement in and better outcomes from therapy.