Q sample construction: a novel approach incorporating a Delphi technique to explore opinions about codeine dependence

Institutional Design of Forest Landscape Restoration in Central Togo: Informing Policy-making through Q Methodology Analysis

Forest landscape restoration (FLR) is a promising tool for restoring ecological functionality and improving human well-being in degraded landscapes. The success of FLR efforts depends on the interests, perceptions, and actions of local communities, extension services, Non-Governmental Organizations, and policymakers. While much research focuses on the direct ecological and economic impacts of FLR, limited attention has been given to how stakeholder perceptions influence the design and implementation of restoration efforts. Understanding these perspectives is crucial for shaping effective policy interventions and ensuring long-term FLR success. This study uses Q methodology to examine stakeholder viewpoints on key considerations and priorities for designing and implementing FLR in Tchamba Prefecture, Togo. The analysis reveals three distinct perspectives: (1) Incentive-Driven Restoration, emphasizing financial incentives and private-sector partnerships as essential for FLR success; (2) Comprehensive and Collaborative Restoration, advocating for an inclusive, multidisciplinary approach that integrates community participation and long-term monitoring; and (3) Incentive-Driven Community Restoration, highlighting the importance of economic incentives in fostering local engagement. Across all perspectives, stakeholders strongly agreed on the importance of biodiversity conservation, stakeholder involvement, and conflict resolution in land use. The findings underscore the need to tailor FLR policies to local contexts and stakeholder preferences, suggesting that flexible, participatory approaches can enhance sustainability and effectiveness. This study contributes to developing inclusive, adaptive restoration policies and highlights the need to integrate behavioural insights into policy-making to foster long-term stakeholder engagement.

Developing a Q Set Using the Modified Delphi Technique to Investigate ICU Nurses' Perspectives on Working with Non-ICU Nurses

Background/Objectives: ICU nurses manage complex clinical situations of critically ill patients, including rapid patient deterioration and multiple invasive lines. The complexity intensifies in catastrophes when non-ICU nurses are trained on short notice and deployed to support ICU nurses. This article details the rigorous development of the Q set, which is essential for ensuring methodological robustness and validity in a Q methodology study exploring ICU nurses' perspectives on working with non-ICU nurses. Methods: A modified Delphi approach was adopted for the expert consensus on the selection of statements, which ensured an unbiased Q sample construction. The methodology involved (1) concourse generation based on the literature review and semi-structured interviews of ICU nurses and (2) Q sample refinement via expert consensus. Results: The process extracted 152 statements in two Delphi rounds with ICU experts (head nurses, bedside nurses, and nursing faculty). The first round finalized 13 and excluded 8 statements. The second round further added 27 and excluded 5 statements. Thus, the final Q sample comprised 40 statements, which were reviewed by a Q methodology expert. Conclusions: The study improved the rigor, precision, and transparency of Q sample construction in ICU nursing research. The incorporation of the expert consensus minimized the bias to accurately examine ICU nurses' perspectives. The results offer valuable insights into non-ICU nurses' integration in critical care settings to guide staffing policies, training, and inter-professional collaborations.

Actor Perceptions of the Governance Framework and Non-Carbon Benefits from the Ghana Cocoa Forest REDD+ Program: An Extended Q-Study of the Juabuso-Bia Hotspot Intervention Area

The expansion of cocoa farms is a major driver of deforestation and emissions in Ghana's high forest zone. The Ghana Cocoa Forest Reducing Emissions from Deforestation and Forest Degradation Program (REDD+) was launched as the world's first commodity-based initiative to address emissions from deforestation caused by cocoa production and generate non-carbon benefits. Hotspot Intervention Areas were established to implement the Ghana Cocoa REDD+ program. This study combines Q-methodology with focus group discussions and interviews to assess stakeholder perceptions in the Juabuso-Bia cocoa landscape regarding the capacity of the Hotspot Intervention Area to facilitate the generation of governance and economic non-carbon benefits to sustain emission reductions. We found that introducing the Hotspot Intervention Area has re-centralized landscape governance, which, coupled with weak collaboration among stakeholders, has led to poor generation of non-carbon benefits. Furthermore, efforts to include women in the leadership structure of the Hotspot Intervention Area can be described as tokenism, and little has been done to improve land and tree tenure for vulnerable groups. This, combined with the low adoption of climate-smart cocoa practices, is likely to negatively affect the generation of economic non-carbon benefits. To overcome these challenges, we recommend reforming the Hotspot Intervention Area, bolstering community-level sensitization, improving access to decision-making spaces that will enhance the participation of women and minority groups in landscape governance, and improving farmers' tenure security through a registration scheme for land and trees. These recommendations can ensure the efficient generation of non-carbon benefits, which are key to the success of REDD+.

A new educational tool for neuropsychological test raters in the dementia field: A Delphi study

BACKGROUND

Neuropsychological testing is the primary endpoint of clinical research in the field of dementia, making it essential for the rater to accurately calculate test data for an extensive assessment. However, many raters lack adequate skill to complete neuropsychological tests with sufficient confidence. Therefore, we developed and examined the utility of a checklist and a manual as tools for educating raters on their basic behaviours when conducting comprehensive neuropsychological evaluations in the field of dementia.

METHODS

We conducted a seven-step comprehensive study to develop rater training tools and examine their usefulness between April 2019 and February 2021 involving: 1. Development of a draft checklist, 2. Delphi review rounds, 3. Design of the final checklist, 4. Item weighting, 5. Examination of reliability, 6. Creating the manual, and 7. Examination of the usefulness of learning through rater educational tools (checklist and manual).

RESULTS

The Delphi review round led to a highly reliable and valid checklist and manual. The total checklist score improved significantly (t = 2.37, P = 0.029) before and after manual learning. We found that the appropriate basic behaviours required by the rater to conduct neuropsychological testing skilfully within the dementia field could be acquired with this tool.

CONCLUSIONS

Using a robust development process, we integrated expert knowledge and experience, and developed a checklist and a manual for learning the basic behaviours of neuropsychological test raters in the field of dementia. Establishing standards of basic behaviour for neuropsychological raters will help promote dementia research and advances in medicine.

Bridging the Gap: Using Consensus to Explore Entrustment Decisions and Feedback Receptivity in Competency-Based Emergency Medicine Residency Programs Through the Construction of a Q-Sample Incorporating a Delphi Technique

Background

Recent changes in medical education calls for a shift toward student-centered learning. Therefore, it is imperative that clinical educators transparently assess the work-readiness of their medical residents through entrustment-based supervision decisions toward independent practice. Similarly, it is critical that medical residents are vocal about the quality of supervision and feedback they receive. This study aimed to explore the factors that influence entrustment-based supervision decisions and feedback receptivity by establishing a general consensus among Taiwanese clinical educators and medical residents regarding entrustment decisions and feedback uptake, respectively.

Methods

In Q-methodology studies, a set of opinion statement (i.e., the Q-sample) is generated to represent the phenomenon of interest. To explore the factors that influence entrustment-based supervision decisions and feedback receptivity, a Q-sample was developed using a four-step approach: (1) literature search using electronic databases, such as PubMed and Google Scholar, and interviews with emergency clinical educators and medical residents to generate opinion statements, (2) thematic analysis and grouping using The Model of Trust, the Ready, Wiling, and Able model, and the theory of self-regulated learning, (3) translation, and (4) application of a Delphi technique, including two expert panels comprised of clinical educators and medical residents, to establish a consensus of the statements and validation for a subsequent Q-study.

Results

A total of 585 and 1,039 statements from the literature search and interviews were extracted to populate the sample of statements (i.e., the concourse) regarding entrustment-based supervision decisions for clinical educators and feedback receptivity emergency medicine residents, respectively. Two expert panels were invited to participate in a Delphi Technique, comprised of 11 clinical educators and 13 medical residents. After two-rounds of a Delphi technique, the panel of clinical educators agreed on 54 statements on factors that influence entrustment-based supervision decisions and were categorized into five themes defined by the Model of Trust. Similarly, a total of 60 statements on the factors that influence feedback receptivity were retained by the panel of medical residents and were categorized into five themes defined by the Ready, Willing, and Able model and the theory of self-regulated learning.

Conclusion

Though not exhaustive, the key factors agreed upon by clinical educators and medical residents reflect the characteristics of entrustment-based supervision decisions and feedback receptivity across specialties. This study provides insight on an often overlooked issue of the paths to teaching and learning in competency-based residency training programs. Additionally, incorporation of the Delphi technique further adds to the existing literature and puts emphasis as an important tool that can be used in medical education to rigorously validate Q-statements and develop Q-samples in various specialties.

Factors affecting the value revitalization of Qajar religious schools in Tehran

Nowadays, due to natural erosion and urban development, Qajar religious schools in Tehran have undergone adverse physical changes. Moreover, the semantic and intangible values of them have faded over time, such that their position in society has declined. The religious schools need the conservation and revitalization of their values. Various research has been conducted on the philosophy of education, and the spatial evolution history of Tehran's religious schools. However, since no study has been carried out on the value revitalization of them, the present study, as an exploratory and novel study, mainly aims to experimentally investigate experts' views to revitalize the value of Qajar religious schools in Tehran. Delphi research method and Q-type factor analysis were used to identify and classify experts' views, respectively. Participants were selected through the purposive non-probability sampling technique. The sample size was selected to be 25, which was confirmed according to the Kaiser-Meyer-Olkin test used for sampling adequacy. To collect data from experts, a questionnaire was used in three rounds based on the Delphi method. Data obtained from the questionnaires were analyzed using the Q method. Based on the obtained results, up to 73.267% of factors affecting the value revitalization of Qajar religious schools in Tehran were identified and interpreted with certainty based on interviews with the experts. The experts were divided into eight groups or factors based on their views, and seven of which introduced common variables and concepts, named based on their constituent variables. Based on the value of the coefficient of variation, the identified effective factors included climatic architecture (20.51%), resilient architecture (13.45%), spiritual architecture (8.98%), environmental aesthetics (8.12%), educational architecture (6.87%), structural architecture (6.450%), and site visiting (4.566%). It was concluded that in the value revitalization of the religious schools, paying serious attention to these seven effective factors underlies the conservation process.

A practical guide to the systematic application of nominal group technique

BACKGROUND

Nominal group technique (NGT) is a highly structured, commonly used way of exploring areas of interest and developing consensus. However, it is sometimes conflated with focus group methods.

AIM

To provide a rationale for selecting NGT as a research method and to examine its systematic application in a doctoral Q-methodology study exploring nursing students' perspectives of preserving dignity in care.

DISCUSSION

An outline of NGT is provided, and it is distinguished from focus group methods. As well as providing a step-by-step guide to using NGT, each step is illustrated with its practical application in the study, and the lessons learned concerning the limitations and strengths of NGT in the context of one study are shared.

CONCLUSION

When applied systematically, NGT enables nurse researchers to collaborate in a meaningful and engaging way with participants and generate tangible outcomes relatively quickly.

IMPLICATIONS FOR PRACTICE

This paper offers practical insight into the use of NGT to explore perceptions and develop consensus.

Experiences of over-the-counter codeine misusers and accounts of recovery: A qualitative study in Tasmania, Australia

INTRODUCTION AND AIMS

There is international concern about misuse of over-the-counter (OTC) codeine, yet few studies have reported the perspectives of misusers themselves. This study explored the experience of OTC codeine misuse and recovery in Tasmania, Australia.

DESIGN AND METHODS

Semi-structured telephone interviews were conducted with 15 self-identified long-term users of OTC codeine. The interview guide prompted responses about reasons for codeine use, positive and negative impacts, recovery, identity and codeine accessibility. Transcripts were analysed abductively using qualitative content analysis. Categories that emerged from misuser accounts were aligned to three broad temporal phases: (i) transition to misuse; (ii) growing awareness; and (iii) towards recovery.

RESULTS

Salient features of the misuse experience included: initial use for the self-treatment of physical pain; ongoing use to self-medicate physical pain, stress or mental health conditions; a perception of safety of OTC codeine; an insidious transition from use to misuse; growing awareness of a problem over time; support provided by family, friends and the internet; recovery through self-change; and recognition that recovery is an ongoing process.

DISCUSSION AND CONCLUSIONS

Knowledge and understanding of the experience of OTC codeine misuse and recovery is critical to inform and tailor approaches to prevention and intervention. The findings suggest that strategies to improve the management of pain, stress and mental health, raise self-awareness of problematic use and potential for self-change, and increase social and web-based supports, should be considered when designing health policy initiatives that aim to reduce misuse.

Assessing the Sustainability of Alternative Structural Solutions of a Building: A Case Study

The implementation of sustainable solutions in the design of buildings is one of the main elements in achieving the transition to sustainability. The variety of structural elements and availability of sustainable materials, and the different preferences of clients, architects, and structural designers make the decision-making process difficult. This research aims to develop a decision model for applying to the early design stage. This work evaluates the sustainability of the load-bearing structures of a commercial building. Three types of load-bearing structures have been selected and compared concerning different physical parameters, cost of construction, cost of materials, technological dimensions (duration expressed in person-hours and machine-hours), and environmental impact. The methodology combines the building information modeling, sustainability criteria, and multi-criteria decision-aiding methods. The presented case study illustrates the proposed approach. The study revealed that multi-criteria decision aiding methods give the possibility to improve the selection process and to assess the sustainability of alternative structural solutions at an early stage of building design. The proposed decision model is versatile and therefore can be applied for different cases.

'For pain, no shame' and 'My secret solace': Accounts of over-the-counter codeine dependence using Q methodology

BACKGROUND

Dependence on over-the-counter (OTC) codeine is recognised internationally as a rising public health issue. The effectiveness of health intervention strategies may be influenced by the beliefs held by those who are dependent. Applying Q methodology, this study aimed to identify shared accounts of OTC codeine dependence.

METHODS

Twenty-six participants from Tasmania, Australia, met eligibility criteria for the study as long-term OTC codeine users with a Severity of Dependence Score of five or higher. Forty-six opinion statements about OTC codeine dependence were sourced from the literature and online discussion forums. These were rank-ordered by participants from least to most agree and explanatory comments for the most strongly positioned statements were provided. By-person factor analysis was used to group participants who had sorted the statements similarly.

RESULTS

Two distinct accounts of OTC codeine dependence were identified. Participants representing Factor One, 'For pain, no shame', were not ashamed of their OTC codeine use, believed access should not be restricted and regarded it as necessary for the relief of physical pain. In contrast, Factor Two, 'My secret solace', was characterized by feelings of guilt and shame. Participants in this group intentionally used codeine for its effects on mood; to help them relax and to relieve stress, rather than solely for pain relief. They did not consider regular use of codeine to be socially acceptable and hid their use from others.

CONCLUSION

The way in which OTC codeine use is viewed by those who are dependent is not uniform. Two distinct accounts were identified in this sample. Participants from each group varied in their beliefs about access, causality, reasons for use and feelings of legitimacy and shame. An understanding of these differences can be used to better target interventions and guide policy for the prevention and management of OTC codeine dependence.