A scoping review of Q-methodology in healthcare research

Dutch midwives' views on father-involvement practices

BACKGROUND

Midwives are uniquely positioned to engage fathers already prenatally and facilitate an equal transition into parenthood for both parents. However, they may face barriers hindering their investment in involving fathers.

AIM

The aim was to investigate barriers and facilitators midwives experience when implementing two father-involvement practices 1) involving fathers in antenatal and postnatal care and (2) encouraging parental conversations about future work/care divisions.

METHODS

Study 1 utilized a World Café with twelve midwives to identify barriers and facilitators, across motivation, opportunity, and ability. Study 2 used a Q-methodology with 31 midwives to assess these factors' relative importance and identify distinct viewpoints.

FINDINGS

The World Café revealed that midwives are motivated to involve fathers, primarily because they anticipate positive outcomes for parents and infants. Key barriers included a lack of time, finances, and educational resources. The Q-study identified that midwives could be clustered in two profiles reflecting different perspectives on the ranking of barriers to involving fathers in prenatal care. The "Educationally Constrained Midwife" lacks knowledge, educational materials, and training, while the "Resource Constrained Midwife" is hindered by time and financial constraints. For encouraging parents to discuss the future task division, only one profile was identified showing that midwives were motivated to incorporate this extra task if they receive additional time, finances, training, and educational materials to share with parents.

CONCLUSION

Addressing educational and resource barriers is crucial for enhancing father-involvement by midwives. Interventions tailored to these profiles can support midwives in adopting practices promoting father-involvement, potentially improving family outcomes and advancing gender equity in caregiving responsibilities.

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.

Prioritization Patterns of Nurses in the Management of a Patient With Delirium: Results of a Q-Methodology Study

Nurses are required to decide on priorities; however, how they prioritize the interventions toward patients with delirium is still unclear. Therefore, expanding the knowledge on (a) how nurses prioritize interventions to manage episodes of delirium and (b) the underlying prioritization patterns were the aims of this study. The Q-methodology was applied in 2021. A systematic review to identify the recommended interventions for patients with delirium was performed, and a nominal group technique was used to select those interventions that are applicable in daily practice (35 out of 96 identified). Then, using a specific scenario, 56 clinical nurses working in hospital medical (n = 31), geriatric (n = 15), and postacute (n = 10) units were asked to order the 35 interventions (from -4 the lowest to +4 the highest priority) using a Q-sort table. Averages (confidence interval at 95%) were calculated at the group level, and a by-person factor analysis was applied to discover underlying patterns of prioritization at the overall and at the individual levels. At the group level, "Ensuring a safe environment (e.g., reducing bed height)" was ranked as the highest priority (2.29 out of four); at the individual level, three prioritization patterns accounting for a total variance of 50.21% have emerged: "Individual needs-oriented" (33.82% variance explained; 41 nurses); "Prevention-oriented" (8.47%; five nurses); and "Cognitive-oriented" (7.92%; six nurses). At the group level, nurses prioritize safety while caring for patients with delirium; however, at the individual level, they follow three different patterns of prioritization oriented toward diverse aspects, suggesting uncertainty in the actions to be taken-with potential implications for patients.

Patient and Family Engagement in Infection Prevention During the COVID-19 Pandemic: A Q-Methodology Study with Stakeholders from a Canadian University Health Care Center

BACKGROUND

Health care-associated infections are frequent complications for hospitalized patients, and the COVID-19 pandemic exacerbated this issue. This study aimed to explore stakeholders' viewpoints on how patients and families should engage in preventing health care-associated infections in hospital settings.

METHODS

The authors employed Q-methodology, a mixed methods approach combining by-person factor analysis with in-depth interviews to capture shared viewpoints among participants. The research was conducted in a university-affiliated adult transplant unit using a purposive sample of staff members, patients, and family members. Participants ranked 40 preselected statements on a tablet using the Q-sorTouch Web application (for example, "Staff members should check that patients and family members wash their hands at key moments") on a continuum from "most agree" (+2) to "most disagree" (-2). Participants then took part in in-depth interviews to elaborate on their rankings. Data analysis included factor extraction and thematic interpretation.

RESULTS

Nineteen participants completed the study. Analysis revealed three distinct viewpoints on patient and family engagement in infection prevention and control: (1) a controlling approach in which health care professionals ensure patient and family compliance, (2) an enabling approach that supports shared responsibility and emphasizes autonomy, and (3) a view of patients and family members as vigilant partners. Seven consensus statements emerged, indicating agreement on strategies in which patients and families are passive rather than proactive.

CONCLUSION

Although a paternalistic model emphasizing health care professional oversight prevailed, alternative perspectives emerged advocating for greater autonomy and responsibility among patients and families. These differing opinions indicate ongoing debate about how best to involve patients and their families in infection control, particularly during periods of heightened risk.

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

INTRODUCTION

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.

AIM

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.

METHODS

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.

RESULTS

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.

DISCUSSION

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.

Subjectivity of Obese Female Adolescents in South Korea Regarding Ego-Types and Characteristics

Background/Objectives: The current study aims to explore the subjective ego types and characteristics of obese female adolescents in South Korea, providing insights into their self-perception and psychosocial challenges. Methods: Utilizing Q-methodology, a total of 49 Q-statements were derived from a comprehensive Q-population. From these, 20 adolescents diagnosed with obesity were selected as the P-Sample. Q-sorting was conducted, and the data collected were analyzed using the PQ Method software version 2.35, employing centroid factor analysis and varimax rotation. Results: The results revealed five distinct types, accounting for a cumulative explanatory variance of 63%. Type 1 (N = 5) was characterized as "obsession with weight loss". Type 2 (N = 3) was identified as "overreacting to peer gaze". Type 3 (N = 6) was labeled "lack of confidence in daily life". Type 4 (N = 4) was described as "difficulty adapting to school life". Finally, Type 5 (N = 2) was characterized as "passivity in physical activity". Furthermore, the consensus statements among each type were examined in Q4 and Q7. Conclusions: These findings provide insights into the self-perception of obese female adolescents, emphasizing the need for tailored psychological interventions to improve their self-image and well-being.

Perspectives of expert physical therapists on the international classification of functioning, disability and health (ICF): a Q study

PURPOSE

Physiotherapists' varied interpretations of the International Classification of Functioning and Health (ICF) and the biopsychosocial model underlying it can significantly influence its dissemination, assimilation, and application. This study analyzed the diverse discourses of Brazilian physiotherapists engaged in teaching and researching the ICF.

MATERIALS AND METHODS

This descriptive cross-sectional study employed Q methodology to explore participants' viewpoints. Participants ranked diverse statements about the ICF into nine categories from "strongly disagree" (-4) to "strongly agree" (+4). Rankings were analyzed through factor analysis to identify emerging factors, then interpreted as viewpoints based on the average ranking of statements within each factor.

RESULTS

A total of 48 experts ranked 59 statements. Participants had diverse specialties, with an average of 19.1 years of professional experience, 13.62 years of teaching, and 16.04 years of engagement with the ICF. Most were affiliated with public universities and held doctoral degrees. Factor analysis revealed two distinct viewpoints, both supporting a biopsychosocial understanding of functionality, emphasizing the ICF's value in either pragmatic or conceptual terms.

CONCLUSIONS

The two viewpoints by experts emphasize the practical and theoretical value of the ICF, reinforcing its biopsychosocial approach to functioning.

Understanding substance use patterns among adolescent girls in Norway through the lens of mattering

Aims: This research explores patterns of views on substance use among Norwegian adolescent girls aged 16-19 years. By examining the participants' experiences, attitudes and needs, the study seeks to uncover how teenage girls experience the use of substances, how the use impacts their daily lives, and their relationships with peers, family and welfare professionals. Methods: To achieve this understanding, we utilised Q methodology to capture the perspectives of 42 Norwegian adolescent girls. Q methodology provides a comprehensive understanding of participants' shared viewpoints and offers insight into their perspectives on substance use. We use the concept of "mattering" to interpret the perspectives on substance use revealed through the Q methodological analysis. Results: We identified three distinct perspectives among the participants: (1) Confident - against illegal substances; (2) Ambivalent - substance use normalised, yet with negative consequences; and (3) Outgoing - positive and curious about illegal substances. The key differences lie in the adolescents' attitudes to illegal substances, parental relationships, and openness about their own substance use. Substance use serves different functions and has varying consequences for each perspective. Conclusions: Secure interpersonal relationships within families, peers and broader social contexts are crucial in shaping adolescent girls' attitudes to substance use. Feeling valued and experiencing mattering within these contexts can protect against problematic behaviours and encourage healthier choices. To support adolescent girls' well-being, healthcare and social work professionals should consider the family's emotional climate and the girls' sense of connectedness to family, peers and society.

What should be publicly funded in the Colombian health system? A mixed methods study of citizens' perceptions

BACKGROUND

In recent years, citizens have become more interested and willing to influence health policy decision-making, and governments worldwide are more prone to citizen engagement in such processes. Prioritising which health technologies should be publicly funded is one decision that requires prudence and consideration of the values and expectations of the people who will be affected by it.

OBJECTIVE

To identify and understand the citizens' perceptions about which health technologies should be publicly funded in Colombia.

DESIGN

Sequential exploratory mixed methods study; the first was a qualitative embedded case study, and the second was a Q methodology study.

PARTICIPANTS

46 citizens were interviewed, and 30 citizens ordered a Q-sample of 45 statements.

ANALYSIS

Interviews were content analysed. We performed a content analysis of the interviews, and, for the quantitative strand, we performed a principal component analysis and varimax rotation to identify view patterns. We also estimated the z-scores of each statement and the load to each factor. We jointly interpreted both sets of findings.

RESULTS

We identified two general approaches citizens used to consider public funding of healthcare technologies. One approach endorsed full coverage of all health technologies required by every Colombian. In the second approach, public funding is conditional on the characteristics of the person who needs the technology, their disease/condition, the kind of technology required and the expectation of efficient health system performance. When integrating the results of the Q methodology, we found five patterns of points of view about the public funding of health technologies.

CONCLUSION

Colombian citizens consider and balance a range of different factors when making decisions about which health technologies are publicly funded. Citizens not only use technical criteria to decide but also provide the perspective and values of those affected by the decision.

Women's preferences for care delivery during labour and birth in Dutch hospitals: A Q-methodology study

PROBLEM

Women's preferences regarding care delivery during labour and birth remain insufficiently understood. Obtaining a clear understanding of these is important to realise a maternity care system that is future-proof and person-centred.

BACKGROUND

Dutch maternity care deals with capacity issues due to staff shortages. Despite expected stable birth rates in the coming decades, this situation jeopardises the provision of care during labour and birth that is responsive to women's preferences.

AIM

To systematically study a variety of women's preferences for care delivery during labour and birth in Dutch hospitals using Q-methodology.

METHODS

Q-methodology is a mixed methods approach. Thirty individual interviews were conducted with women living in the south-western Netherlands, during which they ranked 29 statements about their labour and birth preferences from least to most important. By-person factor analysis was performed to identify factors (viewpoints). Interpretation of the viewpoints was done using the qualitative interview data.

FINDINGS

Four viewpoints emerged from the study sample: 1) The personal approach, 2) The empowering approach, 3) The expert approach and 4) The needs-based approach. Consensus statements show a shared preference for respectful interaction. The study cohort emphasises continuity of adequate information provision, while continuity of care professional is deemed less important.

DISCUSSION

Our study was the first to apply Q-methodology to capture women's preferences for care delivery during labour and birth in Dutch hospitals. Although preferences are individual, they share commonalities in four viewpoints.

CONCLUSION

The viewpoints provide valuable guidance for the allocation of scarce resources to ensure a maternity care system that is responsive to women's preferences.

Treatment Preference Archetypes in Eosinophilic Esophagitis and Their Implications for Therapy

INTRODUCTION

Little is known about how patients make decisions about and prioritize therapies and disease management in eosinophilic esophagitis (EoE). We aimed to systematically identify and characterize patient perspectives and attitudes that influence decision making for EoE management.

METHODS

To understand the diverse attitudes and values of patients with EoE, we designed a study using the Q-method. We iteratively developed 31 statements related to EoE disease management. Participants sorted statements by ranking from +4 (most agree) to -4 (most disagree). By-person factor analysis, using 2-factor and 3-factor rotation, revealed distinct preference archetypes.

RESULTS

Thirty-four adults with EoE (mean age 40.9 years, 51.4% male, 82.9% White) were recruited from gastroenterology and allergy clinics from a single center. We identified 2 treatment-centered archetypes: Medication preference, driven by symptoms and the desire to minimize risk of complications and Natural treatment preference , focusing on identifying trigger foods and diet adherence. Three-factor analysis revealed an additional archetype: Treatment ambivalent, a view of EoE as a mild and episodic (not chronic) disease with low priority to treat. Comparison by factor revealed 54% of those in the natural preference archetype were recategorized as treatment ambivalent , suggesting that they see natural treatment as a less complicated or milder strategy and may be at risk of nonadherence and reduced treatment uptake.

DISCUSSION

We identified 3 distinct treatment preference archetypes among individuals with EoE, underscoring the need for personalized treatment strategies, especially for those favoring natural approaches but masking ambivalence, and may be at risk of nonadherence or loss to follow-up.

Types of caregiving perceptions of family caregivers of elderly nursing home residents during the COVID-19 pandemic in Korea

BACKGROUND

This exploratory study applied Q methodology to identify the types of family caregivers of older adults in nursing homes during the COVID-19 pandemic based on their perceptions of the caregiving role and explore each type's characteristics.

METHODS

Q statements were derived from in-depth interviews and a review of prior research. Q sorting was conducted using 39 P samples on a nine-point scale to determine Q distributions according to the degree of subjective agreeableness for each statement. In-depth interviews were conducted to determine why the subjects rated statements on either extreme.

RESULTS

Four types of family caregivers were identified as a result of an analysis using the PC QUANAL program: caregiving-positive type (type I), caregiving-ambivalent type (type II), nursing home dependent type (type III), and caregiving conflict burnout type (type IV).

CONCLUSION

The study results can help develop interventions and strategies based on perceptions of caregiving and their associated characteristics to provide psychological support to family members of older adult care home residents during the COVID-19 pandemic. Accordingly, the following measures are recommended: continuous follow-up research on specific measures facilitating communication between nursing home staff and family caregivers in the event of a pandemic; development of tools for measuring burnout risk among family caregivers and practical interventions for those at high risk; efforts to improve the image of older adult care homes and change the conventional perceptions of caregiving.

Perspectives on managing innovation readiness in long-term care: a Q-methodology study

BACKGROUND

The scarcity of resources in long-term care demands more than ever that organizations in this sector are prepared for innovation to ensure affordable access to care for older adults. Organizations that are innovation ready are more capable of implementing innovations. Therefore, a better understanding of how stakeholders view innovation readiness in long-term care can provide actionable strategies to enhance their innovative capacities. 'Innovation readiness' indicates the level of maturity of an organization to succeed in any type of innovation. Our study explored perspectives among stakeholders on what they consider important for organizations in long-term care for older adults to be innovation ready.

METHODS

Q-methodology, a mixed-methods approach, was used to investigate the perspectives of 30 stakeholders connected to long-term care for older adults in the Netherlands: academics, (top)management, innovation managers, client representatives, staff, and consultants. Stakeholders were asked to rank 36 statements on innovation readiness on importance. Statements were extracted from literature research and qualitative interviews. Thereafter in the post-interviews stakeholders explained their ranking and reflected on the statements. By-person factor analysis was used to identify clusters in the ranking data. Together with the qualitative data from follow-up interviews, these clusters were interpreted and described as perspectives of the stakeholders.

RESULTS

Four distinct perspectives were identified on what they consider important for innovation readiness in long-term care: (1) 'supportive role of management' (2) 'participation of the client (system) and employees' (3) 'setting the course and creating conditions' and (4) 'structuring decision-making, roles and responsibilities'. The 36 statements represented a complete overview of innovation readiness factors. No additional innovation factors to those previously identified in the literature emerged from the interviews.

CONCLUSIONS

Stakeholders agree that all factors contributing to innovation readiness of long-term care organizations for older adults are accounted for. The variety of perspectives on what is most important shows there is no agreement among stakeholders about a fixed route toward innovation readiness. However, stakeholders suggested a temporal order of the innovation readiness factors, preferably starting with formulating the innovation ambition. This study's results could contribute to developing an assessment tool to deliver a structured approach for managers to assess the innovation readiness of their organization.

REGISTRATION

The study received ethical approval on April 13, 2022 from the Medical Ethics Board of Zuyderland Medical Center in the Netherlands with the number METCZ20220036.

Discussing male sexual and reproductive health in the rheumatology outpatient clinic: a Q-methodology study

OBJECTIVES

Inflammatory arthritis (IA) has been associated with various problems related to male sexual and reproductive health (SRH). However, addressing these issues in the clinic remains a challenge. In this study, we aimed to describe the viewpoints of rheumatologists and male patients with IA regarding the aspects that influence their communication about SRH.

METHODS

Rheumatologists and adult men with IA were invited to participate. This study uses Q-methodology, a mixed methods approach to systematically study subjectivity. Participants ranked 32 aspects according to their degree of influence (least-most influence) in addressing SRH and were then interviewed. Factor analysis was used to identify common patterns in the rankings. These patterns were interpreted as the different viewpoints of rheumatologists and male patients, supported by the qualitative data from the interviews. To obtain more generalizable results, the study was conducted in two countries with different socio-cultural backgrounds and healthcare systems, The Netherlands and Mexico.

RESULTS

30 rheumatologists and 30 men with IA were included in each country. The analysis revealed three viewpoints in each group. Rheumatologists are more likely to be influenced by aspects such as the patient's desire to become a father or the patients' (young) age, but patients by a much more diverse pool of aspects, such as potential side effects of medication on their sexual function.

CONCLUSIONS

This study identified different viewpoints on the aspects that influence discussing SRH between rheumatologists and male patients, and important differences in viewpoints between both groups. Further research is needed to reach consensus on how and when rheumatologists and male patients should discuss SRH.

Supporting People With Musculoskeletal Conditions From Underserved Communities in the United Kingdom to Engage With Physical Activity: A Realist Synthesis and Q-Methodology Study

BACKGROUND

In the United Kingdom, 20 million individuals suffer from a musculoskeletal condition, for which physical activity (PA) is a core treatment. Minority ethnic communities experience a disproportionate impact, experiencing higher levels of pain and engaging in less PA. Research has identified various factors that affect their participation in PA, including lack of access to support, limited knowledge of resources, language barriers, fear of racial harassment while exercising, and insufficient communication/information from healthcare professionals.

METHODS

This project adopted a realist perspective, aiming to understand "what works, in which circumstances, and for whom?" The project had 4 steps: (1) defining review scope with stakeholders; (2) searching and extracting literature, creation of initial program theories; (3) refining/validating initial program theories with stakeholders; and (4) adopting Q-methodology to highlight priority areas.

RESULTS

17 papers were included. Three program theories were identified: (1) Lack of initial access to health service support; (2) Nature of musculoskeletal self-management support-the importance of the therapeutic relationship and value of shared conversations; and (3) Accessible long-term support for PA engagement. The Q-sort exercise highlighted priority areas: (1) complex booking procedures and inadequate translation services, (2) time constraints impact effective patient-centered care, (3) dismissive attitudes/mismatched expectations impact shared decision making, (4) rebuilding trust to strengthen therapeutic relationships, (5) cultural relevance in developing therapeutic relationships, and (6) clinician recommended PA opportunities increase knowledge of PA.

CONCLUSIONS

Our findings shed light on inequities across the UK's musculoskeletal pathways, specifically in relation to PA engagement. This points toward priority areas for future research and interventions.

What are the priorities of consumers and carers regarding measurement for evaluation in mental healthcare? Results from a Q-methodology study

BACKGROUND

The purpose of this study was to identify and describe common views of people with lived experience of mental health challenges - consumers and carers, families and supporters - of what they consider the most important measures to include in health economic evaluations which assess the incremental value of competing options in mental health care.

METHODS

Participants (n = 111) were people living in the state of Victoria, Australia, who identified as consumers of mental healthcare (n = 38); carers, family members and/or supporters (n = 43); or both (n = 30). Factor analysis based on Q-Methodology was used to identify clusters of people who hold similar viewpoints. Common viewpoints were described in terms of the characteristics of the group, and a qualitative interpretation was conducted on the basis of distinguishing statements and quotes provided in participants' own words.

RESULTS

We identified four common views: (1) safety before all else, prioritizing physical, sexual and psychological safety; (2) hope and partnership in processes of care; (3) physical and emotional health and wellbeing; and (4) care access, continuity and partnership with families. Although different priorities were identified for each viewpoint, key priority areas that were common to all views were having an environment in the health service that fosters respect and dignity, and that consumers feel heard and listened to. In sub-group and qualitative analyses, differences were observed regarding the likelihood of consumers and carers holding each of the views, as well as by age group.

CONCLUSIONS

While some differences were noted between the views of consumers and carers and different age groups, there was also common ground regarding what outcomes are of most importance to measure. Including these measures in evaluation frameworks would provide a way of focussing mental healthcare decisions on the aspects of mental healthcare that are of most value to consumers and carers, thereby addressing an important shortcoming of current approaches to decision-making in mental healthcare.

Group concept mapping for health professions education scholarship

While explicit conceptual models help to inform research, they are left out of much of the health professions education (HPE) literature. One reason may be the limited understanding about how to develop conceptual models with intention and rigor. Group concept mapping (GCM) is a mixed methods conceptualization approach that has been used to develop frameworks for planning and evaluation, but GCM has not been common in HPE. The purpose of this article is to describe GCM in order to make it more accessible for HPE scholars. We recount the origins and evolution of GCM and summarize its core features: GCM can combine multiple stakeholder perspectives in a systematic and inclusive manner to generate explicit conceptual models. Based on the literature and prior experience using GCM, we detail seven steps in GCM: (1) brainstorming ideas to a specific "focus prompt," (2) preparing ideas by removing duplicates and editing for consistency, (3) sorting ideas according to conceptual similarity, (4) generating the point map through quantitative analysis, (5) interpreting cluster map options, (6) summarizing the final concept map, and (7) reporting and using the map. We provide illustrative examples from HPE studies and compare GCM to other conceptualization methods. GCM has great potential to add to the myriad of methodologies open to HPE researchers. Its alignment with principles of diversity and inclusivity, as well as the need to be systematic in applying theoretical and conceptual frameworks to practice, make it a method well suited for the complexities of contemporary HPE scholarship.

Patients' perspectives on ethical principles to fairly allocate scarce surgical resources during the COVID-19 pandemic in the Netherlands: a Q-methodology study

OBJECTIVES

During the COVID-19 pandemic, healthcare professionals were faced with prioritisation dilemmas due to limited surgical capacity. While the views of healthcare professionals on fair allocation have been given considerable attention, the views of patients have been overlooked. To address this imbalance, our study aimed to identify which ethical principles are most supported by patients regarding the fair allocation of surgical resources.

DESIGN

A Q-methodology study was conducted. Participants ranked ordered 20 statements covering different viewpoints on fair allocation according to their point of view, followed by an interview. Principal component analysis followed by varimax rotation was used to identify subgroups who broadly agreed in terms of their rankings.

SETTING

The setting of this study was in the Netherlands.

PARTICIPANTS

16 patient representatives were purposively sampled.

RESULTS

Two perspectives were identified, both of which supported utilitarianism. In perspective 1, labelled as 'clinical needs and outcomes', resource allocation should aim to maximise the health gains based on individual patient characteristics. In perspective 2, labelled as 'population outcomes and contribution to society', allocation should maximise health gains as with perspective 1, but this should also consider societal gains.

CONCLUSIONS

There was a broad agreement among patient representatives that utilitarianism should be the guiding ethical principle for fair allocation of scarce surgical resources. The insights gained from this study should be integrated into policymaking and prioritisation strategies in future healthcare crises.

Advancing collaboration in health professions education in the general practice domain, developing a national research agenda

BACKGROUND

Health professions education (HPE) research in the General Practice domain (GP-HPE) is vital for high-quality healthcare. Collaboration among GP-HPE researchers is crucial but challenging. Formulating a research agenda, involving stakeholders, and fostering inter-institutional collaboration can address these challenges and connect educational research and practice.

METHODS

We used Q-methodology to explore perspectives on GP-HPE research of participants from all Dutch postgraduate GP training institutes. Participants individually sorted statements based on the relevance of future GP-HPE research for educational practice. Data analysis comprised inverted factor analysis, rotation, and qualitative interpretation of configurations of all statements. The National Meeting on Educational Research took a participatory approach.

RESULTS

We included 73 participants with diverse involvement in GP-HPE research. We identified five distinct perspectives, each representing a research focus area for developing and innovating GP education: the clinician scientist, the socially engaged GP, the specific GP identity, the GP as an entrepreneur, and the GP engaged in lifelong learning.

DISCUSSION

The resulting five perspectives align with General Practice hallmarks. Q-methodology and a participatory approach facilitated collaboration among stakeholders. Successful inter-institutional collaboration requires a common goal, neutral leadership, participant commitment, regular meetings, audit trail support, process transparency, and reflexivity. Future research should address evidence gaps within these perspectives.

CONCLUSION

Using Q-methodology turned out to be valuable for compiling a national research agenda for GP-HPE research. The research process helped to cross boundaries between researchers in different institutions, thus putting inter-institutional collaborative advantage center stage. Our approach could provide a conceivable procedure for HPE researchers worldwide.

Precision Diabetes Education and Support Considering Patients' Behavioral and Psychological Phenotype: A Q-Methodology Study

BACKGROUND

The prevalence of type 2 diabetes is growing, and diabetes burden is increasing. Precision health in diabetes education and support employs different intervention strategies, depending on an individual's viewpoint on diabetes and self-management behaviors, to improve patients' treatment adherence, clinical outcomes, and quality of life.

OBJECTIVE

To classify the behavioral and psychological phenotypes of self-management behaviors in adults taking oral glucose-lowering medications to develop a theory-driven, person-centered group intervention applicable to busy clinical settings.

METHODS

Q-methodology was used. From January to August 2020, 73 participants (48 male, 25 female) were invited to do Q-sorting with 33 statements. The principal component technique, followed by varimax rotation, was used for factor analysis. The Summary of Diabetes Self-Care Activity questionnaire and HbA1c in the past 6 months were included to obtain comprehensive understanding.

RESULTS

Fifty-one sorts (35 male, 16 female) loaded on 1 of 4 factors: factor A (n = 18): Needing emotional support with enhancing problem-solving skills group; factor B (n = 15): Self-help group; factor C (n = 6): Needing personalized coaching group; and factor D (n = 12): Needing basic diabetes education group.

CONCLUSIONS

Each factor demonstrated a different need for diabetes education and support. Younger participants (factor D) had the poorest diabetes self-management behaviors and required basic diabetes education. Further research is warranted to develop a screening tool to classify the typologies and adopt the findings in a busy clinical setting.

Understanding farmers' perceptions on advisory services in Tanzania: Comparative insights from principal component analysis and Q-methodology

Agricultural advisory services help farmers to access farming skills, technologies and agricultural markets. The services are offered by different actors, who all together form the pluralistic advisory service providers. In recent years, pluralistic advisory service providers have emerged in various developing countries including Tanzania. Pluralistic providers have different institutional arrangements and varying levels of effectiveness, which lead farmers to have diverse perceptions towards them. However, the perceptions of farmers on pluralistic advisory services have not been fully documented, making it difficult to gauge the level of acceptance of the diverse services offered. This paper employs principal component analysis (PCA) and Q-methodology to elicit farmers' perceptions on the pluralistic services using samples of 627 and 23 farmers, respectively. Results from both methods showed that pluralistic providers offered diverse services ranging from production to market information. Further, the two approaches provided concurring findings that advisory services offered did not meet farmers' advisory demands. Furthermore, each method served to fill the shortcomings of the other. Therefore, we recommend a complementary application of both approaches rather than treating them as mutually exclusive in the analysis of perceptions.

Identifying priorities for Australian disability research using Q methodology

BACKGROUND

Globally, there are over an estimated one billion people with disability. Research priorities with a focus on diagnosis and treatment of conditions or policy and service initiatives, traditionally decided by researchers, may not align with priorities of those with lived experience of disability.

OBJECTIVE

To explore and inform disability research for Australia, including perspectives of people with disability.

METHODS

As part of a research program, we used Q methodology to explore "what should guide the Australian research agenda?" People with disability, their families, community organizations and researchers were purposively recruited and sorted 25 statements, developed iteratively using data collated from systematic research mapping and a prior consultation process. The sorting grid ranged from -4 to +4, according to "Which topics should guide disability research the least to the most?" Factor analysis revealed four distinct but interrelated participant viewpoints.

RESULTS

52 participants (65 % female, aged 18-65+ years, 37 % people living with disability), sorted the statements. Viewpoint 1 - design and delivery of services across the lifespan. Viewpoint 2 - understanding the diverse experience of those with disability. Viewpoint 3 - designing systems to address impacts of disability for the individual, their families and society. Viewpoint 4 - addressing mental health for those with disability no matter where they live.

CONCLUSION

These viewpoints focused on design and delivery of services to address the impacts of disabling environments and attitudes on individuals living with impairments, their families and society. The four viewpoints provide a framework for future disability research in consultation with those with lived experience.

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+.

Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study

BACKGROUND

This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics.

METHODS

There was used the Q-methodology a research process following specific steps: (a) identifying the concourse, (b) the Q-sample, and (c) the population (P-set); (d) collecting data using the Q-sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified.

RESULTS

There were involved 56 nurses working in medical, geriatric and log-term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical-oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56.

CONCLUSION

Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions.

A comparison of Swedish IBS patients and general practitioners regarding viewpoints on IBS: a Q-methodology study

OBJECTIVES

Irritable bowel syndrome (IBS) is a common functional gastrointestinal condition. A respectful patient-doctor relationship with good communication is crucial for optimal treatment. Q-methodology is a combination of qualitative and quantitative methods used to study subjectivity. The aim of this study was to compare viewpoints on IBS between patients with IBS and general practitioners (GPs).

METHODS

We conducted a Q-methodology study by including 30 patients and 30 GPs. All participants were asked to complete Q- sorting of 66 statements on IBS using an online software program. Data were processed using factor analysis. In addition, 3 patients and 3 GPs were interviewed.

RESULTS

Three factors were extracted from both groups: Patient Factor 1 'Question the diagnosis of IBS', Patient Factor 2 'Lifestyle changes for a physical disorder', Patient Factor 3 'Importance of a diagnosis', GP Factor 1 'Unknown causes of great suffering', GP Factor 2 'Lifestyle changes are important, stress makes IBS worse', GP Factor 3 'Recognized the way IBS affects patients'. There was a strong and statistically significant correlation between patient Factor 1 and GP Factor 1, with a Pearson's r of 0.81 (p < 0.001). Correlations between other factors varied.

CONCLUSIONS

There was consensus between patients and GPs that IBS is a physical and not a psychiatric disorder of unknown etiology. They also seemed to agree that IBS has a great negative impact on patients' lives and that lifestyle changes are beneficial. There were conflicting opinions regarding gender, cultural factors and the use of antidepressants.

Views of health care professionals on the implementation of preoperative advance care planning in older patients with head and neck cancer: Q methodology

Objective

To investigate the views of health care professionals in a head and neck surgical department toward the implementation of advance care planning prior to surgery for older patients with head and neck cancer.

Method

Q methodology was used to explore and analyze participants' views by combining quantitative and qualitative methods. Participants were asked to rank 35 Q statements generated via semi-structured interviews and a literature review and to explain the reasons for their ranking in subsequent interviews. The data was then analyzed and used to develop a factor series to illustrate participants' views.

Results

This study surveyed 15 health care professionals, including eight doctors and seven nurses. The views of health care professionals toward preoperative implementation of advance care planning discussions were varied and could be categorized into three types: defending the autonomy of patients, patients' knowledge and the Chinese traditional cultural context hinder the implementation of preoperative advance care planning, and lack of confidence in performing preoperative advance care planning.

Conclusions

Although the health care professionals in the head and neck surgical department in this study recognized the benefits of preoperative discussions regarding advance care planning, patients' knowledge level, traditional Chinese values, inadequate capacity among health care professionals, and unsound legal policies have caused these professionals to have misgivings about preoperative counseling and discussing advance care planning with patients. Further studies should be conducted, and strategies to overcome barriers to discussions of preoperative advance care planning should be developed.

Measurement of China's public health level: compilation and research of an index

BACKGROUND

With the development of the economy, public health has become increasingly important. Therefore, it is important to establish a comprehensive and scientific the public health level index (PHL) system to measure public health level as a research priority. The current research has limitations in exploring the PHL system; therefore, the field still lacks a comprehensive indicator system to measure the level of public health. Therefore, this paper aims to develop a multi-level public health index system and utilizes China as a case study to evaluate its public health status. The objective is to offer insights and recommendations for the improvement of public health initiatives in China and other regions.

METHODS

Utilizing data from 2011 to 2020, a comprehensive PHL was developed to encompass three vital indices: the Public Health Service Index (PHS), the Public Health Resource Index (PHR), and the Population Health Level Index (PHL). Subsequently, the PHL, PHS, PHR, and PH were meticulously calculated using a comprehensive evaluation method. Amid the current disparity between public health and economic progress, both the spatial Durbin model and the spatial lag model were finally employed to examine the influence of economic level (EL) on PHL, thus affirming the consistent reliability and accuracy of PHS.

RESULTS

Our findings revealed the following: (i) the PHL, PHS, and PHR indices show increasing trends in China; (ii) both EL and PHL exhibit high-high clustering and low-low clustering states; (iii) the PHL in the area has a positive spatial spillover effect on the surrounding area; (iv) EL will result in the siphoning effect of PHL; and (v) EL can enhance PHL through urbanization, PH, and PHS.

CONCLUSIONS

The PHL system constructed in this paper demonstrates multiple levels, pluralism, spatio-temporal comparability, and robustness. It can reflect not only the input and output of public health initiatives but also the interconnectedness and autonomy within the public health system. Therefore, it can be widely utilized in other areas of public health research.

The Pathway Building Technique in Implementation Research Using Mixed Methods Design

BACKGROUND

Data integration refers to combining quantitative and qualitative data in mixed methods. It can be achieved through several integration procedures. The building integration procedure can be used for developing quantitative instruments by integrating data from the qualitative phase. There are limited examples of data integration using the building procedure in mixed methods and implementation science.

PURPOSE

The purpose of this article is to illustrate how the pathway building technique can be used to integrate data in mixed methods research through concurrent use of implementation science models and frameworks.

METHODS

This two pathway building technique was developed based on a mixed methods implementation project of developing implementation strategies to promote compassionate nursing care of complex patients.

RESULTS

The first pathway is the integration of qualitative data from the first phase of mixed methods study with implementation models and frameworks to create a quantitative instrument (i.e., a Q-sort survey) for the subsequent phase. The second pathway is the operationalization of the Q-sort survey results (i.e., implementation strategies) using an implementation science specification framework.

CONCLUSION

The pathway technique is valuable for mixed methods research and implementation science as it offers a theory-based innovative method to tackle integration challenge.

Trauma-informed care: Insights from a Q-methodology study of advanced practice registered nursing students

BACKGROUND

Trauma-informed care (TIC) aims to create a safe and supportive healthcare environment that empowers patients and cultivates understanding of the role trauma plays in short-term and long-term health. TIC also has the potential to improve health outcomes and foster clinician wellness. Nurse educators must design evidence-based instruction to develop advanced practice registered nurses (APRNs) who deliver high-quality TIC while also protecting their own wellbeing.

OBJECTIVES

To identify patterns in subjective viewpoints about TIC among APRN students and describe how those patterns influence their learning experience in an advanced health assessment course.

DESIGN

Q methodology was used to explore student perceptions of TIC.

SETTING

A virtual advanced health assessment course at a large, midwestern university in the United States.

PARTICIPANTS

Ninety-five APRN students from six specialty APRN programs.

METHODS

Students completed an online Q-sort activity by ranking 32 TIC statements according to how well the statements aligned with their own perspectives. Q-sorts were analyzed using factor analysis and narrative responses to open-ended questions.

RESULTS

Four factors were extracted that revealed different student viewpoints on TIC and their learning experiences: Comfortable/Confident Learners, Uncomfortable/Apprehensive Learners, Empathetic/Hesitant Learners, and Inexperienced/Uncertain Learners.

CONCLUSIONS

All students acknowledged the need to learn about TIC to implement it effectively in practice. It is important for faculty to understand the potential range of divergent student viewpoints about TIC and acknowledge, accept, and support students who have anxiety related to learning about TIC.

Improved Evaluation Metrics for Sentence Suggestions in Nursing and Elderly Care Record Applications

This paper presents a new approach called EmbedHDP, which aims to enhance the evaluation models utilized for assessing sentence suggestions in nursing care record applications. The primary objective is to determine the alignment of the proposed evaluation metric with human evaluators who are caregivers. It is crucial due to the direct relevance of the provided provided to the health or condition of the elderly. The motivation for this proposal arises from challenges observed in previous models. Our analysis examines the mechanisms of current evaluation metrics such as BERTScore, cosine similarity, ROUGE, and BLEU to achieve reliable metrics evaluation. Several limitations were identified. In some cases, BERTScore encountered difficulties in effectively evaluating the nursing care record domain and consistently providing quality assessments of generated sentence suggestions above 60%. Cosine similarity is a widely used method, but it has limitations regarding word order. This can lead to potential misjudgments of semantic differences within similar word sets. Another technique, ROUGE, relies on lexical overlap but tends to ignore semantic accuracy. Additionally, while BLEU is helpful, it may not fully capture semantic coherence in its evaluations. After calculating the correlation coefficient, it was found that EmbedHDP is effective in evaluating nurse care records due to its ability to handle a variety of sentence structures and medical terminology, providing differentiated and contextually relevant assessments. Additionally, this research used a dataset comprising 320 pairs of sentences with correspondingly equivalent lengths. The results revealed that EmbedHDP outperformed other evaluation models, achieving a coefficient score of 61%, followed by cosine similarity, with a score of 59%, and BERTScore, with 58%. This shows the effectiveness of our proposed approach in improving the evaluation of sentence suggestions in nursing care record applications.

Stakeholder perspectives on payment reform in maternity care in the Netherlands: A Q-methodology study

Based on theoretical notions, there is consensus that alternative payment models to the common fee-for-service model have the potential to improve healthcare quality through increased collaboration and reduced under- and overuse. This is particularly relevant for maternity care in the Netherlands because perinatal mortality rates are relatively high in comparison to other Western countries. Therefore, an experiment with bundled payments for maternity care was initiated in 2017. However, the uptake of this alternative payment model remains low, as also seen in other countries, and fee-for-service models prevail. A deeper understanding of stakeholders' perspectives on payment reform in maternity care is necessary to inform policy makers about the obstacles to implementing alternative payment models and potential ways forward. We conducted a Q-methodology study to explore perspectives of stakeholders (postpartum care managers, midwives, gynecologists, managers, health insurers) in maternity care in the Netherlands on payment reform. Participants were asked to rank a set of statements relevant to payment reform in maternity care and explain their ranking during an interview. Factor analysis was used to identify patterns in the rankings of statements. We identified three distinct perspectives on payment reform in maternity care. One general perspective, broadly supported within the sector, focusing mainly on outcomes, and two complementary perspectives, one focusing more on equality and one focusing more on collaboration. This study shows there is consensus among stakeholders in maternity care in the Netherlands that payment reform is required. However, stakeholders have different views on the purpose and desired design of the payment reform and set different conditions. Working towards payment reform in co-creation with all involved parties may improve the general attitude towards payment reform, may enhance the level of trust among stakeholders, and may contribute to a higher uptake in practice.

Does problem-based learning facilitate enactment of learner agency in undergraduate dental curricula? A Q study

INTRODUCTION

Addressing a literature gap on leaner agency in health profession education, this study explores students' perceptions on which aspects of a problem-based learning (PBL) environment cradle their leaner agency enactment.

METHODS

Thirty-eight students from a newly established undergraduate dental medicine programme in Qatar participated in the study. Q methodology was adopted to collect and analyse data both qualitatively and quantitatively. A 40-statement Q-set was established based on a proposed conceptual framework of learner agency in PBL, including three dimensions-intrapersonal, behavioural and environmental.

RESULTS

Q methodological factor analysis identified four significantly different student viewpoints, which underscored participants' enactment of learner agency addressing the intrapersonal, behavioural and environmental dimensions of the conceptual framework. Despite differences in opinion regarding sources of learner agency, the four student viewpoints unanimously underscore the importance of PBL facilitators' expertise to nurture and develop agency amongst undergraduate students. Post-sorting qualitative data further confirmed the quantitative analysis. Time constraints and workload were identified as the main challenges by the participants.

CONCLUSIONS

This study explored enactment of learner agency as perceived by undergraduate dental students in a PBL curriculum. The findings of this study provide new insights into participants' subjective understanding of learner agency in a PBL curriculum in dentistry. Structured support is needed for students having no prior PBL experiences to develop their learner agency at both intrapersonal and behavioural (self-regulated learning) dimensions, and to ensure they interact with their learning environment proactively.

Barriers to implementing health programs based on community participation: the Q method derived perspectives of healthcare professional

BACKGROUND

Community participation in implementing health programs leads to positive organizational, social and individual consequences. This study aimed to investigate the prospects of a sample of Iranian healthcare professionals about their perceived barriers to implementing health programs based on community participation.

METHODS

This was a cross-sectional study that employed a Q-methodology approach. Twenty health professional sorted the 47 statements into a 9-column Q-sort diagram ranging from - 4 as not important to + 4 as very important. The data were analyzed with PQMethod 2.35 software. The centroid factor analysis and varimax rotation were used for data analysis. Factors identified were interpreted and described in terms of the participants perspectives on the phenomenon.

RESULTS

Analysis of the study participants' viewpoints (the Q-sorts) resulted in a five factor solution (accounted for 57% of the total variance) to endorse the main barriers to the implementation of health programs based on community participation in Iran. Barriers related to government, health programs, lack of necessary skills amongst health professionals and weak coordination between departments, barriers related to community, lack of understanding of goals, benefits and transparency of roles and responsibilities were among the important emanated factors to implementing health programs based community participation.

CONCLUSION

Health policymakers and managers should consider the five mentioned identified barriers based on the community when planning and implementing the health program participation and try to empower the community to implement the programs in Iran.

Short-Form Video Exposure and Its Two-Sided Effect on the Physical Activity of Older Community Women in China: Secondary Data Analysis

Background

There is a tendency for older adults to become more physically inactive, especially older women. Physical inactivity has been exacerbated since the COVID-19 pandemic. Lockdowns and information-based preventive measures for COVID-19 increased the number of short-form video app users and short-form video exposure, including content exposure and the duration of exposure, which has demonstrated important effects on youths' health and health-related behaviors. Despite more older adults viewing short-form videos, less is known about the status of their short-form video exposure or the impacts of the exposure on their physical activity.

Objective

This study aims to describe physical activity-related content exposure among older adults and to quantify its impacts along with the duration of short-form video exposure on step counts, low-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA).

Methods

We analyzed a subsample (N=476) of older women who used smartphones and installed short-form video apps, using the baseline data collected from an ongoing cohort study named the Physical Activity and Health in Older Women Study (PAHIOWS) launched from March to June 2021 in Yantai, Shandong Province, China. The information on short-form video exposure was collected by unstructured questions; physical activity-related content exposure was finalized by professionals using the Q-methodology, and the duration of exposure was transformed into hours per day. Step counts, LPA, and MVPA were assessed with ActiGraph wGT3X-BT accelerometers. Multiple subjective and objective covariates were assessed. Linear regression models were used to test the effects of short-form video exposure on step counts, LPA, and MVPA. MVPA was dichotomized into less than 150 minutes per week and 150 minutes or more per week, and the binary logistic regression model was run to test the effects of short-form video exposure on the achievement of spending 150 minutes or more on MVPA.

Results

Of 476 older women (mean age 64.63, SD 2.90 years), 23.7% (113/476) were exposed to physical activity-related short-form videos, and their daily exposure to short-form videos was 1.5 hours. Physical activity-related content exposure increased the minutes spent on MVPA by older women (B=4.14, 95% CI 0.13-8.15); the longer duration of short-form video exposure was associated with a reduced step count (B=-322.58, 95% CI -500.24 to -144.92) and minutes engaged in LPA (B=-6.95, 95% CI -12.19 to -1.71) and MVPA (B=-1.56, 95% CI -2.82 to -0.29). Neither content exposure nor the duration of exposure significantly increased or decreased the odds of older women engaging in MVPA for 150 minutes or more per week.

Conclusions

Short-form video exposure has both positive and negative impacts on the physical activity of older adults. Efforts are needed to develop strategies to leverage the benefits while avoiding the harms of short-form videos.

De-implementation of Low-Value Practices for Autism Spectrum Disorder

Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.

Alternative Clinical Practice Experiences of Korean Nursing Students during the COVID-19 Pandemic

Background: Routine clinical practice (RCP) experiences provide nursing students with the opportunity to gain confidence in their professional roles. The purpose of this study was to explore the alternative clinical practice (ACP) experiences of nursing students during the COVID-19 pandemic using the Q methodology. Methods: Fifty-two nursing students located in four cities across South Korea participated. The participants sorted the order of and ranked 41 Q statements about their experiences with ACP into a Q sort table; the data were analyzed using the PQ method. Results: The following three distinct viewpoints were extracted: (1) ACP helps with balancing learning and life (favorable view of ACP); (2) ACP does not help with balancing theory and clinical field practice (critical view of ACP); and (3) RCP cannot be replaced by ACP (negative view of ACP). Conclusions: The findings of this study indicate that developing a curriculum for clinical practice that can enhance the strengths of ACP while compensating for its weaknesses will help promote learning among nursing students.

Prioritizing risk factors and identifying target areas to address with interventions to improve sustainable employment of persons with a brain injury or a spinal cord injury - A multi-stakeholder consensus process

Background

Achieving sustainable long-term employment is the goal of work integration for persons with acquired brain injury (ABI) or spinal cord injury (SCI). However, decreasing employment rates over time for persons with ABI and SCI indicate that remaining employed in the long-term is a challenge.

Purpose

To identify the most important risk factors that pose a barrier to sustainable employment of persons with ABI or SCI from a multi-stakeholder perspective, and to propose corresponding interventions that address them.

Methods

Multi-stakeholder consensus conference and follow-up survey.

Results

From 31 risk factors to sustainable employment of persons with ABI or SCI identified in previous studies, nine were defined as most important to address with interventions. These risk factors either impacted the person, the work environment or service provision. Potential interventions to address these factors were proposed in mixed condition groups, of which ten were voted on as priority interventions. The follow-up survey revealed strong agreement on the intervention proposals, strong to moderate agreement on impact, but moderate to low feasibility, as most of the interventions were measures at the meso- (service) and macro- (legislation and state regulation) level.

Conclusions

Holding micro-level stakeholder conferences is a valuable method for identifying the most important risk factors to sustainable employment and for developing measures to address them. To implement measures that involve decisions at the meso- or macro-level, representatives from these levels of the healthcare and social system have to be involved.

Measuring educational neglect using the Q method: A model based on the burden of disseminated tungiasis

Background

A paramount factor in the control of neglected tropical diseases from both medical and social aspects is education. New strategies must be constantly pursued to test and provide educational information related to diseases affecting vulnerable populations. We applied the Q method as a model to measure educational neglect based on the burden of disseminated tungiasis.

Methods

Using a saturation method for sample size calculation, we recruited students and healthcare professionals to evaluate and classify 27 statements related to the prevention, control and treatment of tungiasis. After quantitative analysis, the Q method was applied based on the paired use of the centroid method and Varimax rotation, and 4 factors were extracted representing the main sets of viewpoints among the participants.

Results

We included 119 healthcare professionals with different academic degrees. Statements classified by specialists with a + agreement were also classified as a + agreement by most of the participants. However, we detected 5 important disagreements related to the topical treatment of tungiasis and control of the disease in the environment and animals. The Q method showed that almost no consensus was detected for four statements. The classification of each statement was not related to the participants' academic degree.

Conclusions

There is significant educational neglect related to tungiasis prevention and treatment in healthcare sciences in Brazil. We conclude that the Q method may be an interesting strategy alone or associated with quantitative strategies for detecting educational limitations related to neglected diseases. In countries where neglected diseases are endemic, a detailed study evaluating the quality of education related to these diseases must be prioritized.

Identification of Key Factors for Optimized Health Care Services: Protocol for a Multiphase Study of the Dubai Vaccination Campaign

BACKGROUND

Mass vaccination of the global population against the novel COVID-19 outbreak posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population aged >18 years against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers across the city of Dubai, the largest of which was the Dubai One Central (DOC) vaccination center. It was operational between January 17, 2021, and 27 January 27, 2022.

OBJECTIVE

The multiphase research study aims to empirically explore the opinions of multiple health care stakeholders, elicit the key success factors that can influence the effective delivery of emergency health care services such as a COVID-19 mass vaccination center, and explore how these factors relate to one another.

METHODS

To understand more about the operations of the DOC vaccination center, the study follows a multiphase design divided into 2 phases. The study is being conducted by the Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semistructured interviews (SSIs) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, the administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study, and 30 agreed to participate in the SSIs. To validate the participation of various stakeholders, phase 2 will analytically investigate one's subjectivity through Q-methodology and empirically investigate the opinions obtained from the research participants during phase 1.

RESULTS

As of July 2022, 30 SSIs were conducted with the research participants.

CONCLUSIONS

The study will provide a comprehensive 2-phase approach to obtaining the key success factors that can influence the delivery of high-quality health care services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future health care services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the DOC vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/42278.

Prioritizing outcome measures after aneurysmal subarachnoid hemorrhage: A q-sort survey of patients, health care providers and researchers

Objective

To understand which outcome measures patients and their families, health care providers, and researchers prioritize after aneurysmal subarachnoid hemorrhage (aSAH).

Methods

We conducted a cross-sectional q-sort survey with participants from three key stakeholder groups. Potential outcomes were identified from interviews and focus groups. Participants were purposively sampled to achieve diversity based on stakeholder group, geography, and profession. Respondents sorted 27 outcomes in a quasi-normally distributed grid (Q-Sort) from most to least important. Principal components analysis was used to determine similarities in the way participants sorted the outcome measures resulting in distinct groupings. Overall rankings were also reported.

Results

112 participants were invited. 70 responded and 64 participants from 25 different countries completed a Q-sort. Balanced stakeholder representation was achieved. Five distinct patterns were identified based on survival, pathophysiological, psychological, resource use, and functional outcome measures. Quality of life as reported by the patient was the highest ranked outcome measure followed by independence and functional measures. Survival and biomedical outcomes were ranked in the middle and cost measures last.

Conclusions

In this diverse sample of key stakeholders, we characterized several distinct perspectives with respect to outcome measure selection in aSAH. We did not identify a clear pattern of opinion based on stakeholder group or other participant characteristics. Patient-reported measure of quality of life was ranked the most important overall with function and independence also highly rated. These results will assist study design and inform efforts to improve outcome selection in aSAH research.

Identifying, classifying and prioritizing factors affecting human errors in the mine design process: A mixed methods research

BACKGROUND: Mines are often home to many dangers with a high rate of accidents and occupational diseases. One of the most effective ways to prevent these adverse incidents is to identify and control the influential factors causing human error in design and the ensuing negative consequences. OBJECTIVE: This study aimed to explore, categorize and prioritize factors affecting human errors in the mine design process. METHODS: The study has a mixed-method design combining qualitative and quantitative data. In the qualitative phase, the required data were collected by conducting semi-structured interviews with 12 surface mine designers. The causes of errors were extracted and categorized by the latent content analysis using MAXQDA2022 software. The identified causes in the qualitative phase were sent to expert designers in Q tables, and the data were analyzed by factor analysis. RESULTS: Of the identified codes in the qualitative phase, 40 main themes in five different categories (individual, organizational, external, task, and environmental factors) were determined as causes. The results of the quantitative phase suggest the existence of four different mental patterns regarding the causes of design errors (DEs). The data analysis also shows that organizational and personal factors, particularly supervision and inspection, experience, and technical knowledge, were the strongest causes of DEs and environmental (hotness, coldness, indoor air quality, and noise) and external (work-family conflict) factors being the weakest ones. CONCLUSION: This study not only identifies and categorizes the causes of design errors in the mining industry but also suggests some control strategies for these errors based on the mental patterns of the experts.

Stakeholders’ Perspectives on the Application of New Diagnostic Devices for Urinary Schistosomiasis in Oyo State, Nigeria: A Q-Methodology Approach

New diagnostic devices for schistosomiasis should be designed to function best within the local endemic health care context and support stakeholders at various levels of the health care system in performing the tasks to help control and eventually eliminate schistosomiasis.

Urinary schistosomiasis is a waterborne parasitic infection caused by Schistosoma haematobium that affects approximately 30 million people annually in Nigeria. Treatment and eradication of this infection require effective diagnostics. However, current diagnostic tests have critical shortcomings and consequently are of limited value to stakeholders throughout the health care system who are involved in targeting the diagnosis and subsequent control of schistosomiasis. New diagnostic devices that fit the local health care infrastructure and support the different stakeholder diagnostic strategies remain a critical need. This study focuses on understanding, by means of Q-methodology, the context of use and application of a new diagnostic device that is needed to effectively diagnose urinary schistosomiasis in Oyo State, Nigeria. Q-methodology is a technique that investigates subjectivity by exploring how stakeholders rank-order opinion statements about a phenomenon. In this study, 40 statements were administered to evaluate stakeholder perspectives on the context of use and application of potential new diagnostic devices and how these perspectives or viewpoints are shared with other stakeholders. Potential new diagnostic devices will need to be deployable to remote or distant communities, be affordable, identify and confirm infection status before treatment in patients whose diagnosis of urinary schistosomiasis is based on self-reporting, and equip health care facilities with diagnostic devices optimized for the local setting while requiring local minimal infrastructural settings. Similarly, the context of use and application of a potential new diagnostic device for urinary schistosomiasis is primarily associated with the tasks stakeholders throughout the health care system perform or procedures employed. These findings will guide the development of new diagnostic devices for schistosomiasis that match the contextual landscape and diagnostic strategies in Oyo.

Establishing the content validity of a new emergency department patient-reported experience measure (ED PREM): a Delphi study

Background

Patient-reported experience measures aim to capture the patient’s perspective of what happened during a care encounter and how it happened. However, due to a lack of guidance to support patient-reported experience measure development and reporting, the content validity of many instruments is unclear and ambiguous. Thus, the aim of this study was to establish the content validity of a newly developed Emergency Department Patient-Reported Experience Measure (ED PREM).

Methods

ED PREM items were developed based on the findings of a systematic mixed studies review, and qualitative interviews with Emergency Department patients that occurred during September and October, 2020. Individuals who participated in the qualitative interviews were approached again during August 2021 to participate in the ED PREM content validation study. The preliminary ED PREM comprised 37 items. A two-round modified, online Delphi study was undertaken where patient participants were asked to rate the clarity, relevance, and importance of ED PREM items on a 4-point content validity index scale. Each round lasted for two-weeks, with 1 week in between for analysis. Consensus was a priori defined as item-level content validity index scores of ≥0.80. A scale-level content validity index score was also calculated.

Results

Fifteen patients participated in both rounds of the online Delphi study. At the completion of the study, two items were dropped and 13 were revised, resulting in a 35-item ED PREM. The scale-level content validity index score for the final 35-item instrument was 0.95.

Conclusions

The newly developed ED PREM demonstrates good content validity and aligns strongly with the concept of Emergency Department patient experience as described in the literature. The ED PREM will next be administered in a larger study to establish its’ construct validity and reliability. There is an imperative for clear guidance on PREM content validation methodologies. Thus, this study may inform the efforts of other researchers undertaking PREM content validation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00617-5.

Broadening the scope of social support, coping skills and resilience among caretakers of children with disabilities in Uganda: a sequential explanatory mixed-methods study

BACKGROUND

Most caretakers of children with disabilities (CWDs) have adverse health outcomes. Approximately 31% of the caretakers have clinical depression in the world. In Sub-Saharan Africa, 42% of them face severe psychological distress. Caretakers in Africa face additional cultural challenges that undermine their coping skills, access to social support, and resilience.

METHODS

This study used sequential explanatory mixed methods to examine the relationships of social support, coping skills and resilience among caretakers of CWDs in Uganda. A total of 621 caretakers were surveyed, and 43 of them participated in interviews. Hierarchical cluster analysis and binary logistic regression were conducted to determine coping patterns and predict caretakers' likelihood of using them. Hierarchical linear regression and thematic analyses then explored the relationships and perceptions of coping skills and resilience related to social support. A joint display was used to integrate results and show the convergence and expansion of quantitative and qualitative results.

RESULTS

Quantitative and qualitative findings converged that caretakers who received social support used adaptive coping skills and had higher resilience. Qualitative results expanded the finding that caretakers who received formal social support perceived it as a safer mode of care than informal social support.

CONCLUSIONS

The study expanded the scope of social support, coping skills, and resilience. Caretakers perceived formal social support from schools as a safe mode of care that enabled them to use adaptive coping skills and have high resilience. Therefore, enrolling children with disabilities in schools at an early age is beneficial for building the resilience of their caretakers.

A scoping review of Q methodology nursing education studies

OBJECTIVES

The purpose of this review was to examine the characteristics of published Q methodology nursing education studies including the purposes, the methodological variations, and the major implications to inform best practices.

DESIGN

Scoping review design using the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews.

DATA SOURCES

Academic Search Complete, CINAHL Complete, Education Research Complete, Embase, ERIC, Proquest Nursing and Allied Health, PubMed, PsycInfo, SocINDEX, and the Web of Science Core Collection.

REVIEW METHODS

A comprehensive search of English language journal articles was conducted for Q methodology studies published between 2015 and 2020 that used undergraduate nursing students or nursing faculty as participants. Data were extracted using a modified version of the Assessment Review Instrument for Q Methodology.

RESULTS

Eighteen studies from five countries met inclusion criteria. The majority were single-site studies and used nursing students as participants. The number of stimuli for sorting in the Q sample ranged from 21 to 60. Study aims fell into three broad domains: attitudes about patient populations or settings (N = 7), perceptions about teaching methods (N = 9), or beliefs about professional/practice issues (N = 2). Seven studies specifically explored simulation. Unique viewpoints discovered ranged from one to five in each study. Findings were used to inform teaching, create curricula, evaluate programs, and to generate more questions for study. Strategies for reporting the Q methodology research steps and findings varied significantly.

CONCLUSION

Q methodology is a useful research approach to discover variations in perspectives to inform best educational practices. Use of a standardized flow sheet could enhance reporting the Q methodological approach which may lead to a better understanding and acceptance of the method in the discipline.

Examining perspectives on the adoption and use of computer-based patient-reported outcomes among clinicians and health professionals: a Q methodology study

OBJECTIVE

To determine factors that influence the adoption and use of patient-reported outcomes (PROs) in the electronic health record (EHR) among users.

MATERIALS AND METHODS

Q methodology, supported by focus groups, semistructured interviews, and a review of the literature was used for data collection about opinions on PROs in the EHR. An iterative thematic analysis resulted in 49 statements that study participants sorted, from most unimportant to most important, under the following condition of instruction: "What issues are most important or most unimportant to you when you think about the adoption and use of patient-reported outcomes within the electronic health record in routine clinical care?" Using purposive sampling, 50 participants were recruited to rank and sort the 49 statements online, using HTMLQ software. Principal component analysis and Varimax rotation were used for data analysis using the PQMethod software.

RESULTS

Participants were mostly physicians (24%) or physician/researchers (20%). Eight factors were identified. Factors included the ability of PROs in the EHR to enable: efficient and reliable use; care process improvement and accountability; effective and better symptom assessment; patient involvement for care quality; actionable and practical clinical decisions; graphical review and interpretation of results; use for holistic care planning to reflect patients' needs; and seamless use for all users.

DISCUSSION

The success of PROs in the EHR in clinical settings is not dependent on a "one size fits all" strategy, demonstrated by the diversity of viewpoints identified in this study. A sociotechnical approach for implementing PROs in the EHR may help improve its success and sustainability.

CONCLUSIONS

PROs in the EHR are most important to users when the technology is used to improve patient outcomes. Future research must focus on the impact of embedding this EHR functionality on care processes.

Reading a Q Methodology Research Article

Health care studies that use Q methodology have increased dramatically in recent years, but most nurses have not learned about this mixed methods approach in their research classes. This teaching column will help readers understand some of the unique terms and characteristics of Q methodology. Understanding this method can help nurses performing evidence-based practice and education. [J Contin Educ Nurs. 2022;53(1):10-12.].