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Background: Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. Methods: Using Q‐methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow‐up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by‐person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. Results: Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision‐making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. Conclusions: Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. Patient or Public Contribution: An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications. [ABSTRACT FROM AUTHOR]

Professional identities may influence a wide range of attitudes, ethical standards, professional commitments and patient safety. This study aimed to explore the important elements that comprise pediatricians' professional identities. A Q-methodology was used to identify the similarities and differences in professional identity. Forty pediatricians were recruited from two tertiary referral hospitals in Taiwan. A list of statements was developed by five attending physicians and three residents. R software was used to analyze the Q-sorts to load the viewpoints and formulate the viewpoint arrays. Additional qualitative data—one-to-one personal interviews—were analyzed. Twenty-eight of forty pediatricians, 11 males and 17 females, with an average age of 39.9 (27–62) years, were associated with four viewpoints. We labeled the four viewpoints identified for professional identity as (1) professional recognition, (2) patient communication, (3) empathy and (4) insight. The professional recognition viewpoint comprised of youngest participants—28–36 years—with the majority as residents (77.8%), while the empathy viewpoint comprised the oldest participants—38–62 years—with all as attending physicians. All participants in the empathy and insight viewpoints were married. This study found professional identity to be a multifaceted concept for pediatricians, especially in the areas of professional recognition, patient communication, empathy and insight into patient care. [ABSTRACT FROM AUTHOR]

Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed. [ABSTRACT FROM AUTHOR]

Purpose: There is little consensus regarding what constitutes an effective therapist when working with adults with intellectual disabilities (ID) who have a mental health problem. This study aims to explore whether clusters of clinical psychologists (CPs) could be differentiated with regards to beliefs as to what defines an effective therapist for adults with ID experiencing psychological distress and seeking treatment. Design/methodology/approach: Four interviews with CPs and an associated thematic analysis created the 49-item Q-set. These items were then sorted into a forced quasi-normal distribution by N = 27 CPs via an online Q-sorting task. Findings: Three participant clusters were identified in the principal components analysis that accounted for 49% of the variance. These clusters were labelled the creative collaborator, the reflective expert and the system integrator. Research limitations/implications: Differences exist regarding beliefs as to what the psychotherapeutic approaches effective therapists working with ID and comorbid mental health problems should take. These differences approximated to preferred psychological therapy models. This study is critiqued to enable future research on this topic to progress. Originality/value: To the best of the authors' knowledge, this is the first study to explore what constitutes an effective psychological therapist for people who have ID. [ABSTRACT FROM AUTHOR]

Interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16–21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: "Relieving distress and experiencing a happier emotional state"; "Learning to cope with cyclical distressing emotional states"; "Understanding and processing distressing emotional states"; and "Reduced interference of ongoing distressing emotional states with daily life". All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes. [ABSTRACT FROM AUTHOR]

Background: Palliative wound care is important for stability in terminal care. It addresses both the physical and psychological needs of patients and facilitates other aspects of terminal care. Appropriate competencies of nurses regarding palliative wound care can improve patient outcomes and raise their quality of life. The purpose of this study was to identify how wound care nurses structure the subjective frames regarding palliative wound care. Method: This study utilized Q-methodology to analyze their subjective viewpoints. Forty nurses experienced in palliative wound care were asked to completely classify 35 Q-statements into a normal distribution shape. The PQ-Method program was used to conduct principal factor analysis and varimax rotation for data analysis. Results: This study revealed 4 Q-factors of palliative wound care: "Focusing on care within the boundary of current patient demands," "Comparing continuously the priorities on wound healing and disease care," "Preparing and preventing from worsening via tracking care in advance," and "Moving forward with a clear direction by confronting the declining condition." Conclusion: We hope that the results of this study are used in the development of nursing education that reflects professional perspectives of palliative wound care, thus helping to improve nursing competencies in palliative care. [ABSTRACT FROM AUTHOR]

Aim: Older adult attitudes and perceptions of dementia can have a major impact on early diagnosis, efforts to prevent and appropriately treat it, as well as being a family burden. The aim of this study is to explore attitudes and perceptions of dementia of home‐dwelling older adults using Q‐methodology. Method: A total of 42 adults, age 65 or over, who live in South Korea ranked 37 Q statements about their attitudes and perceptions of dementia into A Q sort table grid. Results: The following three distinct viewpoints were extracted: (1) it is my responsibility to prevent and to care about dementia (family‐centered view); (2) there are no ways to treat dementia (despairing views); and (3) dementia is a national responsibility (nation‐centered view). Conclusion: Based on these results, central and local government and communities should work together with older adults to manage dementia and reflect these three viewpoints when developing systematic dementia management programs. [ABSTRACT FROM AUTHOR]

Background: Active patient involvement in treatment decisions is seen as a feature of patient‐centred care that will ultimately lead to better healthcare services and patient outcomes. Although many factors have been identified that influence patient involvement in treatment decisions, little is known about the different views that patients have on which factors are most important. Objective: This study explores the views of patients with a chronic condition on factors influencing their involvement in treatment decisions. Design: Q‐methodology was used to study the views of patients. Respondents were asked to rank a set of 42 statements from the least important to the most important for active patient involvement in treatment decision‐making. The set of 42 statements was developed based on a literature search and a pilot in which two external researchers, 15 patients and four healthcare professionals participated. A total of 136 patients with one of three major chronic conditions were included: diabetes types 1 and 2, respiratory disease (i.e., chronic obstructive pulmonary disease and asthma) and cancer (i.e., breast cancer and prostate cancer). Data were collected in a face‐to‐face interview setting in the Netherlands. Results: Four distinct views on the factors influencing active patient involvement were identified among patients with a chronic condition. (1) Enabled involvement: the extent to which patients are facilitated and empowered to participate will lead to patient involvement. (2) Relationship‐driven involvement: the relationship between patients and healthcare professionals drives patient involvement. (3) Disease impact‐driven involvement: the severity of disease drives patient involvement. (4) Cognition‐driven involvement: knowledge and information drive patient involvement. Discussion and Conclusion: From the patients' perspective, this study shows that there is no one‐size‐fits‐all approach to involving patients more actively in their healthcare journey. Strategies aiming to enhance active patient involvement among patients with a chronic condition should consider this diversity in perspectives among these patients. Patient Contribution: Patients are the respondents as this study researches their perspective on factors influencing patient involvement. In addition, patients were involved in pilot‐testing the statement set. [ABSTRACT FROM AUTHOR]

For Small-Group Active Learning (SMAL) to be effective, students need to engage meaningfully in learning activities to construct their knowledge. Teachers can have difficulty engaging their students in this process. To improve engagement, we aimed to identify the diversity in medical students' appreciation of SMAL, using the concepts of epistemic beliefs and approaches to learning. Q-methodology is a mixed-method research design used for the systematic study of subjectivity. We developed a set of 54 statements on active learning methods. In individual interviews, first-year medical students rank ordered their agreement with these statements and explained their reasons. Data were analyzed using a by-person factor analysis to group participants with shared viewpoints. A four-factor solution (i.e. profiles) fit the data collected from 52 students best and explained 52% of the variance. Each profile describes a shared viewpoint on SMAL. We characterized the profiles as 'understanding-oriented', 'assessment-oriented', 'group-oriented', and 'practice-oriented'. The four profiles describe how and why students differ in their appreciation of SMAL. Teachers can use the profiles to make better-informed decisions when designing and teaching their SMAL classes, by relating to students' epistemic beliefs, and approaches to learning. This may improve student motivation and engagement for SMAL. [ABSTRACT FROM AUTHOR]

When nurses practise recovery‐focused care, they contribute positively to the consumer's mental health recovery journey and empower the person to be actively engaged in the management of their illness. While using recovery‐focused care is endorsed in mental health policy, many health professionals remain uncertain about its application with consumers who have a risk for aggression during their admission to an acute mental health inpatient setting. This paper reports on Australian research using Q‐methodology that examined the knowledge and skill components of recovery‐focused care that nurses use to reduce the risk for aggression. The data from forty mental health nurses revealed five factors that when implemented as part of routine practice improved the recovery outcomes for consumers with risk of aggression in the acute mental health settings. These factors were as follows: (I) acknowledge the consumers' experience of hospitalization; (II) reassure consumers who are going through a difficult time; (III) interact to explore the impact of the consumer's negative lived experiences; (IV) support co‐production to reduce triggers for aggression; and (V) encourage and support consumers to take ownership of their recovery journey. These findings provide nurses with a pragmatic approach to use recovery‐focused care for consumers with risk for aggression and contribute positively to the consumers' personal recovery. [ABSTRACT FROM AUTHOR]

Background: Although an integral part of ethical and quality health care, little is known about the informed decision making of Chinese women with different socioeconomic backgrounds within the context of antenatal testing. Methods: To explore women's viewpoints on informed decision making regarding antenatal screening, a Q‐methodology study that combines both quantitative factor analysis and interviews was conducted between June 2016 and February 2017 in Shanghai and Duyun. A total of 169 women (84 Shanghai and 85 Duyun) participated in the study of 41 ranked statements along a Q‐sorting grid. Results: Using by‐person factor analysis, five distinct viewpoints are identified: (a) choice is shared with the partner/husband, but the mother has the right to make the final decision; (b) having antenatal tests is not about choice but about a mother's responsibility; (c) choice is a shared decision led primarily by the partner/husband and secondarily by the doctors; (d) choice should be made using the advice of doctors, but the decision should be made with the partner/husband; and (e) choice is a responsibility shared with the partner, family and doctors. Conclusions: The study reveals that women with better education and higher incomes demonstrate more autonomy than those with less education. The nuclear family clearly emerges as the main decision makers in health‐care services in China. Patient and Public Contribution: The 169 participants shared their views and stories for at least an hour. They were debriefed after the interviews and contributed their thoughts on our study design and interpretation of the data. [ABSTRACT FROM AUTHOR]

Background: Researchers of nursing education have found that students best learn concepts of caring from caring interactions with faculty, classmates, and patients. This places nursing faculty in the position to influence students' opinions and impact student acceptance and respect for the concept of caring within the nursing profession. However, literature shows that students do not always perceive faculty's caring and caring acts to exist. Objective: The purpose of the study was to explore contemporary nursing students' perceptions of which characteristics, qualities, or behaviors exhibited by faculty are consistent with caring in academic settings, such as classrooms, simulation, and skills laboratory using Duffy's Quality Caring model. Methodology: Q-methodology, a research method specifically used to study people's "subjectivity" or viewpoints, was used. This method consists of five steps, which are concourse development, creating of Q-statements from the concourse, data collection via Q-sort, which rank orders the Q-statements, data analysis using correlations and factor analysis, and lastly, interpretation of factors that assisted in the identification of model Q-sort(s) and descriptions of the perceptions. Results: Three factors emerged, and the model Q-sorts associated with each were entitled "content-conscious," "cheerleader," and "consumer-focused." Conclusion: Most contemporary pre-licensure nursing students see the delivery of content effectively and efficiently as the most caring behavior faculty can exhibit. Additionally, students believe that they should receive a quality product they have purchased and that faculty displays caring by helping them reach their goals. Lastly, only a small portion of students desire caring faculty who mentor them and support them emotionally. This information could help faculty understand contemporary nursing students and the characteristics that students feel demonstrate caring to better support student success and program outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Northern Thailand has a distinct culture and set of health beliefs. Nurses' beliefs influence approaches to care affecting health care outcomes. This study explored the content, origin, and sociocultural influences on health beliefs of Northern Thai nurses and how they influence clinical practice and education. Method: Q-methodology was used in this study. Data were collected with interviews using Q-cards, Q-sort distribution board, and a semistructured interview guide. Results : Data were collected from 30 clinical nurses and 30 nurses working in academia. Q-factor analysis produced three factors accounting for 48% of variance: personal experience, Thai and Buddhist beliefs, and contemporary beliefs. Discussion: Participants who felt strongly rooted in their culture and beliefs were homogeneous in recognizing the need for evidence-based practice. Nurses aware of the nature and sources of their beliefs and those of patients are well-placed to balance maintenance of cultural traditions with the need to provide evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: In Norway, 6000 patients were operated on due to hip fracture in 2016. Hip fracture results in increased suffering and often in a dramatic change in an older person's life. The experience of suffering in patients with hip fracture, or nursing staff's perception of it in the preoperative period, is sparsely studied. The perspective of the study was based on caring sciences. Aim: The aim of this study was to gain a deeper understanding of subjective experiences of suffering among elderly hip‐fracture patients during the preoperative period, seen from the patients' and nurses' perspective. Methodological approach: A Q‐methodological approach was used. Forty statements (Q‐sample), based on interviews and theory, were ranked in a forced‐choice distribution curve from 'mostly agree' to 'mostly disagree', followed by postinterviews. Nine patients and five nurses participated. A by‐person factor analysis in the form of principal component analysis with varimax and hand rotation was conducted. Results: Three factors, also called viewpoints, emerged as follows: (i) 'Feeling safe through presence, trust and hope'; (ii) 'Feeling safe occurs when the patient is seen, met and informed'; and (iii) 'Feeling alone and angry at oneself'. A polarisation between participants occurred, since the youngest patients (median age 73), the oldest patients (median age 90) and the nurses were represented in each specific factor. Conclusion: There exist differences between how the nursing staff, the youngest and the oldest elderly patients experienced the preoperative period and what can enhance or alleviate their suffering. Where the youngest elderly communicated safety through trust and relatives' presence, the oldest elderly communicated insecurity in relation to staff and experienced severe pain and loneliness. Nursing staff and one patient emphasised the importance of seeing the patient in the first meeting to establish a feeling of security. [ABSTRACT FROM AUTHOR]

Background: Patient-centered care (PCC) has been proposed as the way forward in improving primary care for patients with multi-morbidity. However, it is not clear what PCC exactly looks like in practice for patients with multi-morbidity. A better understanding of multi-morbid patients' views on what PCC should look like and which elements are most important may help to improve care delivery for this vulnerable population. The present study thus aimed to identify views of patients with multi-morbidity on the relative importance of PCC aspects in a Dutch primary care setting. Methods: Interviews were conducted with 16 patients with multi-morbidity using Q-methodology, which combines quantitative and qualitative analyses. The participants ranked 28 statements about the eight dimensions of PCC (patients' preferences, information and education, access to care, emotional support, family and friends, continuity and transition, physical comfort, and coordination of care) by relative importance. By-person factor analysis using centroid factor extraction and varimax rotation were used to reveal factors that represent viewpoints. Qualitative interview data were used to interpret the viewpoints. Results: The analyses revealed three factors representing three distinct viewpoints of patients with multi-morbidity on what is important for patient-centered care in the primary care setting. Patients with viewpoint 1 are prepared proactive patients who seem to be well-off and want to be in charge of their own care. To do so, they seek medical information and prefer to be supported by a strongly coordinated multidisciplinary team of healthcare professionals. Patients with viewpoint 2 are everyday patients who visit GPs and require well-coordinated, respectful, and supportive care. Patients with viewpoint 3 are vulnerable patients who are less resourceful in terms of communication skills and finances, and thus require accessible care and professionals taking the lead while treating them with dignity and respect. Conclusion: The findings of this study suggest that not all patients with multi-morbidity require the same type of care delivery, and that not all aspects of PCC delivery are equally important to all patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: The purpose of this study is to understand subjective structures of subjectivity on organ donation by using of Q method, draw up plans to promote positive perceptions by each type and utilize a basic material to provide authentic ways for activating organ donation. Method/Statistical Analysis: To collect non-structured statements, a population was extracted by use of materials such as literatures and news articles and interviews, then finalized 32 Q samples. These were distributed final 33 p samples via Q sorting procedures and analysed the results throughout Q factors analysis. Findings: Subjectivity of organ donation was finally verified 4 types and explained 59.2% of total variables. The power of explanation by type was 40.3% for the 1st type, 10.6% for the 2nd type, 4.8% for the 3rd type and 3.5% for the 4th type. Among 33 participants, 18 for 1st type, 6 for the 2nd type, 6 for the 3rd type and 3 for the 4th type was distributed. Each type was shown as a type for social public interest-oriented donors, a reluctant type for donating their conviction, a passive type for donating organs and a type for donating organs after their death recognition. Improvements/Applications: This study will be helpful and useful in drawing up plans for promoting positive perceptions depending upon individual subjectivity of organ donation and utilizing basic materials to provide realistic ways for activating organ donation. [ABSTRACT FROM AUTHOR]

Background: Patients are often not actively involved in their acute pain management. Objectives: To understand the attitudes of patients, family caregivers and nurses to patient participation in pain management after their knee or hip joint replacement. Design: Q-methodological design. Methods: 45 participants were recruited, included 15 patients, 15 caregivers and 15 nurses. Forty-nine statements were rank-ordered in a Q-sort table. Results: Four factors which explained 65% of the variance were identified from factor analysis. They are named "Endurers", "Supporters", "Worriers" ,and "Wabblers". Conclusion: Each group have a significant knowledge deficit in pain management. Patients and caregivers were more likely to have a passive attitude and false cognition towards pain and analgesic drugs. Nurses often play a role as a supporter, however, it is hard for them to understand their important role in facilitating patient involvement in their pain management. [ABSTRACT FROM AUTHOR]

Self-management support programs are reported to have positive effects on the health and care of people with physical disabilities. It is unclear how physiotherapists (PTs) view self-management support. A cross-sectional study with mixed-methods design using Q-methodology was conducted to determine the perspectives of Dutch PTs on self-management support. PTs (n = 39) rank-ordered 37 validated statements about self-management support from "most disagree (−3)" to "most agree (+3)." Differences in perspectives on self-management support were explored in a by-person centroid factor analysis on the basis of the explained variance (R2). After having sorted the statements, PTs explained their ranking of −3 and +3 statements in semi-structured interviews. All PTs recognized self-management support as intrinsic part of physiotherapy practice. Nevertheless, four particular perspectives could be identified: (1) the "externally driven educator" (R2 = 14%), (2) "internally driven educator" (R2 = 9%), (3) "client-centered coach" (R2 = 13%), and (4) "client-initiated coach" perspective (R2 = 15%). Each perspective reflects particular goals and perceptions of self-management support. Differences were identified with respect to the PTs' role perception (educating or coaching), drive (external or internal), and collaboration with the patient (as partner or not). The identified perspectives can be used in the physiotherapy education curriculum to create awareness about the various ways of practicing self-management support and the skills needed to be able to tailor support to patient needs and to switch between perspectives. [ABSTRACT FROM AUTHOR]

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. • This study reveals three perspectives on payment reform in Dutch maternity care. • There is consensus across perspectives on the need for payment reform. • The perspectives differ in their focus on either outcomes, equality or collaboration. • Disagreement remains on the goal, conditions and desired design of the reform. • Co-creation from the start is crucial to facilitate trust and promote uptake of reform. [ABSTRACT FROM AUTHOR]

Aims: An Ecological approach to alcohol behaviour focuses on understanding individual-environment transactions, rather than on cognitive antecedents of behaviour. Meaning exists in the interdependence of individuals and their environments, in terms of affordances. Through subjective experience, this study focussed on group viewpoints related to alcohol-related affordances, or opportunities to consume alcohol in shared drinking environments. Methods: Forty students with a range of self-reported drinking behaviours participated in a Q-Methodology study, ranking 60 statements along a symmetrical grid. This varied concourse of alcohol-related affordances was obtained from a previous observation study within licenced premises and a photo-elicitation interview study with drinkers. Findings: Factor analysis and post-sort interviews revealed four subjective perspectives held by groups about their drinking behaviour: 13 participants were aware of contextual influences, but autonomous in their drinking choices; 12 participants were conscious of influences and compliant to their effects; six participants were unaware of influences, but unanimous with their peers; two participants were concerned about acting appropriately in a context by taking up canonical affordances. Conclusions: Grouping subjectivities from a varied concourse of affordances can reveal subjective experience in relation to drinking environments and alcohol behaviour. This conceptual approach for understanding drinking behaviour should be studied further. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities have less favourable outcomes in—among others—oral health variables, compared to their peers without intellectual disabilities. Before being able to develop target interventions for caregivers, all their prevailing viewpoints regarding oral hygiene need to be identified. Methods: This Q‐methodology study—conducted among 40 caregivers of care‐dependent Institutionalized living persons with moderate intellectual disability—used by‐person factor analysis to reveal clusters of caregivers based on the way their statements were sorted. Results: A 4‐factor solution was chosen based on both the Q‐sorting and the interviews. The four factors identified were responsible and perseverant, motivated but aware of obstacles, social minded and knowledgeable and concerned and insecure. Conclusion: Q‐methodology can be used to determine the different attitudes that caregivers have regarding oral health care. Developing a tool to determine into which factor caregivers should be categorized may be the next step in tailoring oral health instruction. [ABSTRACT FROM AUTHOR]

Aim: To understand Chinese nurses’ perceptions of health beliefs, their content, origin and the influence of sociocultural factors, as a basis of their evidence‐based practice. This study contributes to a larger study to establish the health beliefs of Japanese, Australian, Chinese, South Korean and Thai nurses. Background: Registered nurses teach patients and students about maintaining or attaining health are subject to the same range of influences and their health beliefs may be antithetical to current health evidence. Methods: Q‐method design using q‐sort and interview was used to explore the perspectives on a range of health beliefs of 60 nurses in four cities in China. Findings: Three factors arose from the perceptions of the participants about health and accounted for 50.2% of the total variance: (1) social impact, (2) ‘the importance of evidence’, and (3) beliefs rooted in culture. Discussion: Influence on nurses’ health beliefs was explored in terms of the internalized and frequently unconscious beliefs, values and norms tying them to their communities, reflecting the need for nurses to be aware of their health beliefs and behaviours. Conclusions: Education for nurses in practice needs to acknowledge that individual practitioners’ beliefs strongly influence health teaching for patients and families. In order to implement evidenced‐based practice and teach in line with current evidence nurses need to critically examine and reflect on the impact of culture, society and the media on their own health beliefs. Implications for nursing policy and health policy: Education policy needs to consider that culture and societal pressures affect nurses’ health beliefs and practice. Critical thinking, reflective and evidence‐based practice need to be emphasized in clinical training and nurse education. China also needs to develop policies to allow nurses to be able to assess the reliability of health information on the Internet and to make quality health research more available. [ABSTRACT FROM AUTHOR]

Purpose There is limited research on the role of enjoyment of exercise among people with arthritis. The aim of the present study was to determine distinct viewpoints on exercise held by people with arthritis, and how enjoyment features in these viewpoints. Methods A Q-methodology study was conducted, which involved two interviews with people with rheumatoid arthritis, osteoarthritis or ankylosing spondylitis (aged 20-85 years). In the first interviews, 11 participants helped to create the Q-set, a set of statements reflecting a range of existing views on exercising. In the second interviews, 12 participants (nine of the 11 from the first interviews and three others) ranked the Q-set on a forced quasi-normal distribution of agreement. A Q-method factor analysis was carried out to determine groupings of participants with similar views on exercise. Results Four groupings were discovered, and defined in terms of rankings of statements and illustrative quotes from the ranking procedure. The first grouping had all changed their exercise habits after diagnosis with arthritis. The second grouping had a shared enjoyment for walking to stay healthy. The third grouping's viewpoints focused on knowledge about how much exercise they should carry out. The fourth grouping shared a sense of importance of being responsible for their health by exercising. Conclusion These findings provide information about the role that enjoyment plays in motivating people with arthritis to exercise, although enjoyment of exercise was not expressed by all participants. People with arthritis who share these viewpoints on exercise enjoyment may require different forms of advice regarding feasible and enjoyable exercise. [ABSTRACT FROM AUTHOR]

Objective: Kidney transplant recipients face many self-management challenges. We aimed to identify profiles of attitudes towards self-management support (SMS) shortly after kidney transplantation.Methods: Profiles were generated using Q-methodology: In face-to-face interviews participants rank-ordered opinion statements on aspects of SMS according to agreement. Socio-demographic and medical characteristics were assessed using a questionnaire. By-person factor analysis was used to analyze the rankings and qualitative data was used to support choice of profiles. The resulting factors represent clusters of patients with similar attitudes towards SMS.Results: Forty-three patients (mean age=56; 77% male) participated. Four profiles were identified: (A) transplant-focused and obedient; (B) holistic and collaborative; (C) life-focused and self-determined; and (D) was bipolar. The positive pole (D+) minimalizing and disengaged and the negative pole (D-) coping-focused and needy represent opposing viewpoints within the same profile. Socio-demographic and medical characteristics were not related to profile membership.Discussion: Each profile represents a specific attitude on post-transplant life, responsibility for health and decision-making, SMS needs, and preferences for SMS.Practical Implications: Patients vary in their attitude, needs and preferences for SMS indicating the necessity of providing personalized support after kidney transplantation. Health professionals should explore patients' SMS needs and adapt support accordingly. [ABSTRACT FROM AUTHOR]

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1 - health management and the importance of evidence; (ii) factor 2 - challenging local cultural belief, and Eastern and Western influences; (iii) factor 3 - commonsense; (iv) factor 4 - health and clinical practice; and (v) factor 5 - health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice. [ABSTRACT FROM AUTHOR]

Q-sample construction is a critical step in Q-methodological studies. Prior to conducting Q-studies, researchers start with a population of opinion statements (concourse) on a particular topic of interest from which a sample is drawn. These sampled statements are known as the Q-sample. Although literature exists on methodological processes to conduct Q-methodological studies, limited guidance exists on the practical steps to reduce the population of statements to a Q-sample. A case exemplar illustrates the steps to construct a Q-sample in preparation for a study that explored perspectives nurse educators and nursing students hold about simulation design. Experts in simulation and Q-methodology evaluated the Q-sample for readability, clarity, and for representativeness of opinions contained within the concourse. The Q-sample was piloted and feedback resulted in statement refinement. Researchers especially those undertaking Q-method studies for the first time may benefit from the practical considerations to construct a Q-sample offered in this article. [ABSTRACT FROM AUTHOR]

Due to demographic changes and a widely supported policy of ageing in place, the number of community-dwelling older people will increase immensely. Thus, supportive neighbourhoods enabling older people to age in place successfully are required. Using Q-methodology, we examined older people's perceptions of the comparative importance of neighbourhood characteristics for ageing in place. Based on the World Health Organization's Global Age-friendly Cities guide, we developed 26 statements about physical and social neighbourhood characteristics. Thirty-two older people in Rotterdam, half of whom were frail, rank-ordered these statements. Q-factor analysis revealed three distinct viewpoints each among frail and non-frail older people. Comparisons within and between groups are discussed. Although both frail and non-frail older people strongly desired a neighbourhood enabling them to age in place, they have divergent views on such a neighbourhood. Older people's dependence on the neighbourhood seems to be dynamic, affected by changing social and physical conditions and levels of frailty. [ABSTRACT FROM PUBLISHER]

Background: Self-management support is a major task of nurses in chronic care. Several conceptualizations on what self-management support encompasses are described in the literature. However, nurses' attitudes and perceptions related to self-management support are not known. Objective: To reveal distinctive perspectives of nurses toward self-management support in chronic care. Design and methods: A Q-methodological study was conducted in which nurses rank- ordered 37 statements on self-management support. Thereafter they motivated their ranking in semi-structured interviews. Participants and setting: A purposive sample of 49 Dutch nurses with a variety of educational levels, age, and from different healthcare settings was invited by e-mail to participate in the study. Thirty-nine nurses (aged 21-54 years) eventually participated. The nurses worked in the following settings: hospital (n = 11, 28%), home-care (n = 14, 36%), mental health care (n = 7, 17%), elderly care (n = 6, 15%) and general practice (n = 1, 3%). Results: Four distinct perspectives on the goals for self-management support were identified: the Coach, the Clinician, the Gatekeeper and the Educator perspective. The Coach nurse focuses on the patient's daily life activities, whereas the nurses of the Clinician type aim to achieve adherence to treatment. The goal of self-management support from the Gatekeeper perspective is to reduce health care costs. Finally, the Educator nurse focuses on instructing patients in managing the illness. Conclusions: The changing role of chronic patients with regard to self-management asks for a new understanding of nurses' supportive tasks. Nurses appear to have dissimilar perceptions of what self-management support entails. These distinct perceptions reflect different patient realities and demand that nurses are capable of reflexivity and sensitivity to patient needs. Different perspectives toward self-management support also call for diverse competencies and consequently, also for adaptation of educational nursing programs. [ABSTRACT FROM AUTHOR]

New mothers with severe mental illness (SMI) frequently experience significant difficulties in caring for their babies. There are no structured, evidence-based interventions that guide health professionals to help these women improve early parenting. The extensively researched and effective Triple P Positive Parenting Programme has recently been expanded to families with children less than 1 year old, which provides an opportunity to develop the intervention for women with severe postnatal mental illness. This study explored the views of mothers with SMI about the acceptability and feasibility of Baby Triple P (Baby TP) in the setting of a psychiatric Mother and Baby Unit (MBU). An 88-item Q-sort was conducted with a purposive sample of 15 mothers using Q-methodology. Three main factors were identified: ' what we need', ' what we want' and ' we can do it'. A consensus was noted with general agreement about the benefits of Baby TP, and suitability of the MBU environment to accommodate Baby TP. Baby TP was viewed as an acceptable and feasible parenting intervention and deemed positive and non-stigmatising. Mothers requested more staff awareness and knowledge about the programme so that they were supported in learning and generalising skills. [ABSTRACT FROM AUTHOR]

Purpose: This study’s purpose is to classify and analyze caregivers' recognition of the elderly suicidal intents. Methods: This study uses applied Q-methodology to measure human subjectivity in depth. Concretely, 35 statements are composed in depth interviews and literature investigation. Then, Q-cards and distributive chart of Q-sampling were given to 25 caregivers randomly-selected, who were asked to arrange them on a 7-score based. After coding Q-factor analysis is carried out with the PC-QUANL program. Results: Four types of indicators of the elderly suicidal intents were identified by the caregivers. These are Knowledge-based recognition, Behavioral measure based recognition, Negative comprehension and Sympathy. Conclusion: In this study, four types of recognition were yielded among the caregivers and the characteristics of each type were analyzed. These findings may be useful in assessing suicidal potential and nursing interventions. [ABSTRACT FROM AUTHOR]

Aims To report a study undertaken to explore the underlying factors influencing e-learning adoption in nurse education. Background Despite e-learning's high profile it has not been readily integrated into teaching practice in nurse education. Previous research has identified generic, cross-disciplinary factors but has left out 'soft' factors. Design The study adopted an exploratory descriptive design. Methods Q-methodology was used to explore e-learning adoption in a Division of Nursing located in an institution of Higher Education in the UK. Between September-December 2009, 38 participants were recruited to participate in Q-sorts and post-sort interviews. The Q-sort data were factor analysed and the interviews were coded to their respective factors to develop in-depth narratives. Findings Four factors were identified: 'E-learning advocates' saw e-learning's potential to improve nurse education and prepare future nurses for their evolving role; the 'Humanists' had avoided e-learning because they valued human interaction; the 'Sceptics' doubted that technology could improve learning outcomes; and the 'Pragmatics,' only used e-learning as a tool to post lecture notes online to supplement what they covered in class. Conclusion The findings point to the variety of responses existing among nurse academics faced with integrating e-learning into their teaching. Moving beyond the binary labels commonly attributed to those considered either 'early adopters' or 'laggards,' the findings contribute to the literature by revealing a wider breadth of views and responses towards technology. Acknowledging these views can inform future e-learning strategies and lead to improvement in e-learning use in nurse education. [ABSTRACT FROM AUTHOR]

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Head and neck cancer patients are at high risk of malnutrition and its complications and therefore often undergo non-oral nasogastric or percutaneous endoscopic gastrostomy (PEG) nutrition support. However, there is little evidence that either approach is effective in this group. While one possible explanation for these findings relates to the relationship between artificial tube feeding and poor quality of life, there is little research that examines the patient's subjective experience of nutrition support. This study investigated the experiences of PEG tube feeding in head and neck cancer patients undergoing radical treatment. Conventional Q-methodology was used with 15 head and neck cancer patients, who rank-ordered 36 statements according to the extent to which these reflected their experiences of PEG tube feeding. The sorted statements were factor-analysed case-wise to provide clusters of similar experiences. Three perspectives emerged. Factor 1, labelled 'Constructive cognitive appraisal', focused around positive adaptation to, and acceptance of, PEG feeding. Factor 2, labelled 'Cognitive-affective dissonance', reflected ambivalence between cognitive acceptance and affective rejection of the PEG tube. Factor 3, labelled 'Emotion-focused appraisal', was characterised by tube-focused anxiety and fear. The findings broadly confirm Levanthal et al.'s Self-Regulatory Model of coping and support the need for genuine and individualised patient-centred nutritional care. [ABSTRACT FROM AUTHOR]

Whether culture-based modesty may be a barrier to women's health care has been a longstanding question. Numerous studies have noted that, in certain cultures, modesty is considered a barrier to mammography screening and breast feeding. Though modesty has been noted as an inherent aspect of the lived experience of many cultures, no extant measures or clear definitions were found. Jewish women, some having strict rules regarding modesty, were sampled to understand their definition of modesty. These perspectives were objectively analyzed using Q methodology. We found that although some perspectives on modesty may be accounted for by culture, there are others that are not. [ABSTRACT FROM AUTHOR]

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In Norway, about 8,000 children live in foster homes (about 3.300 in age group 13-17). What does 'family' mean to these children? We explored the views and feelings about 'family' among 22 adolescents who are living in long-term foster care. Three patterns emerged. Most of the participants expressed confidence and adjustment in the foster home placement and felt bonded to both their foster family and to their birth family. Other adolescents expressed a strong sense of membership to their birth family but not to their foster family, and the remaining adolescents described a weak bond to birth family but a strong bond to their foster family. The main implications of the three patterns are discussed in the light of policy and practice. [ABSTRACT FROM AUTHOR]

Vermaire JH, Hoogstraten J, van Loveren C, Poorterman JHG, van Exel NJA. Attitudes towards oral health among parents of 6-year-old children at risk of developing caries. Community Dent Oral Epidemiol 2010; 38: 507-520. © 2010 John & Wiley & Sons A/S Parental attitudes are likely to play a role in achieving and maintaining a desired level of oral health in children. To be useful in individually delivered caries prevention programmes, parental attitudes should be identified at individual level. Q-methodology has been proved successful in identifying attitudes in a wide range of disciplines but in dentistry Q-studies are scarce. In this study Q-methodology was used to identify parents' prevailing attitudes towards the oral health of their children. Thirty-nine parents ranked 37 statements regarding the dental health behaviour they apply to their 6-year-old child. They later explained their rankings during a short interview. In Q-methodology, rather than reporting one average composite attitude and opinion, various combinations of opinions and attitudes concerning these statements are identified using by-person factor analysis. Based on their beliefs, attitudes and cognitions, five categories of parents were found: (i) conscious and responsible, (ii) trivializing and fatalistic, (iii) appearance-driven and open-minded, (iv) knowledgeable but defensive and (v) conscious and concerned. Q-methodology appears to be a fruitful way to structure the complexity of parents' opinions and attitudes towards their children's dental health. It appears that Q-methodology provides comprehensive clusters of individual attitudes, based on various levels of responses to a wide range of questions. The five identified profiles may be useful in developing tailor-made prevention strategies in caries prevention. [ABSTRACT FROM AUTHOR]

In July 2006 a war between Lebanon and Israel resulted in severe environmental damage in Lebanon from Israeli bombing raids. An attack on the Lebanese Jiyyeh Power Plant released 15,000 tons of heavy fuel oil into the Mediterranean Sea. Remarkably, a clean-up operation was effected despite a continued state of war and lack of capacity in the Lebanese government. Civil society environmentalists played a key role in dealing with the pollution and complying with pollution-control legislation. In this study we use Q-methodology to analyse discourses on the effectiveness of pollution legislation during times of conflict using the Jiyyeh oil spill as an example. We interviewed 35 people from eight different stakeholder groups involved in environmental issues. Five distinct discourses were generated covering compensation schemes, need for new legislation, role of stakeholders during wartime and strengthening government ministries. [Copyright &y& Elsevier]

Background: An interdisciplinary team-based approach in nursing homes has been suggested in the literature as a strategy for delaying functional decline in residents. Function-focused care is a philosophy-based approach in which interdisciplinary practitioners assess functional capacity and help older adults to optimize and maintain their remaining abilities. Purpose: This study explored and described the shared subjective frames of interdisciplinary practitioners as regards function-focused care for nursing home residents. Methods: Q-methodology was used to analyze the subjectivity of each factor of function-focused care for nursing home residents. Data were collected from August to September 2016. Thirty-four Q-statements were selected and scored by the 30 interdisciplinary practitioners on a 9-point scale with a normal distribution. Data were analyzed using the PQ Method 2.33 program. Results: The results revealed four factors of function-focused care, including (a) using a wait-and-see approach to encourage self-care, (b) maintaining interactive communications to identify and respond to changes, (c) reinforcing residents' inner and outer strengths for homeostasis, and (d) using a tailored approach based on comparisons between the past and the present. Shared subjectivity may provide an important collaborative framework to identify and solve complex problems related to the functional needs of nursing home residents. Conclusions: The results of this study elucidate the subjectivities of interdisciplinary practitioners and better enable their provision of effective care in support of the remaining functional abilities of older adults living in nursing homes. The findings may be used as a reference to establish communication methods and shared documentation for interdisciplinary practitioners in nursing homes and construct interdisciplinary function-focused care practice guidelines. [ABSTRACT FROM AUTHOR]

Population ageing and restricted budgets result in the need for an efficient allocation of scarce resources in care services for older people. As these services tend to address more than only health, diverse wellbeing measures have been developed to assess their benefits in economic evaluations. These measures are grounded in research on wellbeing of older people and its determinants. Little is known about possible heterogeneity in this context and the extent to which wellbeing measures cover the aspects of wellbeing that are most important to older people with different views on wellbeing. We conducted a Q-methodology study between December 2016 and October 2017 to investigate the variety in views among people aged 65 and older in the Netherlands on what is important to their wellbeing. A purposive sample of 53 respondents ranked 34 opinion statements according to importance to their wellbeing and explained their ranking during a follow-up interview. Data were analysed using by-person factor analysis to identify common patterns in the rankings of the statements. Five distinct views were extracted in which different aspects were considered important: (I) health, financial security and a life partner; (II) family, support and physical functioning (III); autonomy, mental health and helping others; (IV) social contacts, support, mental health and religion; and (V) a life partner, social contacts, living environment and adaptation. This heterogeneity in views of older people on what constitutes wellbeing supports the use of person-centered approaches in care services for older people. Arguably, (evaluations of) policies and services for older people should take this plurality into consideration. • Little is known about the views of older people on what constitutes wellbeing. • This study found five distinct views on what they find important for wellbeing. • Each view accentuates specific domains or aspects within domains of wellbeing. • Only the domains health and social relations were important in most views. • Health and social care services for older people should consider this plurality. [ABSTRACT FROM AUTHOR]

Aim To discover the structure of the frames of reference for nursing home staff members' subjective judgment of residents' achievement of ego integrity. Methods Q-methodology was applied. Twenty-eight staff members who were working in a nursing home sorted 34 Q-statements into the shape of a normal distribution. Results A centroid factor analysis and varimax rotation, using the PQ-method program, revealed four factors: identifying clues to residents' positive acceptance of their whole life span, identifying residents' ways of enjoying their current life, referencing residents' attitudes and competencies toward harmonious relationships, and identifying residents' integrated efforts to establish self-esteem. Conclusion These subjective frames of reference need to be investigated in order to improve the relationships with nursing home residents and their quality of life. Consequently, the fundamental monitoring tools to help staff members make subjective judgments can be formed. [ABSTRACT FROM AUTHOR]