Kirschbaum, Melissa, Tony Barnett, & Merylin Cross ( in press, 2019, November). Q sample construction: A novel approach incorporating a Delphi technique to explore opinions about codeine dependence. BMC Medical Research Methodology, 19(1). (Open access: ( (doi: 10.1186/s12874-019-0741-9) (Link:

Abstract: Background: Q methodology is an evidenced approach to researching subjectivity, involving a combination of qualitative and quantitative techniques. The methodology has been used successfully in healthcare research to explore the opinions of patients and healthcare providers about topics such as the illness experience, healthcare services, clinical practice and professional training. Q methodology studies require the generation of a Q sample, a set of opinion statements representing the phenomenon of interest. This paper describes a novel and rigorous approach to develop a Q sample for a study exploring misusers’ opinions about over-the-counter (OTC) codeine dependence and critically examines the associated methodological issues. Methods: Development of the Q sample in this study involved three steps; (1) identification of opinion statements via a comprehensive literature search, (2) application of a theoretical framework, the Capability, Opportunity, Motivation – Behaviour (COM-B) model of behaviour, to group and then reduce the number of statements and (3) use of a Delphi technique to achieve expert consensus on the final selection of statements. The Delphi component involved a multidisciplinary panel of 15 addiction experts comprised of doctors, nurses, pharmacists, psychologists and researchers, who were recruited purposively. Experts rated each statement using a 5-point scale of perceived importance. Two Delphi rounds were undertaken and consensus for inclusion of a statement was set at a median score of ≥4 and an interquartile range of ≤1. Results: A total of 842 statements representing codeine misusers’ opinions about OTC codeine dependence were identified from the literature. Statements were grouped thematically using the COM-B framework and representative statements were selected, reducing the number to 111. After two Delphi rounds, addiction experts achieved consensus on 46 statements which formed the final Q sample. Conclusions: This paper describes a new and systematic approach to Q sample construction and explores associated methodological issues that could be useful for those considering Q methodology and for furthering the rigour of this research technique.

Melissa Kirschbaum <> is in the University of Tasmania Centre for Rural Health, Launceston, Tasmania, Australia.