Q Bibliography: Meshaka et al. on the involvement of pregnant women in research

Meshaka, Riwa, Stephen Jeffares, Farah Sadrudin, Nicole Huisman, & Ponnusamy Saravanan (2016, February). Why do pregnant women participate in research? A patient participation investigation using Q-methodology. Health Expectations, in press. ePublication prior to print.


Patient participation in study design is paramount to design studies that are acceptable to patients. Despite an increase in research involving pregnant women, relatively little is known about the motivational factors that govern their decision to be involved in a clinical trial, compared to other patient groups. Objective: To better understand the viewpoints of pregnant women who take part in clinical trials. Method: We chose to use Q-Methodology, a method of exploring the structure of opinions surrounding a topic. We developed a set of 40 statements that encompassed the reasons why pregnant women might want to take part in research and 30 research participants from the PRiDE study (an observational trial investigating the role of micronutrients in gestational diabetes) were asked to rank them in order of agreement. The finished matrices from each participant were compared and analysed to produce capturing viewpoints. Results: About 30 women aged 19-40 involved in the PRiDE study completed the questionnaire. There were two overarching motivators that emerged: a willingness to help medical research and improve our knowledge of medical science, and having a personal connection to the disease, therefore a potential fear of being affected by it. A third, less significant viewpoint, was that of a lack of inconvenience being a motivating factor. Conclusion and discussion: Understanding what motivates pregnant women to decide to take part in a research study is valuable and helps researchers maximize their uptake and retention rates when designing a trial involving pregnant women.

Ponnusamy Saravanan <p.saravanan> is in the Warwick Medical School, Coventry, UK.

Q workshop at health conference, July 15-17, Samos Island, Greece

Noori Akhtar-Danesh is scheduled to direct a workshop entitled “Q-methodology: Bridging between Qualitative and Quantitative Methods in Health Research” at the 8th International Conference on Information Communication Technologies in Health, July 15-17, Samos Island, Greece. The workshop is designed to help participants to develop an understanding of Q methodology as an emerging research method for the study of subjectivity in health research. The different steps of Q methodology in health research will be explained as it is applied to a research topic and participants will have the opportunity to participate actively in the different steps of the research process. Also, some common issues in Q methodology such as sample size, reliability and validity, and interpretation of the statistical analysis will be discussed.

Noori Akhtar-Danesh is Associate Professor of Biostatistics, McMaster University, Hamilton, Ontario, Canada, and former president of ISSSS.

Van Staa et al. on care of adolescents with chronic disorders

Van Staa, A., Jedeloo, S., Latour, J., & Van Exel, J. (2008). Using Q-methodology to explore preferences for care of adolescents with chronic disorders: 4 profiles. Pediatrics, 121(Suppl.), S154-S155. Available online

Introduction: Adolescents with chronic disorders are seldom asked to give opinions about their preferences for care, even though they are frequent health care users and soon need to take over the responsibility of managing their own care.

Objective: The aim of the study was to investigate care-related preferences of adolescents with chronic disorders.

Methods: A Q-methodologic study was conducted in a random sample of 31 adolescents with various congenital and acquired disorders from the total population of Erasmus Medical Center-Agia Sophia Children�s Hospital (12�19 years). Adolescents rank-ordered 37 statements about preferences for care and self-care using a quasi-normal distribution. Factor analysis was applied to identify clusters in the Q-sorts, groups of adolescents with common preferences.

Results: Four profiles were distinguished: concerned and compliant, backseat patient, opinionated and careless, and worried and insecure. Differences between profiles are related to independence competencies, level of involvement in management of the illness, adherence to therapeutic regimens, and appreciation of their parents� role. All adolescents want to have an important say in treatment-related decisions. Although adolescents are used to being accompanied by their parents in the consultation room, they sometimes prefer to be on their own.

Conclusions: Four different preference profiles were uncovered. Caregivers recognize these profiles in daily practice. Because the goal of Q-methodology is to establish different patterns but not their prevalence, the distribution of profiles will be explored in a large follow-up survey. Additional use of these profiles in daily practice will be also explored, because rank-ordering the statements stimulated adolescents to talk about care issues.

Askay et al. on distress among burn survivors

Askay, S.W., Stricklin, M., Carrougher, G.J., Patterson, D.R., Klein, M.B., Esselman, P.C., & Engrav, L.H. (2008, December 3). Using Q methodology to identify reasons for distress in burn survivors postdischarge. Journal of Burn Care Research (Epublication ahead of print, available http://www.ncbi.nlm.nih.gov/pubmed/1906073/)

Abstract: Reasons for distress after burn injuries have not been codified based on any type of acceptable empirical or statistical technique. The unique design methodology proposed in this study can identify the most common reasons cited for causing distress in burn survivors after discharge. A Q-sort task was developed with the assistance of our burn advisory group. After identifying 50 possible reasons for distress after discharge, each reason was placed on a laminated game card. In compliance with Q methodology, a game board was developed that allowed patients to rank order each reason from “not causing distress” to “causing significant distress.” A total of 69 burn survivors were enrolled in the study at four different time points: 1 month, 6 months, 1 year and 2 years postdischarge. After factor analysis, four factors accounted for all of the participants across time points. This indicates that at least four distinct groups of people can be categorized according to themes raised in rating reasons for distress. This Q-sort technique allowed us to capture the complexity of conceptualizing human distress by categorizing clusters of reported problems into similar groups. This methodology shows great promise for developing interventions that target unique needs of burn survivors.

The authors are variously associated with the Department of Rehabilitation Medicine, University of Washington School of Medicine; the Federal University of Piaui, Brazil; and the Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle.

Valaitis et al. on Web conferencing in the health sciences

Valaitis, Ruta, Noori Akhtar-Danesh, Kevin Eva, Anthony Levinson, and Bruce Wainman (2007). Pragmatists, positive communicators, and shy enthusiasts: Three viewpoints on Web conferencing in health sciences education. Journal of Medical Internet Research, 9(5), e39 .

Abstract Background:

Web conferencing is a synchronous technology that allows coordinated online audio and visual interactions with learners logged in to a central server. Recently, its use has grown rapidly in academia, while research on its use has not kept up. Conferencing systems typically facilitate communication and support for multiple presenters in different locations. A paucity of research has evaluated synchronous Web conferencing in health sciences education. Objective: McMaster University Faculty of Health Sciences trialed Wimba’s Live Classroom Web conferencing technology to support education and curriculum activities with students and faculty. The purpose of this study was to explore faculty, staff, and student perceptions of Web conferencing as a support for teaching and learning in health sciences. The Live Classroom technology provided features including real-time VoIP audio, an interactive whiteboard, text chat, PowerPoint slide sharing, application sharing, and archiving of live conferences to support student education and curriculum activities. Methods: Q-methodology was used to identify unique and common viewpoints of participants who had exposure to Web conferencing to support educational applications during the trial evaluation period. This methodology is particularly useful for research on human perceptions and interpersonal relationships to identify groups of participants with different perceptions. It mixes qualitative and quantitative methods. In a Q-methodology study, the goal is to uncover different patterns of thought rather than their numerical distribution among the larger population. Results: A total of 36 people participated in the study, including medical residents (14), nursing graduate students (11), health sciences faculty (9), and health sciences staff (2). Three unique viewpoints were identified: pragmatists (factor 1), positive communicators (factor 2A), and shy enthusiasts (factor 2B). These factors explained 28% (factor 1) and 11% (factor 2) of the total variance, respectively. The majority of respondents were pragmatists (n = 26), who endorsed the value of Web conferencing yet identified that technical and ease-of-use problems could jeopardize its use. Positive communicators (N = 4) enjoyed technology and felt that Web conferencing could facilitate communication in a variety of contexts. Shy enthusiasts (N = 4) were also positive and comfortable with the technology but differed in that they preferred communicating from a distance rather than face-to-face. Common viewpoints were held by all groups: they found Web conferencing to be superior to audio conferencing alone, felt more training would be useful, and had no concerns that Web conferencing would hamper their interactivity with remote participants or that students accustomed to face-to-face learning would not enjoy Web conferencing. Conclusions: Overall, all participants, including pragmatists who were more cautious about the technology, viewed Web conferencing as an enabler, especially when face-to-face meetings were not possible. Adequate technical support and training need to be provided for successful ongoing implementation of Web conferencing. The authors are members of the Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. The article in its entirety can be accessed at http://www.jmir.org/2007/5/e39/

Gregg et al. on substance abuse in schizophrenia

Gregg, Lynsey, Gillian Haddock, & Christine Barrowclough (2009 February). Self-reported reasons for substance use in schizophrenia: A Q methodological investigation. Mental Health and Substance Use: Dual Diagnosis, 2(1), 24-39.

Abstract: Large numbers of people with a diagnosis of schizophrenia use drugs and alcohol, resulting in poorer symptomatic and functional outcomes for many. Aims: To examine the reasons that people with a diagnosis of schizophrenia give for their own alcohol and drug use. Method: Q methodology was used to examine reasons for use. Forty-five people with a diagnosis of schizophrenia or schizoaffective disorder and comorbid substance misuse completed the sorting procedure. Results: Analysis of the Q Sorts revealed three distinct groups of substance users: (1) those who predominantly used for social and enhancement reasons, to �chill out and have a good time with others:� (2) those who used to regulate negative affect and alleviate positive symptoms, to �cope with distressing emotions and symptoms:� (3) those who used substances to augment themselves and intensify their experiences, to �feel bigger, better and inspired.� Conclusion: People with a diagnosis of schizophrenia who use substances explain their substance use in different ways. The identification of subgroups of users may be useful in the development of interventions aimed at reducing substance use in this group.

Lynsey Gregg and co-authors are in the Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, UK.