An extra care community's perceived priorities for 'whole system' relationships: a Q-methodological study

Different views on collaboration between older persons, informal caregivers and care professionals

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.

A scoping review of Q-methodology in healthcare research

BACKGROUND

Q-methodology is an approach to studying complex issues of human 'subjectivity'. Although this approach was developed in the early twentieth century, the value of Q-methodology in healthcare was not recognised until relatively recently. The aim of this review was to scope the empirical healthcare literature to examine the extent to which Q-methodology has been utilised in healthcare over time, including how it has been used and for what purposes.

METHODS

A search of three electronic databases (Scopus, EBSCO-CINAHL Complete, Medline) was conducted. No date restriction was applied. A title and abstract review, followed by a full-text review, was conducted by a team of five reviewers. Included articles were English-language, peer-reviewed journal articles that used Q-methodology (both Q-sorting and inverted factor analysis) in healthcare settings. The following data items were extracted into a purpose-designed Excel spreadsheet: study details (e.g., setting, country, year), reasons for using Q-methodology, healthcare topic area, participants (type and number), materials (e.g., ranking anchors and Q-set), methods (e.g., development of the Q-set, analysis), study results, and study implications. Data synthesis was descriptive in nature and involved frequency counting, open coding and the organisation by data items.

RESULTS

Of the 2,302 articles identified by the search, 289 studies were included in this review. We found evidence of increased use of Q-methodology in healthcare, particularly over the last 5 years. However, this research remains diffuse, spread across a large number of journals and topic areas. In a number of studies, we identified limitations in the reporting of methods, such as insufficient information on how authors derived their Q-set, what types of analyses they performed, and the amount of variance explained.

CONCLUSIONS

Although Q-methodology is increasingly being adopted in healthcare research, it still appears to be relatively novel. This review highlight commonalities in how the method has been used, areas of application, and the potential value of the approach. To facilitate reporting of Q-methodological studies, we present a checklist of details that should be included for publication.

A literature review to guide novice researchers using Q methodology in the development of a framework for concourse management

BACKGROUND

For novice Q methodology researchers, the development of the concourse is challenging. This challenge is exacerbated by the paucity of literature focusing on the development of the concourse.

AIM

To highlight the lack of strategy related to concourse development in Q methodology literature and to undertake a selected literature review to suggest frameworks for concourse development to guide researchers.

DISCUSSION

A limited search conducted using CINAHL PLUS appraised the variety of concourse strategies used in Q studies. Of 44 papers located, 23 used no strategy while the others used one of four types of strategy: thematic, profession-specific, broader healthcare and social care frameworks or a framework that the researchers devised specifically for their research.

CONCLUSION

The Q methodology literature frequently lacks discussion about the development of the concourse. Therefore, studies that focus on concourse development should be a focus of future research, along with the further development of the ideas put forward in this paper for possible frameworks.

IMPLICATIONS FOR PRACTICE

This paper will raise awareness inside and outside the Q methodology community that novice researchers want to use Q methodology but may require more detail about how to construct robust concourses.