A Theoretically Informed Critical Review of Research Applying the Concept of Liminality to Understand Experiences with Cancer: Implications for a New Oncological Agenda in Health Psychology.

Liminality was described more than 20 years ago as a major category explaining how cancer is experienced. Since then, it has been widely used in the field of oncology research, particularly by those using qualitative methods to study patient experience. This body of work has great potential to illuminate the subjective dimensions of life and death with cancer. However, the review also reveals a tendency for sporadic and opportunistic applications of the concept of liminality. Rather than being developed in a systematic way, liminality theory is being recurrently 're-discovered' in relatively isolated studies, mostly within the realm of qualitative studies of 'patient experience'. This limits the capacity of this approach to influence oncological theory and practice. In providing a theoretically informed critical review of liminality literature in the field of oncology, this paper proposes ways of systematizing liminality research in line with a processual ontology. In so doing, it argues for a closer engagement with the source theory and data, and with more recent liminality theory, and it sketches the broad epistemological consequences and applications.

A "transmission gap" between research and practice? A Q-methodology study of perceptions of the application of attachment theory among clinicians working with children and among attachment researchers.

Clinical practitioners are frequently encouraged, through literature, training, and policy, to learn, understand, refer to and use their knowledge of attachment theory and research when working to meet the needs of children and families. However, there has been very little empirical study of how practitioners understand and perceive the relevance of attachment concepts and methods. Q-methodology was used to examine the perceptions of attachment knowledge and its applications for practice among 30 UK clinicians working with children and an international group of 31 attachment researchers. Factor analysis revealed three perspectives, described as: i) pragmatic, developmental, and uncertain, ii) academic, and iii) autodidactic and therapeutic. Participants agreed on core tenants of theory, their aspirations for clinical practice and the inaccessibility of current assessment measures for practitioners. Yet they diverged on their understandings of attachment insecurity, disorganisation, and the implications of both for various aspects of child development.

Self-management of chronic low back pain: Four viewpoints from patients and healthcare providers.

A move towards self-management is central to health strategy around chronic low back pain, but its concept and meaning for those involved are poorly understood. In the reported study, four distinct and shared viewpoints on self-management were identified among people with pain and healthcare providers using Q methodology. Each construes self-management in a distinctive manner and articulates a different vision of change. Identification of similarities and differences among the viewpoints holds potential for enhancing communication between patients and healthcare providers and for better understanding the complexities of self-management in practice.

Definitions of love in a sample of British women: an empirical study using Q methodology.

Social psychological research has increasingly acknowledged that any pretensions to a singular theory of love should be replaced with a concern about its affirmation and what people actually say and do in love's name. Lee's (1977) love styles research and Sternberg's (1995) theory of love as a story are prime examples. Despite traditional definitions of love in western cultures being dominated by feminine images and tales of gender difference, however, the personal definitions and experiences of women have received comparatively little empirical attention, particularly in recent years and despite some well-documented changes in their cultural circumstances. This study remedies that situation through presentation of a Q methodological study in which a convenience sample of 59 British women were asked to Q sort 54 single-word descriptors of love to define love as they had experienced it. Factor analysis of the resulting Q sorts revealed six distinct definitions of love, interpreted as 'attraction, passion & romance', 'unconditional love', 'sex & fun', 'friendship & spirituality', 'a permanent commitment', and 'separate people, separate lives'. The six definitions are then discussed in terms of their allegiance to traditionally feminine and/or masculine values and as a means of highlighting the changing face of Britain's relational culture.

An investigation of constructions of justice and injustice in chronic pain: a Q-methodology approach.

This study used Q-methodology to explore justice-related accounts of chronic pain. Eighty participants completed the Q-sorting procedure (33 chronic pain sufferers and 47 non-pain sufferers). Analysis revealed five main factors. Three factors blame: society for poor medical and interpersonal treatment; the chronic pain sufferer for indulging in self-pity and unempathic healthcare workers for ignoring patients. A fourth factor acknowledges the unfairness of pain and encourages self-reliance. The fifth factor rejects injustice in the chronic pain discourse. Overall, there is a shared view that chronic pain brings unfair treatment, disrespect and a de-legitimization of pain. Future research ideas are suggested.

Older people and 'active ageing': Subjective aspects of ageing actively.

Following a critical overview of the active ageing concept, a thematic decomposition of 42 transcribed interviews with British people aged 72 years and over indicates that active ageing is understood in relation to physical, cognitive, psychological and social factors, but that these co-exist in complex combinations. The notion of activity in active ageing is grasped in relation to an active/passive distinction which emphasizes the enhancement or diminishment of concrete powers of activity. A 'challenge and response' framework is suggested for future research on active ageing.

Which measure of quality of life performs best in older age? A comparison of the OPQOL, CASP-19 and WHOQOL-OLD.

BACKGROUND: Most measures of quality of life (QoL) are based on 'expert' opinions. This study describes a new measure of QoL in older age, the Older People's QoL Questionnaire (OPQOL), which is unique in being derived from the views of lay people, cross-checked against theoretical models for assessment of comprehensiveness. Its performance was assessed cross-sectionally and longitudinally. It was compared with two existing QoL measures in the cross-sectional studies in order to identify the optimal measure for use with older populations. METHODS: Data were taken from three surveys of older people living at home in Britain in 2007-2008: one population survey of people aged 65+, one focused enumeration survey of ethnically diverse older people aged 65+, one follow-up of a population survey of people aged 65+ at baseline in 1999/2000. Measures were QoL (using OPQOL, Control, Autonomy, Satisfaction, Pleasure--19 items (CASP-19), World Health Organization Quality of Life questionnaire--version for older people (WHOQOL-OLD)), health, social and socioeconomic circumstances. The CASP-19 and WHOQOL-OLD were not administered to the longitudinal sample in order to reduce respondent burden. RESULTS: Psychometric tests were applied to each QoL measure. The OPQOL, CASP-19 and WHOQOL-OLD performed well with the cross-sectional samples; however, only the OPQOL met criteria for internal consistency in the Ethnibus samples. CONCLUSION: The OPQOL is of potential value in the outcome assessment of health and social interventions, which can have a multidimensional impact on people's lives. Further research is needed to examine whether differences by ethnicity reflect real differences in QoL, methodological issues, variations in expectations or cultural differences in reporting.

A Q-methodological study of smoking identities.

In contrast to the psychological literature on adolescent smoking, little research has investigated the social identities of adult smokers. This study aimed to identify shared 'smoking identities' amongst a sample of 64 British smokers from different socio-economic groups using Q-methodology. Participants were asked to sort 70 items concerning smoking and smokers according to their agreement/disagreement with them. The 64 Q-sorts were then subjected to a by-person factor analysis yielding six factors, with the first four interpretable factors being presented here. Each factor is understood to represent a distinct 'identity position'. The first two, the 'addicted' smoker, and the 'in control' smoker, oriented around a biomedical model of smoking as an addictive health risk. The final two, the 'no big deal' smoker and the 'proud' smoker reflected alternative understandings and values. The identity positions also differed in the extent to which smoking was considered a core part of self-identity. Unpacking the 'smoking identities' of current smokers offers the opportunity to devise targeted health promotion.

Constructions of sexual relationships: a study of the views of young people in Catalunia, England and Slovakia and their health implications.

Q methodology was applied to investigate the views of young people from Catalunia, England and Slovakia regarding sexual relationships and their health implications. The Q sorts of 188 16-18-year-olds from these three diverse European regions were reduced by Q factor analysis to six clear accounts. These accounts are presented in relation to three emergent themes: (a) traditionalism/liberalism; (b) locus of responsibility; and (c) the relationship between sex and love, and these discursive themes are discussed in relation to health-salient criteria such as awareness of sex-related risk and corresponding implications for conduct.

The subjective experience of partnership love: a Q Methodological study.

The social scientific literature seems increasingly to accept that defining partnership or 'romantic' love in a singular and timeless fashion might not be a realisable task (Fehr, 1988). One clearly discernible response to this situation takes the form of a turn towards studying the subjective experience of partnership love. The work of Marston, Hecht, Manke, McDaniel, and Reeder (1998) and Sternberg (1995, 1996, 1998) are highlighted as theoretical and methodological exemplars in this regard. Each successfully abstracts a range of cultural conceptions of partnership love from the subjective experiences of their participants. It is argued, however, that the subjective experiences of the participants themselves, and particularly the holistic or Gestalt nature of those experiences, are left behind in the process of abstraction. This new research seeks to rectify that situation. An alternative (but nonetheless related) approach to the study of partnership love is duly outlined and an illustrative Q-Methodological study is reported which reveals eight distinct subjective experiences of partnership love at work amongst our participants (N = 50). Each of these holistic experiences is presented in the form of a narrative account. These accounts are then discussed and situated in relation to existing academic, cultural and historical conceptions of partnership love.

Putting the Q into quality of life; the identification of subjective constructions of health-related quality of life using Q methodology.

Health related quality of life (HRQOL) is presented as a largely subjective construct of increasing importance in health discourse and practice. Key difficulties with the assessment and measurement of quality of life (QOL) are discussed. A Q methodological investigation of subjective constructions of health-related QOL is then reported using importance items derived from studies of the WHOQOL. Eight factors emerged from a factor analysis of the Q sorts of 90 healthy participants, each corresponding to a distinct construction of the meaning and relevance of QOL. The factors are interpreted and discussed under the following headings: 'Happy families, 'Stand on my own two feet', 'Emotional independence', 'Just do it!', 'Life as a positive challenge', 'In God we trust', 'Staying healthy enough to bring home the bacon' and 'You can't choose your family'. This diversity of views has implications for QOL testing.