Types of Client Perceptions Regarding Counselling Experiences at Psychological Counselling Centres: Utilising Q Methodology.

This study used Q methodology to explore the various types and characteristics of clients' subjective perceptions concerning their experiences at psychological counselling centres. We selected 33 Q samples from a Q population of 135; of the Q sample, 31 P samples underwent Q sorting. Subsequently, we analysed the data using the Quanl Program. The study categorised perception into four distinct types. Type 1 values therapeutic counselling relationships, Type 2 prioritises counselling services, Type 3 values counsellor assignment, and Type 4 prioritises the counselling structure. This study provides valuable basic data to clients, counsellors, and counselling institutions.

Identifying communication barriers between nurses and patients from the perspective of Iranian nurses: a Q-methodology-based study.

BACKGROUND: Effective communication is essential for high-quality healthcare, yet barriers often impede meaningful connection between nurses and patients. This study aimed to prioritize communication barriers between nurses and patients in Iranian hospitals, exploring nurses' perspectives. METHODS: Thirty-one nurses participated in a six-step Q methodology study to identify different perspectives on communication barriers. Participants sorted a set of statements based on their own experiences and beliefs. RESULTS: The average age of participants was 38.07 (SD = 6.49), with 70% being women. Four distinct factors emerged, explaining 47% of the total variance in perspectives: Organizational factors and work conditions (20%), Emotional distress and psychological barriers (11%), Lack of mutual understanding and awareness (7%), and declining professional motivation and engagement among nurses (9%). CONCLUSION: These findings highlight the multi-faceted nature of communication barriers between nurses and patients in this context. Interventions should address organizational factors, emotional well-being of nurses, cultural awareness, and professional motivation to improve communication and ultimately, patient care. This study provides valuable insights for Iran and other developing countries that are facing similar challenges.

Precision Diabetes Education and Support Considering Patients' Behavioral and Psychological Phenotype: A Q-Methodology Study.

BACKGROUND: The prevalence of type 2 diabetes is growing, and diabetes burden is increasing. Precision health in diabetes education and support employs different intervention strategies, depending on an individual's viewpoint on diabetes and self-management behaviors, to improve patients' treatment adherence, clinical outcomes, and quality of life. OBJECTIVE: To classify the behavioral and psychological phenotypes of self-management behaviors in adults taking oral glucose-lowering medications to develop a theory-driven, person-centered group intervention applicable to busy clinical settings. METHODS: Q-methodology was used. From January to August 2020, 73 participants (48 male, 25 female) were invited to do Q-sorting with 33 statements. The principal component technique, followed by varimax rotation, was used for factor analysis. The Summary of Diabetes Self-Care Activity questionnaire and HbA1c in the past 6 months were included to obtain comprehensive understanding. RESULTS: Fifty-one sorts (35 male, 16 female) loaded on 1 of 4 factors: factor A (n = 18): Needing emotional support with enhancing problem-solving skills group; factor B (n = 15): Self-help group; factor C (n = 6): Needing personalized coaching group; and factor D (n = 12): Needing basic diabetes education group. CONCLUSIONS: Each factor demonstrated a different need for diabetes education and support. Younger participants (factor D) had the poorest diabetes self-management behaviors and required basic diabetes education. Further research is warranted to develop a screening tool to classify the typologies and adopt the findings in a busy clinical setting.

Identifying the priorities for supervision by lived experience researchers: a Q sort study.

BACKGROUND: Lived experience researchers draw on their lived and living experiences to either lead on or inform research. Their personal experiences are relevant to the research topic and so they must manage the interplay of their health and healthcare experiences with the research, population, and data they work with, as well as the more general challenges of being a researcher. Lived experience researchers must navigate these dilemmas in addition to queries over their competency, due to issues relating to intersectionality and epistemic injustice. This justifies a motivation to better understand the experiences of lived experience researchers and develop appropriate and personalised supervision based on their preferences and needs. METHODS: Q methodology was used to identify a collection of identity-related issues that impact lived experience researchers during PhD research in the context of the UK. These issues were presented in the form of 54 statements to 18 lived experience researchers to prioritise as topics to explore in supervision. RESULT: It was found that lived experiences researchers could be grouped into three distinct factors following an inverted factor analysis: Factor 1: Strengthening my identity, skills, growth, and empowerment; Factor 2: Exploring the emotional and relational link I have with the research and Factor 3: Navigating my lived and professional experiences practically and emotionally. The findings suggest that there may be three types of lived experience researchers, each with different needs from supervision, suggesting the population is heterogeneous. CONCLUSION: The research identified a deeper understanding of the needs of lived experience researchers and highlights the importance of personalised supervision according to the individual needs of the researcher and their preferences for supervision. The findings reinforce the importance of integrating a clinical dimension into supervision to support the needs of all lived experience researchers.

Making Landscapes Negotiable: Q-methodology as a Boundary-Spanning and Empowering Diagnostic.

Landscapes are conceptually fuzzy and rich, and subject to plural framings. They are places of inquiry and intervention for scientists and practitioners, but also concepts bound to peoples' dynamic identities, knowledge systems, inspiration, and well-being. These varying interpretations change the way landscapes function and evolve. Developed in the 1930s, Q-methodology is increasingly recognized for being useful in documenting and interrogating environmental discourses. Yet its application in the context of how integrated landscape approaches better navigate land-use dilemmas is still in its infancy. Based on our experience and emerging literature, such as the papers in this special collection, this article discusses the value of Q-methodology in addressing landscape sustainability issues. Q-methodology helps unravel and communicate common and contradicting landscape imaginaries and narratives in translational and boundary-spanning ways, thus bridging actors' different understandings of problems and solutions and revealing common or differentiated entry points for negotiating trade-offs between competing land uses. The methodology can be empowering for marginalized people by uncovering their views and aspirational values to decision-makers and policymakers. We argue that this potential can be further strengthened by using Q to identify counter-hegemonic discourses and alliances that combat injustices regarding whose knowledge and visions count. In this way, applying Q-methodology in integrated landscape approaches can become a key tool for transitioning toward just, inclusive, and sustainable landscapes.

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.

Holding the hope? Therapist and client perspectives on long COVID recovery: A Q-methodology.

PURPOSE: Long COVID is a global health concern which has debilitating effects on the individual experiencing it. In the United Kingdom, psychological therapies are being offered to people with long COVID, although the evidence for these therapies is yet to be demonstrated. This research aimed to understand how therapists and clients define and understand recovery from long COVID, and use hope theory to interpret the results. METHODS: An online Q-methodology was employed, where participants sorted a range of statements pertaining to long COVID recovery based on their level of agreement with them. These arranged statements (Q-sorts) were collated and factor analysed to explore and compare underlying perspectives. RESULTS: Sixteen participants were recruited for the study, including eleven clients, four IAPT therapists and one therapist working in the broader long COVID pathway. A four-factor model is reported, including (1) Psychological Pathways to Recovery, (2) Social Context and Agency, (3) Physiological Goals of Recovery and (4) Personal Meaning Making. All IAPT therapists loaded onto the psychological pathways factor, whereas the remaining participants shared more diverse perspectives. CONCLUSIONS: The belief that long COVID recovery was possible, taken as an indicator of hopefulness, was rated highest for Factor 1, Psychological Pathways to Recovery, and Factor 3, Physiological Recovery Goals. This suggested that having a clear definition of recovery, or clear guidance on how to intervene, promoted hopefulness and, theoretically, well-being. However, clients reported experiences of being invalidated and disbelieved by health professionals, with psychological explanations sometimes being experienced as dismissive and invalidating. Clinical implications and future research directions are discussed.

Actor Perceptions of the Governance Framework and Non-Carbon Benefits from the Ghana Cocoa Forest REDD+ Program: An Extended Q-Study of the Juabuso-Bia Hotspot Intervention Area.

The expansion of cocoa farms is a major driver of deforestation and emissions in Ghana's high forest zone. The Ghana Cocoa Forest Reducing Emissions from Deforestation and Forest Degradation Program (REDD+) was launched as the world's first commodity-based initiative to address emissions from deforestation caused by cocoa production and generate non-carbon benefits. Hotspot Intervention Areas were established to implement the Ghana Cocoa REDD+ program. This study combines Q-methodology with focus group discussions and interviews to assess stakeholder perceptions in the Juabuso-Bia cocoa landscape regarding the capacity of the Hotspot Intervention Area to facilitate the generation of governance and economic non-carbon benefits to sustain emission reductions. We found that introducing the Hotspot Intervention Area has re-centralized landscape governance, which, coupled with weak collaboration among stakeholders, has led to poor generation of non-carbon benefits. Furthermore, efforts to include women in the leadership structure of the Hotspot Intervention Area can be described as tokenism, and little has been done to improve land and tree tenure for vulnerable groups. This, combined with the low adoption of climate-smart cocoa practices, is likely to negatively affect the generation of economic non-carbon benefits. To overcome these challenges, we recommend reforming the Hotspot Intervention Area, bolstering community-level sensitization, improving access to decision-making spaces that will enhance the participation of women and minority groups in landscape governance, and improving farmers' tenure security through a registration scheme for land and trees. These recommendations can ensure the efficient generation of non-carbon benefits, which are key to the success of REDD+.

Advancing collaboration in health professions education in the general practice domain, developing a national research agenda.

BACKGROUND: Health professions education (HPE) research in the General Practice domain (GP-HPE) is vital for high-quality healthcare. Collaboration among GP-HPE researchers is crucial but challenging. Formulating a research agenda, involving stakeholders, and fostering inter-institutional collaboration can address these challenges and connect educational research and practice. METHODS: We used Q-methodology to explore perspectives on GP-HPE research of participants from all Dutch postgraduate GP training institutes. Participants individually sorted statements based on the relevance of future GP-HPE research for educational practice. Data analysis comprised inverted factor analysis, rotation, and qualitative interpretation of configurations of all statements. The National Meeting on Educational Research took a participatory approach. RESULTS: We included 73 participants with diverse involvement in GP-HPE research. We identified five distinct perspectives, each representing a research focus area for developing and innovating GP education: the clinician scientist, the socially engaged GP, the specific GP identity, the GP as an entrepreneur, and the GP engaged in lifelong learning. DISCUSSION: The resulting five perspectives align with General Practice hallmarks. Q-methodology and a participatory approach facilitated collaboration among stakeholders. Successful inter-institutional collaboration requires a common goal, neutral leadership, participant commitment, regular meetings, audit trail support, process transparency, and reflexivity. Future research should address evidence gaps within these perspectives. CONCLUSION: Using Q-methodology turned out to be valuable for compiling a national research agenda for GP-HPE research. The research process helped to cross boundaries between researchers in different institutions, thus putting inter-institutional collaborative advantage center stage. Our approach could provide a conceivable procedure for HPE researchers worldwide.

From polarity to plurality: Perceptions of COVID-19 and policy measures in England and Scotland.

AIM: The aim of this study was to uncover perspectives on the COVID-19 pandemic and the responses implemented by the UK and Scottish Governments to help control the spread of infection. Such understanding could help to inform future responses to pandemics at individual, community and national levels. METHOD: Q methodology was used to elicit perspectives from people in England and Scotland with different experiences of the pandemic including public health officials, key workers, those on furlough, those who were unvaccinated or vaccinated to different levels, those who were 'shielding' because they were at higher risk and people with different scientific expertise. Participants rank-ordered phrases about different aspects of COVID-19 according to their viewpoint. Factor analysis was then conducted in conjunction with interview material from the same respondents. RESULTS: A four-factor solution was statistically supported and was interpretable alongside the qualitative accounts of participants loading on these factors. These four perspectives are titled Dangerous and Unaccountable Leadership, Fear and Anger at Policy and Public responses, Governing Through a Crisis and Injustices Exposed. CONCLUSION: The four perspectives demonstrate plurality and nuance in views on COVID-19 and the associated policies and restrictions, going beyond a binary narrative that has been apparent in popular and social media. The four perspectives include some areas of common ground, as well as disagreement. We argue that understanding the detail of different perspectives might be used to build cohesion around policy initiatives in future. PATIENT OR PUBLIC CONTRIBUTION: The development of the statement set, which is rank-ordered by participants in a Q study, and factor interpretations were informed by views of the general public. The statement set was initially developed using existing publicly available material based on members of the general public experiencing the pandemic first hand. It was then piloted with members of the public experiencing different challenges as a result of COVID-19 and the subsequent lockdown and updated based on feedback. Finally, interpretations of the identified factors were presented publicly and edited according to their feedback.

Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study.

BACKGROUND: This study aimed at (a) exploring how nurses prioritise interventions to prevent delirium among patients identified at risk and (b) describing the underlying prioritisation patterns according to nurses' individual characteristics. METHODS: There was used the Q-methodology a research process following specific steps: (a) identifying the concourse, (b) the Q-sample, and (c) the population (P-set); (d) collecting data using the Q-sort table; (e) entering the data and performing the factor analysis; and (f) interpreting the factors identified. RESULTS: There were involved 56 nurses working in medical, geriatric and log-term facilities (46; 82.2 %). The preventive intervention receiving the highest priority was 'Monitoring the vital parameters (heart rate, blood pressure, oxygen saturation)' (2.96 out of 4 as the highest priority; CI 95 %: 2.57, 3.36). Two priority patterns emerged among nurses (explained variance 44.78 %), one 'Clinical-oriented' (36.19 %) and one 'Family/caregiver-oriented' (8.60 %) representing 53 nurses out 56. CONCLUSION: Alongside the overall tendency to prioritise some preventive interventions instead of others, the priorities are polarised in two main patterns expressing two main individual characteristics of nurses. Knowing the existence of individual patterns and their aggregation informs how to shape educational interventions.

Identifying priorities for Australian disability research using Q methodology.

BACKGROUND: Globally, there are over an estimated one billion people with disability. Research priorities with a focus on diagnosis and treatment of conditions or policy and service initiatives, traditionally decided by researchers, may not align with priorities of those with lived experience of disability. OBJECTIVE: To explore and inform disability research for Australia, including perspectives of people with disability. METHODS: As part of a research program, we used Q methodology to explore "what should guide the Australian research agenda?" People with disability, their families, community organizations and researchers were purposively recruited and sorted 25 statements, developed iteratively using data collated from systematic research mapping and a prior consultation process. The sorting grid ranged from -4 to +4, according to "Which topics should guide disability research the least to the most?" Factor analysis revealed four distinct but interrelated participant viewpoints. RESULTS: 52 participants (65 % female, aged 18-65+ years, 37 % people living with disability), sorted the statements. Viewpoint 1 - design and delivery of services across the lifespan. Viewpoint 2 - understanding the diverse experience of those with disability. Viewpoint 3 - designing systems to address impacts of disability for the individual, their families and society. Viewpoint 4 - addressing mental health for those with disability no matter where they live. CONCLUSION: These viewpoints focused on design and delivery of services to address the impacts of disabling environments and attitudes on individuals living with impairments, their families and society. The four viewpoints provide a framework for future disability research in consultation with those with lived experience.

A comparison of Swedish IBS patients and general practitioners regarding viewpoints on IBS: a Q-methodology study.

OBJECTIVES: Irritable bowel syndrome (IBS) is a common functional gastrointestinal condition. A respectful patient-doctor relationship with good communication is crucial for optimal treatment. Q-methodology is a combination of qualitative and quantitative methods used to study subjectivity. The aim of this study was to compare viewpoints on IBS between patients with IBS and general practitioners (GPs). METHODS: We conducted a Q-methodology study by including 30 patients and 30 GPs. All participants were asked to complete Q- sorting of 66 statements on IBS using an online software program. Data were processed using factor analysis. In addition, 3 patients and 3 GPs were interviewed. RESULTS: Three factors were extracted from both groups: Patient Factor 1 'Question the diagnosis of IBS', Patient Factor 2 'Lifestyle changes for a physical disorder', Patient Factor 3 'Importance of a diagnosis', GP Factor 1 'Unknown causes of great suffering', GP Factor 2 'Lifestyle changes are important, stress makes IBS worse', GP Factor 3 'Recognized the way IBS affects patients'. There was a strong and statistically significant correlation between patient Factor 1 and GP Factor 1, with a Pearson's r of 0.81 (p < 0.001). Correlations between other factors varied. CONCLUSIONS: There was consensus between patients and GPs that IBS is a physical and not a psychiatric disorder of unknown etiology. They also seemed to agree that IBS has a great negative impact on patients' lives and that lifestyle changes are beneficial. There were conflicting opinions regarding gender, cultural factors and the use of antidepressants.

Twenty five years of world heritage status: Show us the benefits!

In the Solomon Islands and around the Pacific there is commonly a disconnect between government priorities for economic development through resource extraction and community aspirations for local resource management, conservation, and alternative pathways to livelihoods development, which includes tourism. Nowhere is this disconnect more stark than in communities on Rennell Island, within the region's oldest inscribed World Heritage area. These communities have so far resisted extractive industry development but have not yet benefited from inscription. Alternative livelihood opportunities compatible with a conservation economy are a priority. Our research objective was to explore community aspirations and priorities. We used Q-methodology to reveal discourses associated with conservation, livelihoods generation, and drivers of well-being and then evaluated these aspirations in scenarios in a socio-ecological system. We revealed three factors, each aligned with conservation and tourism development with clear opposition to extractive industries. Key differences focussed on immediate personal circumstances, attachment to kastom, and food and water security. Our research points to clear support for the area's continued conservation and for livelihood pathways that might secure this but low capacity to pursue this. Notwithstanding, the communities' patience is wearing thin and there is growing cynicism about the role of World Heritage protection as a route towards livelihoods development.

The Livestock Frontier in the Paraguayan Chaco: A Local Agent-based Perspective.

Deforestation is one of the most relevant transformations characterizing global environmental change in the tropics at present. There is wide consensus in pointing the context-dependent nature of tropical deforestation. In this sense, a better characterization of the phenomenon considering the social context could provide a more accurate picture of tropical deforestation. With this aim, a Q-methodology discourse analysis was conducted to characterise the different discourses that coexist in the particular region of the Paraguayan Chaco concerning the development of cattle ranching and derived deforestation. Four different discourses were identified as making sense the wide range of interests and values coexisting and clashing in the Paraguayan Chaco, namely: the Environmentalist discourse, the Business discourse, the Resigned discourse, and the Possibilist discourse. The results point that the fundamental differences between the discourses are largely explained by the different positions on three specific domains: (i) the socio-economic benefits the expansion of cattle ranching brings about; (ii) the environmental impacts the expansion of cattle ranching and the derived deforestation brings on; and, finally (iii) the degree to which an active intervention from the side of policy making to regulate the expansion of cattle ranching and to minimize possible detrimental effects is seen as necessary. The position of the different discourses in relation to these domains could help policy makers to make measures and regulations more widely accepted and followed.

Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology.

BACKGROUND: Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling. OBJECTIVE: This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments. DESIGN: A mixed method approach using the Q Methodology was employed. SETTING(S): Three public and private hospitals in Japan. PARTICIPANTS: Eighteen nurses participated in the study. METHODS: Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies. RESULTS: Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population. CONCLUSIONS: Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand. STUDY REGISTRATION: Not registered.

Subjectivity study on health conservation of elderly hemodialysis patients.

BACKGROUND: Health conservation enables elderly hemodialysis patients to maintain a positive state of well-being while undergoing treatment and maintenance of disease. This study was to identify the type of perceptions on health conservation of elderly hemodialysis patients and compare the characteristics of perceptions. METHODS: This study used an exploratory study design applying Q methodology, which is designed to research subjectivity. The study determined a population of subjective statements, the concourse, based on the preceding literature and interviews with twenty-five elderly patients over 65 years of age with hemodialysis. We chose a total of 50 statements considered to be representative of the concourse for the Q-sample. The study selected 50 elderly patients over 65 years of age with hemodialysis as the P-set. The participants provided their internal viewpoints by sorting the Q-sample items into a grid. The researchers performed an analysis using PC-QUANL program. Data were collected from June to November, 2019. RESULTS: Type I, 'support system-based effort' focused on one's own effort, positive and proactive attitude, family support, medical instructions, information, and medications. Type II, 'skeptical life maintaining' expressed a pessimistic future without hope, strongly negative perception on preserving health, and thus minimal effort and motivation to continue life. Type III, 'treatment process interest' is based on an interest in the hemodialysis process; for them, it is important to follow medical staff's instructions, take regular medications precisely, pay attention to the results of regular monthly blood tests, and control their health. Type IV, 'positive effort' accepts hemodialysis positively, lives with hemodialysis, and carries out all daily life activities. CONCLUSION: In nursing practice, nurses need to pay attention to the perceptions on health conservation of elderly hemodialysis patients. This study can be implied as the evidence of nursing practice based on the perception on health conservation of elderly hemodialysis patients.

Meaningful Clinical Outcomes for Young People and Parents When Treated for Chronic Musculoskeletal Pain in the UK: Q Set Development.

Previous studies have established a core outcome set for pediatric chronic pain clinical trials. The aim of this research was to establish which outcomes young people and parents considered important to measure during treatment for chronic musculoskeletal pain. To the best of our knowledge, this is the first study to explore which outcomes could be used to tailor interventions within a clinical setting. Twenty-one young people (aged 11-18 years) and 21 parents were recruited from 2 UK hospital sites and took part in semi-structured interviews that incorporated drawing a timeline of their treatment. They identified positive and negative outcomes showing the perceived effectiveness of treatment. Informed by Q methodology, the words and phases of young people and parents were developed into 101 statements that were mapped onto the core outcome set and represented wide-ranging opinions regarding the outcomes they considered important (Q set). This approach helped identify additional statements related to "parent and family functioning" not routinely considered. Outcomes related to the treatment experience and adverse effects were highlighted as important, yet are not routinely prioritized in clinical research. Parents prioritized outcomes related to the treatment experience, whereas young people prioritized their overall well-being. Over the course of treatment, outcome focus changed, with some outcomes only deemed relevant at a specific time point. Overall, the research highlighted the need for clinical guidance on which outcome domains to measure during the treatment course to gauge treatment effectiveness and optimally tailor interventions. PERSPECTIVE: This study established the range of outcomes that were important to young people and their parents during treatment for chronic musculoskeletal pain. The findings show how young people and parents have different outcome preferences and how their outcome focus changes during the treatment course.

An Exploration of Pediatricians' Professional Identities: A Q-Methodology Study.

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.

Users' involvement in digital health collaborative projects.

PURPOSE: This research analyzes the roles of users in innovative digital health collaborative projects from the perspective of the user by considering three dimensions: their motivation, project activities and the support of the partnership for their effective involvement. DESIGN/METHODOLOGY/APPROACH: The authors unraveled profiles of users by using a Q-methodological analysis of 24 statements and 44 service users. The statements for the three dimensions were designed according to previous models of stakeholder identification and customer participation in new product management. FINDINGS: The authors obtained two profiles that advocate active participation of users, though with a different degree of involvement. One of them supports the role of users as "advisors" of users' preferences and needs, and the other indicates a higher involvement of users as "cocreators" of the innovation, with the same contribution and responsibility as the other partners. ORIGINALITY/VALUE: Previous research has analyzed user involvement in digital health, as part of wider research on factors leading to the success and adoption of innovations. Moreover, previous research has analyzed user involvement in innovation projects, but without differentiating between projects carried out by an individual organization and those conducted by a partnership. This research contributes to filling this gap by revealing users' expectations about their involvement and how they think they will fit in with the dynamics of collaborative projects.