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.

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.

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.

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.

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.

What treatment outcomes matter in adolescent depression? A Q-study of priority profiles among mental health practitioners in the UK and Chile.

Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed.

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.

Discordance between farmers and scientists - Perspectives on nitrogen reduction measures in Denmark.

Mitigating nitrogen leaching from agricultural land is imperative for enhancing the ecological status of aquatic ecosystems. Incorporating the knowledge and perceptions of farmers regarding the feasibility and effectiveness of implementing nitrogen reduction measures is vital for increasing the adoption rate of such measures and related policies. Concurrently, the insights and perspectives of scientists advising policymakers on the implementation of these measures can facilitate a more comprehensive understanding of the barriers and potential for implementation. In this study, we employ Q methodology to elucidate the opinions of 11 farmers and 14 key scientists involved in providing contractual science policy advice to Danish ministries on nitrogen reduction measures. Results show that across the perspectives of farmers and scientists, four main factors (viewpoints) can be identified: 'Evidence-driven viewpoints', 'On-farm efficiency-driven viewpoints', 'Hydrological and landscape-scale viewpoints', 'Innovation-based viewpoints. From this, we suggest that within the field of nitrogen mitigation and implementation, there is a general broad division and opposing perspectives between scientists and farmers. The evidence presented here shows that scientists' viewpoints do not correspond to the viewpoints of farmers in most cases. Scientists broadly believe that landscape and long-term measures, especially wetlands, are most effective nitrogen measures, according to scientific evidence. This clashes severely with some farmer participants, who strongly believe that there should be more personal freedom and flexibility to make individual farm level management choices. This is a significant barrier to the uptake of the best possible measures.

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.

Balancing Ambitions and Realities: Stakeholder Perspectives on Jurisdictional Approach Outcomes in Sabah's Forests.

The jurisdictional approach concept emerged in response to the widespread failure of sectoral forest conservation projects. Despite its increasing popularity, understanding jurisdictional approach outcomes is challenging, given that many remain in either the formation or implementation stage. Furthermore, diverse stakeholders hold different perspectives on what exactly a jurisdictional approach is intended to pursue. These different perspectives are important to unravel, as having a shared understanding of the outcomes is important to build the critical support needed for it. This study aims to add to the limited evidence with a case study in Sabah, Malaysia, which is committed to addressing a leading deforestation driver (palm oil) through sustainability certification in a jurisdiction. We used Q-methodology to explore stakeholder perceptions, revealing three distinct perspectives regarding what outcomes jurisdictional approaches should pursue. We asked about outcomes achievable within ten years (2022-2032) and considering real-world constraints. We found different perspectives regarding economic, environmental, governance, and smallholders' welfare outcomes. However, we found consensus among stakeholders about some outcomes: (i) that achieving zero-deforestation is untenable, (ii) that issuing compensation or incentives to private land owners to not convert forests into plantations is unrealistic, (iii) that the human well-being of plantation workers could improve through better welfare, and (iv) the free, prior and informed consent given by local communities being required legally. The findings offer insights into key stakeholders' perceptions of the deliverables of jurisdictional approaches and the difficulty of achieving its objectives under real-world constraints.

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+.

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.

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.

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.

Examining Attitudes Towards Mental Health Diagnoses: A Q-Methodology Study.

BACKGROUND: Debates exist regarding the validity and utility of functional psychiatric diagnoses. How mental health diagnoses are understood has real impacts for service users and service delivery. AIMS: To investigate different attitudes about the utility of psychiatric diagnoses. METHODS: Forty-one stakeholders sorted 57 statements related to the usefulness of psychiatric diagnoses. Using q-methodology, four viewpoints were identified and interpreted. RESULTS: Viewpoint 1 (Pathologising human experience) regarded diagnoses as pseudo-scientific constructs that lacked validity and obscured the relationships between lived experience and distress. Viewpoint 2 (Illnesses like any other) held that labels reflected real disorders and diagnosis offered important benefits for service users and services. Viewpoint 3 (Stigmatised conditions) similarly regarded diagnoses as reflecting real disorders, but diagnostic criteria were viewed as biased and the impacts of applying labels seen as causing problems for service users. Conversely, Viewpoint 4 (Useful short-hands) viewed diagnostic processes as imperfect but necessary for supporting communication and structuring service delivery. CONCLUSIONS: While not all viewpoints are in keeping with empirical evidence, we hope results will enable professionals and service users to take meta-positions in relation to their own and others' attitudes, and to reflect on the impacts of privileging certain viewpoints over others.

Exploring US internal medicine resident career preferences: a Q-methodology study.

Career selection in medicine is a complex and underexplored process. Most medical career studies performed in the U.S. focused on the effect of demographic variables and medical education debt on career choice. Considering ongoing U.S. physician workforce shortages and the trilateral adaptive model of career decision making, a robust assessment of professional attitudes and work-life preferences is necessary. The objective of this study was to explore and define the dominant viewpoints related to career choice selection in a cohort of U.S. IM residents. We administered an electronic Q-sort in which 218 IM residents sorted 50 statements reflecting the spectrum of opinions that influence postgraduate career choice decisions. Participants provided comments that explained the reasoning behind their individual responses. In the final year of residency training, we ascertained participating residents' chosen career. Factor analysis grouped similar sorts and revealed four distinct viewpoints. We characterized the viewpoints as "Fellowship-Bound-Academic," "Altruistic-Longitudinal-Generalist," "Inpatient-Burnout-Aware," and "Lifestyle-Focused-Consultant." There is concordance between residents who loaded significantly onto a viewpoint and their ultimate career choice. Four dominant career choice viewpoints were found among contemporary U.S. IM residents. These viewpoints reflect the intersection of competing priorities, personal interests, professional identity, socio-economic factors, and work/life satisfaction. Better appreciation of determinants of IM residents' career choices may help address workforce shortages and enhance professional satisfaction.

Using Q methodology in health sciences education to study subjectivity.

Q methodology is a unique, yet underutilized methodology designed specifically to scientifically study subjectivity. Q, as it is most often referred to, is an appropriate methodology whenever a researcher is interested in uncovering and describing the multiple divergent viewpoints on any topic. Such discovery of viewpoints provides insight into the subjectivities related to policies, values, priorities, judgements, opinions, and decisions. The disciplines where Q has been used for research are many, and include health sciences, education, and other social science / behavioral science fields. Because of its rather idiosyncratic place in research, however, many Q methodologists are self-taught or seek education through a few select universities that offer graduate level Q courses. The key to successfully approaching a Q study is to embrace its unique approach to studying subjectivity such that it is a powerful tool in health science education and other fields. It is common to find inconsistencies related to Q terminology, analyses, and decision making across studies. There is often an over reliance on concepts that come from purely quantitative methodologies such as R factor analysis rather than embracing the qualitative-quantitative hybridity of Q. This article is written as a primer with a focus on understanding Q at a deeper level rather than a step-by-step guide.

Barriers to implementing health programs based on community participation: the Q method derived perspectives of healthcare professional.

BACKGROUND: Community participation in implementing health programs leads to positive organizational, social and individual consequences. This study aimed to investigate the prospects of a sample of Iranian healthcare professionals about their perceived barriers to implementing health programs based on community participation. METHODS: This was a cross-sectional study that employed a Q-methodology approach. Twenty health professional sorted the 47 statements into a 9-column Q-sort diagram ranging from - 4 as not important to + 4 as very important. The data were analyzed with PQMethod 2.35 software. The centroid factor analysis and varimax rotation were used for data analysis. Factors identified were interpreted and described in terms of the participants perspectives on the phenomenon. RESULTS: Analysis of the study participants' viewpoints (the Q-sorts) resulted in a five factor solution (accounted for 57% of the total variance) to endorse the main barriers to the implementation of health programs based on community participation in Iran. Barriers related to government, health programs, lack of necessary skills amongst health professionals and weak coordination between departments, barriers related to community, lack of understanding of goals, benefits and transparency of roles and responsibilities were among the important emanated factors to implementing health programs based community participation. CONCLUSION: Health policymakers and managers should consider the five mentioned identified barriers based on the community when planning and implementing the health program participation and try to empower the community to implement the programs in Iran.

What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression.

Interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16-21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: "Relieving distress and experiencing a happier emotional state"; "Learning to cope with cyclical distressing emotional states"; "Understanding and processing distressing emotional states"; and "Reduced interference of ongoing distressing emotional states with daily life". All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes.

Diversity of perspectives in biodiversity conservation: A case study of port land use in Antwerp and Rotterdam.

Conflicts of interest often undermine conservation initiatives against biodiversity decline. Effective decision-making requires a deeper understanding of the positions, criteria, concerns, and perspectives of stakeholders. However, managing so many perspectives can be difficult, and if not done well, conflicts arise which make it difficult to achieve conservation goals. The purpose of this study is to demonstrate that identifying areas of consensus is a good starting point to generate more effective debates and address complex issues. To do this, we investigate the diversity of perspectives regarding biodiversity conservation schemes among stakeholders in the studied ports of Antwerp and Rotterdam. Using Q-methodology, a semi-quantitative technique that enables us to systematically study the subjective views of stakeholders involved in a topic, we identified and organized a range of shared perspectives into three groups, known as factors. A total of 20 participants sorted 45 statements according to their perceptions and objectives, from -4 'most disagreeable' to 4 'most agreeable'. Then, respondents explained their rankings in a post-sorting interview. Next, the data was analyzed quantitatively and qualitatively. The quantitative analysis was conducted in two parts: (i) Dividing respondents into groups based on similar perspectives and (ii) coupling distinguishing statements with one of the factors characteristic of that viewpoint. Finally, in a qualitative analysis, we used the distinguishing statements and insights from interviews to create narratives and titles for the three factors: (1) Ports are key for our economic wealth, hence port development should continue, (2) Nature first, and (3) Multi-actor governance. Our findings confirm consensuses in three areas: policy, land use, and mitigation tactics. Interestingly, all narratives unanimously agreed on the importance of regulating port development and land use changes via legislation and environmental impact assessments. However, they debated the rigidity of legislation and whether offsetting port expansion (and associated land and resource use claims) should take place locally or internationally. We also found that decision-making mostly followed a human-centered perspective, where economic values were more relevant than intrinsic ones. These insights can serve as a baseline for stakeholders to form coalitions around areas of consensus to depolarize debates and avoid decision-making gridlocks.