Designing and Conducting Q Methodology in Implementation Research: A Methodological Discussion

Q methodology combines qualitative and quantitative methods to uncover subjective viewpoints about complex phenomena and classify the shared views in clusters of values and beliefs. The purpose of this paper is to demonstrate the utility of Q methodology for implementation research by illustrating how it was used for selecting and choosing implementation strategies from the perspective of experts and stakeholders. In a sequential mixed methods study focused on proposing implementation strategies to promote compassionate care for complex patients, Q methodology was used to determine shared opinions of compassionate care experts, nurses, nurse managers, health care administrators, and policymakers to rank implementation strategies in terms of their usefulness, feasibility, and importance in promoting the uptake of behavioral indicators of compassion in practice. The Q-sort survey was developed based on the qualitative findings and using implementation science frameworks. Five highly ranked implementation strategies were selected using factor analysis to identify consensus and divergence in the perspectives of stakeholders. Using an exemplar implementation study, we demonstrated that Q methodology can benefit implementation researchers for structured elicitation of perspectives of multiple stakeholders because it allows for studying and developing a nuanced understanding of complex and divisive implementation issues.