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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.

Background Jordan is a low-to-middle income country in the Middle East that reports one of the highest smoking rates among males globally, with 90% of males initiating smoking by the age of 24. However, little is known about the in-depth viewpoints of young males surrounding their smoking initiation and interest in cessation. This study sought to identify the perceptions of young Jordanian adult males who smoke and generate relevant statements that can inform future psychosocial measurement tools and studies involving young male adult smokers in Jordan and the Middle Eastern Region. Methods A Q-methodology study design was used. An initial set of statements was developed by reviewing the published literature and then piloted. Each statement was rated based on its clarity and relevance to the experiences of a small group of young Jordanian smokers. Piloting resulted in the refinement of statements. The final Q-sample (Q-statements) was composed of 94 statements related to smoking and cessation perspectives. 35 male smokers completed the Q-sorting exercise. Findings Three factors were extracted: the in-control viewpoint, the health-conscious viewpoint, and the emotional/affect regulation viewpoint. Conclusion Our findings offer insights regarding smoking initiation and continuation in a group of smokers driving the highest rates of smoking in Jordan.

Environmental justice is an important component of sustainable tourism, but stakeholder perspectives related to environmental justice may vary. Using Q-methodology, we investigated different stakeholder perceptions related to environmental justice within the context of tourism and ecological restoration. Specifically, in the Erhai Lake basin, China, we explore perspectives around an ecological restoration effort that included the government mandated closure of 1900 establishments (inns and restaurants) in response to environmental degradation. We identify and explore four environmental justice perspectives: the togetherness, protection, operator loss, and local loss perspectives. These four perspectives are contextualized within three dimensions of environmental justice (i.e., distribution, recognition, and participation). Our findings highlight differing views related to who is affected most by the inn closures (e.g., future generations, local residents, inn owners), and general consensus related to the outcomes of the process being more important than the process itself. Finally, we discuss potential reasons for these differing perspectives and recommend ways to improve environmental justice among different stakeholders. This research can facilitate sustainable development of tourism by highlighting the facets of ecological restoration policy implementation most important to stakeholders, including recognition of diverse stakeholder concerns and identities, clear and well supported rationale for policy design, and increased equity in the distribution of costs and benefits of policies.

Background Active patient involvement in treatment decisions is seen as a feature of patient‐centred care that will ultimately lead to better healthcare services and patient outcomes. Although many factors have been identified that influence patient involvement in treatment decisions, little is known about the different views that patients have on which factors are most important. Objective This study explores the views of patients with a chronic condition on factors influencing their involvement in treatment decisions. Design Q‐methodology was used to study the views of patients. Respondents were asked to rank a set of 42 statements from the least important to the most important for active patient involvement in treatment decision‐making. The set of 42 statements was developed based on a literature search and a pilot in which two external researchers, 15 patients and four healthcare professionals participated. A total of 136 patients with one of three major chronic conditions were included: diabetes types 1 and 2, respiratory disease (i.e., chronic obstructive pulmonary disease and asthma) and cancer (i.e., breast cancer and prostate cancer). Data were collected in a face‐to‐face interview setting in the Netherlands. Results Four distinct views on the factors influencing active patient involvement were identified among patients with a chronic condition. (1) Enabled involvement: the extent to which patients are facilitated and empowered to participate will lead to patient involvement. (2) Relationship‐driven involvement: the relationship between patients and healthcare professionals drives patient involvement. (3) Disease impact‐driven involvement: the severity of disease drives patient involvement. (4) Cognition‐driven involvement: knowledge and information drive patient involvement. Discussion and Conclusion From the patients' perspective, this study shows that there is no one‐size‐fits‐all approach to involving patients more actively in their healthcare journey. Strategies aiming to enhance active patient involvement among patients with a chronic condition should consider this diversity in perspectives among these patients. Patient Contribution Patients are the respondents as this study researches their perspective on factors influencing patient involvement. In addition, patients were involved in pilot‐testing the statement set.

Forest restoration/creation is a policy focus worldwide, with initiatives pledging to plant billions of trees. While there is an emphasis on providing “the right tree in the right place,” we need to understand for whom the trees are right. Such social dimensions are frequently overlooked, despite being critical to successful forest restoration/creation. We used Q‐methodology to examine what forest biodiversity attributes (e.g., functions, behaviors, colors, smells) people (N = 194) relate to and how in Britain. We found that shared public perspectives on biodiversity attributes are multifaceted, influenced by personal experience and vary across taxa. This heterogeneity highlights the importance of gaining a richer understanding of human–nature relationships, as restoration/creation initiatives need to deliver biodiverse forests to accommodate the plurality of preferences brought to bear upon them. Based on our findings, emphasizing biodiversity in forest restoration/creation should contribute to greater use of, comfort in, and meaningful engagement with, forests in the future by a wider set of publics.

This study explores possible reasons for cancel culture in higher education in the Arab world. Specifically, through Q methodology, it investigates the perceptions of twenty-one academics of different nationalities and from different backgrounds working in various universities in the Arab world as to the causes and their professional experiences of cancel culture. The aim is to contribute to a necessary discussion of cancel culture and its impacts on Arab higher education, with the hope of strengthening the region’s academic freedom. The data reveal that several political and social issues engender cancel culture in Arab universities. In effect, results indicate that academics working in higher education in the Arab world embrace a ‘culture of safetyism’ to keep themselves, their students and the societies in which they live ‘emotionally safe’.

Today’s agriculture, food, and natural resources (AFNR) sectors face many wicked problems like climate change. Addressing these complex problems will require people to have both social and technical knowledge. However, having knowledge is insufficient. Individuals must be able to think about things as they occur in complex systems. Systems thinking has been proposed as a way of tackling complex problems. The purpose of this study was to determine if there is a continuum of systems thinking paradigms, beyond the hard systems thinking and soft systems thinking dichotomy proposed by Checkland. A novel research method called Q methodology was used, which included two steps: (a) the collection of data that forms the Q-sorts and (b) the by-person factor analysis of the Q-sorts. Overall, the findings from this study support the idea that systems thinking occurs on a continuum which includes (a) Hard systems thinking, (b) HARDsoft systems thinking, (c) SOFThard systems thinking and (d) Soft systems thinking. HARDsoft and SOFThard systems thinking were newly discovered in this research. The four systems thinking paradigms identified in this study better reflect the nuances and complexities that are associated with human thought and can provide a more specialized approach to solving complex issues.

Lifestyle of an individual is distinguished from that of others by its reflection of individual values and subjectivity. Therefore, this study attempted to explore recognition type by focusing on individual subjectivity using the Q methodology for health-related lifestyles. Q-Methodology was divided into five stages. Step 1-Q sample collected statements about representative lifestyle behavior; Step 2-P sample recruited 34 study participants to express subjectivity about lifestyle; Step 3-Q sort classified statements according to subjective perspective; Step 4-Q-factor analysis examined the correlation between participants’ responses; and Step 5-factor analysis could be interpreted as a lifestyle factor. Health-related lifestyles were divided into four recognition types that focused on (A) interpersonal and emotional well-being, (B) happiness and daily management, (C) emotional well-being and cultivation, and (D) regular life practice. Individual subjectivity was reflected in all factors, and preferred behavior was interpreted in relation to health. The limitations and directions addressed in previous studies to promote healthy lifestyles were clarified. Lifestyle diversity reflects individual values and subjectivity. Considering the multidimensional nature of health lifestyle perception types emphasizes the need for a tailored approach. This study offers valuable insights for developing community health management strategies and public health policies aimed at improving health and quality of life.

Background The scarcity of resources in long-term care demands more than ever that organizations in this sector are prepared for innovation to ensure affordable access to care for older adults. Organizations that are innovation ready are more capable of implementing innovations. Therefore, a better understanding of how stakeholders view innovation readiness in long-term care can provide actionable strategies to enhance their innovative capacities. ‘Innovation readiness’ indicates the level of maturity of an organization to succeed in any type of innovation. Our study explored perspectives among stakeholders on what they consider important for organizations in long-term care for older adults to be innovation ready. Methods Q-methodology, a mixed-methods approach, was used to investigate the perspectives of 30 stakeholders connected to long-term care for older adults in the Netherlands: academics, (top)management, innovation managers, client representatives, staff, and consultants. Stakeholders were asked to rank 36 statements on innovation readiness on importance. Statements were extracted from literature research and qualitative interviews. Thereafter in the post-interviews stakeholders explained their ranking and reflected on the statements. By-person factor analysis was used to identify clusters in the ranking data. Together with the qualitative data from follow-up interviews, these clusters were interpreted and described as perspectives of the stakeholders. Results Four distinct perspectives were identified on what they consider important for innovation readiness in long-term care: (1) ‘supportive role of management’ (2) ‘participation of the client (system) and employees’ (3) ‘setting the course and creating conditions’ and (4) ‘structuring decision-making, roles and responsibilities’. The 36 statements represented a complete overview of innovation readiness factors. No additional innovation factors to those previously identified in the literature emerged from the interviews. Conclusions Stakeholders agree that all factors contributing to innovation readiness of long-term care organizations for older adults are accounted for. The variety of perspectives on what is most important shows there is no agreement among stakeholders about a fixed route toward innovation readiness. However, stakeholders suggested a temporal order of the innovation readiness factors, preferably starting with formulating the innovation ambition. This study’s results could contribute to developing an assessment tool to deliver a structured approach for managers to assess the innovation readiness of their organization. Registration The study received ethical approval on April 13, 2022 from the Medical Ethics Board of Zuyderland Medical Center in the Netherlands with the number METCZ20220036.

The integration of artificial intelligence (AI) into second language (L2) writing instruction has generated an ongoing debate concerning its pedagogical value, ethical implications, and classroom implementation. While existing research highlights AI's potential to enhance writing development, teachers' subjective views remain underexplored. This study uses Q‐methodology to examine educators' perspectives on the pedagogical role of AI, particularly AI‐generated feedback, in L2 writing instruction. Forty teachers sorted 42 statements that captured pedagogical, emotional, and ethical concerns related to AI‐supported writing practices. By‐person factor analysis revealed four distinct viewpoints: (1) Instructor‐Led Guided Trust, (2) Institution‐Dependent Conditional Trust, (3) Strategic Resistance, and (4) Transformative Embrace. These perspectives reflect varying degrees of trust in AI, informed by beliefs about instructional quality and teacher roles. The findings emphasize the need for teacher agency, contextual responsiveness, and targeted professional development in AI adoption. This study contributes to a deeper understanding of how educators reconcile emerging technologies with pedagogical integrity, offering practical implications for policy, training, and future research in technology‐enhanced education.