In many European countries, semi-autonomous agencies have been created in health policy to safeguard general public interests. In executing their tasks, these agencies need to deal with conflicting expectations. Particularly avoiding the risk of regulatory capture and aligning with parent ministries are frequently studied challenges, even more so when complex issues such as scarcity are at stake. In this paper, we use q-methodology to provide a thorough overview of the debate regarding the role of an important agency in the Dutch healthcare system; the National Health Care Institute (Zorginstituut Nederland). We conducted 41 q-interviews with agency employees, evaluators, regulatees, ministry employees, health policy experts, members of its advisory committees, and peer agencies. We identify three viewpoints on what the agency should focus on. These are on societally relevant issues, strict package management, and efficient organisation of care. In doing so, our study shows how agencies are pulled in different directions by conflicting expectations. We show that this can be problematic because it complicates a clear role of the agency that allows addressing such issues. We thereby contribute to theories on agencies' complex relations with their external environment such as regulatory capture, tripartism, reflexive regulation, legal boundaries, and stewardship theory.

Conflict between carnivores and livestock farmers affects human livelihoods and predator populations. Historically, successful mitigation of this conflict has been limited, sometimes because of a lack of participation among stakeholders to create and implement agreeable and effective solutions. Finding common ground between stakeholders can, however, be difficult, partly because of the range and intensity of values held. Using a novel combination of Q-methodology and the Delphi technique, I investigated whether a diverse range of stakeholders could agree on how to mitigate conflict between carnivores and livestock farmers in Namibia. A strong consensus was reached on using conservation education and husbandry training to reduce livestock depredation. Two narratives emerged: one group preferred non-lethal methods to manage the conflict, whereas a smaller group preferred lethal measures. This new decision-making exercise has potential to be applied to other conservation conflicts to assist with participatory decision making.

Background: Randomized controlled trials have established that cognitive behavioural therapy (CBT) is effective in helping people with psychosis, though there is enormous variability in outcome. It is not clear what patient factors contribute to good outcomes. In fact, most studies considering client factors have excluded people with psychosis. It is clinicians who are deciding who is likely to benefit from CBT for psychosis (CBTp), though little is understood in terms of their views on who benefits from CBTp. Aims: This study investigated clinicians’ views on client characteristics that influence outcome in CBTp. Method: A Q-set of 61 client characteristics was developed from a literature search and interviews with clinicians experienced in working with CBT and/or psychosis. Twenty-one participants (familiar with psychosis and CBT through education, profession, practice or knowledge) rated the items based on their importance in effecting a positive outcome, on a forced normal distribution. Results: 21 completed Q-sorts yielded four factors, named as: acceptance and application of the cognitive model; attending to the present; secure base; meaningful active collaboration. Conclusions: Items regarding therapeutic alliance were highly endorsed throughout all factors. Some empirically-based items were not endorsed, although overall, clinician responses were consistent with prior research.

Due to demographic changes and a widely supported policy of ageing in place, the number of community-dwelling older people will increase immensely. Thus, supportive neighbourhoods enabling older people to age in place successfully are required. Using Q-methodology, we examined older people's perceptions of the comparative importance of neighbourhood characteristics for ageing in place. Based on the World Health Organization's Global Age-friendly Cities guide, we developed 26 statements about physical and social neighbourhood characteristics. Thirty-two older people in Rotterdam, half of whom were frail, rank-ordered these statements. Q-factor analysis revealed three distinct viewpoints each among frail and non-frail older people. Comparisons within and between groups are discussed. Although both frail and non-frail older people strongly desired a neighbourhood enabling them to age in place, they have divergent views on such a neighbourhood. Older people's dependence on the neighbourhood seems to be dynamic, affected by changing social and physical conditions and levels of frailty.

In Thailand, horticultural practices are a significant source of non-point source (NPS) pollution, and the government is considering best management practices (BMPs) as control measures for reducing agricultural NPS pollution to water. A prevailing assumption that farmers’ reactions to regulations will be homogenous is not based on underlying insights into attitudinal positions that may explain alternative behavioural responses. This paper uses Q-methodology to identify attitudinal discourses relating to BMP uptake. The approach combines the strengths of qualitative and quantitative research in order to explore subjectivity. The study is conducted with citrus growers in the Ping river basin, where farmers are facing increasing competition from alternative water uses. Four ‘discourses’ or viewpoints are identified, namely conservationist, traditionalist, disinterested and risk-averse. The different attitudes of these four groups are likely to be associated with distinctive behavioural reactions to the adoption of alternative policy instruments for pollution control. These discourses could usefully inform targeted policies for the control of NPS pollution from agriculture.

Negative stereotypes not only affect how older people feel about themselves, but also how younger people feel about old age and their prospect of growing old. The research reported in this paper has examined the negative and potentially harmful stereotypes of older people portrayed in magazine advertisements in the United States, as perceived by groups of older and young people. Q-methodology sorts of 40 advertisements with negative images of older people, along with personal interviews, were used to probe older people's and college student's feelings and attitudes about the images. The subjects were placed in four categories: ‘moralists’, ‘objectors’, ‘ageing moralists’ and ‘resentfuls’. Regardless of whether stereotypes were used, the older people liked the advertisements that showed them as being clever, vibrant and having a sense of humour. Neither the older people nor the students liked advertisements that ridiculed or poked fun at older people, or presented them as being out of touch with reality and unattractive. Both groups rated the stereotypes dealing with the real problems associated with ageing as inoffensive. The comparison of the two age groups showed a strong consensus about which images were acceptable and which offensive.

We consider the adoption of biologically integrated agricultural practices from the perspective of farm management style. Adoption decisions for farming practices must fit into a broader farm decision-making context that incorporates economic, environmental, social, family and personal considerations, as well as use of agricultural information sources. Drawing from a study of California almond and winegrape growers, we demonstrate that management styles differ substantially among farmers, these differences affect use of information sources and adoption of biologically based practices on the farm, and such adoption does not negatively affect crop performance. We used Q-methodology, a method for eliciting qualitative data using a variant of factor analysis, to identify three distinct management styles among a purposive sample of 40 growers. The Environmental Stewards' management style places higher priority on conservation of natural resources than on getting the highest possible yields or profits. Production Maximizers, with a different style, prioritize more traditional goals of producing the highest possible yields and quality and focusing resources on the farm rather than on outside concerns. Networking Entrepreneurs, on the other hand, value learning about innovative techniques in social contexts such as informational field days, evaluate new information with a business-like attitude and enjoy off-farm interests. A two-season mail survey of farming practices and information sources demonstrated that differences in management styles affect the adoption of practices. Environmental Stewards were more likely to practice biological pest control and encourage wildlife and less likely to use the most toxic chemicals. Production Maximizers had a greater tendency to use prophylactic and broad-spectrum chemicals, while Networking Entrepreneurs preferred more innovative biological pest controls but tended to avoid time-consuming cultural practices. Production Maximizers were distinguished by less use of more social forms of communication, such as attending field days and talking with other growers. Crop health and quality indicators showed that almost all growers were managing their crops very successfully, regardless of management style or choice of practices. These results hold important implications for efforts to increase the adoption of sustainable agriculture, especially by showing that contents and methods of outreach efforts must vary to accommodate diverse farm management styles.

Since the return of the refugee population to Kosovo, attempts at development of an emergency medical system in Kosovo have met with varied success, and have been hampered by unforeseen barriers. These barriers have been exacerbated by the lack of detailed health system assessments. A multimodal approach of data collection and analysis was used to identify potential barriers, and determine the appropriate level of intervention for emergency medicine (EM) development in Kosovo. The four step, multi-modal, data collection tool utilized: 1) demographic and health systems data; 2) focus group discussions with health-care workers; 3) individual interviews with key individuals in EM development; and 4) Q-Analysis of the attitudes and opinions of EM leaders.

Results indicated that Emergency Medicine in Kosovo is under-developed. This method of combined quantitative and qualitative analysis identified a number of developmental needs in the Kosovar health system. There has been litde formal training, the EMS system lacks organization, equipment, and a reliable communication system, and centralized emergency centers, other than the center at Prishtina Hospital, are inadequate. Group discussions and interviews support the desire by Kosovar health-care workers to establish EM, and highlight a number of concerns. A Q-methodology analysis of the attitudes of potential leaders in the field, supported these concerns and identified two attitudinal groups with deeper insights into their opinions on the development of such a system.

This study suggests that a multi-modal assessment of health systems can provide important information about the need for emergency health system improvements in Kosovo. This methodology may serve as a model for future, system-wide assessments in post-conflict health system reconstruction.