Using QMethodology to Identify Reasons for Distress in Burn Survivors Postdischarge

Abstract

Reasons for distress after burn injuries have not been codified based on any type of acceptable empirical or statistical technique. The unique design methodology proposed in this study can identify the most common reasons cited for causing distress in burn survivors after discharge. A Q-sort task was developed with the assistance of our burn advisory group. After identifying 50 possible reasons for distress after discharge, each reason was placed on a laminated game card. In compliance with Qmethodology, a game board was developed that allowed patients to rank order each reason from "not causing distress" to "causing significant distress." A total of 69 burn survivors were enrolled in the study at four different time points: 1 month, 6 months, 1 year and 2 years postdischarge. After factor analysis, four factors accounted for all of the participants across time points. This indicates that at least four distinct groups of people can be categorized according to themes raised in rating reasons for distress. This Q-sort technique allowed us to capture the complexity of conceptualizing human distress by categorizing clusters of reported problems into similar groups. This methodology shows great promise for developing interventions that target unique needs of burn survivors.

A scoping review of Q-methodology in healthcare research

“…4 ), with four studies [ 32 , 38 – 40 ] reporting on multiple countries. Nine studies did not state which country the research had been conducted in [ 41 – 49 ]. The majority of studies were conducted in the UK (n = 85), followed by The United States (US) (n = 46), South Korea (n = 40), Canada (n = 22), the Netherlands (n = 22) and Australia (n = 12).…”

“…Q-methodology was described as an ideal method for exploring complex or controversial topics [ 50 ] and topics that were likely to elicit strong opinions, differing perspectives, or underacknowledged views, something which is particularly pertinent to healthcare [ 51 – 54 ]. For example, Askay et al [ 42 ] reasoned that standardised and relatively objective assessments, such as questionnaires, may not be appropriate to assess the physical, emotional and social reasons for distress in burn survivors because they are unlikely to be able to quantify the complex interactions among the reasons. Q-methodology was also used due to its less-confronting nature (i.e., participants are not asked direct questions but rather they respond to pre-established statements) [ 55 ].…”

“…Q-methodology was said to allow participants to create their own meaning while reducing the impact of prior assumptions and the potential biases of the researcher [ 69 , 70 ]. Many studies referred to the integration of qualitative and quantitative techniques as one of Q-methodology’s key strengths, [ 42 , 71 – 73 ] combining the richness of qualitative data with the rigour of statistical analysis [ 74 ]. Q-methodology was also described as avoiding problems associated with missing data because Q-sorts are only analysed as completed wholes [ 75 ].…”

“…Other common topic areas were those that have clear emotional and moral dimensions, including chronic disease, end-of-life care, resource allocation, and gender, sexual and reproductive health. As we and others have noted, [ 42 , 55 ] these are the kinds of matter considered highly suited to investigation using Q-methodology. In this vein, many authors of articles we reviewed cited the value of using Q-methodology in being able to study complex and contentious topics in which there were likely to be differing opinions [ 51 – 54 ].…”

Effects of A Nurse-Led Transitional Burns Rehabilitation Programme (4Cs-TBuRP) For Adult Burn Survivors: Protocol for a Randomised Control Trial

“…As rehabilitation occurs, the burn patient is able to attain a degree of pre-injury abilities as closely as possible (6, 7), and is able to do things that are desirable to them as recover progresses (8,9). Along the recovery trajectory for burn survivors, previous studies have observed that the greatest physical and psychosocial decline may be experienced following discharge (10)(11)(12). Concerns regarding pain, anxiety, and uncertainties about return to work/ community integration may emerge immediately following discharge (13,14).…”