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BMC Health Serv Res. 2019 Jan 14;19(1):35. doi: 10.1186/s12913-019-3884-9.

Who knows best? A Q methodology study to explore perspectives of professional stakeholders and community participants on health in low-income communities.

Author information

1
Yunus Centre for Social Business and Health, Glasgow Caledonian University, M201, 2nd Floor, George Moore Building, Cowcaddens Road, Glasgow, G4 OBA, Scotland. neil.mchugh@gcu.ac.uk.
2
Yunus Centre for Social Business and Health, Glasgow Caledonian University, M201, 2nd Floor, George Moore Building, Cowcaddens Road, Glasgow, G4 OBA, Scotland.

Abstract

BACKGROUND:

Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While there is growing understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these groups.

METHODS:

Q methodology was used to identify and describe the shared perspectives ('subjectivities') that exist on i) why health is worse in low-income communities ('Causes') and ii) the ways that health could be improved in these same communities ('Solutions'). Purposively selected individuals (n = 53) from low-income communities (n = 25) and professional stakeholder groups (n = 28) ranked ordered sets of statements - 34 'Causes' and 39 'Solutions' - onto quasi-normal shaped grids according to their point of view. Factor analysis was used to identify shared points of view. 'Causes' and 'Solutions' were analysed independently, before examining correlations between perspectives on causes and perspectives on solutions.

RESULTS:

Analysis produced three factor solutions for both the 'Causes' and 'Solutions'. Broadly summarised these accounts for 'Causes' are: i) 'Unfair Society', ii) 'Dependent, workless and lazy', iii) 'Intergenerational hardships' and for 'Solutions': i) 'Empower communities', ii) 'Paternalism', iii) 'Redistribution'. No professionals defined (i.e. had a significant association with one factor only) the 'Causes' factor 'Dependent, workless and lazy' and the 'Solutions' factor 'Paternalism'. No community participants defined the 'Solutions' factor 'Redistribution'. The direction of correlations between the two sets of factor solutions - 'Causes' and 'Solutions' - appear to be intuitive, given the accounts identified.

CONCLUSIONS:

Despite the plurality of views there was broad agreement across accounts about issues relating to money. This is important as it points a way forward for tackling health inequalities, highlighting areas for policy and future research to focus on.

KEYWORDS:

Health inequalities; Q methodology; United Kingdom, Causes, Solutions; Views

PMID:
30642316
PMCID:
PMC6332861
DOI:
10.1186/s12913-019-3884-9
[Indexed for MEDLINE]
Free PMC Article

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