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

Neil McHugh*, Rachel Baker, Olga Biosca, Fatma Ibrahim, Cam Donaldson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)
185 Downloads (Pure)


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.

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.

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.

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.
Original languageEnglish
Article number35
Number of pages13
JournalBMC Health Services Research
Publication statusPublished - 14 Jan 2019


  • health inequalities
  • Q methodology
  • views
  • United Kingdom
  • Causes
  • Solutions

ASJC Scopus subject areas

  • Health Policy


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