Introduction

Involvement of service users in practice and in research has been driven primarily by governmental authorities’ demands for their involvement. However, professionals may regard involvement of service users in service development as demanding and time consuming (Slettebø et al., 2010). This is particularly the case when service users are prisoners or ex-prisoners and power differentials between them and the professionals are great and the prison hierarchy works against the engagement of prisoners. In the latter case, several reasons have been identified: prisoners are not regarded as deserving, peer pressure from fellow inmates and lack of resources required to allow prisoners’ participation while retaining secure conditions (Chapter 8, Hean et al. in this volume). Similarly, the voice of the prisoner may be difficult to include because of ethical restrictions—for example, research ethics committees not allowing researchers to engage prisoners in service development projects because of their vulnerability (see Bjørkly & Ødegård, 2017; Chapter 9, Sepannen et al. in this volume). Thus, novel ways that can overcome these obstacles are required to get the voices of prisoners/ex-prisoners included as service users in service development and organisational learning.

In this chapter we introduce Q methodology (Brown, 1991/1992; Stephenson, 1953) and suggest how this research method can be applied in order to reveal the views of service users in contact with the criminal justice system. An empirical research example based on ex-prisoners’ experiences of service provisions in an UK mentorship organisation will be presented to illustrate the method and to critique its utility as a means of representing the service user voice during service development interventions and action research type projects.

Exemplar Study

The aim of the study was to explore the experiences of service users of a volunteer organisation in southern England that provided services to people leaving prison to facilitate their societal reintegration after leaving prison. The service provision encompassed meeting clients’ various acute needs and mentoring. The study sought to give the client a voice in the further development of the service. The focus was particularly on younger clients, whose age and other vulnerabilities (e.g. literacy) had made representation of their voices in service development challenging in the past. The study was part of a wider project led by a consortium of European researchers and practitioners (COLAB-H2020-MSCA-RISE-2016/734536) working together to merge their combined knowledge of methods of organisational change in other fields and apply these to the criminal justice system. This project had identified that representing the service user voice in organisational change and innovation interventions (see Chapter 8 of this volume) in this context was problematic, and Q method was proposed as having the potential to address this issue. Twenty-one young people (19 males and 2 females, aged 19–30) were recruited for the study.

Q Method

Q method was developed by William Stephenson in the 1930s, aiming to develop a method for systematic investigation of human subjectivity, such as persons’ viewpoints, feelings or preferences. The method and its methodology represented something new and innovative and met scepticism and resistance for many years, particularly from the prevailing objectivist perspective. However, during the last decades, Q method has increasingly been recognised and applied in several new research fields, including social policy (Brown, 1980), psychology (Goldstein & Goldstein, 2005), human geography (Eden et al., 2005), child welfare (Ellingsen, 2011), interprofessional collaboration (Sæbjørnsen, 2017) and ex-prisoners’ experience of service provisions (Sjo & Sæbjørnsen, 2018). Q method has contributed to valuable insight into viewpoints, meanings, thoughts and feelings of people in vulnerable situations.

In brief, participants in a Q study are asked to relate to a set of stimuli and to express their perspectives by use of these stimuli. The most frequently used form of stimuli is statements, but other forms of stimuli, such as images, have also been used (Stephenson, 1980; Størksen et al., 2011; Taylor & Delprato, 1994). However, hereafter, such stimuli will be referred to as statements. The participants are asked to relate to a set of statements and then to sort the statements according to their subjective meaning, such as in order of subjective importance. The individual participant’s sorting procedure is often referred to as a Q sort. The analyses will show how participants share their subjective viewpoints. Through the analyses, the identification of similarities and differences, as well as attempts to reach a consensus, viewpoints and perspectives will become visible.

The research process of a Q study can be explained in the following four steps (Brown, 1991/1992; van Exel & de Graaf, 2005):

  1. 1.

    Concourse identification

  2. 2.

    Q sampling

  3. 3.

    Q sort administration

  4. 4.

    Analysis and interpretation.

Step 1: Concourse Identification

The concourse constitutes a central element in Q methodology, which is the basis of the Q method. The concourse represents everything that is communicable on the topic under investigation (Brown, 1980; Stephenson, 1953) or ‘the flow of communicability surrounding any topic’ (Brown, 1991/1992, p. 3). In Norway, the concept has been translated to kommunikasjonsunivers (Thorsen & Allgood, 2010) meaning communication universe, which refers to the different ways of expressing information about the topic. Different groups will describe the topic in different ways, but the most important outcome being aimed at is the emergence of different subjective statements that together form a picture of the participants’ subjective viewpoints or perspectives about the topic.

The purpose of this first step is to identify the concourse around the topic of investigation, which involves identifying all relevant statements pertaining to the topic. A total of 200 statements or more is not unusual at this step. Transcripts from in-depth interviews with participants are often the basis for concourse identification. Often, only a few interviews (3–4) are sufficient for concourse identification (Ellingsen et al., 2010), and a large number of potential statements may be derived from the interviews for Q set development. This is known as a naturalistic concourse approach (Ellingsen, 2011; Sæbjørnsen et al., 2016). Each statement is pasted onto a card to form a pile of so called Q sort cards. By using statements derived from interviews with service users, the statements become meaningful and understandable to the service user. Involving them in the development of this tool in this way may contribute to the service users’ feeling recognised and being taken seriously by the service providers (Honneth, 2008; Sæbjørnsen, 2017). Such a form of service user involvement may even contribute to the development of a trusting relationship between service provider and service user.

Concourse identification may also take a theoretical approach. Such an approach entails the researcher, in a systematic way, seeking to represent what is likely to be part of a hypothetical communication on a selected topic (Kvalsund & Allgood, 2010). For this purpose, statements are derived from other media, such as newspapers, literature or from daily communication between human beings (Brown, 1991/1992; Corr, 2006). The third approach to concourse identification constitutes a combination of naturalistic and theoretical approaches (Sæbjørnsen et al., 2016).

Step 2: Q Sampling

The identified concourse constitutes the basis for the statements that the participants will be asked to examine. However, handling a very large number of statements will be difficult for the participants; hence, it is important to make a systematic reduction in the number of statements, seeking to ensure that nuances in the identified concourse remain. This selection process is referred to as the Q sampling, in which the Fisher Block Balance Design (Stephenson, 1953) is useful for categorisation and balancing, as well as a reduction of statements. After this process, the number of statements will often have been reduced to 20–50, depending on the study topic and the participants’ ability to relate to different statements. The development of the Q cards (and the statements written on them) should be conducted by a researcher who is competent in Q methodology, but service users as well as service providers could be involved in the selection of statements.

In the Q sampling it is important to select statements that allow for self-reflection so that the participant can weigh the subjective significance or how important the statements are to him or her (Brown, 1980; Thorsen, 2006). This is known as psychological significance (Kvalsund & Allgood, 2010). When developing the Q sample for the study, it is therefore recommended to avoid statements that would just result in ‘agree’ or ‘not agree’. Whether the statements are formulated negatively or positively does not influence the results of the study because the results only depend on the participants’ ranking of the statements. However, it is recommended to formulate most statements positively because it eases the participants’ sorting.

Step 3: Q Sort Administration

A Q study can be accomplished even with a relatively limited number of participants, and more than 50 participants would be unusual. Prior to Q sort, the researcher gives sorting instructions, such as ‘sort the statements in accordance with the degree to which you agree with it’ or ‘sort the statements in accordance with the degree to which it is important to you’. Each of the participants will be asked to rank order the statements, by sorting the cards onto a Q sort grid. This grid is a template provided by the researcher upon which the participant can place their cards in order of their perceived relevance to their own personal situation. Most often the participants in a Q study sort the cards once. However, it would also have been possible to ask participants to do several Q sorts, based on different instructions, for the purpose of comparing the different Q sorts. For example, the American psychologist Carl Rogers took advantage of this opportunity when he applied Q method in individual therapy. First, he asked the clients to sort the cards according to their ‘ideal self’ and then according to their ‘real self’ (Smith, 2001).

The scale and shape of a Q sort grid may vary from study to study, but the ranking of statements is horizontal and not vertical, which means that the rank order inside one column is always irrelevant. The grid example shown in Fig. 14.1 has a scale from −5 to +5, which means that the participants in that specific study had a choice of 11 different values available for the rank ordering. During a Q sort, the participant will place the statement that he most agrees with on +5 and those of the remaining statements that he agrees with on the +4 columns, and so forth. A corresponding procedure will be used for the statements that the participant agrees with least. The limited spaces available in the +5 row and the −5 row forces the participant to prioritize which statements he will give one of these ‘exclusive’ values.

Fig. 14.1
figure 1

Q sort grid

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In order to ease the sorting of the statements onto the grid, the participant will first be asked to sort the cards into three piles: ‘most agree’, ‘least agree’ and ‘more neutral/not quite sure’. As shown in Fig. 14.2, the participant then starts with sorting the cards from the ‘most agree’ pile onto the right (plus) section of the grid before moving on to the cards from the ‘least agree’ pile onto the left (minus) section of the grid. Finally, the participant sorts the cards from the last pile on to the middle section of the grid.

Fig. 14.2
figure 2

A participant performing a Q sort

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Prior to Q sorting, and sometimes also during Q sorting, the researcher must explain practicalities and guide the participant on how to sort the cards, but do so without influencing their views. It is important that the researcher enables the participant to feel secure and free to express his subjective views.

After the Q sort, the researcher will normally ask the participant to look over the Q sort, in order to make adjustments, if needed. The sorting procedure often makes the participant more conscious about his viewpoints, which he might not have been aware of prior to the Q sort. In conformity with other research approaches, Q method provides a picture of a participant’s view at the time of a Q sort performance. Nevertheless, the perspectives will normally be relatively stable, and a test-retest-reliability (same sorting at two different points in time) from r = 0.80 up to 0.90 is anticipated (Brown, 1980).

Step 4: Analysis and Interpretation

The result of each participant’s Q sort will be subjected to person-centred factor analysis or a ‘by person factor analysis’. This means that it is the individual Q sort or perspective, consisting of each participant’s valuation of each of the statements (for example from −5 to +5) that is subjected to factor analysis, not the single statement or item as in traditional, explorative factor analysis. PQMethod (Schmolck, 2002) is the most commonly applied analysis programme in Q studies. The software programme can be downloaded free of charge (http://schmolck.org/qmethod/downpqwin.htm).

All the participants’ Q sorts are put into the programme for Q factor analysis, person by person. In Q factor analysis, a factor consists of persons who have sorted the statements similarly. This is different from conventional factor analysis, where clusters of variables constitute the factors. Based on the emerging factors, the researcher will make an analytical assessment about how many factors to retain for the final factor solution. Selection of a final factor solution is often based on a factor eigenvalue and the number of significant loadings that the factor is based on (Watts & Stenner, 2012). The factors, which are often referred to as perspectives, represent different perspectives prevailing among the participants, and usually a Q study identifies several different perspectives. This means that persons who have similar, though not identical, subjective viewpoints contribute to define the same factor. The factors show the typical way that the participants who define the perspective have sorted the cards. After the computer-based analysis, the factors or perspectives are further interpreted by abduction. In this abductive interpretation, the researcher seeks to understand the different perspectives the Q analysis has pinpointed and what these represent. Further investigation of the factors, including what the factor expresses, important and unimportant statements in this perspective and the particular properties of the specific factor can convey a good picture of which viewpoints each perspective represents. This means that a statement can have a different meaning depending on which context it is placed in, and should, hence, be interpreted holistically. A procedure using ‘crib sheets’ as described by Watts and Stenner (2012) may be useful in this systematic factor interpretation. For interpretation of each factor, the ‘crib sheet’ procedure involves focusing the overall configuration of the statements, identification of statements that were ranked higher and lower than in the other factors, and statements that were ranked in the outer edges of the grid, that is, −5 and +5. The analysis reveals each perspective’s characteristics and also what the participants have in common across the different perspectives that have emerged.

Illustrative Example of Using the Q Method With Ex-Prisoners as Service Users

Participants

Twenty-one young ex-prisoners (19 males and 2 females) aged 19–30, with experiences from imprisonments in England, participated in this study. Type of crime as well as number and duration of imprisonments varied among the participants, but the majority had expiated sentences related to substance misuse. The participants were recruited by the third sector charity organisation and their partners in southern England who had the remit of mentoring people in contact with the criminal justice system, especially after their release from prison.

Materials and Procedure

This Q study was carried out in accordance with the steps commonly used in Q studies (Brown, 1991/1992; van Exel & de Graaf, 2005).

  • Identification of the concourse. Semi-structured interviews with three ex-prisoners and one professional with expert knowledge of the field were conducted. Based on the transcribed interview texts, a total of 199 statements were identified as belonging to the concourse of young ex-prisoners’ views about their situation, needs and possibilities.

  • Development of the set of statements (Q set or Q sample). The statements were selected from interview texts. The selection of statements for the Q set involved development and application of a two-dimensional scheme, inspired by Fisher’s balanced block design, as recommended by Stephenson (1953). The purpose of using such a categorisation tool is to strengthen concourse representativeness in the Q set (Sæbjørnsen et al., 2016). The Q set (consisting of 42 statements) and the Q sort grid (Fig. 14.1) were tested by research colleagues and professional service providers, which resulted in amendment of some of the statements.

  • Administration of the Q sorts. The Q set was presented to the participants on 42 statement cards, with one statement printed on each card. The participants were asked to relate to the statements and sort them into the grid, in accordance with the degree to which they agreed with the statements. In order to simplify the sorting procedure, the participants first read through the statements or had the statements read aloud and conducted a preliminary sort into three piles (agree, disagree and neutral/uncertain). The participants sorted the cards without interference from the researcher or others. The researcher answered clarifying questions and took notes of participants’ comments and deepening expressions.

  • Analysis and interpretation of the data obtained from Q sorts and participants’ comments during the sorting procedures.

Analysis

In Q studies, factor interpretation is based on the understandings that the factors represent (McKeown & Thomas, 1988), and the researcher searches for the best plausible explanations (Stephenson, 1961; Wolf, 2004). As suggested by Watts and Stenner (2012), the interpretation of each factor was based on the overall configuration of the participants’ statements, statements that were ranked higher and lower than in the other factors, and statements that were ranked −5 and +5.

The 21 completed Q sorts were entered into the computer programme PQMethod (Schmolck, 2002) for data analysis. The Q sorts were then subjected to factor analysis using a principal component analysis with a Varimax rotation (Shemmings, 2006; Stainton Rogers, 1995). The rotation of factors is used in accordance with the criterion of simple structure, which means that the factors are distinct from each other, and the factor structure can then be meaningfully interpreted by the researcher (Munro, 1997). The emerging factors revealed how the participants’ shared viewpoints clustered together and which statements that the participants, on the same factor, typically had rated positively or negatively.

Ethical Considerations

Approvals were obtained from the Norwegian Centre for Research Data (NSD). Initially, the participants were informed both verbally and in writing about the research project. The participants gave their written consent. They were informed that all information, such as how they sorted the cards and their verbal comments, would be treated anonymously.

Findings and Factor Interpretation

A principal component analysis with a Varimax rotation resulted in three factors (Table 14.2). The correlation between the factors was low (Table 14.1), indicating the presence of differing perspectives.

Table 14.1 Three factor correlation matrix
Full size table

The factor loadings indicate the degree to which each Q sort correlates with each of the three factors, as shown in Table 14.2. An X marks a Q sort loading significantly on one factor. The closer a Q sort is to 1, the more equal it is to the factor:

Table 14.2 Factor matrix with an X indicating a defining sort
Full size table

As shown in Table 14.2, 8 of the 21 participants loaded significantly on Factors 1, 6 on Factors 2 and 7 define Factor 3. A visual inspection of the factors is a common approach in Q. The resulting factor scores (z scores) were converted back to the original values of the scale used in the factor matrix. How each of the statements was typically sorted by each of the three factors is shown in Table 14.3.

Table 14.3 Factor scores for each statement
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Each factor consists of persons who have sorted their statements similarly. Therefore the factor analysis showed the following three groups or types of participant.

Factor 1—The Prison Weary Optimist

The participants associated with Factor 1 seem to have had a very difficult time in prison, but were still optimistic about the future. All 8 participants were male, aged 21–30 years. Their age at first time of imprisonment varied from 15 to 22 years, and the number of imprisonments varied from 1 to 12. Seven of these boys had drug/alcohol problems and mental health difficulties, and two of them needed to see mental health services. Except for one, all of the boys grew up in their parents’ homes. Only one boy reported that he had no contact with his family. The participants’ housing arrangements varied: some were in hostels or shared flats, some in ‘supported accommodations’, and one stayed with his parents. Five boys had some regular day activity, such as work or following a treatment programme.

The Factor 1 participants expressed bad and painful experiences from prison life (#30/+4) including having a life crisis with no help being available (#2/+4), at least in the cases of those who did not constantly and every day, ‘beg for help and act weird’ (#21/+4). These boys seemed to believe that prison officers did not at all care about the prisoners (#29/−5). When in prison, they did not seem to have been offered any counselling or anyone to talk to in order to prepare for life after release (#32/−4). Avoiding new prison terms seemed really important to these participants (#31/−5). Even after prison release, these boys did not seem impressed by the number of different organisations offering them help (#1/−3). They did not seem to have had anyone ready to help them with such issues as needing a place to live after release (#7/−1). The boys expressed that it was quite frustrating that it was so difficult to get mental health services (#24/+3). They all saw probation services regularly, but they did not seem to find that useful (#19/−4). More than any other factor, these boys expressed that the lack of contact between probation and other services had put them in stressful situations, such as disturbing other appointments (#40/+3).

Despite bad experiences from prison and little useful help in order to resettle after release, these boys seemed positive and very optimistic about the future (#14/+5). Somehow, they were thinking differently at that point. They strongly expressed that they wanted to live life as a normal person, without crime and drugs (#34/+ 5), and they seemed to trust their own ability to succeed with such plan (#18/+ 3). Interestingly, Factor 1 gave the statement ‘I have someone who really cares about me, that I can call any time, just help me thinking’ quite a high value (#10/+ 3). These relationships may be important recourses for these boys, for their positivism and motivation for change.

Factor 2—The Resilient Optimist

The overall impression is that the 6 male participants, age 20–29, who constituted Factor 2, ignored difficulties and reached for possibilities. Feelings of having someone who care and a sound mental health seemed to reduce the suffering they experienced as a result of a lack of other basic life amenities. Age of first imprisonment varied from 13 to 25, and the number of imprisonments varied from one to four. Only two boys reported drug/alcohol problems. Except for one boy, the participants reported that they did not need any help from mental health services. Four boys grew up in their parents’ home, and two grew up in foster homes and/or children’s homes. Only one boy reported extensive contact with his family, and one boy had no family contact at all. The boys’ housing situations varied from hostel, sleeping on a friend’s sofa or just living on the street, and they saw it as very important to get their own space (#20/+ 4). Except for one boy who worked occasionally, these boys had no regular day activity.

The typical Factor 2 participant seemed to think that life was currently getting very good and was optimistic about the future (#14/+5). Crime and drugs seemed to have been a part of their upbringing (#9/+3), but they emphasised that they had completely changed their way of thinking and just wanted to live life without drugs and crime (#34/+5). Unlike the other factors, these boys did not seem to have felt left alone in crisis when in prison (#2/−3). Rather, they expressed having had some help in prison (#25/+1), such as counselling about how to handle life after release (#32/+3). These boys did not seem to have experienced prison life as being as hard as the other factor groupings did (#30/−2), but they did not want to go back to prison again (#31/−4), and they did not agree that prison officers really cared about the prisoners (#29/−3).

Different from the other factors, the Factor 2 participants did not seem to experience any mental health difficulties (#4/−4 and #24/−4). They emphasised that they had someone who really cared about them, whom they could talk to about anything (#10/+4). They also had somebody who helped them when they were released #7/+4), and they had not lost contact with their family (#3/−5). More than the other factors, these boys seemed to have been surprised by the many organisations that were offering to help them resettle after release (#1/+3).

Factor 3—The Lonely, Indigent and Ill

The overall impression of Factor 3 is that the 7 participants associated with it, 2 females and 5 males, suffered from loneliness and lack of care and having several unmet basic needs, particularly due to a lack of mental health treatment and a good place to live.

The participants were from 19 to 30 years old. Their age at their first time in prison varied from 16 to 25 years, and the number of imprisonments varied from 1 to 11. Three participants reported alcohol/drug problems. Five participants reported that they needed mental health services. Three of the participants grew up in foster homes and children’s homes, and four in a parent’s home. Except for one participant, the Factor 3 participants reported that they had little or no current contact with their family. The housing situation for these participants varied from shared flat, hostel and living on the street. None of them had regular day activities.

The typical Factor 3 participant seemed to emphasise that their two most important needs were a proper place to live (#20/+5) and anxiety treatment (#4/+5). The long wait to see the mental health service caused them frustration (#24/+4). Nothing seemed to have been prepared for them before release (#22/−5). They seemed not to have received any help when in prison (#25/−3), nor did anybody there ask them about plans after release, such as how to get a place to live or a job (#32/−3). They seemed very convinced that they did not want to go back to prison again (#31/−5).

More than the other factors, Factor 3 participants emphasised that they were brought up around crime, drugs and things ‘normal people’ would not do (#9/+4). If they, for example, got bad news, they used to take drugs and then often got involved in more crime (#38/+4). When experiencing life crises, it was not their habit to ask for help (#37/−3). However, they seemed to appreciate the help they got from the third sector organisation (#26/+3), and they would like it if workers from this organisation had come to see them when in prison (#41/+3). Unlike the other factors, these participants seemed to find it quite useful to see probation (#19/+3 and #28/−3), and those who attended alcohol/drug treatments did not express that they did it just to ‘please’ probation (#33/−4). Less than the other factors, this grouping of participants had somebody who really cared for them (#6/−1), and they did not have anybody to help them resettle and find a place to live after release (#7/−2).

Discussion

In this chapter we have introduced Q methodology (Brown, 1991/1992; Stephenson, 1953) and shown how this research method can be applied in order to reveal the views of service users in contact with the criminal justice system. We now discuss the utility of this analysis in terms of how it uncovers service users’ perspectives and may be employed in service development as well as what its strengths and weaknesses are.

Service Users’ Perspectives

The findings reveal that service users’ perspectives, although with some overlap, vary considerably, as demonstrated by the three Q factors emerging in the analysis.

The differences in perspectives tell us that service users do not have a single voice and should not be understood as a homogeneous entity. Findings in this study support those of Larsen et al. (2019) that ex-prisoners are as different from each other as are those in any other groups of people. Many ex-prisoners suffer from drug addiction, mental health issues and re-offending, but not all of them do. Differences in situations and needs require flexibility in the service provision system. This should be reflected in, for example, development of a rehabilitation plan by an organisation such as the third sector organisation involved with this particular sample. Some ex-prisoners need help with the basic things in life, such as housing and having enough money to buy food and clothes. Others may have additional or different needs related, for example, to mental health issues. Ex-prisoners may also vary considerably with regard to how they perceive the world. As Factor 1—Prison weary optimist showed, these boys had a relatively optimistic view of the future. Optimism also characterised Factor 2—Resilient optimist. The participants associated with Factor 3—Lonely, indigent and ill, however, seemed to have many unmet basic needs that coloured their hopes for the future.

It has been suggested that the differences in perspectives, as a result from the use of Q method, would not be easily accessible in, for example, research interviews. Sometimes participants in a Q study want to deepen single statements, explain the way that they have sorted the cards or share some reflections after the sorting procedure. This is an opportunity for additional valuable information to be collected on the theme of the Q study. In order to collect such information, if the participant agrees, the Q sorting can be audio recorded and then transcribed. Such information would normally be treated in the same way as interview data (Shemmings & Ellingsen, 2012). However, it is important to emphasise that participants who do not want to elaborate or share their views verbally are not required to do so.

Some people, when in vulnerable positions in life, may appreciate opportunities to elaborate verbally about their difficulties, perhaps as a way of trying to get rid of some frustration. Others, in similar positions, but with a different personality, might try to avoid such elaboration and refuse participation in traditional interview-based studies. The Q sort may prove more comfortable for them, therefore. Both of the two different ‘types’ of persons may represent significant and different views. In studies aiming to explore views of persons who share a specific and particularly vulnerable position in life, such as persons newly released from prison, views from both of these types should be included. The flexibility in the Q method, which has been appreciated by many researchers in various research fields (Sæbjørnsen & Ellingsen, 2015), offers a means of including both types of participants. Some will only perform the Q sorting, while others will also take the opportunity to comment and deepen what they express through the Q sorting. Hence, Q studies may achieve a greater broadness within the participant group under study, compared to studies that rely on data from surveys or interviews alone (Sæbjørnsen, 2017). However, although participants’ comments may imply valuable qualitative data, the Q sorts will always constitute the most important data in a Q study.

In a broader sense, ex-prisoners having new ways to express themselves through the flexibility of the Q methodology may also expand their opportunities for personal growth and development. Bandura’s (1994) concept self-efficacy is relevant in this context, as it pinpoints central essential aspects of recovery processes and recovery-oriented practices.

Perceived self-efficacy is people’s beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives. Self-efficacy beliefs determine how people feel, think, motivate themselves and behave. Such beliefs produce these diverse effects through four major processes. They include cognitive, motivational, affective and selection processes (p. 1).

According to Bandura, then, a strong sense of efficacy enhances human accomplishment and personal well-being in many different ways, but people who doubt their capabilities will shy away from difficult tasks that they see as personal threats. The most effective way to create a strong sense of efficacy is through mastery experiences. For example, achievement of a new crime- and drug-free life after prison release implies many challenges, yet it is not impossible, as is also documented by Sjo and Sæbjørnsen (2018) and Landheim (2016). However, anything that contributes to strengthening an ex-prisoner’s self-efficacy may increase his possibility of achieving a goal of a ‘new life’ after prison release. By being able to express their subjective world views and present their perspectives in this non-threatening and non-confrontational method, ex-prisoners will feel empowered as well as increase the likelihood that adequate services can be offered to this group of service users. Q methodology may be one step in this direction.

Service User Involvement

The service user perspective must be considered in service development. As already described, Q methodology, which is designed for investigation of human subjectivity (Brown, 1980), is useful for gaining insight into these views in a less confrontational and accessible format. The method can be adapted to different participant groups, ages and cognitive levels, and nuanced information about service users’ needs may be easily obtained both in the Q sort and any recording of interviews during this process. This is in contrast to more quantitative tools such as questionnaires where the service users’ responses do not take into consideration the ‘subjectivity’ of the person. On the other hand, the method is also less direct and confrontational in style compared to face-to-face interviews, and Q sorting provides a less stressful, perhaps even playful, way of presenting one’s perspective.

Although Q sorting may simply be a tool to evaluate the range of experiences and types of the service users, the Q sort cards can also be used in client-professional interactions more widely. The administration of the Q sort cards may therefore serve as the basis for dialogues and reflections between actors, including the ex-prisoner himself. For example, multiple copies of the set of Q sort cards and Q sort grid may be made and given to each case worker/mentor working with ex-prisoners for them to use as a shared tool for reflection in one-to-one sessions with a service user. By asking the service user to sort the cards and discuss this process, case workers may be able to raise sensitive subjects for further communication and discussions between the service user and themselves, the service provider(s), in a gentle, unaggressive fashion. Service users may develop their insight and understanding, acquire new knowledge and self-reflectivity through the Q sorting (Sæbjørnsen, 2017; Sjo & Sæbjørnsen, 2018). The fact that participants in Q studies are forced to value each statement subjectively and prioritise statements in relation to one another implies reflection on issues mentioned in the statements. As a result of the Q sort process, new personal, subjective opinions and new understanding may evolve.

This new understanding may convey a change in mindset that may be very useful in interventions with ex-prisoners who aim at a new start in life. The Q method may therefore be used to measure a client’s progress over time, by asking the service user to sort the statements in his first meeting with the mentor, and then, after some weeks, ask him to make a new sort and compare the results. Every completed Q sort may also be captured in a photo and be used as a point of reference in later meetings. The service user may be given a copy of the photos, as a documentation or reminder of an ongoing change. A Q methodological approach may possibly also be used in combination with other clinical tools presented in this book, such as the HCR-20 and ERM (see Chapters 10 and 11).

Finally, the Q method can also be used to compare views of service users and views of mentors (see Chapter 15). Experienced mentors may feel that they have built up some general knowledge about service users that they can present in service development sessions. However, it is possible that the service user and mentor perspectives might not agree. For example, the mentor could be less optimistic about the potential of the service user to remain crime free. However, such conflicts may be used creatively, as an approach to get deeper insight into the service user’s view or feeling and/or an opportunity for the service user’s and mentor’s joint engagement in addressing differences in views.

Q Methodology—Some Potential Challenges

Although Q method has been used by researchers in this chapter and later in Chapter 15 to understand young ex-prisoners’ life situations and experiences of the case study third sector mentorship charity, about its utility as a tool for both individual service user work and utility for service development, some challenges should be mentioned. As already alluded to, development of Q statements is a time-consuming process, but one important advantage is that the process is likely to result in a well-tailored tool for investigation of the subjective views of a group of participants. We illustrated here Q statements developed for use in the third sector mentorship charity. If the aim is to develop a Q set that can be transferred to service users in other contexts, in other services, for example, this advantage may also be seen as a problem. However, it is possible to develop a context-neutral basis for statements, consisting, for example, of 20–30 statements, and, in addition, develop some context-specific statements that can be added to the Q set. Further, as already suggested, Q method may be applied in therapy and as an approach to dialogue between mentor and service user. However, as in all therapeutic dialogues with people in vulnerable situations, it is important to be aware that triggering sensitive issues could cause a service user frustration and despair that will need to be addressed. The use of Q sorting in dialogues between service users and mentors should therefore be used cautiously.

Concluding Remarks

This chapter has exemplified and suggested how Q methodology can be applied to elicit ex-prison service users’ views in research, in therapy or in dialogues between service user and mentor, as well as in including service users’ voice in service development. The method is undoubtedly flexible and may be used for several purposes. However, it would also have been interesting to test Q method as a means of stimulating dialogue during a Change Laboratory workshop and other service development models (see Chapter 8).

The value of involving people in vulnerable situations in service user involvement should always be weighed against the risk involved with it. Applying Q method as a means of including service users’ voices in a service development workshop should thus probably be based on results of Q sorts performed by a representative group of anonymous service users, prior to the workshop. Involving one to two service user representatives in a workshop to comment on their views and discuss with service providers might be an even better way to involve service users in service development worth exploring in further studies.