Jeroen van de Pol

68 Chapter 3 understandings and diverging opinions about a certain subject. Other than Likert- scale questionnaires, Q-methodology forces the participant to rank statements [19]. Practicing community pharmacists from the Utrecht Pharmacy Practice network for Education and Research (UPPER) network were invited by e-mail. Approximately 65% (1,295 out of 2,000) of all Dutch community pharmacies is affiliated with the UPPER network [22]. A random sample of 100 pharmacies were additionally contacted by phone (JvdP). In order to increase attention for the study an item was published in the UPPER newsletter and on the website of The Royal Dutch Pharmacists Association (KNMP). Development of Q-set Q-methodology consists of several steps. The first step is the construction of the Q-set. A Q-set consists of multiple statements regarding a specific subject. Specifically for this study, potential activities of community pharmacists, rather than statements were presented. The activities considered for this Q-study were based on a previous time-utilization research in which actual time-utilization in daily practice was obtained [13]. It was deliberately aimed to have a balanced set of traditional and more innovative activities. In total 61 activities were defined. These 61 activities were reviewed by a panel of ten practicing community pharmacists. Activities were rated based on whether they were performed on a daily, weekly or monthly basis and checked if activities were clearly written. Based on the feedback provided by the panel, 13 activities were discarded because they were deemed not relevant or not practiced on a regular basis. Activities were reformulated if the panel did not deem the activity clearly written. The remaining 48 activities were divided into 5 different categories: Cognitive pharmaceutical services (CPS; 17), logistics (L; 12), Pharmacy management (PM; 10), quality assurance (QA; 6) and other (O; 3). The list of the 61 starting activities and final 48 activities can be found in supplementary material table 2. Data collection: Q-sorting by the participants The next step in Q-methodology is Q-sorting. Participants were asked to rank the importance of certain activities that they could perform in community pharmacy practice. When ranking the activities, participants were explicitly asked to rank the importance of these activities regarding their role as a pharmacist and not taking the current restrictions and possibilities from daily practice into account. Participants were first asked to categorize the 48 activities as “important”,