Managing complex problems in socio-ecological systems (SES) requires innovative approaches, which account for multiple scales, large datasets, and diverse lived experiences. By combining two commonly utilized mixed-methods, public participation GIS (PPGIS) and Q-method (Q), Q + PPGIS has the potential to reveal competing agendas and reduce conflict, but its benefits and weaknesses are comparatively understudied. Using a systematic review, we evaluated how different studies have employed and implemented the Q + PPGIS method. We found 16 studies, comprising 30 publications, with considerable variation in their geographic foci, research disciplines, and addressed SES challenges. These studies exhibit a lack of cohesion between methodological design and implementation and the absence of a consistent application of the method. Nonetheless, Q + PPGIS offers a tool that can guide policy, better inform stakeholders, and reduce conflict based on misconceptions. Resolving the shortcomings identified here will broaden Q + PPGIS utility in geographically situating and representing multiple realities within complex socio-ecological systems challenges.