Towards an overall model
April, 2013
Modeling Decisions
Outcome (What are we explaining?)
• General (e.g., longevity) vs. specific (e.g., MI)?
• Incidence vs. progression or survival?
(i.e., absolute or relative?)
• Outcomes or distribution of outcomes? (Individual vs. societal?)
Population (Whom are we considering?)
• Overall average tendencies, or particular sub-groups?
• Local or universal? Current patterns or historical trends?
Perspective (Why?)
• All factors or a simplified model? How distilled?
• Prediction vs. explanation?
Form (How?)
• Mathematical or compositional?
Next
• Organic or structural?
Social Support
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Disease
management
behaviors
Seema Nagpal, PhD thesis, 2011
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Explanations:
Reasons look
outwards (the
“Why?” questions)
Analysis:
Mechanisms look
inwards (the
“How?” questions)
The Person
Family
Determinants
at higher level
influence health
at lower level
Neighborhood
National
Global Factors
Health status
and risk factors
at lower levels
aggregate
to higher levels
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Causes of cases vs. Population Rates
High
Population
Incidence
RF
D
Low
High
Individual risk categories
Elements of a ‘model’
• Elements & links; is this
sufficient?
Lalonde
• Magnitude & pattern of
influence
Selye
• Layering of influences
IOTF
• Historical: time dimension &
external influences
• Model vs. Framework
Minard
Frank-Etches
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Lalonde’s Health Field Concept
Human
Biology
Environment
Health
Health Care
Organization
Lifestyle
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Theory of Planned Behaviour
Attitudes
Subjective
Norms
Behavioural
Intention
Behaviour
Perceived
Behavioural
Control
Ajzen & Madden, (1986), Journal of Experimental Social
Psychology, 22, 453
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Selye’s conception of generalized reaction:
initial fall in performance during alarm phase
followed by heightened vigilance during
resistance phase, leading to precipitous fall
as body becomes exhausted.
Alarm
Resistance
Exhaustion
Selye’s notion of optimal level
of stress:
too little impairs performance
(‘rust out’); we operate at peak
under optimal stress, but can
wear out with prolonged stress.
Note similar findings for anxiety.
Charles Joseph Minard’s 1869 diagram of
Napoleon’s Russian campaign of 1812-13
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Vera Etches
John Frank
Structural Starting-Point for our Overall Model
Global
influences
Societal
processes
Individual
actions
Biological
processes
Health
outcomes,
e,g.:
Overall
mortality
CVD,
cancer
Mental
health
Obesity
QoL