towards an overall model april, 2013. modeling decisions outcome (what are we explaining?) general...
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Towards an overall model
April, 2013
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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?• Organic or structural? Next
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Diseasemanagementbehaviors
Seema Nagpal, PhD thesis, 2011
Social Support Back
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Family
Neighborhood
National
Global Factors
Determinants at higher level
influence health at lower level
∑
Explanations:Reasons lookoutwards (the
“Why?” questions)
Analysis:Mechanisms look
inwards (the “How?” questions)
∑∑
∑ Health statusand risk factors at lower levels
aggregate to higher levels
Physical Emotio
nal
SocialSpiritu
al
The Person
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PopulationIncidence
Individual risk categoriesLow High
High
D
RF
Causes of cases vs. Population Rates
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Elements of a ‘model’
• Elements & links; is this sufficient?
• Magnitude & pattern of influence
• Layering of influences
• Historical: time dimension & external influences
• Model vs. Framework
Lalonde
Selye
IOTF
Minard
Next
Frank-Etches
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Health
Health CareOrganization
HumanBiology
Environment
Lifestyle
Lalonde’s Health Field Concept Back
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Theory of Planned Behaviour
AttitudesAttitudes
Subjective Subjective NormsNorms
Perceived Perceived BehaviouraBehavioura
l Controll Control
BehaviouraBehavioural Intentionl Intention BehaviourBehaviour
Ajzen & Madden, (1986), Journal of Experimental Social Psychology, 22, 453
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Alarm Resistance Exhaustion
Selye’s conception of generalized reaction:initial fall in performance during alarm phasefollowed by heightened vigilance during resistance phase, leading to precipitous fallas body becomes exhausted.
Selye’s notion of optimal levelof stress: too little impairs performance(‘rust out’); we operate at peak under optimal stress, but canwear out with prolonged stress.Note similar findings for anxiety.
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Charles Joseph Minard’s 1869 diagram of Napoleon’s Russian campaign of 1812-13
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John Frank
Vera Etches
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Globalinfluences
Societal processes
Individualactions
Biologicalprocesses
Healthoutcomes,
e,g.:
Structural Starting-Point for our Overall Model
Overallmortality
CVD,cancer
Mental health
Obesity
QoL