STEP 1 DEVELOPING A CONCEPTUAL MODEL INSTRUCTIONS AND

WORKSHEET

INSTRUCTIONS:

A conceptual model is a visual representation of a public health issue that maps

out hypothesized relationships (causal or association) among determinants, risk
factors, intermediate outcomes and long-term health outcomes. The model can
be as simple or as complex as you wish. The model above is very simple. Later
on, you will see examples of more complex models. There is no right or wrong.
The level of detail needed will depend on the issue and the intended use of the
model.

A conceptual model:

Provides a clear visual depiction of the public health issue being

addressed
Shows the connections among the factors contributing to the public
health issue
Uses visual clues (colour, shape, size etc.) to show relationships among
factors
May include settings, partners and delivery systems
May identify populations to be included and those excluded
Often depicts the context of the public health issue
May depict outcomes and comparators

The purpose of a conceptual model is to:

describe the public health issue and communicate with others about it
identify links between social, environmental and biological determinants
and pertinent outcomes
identify strategic points for action
identify interventions that might act on those points
increase transparency and accountability for the decision-making by
explicitly showing the conceptual framework underlying the literature
review.

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When to Construct a Conceptual Model

In the public health practice context, a conceptual model is typically

constructed at the beginning of the planning process.

Constructing a Conceptual Model

The complexity of the conceptual model will vary with the issue being addressed
and the level of detail the author would like to communicate. There is no wrong
model. You know you have succeeded when it makes your complex problem
more understandable by showing the relationships among the factors
contributing to it.

Conceptual models are iterative documents that evolve as the practice issue
changes and/or the context changes.

The following is the basic process for developing a conceptual model.

1. Define the practice issue

The practice issue and its importance within the population health frame needs
to be clearly defined. Outline what is driving the need for addressing the issue.

2. Identify your team

In most cases, development of a model will be easier by bringing together a

small team to assist. The team members will need to have knowledge of the
practice issue. Internal and sometimes external subject matter experts may
provide input.

3. Review current knowledge of the issue

In order to build a conceptual model, the team will need to share a common
understanding of the relationships underlying the public health issue. You may
also wish to search the literature for conceptual models which have already
been developed. These can provide a very useful starting point and are often
available. Alternatively, this common understanding can be acquired by reading
a systematic review or textbook on the subject. In some cases, consultation
with external partners (including academics) with a research interest in the
issue may be helpful to you.
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4. Draw the conceptual model

The specialist visually depicts the issue/intervention in a manner that makes the
most sense to the team. Shape, colour, size, and arrows can be used to depict
the relationships among the factors. The relative importance of the factors can
then be quickly appreciated.

The model can be as simple or as complex as you wish. For a very complex
model, additional models can be developed to explain parts of the larger model
or to further explain the relationships.

Figures 1 and 2 illustrate two examples of conceptual models developed at Peel

Public Health.

Figure 1 describes the workforce development model for the health unit. This
model shows us several key elements that are at play when we think about
workforce development in public health. This model, and others like it, helped
visualize the connections between the planning, development and management
aspects. It provides a sense of how the various parts of the workforce
development fix together.

Figure 2 portrays a Framework for Investigating the Social Ecology of Tobacco

Use. This model is being used by Peel Public Health to understand the many
tobacco-related subsystems.

5. Verify the conceptual model with stakeholders

Refine the conceptual model by using it with stakeholders to explain the

practice issue. Once the model is well developed, it can provide the conceptual
framework for program planning and evaluation.

Four design questions to be asked in the verification process:

1. Is the level of detail sufficient to create an understanding of the factors

and their relationships?

2. Are all the key factors accounted for?

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 3. Do the factors fit together logically? Are there other plausible pathways?

4. Have all the relevant external contextual factors been identified and their
potential influence described?

References:

National Institute for Health and Clinical Excellence. Methods for development
of NICE public health guidance. 2006.

Briss PA, Zara S, Pappaioanou M, Fielding J, Wright-De Agero L, Truman Bl, et

al. Developing an Evidence-Based Guide to Community Preventive Services
Methods. AmJPrevMed. 2000; 18(I5); 35-43.

Wholey, JS, Hatry HP, Newcomer KE, editors. Handbook of Practical Program
Evaluation. 2nd ed. 2004.

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Worksheet for Constructing a Conceptual Model

1. Define the practice issue (define the practice issue at hand. Remember
this step is not your PICO step/question and does not need to conform to
the PICO format)

2. Identify your team (Who are the internal and external subject matter
experts?)

3. Review current knowledge of the issue (Where did you search i.e. which
databases did you use? Who did you speak to/consult with?)

4. Draw the conceptual model (Map out the public health issue with the
relevant factors and context show the relationships amongst the
factors. Various software programs can be used to draw the map
PowerPoint, Word, Visio. Attach the model to this tool).

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5. Verify the conceptual model with stakeholders (After constructing the
conceptual model, share it with various stakeholders and ask the
following four questions. Summarize all stakeholders responses to these
questions).

1. Is the level of detail sufficient to create an understanding of the public

health issue, the relevant factors and how they relate to one another?

2. Are all the key factors accounted for?

3. Do the factors fit together logically? Are there other plausible pathways?

4. Have all the relevant external contextual factors been identified and their
potential influence described?

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Figure 1: Workforce Development Conceptual Model

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Figure 2: Framework for Investigating the Social Ecology of Tobacco Use