Conceptual Model Training

“Buying a car” example

Facilitation Questions to Create

Conceptual Model

1. What are some important reasons someone

might buy a car?

2. What are some important reasons someone

might NOT buy a car?

3. What else influences whether or not someone

will buy a car?

4. Why might someone choose to buy a car?

5. Who might be in the market to buy a new car?

Savings/ credit

Condition of old car

Commuting

New baby Buy car

Income

Age

Urban/suburban/ rural

Garden

Sample Conceptual Model

Discussion Questions

1. What do you think makes this model useful?

2. If you were selling cars, how would this

model affect who you will try to sell a car to?

How about where you build a car

dealership?

3. If you were selling cars, would this model

help you? Why?

4. If you were buying a car, would this model

help you? Why or why not?

“Flu Vaccination”

example

Facilitation Questions to Create

Conceptual Model

1. What influences whether or not someone

will get a flu vaccine? Why might someone

choose to get a vaccine or not?

a. What influences these factors?

2. How are all these factors related to each

other? What relationships exist between

these factors?

Decision to

get a flu

vaccine (or

not get it)

Cost

Belief of vaccine’s

effectiveness

Belief about severity of flu

Belief that getting

vaccine is painful

Availability of vaccine

(shortages)

Convenience

(time/location)

Belief that vaccine causes

flu/other issues

Prior experience getting/not

getting flu vaccine

Friends/family get/don’t

get flu vaccine

Exposure to education/

awareness campaigns

Doctor

recommends it

Have PCP/See a

doctor

Health Insurance

Income

Geographic

location (Rural/Urban)

Cultural Norms

Sample Conceptual Model

Discussion Questions

1. What do you think makes this model useful?

2. If you were a public health official trying to

encourage more people to get the flu

vaccine, would this model help you? How

so?

Facilitated Activity #1

Building Conceptual Models

Introduction

• Purpose of activity

• Ground rules

• Meeting logistics

Part I: Identifying factors affecting

[the health outcome]

Step 1: Brainstorm

– On your own, list 5-10 factors that

contribute to or worsen [health outcome]

(Part 1 of worksheet)

Domains/Categories

1. Health

2. Social

3. Behavior

4. Environment

5. Health care

Step 2: Domains and factors

Organize your list into these domains using worksheet

6. Family/community

7. Demographic

8. Attitudes/beliefs

9. Genetic

Part I: Identifying factors affecting

[the health outcome]

Step 3: Adding factors

• We will choose additional factors from

each domain and add to Part 3 of

worksheet

Additional factors by Domain/Category

Health

• Physical health

• Mental health

• Dental health

• Stress/Trauma

• Weight

• Fitness

• Memory

• ADL/Self-care

• Pain

• Mobility

• Pregnancy

• Addictions

• IQ

• Sight/hearing ability

• Communication ability

Social

• Education

• Income/poverty

• Support from friends/family

• Sense of community

• Employment status

• Racism/discrimination

• Marital status

• Religion

• SNAP/income support

• Literacy

• Language(s) spoken

• Immigration status

• Culture/Religious Practices

• Social outcast

Additional factors by Domain/Category

Behavior

• Exercise

• Smoking

• Drinking alcohol

• Taking drugs

• Sexual behavior

• Sleep

• Use of health care services

• Risk taking

• Leisure time/activities/

• hobbies

• Sources of information

• Getting information

• Internet/media usage

• Social skills

Environment

• Occupational health/work

conditions

• Industry

• Access to food

• Food quality

• Housing quality

• Transportation

• Weather

• Violence

• Green space/Parks

• Good schools

• Climate change

Additional factors by Domain/Category

Health care

• Insurance status

• Affordability of health care

• Availability of health care

• Quality of care

• Regular doctor

• Availability of medications

• Follow up care

• Coordination of care

• Alternative Health care

• Health education

Family/community

• Family type

• Family size

• Community involvement

• Social values

• Social policies

• Social programs

• Laws

Additional factors by Domain/Category

Demographic

• Male/Female

• Race/ethnicity

• Urban/rural

• Age

• Place

Attitudes/beliefs

• Health related beliefs

• Sense of control

• Hope

• Hostility/anger

Genetics

• Inherited conditions

• Risk factors

Part I: Identifying factors affecting

[the health outcome]

Step 4: Fill in domain charts

• We will take turns reading out factors from Part 3 of the worksheet

• Provide your reasoning/example

• Discussion

• Group decision about keeping factor

• Write on sticky note and place on Domain flipchart

**Only factors that are discussed during this step will be included in the path diagram!!**

Part II: Modeling [the health

outcome]

• Introduction: Recap of last meeting of

Conceptual model training and “buying a

car” example

Savings/ credit

Condition of old car

Commuting

New baby Buy car

Income

Age

Urban/suburban/ rural

Garden

Sample Conceptual Model

Part II: Modeling [the health

outcome]• Step 1: Take turns selecting factors

– Place [health outcome] on far right

– One person selects a factor to add to the model• Where does it belong on model?

• Does the factor go all the way on the left, or does something else affect it?

• Does the factor go all the way on the right, or does it affect something else?

• Does this factor affect something else?

• Group discussion

– Next person selects a factors to add to the model– Continue until all factors have been moved from

‘Domain’ flip charts to model

Part II: Modeling [the health

outcome]

• Step 2: Building the paths

– We will decide on how all the factors fit

together in the model

– Start with left most factor:

• What factor does this directly affect?

– Place arrows between factors on model

– Continue until all factors have connecting

arrows

Part II: Modeling [the health

outcome]

• Step 3: Reviewing the path diagram

– Does anything look like it doesn’t belong?

– Have all arrows been added? (Look at each

factor)

– Group reviews models and makes additions

and changes

Facilitated Activity #2

Developing Research Questions

Introduction

• Recap of last meeting: Building conceptual

models

• Today’s agenda

Part I: Review of models

• Topic Group reviews their own conceptual

model, discusses, and makes

additions/changes

• Topic Group reviews models from other

groups and discusses

• Topic Group reviews Conceptual Model

Factor Summary sheet

[Insert Topic Group

conceptual model]

[Insert Topic Group

conceptual model]

[Insert Topic Group

conceptual model]

Conceptual Model Factor Summary

[Insert Summary of Conceptual model factors –unique and similar factors across all Topic Groups]

Part II: Training on Creating

Research Questions

**Use optional training powerpoint included

in materials**

Part III: Question development

• Go through each Question prompt and

write down 2-3 questions on Worksheet

Time to develop

your own research

questions!

Step 1 (Prompt #1): Causes

In order to improve [health topic], we need to better understand the relationship between ____ and ____

X Y

Example: “Are people more likely to buy a car after having a first child or after a third child?

Step 2 (Prompt #2): Impact

If we could change one of the factors in the model, would it likely have a strong effect (BIG IMPACT) on [health topic]?

X Y[health topic]

A

J

Example: “If we could help people have better credit scores, would that impact their ability to buy a car?”

Step 3 (Prompt #3): Patient-Centeredness

• What questions (if answered) would help patients with [health condition] make more informed decisions?

• If we could answer this questions, patients with [health condition] would have better information for choosing treatments or making other types of decisions

Example: “If we provided fuel efficiencies across cars, would that help people make better decisions about which car to buy?”

Step 4 (Prompt #4): Verification

• Are there relationships in the model that we need to know more about?

• Is there something that needs to be proven as fact?

• Do we need more evidence to show that a particular cause is important or that a promising treatment is effective?

Example: “Are people who just moved to a new neighborhood more likely to be shopping for a car compared to people who have lived in a neighborhood longer?”

Step 5 (Prompt #5): New Directions

• Looking at the models, what is a new way of thinking about [health topic]?

• Is there something important as a ‘cause’ or ‘solution’ that is missing or misunderstood in these models?

• Is there something in the models that we know very little about right now?

Example: “What are the factors impacting future sales of self-driving cars?”

Part III: Question development

• Step 6: Review all questions on worksheet

and highlight the ones you feel are most

important

Part IV: Listing questions

• Step 1: Listing Questions

– Each person to read one of their questions off

their list and provide explanation of why they

feel it’s important

– Continue through group as time allows

• Step 2: Wrap-up

– Plan for next meeting

Creating Research Questions

SEED Method Training

Step 1. Identify a focus area

We already have a research area:

All of the questions we create today will fit into this focus

area. Everyone here today was invited to participate

because they already have some experience in this area.

Lung Cancer Outcomes

Step 2. Identify a topic

Using conceptual models and highlighted factors to come up with potential topics.

• The other two groups also developed their conceptual models.

• We reviewed all of the factors and relationships in those models.

• Then, you had the opportunity to highlight the factors or relationships in those models that you think we need to know more about.

• That process helped us identify some potential topics within our focus area to ask questions about.

Step 3. Begin to ask questions about a topic

How we ask a question can lead to different types of answers and research

• It might lead to research that aims to explore a topic (to gain new insights we didn’t have before. )

• Or, it might aim to explain a topic, so that we understand it in more detail.

For example….

Let’s assume our research area was something like factors that affect whether someone gets a flu shot.

• Let’s say that some topics identified were

– Fear of negative side effects

– Perceptions of how effective the shot is at preventing the flu

Some questions are framed that lead to open-ended,

exploratory types of inquiry that focuses on how and why

things happen.

WHY: Why do people feel the flu shot is ineffective?

• Asking this type of question leads to exploring the

relationship between perceived effectiveness and action.

• If we ask this question in an open-ended way, we can listen

to the stories people tell, record the words that they use, and

try to understand the issue from their point of view.

Open ended, exploratory questions

Perceived effectiveness of flu shot

Getting a flu shot (ACTION)

WHAT: What are the negative side effects of the flu vaccine

that people fear?

• Asking this question also seeks exploratory information from

the point of view of respondents.

Open ended, exploratory questions

Some questions seek to narrow something down and

understand the specifics in greater detail. These questions

may come after we have explored a topic and want to know

more about it.

HOW: How does previous experience with the flu affect intention to get the flu vaccine next year?

• With How questions, we can look specifically at how two factors are related.

Open ended, exploratory questions

When we research these “how” questions, we may wish to find a specific relationship between factors. We refer to this as testing a hypothesis.

Hypothesis: People who have had the flu are more likely to want a flu shot in the future.

• Having a hypothesis like this allows us to make predictions and test them with data.

Hypothesis

When we talk about factors being related, that might mean that as one occurs, the other is also MORE LIKELY to occur.

Here are some examples:

– As it gets hotter, ice cream sales go up.

– As adults age, the likelihood of falling is greater.

– As driving speed goes up, the likelihood of fatal car crashes increases.

Other examples?

Related factors

On the other hand, when two factors are related it can

mean that as one occurs, the other is LESS LIKELY to occur.

• As seatbelt use goes up, the likelihood of fatal injuries

in car accidents goes down.

• The more cigarettes a person smokes in a day, the

lower the likelihood of healthy lung functioning.

• As the price of an item rises, the number of potential

customers decreases.

Other examples?

Related factors

We can ask people whether they had the flu and also ask them

about their intentions to get a flu shot.

• When we test a hypothesis using data, we may or may not

find that it is supported.

Testing a Hypothesis

If our hypothesis is supported, we may then wish to be able to

create a better prediction.

For example, when we analyze the data we may be able to say

something like:

People who had the flu this year are 3 times as likely to

say they intend to get a flu shot next year compared to

people who did not get the flu this year.

You may have noticed that a question like this one compares

two groups. Who are we comparing here?

Testing a Hypothesis

When, Where, and Who can help us create better questions

Before: What are the negative side effects of the flu vaccine that people fear?

After: What are the negative side effects of the flu vaccine that African American seniors in the East End fear before getting the flu shot?

Before: Why do people feel the flu shot is ineffective?

After: Prior to the 2015 flu season, why did uninsured young adults in Virginia feel the flu shot is ineffective?

Before: How does previous experience with the flu affect intention to get the flu vaccine next year?

After: Among adults age 18-64 in Virginia in 2015, how much more likely were those who had the flu the previous year to state that they intended to get the vaccine this year, compared to adults who did not have the flu last year?

When asking these questions, we consider:

• Who is the population of interest?

– Can they be defined by age, sex, race, place, condition, or some other characteristic?

• What is being compared?

– Two different interventions or treatments? Two populations? Two behaviors or social conditions?

• Is the outcome clearly defined?

Another set of framing of research questions includes

SHOULD?

That is, does the evidence support a specific set of

actions?

Step 4. Creating research questions

• Be specific when using terms.

For example, when a flu vaccine is mentioned, does that mean only injectable flu shots, or does it include nasal sprays?

• Avoid questions that are too narrow

-- Such as questions that require only a YES/NO answer or are answered with a simple fact.

• Avoid questions that are too broad – narrow down to something that can be answered in one study.

• Look at topics that are measurable and researchable.

Some questions are not researchable because we can’t observe and collect data on them.

For example, we can’t use research to answer a question like ‘Is vanilla ice cream better than chocolate ice cream?’

We can, however, answer a question such as, ‘Do more people buy vanilla ice cream or chocolate ice cream?’

Importance

There are an infinite number of research questions we

can ask. However, there is limited time and resources so

we must ultimately choose questions that are important.

Adds to current knowledge

Knowledge is always evolving and growing. We want to

answer NEW questions rather than questions that have

already been answered.

**Sometimes things that YOU know are not always things

people in the scientific world know – this is why we are

here! We are helping to grow the current knowledge by

including more perspectives!**

Research questions are ones that we can use evidence to support or

discredit!

Facilitated Activity #3

Prioritizing Research Questions

Introduction

• Recap from last meeting

• Plan for today’s meeting

Part I: Prioritization

• Step 1: Listing questions

– Review and discuss group’s research questions from last meeting

• Step 2: Multi-voting

– Vote on most important questions using ballots

Topic Group #1: Research Questions

[Insert Topic Group #1’s research questions from last meeting]

Topic Group #2: Research Questions

[Insert Topic Group #2’s research questions from last meeting]

Topic Group #3: Research Questions

[Insert Topic Group #3’s research questions from last meeting]

Part II: Making research questions

patient-centered

Population

• Who should be included as research

participants?

• Are there people you think should be a

part of a study? Not part of the study?

Meaningful Outcomes

• What outcomes would be most

meaningful/important/helpful to patients?

• What should researchers measure?

[Optional prompts]

Treatment

• What should we compare the treatment

to?

Timeframe

• What timeframe would be best for patients

to look at outcomes?

• What about follow-up?

Setting

• What settings should this research take

place in? Hospitals? Clinics? Community

Centers? Home?

Wrap-up

• Project conclusions

• Next steps