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Conceptual Models and Theories

Developing a research framework.

Premkumar, Beulah M.Sc (N)., M.Phil * ; David, Shirley M.Sc (N)., Ph.D (N) ** ; Ravindran, Vinitha M.Sc (N)., Ph.D (N) ***

* Professor, College of Nursing, CMC, Vettore

** Professor, College of Nursing, CMC, Vettore

*** Professor, College of Nursing, CMC, Vettore

Conceptual models and theories provide structure for research. Research without a theoretical base provides isolated information which may not be used or applied effectively. The challenge for nurse researchers is to identify a model or theory that would a best fit for their area of study interest. In this research series article the authors unravel the simple steps that can be followed in identifying, choosing, and applying the constructs and concepts in the models or theories to develop a research framework. A research framework guides the researcher in developing research questions, refining their hypotheses, selecting interventions, defining and measuring variables. Roy's adaptation model and a study intending to assess the effectiveness of grief counseling on adaptation to spousal loss are used as an example in this article to depict the theory- research congruence.

Introduction

The history of professional Nursing started with Florence Nightingale who envisioned nurses as a knowledgeable force who can bring positive changes in health care delivery (Alligood, 2014). It was 100 years later, during 1950s, a need to develop nursing knowledge apart from medical knowledge was felt to guide nursing practice. This beginning led to the awareness of the need to develop nursing theories (Alligood, 2010). Until then, nursing practice was based on principles and traditions that were handed down through apprenticeship model of education and individual hospital procedure manuals. It reflected the vocational heritage more than a professional vision. This transition from vocation to profession involves successive eras of history in nursing: the curriculum era, research emphasis era, research era, graduate education era, and the theory era (Alligood, 2014).

The theory era was a natural outcome of research era and graduate education era, where an understanding oí research and knowledge development increased. It became obvious that research without conceptual and theoretical framework produced isolated information. This awareness and acceptance paved way to another era, the theory utilization era, which placed emphasis on theory application in nursing practice, education, administration, and research (Alligood, 2014). Conceptual models and theories are structures that provide nurses with a perspective of the patient and the professional practice. Conceptual models provide structure for a phenomenon, direct thinking, observations, and interpretations and further provide direction for actions (Fawcett & Desanto-Madeya, 2005). In research, a framework is the underpinning of the study and if a framework is based on a theory it is called as theoretica framework and if it represents a conceptual model then it is generally called the conceptual framework. More often it is known as a research framework. However the terms conceptual framework, conceptual model theoretica framework, and research framework are often usee interchangeably (Polit & Beck, 2014).

Definitions of Terminologies

When nurse researchers are making decisions about theories and models for their study, it is important to understand the definitions of different related terminology. According Grove, Burns and Gray (2013) conceptual models are examples of grand theories and are highly abstract with related constructs. “A conceptual model broadly explains phenomenon of interest, expresses assumption, and reflects a philosophical stance” (Grove et al., 2013). A conceptual model is an image of a phenomenon. A theory in contrast represents a set of defined concepts that offers a systematic explanation about how two or more concepts are interrelated. Theories can be used to describe, explain, predict, or control the phenomenon that is of interest to a researcher (Grove et al., 2013).

Constructs are abstract descriptions of a phenomenon or the experiences or the contextual factors. Concepts are the terms or names given to a phenomena or idea or an object and are often considered as the building blocks of a theory (Grove et al., 2013). Many conceptual models are made of constructs. Concepts are derived from constructs or vice versa. For example, in the Transactional model of Stress and Coping by Lazarus and Folkman (1984) the constructs included are stressors, mediating processes, moderators and the outcomes. The examples of related concepts to these constructs are shown in Figure 1 .

Conceptual Framework in Research

Conceptual models and theories serve as the foundation on which a study can be developed or as a map to aid in the design of the study (Fawcett, 1989). When concepts related to the study are integrated and formulated into a workable model for the specific study it is generally known as a research framework (Grove, Gray & Burns, 2015). When concepts or constructs in the models or theory are converted into measurable terms they are known as variables (Grove et al., 2013). According to the purposes explicated by Sharma (2014) and Polit and Beck (2014) the use of conceptual/research framework m research can be summarized as follows:

• - It provides a structure for the study which helps the researcher to organize the process of investigation
• - It helps in formulating hypothesis, developing a research question and defining the variables
• - It guides development, use, and testing of interventions and selection of data collection instruments
• - It provides direction for explaining the study results and situate the findings in the gaps identified in the literature

Nurse researchers regularly select and use conceptual frameworks for carrying out their studies. Conceptual models and theories explicitly or implicitly guide research (Radwin & Fawcett, 2002). Researchers use both nursing and non- nursing models to provide a framework for their studies. There are however, two challenges for researchers and students in relation to using conceptual frameworks in their investigations. The first is to identify the conceptual model or a theory that will be the best fit and will be useful in guiding their research and the second is to incorporate and clearly articulate the model in relation to their study variables, interventions and the outcomes to convert it into their research framework (Radwin & Fawcett, 2002). A few essential steps need to be followed to choose a conceptual model and to incorporate it into the individual studies. Let us consider the steps with an example of a study intending “ to assess the effectiveness of grief counseling intervention in helping individuals cope and adapt after the loss of their spouse”.

1. The Purpose of the Study

The choice of conceptual model to guide the research first and foremost depends on the purpose of one's research. It can be educating staff/patient/families, improving academic and clinical teaching, changing practice by translating research evidence into practice, implementing a quality improvement strategy, encouraging behavior change, supporting individuals during crisis, assisting to cope etc. The researcher should look for a model or a theory that addresses similar purpose. It would be useful to identify and select the key concept in which the researcher is interested in at this stage (Sharma, 2014). In the example mentioned above the key concept of interest is ‘adaptation’ after a loss which is a traumatic life event.

2. Study Variables

The second step is to identify general variables that are included or may be included in the study. The variables are related to the constructs/concepts of interest in the study. The concepts and variables may be based on previous research findings, experiential knowledge or hunches and intuitions (Sharma, 2014). In the adaptation to spousal loss study in addition to the main concept of adaptation, other variables such as grief, coping, quality of life, and demographic and social factors that may influence adaptation may be included in the objectives.

3. Gathering Relevant Information

Once the researcher has identified the concepts and variables of interest, the next step involves in-depth study of existing models and theories to gather information about the relevant concepts and variables. The researcher can quickly skim through the literature to seek a few models that relate to the concepts and variables of interest in the study. The researcher must then read about them from primary sources to obtain comprehensive evidence about each model or theory (Sharma, 2014). When choosing a model for the study the researcher needs to analyze and evaluate the models she /he considers to understand its most important features (Fawcett, 1989). Some questions that need to be asked are: What is the historical evolution of the model? What methods are indicated for nursing knowledge development? What are the assumptions listed? How are the concepts person, environment, health, and nursing defined? How are these metaparadigm concepts linked and how is nursing process described? What is the major area of concern in the care identified in the model?

The researcher's previous experience and knowledge about theories and models greatly assist in quick decisions on choosing a model that would best fit their study purpose. Nurse researchers who have an interdisciplinary knowledge and experience may choose an overarching model or theory to develop their research framework for their study. It is the novice researchers who often find it difficult to decide on a model and have confusions regarding explicating their research framework. The above listed questions, if carefully considered will help them in choosing an appropriate model. Once a theory or conceptual model is identified the researcher need to studv it in-depth to understand each concent and propositions so that it can appropriately be integrated into the study (Sharma, 2014).

In the study example in this paper the researcher intends to assess how people adjust after the death of their spouse and how grief counseling will help in their adjustment to life after their loss. As the process of interest, as indicated already, is adaptation to traumatic life event, adaptation model that is purported by Sr. Callista Roy (1976) is chosen as the best fit as Roy's adaptation model focuses on how individuals cope after a stimuli and manifest adaptive behaviors (see Figure 2 ).

4. Understanding the Premises and Principles of the Selected Model: Roy's Conceptual Model

Once a model that is relevant to the study is selected the underlying premises and philosophy of the model or theory have to be explicated. The definitions of the concepts in the model have to be understood to enable the researcher to formulate her/his study framework which can be integrated with the chosen model (Mock et al., 2007). An in-depth review of literature on how the conceptual model was developed and refined, background information about the theorist or author, and the definitions of concepts included in the model is mandatory to examine how the researcher's study can be designed and executed. In Roy's adaptation model (Fawcett, 1989), Roy considers human being as an open system who is in constant interaction with the environment. She explains health as a process of being or becoming an integrated whole person. The goal of nursing is to assist individuals in positively adapting to environmental changes or what she terms ‘stimuli’. Three types of stimuli are explained in the model: 1. ‘Focal’ which is the life event itself, 2. ‘contextual’ which are the factors associated and contributing to or opposing the stimuli and 3.‘residual’ which are present innately which may not be altered, explained, or reasoned. The adaptation occurs through coping process at the regulator and cognator subsystem levels. The regulator subsystem refers to the automatic response that occurs naturally in the chemical, neural, and endocrine systems. The cognator subsystem respond through four cognitive emotional channels: perceptual and information processing, learning, judgment, and emotion. Adaptation in Roy's model is explained as conscious choice of individuals to create successful human and environmental integration which can be manifested as integrated adaptation in four adaptive behavioural modes. The four adaptive modes are the physical/physiological, self-concept, role functioning, and interdependence. If integrated adaptation did not happen it can result in compensatory or compromised adaptation.

5. Finalizing the Study Design, Variables, Tool, and Intervention

In a nursing theory or a conceptual model how a theorist defines nursing action and what is expected as outcomes helps the researcher to choose the research design and intervention (Mock et al., 2007). Further the concepts in the model guides the researcher to choose variables that would be of interest to nursing. In Roy's adaptation theory, nursing assessment and interventions that promote adaption is purported. On the basis of this premise the investigator can choose a specific intervention that would enhance integrated adaptation of an individual after a crisis (stimuli). The investigator then can measure whether the intervention has been effective in promoting adaptation by looking at the four modes of adaptive behavior (physical/physiological, self- concept, role functioning, and interdependence). The congruence of the constructs of Roy's adaptation model and the study variables is depicted in Figure 3 .

In the example being discussed the focal stimuli is the death of a spouse. The contextual stimuli are the grief reaction, social and spiritual support systems available for the person who has experienced loss and her or his economic status. The residual stimuli include variables such as the age, gender, years spent with spouse, race, or ethnic background. The researcher has chosen grief counseling as the intervention in the study. This is based on Roy's model which explains that when interventions are aimed at how contextual stimuli can be addressed it will result in better coping process and this will facilitate adaptation (Fawcett, 1989). When choosing the intervention it is vital to know that there is established evidence for the intervention (Mock et al., 2007). In this study grief counseling is chosen because of its established evidence on the effect on person's adjustment (Neimeyer & Currier, 2009). Other variables which relate to the adaptation model include coping with grief and the outcome variables as adaptive behaviours in physiological, interpersonal, role functioning, and self-concept domains (see Figure 3 ).

Once there is clarity about the variables of interest and the intervention, it becomes relatively simpler to decide on the study design and the instruments/tools which can be used to measure the variables. As shown in Figure 4 , the contextual variables can be measured using a socio-demographic data profile. Grief which is another contextual stimuli will be measured by the grief scale (Fireman, 2010). The grief scale measures the thoughts, feelings, and behaviours of people who are in the grieving process after a loss. A part of the demographic profile will measure the influence of the residual variables. The intervention which is the grief counseling will be administered by the researcher who has had special training in this method of counseling. How individuals cope to loss can be measured by the Ways of Coping Scale (Folkman & Lazarus, 1988). This scale consists of coping in eight domains namely problem focused coping, wishful thinking, distancing, seeking social support emphasizing the positive, self-blame, tension reduction, and self-isolation. The coping and the adaptation behaviors may be measured using the “Coping and Adaptation Processing Scale” (CAPS Short form, 2015) which is developed by Roy herself. CAPS is a tool which can be used to measure coping and adaptation in people suffering with chronic or acute health issues and can be used when the stimuli is an acute loss.

As the researcher intends to use grief counseling as an intervention, the research design will be an experimental design and the coping and adaptation process can be measured prior to and after the counseling sessions using both ways of coping and CAPS scales. As there may not be adequate number of samples available to represent the phenomenon of interest the study can be designed as a one group pretest posttest quasi experimental design instead a true experimental design with a control group. The research framework that is developed from the adaptation model may be modified as follows based on the research design (see Figure 4 ).

6. Using the Research Framework for Analysis and Interpretation of the Results

The framework that is developed for the study can guidi the analysis and will also help in interpretation of the finding The research report can easily incorporate the concepts in th(original model and also the developed framework and can b< discussed in relation to current study findings. As th(researcher's background knowledge that is gained in th(framework development process is elaborate, the concepts o: the model can guide the researcher to situate the findings wit! in the theoretical literature (Mock et al., 2007).

Choosing and applying a conceptual model or theory to develop a research frame work is a challenging but an educative process. It also involves an iterative process of moving back and forth between what is the phenomenon and variables of interest to the researcher and what and how the theorists explain and define concepts in their models. The first and foremost step to be remembered is to identify the core concept that the researcher is interested in which will pave way for searching the literature on the model that will match the researcher's interest. The researcher must understand that all variables in a given model may not be of interest to him or her or variables from more than one model may apply to the areas of interest to be studied. Both are acceptable. Researchers need to be creative in developing the research framework based on the model/models that is/are of interest. The nursing conceptual models serve as guides for articulating, reporting and recording nursing thought anc action in research. Further, the models also ultimately assist researchers in applying findings in clinical practice.

Conflicts of Interest: The authors have declared no conflicts of interest.

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conceptual model; theory; research framework; Roy's adaptation model; spousal loss; grief

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• Published: 09 March 2020
• Volume 10 , pages 18–26, ( 2020 )

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As a powerful means of theory building, conceptual articles are increasingly called for in marketing academia. However, researchers struggle to design and write non-empirical articles because of the lack of commonly accepted templates to guide their development. The aim of this paper is to highlight methodological considerations for conceptual papers: it is argued that such papers must be grounded in a clear research design, and that the choice of theories and their role in the analysis must be explicated and justified. The paper discusses four potential templates for conceptual papers – Theory Synthesis, Theory Adaptation, Typology, and Model – and their respective aims, approach for using theories, and contribution potential. Supported by illustrative examples, these templates codify some of the tacit knowledge that underpins the design of non-empirical papers and will be of use to anyone undertaking, supervising, or reviewing conceptual research.

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Introduction

The major academic journals in the field of marketing acknowledge the need for good conceptual papers that can “bridge existing theories in interesting ways, link work across disciplines, provide multi-level insights, and broaden the scope of our thinking” (Gilson and Goldberg 2015 , p. 128). Indeed, many of the most impactful marketing papers of recent decades are conceptual as this type of research enables theory building unrestricted by the demands of empirical generalization (e.g., Vargo and Lusch 2004 ). Authors crafting conceptual papers can find valuable advice on problematizing (Alvesson and Sandberg 2011 ), theorizing and theory building (Corley and Gioia 2011 ; Cornelissen 2017 ; Shepherd and Suddaby 2017 ), and the types of conceptual contribution that warrant publication (Corley and Gioia 2011 ; MacInnis 2011 ). However, a lack of commonly accepted templates or “recipes” for building the paper means that writing a conceptual piece can be a struggle (Cornelissen 2017 ). As a result, reviewers often face conceptual papers that offer little more than a descriptive literature review or interesting but disjointed ideas.

In empirical papers, the recipe typically is the research design that provides the paper structure and logic, guiding the process of developing new knowledge and offering conventions for reporting the key elements of the research (Flick 2018 , p. 102). The research design explains how the ingredients of the study were selected, acquired, and analyzed to effectively address the research problem, and reviewers can evaluate the robustness of this process by reference to established conventions in the existing literature. As conceptual papers generally do not fit the mold of empirical research, authors and reviewers lack any such recipe book, making the critical issue of analytical rigor more challenging.

This paper addresses issues of methodology and research design for conceptual papers. The discussion is built on previous “how to” guides to conceptual research, and on examples from high quality journals to identify and illustrate different options for conceptual research design. This paper discusses four templates—Theory Synthesis, Theory Adaptation, Typology, and Model—and explicates their aims, their approach to theory use, and their contribution potential. The paper does not focus on theory building itself but supports it, as analytical rigor is a prerequisite for high quality theorizing. Nor is the focus on literature reviews or meta-analyses; while these are important non-empirical forms of research, there are well articulated existing guidelines for such articles (see for example Webster and Watson 2002 ; Palmatier et al. 2018 ).

The ultimate goal of this paper is to direct scholarly attention to the importance of a systematic approach to developing a conceptual paper. Experienced editors and reviewers have noted that researchers sometimes underestimate how difficult it is to write a rigorous conceptual paper and consider this an easy route to publishing—an essay devoid of deeper scholarship (Hirschheim 2008 ). In reality, developing a cogent argument and building a supporting theoretical explanation requires tacit knowledge and skills that doctoral programs seldom teach (Yadav 2010 ; King and Lepak 2011 ). As Fulmer puts it, “in a theoretical paper the author is faced with a mixed blessing: greater freedom and page length within which to develop theory but also more editorial rope with which to hang him/herself” ( 2012 , p. 330).

The paper is organized as follows. The next section outlines key methodological requirements for conceptual studies. Four common types of research design are then identified and discussed with supporting examples. The article ends with conclusions and recommendations for marketing scholars undertaking, supervising, or reviewing conceptual research.

Conceptual papers: some methodological requirements

The term “research design” refers to decisions about how to achieve research goals, linking theories, questions, and goals to appropriate resources and methods (Flick 2018 , p. 102). In short, the research design is a plan for collecting and analyzing evidence that helps to answer the question posed (Ragin 1994 , p. 191). Like any design, the research design should improve usability ; a good research design is the optimal tool for addressing the research problem, and it communicates the logic of the study in a transparent way. In principle, any piece of research should be designed to deliver trustworthy answers to the question posed in a credible and justified manner.

An empirical research design typically involves decisions about the underlying theoretical framing of the study as well as issues of data collection and analysis (e.g. Miller and Salkind 2002 ). Imagine, for example, an empirical paper where the authors did not argue for their sampling criteria or choice of informants, or failed to define the measures used or to show how the results were derived from the data. It can be argued that conceptual papers entail similar considerations (Table 1 ), as the omission of equivalent elements would create similar confusion. In other words, a well-designed conceptual paper must explicitly justify and explicate decisions about key elements of the study. The following sections elaborate more specifically on designing and communicating these “methodological” aspects of conceptual papers.

Explicating and justifying the choice of theories and concepts

Empirical and conceptual papers ultimately share a common goal: to create new knowledge by building on carefully selected sources of information combined according to a set of norms. In the case of conceptual papers, arguments are not derived from data in the traditional sense but involve the assimilation and combination of evidence in the form of previously developed concepts and theories (Hirschheim 2008 ). In that sense, conceptual papers are not without empirical insights but rather build on theories and concepts that are developed and tested through empirical research.

In an empirical study, the researcher determines what data are needed to address the research questions and specifies sampling criteria and research instruments accordingly. In similar fashion, a conceptual paper should explain how and why the theories and concepts on which it is grounded were selected. In simple terms, there are two possible points of departure. The first option is to start from a focal phenomenon that is observable but not adequately addressed in the existing research. The authors may inductively identify differing conceptualizations of that phenomenon, and then argue that the aspect of interest is best addressed in terms of particular concepts or theories. That is, the choice of concepts is based on their fit to the focal phenomenon and their complementary value in conceptualizing it. One key issue here is how the researcher conceptualizes the empirical phenomenon; in selecting particular concepts and theories, the researcher is de facto making an argument about the conceptual ingredients of the empirical phenomenon in question.

A second and perhaps more common approach is to start from a focal theory by arguing that a particular concept, theory, or research domain is internally incoherent or incomplete in some important respect and then introducing other theories to bridge the observed gaps. In this case, the choice of theories or concepts is based on their ability to address the observed shortcoming in the existing literature, i.e. their supplementary value. This simplified account raises a critical underlying question: what is the value that each selected concept, literature stream, or theory brings to the study, and why are they selected in preference to something else?

Explicating the role of different theories and concepts in the analysis

Conceptual papers typically draw on multiple concepts, literature streams, and theories that play differing roles. It is difficult to imagine a (published) empirical paper where the reader could not distinguish empirical data from the literature review. In a conceptual paper, however, it is sometimes difficult to tell which theories provide the “data” and which are framing the analysis. In this regard, Lukka and Vinnari ( 2014 ) drew a useful distinction between domain theory and method theory. A domain theory is “a particular set of knowledge on a substantive topic area situated in a field or domain” (ibid, p. 1309)—that is, an area of study characterized by a particular set of constructs, theories, and assumptions (MacInnis 2011 ). A method theory, on the other hand, is “a meta-level conceptual system for studying the substantive issue(s) of the domain theory at hand” (Lukka and Vinnari 2014 , p. 1309). For example, Brodie et al. ( 2019 ) sought to advance engagement research (domain theory) by drawing new perspectives from service-dominant logic (method theory). The distinction is relative rather than absolute; whether a particular theory is domain or method theory depends on its role in the study in question (Lukka and Vinnari 2014 ). Indeed, a single study can accommodate multiple domain and method theories.

In a conceptual paper, one crucial function of the research design is to explicate the role of each element in the paper; failure to explain this is likely to render the logic of “generating findings” practically invisible to the reader. Defining the roles of different theories also helps to indicate the paper’s positioning, and how its contribution should be evaluated. Typically, the role of the method theory is to provide some new insight into the domain theory—for example, to expand, organize, or offer a new or alternative explanation of concepts and relationships. This means that contribution usually centers on the domain theory, not the method theory (Lukka and Vinnari 2014 ). For example, marketing scholars often use established theories such as resource-based theory, institutional theory, or practice theory as method theories, but any suitable framework (even from other disciplines) can play this role. Footnote 1

Making the chain of evidence visible and easy to grasp

Conceptual papers typically focus on proposing new relationships among constructs; the purpose is thus to develop logical and complete arguments about these associations rather than testing them empirically (Gilson and Goldberg 2015 ). The issue of how to develop logical arguments is hence pivotal. As well as arguing that concepts are linked, authors must provide a theoretical explanation for that link. As that explanation demonstrates the logic of connections between concepts, it is critical for theory building (King and Lepak 2011 ).

In attempting to analyze what constitutes a good argument, Hirschheim ( 2008 ) adopted a framework first advanced by the British philosopher Toulmin ( 1958 ), according to which an argument has three necessary components: claims, grounds, and warrants. Claims refer to the explicit statement or thesis that the reader is being asked to accept as true—the outcome of the research. Grounds are the evidence and reasoning used to support the claim and to persuade the reader. In a conceptual paper, this evidence is drawn from previous studies rather than from primary data. Finally, warrants are the underlying assumptions or presuppositions that link grounds to claims. Warrants are often beliefs implicitly accepted within the given research domain—for example the assumption that organizations strive to satisfy their customers. In a robust piece of research, claims should be substantiated by sufficient grounds, and should be of sufficient significance to make a worthwhile contribution to knowledge (Hirschheim 2008 ).

In practice, the chain of evidence in a conceptual paper is made visible to the reader by explicating the key steps in the argument. How is the studied phenomenon conceptualized? What are the study’s implicit assumptions, stemming from its theoretical underpinnings? Are the premises and axioms used to ground the arguments sufficiently explicit to enable another researcher to arrive at similar analytical conclusions? Conceptual clarity, parsimony, simplicity, and logical coherence are important qualities of any academic study but are arguably all the more critical when developing arguments without empirical data.

A paper’s structure is a strong determinant of how easy it is to follow the chain of argumentation. While there is no single best way to structure a conceptual paper, what successful papers have in common is a careful matching of form and structure to theoretical purpose of the paper (Fulmer 2012 ). The structure should therefore reflect both the aims of the research and the role of the various lenses deployed to achieve those aims—in other words, the structure highlights what the authors seek to explain. A clear structure also contributes to conceptual clarity by making the hierarchy of concepts and their elements intuitively available to the reader, eliminating any noise that might distort the underlying message. As Hirschheim ( 2008 ) noted, a clear structure ensures a place for everything—omitting nothing of importance—and puts everything in its place, avoiding redundancies.

Common types of research design in conceptual papers

In marked contrast to empirical research, there is no widely shared understanding of basic types of research design in respect to conceptual papers, with the exception of literature reviews and meta-analyses. To address this issue, the present study considers four such types: Theory Synthesis, Theory Adaptation, Typology , and Model (see Table 2 ). These types serve to clarify differences of methodological approach—that is, how the argument is structured and developed—rather than the types of conceptual contributions that are the main consideration of MacInnis ( 2011 ). The four types discussed here derive from an analysis of goal setting, structuring, and logic of argumentation in multiple articles published in high quality journals. It should be said that the list is not exhaustive, and other researchers would no doubt have formulated differing perspectives. Nevertheless, the presented scheme can inspire researchers to explore and explicate one’s approach to conceptual research, and perhaps to formulate an alternative approach. It should also be noted that the goals of a conceptual article can be as varied as in any other form of academic research. Table 2 identifies some possible or likely goals for each suggested type; these are not mutually exclusive and are often combined.

Theory synthesis

A theory synthesis paper seeks to achieve conceptual integration across multiple theories or literature streams. Such papers offer a new or enhanced view of a concept or phenomenon by linking previously unconnected or incompatible pieces in a novel way. Papers of this type contribute by summarizing and integrating extant knowledge of a concept or phenomenon. According to MacInnis ( 2011 ), summarizing helps researchers see the forest for the trees by encapsulating, digesting, and reducing what is known to a manageable whole. Integration enables researchers to see a concept or phenomenon in a new way by transforming previous findings and theory into a novel higher-order perspective that links phenomena previously considered distinct (MacInnis 2011 ). For example, a synthesis paper might chart a new or unstructured phenomenon that has previously been addressed in piecemeal fashion across diverse domains or disciplines. Such papers may also explore the conceptual underpinnings of an emerging theory or explain conflicting research findings by providing a more parsimonious explanation that pulls disparate elements into a more coherent whole.

This kind of systematization is especially helpful when research on a given topic is fragmented across different literatures, helping to identify and underscore commonalities that build coherence (Cropanzano 2009 ). For example, in their review of conceptualizations of customer experience across multiple literature fields, Becker and Jaakkola’s ( 2020 ) analysis of the compatibility of various elements and assumptions provided a new integrative view that could be generalized across settings and contexts. In more mature fields, synthesis can help to identify gaps in the extant research, which is often the goal of systematic literature reviews. However, gap spotting is seldom a sufficient source of contribution as the main aim of a conceptual paper should be to enhance existing theoretical understanding on the studied phenomenon or concept. The synthesis paper represents a form of theorizing that emphasizes narrative reasoning that seeks to unveil “big picture” patterns and connections rather than specific causal mechanisms (Delbridge and Fiss 2013 ).

Although there is sometimes a fine line between theory synthesis and literature review, there remains a clear distinction between the two. While a well-crafted literature review takes stock of the field and can provide valuable insights into its development, scope, or future prospects, it remains within the existing conceptual or theoretical boundaries, describing extant knowledge rather than looking beyond it. In the case of a conceptual paper, the literature review is a necessary tool but not the ultimate objective. Moreover, in a theory synthesis paper, the role of the literature review is to unravel the components of a concept or phenomenon and it must sometimes reduce or exclude incommensurable elements. A lack of elegance occurs when authors attempt to hammer together separate research ideas in a series of “minireviews” instead of attending to a single conceptual theme (Cropanzano 2009 ). For example, a literature review that seeks to integrate multiple research perspectives may instead merely summarize in separate chapters what each has to say about the concept. Typically, different research perspectives employ differing terms and structure, or categorize conceptual elements in distinct ways. Integration and synthesis requires that the researcher explicates and unravels the conceptual underpinnings and building blocks that different perspectives use to conceptualize a phenomenon, and the looks for common ground on which to build a new and enhanced conceptualization.

A theory synthesis paper may seek to increase understanding of a relatively narrow concept or empirical phenomenon. For example, Lemon and Verhoef ( 2016 ) summarized the conceptual background and extant conceptualizations of customer journeys to produce a new integrative view. They framed the journey phenomenon in terms of the consumer purchasing process and organized the extant research within this big picture. Similarly, arguing that the knowledge base of relationship marketing and business networks perspectives was unduly fragmented, Möller ( 2013 ) deployed a metatheoretical lens to construct an articulated theory map that accommodated various domain theories, leading to the development of two novel middle-range theories.

Ultimately, a theory synthesis paper can integrate an extensive set of theories and phenomena under a novel theoretical umbrella. One good example is Vargo and Lusch’s ( 2004 ) seminal article, which pulled together key ingredients from diverse fields such as market orientation, relationship marketing, network management, and value management into a novel integrative narrative to formulate the more parsimonious framework of service-dominant logic. In so doing, they drew on resource based theory, structuration theory, and institutional theory as method theories to organize and synthesize concepts and themes from middle-range literature fields (e.g., Vargo and Lusch 2004 , 2016 ). While extant research provided the basis for a novel framework, existing concepts were decomposed into such fine-grained ingredients that the resulting integration was a new theoretical view in its own right rather than a summary of existing concepts.

Theory adaptation

Papers that focus on theory adaptation seek to amend an existing theory by using other theories. While empirical research may gradually extend some element of theory within a given context, theory-based adaptation attempts a more immediate shift of perspective. Theory adaptation papers develop contribution by revising extant knowledge—that is, by introducing alternative frames of reference to propose a novel perspective on an extant conceptualization (MacInnis 2011 ). The point of departure for such papers, then, is the problematization of a particular theory or concept. For example, the authors might argue that certain empirical developments or insights from other streams of literature render an existing conceptualization insufficient or conflicted, and that some reconfiguration or shift of perspective or scope is needed to better align the concept or theory to its purpose or to reconcile certain inconsistencies. Typically, the researcher draws from another theory that is equipped to guide this shift. The contribution of this type of a paper is often positioned to the domain where the focal concept is situated.

The starting point for the theory adaptation paper is the theory or concept of interest (domain theory). Other theories are used as tools, or method theories (Lukka and Vinnari 2014 ) to provide an alternative frame of reference to adjust or expand its conceptual scope. One “method” of adaptation is to switch the level of analysis; for example, Alexander et al. ( 2018 ) provided new insights into the influence of institutions on customer engagement by shifting from a micro level analysis of customer relationships—the prevailing view in the field—to meso and macro level views, adapting Chandler and Vargo’s ( 2011 ) process of oscillating foci. Another option is to use an established theory to explore new aspects of the domain theory (Yadav 2010 ). As one example of this type of design, Brodie et al. ( 2019 ) argued for the practical and theoretical importance of expanding the scope of engagement research in two ways: from a focus on consumers to a broad range of actors, and from dyadic firm-customer relationships to networks. As well as justifying why a particular extension or change of focus is needed, a theory adaptation paper must also show that the selected method theory is the best available option. For example, Brodie et al. ( 2019 ) explained that they employed service-dominant logic to broaden the conceptual scope of engagement research because it offered a lens for understanding actor-to-actor interactions in networks. Similarly, Hillebrand et al. ( 2015 ) used multiplicity theory to revise existing perspectives on stakeholder marketing by viewing stakeholder networks as continuous rather than discrete. They argued that this provides a more accurate understanding of markets characterized by complex value exchange and dispersed control.

A typology paper classifies conceptual variants as distinct types. The aim is to develop a categorization that “explains the fuzzy nature of many subjects by logically and causally combining different constructs into a coherent and explanatory set of types” (Cornelissen 2017 ). A typology paper provides a more precise and nuanced understanding of a phenomenon or concept, pinpointing and justifying key dimensions that distinguish the variants.

Typology papers contribute through differentiation— distinguishing, dimensionalizing, or categorizing extant knowledge of the phenomenon, construct, or theory in question (MacInnis 2011 ). Typologies reduce complexity (Fiss 2011 ). They demonstrate how variants of an entity differ, and hence organize complex networks of concepts and relationships, and may help by recognizing their differing antecedents, manifestations, or effects (MacInnis 2011 ). Typologies also offer a multidimensional view of the target phenomenon by categorizing theoretical features or dimensions as distinct profiles that offer coordinates for empirical research (Cornelissen 2017 ). For example, the classic typologies elaborated by Mills and Margulies ( 1980 ) and Lovelock ( 1983 ) assigned services to categories reflecting different aspects of the relationship between customers and the service organization, facilitating prediction of organizational behavior and marketing action. These theory-based typologies have informed numerous empirical applications.

The starting point for a typology paper is typically recognition of an important but fragmented research domain characterized by differing manifestations of a concept or inconsistent findings regarding drivers or outcomes. The researcher accumulates knowledge of the focal topic and then organizes it to capture the variability of particular characteristics of the concept or phenomenon. For example, after exploring different approaches to service innovation, Helkkula et al. ( 2018 ) proposed a typology of four archetypes. They suggested that variance within the extant research could be explained by differences of theoretical perspective and argued that each type had distinct implications for value creation.

The dimensions of a typology can also be differentiated by applying another theory (i.e. methods theory) that provides a logical explanation of why differences exist and why they are relevant. For example, to examine the boundaries of resource integration, Dong and Sivakumar ( 2017 ) developed a typology of customer participation, using dimensions drawn from resource-based theory, to address the fundamental resource deployment questions of whether there is a choice in terms of who performs a task and what task is performed (Kozlenkova et al. 2014 ).

Snow and Ketchen Jr. ( 2014 ) argued that well-developed typologies are more than just classification systems; rather, a typology articulates relationships among constructs and facilitates testable predictions (cf. Doty and Glick 1994 ). In this way, a typology can propose multiple causal relationships in a given setting (Fiss 2011 ). While a typology paper enhances understanding of a phenomenon by delineating its key variants, it can be seen to differ from a synthesis or adaptation paper by virtue of its explanatory character. This is the typology’s raison d’etre; types always explain something, and the dimensions that distinguish types account for the different drivers, outcomes, or contingencies of particular variants of the phenomenon. By accommodating asymmetric causal relations, typologies facilitate the development of configurational arguments beyond simple correlations (Fiss 2011 ).

The model paper seeks to build a theoretical framework that predicts relationships between concepts. A conceptual model describes an entity and identifies issues that should be considered in its study: it can describe an event, an object, or a process, and explain how it works by disclosing antecedents, outcomes, and contingencies related to the focal construct (Meredith 1993 ; MacInnis 2011 ). This typically involves a form of theorizing that seeks to create a nomological network around the focal concept, employing a formal analytical approach to examine and detail the causal linkages and mechanisms at play (Delbridge and Fiss 2013 ). A model paper identifies previously unexplored connections between constructs, introduces new constructs, or explains why elements of a process lead to a particular outcome (Cornelissen 2017 ; Fulmer 2012 ).

The model paper contributes to extant knowledge by delineating an entity: its goal is “to detail, chart, describe, or depict an entity and its relationship to other entities” (MacInnis 2011 ). In a conceptual article, creative scope is unfettered by data-related limitations, allowing the researcher to explore and model emerging phenomena where few empirical data are available (Yadav 2010 ). The model paper typically contributes by providing a roadmap for understanding the entity in question by delineating the focal concept, how it changes, the processes by which it operates, or the moderating conditions that may affect it (MacInnis 2011 ).

A model paper typically begins from a focal phenomenon or construct that warrants further explanation. For example, Huang and Rust ( 2018 ) sought to explain the process and mechanism by which artificial intelligence (AI) will replace humans in service jobs. They employed literature that tackles key variables associated with the target phenomenon: service research illuminates the focal phenomenon, technology-enabled services, and research across multiple disciplines discusses the likely impact of AI on human labor. By synthesizing this literature pool, they identified four types of intelligence and then built a theory that could predict the impact of AI on human service labor. This involved a particular kind of formal reasoning, supported by research from multiple disciplines and real-world applications (Huang and Rust 2018 ). In other words, the authors use method theories and deductive reasoning to explain relationships between key variables, facilitated by theories in use (MacInnis 2011 ).

Model papers typically summarize arguments in the form of a figure that depicts the salient constructs and their relationships, or as a set of formal propositions that are logical statements derived from the conceptual framework (Meredith 1993 ). For example, Payne et al. ( 2017 ) used resource-based theory to develop a conceptual model of the antecedents and outcomes of customer value propositions. While figures and propositions of this kind help the reader by condensing the paper’s main message, Delbridge and Fiss ( 2013 ) noted that they are also a double-edged sword. At their best, propositions distill the essence of an argument into a parsimonious and precise form, but by virtue of this very ability, they also put a spotlight on the weaknesses in the argument chain. According to Cornelissen ( 2017 ), the researcher should therefore be clear about the “causal agent” in any proposed relationship between constructs when developing propositions—in other words, the trigger or force that drives a particular outcome or effect. Careful consideration and justification of the choice of theories and the manner in which they are integrated to produce the arguments is hence pivotal in sharpening and clarifying the argumentation to convince reviewers and readers.

Conclusions

This paper highlights the role of methodological considerations in conceptual papers by discussing alternative types of research design, in the hope of encouraging researchers to critically assess and develop conceptual papers accordingly. Authors of conceptual papers should readily answer the following questions: What is the logic of creating new knowledge? Why are particular information sources selected, and how are they analyzed? What role does each theory play? For reviewers, assessing conceptual papers can be difficult not least because the generally accepted and readily available guidelines for evaluating empirical research seldom apply directly to non-empirical work. By asking these questions, reviewers and supervisors can evaluate whether the research design of a paper or thesis is carefully crafted and clearly communicated to the reader.

The paper identifies four types of conceptual papers—Theory Synthesis, Theory Adaptation, Typology, and Model—and discusses their aims, methods of theory use, and potential contributions. Although this list is not exhaustive, these types offer basic templates for designing conceptual research and determining its intended contribution (cf. MacInnis 2011 ). Careful consideration of these alternative types can facilitate more conscious selection of approach and structure for a conceptual paper. Researchers can also consider opportunities for combining types. In many cases, mixing two types can be an attractive option. For example, after distinguishing types of service innovation in terms of their conceptual underpinnings, Helkkula et al. ( 2018 ) synthesized a novel conceptualization of service innovation that exploited the strengths of each type and mitigated their limitations. Typologies can also provide the basis for models, and synthesis can lead to theory adaptation.

This paper highlights the many alternative routes along which conceptual papers can advance extant knowledge. We should consider conceptual papers not just as a means to take stock, but to break new ground. Empirical research takes time to accumulate, and the scope for generalization is relatively narrow. In contrast, conceptual papers can strive to advance understanding of a concept or phenomenon in big leaps rather than incremental steps. To be taken seriously, any such leap must be grounded in thorough consideration and justification of an appropriate research design.

A discussion of how different theoretical lenses can be integrated is beyond the scope of this paper, but see for example Okhuysen and Bonardi ( 2011 ) and Gioia and Pitre ( 1990 ).

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• What Is a Conceptual Framework? | Tips & Examples

What Is a Conceptual Framework? | Tips & Examples

Published on August 2, 2022 by Bas Swaen and Tegan George. Revised on March 18, 2024.

A conceptual framework illustrates the expected relationship between your variables. It defines the relevant objectives for your research process and maps out how they come together to draw coherent conclusions.

Keep reading for a step-by-step guide to help you construct your own conceptual framework.

Table of contents

Developing a conceptual framework in research, step 1: choose your research question, step 2: select your independent and dependent variables, step 3: visualize your cause-and-effect relationship, step 4: identify other influencing variables, frequently asked questions about conceptual models.

A conceptual framework is a representation of the relationship you expect to see between your variables, or the characteristics or properties that you want to study.

Conceptual frameworks can be written or visual and are generally developed based on a literature review of existing studies about your topic.

Your research question guides your work by determining exactly what you want to find out, giving your research process a clear focus.

However, before you start collecting your data, consider constructing a conceptual framework. This will help you map out which variables you will measure and how you expect them to relate to one another.

In order to move forward with your research question and test a cause-and-effect relationship, you must first identify at least two key variables: your independent and dependent variables .

• The expected cause, “hours of study,” is the independent variable (the predictor, or explanatory variable)
• The expected effect, “exam score,” is the dependent variable (the response, or outcome variable).

Note that causal relationships often involve several independent variables that affect the dependent variable. For the purpose of this example, we’ll work with just one independent variable (“hours of study”).

Now that you’ve figured out your research question and variables, the first step in designing your conceptual framework is visualizing your expected cause-and-effect relationship.

We demonstrate this using basic design components of boxes and arrows. Here, each variable appears in a box. To indicate a causal relationship, each arrow should start from the independent variable (the cause) and point to the dependent variable (the effect).

It’s crucial to identify other variables that can influence the relationship between your independent and dependent variables early in your research process.

Some common variables to include are moderating, mediating, and control variables.

Moderating variables

Moderating variable (or moderators) alter the effect that an independent variable has on a dependent variable. In other words, moderators change the “effect” component of the cause-and-effect relationship.

Let’s add the moderator “IQ.” Here, a student’s IQ level can change the effect that the variable “hours of study” has on the exam score. The higher the IQ, the fewer hours of study are needed to do well on the exam.

Let’s take a look at how this might work. The graph below shows how the number of hours spent studying affects exam score. As expected, the more hours you study, the better your results. Here, a student who studies for 20 hours will get a perfect score.

But the graph looks different when we add our “IQ” moderator of 120. A student with this IQ will achieve a perfect score after just 15 hours of study.

Below, the value of the “IQ” moderator has been increased to 150. A student with this IQ will only need to invest five hours of study in order to get a perfect score.

Here, we see that a moderating variable does indeed change the cause-and-effect relationship between two variables.

Mediating variables

Now we’ll expand the framework by adding a mediating variable . Mediating variables link the independent and dependent variables, allowing the relationship between them to be better explained.

Here’s how the conceptual framework might look if a mediator variable were involved:

In this case, the mediator helps explain why studying more hours leads to a higher exam score. The more hours a student studies, the more practice problems they will complete; the more practice problems completed, the higher the student’s exam score will be.

Moderator vs. mediator

It’s important not to confuse moderating and mediating variables. To remember the difference, you can think of them in relation to the independent variable:

• A moderating variable is not affected by the independent variable, even though it affects the dependent variable. For example, no matter how many hours you study (the independent variable), your IQ will not get higher.
• A mediating variable is affected by the independent variable. In turn, it also affects the dependent variable. Therefore, it links the two variables and helps explain the relationship between them.

Control variables

Lastly,  control variables must also be taken into account. These are variables that are held constant so that they don’t interfere with the results. Even though you aren’t interested in measuring them for your study, it’s crucial to be aware of as many of them as you can be.

A mediator variable explains the process through which two variables are related, while a moderator variable affects the strength and direction of that relationship.

A confounding variable is closely related to both the independent and dependent variables in a study. An independent variable represents the supposed cause , while the dependent variable is the supposed effect . A confounding variable is a third variable that influences both the independent and dependent variables.

Failing to account for confounding variables can cause you to wrongly estimate the relationship between your independent and dependent variables.

Yes, but including more than one of either type requires multiple research questions .

For example, if you are interested in the effect of a diet on health, you can use multiple measures of health: blood sugar, blood pressure, weight, pulse, and many more. Each of these is its own dependent variable with its own research question.

You could also choose to look at the effect of exercise levels as well as diet, or even the additional effect of the two combined. Each of these is a separate independent variable .

To ensure the internal validity of an experiment , you should only change one independent variable at a time.

A control variable is any variable that’s held constant in a research study. It’s not a variable of interest in the study, but it’s controlled because it could influence the outcomes.

A confounding variable , also called a confounder or confounding factor, is a third variable in a study examining a potential cause-and-effect relationship.

A confounding variable is related to both the supposed cause and the supposed effect of the study. It can be difficult to separate the true effect of the independent variable from the effect of the confounding variable.

In your research design , it’s important to identify potential confounding variables and plan how you will reduce their impact.

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What is a Conceptual Framework and How to Make It (with Examples)

A strong conceptual framework underpins good research. A conceptual framework in research is used to understand a research problem and guide the development and analysis of the research. It serves as a roadmap to conceptualize and structure the work by providing an outline that connects different ideas, concepts, and theories within the field of study. A conceptual framework pictorially or verbally depicts presumed relationships among the study variables.

The purpose of a conceptual framework is to serve as a scheme for organizing and categorizing knowledge and thereby help researchers in developing theories and hypotheses and conducting empirical studies.

In this post, we explain what is a conceptual framework, and provide expert advice on how to make a conceptual framework, along with conceptual framework examples.

Table of Contents

What is a Conceptual Framework in Research

Definition of a conceptual framework.

A conceptual framework includes key concepts, variables, relationships, and assumptions that guide the academic inquiry. It establishes the theoretical underpinnings and provides a lens through which researchers can analyze and interpret data. A conceptual framework draws upon existing theories, models, or established bodies of knowledge to provide a structure for understanding the research problem. It defines the scope of research, identifying relevant variables, establishing research questions, and guiding the selection of appropriate methodologies and data analysis techniques.

Conceptual frameworks can be written or visual. Other types of conceptual framework representations might be taxonomic (verbal description categorizing phenomena into classes without showing relationships between classes) or mathematical descriptions (expression of phenomena in the form of mathematical equations).

Figure 1: Definition of a conceptual framework explained diagrammatically

Conceptual Framework Origin

The term conceptual framework appears to have originated in philosophy and systems theory, being used for the first time in the 1930s by the philosopher Alfred North Whitehead. He bridged the theological, social, and physical sciences by providing a common conceptual framework. The use of the conceptual framework began early in accountancy and can be traced back to publications by William A. Paton and John B. Canning in the first quarter of the 20 th century. Thus, in the original framework, financial issues were addressed, such as useful features, basic elements, and variables needed to prepare financial statements. Nevertheless, a conceptual framework approach should be considered when starting your research journey in any field, from finance to social sciences to applied sciences.

Purpose and Importance of a Conceptual Framework in Research

The importance of a conceptual framework in research cannot be understated, irrespective of the field of study. It is important for the following reasons:

• It clarifies the context of the study.
• It justifies the study to the reader.
• It helps you check your own understanding of the problem and the need for the study.
• It illustrates the expected relationship between the variables and defines the objectives for the research.
• It helps further refine the study objectives and choose the methods appropriate to meet them.

What to Include in a Conceptual Framework

Essential elements that a conceptual framework should include are as follows:

• Overarching research question(s)
• Study parameters
• Study variables
• Potential relationships between those variables.

The sources for these elements of a conceptual framework are literature, theory, and experience or prior knowledge.

How to Make a Conceptual Framework

Now that you know the essential elements, your next question will be how to make a conceptual framework.

For this, start by identifying the most suitable set of questions that your research aims to answer. Next, categorize the various variables. Finally, perform a rigorous analysis of the collected data and compile the final results to establish connections between the variables.

In short, the steps are as follows:

• Choose appropriate research questions.
• Define the different types of variables involved.
• Determine the cause-and-effect relationships.

Be sure to make use of arrows and lines to depict the presence or absence of correlational linkages among the variables.

Developing a Conceptual Framework

Researchers should be adept at developing a conceptual framework. Here are the steps for developing a conceptual framework:

1. Identify a research question

Your research question guides your entire study, making it imperative to invest time and effort in formulating a question that aligns with your research goals and contributes to the existing body of knowledge. This step involves the following:

• Choose a broad topic of interest
• Conduct background research
• Narrow down the focus
• Define your goals
• Make it specific and answerable
• Consider significance and novelty
• Seek feedback.

 2. Choose independent and dependent variables

The dependent variable is the main outcome you want to measure, explain, or predict in your study. It should be a variable that can be observed, measured, or assessed quantitatively or qualitatively. Independent variables are the factors or variables that may influence, explain, or predict changes in the dependent variable.

Choose independent and dependent variables for your study according to the research objectives, the nature of the phenomenon being studied, and the specific research design. The identification of variables is rooted in existing literature, theories, or your own observations.

3. Consider cause-and-effect relationships

To better understand and communicate the relationships between variables in your study, cause-and-effect relationships need to be visualized. This can be done by using path diagrams, cause-and-effect matrices, time series plots, scatter plots, bar charts, or heatmaps.

4. Identify other influencing variables

Besides the independent and dependent variables, researchers must understand and consider the following types of variables:

• Moderating variable: A variable that influences the strength or direction of the relationship between an independent variable and a dependent variable.
• Mediating variable: A variable that explains the relationship between an independent variable and a dependent variable and clarifies how the independent variable affects the dependent variable.
• Control variable: A variable that is kept constant or controlled to avoid the influence of other factors that may affect the relationship between the independent and dependent variables.
• Confounding variable: A type of unmeasured variable that is related to both the independent and dependent variables.

Example of a Conceptual Framework

Let us examine the following conceptual framework example. Let’s say your research topic is “ The Impact of Social Media Usage on Academic Performance among College Students .” Here, you want to investigate how social media usage affects academic performance in college students. Social media usage (encompassing frequency of social media use, time spent on social media platforms, and types of social media platforms used) is the independent variable, and academic performance (covering grades, exam scores, and class attendance) is the dependent variable.

This conceptual framework example also includes a mediating variable, study habits, which may explain how social media usage affects academic performance. Study habits (time spent studying, study environment, and use of study aids or resources) can act as a mechanism through which social media usage influences academic outcomes. Additionally, a moderating variable, self-discipline (level of self-control and self-regulation, ability to manage distractions, and prioritization skills), is included to examine how individual differences in self-control and discipline may influence the relationship between social media usage and academic performance.

Confounding variables are also identified (socioeconomic status, prior academic achievement), which are potential factors that may influence both social media usage and academic performance. These variables need to be considered and controlled in the study to ensure that any observed effects are specifically attributed to social media usage. A visual representation of this conceptual framework example is seen in Figure 2.

Figure 2: Visual representation of a conceptual framework for the topic “The Impact of Social Media Usage on Academic Performance among College Students”

Key Takeaways

Here is a snapshot of the basics of a conceptual framework in research:

• A conceptual framework is an idea or model representing the subject or phenomena you intend to study.
• It is primarily a researcher’s perception of the research problem. It can be used to develop hypotheses or testable research questions.
• It provides a preliminary understanding of the factors at play, their interrelationships, and the underlying reasons.
• It guides your research by aiding in the formulation of meaningful research questions, selection of appropriate methods, and identification of potential challenges to the validity of your findings.
• It provides a structure for organizing and understanding data.
• It allows you to chalk out the relationships between concepts and variables to understand them.
• Variables besides dependent and independent variables (moderating, mediating, control, and confounding variables) must be considered when developing a conceptual framework.

Frequently Asked Questions

What is the difference between a moderating variable and a mediating variable.

Moderating and mediating variables are easily confused. A moderating variable affects the direction and strength of this relationship, whereas a mediating explains how two variables relate.

What is the difference between independent variables, dependent variables, and confounding variables?

Independent variables are the variables manipulated to affect the outcome of an experiment (e.g., the dose of a fat-loss drug administered to rats). Dependent variables are variables being measured or observed in an experiment (e.g., changes in rat body weight as a result of the drug). A confounding variable distorts or masks the effects of the variables being studied because it is associated both with dependent variable and with the independent variable. For instance, in this example, pre-existing metabolic dysfunction in some rats could interact differently with the drug being studied and also affect rat body weight.

Should I have more than one dependent or independent variable in a study?

The need for more than one dependent or independent variable in a study depends on the research question, study design, and relationships being investigated. Note the following when making this decision for your research:

• If your research question involves exploring the relationships between multiple variables or factors, it may be appropriate to have more than one dependent or independent variable.
• If you have specific hypotheses about the relationships between several variables, it may be necessary to include multiple dependent or independent variables.
• Adequate resources, sample size, and data collection methods should be considered when determining the number of dependent and independent variables to include.

What is a confounding variable?

A confounding variable is not the main focus of the study but can unintentionally influence the relationship between the independent and dependent variables. Confounding variables can introduce bias and give rise to misleading conclusions. These variables must be controlled to ensure that any observed relationship is genuinely due to the independent variable.

What is a control variable?

A control variable is something not of interest to the study’s objectives but is kept constant because it could influence the outcomes. Control variables can help prevent research biases and allow for a more accurate assessment of the relationship between the independent and dependent variables. Examples are (i) testing all participants at the same time (e.g., in the morning) to minimize the potential effects of circadian rhythms, (ii) ensuring that instruments are calibrated consistently before each measurement to minimize the influence of measurement errors, and (iii) randomization of participants across study groups.

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Using a conceptual model in nursing research - mitigating fatigue in cancer patients

Victoria mock.

Dept of Health Systems & Outcomes, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA, Director of Nursing Research Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA

Christine St. Ours

Johns Hopkins University School of Nursing, Baltimore, Maryland, USA

Amy Bositis

Miriam tillery, anne belcher, sharon krumm.

Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA

Ruth McCorkle

Center for Excellence in Chronic Illness Care, Yale University School of Nursing, New Haven, Connecticut, USA

This paper is a discussion of the use of the Levine Conservation Model to guide the investigation of an exercise intervention to mitigate cancer-related fatigue.

Researchers use conceptual models or theoretical frameworks to provide an organizing structure for their studies, to guide the development and testing of hypotheses, and to place research finding within the context of science. Selection of an appropriate and useful framework is an essential step in the development of a research project.

A descriptive approach is used to present the components of the conceptual model and details of the articulation of the study intervention and outcomes with the model.

The Levine Conservation Model provided a useful framework for this investigation, conducted in 2002-2006, of the effects of exercise on fatigue and physical functioning in cancer patients. The four conservation principles of the model guided the development of the exercise intervention, the identification of salient outcomes for patients, and the selection of appropriate instruments to measure study variables. The model is also proving useful in the analysis and interpretation of data in relation to the conservation principles.

Use of an appropriate conceptual model facilitates the design and testing of theory-based interventions and the development of science to support nursing practice.

Introduction

Nurse researchers regularly use conceptual models to design and conduct their investigations. In this paper, we provide a dynamic example from a nursing study which enrolled 138 participants between 2002 and 2006. The purpose of this paper is to describe the use of a nursing conceptual model, the Levine Conservation Model ( Levine 1996 ), to guide the development and implementation of a randomized clinical trial. The trial tests the effects of exercise in mitigating cancer-related fatigue in individuals being treated with radiation therapy or adjuvant chemotherapy following a cancer diagnosis.

A conceptual model or theoretical framework provides a coherent, unified and orderly way of envisioning related events or processes relevant to a discipline ( Fawcett 2005 ). In research, a framework illustrates the overall conceptual design of the study. The terms ‘conceptual model’ and ‘theoretical framework’ are often used interchangeably, but a theoretical framework generally incorporates at least part of a specific theory as the basis for a study. In addition, a theoretical framework often includes propositional statements describing the relationships among variables and has received more testing than the more tentative conceptual model ( Polit & Beck 2004 ).

The most common use of conceptual models is to provide an organizing structure for the research design and methods. A second purpose is to guide the development and testing of interventions and hypotheses based on the tenets of the theory. A third function is to explain the study results and place the findings within the context of science in a specific field of investigation. The interpretation of findings flows from the conceptualization represented by the framework ( Radwin & Fawcett 2002 , Polit & Beck 2004 ).

At its most fundamental, a conceptual model is composed of concepts and the theoretical linkages between them which together describe a particular relationship between two or more concepts. Concepts are connected in a theory by verbal or mathematical statements called propositions. Research hypotheses are derived from these propositions, in that hypotheses describe a presumed relationship between two or more measures of concepts in the conceptual model ( Fawcett 1978 ). Testing hypotheses in the context of a study can be expected to yield information about the validity of the propositions in the underlying theory, and thus the relationships between the concepts under investigation. This information can be added to the evidence in support (or in refutation) of the theory and builds the science related to the concepts being studied ( Fawcett 2005 ).

Cancer-related fatigue

Cancer-related fatigue is defined by the National Comprehensive Cancer Network (NCCN) as a distressing persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning ( NCCN 2006 ). Fatigue is an almost universal symptom in patients receiving cytotoxic chemotherapy, radiation therapy, bone marrow transplantation, or treatment with biological response modifiers ( Wagner & Cella 2004 ). This problem, which affects 70-100% of cancer patients, has been exacerbated in recent years by the increased use of fatigue-inducing multimodal treatments and of dose-dense, dose-intense protocols ( Ahlberg et al. 2003 ). In patients with metastatic disease, the prevalence of cancer-related fatigue exceeds 75%, and cancer survivors report that fatigue is a disruptive symptom months or even years after treatment ends ( Andrykowski et al. 1998 , Broeckel et al. 1998 , Bower et al. 2000 ). Patients perceive fatigue to be the most distressing symptom associated with cancer and its treatment, more distressing even than pain or nausea and vomiting, which in the case of most patients can be managed effectively by medication ( Curt et al. 2000 ). Compared with the fatigue of healthy individuals that resolves with adequate rest and sleep - the fatigue of cancer patients often remains after a period of rest or sleep, is of greater magnitude and persistence, is more disruptive to activities of daily living, and has a more negative affective impact ( Glaus et al. 1996 ). Fatigue in cancer patients has been under-reported, underdiagnosed and undertreated. The most important effect of persistent cancer-related fatigue is altering quality of life, as cancer patients become too tired to participate fully in valued roles and activities ( Dean & Ferrell 1995 ).

Management of cancer related fatigue (CRF) is important in that high levels of fatigue may affect functional status and the ability to tolerate cancer treatment. Research reports indicate that fatigue may have a profound effect on functional status ( Given et al. 2001 , Nail 2002 ) and it is uncertain whether patients regain full functioning when treatment is over ( Bower et al. 2000 ). Furthermore, if fatigued patients cannot tolerate their cancer treatment or must choose between treatment and quality of life, control of their malignancy may be compromised ( Malik et al. 2001 ). Healthcare professionals have been challenged in their efforts to help patients manage distressing symptoms and remain as fully engaged in life as possible. However, increasing evidence indicates that exercise training is effective in managing the fatigue associated with cancer diagnosis and treatment ( Winningham 2001 , Stricker et al. 2004 , Schmitz et al. 2005 ).

Levine Conservation Model

Selecting an appropriate conceptual model or theoretical framework is an important step in research development because it provides a pattern of reasoning to guide the research. The Levine Conservation Model was adopted for the study discussed here because it includes principles that help explain cancer-related fatigue and support exercise as a potential intervention for the fatigue ( Levine 1973 ). Although in our earlier work we had used a more general adaptation model ( Mock et al. 1994 , 1997 ), our team first adopted the Levine Conservation Model for a pilot project studying cancer-related fatigue in 1995-1996 ( Mock et al. 1998 , 2001 ); this was then followed by a multi-site clinical trial, ‘Fatigue in Cancer Patients: An Exercise Intervention’, in 1996-2001 ( Mock et al. 2005 ). Data from both the pilot study and larger clinical trial supported the model and demonstrated its usefulness as a framework for the investigation of the effects of exercise on fatigue and physical functioning in cancer patients.

Levine’s Conservation Model proposes a general mechanism underlying biobehavioural symptoms, such as fatigue, that necessitates a response or adaptation from the individual to maintain unity and integrity ( Levine 1996 ). According to Levine, the goal of the individual is conservation or preserving an integrated and balanced whole ( Levine 1973 ). The four conservation principles that underlie this model are conservation of energy, conservation of structural integrity, conservation of personal integrity and conservation of social integrity ( Levine 1989 ). When environmental challenges occur, as in the case of cancer and its treatment, the individual begins a multidimensional process of adaptation to maintain life and conserve individual integrity. Nursing interventions are aimed at promoting and supporting this adaptation.

The diagnosis of cancer and the subsequent surgical, chemotherapy and radiotherapy treatments produce an altered biochemical environment (threat to structural integrity) and create psychosocial distress related to survival and quality of life (threats to personal and social integrity). The processes of diagnosis and treatment are often lengthy and emotional responses are energy-depleting. When environmental and psychological stress is prolonged, chronic fatigue behaviours are manifested. Cancer patients typically reduce their usual levels of physical activity and this reduction, if prolonged, inevitably leads to changes in structural and functional integrity and a reduced tolerance for normal activity. This process can threaten personal and social integrity by affecting emotional equilibrium, social roles and health-related quality of life.

Evidence is accumulating that exercise interventions have the potential to assist the individual in adapting to the physical and psychological stress of cancer and related treatments ( Dimeo et al. 2004 , Stricker et al. 2004 , Galvao & Newton 2005 , Knols et al. 2005 , Schmitz et al. 2005 ). Exercise can help to maintain or increase capacity for physical activity and activity tolerance, resulting in performance of daily activities with less fatigue ( Lucia et al. 2003 , ASCM 2005 ). Exercise can also improve emotional responses ( Mock et al. 1997 , Segar et al. 1998 , Dimeo et al. 1999 ) [Levine Model: personal integrity] and provide energy for social interactions ( Holley & Borger 2001 , Mock et al. 2001 ) (Levine Model: social integrity). Many studies of cancer patients and survivors have demonstrated the clinical benefits of regular exercise - both aerobic exercise and strength training programmes ( Dimeo 2001 , Segal et al. 2001 , 2003 , Courneya et al. 2003a , 2003b ). Although the studies have not been uniformly rigorous, the overall benefits have been substantiated in meta-analyses and systematic reviews ( Knols et al. 2005 , Schmitz et al. 2005 , Conn et al. 2006 , McNeely et al. 2006 , Mitchell et al. 2007 ).

The purpose of the ongoing study described here was to determine the effects of a nurse-directed, moderate-intensity, home-based exercise programme to mitigate fatigue and maintain physical functioning in individuals receiving cancer treatment. The study design employed is a randomized controlled clinical trial. The enrolment eligibility criteria require that patients be 21 years of age or older with a newly diagnosed cancer, histologically staged at 0, I, II or III. Patients must be scheduled to receive chemotherapy, radiation therapy, or both as their initial treatment, must show no evidence of metastatic disease, and be free of concurrent health problems/disabilities that would limit their ability to participate in an exercise programme. They must not currently be exercising more than three times per week, for a total of 120 minutes. One-hundred and thirty-eight patients scheduled to receive chemotherapy or radiation therapy at one of four academic cancer centre-affiliated treatment sites have been enrolled. The study was approved by the University Institutional Review Board.

Once eligibility is determined and informed consent is obtained, patients are randomized into exercise (EX) or usual care (UC) groups. Patients assigned to the EX group are given a written prescription for an individualized, symptom-limited, home-based walking and muscle-strengthening exercise programme that they maintain throughout their cancer treatment. These patients are taught the programme with the assistance of a booklet and video describing the walking exercise programme and instructional materials that detail the muscle-strengthening component. The walking exercise programme that extends from the beginning of cancer treatment through treatment completion is a brisk, incremental 20- to 30-minute walk, followed by 5 minutes of slow walking (cool-down). The muscle-strengthening programme consists of 3-5 minutes of warm-up and one set of 10-20 repetitions with elastic resistance bands for each of the six exercises prescribed.

Patients in the UC group receive standard care as provided by their oncology care team and no prescribed exercise programme. Patients in both groups receive phone calls every 2 weeks from a research nurse. During these calls, EX group patients are assessed in terms of the appropriateness of their walking and muscle-strengthening prescription, are coached on their exercising, and have their walking or muscle-strengthening prescription revised as needed. Patients in the UC group are contacted on the same schedule to provide an attentional control for the study and are assessed in terms of their response to cancer treatment and changes in current activity level. Patients in both groups are referred to their oncology care team regarding issues related to side effects or symptom management and are given an educational pamphlet.

Managing fatigue

All patients are assessed by treadmill, dual-energy X-ray absorptiometry scan, muscle strength test, self-reported activity level and symptom questionnaires at pretest (at baseline before beginning cancer treatment) and again at post-test (following the completion of treatment). Activity level is measured objectively by use of pedometer and accelerometer for 1 week at pretest, mid-test and post-test. At mid-treatment, fatigue and other symptoms are assessed in both groups. All patients are asked to complete a weekly log during their treatment to record daily fatigue levels. The weekly log for the EX group also includes a record of minutes walked, pulse rate, perceived exertion, pedometer values and comments. Follow-up data are collected for each patient at 1-, 3- and 6-month time points after completion of cancer treatment. At these follow-up points, the questionnaires quantify fatigue and other symptoms as well as level of physical functioning. At study end, groups will be compared by repeated measures of analysis, anova and ancova . Multivariate regression procedures will be used to determine the predictors of cancer-related fatigue and of adherence to exercise during cancer treatment.

This study has been designed to test the efficacy of a low-cost, self-care health-promotion activity in mitigating fatigue, the most common and distressing symptom of cancer treatment. The biobehavioural outcomes include both subjective, self-reported symptoms and objective, physiological changes in physical capacity and performance.

Using the Levine Conservation Model to guide the study

Once the Levine Conservation Model was chosen to guide this study, the study variables were carefully selected to be congruent with the model, as were the tools used for data collection and the intervention being tested. This approach ensured that appropriate outcome variables were used in the evaluation, which includes measurement of the four components of this particular model. Also, it became clear that all four components should be addressed in implementing the intervention, as well as in interpreting the study data.

Four aims and two hypotheses were identified for the study; these flow from propositional statements identified for the Levine Conservation Model:

• Aim 1  To test the hypothesis that patients receiving radiation therapy or adjuvant chemotherapy for prostate, breast, or colorectal cancer who participate in a regular exercise programme demonstrate significantly lower levels of fatigue, sleep disturbance, and emotional distress, with significantly higher levels of physical functioning and quality of life compared to similar patients who do not participate in regular exercise. Propositional statement: Regular exercise decreases fatigue, sleep disturbance, and emotional distress as well as increases physical functioning and health-related quality of life.
• Aim 2  To test the hypothesis that the amount of change in physical functioning from baseline to post-2 (as measured by the treadmill test, body composition evaluation, and self-reported exercise/activity level) is correlated with the amount of change in levels of fatigue, difficulty sleeping, emotional distress, and quality of life. Propositional statement: There is a significant relationship between changes in levels of physical functioning and changes in levels of fatigue, difficulty sleeping, emotional distress, and quality of life.

Two secondary aims were identified for the study:

• Aim 3  To determine factors that predict patients at high risk for cancer treatment-related fatigue.
• Aim 4  To determine factors that predict adherence and non-adherence to the exercise intervention.

Because these were exploratory aims, no hypotheses were developed for them.

Instruments

The four components of the Levine Conservation Model and how they were incorporated into instrument selection are shown in Table 1 . Conservation of energy is represented by the main study variable fatigue as well as by the sleep variable, which has obvious implications for both fatigue and conservation of energy. The study uses the NCCN definition of fatigue and fatigue is measured by the modified Piper Fatigue Scale, which assesses overall fatigue and four dimensions of subjective fatigue: temporal, severity, affective and sensory ( Piper et al. 1998 ). In addition, subjects record daily self-reported fatigue levels in logs that are mailed every week to the study team. A simple measure of rating fatigue on a scale of 0 (no fatigue) to 10 (a great deal of fatigue) is used on the daily logs to decrease respondent burden. The Profile of Mood States fatigue subscale and the fatigue item on the Symptom Distress Scale (SDS) provide additional measures of fatigue. Sleep quality and quantity are measured by the Pittsburgh Sleep Quality Index ( Buysse et al. 1989 ).

Components of the Levine Conservation Model as framework for the study variables and instruments (from consultation with Jacqueline Fawcett, PhD, RN, FAAN, 1996)

Conservation of structural integrity is represented by physical functioning, defined as the ability to ambulate and to perform normal activities of daily living, and is measured by maximum functional capacity [using a modified Balke Protocol Stress Test ( ACSM 2005 )] as well as by pedometer and accelerometer, which measure steps taken and speed of movement. Self-perceived physical functional ability is measured by the Medical Outcome Study-36 Physical Functioning Subscale ( Ware & Sherbourne 1992 ). The self-reported level of weekly exercise is quantified at baseline and post-test by the Physical Activity Questionnaire, which converts daily activity into metabolic equivalents of oxygen consumption ( Kohl et al. 1988 ).

Conservation of personal integrity is represented by the study variables of emotional distress and quality of life. Emotional distress is defined as an uncomfortable mood state or psychological response and is measured by the Profile of Mood States Scale (POMS). The short-form POMS measures subjects’ mental/psychological status ( Shacham 1983 ) on subscales that assess six emotional dimensions: anxiety, depression, anger, vigour, fatigue and confusion. An additional measure of emotional distress is provided by the anxiety and depression items from the SDS. Quality of life is defined as self-assessment of satisfaction with the physical, social and emotional aspects of one’s life and is measured by the Medical Outcome Study 36-item Short Form Health Form (MOS SF-36, distributed by RAND). The MOS SF-36 is a multi-item scale that includes eight health concepts: physical functioning, social functioning, role functioning-physical, bodily pain, general mental health, role functioning-emotional, vitality and general health perceptions ( Ware & Sherbourne 1992 ).

Conservation of social integrity is represented by social functioning which, although not a major variable in the study, is measured by the MOS-SF Social Functioning Subscale. Symptom experience, defined as the totality of uncomfortable perceptions related to the cancer diagnosis and treatment, is considered an inherent component of both physical functioning and emotional distress and is measured by the SDS ( McCorkle & Young 1978 ), which assesses the degree of distress associated with 11 symptoms frequently experienced by cancer patients. Some instruments, such as the MOS and SDS, are comprehensive and able to measure several of the study outcomes.

The intervention

Prolonged exposure to the environmental challenges of cancer diagnosis and treatment may erode the individual’s energy resources. According to the NCCN Fatigue Practice Guidelines, exercise has the strongest evidence of benefit in managing cancer-related fatigue ( Mock et al. 2003 ). Even at a moderate level, exercise training produces a more adaptive response by the cardio-respiratory system and greater exercise tolerance, as evidenced by increased cardiac output, lower heart rate and less fatigue, reflecting a reduced level of energy required to perform equivalent work ( ACSM 2005 ).

Using the model to guide the intervention

In using the Levine Conservation Model to guide the development of the intervention, special care was taken to include all components of the model ( Table 2 ). The exercise intervention tested in this study includes the Conservation of energy component within the Levine Model, in which the focus is on balancing the individual’s energy resources with energy expenditure. Conservation of energy is also addressed in informational materials provided to participants. These materials include a booklet on fatigue management that describes ways to conserve energy and make the most efficient use of the energy available. A booklet and video provide the specifics of the walking and strength training programme. Study materials also include daily logs that serve as a diary for many participants.

Components of the exercise intervention as aligned with the Levine Conservation Model

Conservation of structural integrity is concerned with the process of maintaining or restoring the structure of the body. Structure and function are inter-related, and pathophysiological processes can change or threaten structural integrity. As the body adapts to energy depletion and fatigue by decreasing activities of daily living over a prolonged period of time, fatigue, muscle weakness and atrophy may result. Exercise can prevent or reverse the usual response to environmental challenges faced by patients with cancer. Conservation of structural integrity and physical functioning are addressed by the exercise programme itself. Not only are the logs and pedometers used as a means of measuring implementation of the intervention, but they also serve as an integral part of the intervention, providing both feedback and motivation. The exercise programme incorporates bi-weekly phone calls from a research nurse. These exchanges between nurse and participant include assessment of the participant’s tolerance of the exercise programme and negotiation of reasonable goals for exercise activity.

The Conservation of personal integrity emphasizes the concept of personal identity and sense of self. Illness threatens self-identity and sense of self, the foundations of personal integrity. The use of a home-based exercise programme in our study gives participants control of one aspect of their health promotion during an uncertain and difficult time in their lives, when many aspects seem out of the individual’s control. Also, the pedometer allows participants to track their own activity level, and daily logs can promote feelings of control and autonomy. Emotional state, quality of life and social functioning are emphasized in the bi-weekly phone calls, and the research nurses spend time discussing the walking programme and helping patients deal with the tsunami of feelings brought on by their diagnosis and treatment.

The Conservation of social integrity refers to living successfully in a social environment consisting of family, community and employment relationships. Cancer treatment presents major physiological and environmental challenges that affect social roles and quality of life, including reduced tolerance for levels of normal activity. Prior research has shown that early attempts to adapt to compromised energy levels include reductions in social activities ( Mock et al. 2001 ). The reduction in energy and in tolerance for these social interactions has the potential to lead to isolation that may threaten emotional equilibrium. This resulting emotional disequilibrium is characterized by anxiety, depression and difficulty sleeping ( Mock et al. 1997 , Ancoli-Israel et al. 2001 , Nail 2002 , Ahlberg et al. 2003 ). Thus, improvement in, or maintenance of, energy levels resulting from the use of an exercise programme provides an opportunity to continue important social interactions.

It is worthwhile to note that some of the measurement tools used in this study have become elements of the intervention. For example, the daily logs completed by patients serve as an expressive narrative for some participants, as they record their progress, difficulties and frustrations along with personal reflections. They also become a means of tracking their adherence to the exercise programme. Early participants have reported that completing the logs and visualizing the pedometer readings have served as incentives for improving their exercise performance.

During this project, the Levine Conservation Model proved to be a useful organizing framework for the study of a nurse-directed exercise intervention to manage fatigue in cancer patients. Levine indicates that the goal of the individual patient in the face of environmental challenges is adaptation: preserving an integrated self. As noted in the discussion of cancer and its impact on the individual, sustained environmental and psychological stress, as well as alternations in structural integrity, results in chronic fatigue behaviours. The model provides nursing implications for the international clinical care of cancer patients, i.e. the patient benefits from nursing interventions that promote and support adaptation to these challenges and maintain integrity of the individual. There is good evidence that nurse-directed exercise programmes facilitate adaptation by conserving energy and improving functional capacity (structural integrity) resulting in lower levels of fatigue in patients receiving cancer treatment ( Galvao & Newton 2005 , Schmitz et al. 2005 , Mitchell et al. 2007 ). Exercise can also enhance personal integrity and social integrity, which are identified as conservation principles in the Levine Conservation Model.

Evidence for this is seen in earlier work guided by the model ( Mock et al. 1998 , 2001 , 2005 ). Patients who exercised regularly during cancer treatment conserved energy as reflected in lower fatigue levels compared with patients who did not exercise regularly: the conservation of structural integrity was reflected in increased functional capacity in exercisers while there were decreased levels in non-exercisers. Conservation of personal integrity was demonstrated by lower mood distress scores and higher quality of life scores in exercisers. Finally, conservation of social integrity was indicated by increased scores on social functioning for regular exercisers while scores dropped for those with low levels of exercise ( Mock et al. 2001 ). The walking exercise programme tested here was easily taught and monitored by oncology nurses within the context of cancer treatment in outpatient clinics. Advising patients about physical activity is becoming a routine component of nursing care in many countries ( Douglas et al. 2006 ). The low-cost, low-risk intervention is internationally applicable as a health promoting component of cancer care.

In the study described here we were guided by the Levine Conservation Model in defining research variables, developing the intervention and determining the instruments and measurement periods to be used for data collection. Use of the model ensured that appropriate outcomes were used in the evaluation of the impact of the intervention; the focus was on the Levine Conservation Model concepts of enhancement of energy, structural integrity, personal integrity and social integrity. The model has also proved useful in the analysis and interpretation of data in our previous studies. We are using this framework in the current study to explain the study results in relation to the four conservation principles. The use of a conceptual model enables the researchers to test aspects of the underlying theory and to interpret findings within a scientific and theoretical context. The model is then further explicated for its value in guiding practice, e.g. identifying effective nursing interventions to mitigate fatigue and improve functioning during cancer therapies.

Limitations

The Levine Conservation Model is limited in guiding at least one important aspect of research; it is not specific enough to

What is already known about this topic

• Nursing conceptual models can serve as facilitative frameworks for organizing and conducting research studies.
• Theories describe proposed and testable relationships between variables that are conceptually linked.
• There is a lack of clear examples of the use of conceptual models in the development and conduct of nursing research.

What this paper adds

• The Levine Conservation Model is an illustration of a powerful organizing scheme for a randomized clinical trial testing the effects of exercise on cancer-related fatigue during chemotherapy or radiation therapy treatment.
• Research methods in this clinical trial effectively test and support components of the Levine Conservation Model.
• This heuristic model demonstrates the fundamental reciprocal relationships among nursing theory, nursing research and nursing practice.

explain the specific mediating mechanisms by which exercise training achieves physiological and psychosocial outcomes. Thus, additional biological theories (e.g., changes in functional capacity) and psychosocial theories (e.g., stress reduction or distraction) are needed to supplement the Levine Conservation Model for a full understanding of how exercise mitigates the fatigue experience. Another limitation is the lack of stated postulates to accompany the model. This provides an identified area for further development of the theory and has implications for further research with the model. Other recommended areas of cancer-related fatigue research using the model include the exploration of biological and psychosocial mediating mechanisms to further elucidate the relationships among components of the Levine Conservation Model.

The description of the model, and how it was employed to guide a nursing research project, should prove useful to other investigative teams as they seek to design their research and interpret study results within the context of nursing theory. Information gained from our ongoing research is adding to the body of literature suggesting that the Levine Conservation Model is a robust framework for designing and testing theory-based exercise interventions to mitigate cancer-related fatigue. Our experience, applicable on an international level, strongly supports the value of using a conceptual model as a framework for nursing research.

Contributor Information

Victoria Mock, Dept of Health Systems & Outcomes, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA, Director of Nursing Research Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA.

Christine St. Ours, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.

Sue Hall, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.

Amy Bositis, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.

Miriam Tillery, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.

Anne Belcher, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.

Sharon Krumm, Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA.

Ruth McCorkle, Center for Excellence in Chronic Illness Care, Yale University School of Nursing, New Haven, Connecticut, USA.

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