University of Leicester
2019_LEVENE_LS_PhD.pdf (1.03 MB)

Analysing Determinants of Illness in Populations: Development of a Conceptual Framework Linked to a Sequence of Related Empirical Studies

Download (1.03 MB)
posted on 2019-07-16, 13:06 authored by Louis S. Levene
Background: Conceptual frameworks can help researchers and services by characterising disparities in health needs and outcomes between populations, and how these are affected by risk and non-disease factors. As no published conceptual frameworks fully fitted my research needs, I developed a new framework in conjunction with a series of observational studies. Research questions: Does a new conceptual framework for population health research help to: 1. Generate testable hypotheses 2. Establish useful sets of relevant variables for inclusion in analyses 3. Describe relationships between these variables? The framework’s configuration The framework has two components: 1. An illness pathway with three variable groups: illness determinants, health needs, and health outcomes. 2. Two variable groups acting as modifiers of the illness pathway: context (factors not generating illness but describing the settings in which populations live) and interventions. Observational studies: Using the framework, five population studies resulted in seven publications, which: 1. Described how both non-disease variables and clinical performance variables predict variations and persistent disparities in mortality rates between population groups in England 2. Demonstrated that current allocations of practice funding may insufficiently support general practices serving very deprived populations with greater health needs 3. Described the pervasive widespread decline of continuity of care, reflecting general practices’ struggles to provide adequate patient access. Conclusions: The framework supported my research and has service utility. The publications have contributed to knowledge and are relevant to current debates about addressing health inequalities and worsening access to primary care. These studies demonstrate my suitability to undertake research.



Khunti, Kamlesh

Date of award


Author affiliation

Department of Health Sciences

Awarding institution

University of Leicester

Qualification level

  • Doctoral

Qualification name

  • PhD



Usage metrics

    University of Leicester Theses