Supplement to Chapter 4 Complex Relationships and Hypotheses
Complex Relationships and
4 Hypotheses
A s discussed in the textbook, some studies
focus on research questions that are fairly
straightforward and that involve understanding the
relationship between two variables. Examples may
include exploring:
• The effect of an illness (the independent variable
or IV) on fatigue (the dependent variable or DV),
• The effect of a nursing intervention (IV) on pain
(DV), or
• The effect of pain (IV) on quality of life (DV).
Sometimes, however, researchers study multiple
variables that may be interrelated in complex ways.
This Supplement describes some aspects of
complex relationships and complex hypotheses.
We begin by explaining moderating and mediat-
ing variables. For those who wish to learn more,
Bennett (2000) has written a useful description of
the conceptual and statistical differences between
the two.
M O D E R AT I N G
VA R I A B L E S
A moderator variable (MV) affects the strength
or direction of an association between the indepen-
dent and dependent variable. Identifying modera-
tors may be important in understanding when and
for whom to expect a relationship between the IV
and DV, and it often has clinical relevance—for
Polit10e_Supp_Ch04.indd 4-1
• 4-1
example, who benefits the most or the least from
an intervention.
Research Question 1: What is the effect of
nurses’ use of humor (versus the absence of
humor, the IV) on stress (the DV) in hospital-
ized cancer patients (the population)?
Research Question 2: Does nurses’ use of humor
have a different effect on stress in male versus
female patients?
Research Question 1 is a simple research question
with only two variables. Research Question 2 ex-
amines whether the relationship between the IV
and the DV is influenced by or moderated by a
third variable. In this example, gender is an MV.
Moderator (or moderating) variables can be charac-
teristics of the population (e.g., male versus female
patients), of the circumstances (e.g., rural versus
urban settings), or of external agents (e.g., male
versus female nurses using humor). The follow-
ing are examples of question templates that involve
an MV:
• Treatment, intervention: In (population), does the
effect of (IV: intervention) on (DV) vary by (MV)?
• Prognosis: In (population), does the effect of
(IV: disease, condition) on (DV) vary by (MV)?
• Etiology, harm: In (population), does (IV: ex-
posure, characteristic) cause or increase risk of
(DV) differentially by (MV)?
4-1
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 4-2 • Part 2 Conceptualizing and Planning a Study to Generate Evidence for Nursing
M E D I AT I N G VA R I A B L E S
When a study purpose is to understand causal path-
ways, research questions may involve a mediating
variable—a variable that intervenes between the IV
and the DV and helps to explain why the relation-
ship exists. For example, we might ask the follow-
ing: Does nurses’ use of humor have a direct effect
on the stress of hospitalized patients with cancer, or
is the effect mediated by humor’s effect on immune
function (natural killer cell activity)? A mediating
variable can be conceptualized like this:
humor → natural killer cell activity → patient stress
This means that the path through which nurses’
humor affects stress is its effect on natural killer
cell activity.
Many of the theoretical models described in
Chapter 6 of the book involve mediating factors.
Important health outcomes are often not directly
affected by nursing actions but rather by their ef-
fects on such factors as self-efficacy, anxiety, im-
proved health-promoting behaviors, and so on. In
intervention research, moderating variables help
researchers better understand how the intervention
works. Chapter 18 of the book provides an exam-
ple of how hypotheses about mediating variables
are tested.
# Onyewuche (2014) hypothesized that abdominal
T I P : For those with strong statistical
skills, a paper by Levy and colleagues (2011)
discusses advances in statistical methods for
testing hypotheses about mediation effects. This
paper is available online as an open-access
article, and a link to it is provided in the Toolkit
on for Chapter 4.
Example of Moderating and Mediating
Variables: Christopherson and Conner (2012)
studied health-risk behaviors in late adolescence. In
their study of 437 adolescents, loneliness was a me-
diating variable, mediating the relationship between
parental attachment and smoking. Gender moder-
ated the relationships, and so separate analyses
were undertaken for males and females.
Polit10e_Supp_Ch04.indd 4-2
SIMPLE AND COMPLEX
H Y P OT H E S E S
As mentioned in the textbook, hypotheses can be either
simple or complex. We define a simple hypothesis as
a hypothesis that states the predicted relationship be-
tween a single IV and a single DV.
Simple Hypotheses
Figure 4.1 presents a diagram illustrating a simple
hypothesis. In this figure, the hypothesis predicts a
relationship between one IV and one DV (outcome).
In Figure 4.1, the IV is the presumed cause, influ-
ence, or antecedent of DV, which is the predicted
outcome, effect, or consequence. The circles repre-
sent IV and DV, and the hatched area where the two
circles overlap designates the strength of the relation-
ship between them. If the variables were unrelated,
the circles would not overlap at all. For example, let
us suppose that the IV is smoking (versus not smok-
ing) and the DV is having (versus not having) lung
cancer. If the circles did not overlap, it would suggest
that smoking (IV) was unrelated to lung cancer. If
the two circles overlapped completely, it would sug-
gest that everyone who smoked developed lung can-
cer. The relationship depicted in Figure 4.1 suggests
that smoking status is related to lung cancer but that
some smokers do not get cancer—and some people
with lung cancer were not smokers.
Example of a Simple Hypothesis: Nafiu and
obesity (IV) increases the risk of perioperative ad-
verse respiratory events (DV) in children undergoing
elective, noncardiac surgeries.
IV DV
FIGURE 4.1 Schematic representation of a simple
hypothesis. IV, independent variable; DV, dependent
variable.
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 Supplement to Chapter 4 Complex Relationships and Hypotheses
Complex Hypotheses
Most phenomena are affected by a multiplicity
of factors. A person’s weight, for example, is af-
fected simultaneously by such factors as height,
diet, bone structure, activity level, and metabolism.
If the DV were weight and the IV was a person’s
caloric intake, we would not be able to explain or
understand individual variation in weight very well.
For example, knowing that Alex O’Hara’s daily ca-
loric intake averages 2,500 calories would not per-
mit a good prediction of his weight. The overlap
in circles indicating the strength of the relationship
between caloric intake and weight would likely be
smaller than what is shown in Figure 4.1.
Many other factors are related to a person’s
weight, however. Knowledge of those factors, such
as Alex’s height, would improve our ability to accu-
rately understand and predict his weight. Figure 4.2
presents a schematic representation of a complex
hypothesis, showing the situation in which the DV
is influenced by two IVs (IV1 and IV2). To pursue
the preceding example, the hypothesis might be:
Taller people (IV1) and people with higher caloric
intake (IV2) weigh more (DV) than shorter people
and those with lower caloric intake. In this example,
we expect that caloric intake and height would do a
better job in helping us explain variation in weight
(DV) than caloric intake alone. Complex hypoth-
eses have the advantage of allowing researchers to
capture some of the complexity of the real world.
IV1
DV
IV2
FIGURE 4.2 Schematic representation of a complex
hypothesis. IV, independent variable; DV, dependent
variable.
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• 4-3
Example of a Complex Hypothesis with
Multiple Independent Variables: Jolley and col-
leagues (2014) hypothesized that age (IV1), illness
severity (IV2), and presence of a tracheostomy (IV3)
would predict levels of the receipt of a physical
therapy consultation among patients requiring pro-
longed mechanical ventilation.
Just as a phenomenon can be caused or influ-
enced by more than one IV, a single IV can also
influence more than one phenomenon, as illustrated
in Figure 4.3. A number of studies have found, for
example, that cigarette smoking (IV) can lead to
both lung cancer (DV1) and coronary disorders
(DV2). Complex hypotheses are common in studies
that try to assess the effect of a nursing intervention
on multiple outcomes.
Example of a Complex Hypothesis—Multiple
Dependent Variables: Grey and colleagues
(2011) hypothesized that participation in a coping
skills training program for parents of children with
type 1 diabetes, compared to nonparticipation (IV),
would result in better coping (DV1), quality of life
(DV2), and children’s metabolic control (DV3).
Although hypotheses can be even more complex
(e.g., two IVs predicting two DVs), the hypotheses
in nursing studies often are like the ones shown in
Figures 4.1, 4.2, or 4.3.
DV1
IV
DV2
FIGURE 4.3 Schematic representation of a complex
hypothesis. IV, independent variable; DV, dependent
variable.
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 4-4 • Part 2 Conceptualizing and Planning a Study to Generate Evidence for Nursing
Hypotheses are also complex if mediating or mod-
erator variables are included in the prediction. For
example, it might be hypothesized that the effect of
caloric intake (X) on weight (Y) is moderated by gen-
der (Z)—that is, the relationship between height and
weight is different for men and women. Or, we might
predict that the effect of ephedra (X) on weight (Y) is in-
direct, mediated by ephedra’s effect on metabolism (Z).
REFERENCES CITED IN
CHAPTER 4 SUPPLEMENT
Bennett, J. A. (2000). Mediator and moderator variables in
nursing research: Conceptual and statistical differences.
Research in Nursing & Health, 23, 415–420.
Christopherson, T. M., & Conner, B. T. (2012). Mediation of
late adolescent health-risk behaviors and gender influences.
Public Health Nursing, 29, 510–524.
Polit10e_Supp_Ch04.indd 4-4
*Grey, M., Jaser, S., Whittemore, R., Jeon, S., & Lindemann, E.
(2011). Coping skills training for parents of children with
type 1 diabetes: 12-Month outcomes. Nursing Research, 60,
173–181.
Jolley, S. E., Caldwell, E., & Hough, C. (2014). Factors associ-
ated with receipt of physical therapy consultation in patients
requiring prolonged mechanical ventilation. Dimensions of
Critical Care Nursing, 33, 160–167.
*Levy, J.A., Lenderman, L., & Davis, L. (2011). Advances in
mediation analysis can facilitate nursing research. Nursing
Research, 60, 333–339.
Nafiu, O. O., & Onyewuche, V. (2014). Association of abdomi-
nal obesity in children with perioperative respiratory adverse
events. Journal of Perianesthesia Nursing, 29, 84–93.
Sawatzky, R., Ratner, P., Richardson, C., Washburn, C.,
Sudmant, W., & Mirwaldt, P. (2012). Stress and depression
in students: The mediating role of stress management self-
efficacy. Nursing Research, 61, 13–21.
*A link to this open-access journal article is pro-
vided in the Toolkit on for this chapter in
the accompanying Resource Manual. #
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