Concept mapping: Can this methodology be useful for palliative care?


Written by Dr Amal Chakraborty, Research Assistant, ELDAC (End of Life Directions for Aged Care) Project; Research Centre for Palliative Care, Death & Dying; College of Nursing and Health Sciences; Flinders University.

The health care services in Australia are delivered by multiple providers. Due to its multifaceted nature, the Australian health care system often faces challenges in planning and evaluation of service delivery, defining and assessing quality of care, implementing safety procedures, and utilising health technologies effectively. These challenges pose burdens on the health care system and require stakeholders to work through processes and methods that can unravel the complexity. As a consequence, higher use of the health services by consumers, specifically by older populations, make them particularly vulnerable with increased risk of illnesses due to barriers in accessing health care related information, services and support.

Social science researchers over the past decades have developed and applied conceptualisation methodologies such as the ‘idea mapping’, ‘mind mapping’, ‘causal mapping’, and ‘cognitive mapping’ to better understand the complexities surrounding the health care systems. Although these methodologies are of utility for bringing clarity to individual’s creative thinking, they do not integrate input from multidisciplinary stakeholders with differing content expertise or interest. (1) By contrast, group concept mapping (GCM) methodology is a structured conceptualisation process designed to capture diverse stakeholder perspectives in organising their ideas on a given topic. (2) This mixed-method participatory approach has evolved over a period of nearly 35 years, and has been widely applied in the disciplines of medicine, public health, social work, and education. (3) The GCM methodology utilises both qualitative and multivariate statistical techniques to represent stakeholder ideas visually in a series of interpretable two-dimensional maps. (4) It is a suitable process to identify priorities for immediate application to program development, strategic/action planning and service delivery. It is also used in the areas of program evaluation to enhance the relevance, ownership and utilisation of results. A strength of the GCM approach is that it allows priorities to be tailored to different contexts based on organisational and participants’ background characteristics.

The GCM can be undertaken in either face-to-face meetings or via on-line web interface involving a six-step process. (4) These steps are: (i) preparation, (ii) generating the ideas, (iii) sorting and rating, (iv) analysis, (v) interpretation, and (vi) utilisation of the results. The preparation step involves developing research question/s and study materials, recruiting participants, arranging logistics for stakeholder participation, and obtaining ethical approval. The generating the ideas step involve face-to-face brainstorming workshops with stakeholders, analysis of interviews, abstraction of open-ended survey responses, or text extraction from literature reviews. Following a structured synthesis process, the ideas generated are then consolidated into common themes and transformed into a unique set of statements for subsequent sorting and rating activities. In sorting activity participants are asked to group all the consolidated statements into piles according to their perceived similarity. The rating activity generally involve the same participant groups and ask them to rate the consolidated statements using a 5-point scale, representing 1=not at all important/achievable, and 5=extremely important/achievable. Data generated from the sorting and rating activities are analysed using the Concept Systems Global Max software. The analysis step involves three sequential stages, which are, creating a unique binary matrix of similarities, non-metric multidimensional scaling, and hierarchical cluster analysis. Completing the data analysis, stakeholders are engaged in the interpretation step to review the results. Finally, in the utilisation step participants are engaged to discuss ‘sensibility’ of the results and their implications for policy and practice.

Application of the GCM methodology has been relatively new in Australia. (5, 6, 7) Participatory nature of this methodology may be of utility to further strengthening the evidence-base on how the palliative health care issues are perceived in primary health care, aged care, tertiary care and health promotion contexts in Australia.


1. Trochim W, Kane M. Concept mapping: an introduction to structured conceptualization in health care. International Journal for Quality in Health Care. 2005;17(3):187-91.
2. Rosas SR, Kane M. Quality and rigor of the concept mapping methodology: a pooled study analysis. Evaluation and Program Planning. 2012;35(2):236-45.
3. Trochim WM, McLinden D. Introduction to a special issue on concept mapping. Evaluation and Program Planning. 2017;60:166-75.
4. Kane M, Trochim WM. Concept mapping for planning and evaluation: Sage; 2007.
5. Dawson AP, Cargo M, Stewart H, Chong A, Daniel M. Identifying multi-level culturally appropriate smoking cessation strategies for Aboriginal health staff: a concept mapping approach. Health Education Research. 2013;28(1):31-45.
6. Stankov I, Howard N, Daniel M, Cargo M. Policy, Research and Residents’ Perspectives on Built Environments Implicated in Heart Disease: A Concept Mapping Approach. International Journal of Environmental Research and Public Health. 2017;14(2):170.
7. Cargo M, Potaka-Osborne G, Cvitanovic L, Warner L, Clarke S, Judd J, et al. Strategies to support culturally safe health and wellbeing evaluations in Indigenous settings in Australia and New Zealand: a concept mapping study. International Journal for Equity in Health. 2019;18(1):194.

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