Causal mediation analysis: what is it and how can it be used to inform practice and policy?

Abstract

Causal mediation, a quantitative analysis method, has the potential to be a valuable addition to any primary care provider, researcher, or student's toolbox. This manuscript describes the theory behind causal mediation, provides a running example to help understand the application of this method in research, and explains how the results may be applied practically to help design appropriate interventions. Causal mediation allows an exploration of the mechanism of action of a primary care intervention on an outcome that may pass through a third variable that is on the causal pathway, a mediator. Causal mediation analysis allows the decomposition of the total effect of an intervention on an outcome into both direct and indirect effects. Careful interpretation of generated results can guide decision-makers when devising or refining interventions or policies that affect patient health outcomes in primary care. Causal mediation has been used in many disciplines and is well-positioned to answer varied research questions. However, the full extent of its potential has yet to be realized.