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In the real world, the determinants are interconnected, forming a web of factors contributing to the experience of the health problem. The determinants can co‐occur simultaneously or sequentially, and interact with each other to produce the health problem. For instance, older persons are prone to arousability (i.e. light sleep), which may be exacerbated if they reside in a noisy neighborhood (simultaneous); they start drinking alcohol (sequential) thinking that it would help them sleep better; alcohol causes light sleep thereby further contributing to awakenings at night, and intensifies the effects of medications such as sleeping pills and other antidepressants (interaction). The specific determinants or combination of factors contributing to the health problem could vary across client populations or within the same population over time. For example, young and middle‐aged adults (compared to older adults) report difficulty falling asleep, which they attribute to stress related to daily life and work; the level at which they experience this sleep difficulty fluctuates over time as a result of changes in life and work events and clients' use of effective strategies to promote sleep (e.g. engagement in relaxation).

The identification and the specification of the inter‐relationships among determinants are essential for understanding why and how the health problem is generated and maintained. A critical analysis of the inter‐relationships (described in Chapter 4) assists in determining the factors that are and are not amenable to change (Aráujo‐Soares et al., 2018; Bartholomew et al., 2016; Fernandez et al., 2019; Lippe & Ziegelman, 2008). Factors that are malleable and have the greatest scope for change are targeted by the intervention (Wight et al., 2016); they inform the specification of its active ingredients. Factors that cannot be modified (e.g. personal and contextual characteristics) are considered as potential moderators, indicating the need for tailoring of the intervention (Fleury & Sidani, 2018).