title: Testing mediation in nursing research: beyond Baron and Kenny.
abstract: BACKGROUND
  R. M. Baron and D. A. Kenny (1986) defined mediation and described how to perform statistical tests of mediation hypotheses. Their approach to testing mediation has been used extensively in the nursing literature. However, many statisticians have identified problems with the Baron and Kenny approach.
  
  
  OBJECTIVE
  The aim of this paper is to critically evaluate alternative approaches to testing mediation.
  
  
  METHODS
  The Baron and Kenny approach and its shortcomings are briefly reviewed. A critical analysis of 17 alternate methods in three categories is then presented: (a)causal steps, (b) difference in coefficients, and (c) product of coefficients. The evaluation focuses on Type I error rate control, power, ease of computation, and versatility of use.
  
  
  RESULTS
  Of the methods that control Type I error rate adequately, the joint significance test of [alpha] and [beta], the asymmetric distribution of products test, and the test of the products using the percentile bootstrap method are the most powerful tests of mediation. Of these three, the joint significance test of [alpha] and [beta] is superior due to its computational ease and versatility of use.
  
  
  CONCLUSIONS
  Knowledge development in nursing will benefit from continued research testing mediation models. Nurse researchers could move beyond the Baron and Kenny approach to utilize more robust tests of mediation.
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Box 2455, Clinical Sciences Center, K6/3, 600 Highland Avenue, Madison, WI 53792, USA.
authors.forename: Melanie R
authors.initials: MR
authors.lastname: Krause
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Serlin
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Ward
authors.forename: Rachel Yaffa Zisk
authors.initials: RY
authors.lastname: Rony
authors.forename: Miriam O
authors.initials: MO
authors.lastname: Ezenwa
authors.forename: Florence
authors.initials: F
authors.lastname: Naab
mesh_terms: D015982:Bias; D003627:Data Interpretation, Statistical; D015987:Effect Modifier, Epidemiologic; D006801:Humans; D015233:Models, Statistical; D009010:Monte Carlo Method; D015399:Nursing Research / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D012107:Research Design; D018709:Statistics, Nonparametric
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