Original ArticlesUpstream Factors in Population Health A Concept Analysis to Advance Nursing TheoryDistelhorst, Karen S. PhD, APRN, GCNS-BC; Graor, Christine Heifner PhD, APRN-BC; Hansen, Dana M. PhD, APRN, ACHPNAuthor Information Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, Ohio (Dr Distelhorst); School of Nursing, University of Akron, Akron, Ohio (Dr Graor); and College of Nursing, Kent State University, Kent, Ohio (Dr Hansen). Correspondence: Karen S. Distelhorst, PhD, APRN, GCNS-BC, Office of Nursing Research and Innovation, Cleveland Clinic, 9204 Euclid Ave/T4-42, Cleveland, OH 44195 ([email protected]). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Advances in Nursing Science: July/September 2021 - Volume 44 - Issue 3 - p 210-223 doi: 10.1097/ANS.0000000000000362 Buy Metrics Abstract The assessment of upstream factors is important in population-based nursing practice. The aim of this concept analysis is to enhance understanding of upstream factors and articulate a definition linked to the Conceptual Model for Nursing and Population Health. Upstream factors are thus defined as established conditions related to economic, social, and physical environments that occur outside the health care system, in the communities where people live, and contribute indirectly to the health outcomes for groups of individuals through multiple causal pathways. This concept analysis highlights the need for middle-range theory to guide nursing assessment and contributes to conceptual model evaluation. © 2021 Wolters Kluwer Health, Inc. All rights reserved.