Environmental stimuli include three middle range theoretical concepts, and their empirical
indicators. These are: (a) focal—those stimuli immediately confronting individuals, i.e.,
chronic illness; (b) contextual--contributing factors, i.e., degree of rurality, demographics, and
hardiness; and (c) residual stimuli--unknown factors that may influence the situation, i.e.,
optimism, spirituality (Roy & Andrews, 1999).