HEALTH
PROMOTION MODEL
INTRODUCTION
The health promotion model (HPM) proposed by
Nola J Pender (1982; revised, 1996) was designed
to be a “complementary counterpart to models of
health protection.” It defines health as a
positive dynamic state not merely the absence of
disease. Health promotion is directed at
increasing a client’s level of wellbeing. The
health promotion model describes the multi
dimensional nature of persons as they interact
within their environment to pursue health. The
model focuses on following three areas:
·
Individual characteristics and experiences
·
Behavior-specific cognitions and affect
·
Behavioral outcomes
The health promotion model notes that each
person has unique personal characteristics and
experiences that affect subsequent actions. The
set of variables for behavioral specific
knowledge and affect have important motivational
significance. These variables can be modified
through nursing actions. Health promoting
behavior is the desired behavioral outcome and
is the end point in the HPM. Health promoting
behaviors should result in improved health,
enhanced functional ability and better quality
of life at all stages of development. The final
behavioral demand is also influenced by the
immediate competing demand and preferences,
which can derail an intended health promoting
actions.
ASSUMPTIONS OF THE HEALTH PROMOTION MODEL
The HPM is based on the following assumptions,
which reflect both nursing and behavioral
science perspectives:
1.
Persons seek to create conditions of living
through which they can express their unique
human health potential.
2.
Persons have the capacity for reflective
self-awareness, including assessment of their
own competencies.
3.
Persons value growth in directions viewed as
positive and attempts to achieve a personally
acceptable balance between change and stability.
4.
Individuals seek to actively regulate their own
behavior.
5.
Individuals in all their biopsychosocial
complexity interact with the environment,
progressively transforming the environment and
being transformed over time.
6.
Health professionals constitute a part of the
interpersonal environment, which exerts
influence on persons throughout their lifespan.
7.
Self-initiated reconfiguration of
person-environment interactive patterns is
essential to behavior change.
THEORETICAL PROPOSITIONS OF THE HEALTH
PROMOTION MODEL
Theoretical statements derived from the model
provide a basis for investigative work on health
behaviors. The HPM is based on the following
theoretical propositions:
1.
Prior behavior and inherited and acquired
characteristics influence beliefs, affect, and
enactment of health-promoting behavior.
2.
Persons commit to engaging in behaviors from
which they anticipate deriving personally valued
benefits.
3.
Perceived barriers can constrain commitment to
action, a mediator of behavior as well as actual
behavior.
4.
Perceived competence or self-efficacy to execute
a given behavior increases the likelihood of
commitment to action and actual performance of
the behavior.
5.
Greater perceived self-efficacy results in fewer
perceived barriers to a specific health
behavior.
6.
Positive affect toward a behavior results in
greater perceived self-efficacy, which can in
turn, result in increased positive affect.
7.
When positive emotions or affect are associated
with a behavior, the probability of commitment
and action is increased.
8.
Persons are more likely to commit to and engage
in health-promoting behaviors when significant
others model the behavior, expect the behavior
to occur, and provide assistance and support to
enable the behavior.
9.
Families, peers, and health care providers are
important sources of interpersonal influence
that can increase or decrease commitment to and
engagement in health-promoting behavior.
10.
Situational influences in the external
environment can increase or decrease commitment
to or participation in health-promoting
behavior.
11.
The greater the commitments to a specific plan
of action, the more likely health-promoting
behaviors are to be maintained over time.
12.
Commitment to a plan of action is less likely to
result in the desired behavior when competing
demands over which persons have little control
require immediate attention. 13. Commitment to a
plan of action is less likely to result in the
desired behavior when other actions are more
attractive and thus preferred over the target
behavior.
13.
Persons can modify cognitions, affect, and the
interpersonal and physical environment to create
incentives for health actions.
THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH
PROMOTION MODEL
Individual Characteristics and Experience
v PRIOR RELATED BEHAVIOR
Frequency of the similar behaviour in the past.
Direct and indirect effects on the likelihood of
engaging in health promoting behaviors.
v PERSONAL FACTORS
Personal factors categorized as biological,
psychological and socio-cultural. These factors
are predictive of a given behavior and shaped by
the nature of the target behaviour being
considered.
Personal biological factors
Include variable such as age gender body mass
index pubertal status, aerobic capacity,
strength, agility, or balance.
Personal psychological factors
Include variables such as self esteem self
motivation personal competence perceived
health status and definition of health.
Personal socio-cultural factors
Include variables such as race ethnicity,
accuculturation, education and socioeconomic
status.
Behavioural Specific Cognition and Affect
v PERCEIVED BENEFITS OF ACTION
Anticipated positive out comes that will occur
from health behaviour.
v PERCEIVED BARRIERS TO ACTION
Anticipated, imagined or real blocks and
personal costs of understanding a given
behaviour
v PERCEIVED SELF EFFICACY
Judgment of personal capability to organise and
execute a health-promoting behaviour. Perceived
self efficacy influences perceived barriers to
action so higher efficacy result in lowered
perceptions of barriers to the performance of
the behavior.
v ACTIVITY RELATED AFFECT
Subjective positive or negative feeling that
occur before, during and following behavior
based on the stimulus properties of the
behaviour itself. Activity-related affect
influences perceived self-efficacy, which means
the more positive the subjective feeling, the
greater the feeling of efficacy. In turn,
increased feelings of efficacy can generate
further positive affect.
v INTERPERSONAL INFLUENCES
Cognition concerning behaviours, beliefs, or
attitudes of the others. Interpersonal
influences include: norms (expectations of
significant others), social support
(instrumental and emotional encouragement) and
modelling (vicarious learning through observing
others engaged in a particular behaviour).
Primary sources of interpersonal influences are
families, peers, and healthcare providers.
v SITUATIONAL INFLUENCES
Personal perceptions and cognitions of any given
situation or context that can facilitate or
impede behaviour. Include perceptions of options
available, demand characteristics and aesthetic
features of the environment in which given
health promoting is proposed to take place.
Situational influences may have direct or
indirect influences on health behaviour.
Behavioural
Outcome
v COMMITMENT TO PLAN OF ACTION
The concept of intention and identification of a
planned strategy leads to implementation of
health behaviour.
v IMMEDIATE COMPETING DEMANDS AND
PREFERENCES
Competing demands are those alternative
behaviour over which individuals have low
control because there are environmental
contingencies such as work or family care
responsibilities. Competing preferences are
alternative behaviour over which individuals
exert relatively high control, such as choice of
ice cream or apple for a snack
v HEALTH PROMOTING BEHAVIOUR
Endpoint or action outcome directed toward
attaining positive health outcome such as
optimal well-being, personal fulfillment, and
productive living.
REFERENCES
-
Marriner TA, Raile AM. Nursing theorists and
their work. 5th ed. Sakraida T.Nola J. Pender.
The Health Promotion Model. St Louis: Mosby;
2005
-
Polit DF, Beck CT. Nursing research:Principles
and methods. 7th ed. Philadelphia: Lippincott
Williams & Wilkins; 2007
-
Black JM, Hawks JH, Keene AM. Medical surgical
nursing. 6th ed. Philadelphia: Elsevier Mosby;
2006.
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Potter PA, Perry AG. Fundamentals of nursing.
6th ed. St.Louis: Elsevier Mosby; 2006.
