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Copy of Nola Pender's Health Promotion Model

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Monica Meier

on 12 June 2016

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Transcript of Copy of Nola Pender's Health Promotion Model

Context for Developing
the Health Promotion Model
Focus of health care at the time was based around
of disease
The majority of models were
oriented and focused on
sources of motivation
Example: Health Belief Model: "fear" or "threat" motivates health behavior
Pender wanted to intervene before acute and chronic health problems developed in attempt to:
1. Improve quality of life
2. Reduce health care costs

HPM's Assumptions
1. Individuals seek to actively regulate their own behaviors

2. Individuals, in all their biopsychosocial complexity, interact with the environment transforming the environment as well as being transformed over time

3. Health professionals, such as nurses, constitute a part of the interpersonal environment, which exerts influence on people through their life span

4. Self-initiated reconfiguration of the person-environment interactive patterns is essential to changing behavior

Major Concepts
1. Individual characteristics and experiences

Individuals and their experiences are unique
Prior related behavior
- "often the best predictor of behavior is the frequency of the same or a similar behavior in the past" (Pender et al, 2011).
Can have direct &/or indirect effects on predicting engagement in health-promoting behaviors
Personal factors
- biologic, psychologic, and sociocultural
General characteristics that influence health behavior
I.e.) Age, race, BMI, self-esteem, SES, education, health perception, etc.

Theory Evaluation
Move away from treatment approach & negative sources of motivation

Important concept is behavior-specific variables and their motivational significance; considered modifiable through nursing interventions

Logical Adequacy:
Provides for predictive ability related to specific concepts (self-efficacy, perceived barriers; social support). Relationship between concepts is clear and makes sense with end-point being a health-promoting action

Widely used model among researchers, nurses, and other health care disciplines to predict health promoting behaviors

The model is multidimensional and highly generalizable to a wide range of populations, health settings, and health-promoting behaviors. Specific to health-promotion.

The model's purpose can be stated clearly, though the model is complex and includes a large number of concepts

Specific concepts can be tested to determine their predictability, though testing of the entire HPM remains limited and a continued challenge due to its complexity.
Health Promotion Model (HPM)

• Middle range nursing model; approach-oriented model

• 1982- First published; 1996- revised to include changes in theoretical perspectives and empirical findings
First version
- general influences on health behaviors
Second version
- behavior-specific influence – found to be more predictive than general influences

• Combines the nursing perspective with concepts from expectancy-value theory and social cognitive theory
Expectancy-value theory
: Individuals partake in actions to meet goals that are perceived as possible and that result in positive outcomes
Social cognitive theory
: Interaction between thoughts, behavior & environment --> in order to alter behavior, one must alter how they think

• “A framework for integrating nursing and behavioral science perspectives with factors influencing health behaviors” (Pender et al, 2011)

Designed to guide nurses in assessing the biopsychosocial processes behind individuals’ motivation to engage in behaviors directed toward improving health

By understanding the determinants of health behaviors, nurses can collaborate with patients/clients to assist them in changing behaviors and achieving healthy lifestyles

So what's its Purpose?
Behavior-specific Cognitions and Affect

Perceived benefits of action, perceived barriers to action; perceived self-efficacy:
Individuals are more likely to engage in a target behavior if they: believe the action will provide positive outcomes (intrinsic or extrinsic), perceive barriers as being low; feel efficacious/skilled to perform the action
self-efficacy --> perception of barriers
Activity-related affect:
Subjective + or - feeling based on stimulus properties associated with behavior
positive subjective feeling --> self-efficacy
self-efficacy --> positive affect
Interpersonal influences
Behaviors, beliefs, or attitudes of family, peers, & healthcare providers as they relate to norms, social support, and modeling can influence undertaking of behaviors
Situational influences
Include options available, demand characteristics, & aesthetic features of the behavior environment and can influence behavior

Critical focus for nursing intervention as it includes modifiable factors**
**Highly motivating variables**
Behavioral outcome
Immediate competing demands, commitment to action plan; health promoting behavior
End-point/action outcome
Health promoting behaviors result in improved health

Major Concepts Continued....
Application in Research
HPM and the Nursing Metaparadigm
biopsychosocial organism
shaped partially by the environment
seeks to establish an environment where the highest level of human potential can be reached
person and environment = reciprocal
social + cultural + physical context
capable of being positively manipulated to facilitate improved health behaviors
realization of inherent/acquired human potential through goal-oriented behavior, competent self-care; fulfilling relationships
events occurring throughout life
can hinder or facilitate the continued quest for health
collaboration with individuals, families, & communities
create positive environment for achieving optimal health/well-being
Personal Practice
(Pender, 2011)
Nursing Theorist: Nola Pender

• Attended Michigan State University: bachelor & masters degrees 1964 & 1965

• Ph.D. from Northwestern University in 1969

• Began studying health-promoting behavior in the mid-1970’s

• Lifetime Achievement Award from Midwest Nursing Research Society in 2005

• Has countless publications including 6 editions of
Health Promotion in Nursing Practice

• Co-founded the Midwest Nursing Research Society

• Professor emerita in the Division of Health Promotion and Risk Reduction at the University of Michigan School of Nursing

• Currently retired; spends time consulting health promotion research

Background on Pender
Putting it together in a Diagram
(Pender et al, 2011)
>250 articles have been published in the last decade that report using/applying HPM

In the past decade, studies “have focused on testing the predictability of the model rather than as a theoretical basis for developing and testing interventions to study the mechanisms of change proposed by the model” (Pender et al, 2011)

Often used as a conceptual framework for study

The majority of Pender’s work looks at health promotion related to adolescents and exercise/physical activity
Wu & Pender (2002) looked at Taiwanese adolescents and the relationship between interpersonal influences, behavior-specific cognitions, competing demands, and physical activity. Found that behavioral-specific cognitions have greater predictive value than interpersonal influences and that perceived efficacy was the strongest variable for this population.

A study by Esposito & Fitzpatrick (2011) used the HPM and 2 derived research tools to look at the relationship between nurses' perception of exercise benefits, their personal exercise behaviors, and their recommendation of exercise to patients
Found a positive correlation between exercise benefits, physical activity, & exercise recommendations

Other studies have used the HPM to predict health-promoting behaviors in a wide variety of patient populations including homeless women, female cancer patients, college students, construction workers, farmers, diabetes patients, and many more!

**Major weakness in many of the studies = incomplete testing of the entire model
Test only a handful of concepts for ability to predict health-promoting behaviors

Application in Practice
But first a word from the Theorist herself...
Application in Practice
• Health promotion can benefit ALL individuals at any point in their lives

• Nursing- key role in developing and implementing health promotion interventions for individuals, families; communities in wide variety of settings

• Study by Esposito & Fitzpatrick (2011) found that nurses who engage in healthy behaviors and have positive attitudes regarding health promotion are more likely to educate patients on healthy behaviors and act as role models for their patients

• Can use HPM as framework for empowering individuals to perform self-care and improve health outcomes
Focus on behavior-specific cognitions- modifiable

• “Successfully addressing modifiable behavior-specific variables in the HPM, such as activity-related affect, as well as interpersonal and situational influences, will enable health-care professionals to assist clients to overcome their barriers and enhance their self-efficacy in relation to lifestyle modification” (Ho et al, 2010).

• Model has been used to develop instruments/tools to measure health promotion model variables in practice
i.e.) Health Promoting Lifestyle Profile II

Try it! Are you leading a health promoting lifestyle?
Nola Pender's
Health Promotion Model

Brittany Granara
Using Theory Analysis by Walker & Avant
(Walker et al, 1995)
• Health promotion can significantly impact the quality of life for individuals as well as the health care system as a whole

• Health promotion is central to nursing practice and APRNs can play an essential role in promoting healthy lifestyles for patients, families and communities

• As a future AGNP, I envision myself using the HPM as a guide to explore patient’s motivation to change and adopt healthy lifestyles whether it is a new diabetic, an obese adolescent, a smoking mother, an athlete, a college freshman, etc.

• The model can help me to assess determinants of health based on the individual, act as a positive role model, develop appropriate nursing interventions and provide education in order to guide positive behavior change

Clinical example
: 28 year-old new mother working full-time as a RN on a busy inpatient floor. Overall healthy individual who is looking to lose the extra 15 lbs of baby weight. She is struggling with her busy schedule and making time for herself. Lives close to the hospital with her husband and their 3-month-old daughter.
Perceived benefits: will lose the weight; improved self-esteem; more energy
Perceived barriers: lack of time, eating on the go; can't afford gym membership
Perceived self-efficacy: limited confidence that she can achieve the action
Activity-related affect: describes feeling great and energized when she does make time to exercise and eat right
Interpersonal influences: supportive family/husband, husband is active = role model
Situational influences: lives on the bike path, easy access to exercise

Assessment of this individual reveals that the greatest variables for nursing intervention is related to perceived barriers and self-efficacy. Working with this woman to evaluate behavior-specific variables and develop strategies for overcoming perceived barriers is key to guiding this patient toward commitment to a plan of action and/or adopting the health-promoting behavior (physical activity). Additionally, boosting self-efficacy is key as it has been shown to decrease perception of barriers and enhance likelihood of engaging in health-promoting behavior.

Photo retrieved from:

Retrieved from: http://nursingtheories.weebly.com/nola-pender.html
(FITNEinc, 2011)
Esposito, E.M., & Fitzpatrick, J.J. (2011). Registered nurses’ beliefs of the benefits of exercise, their exercise behavior and their patient teaching regarding exercise. International Journal of Nursing Practice, 17, 351-356

FITNEinc. (October, 2011). Retrieved from: www.youtube.com

Galloway, R. D. (2003). Health promotion: Causes, beliefs and measurements. Clinical Medical Research, 1(3), 249-258.

Gonzalo, A. (2011). Nola Pender: Health promotion model. Theoretical Foundations of Nursing. Retrieved from: http://nursingtheories.weebly.com/nola-pender.html

Ho, A. Y., Berggren, I., & Dahlborg-Lyckhage, E. (2010). Diabetes empowerment related to pender’s health promotion model: A meta-synthesis. Nursing and Health Sciences, 12 (2), 259-267.

McEwen, M., & Wills, E. M. (2014). Theoretical Basis for Nursing (4th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Nursing Theory. (2013). Health Promotion Model. Nursing Theory. Retrieved from: http://www.nursing-theory.org/theories-and-models/pender-health-promotion-model.php

Pender, N.J. (2011). Health promotion model manual. University of Michigan Deep Blue. Retrieved from: http://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf?sequence=1&isAllowed=y

Pender, N.J., Murdaugh, C. L., & Parsons, M.A. (2011).
Health Promotion in Nursing Practice (6th Edition). Boston, MA: Pearson

University of Michigan School of Nursing. Nola J. Pender. Retrieved from: http://nursing.umich.edu/faculty-staff/nola-j-pender

Walker, S.N., Sechrist, K.R., & Pender, N.J. (1995). Health promotion model- Instruments to measure health promoting lifestyle: Health promoting lifestyle profile (HPLP II). Retrieved from: http://deepblue.lib.umich.edu/bitstream/handle/2027.42/85349/HPLP_II-English_Version.pdf?sequence=3&isAllowed=y

Wu, T. Y., & Pender, N. (2002). Determinants of physical activity among Taiwanese adolescents: An application of the health promotion model. Research in Nursing & Health, 25 (1), 25-36. Doi: 10.1002/nur.10021.
Discussion Board Questions:
1. Pender describes her desire to implement a model based on a positive approach to health seeking behavior as opposed to the prevention models present at the time that were focused on negative sources of motivation (i.e. Health Belief Model). Can you differentiate between positive vs. negative sources of motivation? Do you think one approach is better than the other? Please provide clinical examples.

2. In the interesting article I posted last week by Whitehead (2006), the difference between health promotion and health education was discussed and Pender’s HPM was questioned as being more of a health education model rather than a health promotion framework (look at pages 177-178). After reviewing this presentation about the HPM, what would you classify it as? How do you distinguish between health promotion and health education in the clinical setting?

Whitehead, D. (2006). Health promotion in the practice setting: Finding from a review of clinical issues. Worldviews on Evidence-Based Nursing, 3(4), 165-184.
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