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Pender's Health Promotion Theory

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Lisa Heard

on 7 December 2013

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Transcript of Pender's Health Promotion Theory

Nola Pender's Health Promotion Theory
Pender's Inspiration for the HPM
Professionals intervening after the development of acute or chronic health conditions
Believed prevention of health problem would improve of quality of life
Pender was convinced there could be savings in health care dollars
Felt theories focused on negative motivation and decided to develop a model focusing on positive motivation
Internal Criticism - Consistency

The theory follows a consistent path using the concepts to lead to the end point of the action – health-promoting behavior.
These key concepts are logical and follow throughout the model consistently.

Pender's Background
1941 - Born in Lansing, Michigan
1962 - received diploma in nursing and worked on medical surgical unit in Michigan Hospital
1964 - completed BSN at Michigan State University
1969 - earned Ph.D. from Northwestern University
1972 - received Distinguished Alumni Award, Michigan State University School of Nursing

Evolution of the HPM
1982 - The first version was introduced ~ promotion of optimal health supersedes disease prevention
Study results suggested the model needed additional concepts to increase its power to predict health behavior and its potential use in the development of health promoting nursing interventions (Peterson & Bredow, 2013)
1996 - Theory was revised
Description of the HPM
Middle range theory
Identifies background factors and perceived perceptions of self that influence a individual’s health behavior.
Focus is on health promotion and not on illness prevention.
Health is not defined as "free of disease".
The definition is expanded to include measures taken to promote good health and the individual’s perception of themselves and their life style (Peterson & Bredow, 2013).
Purpose is to assist nurses in understanding the major determinants of health behaviors as a basis for behavioral counseling to promote health lifestyles.

Two theories underlie Pender’s HPM
Expectancy-value theory (Fishbein & Ajzen, 1975)
Individuals are more likely to work toward goals that seem achievable and result in personal gain (Peterson & Bredow, 2013).
Social cognitive theory (Bandura , 1986)
Individuals are more likely to engage in an activity if they are confident they will be able to complete it, even with the presence of barriers (Peterson & Bredow, 2013).

Presented by:
Lisa Heard
Erin Swanton
Theory Description
HPM Diagram
Metaparadigm Concepts

Biological – BMI
Sociological – race, ethnicity, education, socioeconomic status
Physiological – self perception of health status, confidence,
Advocates for health across the life span
Promotes a state of increased well being
Where and individual spends most of their time
Promoting healthy behavior

*Person and environment have a reciprocal relationship*
HPM addresses a person’s desire to be “well”.
Recognition of the influence of healthy behaviors on well-being.
Focuses on “attainment of wellness” - does not use threat to health as a motivator

Are there holes or gaps in the HPM?
Pender used the ideas of theorists to solidify her theory.
Underlying principles - People will work toward a goal if they believe it is of value to them and if they have confidence that it is attainable for them.
Theory is directed on the individual but subject matter may be expanded to a population such as a family, community or society - more research needed
Three major concepts in Pender’s HPM

Individual characteristics and experiences –prior related behavior
Behavior-specific cognitions and affect – how the individual perceives the action will personally benefit them
Behavioral outcome – confidence level
Theory Development
Internal Criticism -Adequacy
Internal Criticism - Clarity
Major concepts for HPM are clear, understandable, tangible
These characteristics affect health promoting actions:
Prior related behavior
Personal factors
Perceived benefits to action
Perceived barriers to action
Perceived self efficacy
Activity related effect
Interpersonal influences
Commitment to a plan of action
Immediate competing demands
Health promoting behavior

The model serves to clarify nursing’s role in “delivering health promoting services to person’s of all ages” (Tomey & Alligood).

Key Concepts of HPM
Individual -
Prior related behavior
Personal factors: biological, psychological, sociocultural
Behavioral-specific -
Perceived benefits of action
Perceived barriers to action
Perceived self-efficacy
Activity-related affect
Interpersonal influences
Situational influences
Behavior outcome -
Commitment to plan of action
Immediate competing demands
Immediate competing preferences
Health promoting behavior

Internal Criticism - Logical Development
The theory follows previously known thoughts and are well supported by two theories:
Expectancy Value Theory
Social Cognitive Theory
Key component's relationship to health promoting behaviors follow a logical course
The conclusions are a result of the components used
Arguments are well supported by theses theories
In her 1996 revision, Pender dropped concepts that were tested and found unreliable
The model is approach oriented as it focuses on the attainment of a goal.

Maintains the definition of the key components throughout the explanation?
The definition of each component in clear and is maintained through out the model.

Level of Theory Development
The HPM is consistent with Middle Range Theory conceptualization
Focuses on a specific phenomenon in healthcare, health-promoting behavior.
It is tangible and pertinent to an individual’s lifestyle
Not abstract

Theory lends itself to empirical testing -
may be used for research aimed at predicting health promoting lifestyles and specific behaviors that enhance health.

It has been refined to focus on 10 determinants of behavior that can be assessed for each patient (Pender, 1996).

The scope of this theory is narrow with focus on the major area of concern for nursing, health promotion
HPM has been widely used in nursing practice
Aids in development of an individualized plan for health promotion by providing a more complete profile of the patient

Variables/key concepts address health promoting behaviors and direct nurses to “systematically assess patients for perceived self efficacy, perceived barriers perceived benefits, interpersonal influences and situational influences that are relevant to the selected health behavior.”(Peterson and Bredow, 2013, p. 227).

Although it is more applicable to practice there are several articles to suggest that further use of the model in practice would be helpful (George, 2006).

External Criticism - Scope
External Criticism - Reality Convergence

External Criticism - Utility
Pender’s HPM is useful to nursing practice

It has been used as a reliable empirical tool to determine probability of health promoting behavior.

Two examples of nursing research using HPM as a framework 
Registered nurses beliefs of the benefits of exercise behavior and their patient teaching regarding exercise
Lifestyle risk factor modification in midlife women with type II diabetes: theoretical modeling of perceived behaviours
Describes the phenomena of “health promotion” which is of interest to nursing

Theory is comprised of a variety of factors of interest to nursing such as;
Assessment of a client’s behavior
Perceived barriers (situational, interpersonal)
Benefits of modified behavior
The theory represents secondary prevention
The theory has been applied to several research studies
External Criticism - Significance
The theory focuses on secondary prevention, health promotion rather than disease prevention
The role of the nurse is to act as a “change agent”
The nurse may assess the client’s health, health beliefs, and behavior to develop individualized nursing interventions to change the client’s behavior toward their health

External Criticism - Pragmatic
HPM can be integrated in the nurses role :
Act as guide for the nurse to develop interventions that will promote behavior change
Interventions may be nutrition, social support, exercise and stress management
Aid in health coaching through assessing a level of commitment to planed behavior change and by providing reinforcement

External Criticism - Discrimination
HPM is unique to nursing – concepts are used to develop nursing interventions that will change client behavior
Unlike other theories focused on health promotion HPM does not focus threat of disease as a motivation for behavior change
Easily applied to individual client care
More research is needed as to how the theory can be applied to families and communities

External Criticism - Complexity
The phenomena of health promotion is complex
The model uses a limited number of concepts which makes it clear, concise and applicable to nursing
Concepts may be interrelated with other concepts within the model
Diagram aids in clarity
George, J. (2011) Nursing theories: The base for professional nursing practice. (6th ed.) New Jersey: Pearson.

McGuire, A. M., Anderson, D. J., (2012 ). Lifestyle risk factor modification in midlife women with type II diabetes: theoretical modeling of perceived behaviours. Australian Journal of Advanced Nursing, 30(1), 49-57.

Esposito, E. M., Fitzpatrick, J. J., (2011) Registered nurses beliefs of the benefits of exercise behavior and their patient teaching regarding exercise. International Journal of Nursing Practice, 17, 351-356. doi:10.1111/j.1440-172x.2011.01951.x

FITNEinc (2011, October 10). The Nurse Theorists V2 - Nola Pender Promo. Retrieved November 3, 2013 from

Pender, N. J. (2008). Portraits of excellence, 2. Available from

Pender, N. (2001). Nursing Theory. Retrieved from

Peterson, S.J., & Bredow, T.S. (2013). Middle range theories: Application to nursing research (3rd ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Tomey, A. M. & Alligood, M. R. (2006) Nursing theorists and their work. (6th Ed.) St. Louis: Mosby.
External Criticism - Scope
Increased number of variables which make testing all variables in single research study difficult
Difficult to learn how variables may affect each other

Number of variables is that it makes the HPM applicable to many different settings
Pender suggested that HPM may be used in schools, workplaces, homes, community health centers and also that it is multidimensional as it may be used for individual, family, community environmental and societal health
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