Nola Pender

The Health Promotion Model

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.
Major Concepts
Health promotion is defined as behavior motivated by the desire to increase well-being and
actualize human health potential. It is an approach to wellness.

On the other hand, health protection or illness prevention is described as behavior motivated
desire to actively avoid illness, detect it early, or maintain functioning within the constraints of
illness.

Individual characteristics and experiences (prior related behavior and personal factors).

Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to

action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational
influences).

Behavioral outcomes (commitment to a plan of action, immediate competing demands and

preferences, and health-promoting behavior).
Subconcepts
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 behavior being considered.

a. Personal biological factors

Include variable such as age gender body mass index pubertal status, aerobic capacity,
strength, agility, or balance.

b. Personal psychological factors

Include variables such as self esteem self motivation personal competence perceived health
status and definition of health.
c. Personal socio-cultural factors

Include variables such as race ethnicity, acculturation, education and socioeconomic status.

Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action

Anticipated, imagined or real blocks and personal costs of understanding a given behavior.

Perceived Self Efficacy

Judgment of personal capability to organize and execute a health-promoting behavior.

Perceived self efficacy influences perceived barriers to action so higher efficacy result in
lowered perceptions of barriers to the performance of the behavior.

Activity Related Affect

Subjective positive or negative feeling that occur before, during and following behavior based on
the stimulus properties of the behavior 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.

Interpersonal Influences

Cognition concerning behaviors, beliefs, or attitudes of the others.

Interpersonal influences include: norms (expectations of significant others), social support

(instrumental and emotional encouragement) and modeling (vicarious learning through
observing others engaged in a particular behavior).

Primary sources of interpersonal influences are families, peers, and healthcare providers.
Situational Influences

Personal perceptions and cognitions of any given situation or context that can facilitate or
impede behavior. 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 behavior.

Commitment to Plan Of Action

The concept of intention and identification of a planned strategy leads to implementation of

health behavior

Immediate Competing Demands and Preferences

Competing demands are those alternative behaviors over which individuals have low control
because there are environmental contingencies such as work or family care responsibilities.

Competing preferences are alternative behaviors over which individuals exert relatively high
control, such as choice of ice cream or apple for a snack

Assumptions
Individuals seek to actively regulate their own behavior.

Individuals in all their biopsychosocial complexity interact with the environment, progressively
transforming the environment and being transformed over time.

Health professionals constitute a part of the interpersonal environment, which exerts influence
on persons throughout their life span.

Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior

change.

Propositions

Prior behavior and inherited and acquired characteristics influence beliefs, affect, and
enactment of health-promoting behavior.

Persons commit to engaging in behaviors from which they anticipate deriving personally valued
benefits.
Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual
behavior.

Perceived competence or self-efficacy to execute a given behavior increases the likelihood of

commitment to action and actual performance of the behavior.

Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior.

Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn,
result in increased positive affect.

When positive emotions or affect are associated with a behavior, the probability of commitment
and action is increased.

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.

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.

Situational influences in the external environment can increase or decrease commitment to or

participation in health-promoting behavior.

The greater the commitments to a specific plan of action, the more likely health-promoting
behaviors are to be maintained over time.

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.

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.

Persons can modify cognitions, affect, and the interpersonal and physical environment to create
incentives for health actions.

Strengths/Weaknesses
Strengths:

It is simple to understand yet it is complex in structure.

Her theory gave much focus on health promotion and disease prevention making it stand out
from other nursing theories.
It is highly applicable in the community health setting.

It promotes the independent practice of the nursing profession being the primary source of
health promoting interventions and education.

Weaknesses:

The model of Pender was not able to define the four most important concepts that a nursing
theory should have, man, nursing, environment and health.

The conceptual framework contains multiple concepts which may invite confusion to the reader.

Its applicability to an individual currently experiencing a disease state was not given emphasis.
Analysis
Due to its focus to health promotion and disease prevention per se, its relevance to nursing
actions given to individuals who are ill are obscure. But then again, this characteristic of her
model also gives the concepts its uniqueness.

Pender’s principles paved a new way of viewing nursing care but then one should also be
reminded that the curative aspect of nursing cannot be detached from our practice.

Community health care setting is the best avenue in promoting health and preventing illnesses.
Using Pender’s Health Promotion Model, community program may be focused on activities that
can improve the well-being of the people. Health promotion and disease prevention can more
easily be carried out in the community, as compared to programs that aim to cure disease
conditions.

For an individual to fully adhere to a health promoting behavior, he or she needs to shell out
financial resources. This limits the application of Pender’s model. An individual who
economically or financially unstable might have lesser commitment to plan of action decreasing
the ideal outcome of a health promoting behavior even if the individual has the necessary will to
complete it.

Although not stated in the model, for example, in the Intensive Care Unit, Health Promotion
Model may still be applied in one way or another. This is projected towards improving health
condition and prevention of further debilitating conditions. Diet modifications and performing
passive and active range of motion exercises are examples of its application.