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Nola J.

Health Promotion Model
Background of the Theorist
The theory: Health Promotion
Five Key Sections

Three focus areas

Background of the Theorist

NOLA J. PENDER (1941-present)

Pender was born August 16, 1941, in Lansing,


Family encouragement to become a registered

nurse led her to the School of Nursing at West
Suburban Hospital in Oak Park, Illinois.
Nola J. Penders first encounter with professional
nursing occurred at 7 years of her age, when she
observed the nursing care given to her
hospitalized aunt.
The experience of watching the nurses caring
for my aunt in her illness created in me a
fascination with the work of nursing, noted
Pender. (Pender, personal communication, May
6, 2004)
Background of the Theorist: Degrees
and Titles

Nursing diploma in 1962

Baccalaureate in Nursing in Michigan State University in


Masters Degree in Human Growth and Development in

Michigan State University in 1965.

PhD in Psychology and Education at Northwestern

University in 1969.
The Theory
In 1975, Pender published A Conceptual
Model for Preventive Health Behavior, as a
basis for studying how individuals made
decisions about their own health care in
a nursing content.
This article identified factors that were found in
earlier research to influence decision making
and actions of individuals in preventing

In 1982, the original HEALTH PROMOTION

MODEL was presented in the first edition of
her text, Health Promotion in Nursing Practice
The Theory
Health promotion can be defined as the
process of empowering people to make
healthy lifestyle choices and motivating
them to become better self-managers.
To accomplish this, health promotion
strategies should focus on patient
education, counseling, and support
mechanisms. Examples of health
promotion approaches include
education and counseling programs that
promote physical activity, improve
nutrition, or reduce the use of tobacco,
alcohol, or drugs.
The Theory
Dr. Nola Pender developed theHealth
Promotion Model (HPM)that is used
universally for research, education, and
practice. The health promotion model
focuses on helping people achieve higher
levels of well-being. It encourages health
professionals to provide positive resources
to help patients achieve behavior specific
changes. The goal of the HPM is not just
about helping patients prevent illness
through their behavior, but to look at ways
in which a person can pursue better health
or ideal health.
The Theory
Assist the nurse in understanding the major
determinants of health behaviors as a basis
for behavioral counseling to promote healthy
Prevention of chronic health problems
Improve quality of life
Health-preventive measures and health
promoting behaviors
Five Key Sections
is a biopsychosocial organism that is partially shaped by the
environment but also seeks to create an environment in which
inherent an acquired human potential can be fully expressed.
Thus, the relationship between person and environment is
reciprocal. Individual characteristics as well as life experiences
shape behaviors including health behaviors
is the social, cultural and physical context in which the life
course unfolds. The environment can be manipulate by the
individual to create a positive context of cues and facilitators
for health enhancing behaviors.
is collaboration with individuals, families, and communities to
create the most favorable conditions for the expression of
optimal health and high-level well-being.
Five Key Sections
in reference to the individual is defined as the
actualization of inherent and acquired human
potential through goal-directed behavior,
competent self-care, and satisfying relationships
with others, while adjustments are made as
needed to maintain structural integrity an
harmony with relevant environments. Health is
an evolving life experience.
are discrete events throughout the life span of
either short (acute) or long (chronic) duration
that can hinder or facilitate ones continuing
quest for health.
Three Focus Areas
Individual Behavioral-
characteristics specific
and cognitions and
experiences affect

characteristics and Behavioral outcome
cognitions and affect
Perceived benefits
of action Immediate
Prior related Perceieved barrier demands (low
behavior of action control and
preferences (high
Perceived self- control))
Personal factors: Activity-related to a plan of
Biological, affect action
and sociocultural Interpersonal
(family, peers,
providers), norms,
support, models
options, demand
Individual Characteristics
and Experiences
behavio Personal Factors

Biologic Socio-
al cultural
Individual Characteristics and
The following individual characteristics are
experiences that affect the subsequent health
Prior Related Behavior
Frequency of the same or similar behavior in
the past.
Direct and indirect effects on likelihood of
engaging in health-promoting behaviors.
Personal Factors
Categorized as biological, psychological, and
These factors are predictive of a given
behavior and are shaped by the nature of the
target behavior being considered.
Personal Biological
Included in these factors are variables such as
age, gender, body mass index, pubertal
status, menopausal status, aerobic capacity,
strength, agility and balance.
Personal Psychological Factor
These factors include variables such as self-
esteem, self- motivation, personal
competence, perceived health status, and
definition of health.
Personal Sociocultural Factor
Factors such as race, ethnicity, acculturation,
education, and socioeconomic status are
2. Behavior-specific cognitions
and affect

Perceived Perceived Perceived

benefits of barriers of self
action action efficacy

Activity- Interperson
related al
affect Influences
Behavioral-specific cognitions and affects
The following are behavioral-specific
cognitions and affects that are considered of
major motivational significance
These variables are modifiable through
nursing actions
Perceived Benefits of
Anticipated positive outcomes that will result
from health behavior.
Perceived Barriers of Action
Anticipated barriers to action are anticipated,
imagined, or real blocks and personal costs of
undertaking a given behavior.
Perceived Self-Efficacy
Perceived self-efficacy is 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.

Efficacy - the ability to produce a desired or intended result.

Activity-related affect
An activity-related affect describes subjective
positive or negative feelings 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 is the
feeling of efficacy. In turn, increased feelings
of efficacy can generate further positive
Interpersonal Influences
These influences are cognitions concerning
behaviors, beliefs, or attitudes of 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 health care providers.
Situational Influences
Situational influences are personal
perceptions and cognition of any given
situation or context that can facilitate or
impede behavior. The exclude perceptions of
available options, demand characteristics, and
aesthetic features of the environment in which
given health-promoting behavior is proposed
to take place.
Situational influences may have direct or
indirect influences on health behavior.
Behavioral Outcome
Commitment to Competing
a Plan of Action Demands and

Health Promoting
Behavioral outcome
Immediate antecedents of behavior or
behavioral outcomes.
A behavioral event is initiated by commitment
to action unless there is a competing demand
that cannot be avoided, or a competing
preference that cannot be resisted.
Commitment to a Plan of Action
This commitment describes the concept of
intention and identification of a planned
strategy that leads to implementation of
health behavior.
Immediate Competing Demands
and Preferences
Competing demands are alternative behaviors
over which individuals have low control,
because there are environmental
contingencies such as work or family care
Competing preferences are alternative
behaviors over which individuals exert
relatively high control, such as choice of ice
cream or an apple for a snack
Health Promoting Behavior
A health-promoting behavior is an end point
or action outcome that is directed toward
attaining positive health outcomes such as
optimal well-being, personal fulfillment, and
productive living.
Examples of health-promoting behavior
are eating a healthy diet, exercising
regularly, managing stress, gaining
adequate rest and spiritual growth, and
building positive relationships.
Persons seek to create conditions of
living through which they can express
their unique human health potential.
Persons have the capacity for reflective
self-awareness, including assessment of
their own competencies.
Persons value growth in directions
viewed as positive and attempt to
achieve a personally acceptable balance
between change and stability
Individuals seek to actively regulate their
own behavior.
Individuals in all their biopsychosocial
complexity interact with 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 spans.
Self-initiated reconfiguration of person-
environment interactive patterns is
essential to behavioral change.