Running Head: HEALTH PROMOTION
Health Promotion Model
Sylvia Assiamah
Coppin State University
NURS 620
Theoretical Foundations Knowledge in Nursing
Dr. Johnson
December 20, 2013
HEALTH PROMOTION
The Health Promotion Model (HPM) was developed and published in 1982 by Nola J.
Pender. The model was developed as a “framework for research aimed at predicting overall
health promoting lifestyles and specific behaviors such as exercise, and use of protective
devices” (Alligood & Tomey, p. 439). Since its first publication, the HPM has been revised to
include diverse populations, and activities which contribute to the overall health of the
individual, family or community.
The major concepts associated with the HPM are briefly discussed below:
 Prior Related Behavior: this concept determines the extent to which past behaviors are
has an influence on present health promoting behaviors.
 Personal Factors: The extent to which biological, psychological, and sociocultural
predicts or shapes the individual(s) health promoting activities.
 Perceived Benefits of Action: the benefits which are earned as a result of embarking on
health activities.
 Perceived Barriers to Action: known or imaginary obstacles, such as finances, which may
impede health promoting activities.
 Perceived Self-Efficacy: A self-awareness of one’s strengths and how it motivates the
individual to pursue and achieve health promoting behaviors.
 Activity – Related Effect: interplay of how other activities unrelated to health promotion,
affect the individual outlook on health promotion activities.
 Interpersonal Influences: how the various relationships in the individual(s) life affect
their participation in health promotion behaviors.
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 Situational Influences: how the unforeseen and unpredicted activities influence the
individual, or whether unexpected situations gear the individual toward, or steer the
individual from partaking in health promotion activities.
 Commitment to a Plan of Action: Specific plans outlined to ensure health promotion
strategies.
 Immediate Competing Demands and Preferences: this includes family, friends, school,
work, all of which are important elements of the individual’s life, but when not managed
properly can be deterrence to the achievement of health promoting behaviors.
 Health Promoting Behavior: includes activities such as exercising, eating a healthy diet,
managing stress, nurturing ones’ self spiritually, ensuring sufficient rest, all of which
aims to generate positive health outcomes (Alligood & Tomey, p 438 – 439).
Aligwood & Tomey (2010), identify the major assumptions of the health promotion model as
a “reflection of behavioral sciences and emphasize the active role of the patient in managing
health behaviors by modifying the environmental context” (p. 441). Nola J Pender, in her own
words, states the following assumptions:
1. Persons seeks 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 theory
own competencies.
3. A person 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
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5. Individuals in all their biophysical complexity interact with the environment
progressively transforming the environment and being transformed overtime
6. Health professionals constitute a part of the interpersonal environment, which exerts
influence on persons throughout their life spans.
7. Self-initiated reconfiguration of person environment interactive patterns is essential to
behavioral change (Alligwood & Tomey, 2010, as adopted from Nola Pender, Nursing
Practice, 1996, p. 54-55).
The framework of the HPM is to provide people with the right tools, while guiding and
assisting the individual to make choices which will contribute to greater health. A person’s
biopsycosoial environment is multifaceted, and influences the individual’s overall course of
action towards health. The model does not provide a quick fix solution to a health problem. What
it does, is to assist the individual assess their environment for tools to influence behavioral
outcomes, in a positive manner.
The concepts outlined in Pender’s model are theoretical and operationally defined. The
concepts of prior related behavior, personal factors, perceived benefits of action, perceived
barriers to action, perceived self-efficacy, activity related affect, interpersonal influences,
situational influences, commitment to a plan of action, immediate competing demands and
preferences, and health promoting behaviors, are explained by Pender in an operational context,
as well as theoretical assertions. Operationally, the concepts are defined to explain how an
individual’s characteristics and experiences affect subsequent health actions. Theoretically,
Pender outlines the biopsycosocial processes, which motivate individual(s) to embark upon
healthy behaviors, targeted toward enrichment of health.
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The Pender health promoting model has a diagram which interlocks the various aspects of the
model. The diagram has three main headings outlined as; individual characteristics and
experiences, behavior specific cognitions and affect, and behavioral outcome. The diagram
pictorially explains that, individual characteristics and experiences influence certain behavior
specific conditions and affect, and this in turn influences the behavioral outcome of the
individual.
The health promotion model has been accepted and integrated into nursing practice.
According to Aligwood & Tomey (2010), “current state-of -the -art clinical practice includes
health promotion activities, as nursing professionals find the HPM very relevant because it is
diversified, and applies to populations and communities of varied backgrounds, and life span” (p.
442). An important nursing function is patient education. As nurses seek ways to limit the effect
of diseases in patients, they work with patients to promote healthy behaviors which contribute to
disease prevention and optimal disease management.
Nurse practitioners are advanced nurse practitioners whose functions among other things
include the role of health promotion. Nurse practitioners “are trained in health promotion,
disease prevention, and medical management and are well equipped to treat patients in primary
care” (Harrington, 2011). As primary care providers, nurse practitioners utilize the health
promotion model to motivate patients to be responsible for their health, through health promoting
behaviors and activities which lead to positive outcomes.
Numerous research studies have been done, using the health promotion model as a theoretical
framework for the study. Mohamadian et al. (2011), assert that the modifiable variables of selfefficacy, perceived barriers, and social support concepts, in the HPM, were found to be strong
predictors of a health promoting life. In the discussion of their study, Mohamadian et al.
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conclude that nurses and other healthcare providers can use the HPM to yield behavior
modification interventions, which leads to a health promoting lifestyle.
In another article, Ho, Berggren, Dahlborg-Lyckhage (2010) explain how the health
promotion model, can be used a tool, in the management of diabetes. As a global health problem,
diabetes is a lifelong disease, which requires a life time commitment to treatment and
management. The authors conclude in their research article that “it is beneficial to use the HPM
in diabetes empowerment, as it provides a framework for explaining clients’ health behaviors,
and there by enable health-care professionals to assist clients to overcome their barriers and
enhance their self-efficacy in relation to lifestyle modification” ( Ho, Berggren, DahlborgLyckhage, 2010).
To determine the probability of nurses providing health promotion activities as part of
nursing interventions for their patients, Esposito & Fitzpatrick (2011), conclude that “the
prospect of impacting the personal exercise behaviors of nurses and potentially influencing the
health behaviors of others is in alignment with the tenets of health promotion and large scale
population health management”. The research indicates that when healthcare providers adopt
health promoting lifestyles, there are likely to recommend similar strategies for their patients.
The health promotion model adopted in the early 80’s has grown to be accepted worldwide,
regardless of culture or social backgrounds. As individual, organizations, state and federal
governments seek to find ways to cut down the growing problem of healthcare costs, the HPM
has generated many health promoting lifestyle programs targeted towards motivating individuals
to attain personal health.
The health promotion model since its inception has been revised and currently serves as a
framework for many primary care models. Aligwood & Tomey (2010), relay the importance of
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the theory stating how “Pender and colleagues have conducted a program of research funded by
the National Institute of Nursing Research to evaluate the HPM in four populations; working
adults, older community dwelling adults, ambulatory cancer patients, and patients undergoing
cancer rehabilitation” (Aligwood & Tomey, p. 439). Based on these studies, the model has been
revised and currently contributes to advanced nursing practice. Currently, nursing professionals
incorporate the HPM into their diverse practice settings, because it has relevance across the life
span.
The HPM provides ample opportunity for advanced nurse practitioners to develop and
implement health promotion activities among varied populations in different stages of the life
span. Nurse practitioners, can promote healthy behaviors amongst their patient(s), by performing
the functions of; researcher, educator, health promoter, care provider, collaborator,
ethics/legislator, and leader. Each of the prior mentioned roles “contributes to a nursing solution
to health policy and healthcare reform by providing a means for how consumers can be
motivated to attain personal health” (Aligwood & Tomey, p. 442).
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References
Alligood M. R., & Tomey, A. M. (2010). Nursing Theorists and Their Work (7th ed.). Missouri:
Mosby/Elsevier.
Esposito, E., & Fitzpatrick, 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(4), 351-356.
Harrington, S. (2011). Mentoring new nurse practitioners to accelerate their development as
primary care providers: A literature review. Journal Of The American Academy Of Nurse
Practitioners, 23(4), 168-174.
Ho, A., Berggren, I., & Dahlborg-Lyckhage, E. (2010). Diabetes empowerment related to
Pender's Health Promotion Model: a meta-synthesis. Nursing & Health Sciences, 12(2),
259-267.
Mohamadian, H., Eftekhar, H., Rahimi, A., Mohamad, H., Shojaiezade, D., & Montazeri, A.
(2011). Predicting health-related quality of life by using a health promotion model among
Iranian adolescent girls: A structural equation modeling approach. Nursing & Health
Sciences, 13(2), 141-148.