HEALTH PROMOTION MODEL

BY: NOLA J. PENDER

PRESENTED BY: MILA MARUYA
HISTORY OF THE THEORY
• 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 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 endpoint
in the Health Promotion Model. 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 intended health-promoting
actions.
 THE HEALTH PROMOTION MODEL
• The Health Promotion Model was designed to be a “complementary counterpart to
models of health protection.” It develops to incorporate behaviors for improving
health and applies across the life span. Its purpose is to assist nurses in knowing
and understanding the major determinants of health behaviors as a foundation for
behavioral counseling to promote well-being and healthy lifestyles.

• Pender’s health promotion model defines health as “a positive dynamic state not
merely the absence of disease.” Health promotion is directed at increasing a
client’s level of well-being. It describes the multi-dimensional nature of persons as
they interact within the environment to pursue health.
 CONCEPTS OF THE THEORY
• 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.
• (Alligood & Tomey, p 438 – 439)
 CONCEPTS OF THE THEORY
• 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.
(Alligood & Tomey, p 438 – 439)
 CONCEPTS OF THE THEORY
• 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.
• (Alligood & Tomey, p 438 – 439)
CONCEPTS OF THE THEORY
• 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
• Interpersonal Influences: how the various relationships in the
individual(s) life affect their participation in health promotion
behaviors.
• (Alligood & Tomey, p 438 – 439)
H
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HPM ASSUMPTIONS
1. Individuals seek to actively regulate their own behavior.
2. Individuals in all their biopsychosocial complexity interact with the
environment, progressively transforming the environment and being
transformed over time.
3. Health professionals constitute a part of the interpersonal environment,
which exerts influence on persons throughout their life span.
4. Self-initiated reconfiguration of person-environment interactive
patterns is essential to behavior change.
 HPM PROPOSITIONS
5. Prior behavior and inherited and acquired characteristics influence beliefs, affect,
and enactment of health-promoting behavior
6. Persons commit to engaging in behaviors from which they anticipate deriving
personally valued benefits.
7. Perceived barriers can constrain commitment to action, a mediator of behavior as
well as actual behavior.
8. Perceived competence or self-efficacy to execute a given behavior increases the
likelihood of commitment to action and actual performance of the behavior.
9. Greater perceived self-efficacy results in fewer perceived barriers to a specific health
behavior.
 HPM PROPOSITIONS
10. Positive affect toward a behavior results in greater perceived self-efficacy,
which can, in turn, result in increased positive affect.
11. When positive emotions or affect are associated with a behavior, the
probability of commitment and action is increased.
12. 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.
13. 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.
 HPM PROPOSITIONS
• 14. Situational influences in the external environment can increase or decrease
commitment to or participation in health-promoting behavior.
• 15. The greater the commitments to a specific plan of action, the more likely health-
promoting behaviors are to be maintained over time.
• 16. 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.
• 17. 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.
• 18. Persons can modify cognitions, affect, and the interpersonal and physical
environment to create incentives for health actions.
SOURCES FOR THEORY DEVELOPMENT

• Pender’s background in nursing, human development, experimental

psychology, and education led her to use a holistic nursing perspective,
social psychology, and learning theory as foundations for the HPM.
• Central to the HPM is the social learning theory of Albert Bandura (1977),
which postulates the importance of cognitive processes in the changing of
behavior. Social learning theory, now titled social cognitive theory, includes
the following self-beliefs: self-attribution, self-evaluation, and self-efficacy.
SOURCES FOR THEORY DEVELOPMENT
• Self-efficacy is a central construct of the HPM
• The expectancy value model of human motivation described by Feather
(1982) proposes that behavior is rational and economical and was
important to the model’s development.
• The HPM is similar in construction to the health belief model (Becker,
1974), which explains disease prevention behavior; but the HPM differs
from the health belief model in that it does not include fear or threat as a
source of motivation for health behavior. The HPM expands to encompass
behaviors for enhancing health and applies across the life span.
HPM STRENGTHS
• The Health Promotion Model is simple to understand yet it is
complex in structure.
• Nola Pender’s nursing 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.
HPM WEAKNESSES

• The Health Promotion Model of Pender was not able to define

the nursing metaparadigm or the 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.
HPM IN PRACTICE
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.
 HPM IN PRACTICE
• In another article, Ho, Berggren, and 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, & Dahlborg-Lyckhage, 2010).
HPM AS RESEARCH FRAMEWORK

• The health promotion model since its inception has been revised
and currently serves as a framework for many primary care
models. Alligood and Tomey (2010), relay the importance of 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” (p. 439).
HPM AS RESEARCH FRAMEWORK

• Alligood and Tomey (2010), relay the importance of 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” (p. 439).
HPM IN EDUCATION
• To determine the probability of nurses providing health promotion
activities as part of nursing interventions for their patients, Esposito
and 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.
HPM IN EDUCATION

• The health promotion model is utilized in most graduate nursing

programs, and is gaining popularity in undergraduate nursing
education.
• Incorporating technology is another way in which the HPM can be
used in education. Research supports the notion that technology
based applications are being used to promote healthy behaviors
 REFERENCES
• Alligood M. R., & Tomey, A. M. (2010). Nursing Theorists and Their Work (7th ed.). Missouri: ‘ Mosby/Elsevier.
• Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization & Application. Elsevier Health Sciences.
• 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).
• Gonzalo, A. (2019). Nola Pender: Health Promotion Model. Nurselabs. Retrieved at https://nurseslabs.com/nola-
pender-health-promotion-model/
• 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).
• 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).
• Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2018). Health promotion in nursing practice. Pearson
Education Canada.
• Sakraida, T. J. (2017). Chapter 2. Health Promotion Model. Nurse Keys. Retrieved at https://nursekey.com/21-
health-promotion-model/