Running head: THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

Theory Application of The Health Promotion Model

Karen Cheeks
Old Dominion University

THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

The Health Promotion Model

The Health Promotion Model was developed by Nola Pender for utilization by
health care providers to assist patients in health promoting behaviors. Pender based the
development of her theory on the social learning theory. The social learning theory
includes the following self-beliefs: self-attribution, self-evaluation, and self-efficacy.
The Health Promotion Model (HPM) is used to include behaviors for enhancing health
and can potentially be applied across the life span. There are seven major assumptions
associated with HPM. The assumptions reflect the behavioral science perspective and
include the participation of the patient in managing health behaviors by modifying the
environmental context. The basic concepts of HPM are: individual characteristics and
experiences, behavior specific cognitions and affect, and behavioral outcomes. HPM
provides a template for the development of instruments such as the Health Promoting
Lifestyle Profile and the Exercise Benefits-Barriers Scale. HPM in its competence or
approach-oriented focus attempts to depict the multifaceted natures of persons interacting
with the environment as they pursue health ( Alligood & Tomey, 2010).
There are multiple benefits related to HPM. HPM is simple to understand and
utilize by health care providers. The model is described as being a significant contributor
for nursing in developing health policy and health care reform to motivate consumers in
attaining personal health. This theory is easily applicable across the lifespan and multiple
environments. HPM is increasingly being incorporated into the curriculum for
undergraduate nursing education. It is already taught extensively in nursing graduate
programs. Numerous researchers also use HPM as a frame of reference in their studies
( Alligood & Tomey, 2010).

THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

Penders theory has been critiqued for being misleading in its definition.
Whitehead argues the HPM needs to be re-conceptualized. According to Whitehead,
HPM should be appropriately called a health education model. He defines health
education as an activity that seeks to inform individuals on the nature and causes of
health/illness and attempts to motivate the individual to accept a process of individual
change. Whitehead defines health promotion as primarily being concerned with
empowering citizens to take control of their health through community development,
political advocacy, formulating integrated health strategies, and social marketing.
Whitehead advocates for Penders model to be updated for the sake of conceptual clarity
and to avoid confusion (Whitehead, Shin, Yun, Pender, Jang, 2005).
Discussion of Articles
The first article relating to Penders theory focused on a study conducted in Iran.
High school students were assessed on oral health behaviors and intervention efforts were
based off Penders HPM to influence behaviors. The studys objective was behavior
specific cognitions such as: perceived benefits, perceived barriers, perceived selfefficacy, oral-health behaviors, related effects, interpersonal and situational influences on
oral health behaviors, commitment to a plan of oral health behavior, and oral health
behaviors taken. The goal of the researchers was to observe the likelihood of performing
oral health behaviors related to the aforementioned behavior-specific cognitions within
the Health Promotion Model (Vikili, Rahaei, Nadrian, YarMohammadi, 2011).
Questionnaires were completed by the high school students and returned. The
results showed a significant statistical positive correlation with all HPM variables. The
results showed interpersonal modeling and perceived self-efficacy as the most powerful

THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

predictors of oral health behaviors. Parents were also shown to be the most important
influence on oral health behavior (Vikili, Rahaei, Nadrian, YarMohammadi, 2011). This
article did a great job outlining its purpose for the use and application of HPM. The
researchers analyzed the studys result well and were effective in showing how Penders
model could be used for future research. This study was also a great example of how
HPM can be used by different health care professions.
The second article focused on what factors would contribute to a healthy lifestyle
among military spouses using the HPM. The researchers objective was to determine
what factors would determine participation in health behaviors. The data obtained would
assist them in developing an intervention program to incorporate optimal behaviorspecific strategies to motivate behavior change (Pidden, Connors, Posey, Ricciardi, &
Agazio, 2013). Based on the HPM different variables were used to examine and
determine the influences on military spouses participation in health promoting behaviors.
Several measurement tools showed perceived health status, self-efficacy, and social
support were positively related to health promoting behaviors. This article depicted how
Penders model could be utilized as a theoretical framework to explore health-promoting
behaviors in different populations. The researchers added a variable to their study, which
was not included in Penders model, but overall did an effective job of showing why the
added variable was relevant in their study.
Clinical Practice
Having worked with patients who suffer from cardiac related health issues, I have
observed many patients do not have healthy dietary practices. According to the World
Health Organization (2015), there is an increase in consumption of foods high in energy,

THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

fats, free sugars, and a decrease in consumption of fruit, vegetables, and whole grains.
Researchers have noted that proper nutrition plays an important role in cardiovascular
health outcomes and in decreasing mortality and morbidity of cardiovascular diseases.
Research has also shown that patients after being discharged from the hospital often
return to unhealthy diets. Patients at high risk for cardiovascular disease would benefit
greatly from continued support and education on a healthy diet and behavioral
modifications ( Luisi, Biffi, Gheri, Sarli, Rafanelli, Graziano, Vidali, Fattirolli, Gensini,
& Macchi, 2015).
Using the HPM as my framework, examination of variables to predict the
likelihood of patients engaging in the health promoting behavior would be utilized.
Examination of variables to predict the likelihood of patients engaging in the health
promoting behavior would be utilized. These variables listed by the HPM are: individual
characteristics and experiences, behavior-specific cognitions, affect, and behavioral
outcome. The Health Promotion Lifestyle Profile instrument would be useful in
assessing my patients prior eating habits, self-efficacy, barriers to implementing a
healthy diet, patients perceived benefits of adopting healthy eating habits, interpersonal
influences that affect eating habits, situational influences, and their commitment to a plan
of action (Allison & Tomey, 2010). Based on the results from the questionnaire, I would
be able to utilize resources and implement health education to increase compliance of the
health promoting behavior.
Personal Philosophy
My personal nursing philosophy is that every human being is deserving of optimal
health, health care, and clinical expertise. Penders Health Promotion Model correlates

THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

well with my nursing philosophy. The aspect of HPM, which is very applicable to my
nursing philosophy, is the ability for it to be used in a variety of populations and multiple
environments. Self-efficacy, which is a central construct of HPM, is compatible with my
nursing philosophy in that it engages the patient in playing an active role in achieving
optimal health by participating in health promoting behaviors. Because I believe
everyone deserves to have optimal health and access to healthcare and health
professionals, this theory provides the framework for pursuing such goals. As a nurse,
utilizing Penders model will allow me to facilitate the process of achieving optimal
health for my patients.
Personal Learning
When I first began this class I thought it was going to be primarily about nursing
theorists view of how nursing should be. I predicted it would be boring and out of touch
with the modern nursing field. Surprisingly I have found reading the different theories to
be enlightening and applicable to our current nursing practice. I was also intrigued by the
different insights offered to the nursing profession, which has contributed to how we
currently practice nursing. The theory application paper was relevant in pushing me to
explore which theory best fits my philosophy of nursing.
The theory I chose applies very well with my area of nursing practice. The Health
Promotion Model can be utilized to decrease incidences of chronic diseases, multiple
hospitalizations, and disease prevention. Implementing the concepts of HPM is not only
beneficial to patients, but also rewarding as well to a nurse. In my nursing practice, my
goal is always to try and see how I can collaborate with my patient to achieve their health
goals. This theory does a good job of providing a framework to allow such collaboration.

THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

References
Allison, M. & Tomey, A. (7th ed.) (2010). Nursing theorists and their work. Missouri:
MOSBY Elesevier.
Luisi, M., Biffi, B., Gheri, C., Sarli, E., Rafanelli, E., Graziano, E., Vidali, S., Fattirolli,
F., Gensini, G., & Machhi, C. (2015). Efficacy of a nutritional education
program to improve diet in patients attending a cardiac rehabilitation program:
outcomes of a one year follow up. Internal and Emergency Medicine 10(6),
671-676. Doi 10. 1007/s11739-015-1211-y
Padden, D.L., Connors, R.A., Posey, S.M., Ricciardi, R., & Agazio, J.G. (2013).
Factors influencing a health promoting lifestyle in spouses of active duty
military. Health Care For Women International, 34(8), 674-693.
Doi: 10. 1080/07399332.2012.736572
Vakilli, M., Rahaei, Z., Nadrian, H., & YarMohammadi, P. (2011). Determinants of
oral health behaviors among high school students in Shahrekord, Iran based on
the Health Promotion Model. Journal of Dental Hygiene, 85(1), 39-48.
Whitehead, D., Shin, Y., Yun, S., Pender, N., & Jang, H. (2005). Letter to the editor
Test of the health promotion model as a casual model of commitment to a plan
for exercise among Korean adults with chronic disease ( Shin, Pender, Yun,
2003) published in your April 2005 issue. Research in Nursing & Health, 28(4),
357-361.
World Health Organization (2015). Healthy diet. Retrieved from
www.who.int/mediacenter/factsheets/fs394/en/

THEORY APPLICATION OF THE HEALTH PROMOTION MODEL

Honor Code
I pledge to support the Honor System of Old Dominion University. I will refrain from
any form of academic dishonesty or deception, such as cheating or plagiarism. I am
aware that as a member of the academic community it is my responsibility to turn in all
suspected violators of the Honor Code. I will report to a hearing if summoned
Karen Cheeks
November, 27,2015