Pender’s Health Promotion Theory

Thursday, July 17, 2008

Health Promotion Model: Heuristic Device for Health Care Professionals

Ourselves, our body, our health….. enhancing self usage towards prevention of illnesses &
promoting well-being.

Nora J. Pender developed the Health Promotion Model that is proposed as a holistic predictive
model of health-promoting behavior for use in research and practice. She is Professor Emeritus
in the School of Nursing at the University of Michigan, and an advocate of health promotion.

“I committed myself to the proactive stance of health promotion and disease prevention with the
conviction that it is much better to experience exuberant well-being and prevent disease than let
disease happen when it is avoidable and then try and cope with it.”
Nola J. Pender, PhD, RN, FAAN

Health Promotion Model has given health care a new direction. According to her, Health
Promotion and Disease Prevention should be the primary focus in health care, and when health
promotion and prevention fail to prevent problems, and then care in illness becomes the next
priority. She defined 2 concepts: health promotion & health protection.

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. (Kozier, 2004)

Figure 1 – Health Promotion Model

This model (Figure 1) is moving towards understanding multi-faceted nature of persons
correlating with their interpersonal nature and interacting with their interpersonal & physical
environments as they trail towards health.
Because of the model, nurses have already advanced their health approaches, addressing not only
the curative side, but as well as prevention of diseases & promotion of well-being. Application of
this theory is varied and substantive on its own.

Applications

Nursing Practice

“We are moving toward an era of science-based practice in nursing that incorporates the latest
findings from the behavioral and biological sciences into practice to assist people of varying
cultural backgrounds to adopt healthy lifestyles.” – Pender

As what they say, prevention is better than cure. Thus, health promotion is valued much. But
how? Question seems hard…hard as if you don’t know how to solve the problems of the world…
But how, again? If super heroes could save life using their super powers, we nurses could do
more by using our caring touch, and therapeutic talks. Health teachings are always part of
nurses’ experience in the workplace. Despite of various clinical & community health care
settings, we nurses are always interacting with our patient/client.

Community health care setting is the best avenue in promoting health & 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. This is because the people in the rural area tend to veer away from modern medical
methods. Most of them, due to financial reasons, choose to avail of the services offered by
“herbolarios” and other folk healers. In our local setting, promoting health to our fellow Filipinos
is very crucial. Though, there are campaigns provided by our government’s health agency, which
is the Department of Health (DOH), there’s still a big percentage in the population who live
unhealthily and many are suffering from different type of diseases.

Nurses, though are scattered in different fields, have common primary concern: to promote
health to every individual. The following are just examples of methods on how to promote health
to our fellows.

Insight from an Academe nurse teaching CHN… A group of students taught the families the
value of eating a balanced diet. They introduced the concept of including the different food
groups in all their meals. They also stressed the benefits and advantages of the various vitamins
and minerals found in those food. Another group encouraged the community to practice lifestyle
modification. They discussed the disadvantages of vices such as smoking and drinking alcoholic
beverages. For disease prevention and health protection, one group tried to inculcate the
importance of early detection of illnesses. They taught the women the proper way and timing of
self-breast examination. The mothers were also encouraged to avail of the vaccination services
offered by the nearby health center. These programs proved to be very beneficial to the
community. Because one can truly build a healthier tomorrow through good community health
practice.

Insight from an ICU nurse… Although most patients admitted in the ICU are experiencing health
problems, 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 & active range of motion exercises are examples of its
application.

Nursing Education

“I believe that the future will be very bright and productive for nurses who direct their careers
toward understanding disease prevention and health promotion processes.” – Pender

Nurses are expected to be adaptive. Indeed, changes are always constant. In health care settings,
patients come & go. Meet & greet. Recover or expire. As this theory advocated, we should not
allow our patients to experience severe conditions if we could only prevent them from
encountering such. We are expected to know, if not in depth, the disease processes. Because of
this know-how, we could apply health promotion and worsening prevention before the hands of
the clock stop moving.

Percentage of nurses is geared towards continuing professional education. Attending seminars &
conventions. Enrolling to masteral & doctoral classes. All are goaled towards becoming
competent nurses. Nursing education is not a one-phase process. It does not end after passing the
licensing exam. It is continuous. Unending. Ever changing. We must be abreast with new
technologies, new approaches, and new techniques. Because of this theory, we nurses could
address more the needs and problems of the client before it progresses to exacerbation. This
model could be a basis for structuring nursing protocols and interventions.

Nursing Research

“I was committed to health promotion and encouraged other scholars to move in that direction
long before health promotion and risk reduction became popular.” - Pender

Research help Health Care provider to develop a systematic problem-solving approach to

improve and develop strategies to promote good health to individuals. Through research we will
be able to clarify and verify the phenomenon.

Evidenced-based practice is fast emerging because of its factual and substantive results. These
researches yield fruitful outcome that of great help in addressing arising problems and in setting
nursing protocols. Much more research must be done to tailor interventions to individuals rather
than to group stereotypes.

If we could remember, common research topics in our nursing college days are health promotion
techniques and disease prevention. To name a few, some geared their research on effectiveness
of Expanded Program on Immunization, others on health practices of mothers and families, some
on efficiency of early detection of common illnesses. These are all but few of the model’s
application to research.
 Of all the theories presented in the
module, Health Promotion Model is the easiest of them, yet substantive & useful. In our day-to-
day experiences as nurses, we are always promoting health, preventing illnesses, and upholding
well-being. We are seen by the public as health advocates. We have knowledge on health &
illnesses, thus, we are expected to share this to laymen and contribute to their well-being. As
what Pender said, “We cannot continue to let people become ill when we have the means to keep
many people well--particularly when problems are environmentally and behaviorally induced”.
Thus, the theory of Pender on Health Promotion is indeed a great to advocate to prolong and
preserve life. This theory really manifests the noble work of a NURSE. Remember, nurses we
are LOVE SERVES.
 ASSUMPTIONS AND THEORETICAL PROPOSITIONS

OF THE HEALTH PROMOTION MODEL (HPM)

HPM Assumptions
The HPM is based on the following assumptions, which reflect both nursing and behavioral science
perspectives:

1. Persons seek 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 their own
competencies.

3. Persons value growth in directions viewed as positive and attempt to achieve a personally
acceptable balance between change and stability.

4. Individuals seek to actively regulate their own behavior.

5. Individuals in all their biopsychosocial complexity interact with the environment,

progressively transforming the environment and being transformed over time.

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

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

behavior change.

HPM Theoretical Propositions

Theoretical statements derived from the model provide a basis for investigative work on health
behaviors. The HPM is based on the following theoretical propositions:

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

2. Persons commit to engaging in behaviors from which they anticipate deriving personally
valued benefits.

3. Perceived barriers can constrain commitment to action, a mediator of behavior as well as

actual behavior.

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

commitment to action and actual performance of the behavior.
HPM Theoretical Propositions (continued)

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

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

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

8. 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.

9. 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.

10. Situational influences in the external environment can increase or decrease commitment to or
participation in health-promoting behavior.

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

12. 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.

13. 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.

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

Source: Pender, N.J., Murdaugh, C. L., & Parsons, M.A. (2002).

th
Health Promotion in Nursing Practice (4 Edition). Upper Saddle River, NJ:

PrenticeHall.
PURPOSE AND MAJOR CONCEPTS:The HPM was proposed as a framework for integrating nursing and
behavioral science perspectives on factors that influence health behaviors. The model is to be used as
guide to explore the biophysical processes that motivate individuals to engage in behaviors directed
toward health enhancement(PENDER, 1996). The model has been used extensively as a framework for
research aimed at predicting health promoting lifestyles as well as specific behaviors.

Major concepts of the HPM are individual characteristics and experiences (prior related behavior and
personal factors), behavior - specific cognitions and affect (perceived benefits of action, perceived self
efficacy, activity related affect, interpersonal influences, and situational influences), and behavioral
outcomes (commitment to a plan of action, immediate competing demands and preferences and health
promoting behavior).

CONTEXT FOR USE AND NURSING IMPLICATIONS

Health promotion services are essential for improving the health of populations everywhere. It is noted
that people of all ages can benefit from the health promotion care, which should be delivered at sites
where people spend much of their time (eg schools and workplaces). Nurses can develop and execute
health promoting interventions to individuals, groups, and families in schools, nursing centers,
occupational health settings and the community at large. Nurses should work toward empowerment for
self care and enhancing the client's capacity for self care through education and development.