Mrs.

RAJESHWARI SIVA PROFESSOR COLLEGE OF NURSING, CMC,VELLORE

CONCEPTUAL MODELS
CONCEPTS

Building blocks of a theory that abstractly describe an object or phenomenon BRICKS Eg. Anxiety, Health, Adaptation

MODELS
Symbolic representations of a

conceptualization Less formal attempts at organizing phenomena than theories Deal with abstractions(concepts) that are assembled by virtue of their advance to a common theme Broadly presents an understanding of the phenomenon of interest and reflects the assumptions and philosophic views of the models designer

FRAMEWORK
Framework

A framework is the overall conceptual underpinnings of a study THEORETICAL FRAMEWORK If based on a theory ( Orems Selfcare theory) CONCEPTUAL FRAMEWORK If based on a specified conceptual model ( Systems model.. Input, process and Output)

HEALTH BELIEF MODEL

The HBM is essentially a concept that

integrates psychological motivators with physical and social settings.

ORIGIN OF HBM
Initiated in 1952 by three socio-psychologists,

Godfrey Hochbaum, Stephen Kegels and Irwin Rosenstock.

1950's the society realized a need to prevent

disease rather than cure it. Through a series of studies over a decade the originators of the HBM conducted systematic studies in order to present a mode of behavior that would help prevent health problems. In 1952 Godfrey Hochbaum presented the first research study that would provide the identification of symptoms pointing towards a chest x-ray in order for the early diagnosis of TB. [Brown, 1999]"

HEALTH BELIEF MODEL

HBM includes General health motivation Peoples response to illness Compliance with medication Health behavior Illness behavior Sick- role behavior

HEALTH BEHAVIOUR
Is any activity undertaken by individuals

who believe themselves to be healthy for the purpose of detecting and preventing disease in any asymptomatic stage

HEALTH BEHAVIOURHEALTH BELIEFS

One is susceptible to health problems

Health problems have undesirable

consequences Health problems and their consequences usually are preventable If health problems are to be overcome, barriers or costs have to be overcome

PHASES OF HBM
Individual Perceptions

Modifying Factors
Likelihood of Action

INDIVIDUAL PERCEPTIONS

MODIFYING FACTORS DEMOGRAPHIC VARIABLES (age,gender,race,ethnicity, ) Sociopsychologic variables (personality, social class, peer and reference group pressure,etc.) STUCTURAL VARIABLES (knowledge about the disease, prior contact with the disease,etc.)

LIKELIHOOD OF ACTIONOL

Perceived preventive benefits action minus Perceived barriers to preventive action

Perceived susceptibility to disease X Perceived seriousness (severity ) of disease X

Perceived threat of disease X

Likelihood of taking recommended preventive health action

Cues to action Mass media campaigns Advice from others reminder postcard from physician or dentist illness of family member or friend newspaper or magazine article

INDIVIDUAL PERCEPTIONS
TYPES

Perceived Susceptibility Perceived Severity PERCEIVED THREAT OF DISEASE

MODIFYING FACTORS
DEMOGRAPHIC VARIABLES

Age, Gender, Educational level SOCIOPSYCHOLOGIC VARIABLES Social class, peer pressure, Personality STRUCTURAL VARIABLES Knowledge about the disease, prior contact with the disease CUES TO ACTION
Health advice, Illness of family member,Mass media

LIKELIHOOD OF ACTION
Perceived severity of health problem

Perceived Benefits
Perceived Barriers Self-efficacy

ESSENTIAL FACTORS FOR EFFECTIVENESS OF HBM

Readiness of individual to consider

behavioural changes to avoid disease or to minimize health risks Existence and power of forces in the individual s environment that urge change and make it possible Behaviors of the individual Each of these above factors are influenced by personality, environment,past experience with health services and health personnel

EXAMPLES
Lifestyle modification among the obese

women Prevention of osteoporosis among menopausal women Dietary modification among diabetics in order to maintain glycemic levels Health beliefs among Indian Muslim women towards mammography as a screening procedure for breast cancer

INDIVIDUAL PERCEPTIONS

MODIFYING FACTORS
DEMOGRAPHIC VARIABLES

LIKELIHOOD OF ACTIONOL

(age,gender,race,ethnicity SOCIOPHYCHOLOGIC VARIABLES (personality, social class, peer and reference group pressure,etc.) STUCTURAL VARIABLES (knowledge about the disease, prior contact with the disease,etc.) Perceived susceptibility to disease X Perceived seriousness (severity ) of disease X

Perceived preventive benefits action minus Perceived barriers to preventive action

Perceived threat of disease X

Likelihood of taking recommended preventive health action

Cues to action Mass media campaigns Advice from others reminder postcard from physician or dentist illness of family member or friend newspaper or magazine article

HEALTH PROMOTION MODEL

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

HPM
The Health Promotion Model (HPM) proposed

by Nola J Pender (1982; revised, 1996) was designed to be a complementary counterpart to models of health protection. It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a clients level of wellbeing. It describes the multi dimensional nature of persons as they interact within their environment to pursue health. It is a wellness oriented framework for explaining and predicting the health promoting components of life

PURPOSE

Integrating nursing and behavioral science perspectives on factors that influence health behaviors. Exploring the biophysical processes that motivate individuals to engage in behaviors directed toward health enhancement

Major concepts
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 Situational influences Behavioral outcomes Commitment to a plan of action Immediate competing demands Preferences Health promoting behavior

COGNITIVE/PERCEPTUAL FACTORS

MODIFYING FACTORS

PARTICIPATION IN HEALTHPROMRTING BEHAVIORS

Importance of Health

Demographic Characteristics

Perceived Control of Health

Biologic characteristics

Interpersonal Influences Perceived Self-Efficacy Situational Factors Definition of Health

Behavioral factors

Perceived Health Status

Likelihood Engaging in Health-Promoting Behaviors

Perceived Benefits of Health Promoting Behaviors

Cues to action

(1987)

THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL

Prior behavior and inherited and acquired characteristics

influence beliefs, affect, and enactment of healthpromoting behavior. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior. Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased.

THEORETICAL PROPOSOTION
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.

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. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior health-promoting behaviors are to be maintained over time

The greater the commitments to a specific plan of action, the more likely Commitment to a plan of action is less likely to result in the desired

behavior when 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. environment to create incentives for health actions.

Persons can modify cognitions, affect, and the interpersonal and physical

AREAS OF FOCUS IN HPM

Individual characteristics and experiences

Behavior-specific cognitions and

Behavioral outcomes

affect

MAJOR CONCEPTS
Individual Characteristics and Experience
Prior related behavior Frequency of the similar behavior in the

past. Direct and indirect effects on the likelihood of engaging in health promoting behaviors.

PERSONAL FACTORS
Biological factors

Age, gender, body mass index, pubertal status, aerobic capacity, strength, agility, or balance Psychological factors Self esteem, self motivation, personal competence, perceived health status and definition of health. Socio-cultural factors Race ethnicity, acculturation, education and socioeconomic status. Behavioral Specific Cognition and Affect

PRIOR RELATED BEHAVIOUR

PERCEIVED BENEFITS OF ACTION

Anticipated positive out comes that will occur from health behavior
PERCEIVED BARRIERS TO ACTION

Anticipated, imagined or real blocks and personal costs of understanding a given behavior
PERCEIVED SELF EFFICACY

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. ACTIVITY RELATED AFFECT Subjective positive or negative feeling that occurred before, during and following behavior Activity-related affect influences perceived selfefficacy

INFLUENCES
INTERPERSONAL INFLUENCES

Norms (expectations of significant others) Social support (instrumental and emotional encouragement) Modeling (vicarious learning through observing others engaged in a particular behavior) Primary sources of interpersonal influences (families, peers, and healthcare providers) SITUATIONAL INFLUENCES Perceptions of options available Demand characteristics Aesthetic features of the environment
Situational influences may have direct or indirect

influences on health behavior.

ASSUMPTIONS
Individuals seek to actively regulate their

own behavior. Individuals in all their biopsychosocial complexity interact with the 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 lifespan. Self-initiated reconfiguration of personenvironment interactive patterns is essential to behavior change

EXAMPLES
Foot care practices of Diabetic clients Promoting quality of life among

hospitalized elderly
Predicting Lifestyles in workplace of

workers in steel industry

Effects of stress management among

hypertensive clients

INDIVIDUAL PERCEPTIONS

MODIFYING FACTORS DEMOGRAPHIC VARIABLES (age,gender,race,ethnicity, ) Sociopsychologic variables (personality, social class, peer and reference group pressure,etc.) STUCTURAL VARIABLES (knowledge about the disease, prior contact with the disease,etc.)

LIKELIHOOD OF ACTIONOL

Perceived preventive benefits action minus Perceived barriers to preventive action

Perceived susceptibility to disease X Perceived seriousness (severity ) of disease X

Perceived threat of disease X

Likelihood of taking recommended preventive health action

Cues to action Mass media campaigns Advice from others reminder postcard from physician or dentist illness of family member or friend newspaper or magazine article

REFERENCE Marriner TA, Raile AM. Nursing theorists and their work. 5th ed. Sakraida T.Nola J. Pender. The Health Promotion Model. St Louis: Mosby; 2005 Polit DF, Beck CT. Nursing research: Principles and methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2007 Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6th ed. Philadelphia: Elsevier Mosby; 2006. Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier Mosby; 2006. Wills and McEwen(2007). Theoretical Basis for Nursing. 2nd Edition. Philadelphia: Lippincott Williams and Wilkins. Aonuevo, C., Abaquin, C., Balabagno, A., Corcega, T., Dones, L., Kuan, L., et. al. (2000). Theoretical Foundation of Nursing. Philippines: UP Open University Kozier, B., Erb, G., Berman, A., Snyder, S. (2004). Fundamentals of Nursing: Concepts, Process, and Practice. 7th Edition. Philippines: Pearson Education South Asia Pvt Ltd University of Michigan School of Nursing (2006). Nora J. Pender Site. Retrieved Jan 23, 2010 from http://www.nursing.umich.edu/faculty/pender Pender N J, S N Walker, K R Sechrist & M Frank-Stronbourg. Nursing Research, 39, pp 326-332. Thomas Butler.J,Principle of Health Education and Health Promotion,Wadsworth / Thomson Learning,USA; 2001

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