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As healthcare providers we share the common goal in improving the health and well-being of our patients. The concepts of the promotion of health and disease prevention are essential to our practice. Pender’s Health Promotion model serves as a tool for nurses to plan behavioral modification interventions in order to assist in the improvement and prevention of unhealthy behaviors. A major focus of nursing is encouraging health-promoting behaviors. This model assists nurses in the achievement of optimum health promotion for their patients and communities. The studies selected in this paper explored if Pender’s Health Promotion Model was able to assist in achievement of positive health promoting behaviors applied to a number of different population groups.
Keywords: health promotion model, Pender, nursing
Pender’s Health Promotion Model
The health promotion model was developed in 1982 by Dr. Nola J. Pender. The theorist, Nola J. Pender, started her career as a diploma nurse and later went on to achieve her doctorate of philosophy in psychology and education (Butts & Rich, 2018, p.446). Pender believed that the goal of nursing care was to help their patients achieve optimal health and well-being. The model was created following Pender’s work examining health promoting and preventative behaviors. The health promotion model claims that each individual’s characteristics and life experiences have a direct impact on their actions and decisions regarding their health (Butts & Rich, 2018, p.446). Health is not defined solely as the absence of disease but the state of well-being. Pender’s health promotion model has been revised since its first creation and has had significant influence on the work of other theorists (Butts & Rich, 2018, p.446).
Pender’s health promotion model concentrates on three major categories: individual characteristics and experiences, behavior-specific cognitions and affect and lastly, the behavioral outcomes (Butts & Rich, 2018, p.446). The first category explores the concept that each individual has his or her own set of characteristics and experiences, which in turn help shape their actions (Butts & Rich, 2018, p.446). Pender emphasized that one’s past actions have a direct link to whether they would partake in future health-promoting behaviors (Butts & Rich, 2018, p.447). Personal attributes and habits can also be a barrier to health-promoting behaviors.
The second category involves the behavior-specific cognitions and affect which have a direct impact on the individual’s motivation for change (Butts & Rich, 2018, p.447). Nursing interventions can be tailored to these variables to assist in forming positive changes. Variables include; the observed benefits and barriers to the action, self-worth, and the activity-related result. The third category is the behavioral outcome (Butts & Rich, 2018, p.447). The start of the outcome begins with the person committing to taking the steps necessary to make a change. During this phase the individual must be supported with barriers addressed in order to produce a positive health-promoting behavior (Butts & Rich, 2018, p.447). The goal of the health promotion model is to stimulate a behavioral change that results in a positive health outcome.
Major concepts in Pender’s health promotion model include; the person, their environment, health, and nursing (Butts & Rich, 2018, p.447). The person is the central focus of the model. The person’s experiences and attributes have a direct impact on future actions and decisions (Butts & Rich, 2018, p.448). One must assess the learned behaviors we gain from our family and community environments. These learned behaviors influence the individual’s ability to participate in health-promoting behaviors (Butts & Rich, 2018, p.448). The environment includes the person’s physical, social, and economic conditions. A healthy environment is free of toxins, has economic stability, and allows access to resources that promote healthy living (Butts & Rich, 2018, p.448). How one defines health has a direct impact on the promotion of well-being and prevention of disease. Through motivation the individual is able to prevent illness and promote healthy behaviors (Butts & Rich, 2018, p.448). In order to foster positive health-promoting behaviors the nurse must take into account the individual’s self-worth, benefits for the change, environmental control, and any potential barriers to change.
In the article, “Predicting Physical Activity Among Urban Adolescent Girls: A Test of the Health Promotion Model,” Voskuil, Robbins, & Pierce (2019), sought to determine if the health promotion model would assist in predicting physical activity in the selected demographic group. The health benefits of moderate physical activity are well established yet many young people are falling short in achieving optimal physical activity (Voskuil, Robbins, & Pierce, 2019). The study collected information in regards to the individuals’ self-efficacy, enjoyment, social support, options, and commitment to physical activity. Additional data including age, body mass index, and pubertal state were also collected. The selected sample size was from eight different schools in low-socioeconomic, urban areas, included adolescent girls in the fifth through eighth grades. The study followed the adolescent girls over a seventeen week period as they underwent a physical activity intervention. The goal was to examine if the introduction of a physical activity intervention would result in lasting moderate-to-vigorous physical activity (Voskuil et al., 2019).
The researchers selected the health promotion model due to its previous success in exploring the explanations for health-promoting behavior in a number of different populations (Voskuil et al, 2019). Voskuil et al. (2019) explain, “the HPM includes three groups of variables that influence behavior: (a) individual characteristics; (b) behavior-specific cognitions and effect; and (c) behavioral contingencies including a commitment to a plan of action” (p.393). The study examined the relationship of the health promotion model on the prediction of moderate to vigorous physical activity among adolescent girls (Voskuil et al., 2019). The results found that self-efficacy was the only factor to have a meaningful impact on the commitment to physical activity. Surprisingly, the study did not find that social support, options for physical activity, or commitment to have a significant effect on commitment to moderate to vigorous physical activity (Voskuil et al., 2019). In addition, there was no correlation to the measured biological factors of the girls. Opening the study to other age groups, genders, and populations could further test the study’s theory (Voskuil et al., 2019).
In order to increase physical activity among this population interventions need to be put in place to assist in fostering self-efficacy. According to Voskuil et al., (2019), “Intervention strategies shown to be effective for increasing PA self-efficacy include active online health games, encouragement from teachers, and use of a multidisciplinary team approach in the school setting” (p.405). Within the health promotion model, self-efficacy was found to be a significant indicator for moderate-to-vigorous physical activity among adolescent girls. School nurses play an important role in assessing the possible barriers of their student population and forming strategic steps to support physical activity in vulnerable individuals (Voskuil et al., 2019).
In the article, “The Effect of a Multi-Strategy Program on Developing Social Behaviors Based on Pender’s Health Promotion Model to Prevent Loneliness of Old Women Referred to Gonabad Urban Health Centers,” the authors Alaviani, Khosravan, Alami, & Moshki (2015), explored applying Pender’s Health Promotion model to assist in the prevention of loneliness in elderly women. Alaviani et al (2015), explains, “since the elderly are faced with problems related to social interactions and interpersonal relations, many of them define the aging period as a loneliness period and look at it as an unpleasant experience” (p.133). The selected subject group included one hundred and fifty elderly Iranian women attending the Gonabad urban Health center for the treatment of moderate loneliness. The methods involved a quasi-experimental study, the data was collected using the Russell’s UCLA loneliness questionnaire and questions were formed based on Pender’s Health Promotion Model (Alaviani et al., 2015). Pender’s health promotion model bases its intervention framework on the assessment of the targeted population (Alaviani et al., 2015). The selected subjects were placed into either the intervention or control groups. Interventions involved therapy sessions and loneliness educational in-services. The sessions aimed to improve the client’s social interactions and also to motivate self-efficacy. The results indicated a reduction in loneliness in the subjects in the intervention group.
The study highlights that Pender’s health promotion model can be used as a tool for nurses to plan behavior modification interventions to improve and/or prevent loneliness (Alaviani et al., 2015). By preventing loneliness in this population we can decrease the likelihood of depression and other mental health issues (Alaviani et al., 2015). Possible solutions in combating loneliness include: having a pet, group therapy, counseling, music therapy, sharing memories, and training society to be more acceptable to the aging process (Alaviani et al., 2015). Nurses can use the health promotion model in combination with these interventions to help initiate behavioral changes and ultimately prevent loneliness.
In the article, “ The Effect of Pender’s Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women,” the authors, Khodaveisi, Omidi, Farokhi, & Soltanian (2017), studied the effect of Pender’s health promotion model on the nutritional behaviors of overweight women. Obesity is a chronic disease seen at an increasing rate worldwide. In this quasi-experimental study, one hundred eight qualified women whom were admitted to the Fatemiyeh Hospital clinic in Iran were randomly placed in the experimental or the control group. The health promotion model was chosen for this study due to its emphasis changing unhealthy behaviors and health promotion (Khodaveisi et al., 2017).
Data collection from the participants was obtained using questionnaires completed at the pre-test and post two-month period (Khodaveisi et al., 2017). The training interventions included educational presentations, question and answer sessions, and group discussions. The results from the study showed Pender’s health promotion model based training resulted in an improvement in nutritional behavior (Khodaveisi et al., 2017). The study was successful in teaching the benefits of healthy nutrition. Positive attitudes from the individuals and from their family members leads to longstanding improvements in nutritional behaviors. In order to foster healthy lifestyles we need to continue to target risk factors and encourage health-promoting behaviors. Khodaveisi, M. et al. (2017) explain, “Health-promoting behaviors include activities that enable people to monitor their health and are, therefore, useful to improve individual and community health” (p.166). This study demonstrates the importance of the healthcare professional in influencing healthy nutritional behaviors and promoting health. Educational programs should be tailored to emphasize the promotion of healthy living and nutrition (Khodaveisi et al., 2017).
Major assumptions of the health promotion model stress that the individual is in control of shaping and sustaining their health behaviors within their environment. Healthcare providers play an important role and influence in the patient’s environment. In order for a behavioral change to occur and be maintained it must be self-initiated (Butts & Rich, 2018, p.449). One must consider the individual’s previous behavior and characteristics that can have a direct influence on future health-promoting behavior. Perceived personal value or benefit, as well as, self-worth can be a driving focus to achieve participation (Butts & Rich, 2018, p.449). A strong indication for commitment to health-promotion behavior can be achieved when others in their environment support and display the behavior.
The simplicity of the health promotion model enables it to be easily adapted in the community health setting (Butts & Rich, 2018, p.450). We have a chance to improve a patient’s well-being and prevent disease when health-promoting behaviors are established in the community environment. Due to its ease of use, the health promotion model is a valuable tool in the field of nursing research (Butts & Rich, p.450). The use of Pender’s Health Promotion Model in the articles explored display how it can positively affect and improve health behaviors. Today the value of healthy lifestyles and behaviors holds even higher significance as health insurance becomes out of reach for many individuals due to rising costs. Pender’s health promotion model drives the nurse to tailor their education to meet the individual and environmental needs of their patient in order to initiate a health-promoting behavioral change (Butts & Rich, p.451).
- Alaviani, M., Khosravan, S., Alami, A., & Moshki, M. (2015). The Effect of a Multi-Strategy Program on Developing Social Behaviors Based on Pender’s Health Promotion Model to Prevent Loneliness of Old Women Referred to Gonabad Urban Health Centers. IJCBNM, 3(2), 132-140.
- Butts, J. B., & Rich, K. L. (2018). Philosophies and Theories for Advanced Nursing Practice. Burlington, MA: Jones & Bartlett Learning.
- Health and Wellness (2016, November 17). Retrieved from https://nursekey.com/health-and-wellness-2/
- Khodaveisi, M., Omidi, A., Farokhi, S., & Soltanian, A. (2017). The Effect of Pender’s Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women. IJCBNM, 5(2), 165-174.
- Voskuil, V. R., Robbins, L. B., & Pierce, S. J. (2019). Predicting physical activity among urban adolescent girls: A test of the health promotion model. Research in Nursing & Health, 42(5), 392–409.
Figure 1. Pender’s Health Promotion Model. Health and Wellness. (2016, November 17). Retrieved from https://nursekey.com/health-and-wellness-2/
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