NATIONAL COLLEGE OF NURSING,
BARWALA, HISAR
Topic – NURSING THEORY
HEALTH PROMOTION MODEL
SUBJECT – ADVANCED NURSING PRACTICE
SUBMITTED TO :- SUBMITTED BY :-
Mrs. Param mam Priyanka
(PROFESSOR ) M.Sc. Nursing 1 ST Year (2020-2022)
NATIONAL COLLEGE OF NURSING,BARWALA, HISAR NATIONAL COLLEGE OF NURSING,BARWALA,
HISAR
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HEALTH PROMOTION MODEL
INTRODUCTION
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 client’s level of wellbeing. The health promotion model describes the multi
dimensional nature of persons as they interact within their environment to pursue health. The
model focuses on following three areas:
● · Individual characteristics and experiences
● · Behavior-specific cognitions and affect
● · Behavioral outcomes
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
end point in the HPM. 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 an intended health promoting actions.
Health professionals intervened only after people developed acute or chronic disease
and experienced compromised lives. Attention was devoted to treating them after the fact. This
reactive approach did not reflect the philosophical beliefs of our predecessors in nursing who
focused on maintaining conditions of healthy interaction between self and the environment.
Health Promotion Model has given health care a new direction. According to Pender, 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.
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Health promotion model appeared in the nursing literature in the early 1980s and focused
on health promoting behaviors rather than health protection or illness prevention behaviors. The
health promotion model has been replaced by revised health promotion model.
The HPM is a competence or approach oriented model in which the motivational source for
behavior change is based on the individual’s subjective value of the change that is how the client
perceives the benefits of changing the given health behavior. The HPM does not include fear or
threat as a motivating source for changing health behavior.
BACKGROUND OF THEORIST
Name NOLA J. PENDER, Born in 1941 in Lansing, Michigan.
Education
PhD in psychology and Education, Northwestern University, Evanston, Illinois, 1969
MA in human growth and development, Michigan State University, East Lansing, Michigan,
1964
BS in nursing, Michigan State University, East Lansing, Michigan, 1962
Diploma in nursing from West Suburban Hospital School of Nursing, Oak Park Illinois
Honorary Degree
Hon. Doctor of Science, Widener University, Chester, Pennsylvania, 1992
HEALTH PROMOTION MODEL
Pender's work was grounded in the global and national health promotion initiatives of the
1980s and 1990s, such as the publication of Healthy People 2000: National Promotion and
Disease Prevention Objectives (1991). Healthy People 2000 developed as a national
collaborative undertaking between the Department of Health and Human Services and the Public
Health Service, and identified people at risk for poor health. It provided a national strategy for
improving the health of most minority populations over the next decade.
Pender asserted that health promotion was a key component in any initiative that
focused on improving health. She stated, "Health care is changing, but it must be further
redesigned to provide widespread access to health promotion programs and services for
individuals, families, and communities in an increasingly diverse society.
Pender originally introduced the Health Promotion Model to the nursing community
in 1982. Pender published the model in the second edition of Health Promotion and Nursing
Practice in 1987. Her paradigm was a middle range theory that reflected a competence or
approach-oriented model of health promotion behavior. Pender's nursing model depicted a
multifaceted, multidimensional interaction between the individual, family or group, and the
environment toward the pursuit of optimum health population" The goal for nursing was to
enhance the ability of the client to provide self-care and actualize healthy behaviors. Pender's
Health Promotion Model (1987) inspired research that explored the influence of its component
constructs to explain and predict personal health behaviors.
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ASSUMPTIONS OF THE HEALTH PROMOTION MODEL
The HPM is based on the following assumptions, which reflect both nursing and behavioral
science perspectives:
● Persons seek to create conditions of living through which they can express their unique
human health potential.
● Persons have the capacity for reflective self-awareness, including assessment of their own
competencies.
● Persons value growth in directions viewed as positive and attempts to achieve a
personally acceptable balance between change and stability.
● 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 person-environment interactive patterns is essential to
behavior change.
COMPONENTS IN HEATH PROMOTION MODEL
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Client: Denote individuals, families, groups, and communities, recipients of health promotion
services
Health: Actualization of inherent and acquired human potential through goal directed behavior
and satisfying relationships with others to maintain structural integrity and harmony with
relevant environments
Health promotion behavior: Expression of human actualizing tendency directed towards optimal
wellbeing, personal fulfillment and productive living
Health promotion: Motivates and seeks to expand positive potential for health in human
environment interactive process
Nursing: Health care discipline to enhance clients for self care, with context of health care
promotion, enhancing success of clients in acquiring knowledge and skills in self care
Environment: Comprehensive term meaning physical, interpersonal and economic circumstances
in which we live
THE MAJOR CONCEPTS/VARIABLES OF THE HEALTH PROMOTION MODEL
The health promotion model describes the multi dimensional nature of persons as they interact
within their environment to pursue health. The model focuses on following three areas:
● Individual characteristics and experiences
● Behavior-specific cognitions and affect
● Behavioral outcomes
Health promoting behavior is the desired behavioral outcome and is the end point in the HPM.
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 an intended health
promoting actions.
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INDIVIDUAL CHARACTERISTICS AND EXPERIENCE
The importance of an individual’s unique personal factors or characteristics and experience will
depend on the target behavior for health promotion. There is flexibility in the health promotion
model to select those characteristics that are relevant to the particular health behavior.
The individual characteristics and experience are divided into – prior related behaviors and
personal factors.
Prior related behavior- these are important because often the best predictor of future behavior
is the frequency of the same or similar behaviors in the past. The direct effect of prior behavior
is of habit formation, as each time a behavior is performed, the habit is strengthened. The
indirect effect of prior-related behaviors are associated with perceptions of self efficacy,
perceived benefits and barriers. Pender et al. indicate that the nurse can help the client move
towards health promoting behavior by focusing on the benefits of doing so and helping identify
how to overcome recognized hurdles in the way of achieving the activity.
Example- The person who has regularly exercised is more likely to continue to exercise than the
person who has been a “couch potato”. The direct effect of prior behavior is possibly that of
habit formation since each time the behavior is performed, the habit is strengthened.
Personal factors -Personal factors categorized as biological, psychological and socio-cultural.
These factors are predictive of a given behavior and shaped by the nature of the target behavior
being considered.
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a. Personal biological factors Include variable such as age, gender, body, mass
index, pubertal status, aerobic capacity, strength, agility, or balance.
b. Personal psychological factors Include variables such as self esteem, self
motivation, personal competence perceived health status and definition of
health.
c. Personal socio-cultural factors Include variables such as race, ethnicity,
education and socioeconomic status.
Example-Children and elderly requires more assistance in health promoting behavior as they had
not developed skills in performing behavioral change activities and as for the elderly factors
such as aging hinders their capability of performing behavioral change.
Some personal factors can influence health behaviors whereas others such as age cannot
be changed. Prior related behavior includes previous experience, knowledge, and skills
in health promoting actions. Individuals who made a habit of a previous health
promoting behavior and received a positive benefit as a result will engage in future
health promoting behaviors. In contrast a person who received hurdles will create a
negative effect. The nurse can focus on positive benefits of behavior teach how to
overcome hurdles and provide positive feedback for the clients’ success.
BEHAVIOR-SPECIFIC COGNITIONS AND AFFECT
This set of variables is considered to be of major motivational significance for acquiring and
maintaining health promoting behaviors. Behavior significance cognition constitute a critical
core for intervention because they can be modified through nursing intervention. They include
the following;
Perceived benefits of action- Prior positive experience with the behavior or observations of
others engaged in the behavior is a motivational factor. The benefits may be intrinsic(feeling
better) or extrinsic (time to socialize while practicing the target behavior).
Example- Earlier patient was able to maintain blood sugar level by doing exercises, maintaining
diet pattern regularly. However, in hospital patient realizes that by performing those activities
will help him in maintaining blood sugar. Patient is motivated by his prior actions towards
promoting his own health.
Perceived barriers to action- A person’s perceptions about available time, inconvenience,
expense and difficulty performing the activity may act as barriers. It affects the health
promoting behaviors by decreasing the individual’s commitment to a plan of action. Barriers are
perceived – they may be real or seen by others or they may be imagined by a person. It is the
perception of the barrier that influences the decision making about participating in the target
behavior.
Example- It is the perception of the barrier that influences the decision making about
participating in the target behavior. Barriers may relate to degree of availability of access of
resources, costs in money and time, and degree of perceived difficulty. Anticipation of loss of
satisfaction associated with such behavior as smoking may be seen as a barrier. Perceived
behavior is more likely to lead to avoidance of behavior.
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Perceived self efficacy -Judgment of personal capability to organize and execute a health-
promoting behavior. Often people who have serious doubts about their capability decrease their
efforts and give up, whereas those with strong sense of efficacy exert greater effort to master
problems or challenges. Four types of information help form the perception of self efficacy-
Having engaged in the behavior and met one’s own standard or received positive feedback from
others, having observed others successfully perform the behavior and be evaluated positively,
being persuaded by others than one has the ability to successfully engage in the target behavior
and physiological states such as calmness, anxiety and fear that influence ones judgment of
competency.
Example- Inspite of having pain in wrist doctor is advising patient to move his wrist to prevent
contractures. Patient efficacy should be enhanced by engaging in the behavior, by providing him
a positive feedback, persuaded by others that they are having capability to overcome the barriers.
And helping the patient to be free from anxiety, fear, and calmness.
Activity related affect- Subjective positive or negative feeling that occur before, during and
following behavior based on the stimulus properties of the behavior itself. Activity-related
affect influences perceived self-efficacy, which means the more positive the subjective feeling,
the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further
positive affect and behaviors associated with a negative affect are usually avoided. There are
three components to this affect : the act-related emotional arousal, the self- related self acting
and the context related environment in which the behavior occurs.
Interpersonal influences- are the person’s thoughts or beliefs about the behaviors, attitude and
beliefs of others and may or may not accurately reflect those behaviors, attitude or beliefs .
Interpersonal influences include: norms (expectations of significant others), social support
(instrumental and emotional encouragement) and modeling (various learning through observing
others engaged in a particular behavior). Primary sources of interpersonal influences are
families, peers, and healthcare providers. Some people depend on the expectations and
encouragement of others, other people decide to participate as they observe others enjoying
engaging in a health promoting activity.
Example-A patient diagnosed with tuberculosis is stigmatized by the society which weakens his
self care efficacy and adherence to treatment regimen. But if family encouragement is provided
and modeling of the society views towards the disease this can improve and enhance the
patient’s efficacy towards health. There by strengthening him to engage him health promoting
activities such as adhering to treatment regimen and other health related activities. The most
common factor influencing the concept of health promotion orientation was individual
perspective, nurses' exhibited a holistic approach in their health promotion practice, they
concentrated on activities such as helping individuals or families to make health decisions or
supporting people in their engagement with health promotion activities. Nurses' strategies for
health promotion included giving information to patients and providing health education .
However, patient participation was mainly limited to personal aspects of care, such as letting
patients decide on a menu, when to get out of bed and what clothes they wanted to wear.
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Situational influences- Personal perceptions and cognitions of any given situation or context
that can facilitate or impede behavior. Include perceptions of options available, demand
characteristics and aesthetic features of the environment in which given health promotion takes
place. Situational influences may have direct or indirect influences on health behavior. Demand
characteristics can directly affect healthy behaviors through policies such as a company
regulation that demands safety equipment to be worn or that establishes a no smoking
environment. Individuals are more apt to perform health promotion behaviors if they are
comfortable in the environment versus feeling alienated. Environments that are considered safe
as well as interesting are also desirable aesthetic features that facilitate health promotional
behaviors.
Example-There is a difference in the personal perception of the people living in slum area and
well organized urban areas toward health and the importance of health promoting behaviors.
COMMITMENT TO PLAN OF ACTION
Commitment to a plan of action involves two processes; commitment and identifying specific
strategies for carrying out and reinforcing the behavior. The concept of intention and
identification of a planned strategy leads to implementation of health behavior. Strategies are
important because commitment often result in good intentions and not actual performance of the
behavior.
IMMEDIATE COMPETING DEMANDS AND PREFERENCES
Competing demands are that alternative behavior over which individuals have low control
because there are environmental contingencies such as work or family care responsibilities
which may compete with a planned visit to the health club and not responding to this
responsibility may cause a more negative outcome than missing the exercise routine. Competing
preferences are alternative behavior over which individuals exert relatively high control, such as
choice of ice cream or apple for a snack, however this control depends on the individuals’
ability to be self regulating or to not ‘’give in”. For example a person who chooses a high fat
food over a low fat food because it tastes better has “given in” to an urge based on a competing
preference
BEHAVIORAL OUTCOME- the desired behavior outcome is health promoting behavior. The
purpose of the health promoting behavior for the client to realize positive health outcome such
as improved functional ability or improved quality of life. Health promoting behavior may
involve increasing healthy behavior already in place, replacing risky or unhealthy behavior or
both of these.
Endpoint or action outcome directed toward attaining positive health outcome such as optimal
well-being, personal fulfillment, and productive living.
THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL
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Theoretical statements derived from the model provide a basis for investigative work on health
behaviors. The HPM is based on the following theoretical propositions:
● Prior behavior and inherited and acquired characteristics influence beliefs, affect, and
enactment of health-promoting 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.
● 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.
● The greater the commitments to a specific plan of action, the more likely health-
promoting behaviors are to be maintained over time.
● 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.
● Persons can modify cognitions, affect, and the interpersonal and physical environment to
create incentives for health actions.
USING THE HEALTH PROMOTION MODEL IN NURSING
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Future will be very bright and productive for nurses who direct their careers toward
understanding disease prevention and health promotion processes. Most important, clients will
benefit from health promotion interventions by developing skill and confidence in caring for
themselves and dependent others enabling them to live healthier and more productive lives. The
health promotion model can be a useful guide to nursing care in relation to assisting the
recipients of nursing care in choosing and carrying out behaviors to increase well-being.
The opportunities for advanced practice nurses in health promotion are absolutely. Advance
practice nurses should interpret the research findings about health promotion and apply them into
clinical practice and protocols and into community partnerships and programs. Nothing more
exciting than to bring groups of researchers together with groups of advanced nurse practitioners
to use the latest knowledge about behavior change and determinants of particular health or risky
behaviors to develop anticipatory guidance and counseling protocols. Of course, "state of the
science" care protocols must be developmentally and culturally appropriate. Advanced practice
nurses can play a vital role in creating partnerships among scientists, practitioners and consumers
to develop appropriate care strategies for specific populations. We must exercise caution in the
application of research from one group to another group. For example, both the meanings and
determinants of health behaviors are likely to differ across early, middle, late adolescence and
adulthood. We must understand the dynamics of behavior through our research to build
interventions with high potential effectiveness.
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
Facilitate client involvement in the assessment, implementation, and evaluation of health goals.
Teach client’s self-care strategies to enhance fitness, improve nutrition, manage stress, and
enhance relationship. Assist individuals, families and communities to increase their level of
health. Educate clients to be effective health care consumers. Assist clients, families, and
communities to develop and choose health promoting options. Guide client’s development in
effective problem solving and decision making. Reinforce client’s personal and family health
promoting behaviors. Advocate in the community for the changes that promote a healthy
environment.
We nurses could do more by using our caring touch, and therapeutic talks. Health teachings are
always part of nurses’ experience in the workplace.
Community health care setting is the best place 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
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conditions. This is because the people in the rural area tend to veer away from modern medical
methods.
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 student nurses taught the families
about the eating habits of 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 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
In health care settings, patients come & go , meet, got admitted , or discharged. As this theory
advocated, we should not allow our patients to experience severe conditions if we could only
prevent them from encountering such. 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 by attending seminars
& conventions. Enrolling to masters & 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 not ending, ever changing process . 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
Research help Health Care provider to develop a systematic problem-solving approach to
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improve and develop strategies to promote good health to individuals. Through research we will
be able to clarify and verify the phenomenon.
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.
Researches in nursing is mainly based on some interventions or forming some protocols for
nursing personals that can help in preventing , promoting and enhancing the health .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.
Studies that tested Pender's (2007) Health Promotion Model included: Murphy and Polivka ;
Pender, et al., illustrates Pender's original Health Promotion Model, on parental perceptions of
childhood obesity , body mass index , school’s role in prevention / treatment of obesity. Subjects
are parents of school aged children in a suburban latchkey program.
Mendias and paar et al studied perceived health and self care learning needs, barriers, preferred
learning modalities. Subjects were- 151 adults outpatients with HIV/AIDS.
Kwong et al 2007 studied on influence on participation in physical activity , healthy dietary
practices , stress management , barriers to these practices.
STRENGTHS OF HEALTH PROMOTION MODEL
• Simple to understand
• Conceptual definitions provide clarity & lead to greater understanding of complexity of
health behavior phenomena
• It is very flexible
• It supports research and also support use of those researches in practice
• Factors which direct or indirect influences clearly set out in a visually simple diagram
that displays their association
• As healthcare costs continue to climb, a healthy lifestyle is ultimate antidote to rising
healthcare costs
LIMITATIONS
• Fails to provide holistic care, and prevent nurses from thinking "outside of the box’’
• In the model spiritual is not included in personal factors
• All the variables to be tested at one time .
CONCLUSION
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Health Promotion Model is substantive & useful as we nurses and in our
day-to-day life experiences that we are always promoting health, preventing illnesses, and
upholding well-being. We work as educator and act as health advocates. We have knowledge on
health & illnesses, thus, we educate the people 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”. This
theory really manifests the noble work of a NURSE.
The various health promotion strategies and tools that have been
developed and presented in the three editions of Health Promotion in Nursing Practice. HPM
model can be used as a basis for structuring nursing protocols and interventions. Nurses in
practice should focus on understanding and addressing variables that are most predictive of given
health behaviors. This is 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. Computer technologies are evolving which
enable health professionals to assess individuals effectively as a basis for personalized
interventions.
Health Promotion Model has long pointed to new directions in health care. Health
Promotion and Disease Prevention should be the primary focus in health care .When health
promotion and prevention fail to prevent problems, then care in illness becomes the next priority.
Health care reform is a paradigm shift to health promotion. Quality of care, access to care, and
tracking and documenting of health promotive care are all integral to reforming the health care
system in a way that is most productive for health care consumers. 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. Health promotion and prevention
should be central to any transformations of the health care system.
Health Promotion Model
Clinical Assessment for Health Promotion Plan
Example: Increasing Physical Activity
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Assess current stage of physical activity [pre-contemplation (PC), contemplation (C),
planning/preparation (P), action (A), maintenance (M)]. If in stages C, P, or A, continue. If in
stage M, reinforce positive behavior. If in stage PC, reinforce benefits of physical activity, and
assess readiness at a later time.
Prior Behavior
What attempts have you made in the past to be physically active?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
What did you learn from these experiences?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Personal Influences
What are the personal benefits of becoming more active?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
What problems (barriers) might you have trying to be more active?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
How sure are you (self-efficacy) that you can overcome these barriers to being more active?
1 2 3 4 5 6 7 8 9 10
Uncertain Very Sure
What physical activities do you enjoy most?
(activity-related affect)
____________________________________________________________________
____________________________________________________________________
Interpersonal Influences
Social Norms - Do any of your family members or friends expect you to be physically active?
Yes No If so, who? ___________________________________________________________
Social Support - Who will encourage you to be active or be active with you?
____________________________________________________________________
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Role Models - Is anyone in your family or any of your friends physically active 3-5 times every
week?
Yes No If so, who, and what do they do?
____________________________________________________________________
____________________________________________________________________
Situational Influences
Where could you be physically active doing what you enjoy?
____________________________________________________________________
____________________________________________________________________
Commitment to a Plan of Action
Are you ready to set goals and develop a plan to become more active?
Yes No Steps of Plan
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Competing Demands and Preferences (At Follow-up)
What problems did you encounter in trying to be more active?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
How can you avoid these problems in the future?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
REFERENCES
1. Marriner TA, Raile AM. Nursing theorists and their work. 5th ed. Sakraida T.Nola J.
Pender. The Health Promotion Model. St Louis: Mosby; 2005
2. Nursing theories, the base for professional nursing practice. 6th edition . Julia B.George
3. Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier Mosby; 2006.
4. Kozier and erb’s fundamental of nursing .8th edition . Pearson education
5. P. Taymoori et al Application of the health promotion model to predict stages of exercise
behavior in Iranian adolescents.,Eastern Mediterranean Health Journal, Vol. 15, No. 5,
2009,pp 1215- 1225.
6. Wikipedia. Health Promotion Model.
Availablefrom:http://en.wikipedia.org/wiki/Health_Promotion_Model..
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