The Health Promotion Model (HPM) has been widely applied to various populations

across the world. The components of the HPM have been separated and analyzed in
order to determine the applicability and helpfulness of each. Numerous studies have
highlighted the utility of the model and its components in aiding in the prediction of a
health promoting lifestyle (HPL) among diverse demographics (Taymoori, Lubans, and
Berry, 2010). A large portion of the available literature centers around the contributing
factors of an HPL among children and adolescents. There have also been many studies
among the college-aged population that look into the various components of the HPM
as those relate to exercise behaviors. The findings of these studies support the
usefulness of the HPM, and its ability to predict an HPL for an individual. Furthermore,
the results shed light on how to further promote health-conscious behaviors among a
range of populations, by targeting specific components of the HPM.

Previous studies have highlighted the importance of taking into consideration the
HPM variables in a wide range of topics, such as the health-related quality of life,
physical activity, and the Transtheoretical Model of Change. To fully appreciate the
implications of this study and the significance of the findings, a review of the literature
regarding the various components of the HPM will be provided. Due to the significant
importance of the HPM cognitive component of perceived self-efficacy, relevant
research emphasizing the implications of self-efficacy and desired behavioral changes
pertaining to a wide range of situations will also be thoroughly considered.
Health Promotion Model and Health-Related Quality of Life

In a 2011 study by Mohamadian et al., the HPM was analyzed for its ability to
predict one’s health-related quality of life. The purpose of the study was to see if there
were any existing relationships between the HPM variables and health-related quality of
life, as well as to identify health-related quality of life predictors. Their analyses revealed
self-efficacy, perceived barriers, and social support each had significant relationships
with involvement in an HPL (Mohamadian et al., 2011). An HPL had a significant positive
and direct influence on the health-related quality of life, and self-efficacy had a
significant positive and direct influence on an HPL and the health-related quality of life.
The Mohamadian et al. (2011) study demonstrated that the HPM could prove to be
useful in explaining and predicting variables relating to the health-related quality of life.
A noteworthy finding of this study was an HPL alone can act as a strong predictor of the
health-related quality of life. Therefore, the value of discovering what contributes to an
individual’s ability to live an HPL becomes evident when striving to understand how to
enhance one’s health-related quality of life. The HPM can help do just this—uncover
what factors promote and impair one’s involvement in living an HPL (Mohamadian et al.,
2011). One would expect those who are characterized as having an excellent
healthrelated quality of life would partake in regular physical activity; therefore, it is
necessary to consider how the HPM relates to physical activity participation.
Health Promotion Model and Physical Activity

While physical activity in itself is not a component of the HPM, it is a major part of
an individual living an HPL, and therefore has been widely addressed in the HPM
research. The HPM has been used as a means to predict exercise behaviors, and the
components of the HPM have been discovered to have both direct and indirect effects
on physical activity. Taymoori, Lubans, and Berry (2010) found the HPM components of
self-efficacy, activity-related affect, interpersonal influences, and commitment to
planning all have direct effects on one’s participation in exercise behaviors. In this same
study, perceived benefits of exercise, perceived self-efficacy, and activity-related affect
were also found to have indirect effects on physical activity involvement.

An additional component of the HPM that has been found to influence physical
activity participation is that of competing demands and preferences, particularly how
those influence the component of commitment to planning (Taymoori, Lubans, & Berry,
2010; Taymoori et al., 2008). The findings of a 2008 study by Taymorri et al. supported
targeting the perceived self-efficacy, perceived exercise benefits and barriers, and
interpersonal components of the HPM in order to enhance one living in a way that
advances an HPL specifically by promoting exercise behaviors.
 In another longitudinal investigation (Wu and Pender, 2005), the HPM was utilized
to gain insight into variables contributing to Taiwanese adolescents’ participation in
physical activity. The study took place over two years, and carried out two separate
waves of data collection with students starting out in eighth grade (Wave 1 of data
collection) and continuing on into ninth grade (Wave 2 of data collection). In Wave 1 of
the data collection involving 969 students, the HPM components of perceived self- 17
efficacy and interpersonal influences had direct effects on physical activity. A year later,
when Wave 2 of the data collection took place with 892 of the original participating
students, perceived self-efficacy was the only HPM component that directly influenced
exercise behaviors. From the literature on the HPM and physical activity, it is clear
several of the HPM components influence exercise behaviors. For this reason, it is vital
to take a look at each separate HPM component, in order to fully understand the impact
each has on physical activity and an HPL.

Health Promotion Model: Interpersonal Influences Component

While the interpersonal influence component of the HPM is not as modifiable as the
components related to behavior-specific cognitions and emotions, it has been found to
be a critical factor when predicting involvement in an HPL. When studying which
components of the HPM could be used to predict a health-related quality of life,
Mohamadian et al. (2001) concluded social support was a key factor in facilitating an
HPL, as well as the health-related quality of life. This supports the findings of many other
investigations looking at predictive variables of an HPL (Chen et al., 2007; Ethgen et al.,
2004; Finch & Vega, 2003; Seo & Hah, 2004; Taymoori et al., 2008; Thanakwang, 2008).

In addition to receiving social support from family members, friends, and peers,
other studies have indicated an important aspect of interpersonal influences in
facilitating exercise behaviors is that of behavioral modeling (Taymoori, Lubans, & Berry,
2010; Taymoori, Niknami, Berry, Ghofranipour, & Kazemnejad, 2009). Taymoori et al.
(2010) noted within the interpersonal influences component, interpersonal norms
supporting the 18 involvement in an HPL contributed to an individual having greater
follow-through when planning to make desirable health promoting behavioral changes.

Research examining the components of perceived benefits of exercise, and barriers

to exercise has also shed light on the interpersonal component of the model. When an
individual believes he or she is not receiving enough social support, this is often times
viewed as a barrier to participating in exercise-related activities (Arzu, Tuzun, & Eker,
2006; Awadalla, et al., 2014; Lovell, Ansari, & Parker, 2010). While a lack of social
support can be viewed as a barrier, the ability to socially interact with others while
participating in exercise can be regarded as a perceived benefit of exercise according to
Lovell, Ansari, and Parker’s (2010) investigation with non-exercising college students.

Health Promotion Model: Perceived Benefits and Barriers Components

Studies utilizing the HPM to investigate physical activity participation have

frequently turned to the components of perceived benefits of, and barriers to action.
These two components of the model have gained significant attention, as the
implications of what an individual perceives as being benefits of, and barriers to exercise
is one in which healthcare providers can help modify to best enhance involvement in an
HPL in someone who is seeking guidance. Furthermore, these components have gained
abundant research attention because the identification of perceived benefits of, and
barriers to exercise have been found to be useful in predicting an individual’s
involvement in physical activity (Gu, et al., 2014).
 In a cross-sectional study with 500 students in grades 9-11, a negative relationship
was found to exist between perceived barriers and the health-related quality of life
(Mohamadian et al., 2011). Perceived barriers had a significant and direct influence on
19 exercise and an HPL, indicating as more barriers are perceived, health promoting
behaviors decrease; this finding is in line with previous findings (Stuifergen et al., 2005).
Similarly, Gu et al., (2014) found perceived barriers were a mediator of college students’
participation in physical activity and their ratings regarding their health-related quality
of life. It was discovered that those who perceived fewer barriers to exercise had a
better health-related quality of life and engaged in greater amounts of exercise.

Health Promotion Model: Commitment to a Plan of Action Component

The behavioral outcome component of the HPM includes one’s commitment to plan
and partake in health promoting behaviors, as well as an individual’s competing
demands and preferences. Taymoori et al., (2008) addressed the influence of
commitment to planning and participating in an HPL on exercise participation, and
found individuals who exercised more frequently identified with a heightened
commitment to living an HPL (Taymoori et al., 2008). Similarly, Taymoori et al., (2010)
found a significant positive correlation between commitment to planning active
behaviors and increased participation in physical activity.
 Individuals who identify more competing demands derailing their physical activity
involvement tend to be characterized by less commitment to planning physical activities
(Taymoori et al., 2009). Additionally, those who acknowledge more competing
preferences in their daily lives, such as watching television, display less commitment to
planning, while those with less competing preferences have a heightened commitment
to planning physical activity (Tamoori, Lubans, & Berry, 2010). This could suggest
individuals who prefer to engage in physical activity, rather than engage in alternative
behaviors, have more positive activity-related affect pertaining to exercise, such as a
sense of accomplishment or enjoyment from exercising.

Because the HPM focuses on behavioral changes, it is beneficial to consider the

Transtheoretical Model of Change and how the two models mesh together. Having
addressed the influence of the HPM components of interpersonal influences, perceived
benefits, perceived barriers, and commitment to a plan of action, this review will now
22 address the stages of change proposed by the Transtheoretical Model of Change
before delving into the final, and most significant, HPM component of perceived
self-efficacy.

* Despite the large percentage of adults in America who are overweight or obese,
obesity rates and disorders related to obesity continue to be on the rise (Fox, 2015).
According to 2014 Centers for Disease Control and Prevention (CDC) data, all states in
the United States have an obesity rate of 20% or above, with three states having a rate
of 35% or above: Arkansas, Mississippi, and West Virginia. According to 2012 data, the
United States was spending approximately $190.2 billion annually on healthcare costs
for obesity-related diseases (Cawley & Meyerhoefer, 2012). Many attempts have been
made to promote healthy living by striving to distribute health-related information in
the United States. While most adults can acknowledge at least some value in partaking
in physical activity or having healthy eating habits, not much progress has been made in
spite of the wide-spread sharing of information (Berkowitz & Borchard, 2009).

* In addition to exercise levels decreasing, a distinct decline can be observed among

college students in regards to nutritional priorities (Gu, Chen, Collins, & Williams, 2014).
Gu et al. (2014) found only 30-50% of college students participate in physical activity,
and that this population of young adults identifies with a large number of perceived
barriers and lower health-related quality of life. It was also revealed in this study that
those who reported greater participation in physical activity identified fewer barriers to
exercise and had a higher rated health-related quality of life (Gu, Chen, Collins, &
Williams, 2014). These findings have great implications in regards to the amount of
perceived barriers, as this component of the HPM greatly predicts behavior change (Janz,
et al, 2002).

The HPM can be utilized to study the factors that contribute to college students’
lack of engagement in an health promoting lifestyle (HPL). The weight that university
students often gain, or the socalled “freshmen 15” is not caused by poor eating habits
alone, but is compounded by lack of exercise and inadequate sleep (Miller, 2011).
Discovering ways to help collegeaged individuals learn healthier habits and how to
implement those health promoting behaviors is a necessary step when addressing the
obesity epidemic in America, as it has been found that more than 80% of those who are
sedentary in college, maintain a sedentary lifestyle throughout adulthood (Sparling &
Snow, 2002).