Nola J. Pender

Health Promotion Theory
Nola J. Pender
 Born on August 16, 1941

 Professor emerita of Nursing at University of Michigan
 Created the Health Promotion Model
 1964 – Earned her BS
 1965 – Earned her MA from Michigan State University in East Lansing, Michigan
 1969 – Received a Ph.D. from Northwestern University of Evanston
 Written a textbook, Health Promotion in Nursing
 Her publications include eight textbooks and 60 scholarly writings
 2012 - Named a Living Legend of the American Academy of Nursing
Health Promotion Theory
 The Health Promotion Model notes that each person has unique personal
characteristics and experiences that affect subsequent actions.
 Health promoting behavior is the desired behavioral outcome and is the endpoint in
the Health Promotion Model
 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.
 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 well-being.
 The health promotion model describes the multi-dimensional nature of persons as
they interact within their environment to pursue health.
 Designed to be a “complementary counterpart to models of health protection.”
 It develops to incorporate behaviors for improving health and applies across the life
span.
 Its purpose is to assist nurses in knowing and understanding the major determinants
of health behaviors as a foundation for behavioral counseling to promote well-being
and healthy lifestyles.
The model focuses on following three areas:
1. INDIVIDUAL CHARACTERISTICS AND EXPERIENCES

- Prior related behavior and personal factors
2. BEHAVIOR-SPECIFIC COGNITIONS AND AFFECT
 Perceived benefits of action, perceived barriers to action, perceived self-efficacy,

activity-related affect, interpersonal influences, and situational influences
3. BEHAVIORAL OUTCOMES
 Commitment to a plan of action, immediate completing demands and preferences,

and health-promoting behavior
Sub concepts of the Health Promotion Model
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 behaviour being considered.
1. Personal biological factors

 Include variable such as age gender body mass index pubertal status, aerobic
capacity, strength, agility, or balance.
2. Personal psychological factors
 Include variables such as self esteem self
motivation personal competence perceived health status and definition of health.

3. Personal socio-cultural factors
 Include variables such as race ethnicity, accuculturation, education and
socioeconomic status.
4. Perceived Benefits of Action
 Anticipated positive out comes that will occur from health behaviour.
5. Perceived Barriers to Action

 Anticipated, imagined or real blocks and personal costs of understanding a given
behaviour
6. Perceived Self-Efficacy
 Judgment of personal capability to organise and execute a health-promoting
behaviour. Perceived self-efficacy influences perceived barriers to action so higher
efficacy result in lowered perceptions of barriers to the performance of the
behavior.
7. Activity-Related Affect
 Subjective positive or negative feeling that occur before, during and following
behavior based on the stimulus properties of the behaviour 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.
8. Interpersonal Influences
 Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal
influences include: norms (expectations of significant others), social support
(instrumental and emotional encouragement) and modelling (vicarious learning
through observing others engaged in a particular behaviour).
 Primary sources of interpersonal influences are families, peers, and healthcare
providers.
9. Situational Influences
 Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behaviour.
 Include perceptions of options available, demand characteristics and aesthetic
features of the environment in which given health promoting is proposed to take
place.
 Situational influences may have direct or indirect influences on health behaviour.
10. Commitment to plan of action

 The concept of intention and identification of a planned strategy leads to
implementation of health behaviour.
11. Immediate Competing Demands and Preferences

 Competing demands are those alternative behaviour over which individuals have
low control because there are environmental contingencies such as work or family
care responsibilities.
 Competing preferences are alternative behaviour over which individuals exert
relatively high control, such as choice of ice cream or apple for a snack.
12. Health Promoting Behavior

 Endpoint or action outcome directed toward attaining positive health outcome such
as optimal well-being, personal fulfillment, and productive living.
Major 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, such as nurses, constitute a part of the interpersonal
environment, which exerts influence on persons throughout their life span.
 Self-initiated reconfiguration of the person-environment interactive patterns is
essential to changing behavior.
14 THEORETICAL ASSERTIONS
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.
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 commitments 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.

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What are the three main areas the Health Promotion Model focuses on?

What are some examples of personal factors according to the model?

Health Promotion Theory

 Born on August 16, 1941

Health Promotion Theory

1. INDIVIDUAL CHARACTERISTICS AND EXPERIENCES

2. BEHAVIOR-SPECIFIC COGNITIONS AND AFFECT

 Perceived benefits of action, perceived barriers to action, perceived self-efficacy,

 Commitment to a plan of action, immediate completing demands and preferences,

Sub concepts of the Health Promotion Model

 Personal factors categorized as biological,

1. Personal biological factors

motivation personal competence perceived health status and definition of health.

5. Perceived Barriers to Action

10. Commitment to plan of action

11. Immediate Competing Demands and Preferences

12. Health Promoting Behavior

 Individuals seek to actively regulate their own behavior.

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