Health Promotion Model
- 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 well being.
- The health promotion model describes the multi dimensional
nature of persons as they interact within their environment to
The model focuses on following
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.
ASSUMPTIONS OF THE HEALTH PROMOTION MODEL
The HPM is based on the following assumptions,
which reflect both nursing and behavioral science perspectives:
Individuals seek to actively regulate their own
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 life span.
Self-initiated reconfiguration of
person-environment interactive patterns is essential to
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
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
Situational influences in the external environment
can increase or decrease commitment to or participation in
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
Persons can modify cognitions, affect, and the
interpersonal and physical environment to create
incentives for health actions.
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
Include variable such as age gender body mass index
pubertal status, aerobic capacity, strength, agility, or
Include variables such as race ethnicity, accuculturation,
education and socioeconomic status.
Behavioural Specific Cognition and Affect
PERCEIVED BENEFITS OF
PERCEIVED BARRIERS TO
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
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.
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.
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
COMMITMENT TO PLAN OF ACTION
The concept of intention and identification of
a planned strategy leads to implementation of health
IMMEDIATE COMPETING DEMANDS AND
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
HEALTH PROMOTING BEHAVIOUR
Endpoint or action outcome directed toward
attaining positive health outcome such as optimal well-being,
personal fulfillment, and productive living.
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