Theory/Author Name and Background
Nola J. Pender developed the Health Promotion Model (HPM) in 1982 and revised it in 1996. There have been subsequent revisions with the fifth edition in 2006. The model has been chosen as appropriate for Family Nurse Practitioners. HPM is a middle-range theory that focuses on creating interventions to enhance activity in pre-teen and teenage families. HPM encourages the discovery of solutions and focuses on variables that have been identified to influence health behaviors. The model was developed to develop a complementary counterpart to models of health protection. The model goes beyond a mere absence of ill health to positive dynamics that promote good health. The model focuses on the well-being of the patient by looking at several aspects that an individual interacts with within the environment.
Currently, Nola Pender is a professor emerita at the University of Michigan, School of Nursing. Nola developed HPM that has become popular among health care providers, educators, and researchers. She has taught nursing for over 40 years. Nola also has lifetime awards and honors in nursing. In addition, she has written several scholarly articles and books about nursing. Pender’s background had influenced to development of a model that would ensure that patients achieved higher levels of well-being. The model is preventive and highlights how individuals make decisions on health and disease issues within nursing. Influences of individual characteristics and environment were critical for the theorist.
Several authors have evaluated and applied HPM in their works. For example, Keegan, Chan, Ditchman, and Chiu (2012) have validated Pender’s HPM as a “motivational model for exercise/physical activity self-management for people with spinal cord injuries (SCIs) and found that the model was applicable as a motivational model for exercise/physical activity for people with SCI” (p. 34).
A study conducted by Galloway (2003) identified HPM as one of the most prevalent models used. Galloway (2003) noted that theoretical models were used to understand variables that influenced health behaviors, predict the involvement, and engagement of patients. The model offers a prudent practice setting found in a nursing environment (Galloway, 2003). Nola Pender and other researchers have focused on developing the model based on emerging evidence and addressing challenges that the nursing profession faces in the 21st century.
For instance, the focus has been on the “Health Promotion Model to examine health-specific outcome measures and behavior-specific outcome measures for health-promoting and prevention behaviors” (Baker, 2007, p. 85). On the other hand, Brenda and Velsor-Friederich (2006) noted that the model was weak when used on adolescents because it could not address the health needs of adolescents since they may not be able to make independent decisions like adults.
The major concerns addressed by the theory are disease prevention and health promotion. This can enhance individual health and ensure healthy environments. Pender aims to influence individual behaviors that promote health by positive motivation. In short, the theory has focused on:
- Experiences and characteristics of a person
- Behavioral outcomes
- Affect and behavior-specific cognition
The model is based on reproductive reasoning. For instance, Nola has based the theory on patients and environmental observation. As a result, a model has been developed to account for the observed phenomena. In this regard, the theorist has focused on developing a simple and most effective explanation for the health-specific outcome and behavior-specific outcome about nursing practices.
The model allows patients and care providers to assess and identify specific areas that affect positive health promotion. In other words, it can relate health issues with their outcomes and against a set of observed health and behavior outcomes. Consequently, nurses can identify challenges that hinder effective health promotion. Studies have noted that reproductive reasoning is a critical component in clinical evaluation and judgment (Altable, 2012).
The concepts of the HPM include environment, person, health, nursing, and illness. However, the major focus has been on the environment and the individual about behaviors and outcomes. The environment has influences on an individual, but people also aim to create a suitable environment in which they can realize their potential fully. At the same time, individuals’ characteristics and experiences in life also shape their behaviors. The environmental factors include social, cultural, and physical aspects. Individuals can manipulate environmental aspects to enhance positive outcomes in health-promoting behaviors.
Nurses have a role in providing treatments, but they must also collaborate with the patient, families, and communities to establish the best condition for health promotion. The theorist has defined these concepts operationally to demonstrate how nurses can apply them to real-life situations in clinical settings. Moreover, many researchers have focused on HPM to understand variables that influenced health behaviors. The author has been consistent with the use of concepts and other terms in theory. For instance, Nola Pender has maintained the critical aspects of the model, which has made it a framework for researchers in health promotion studies (Baker, 2007).
Nola Pender explicitly defined the concepts of the Health Promotion Model. That is, there is no implied meaning in the concepts. For example, environmental factors are identified as social, cultural, and physical elements that can influence individual behaviors and health outcomes. However, when one focuses on cues as a component of individual characteristics, then it becomes complex. Galloway (2003) has observed that cues are more challenging to articulate and measure due to their subtle and complex nature; they may be from the media, environment, or be internally driven” (p. 249). This shows some elements-related concepts are not explicit and may require deeper analysis.
There is a relationship between an individual and the environment. The model indicates that there are relationships among all modifying factors (behavioral and situational) such as “interpersonal influences and biological and demographic characteristics” (Galloway, 2003, p. 249). Individuals learn their behaviors from the environment. Prior experiences could affect one’s self-efficacy and participation in activities. Situational factors could affect a person’s behavior based on the environment of interaction. For instance, options available for patients could influence their behaviors and in turn health outcomes.
Interpersonal influences show social support and beliefs from people who can support an individual. For example, a nurse may urge a patient to reduce weight, and this can offer impetus for such a patient to engage in weight reduction activities. In addition, families and friends also play critical roles in providing social support to patients, but they can also discourage a person from the preferred behavior modification. Finally, demographic characteristics such as age, nationality, race, income, educational background, and gender are also components of the model. For example, socially excluded individuals are less likely to engage in preventive activities.
Nola Pender based the Health Promotion Model on the following assumptions. First, people strive to create the best living environment to maintain their health outcomes. Second, a person can perform a self-assessment to determine his or her strengths and overcome prior nasty experiences. Third, people prefer positive outcomes and growth and therefore, good health can motivate one to engage in health promotion behaviors.
Fourth, an individual can control his or her behavior to gain the desired health outcomes. Fifth, people interact with their environments and exert influence on them, and thus understanding environmental influences is critical for positive health. Sixth, nurses and other health care providers are part of the community that can influence positive health outcomes in patients. Finally, a person can change his or her behaviors if necessary.
The four meta-paradigm concepts of nursing are reflected in the Health Promotion Model. Individuals are considered in the model as having unique life experiences with their environments, which could influence their decisions and health outcomes. The model assumes that people want the best outcomes and have a greater sense of self-responsibility toward their health. Nevertheless, one must understand determining factors, including situational and behavioral ones that may influence human behavior and health outcomes.
The environment is a major paradigm in HPM. Individuals interact with their environments and acquire different experiences. Environmental settings differ. In addition, environmental aspects are numerous and may include cultural elements belief systems, and values among others. The model aims to instill positive experiences such as caring, aesthetics, well-being, and lived experiences. Nurses strive to understand environmental dimensions that could have negative impacts on individual health.
The model is concerned with health-specific outcomes and health-promoting and prevention behaviors. Health reflects aspects of well-being and illness. Patients must understand their health status across their life span. The model tends to reflect an individual’s social, emotional, physical, and moral perspectives. It shows that individuals have relationships with others and thus health becomes relational. Lived experiences are vital in the model because they highlight how people cope with various situations. Health reflects how a person interacts with his or her environment.
Nursing is also found in the model. Nurses strive to offer holistic health to their patients. The theory has been based on nursing studies and evidence. It is fundamental in guiding nursing and practices. Nurses are expected to provide the best quality of care and advise their patients to adopt health promotion behaviors. They must demonstrate the relevance of evidence-based interventions to promote effective decision-making and wellness within a given nursing context.
The theory was clear. It was lucid and maintained consistency throughout its definition of major concepts. Nola Pender based the theory on evidence, and she has revised it to ensure clarity and usability for readers and nurses. A nurse can simply learn major aspects of the theory through critical thinking and use current scientific studies to translate knowledge into useful forms for their practices. The theory is methodological, and nurses can observe and follow behaviors and collaborate with other stakeholders to provide the best care to patients.
The theorist asserts that the model aims to help nurses to comprehend the major influencing factors of health behaviors as a way to enhance quality healthy lifestyles. Nurses can exert influence and recommend best practices for their patients.
The model has been effective in promoting healthy living through physical activities among women cancer survivors. For instance, people should engage in exercise to enhance their chances of survival after diagnosis with cancer.
The model has also been effective for promoting evidence-based practices in nursing courses.
The model is useful for nurse practice. Nurses have a key role in promoting positive health and preventing illnesses. Health promotion is effective for improving the quality of life and well-being of individuals in different settings. The model seeks to promote a balanced approach to life. In other words, individuals need to ensure that they have balanced physical, social, and mental aspects of life. The model can target individuals, families, a given group, community, or patients within a health care setting. Still, nurses can instill positive behaviors in patients through education and promotion of healthy lifestyles and habits.
They have engaged in curative, disease prevention, and promotion of good health and well-being. The focus has been to enhance the overall health of patients. This gives nurses the role of public health advocates, educators, and promoters of health habits and lifestyles among their clients. The model has been effective for applying evidence-based practices in a health care setting.
The Health Promotion Model can help nurses to handle the multifaceted roles they face. For instance, nurses must offer support to their patients, observe the safety and wellness of patients, promote health care delivery and develop their profession. The theory promotes excellence in nursing practices and encourages nurses to learn and observe their patients to promote positive health outcomes. Thus, the role of nurses goes beyond providing treatment to health promoters and educators.
Altable, C. R. (2012). Logic structure of clinical judgment and its relation to medical and psychiatric semiology. Psychopathology, 45(6), 344–51. Web.
Baker, D. (2007). Media Review: Health Promotion in Nursing Practice. Family & Community Health, 30(1), 85 – 86.
Brenda, S., & Velsor-Friederich, B. (2006). Health promotion in adolescents: A review of Pender’s Health Promotion model. Nursing Science Quarterly, 19(4), 366-373.
Galloway, R. D. (2003). Health Promotion: Causes, Beliefs and Measurements. Clinical Medicine & Research, 1(3), 249–258.
Keegan, J., Chan, F., Ditchman, N., & Chiu, C-Y. (2012). Predictive Ability of Pender’s Health Promotion Model for Physical Activity and Exercise in People With Spinal Cord Injuries: A Hierarchical Regression Analysis. Rehabilitation Counseling Bulletin, 56(1), 34-47. Web.