Review the following Evidence-Based-Care sheets-Choose one of the models for your original discussion post.

Pender’s Health Promotion Model

Initial Post – Review the following Evidence-Based-Care sheets. Choose one of the models for your original discussion post.

Pender’s Health Promotion Model

Reflect on whether the model you have chosen applies to the physiological changes seen in the aging population. Your original post should explain why or why not, and include 1 or 2 specific examples that will support your statements.

• According to Nola Pender, nurse theorist and founder of the Health Promotion Model (HPM), health is defined not as the absence of disease but as “an evolving life experience” that involves the “actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others”⁽⁸⁾
  • Health promotion is a holistic approach to patient care that focuses on improving the overall wellbeing and health-related quality of life (HRQOL) of individuals, whether or not illness is present, by increasing and sustaining health-promoting behaviors^(6,9)
    • Examples of health-promoting behaviors are regular exercise, consumption of a nutritious diet, stress management, and adequate rest
    • Health promotion shares common elements with primary prevention in that activities that aim to prevent disease also tend to improve wellbeing and HRQOL (e.g., exercising to reduce risk for cardiovascular disease can also increase energy level and improve mood; eating a diet low in saturated fat can improve cholesterol levels and also contribute to healthy weight loss)⁽⁶⁾
• Pender’s HPM, first developed in 1982 and revised in 1996, is a patient care model that guides nurses in understanding patient behavior regarding health promotion; when patient behaviors are better understood, individualized support can be provided to strengthen lifestyle factors to enhance patient health and prevent illness or disease^(6,8,9)
  • The HPM is rooted in the following three human behavioral theories:⁽⁶⁾
    • The theory of reasoned action, which states that an individual is more likely to perform an action if he or she perceives that the action will have a desirable effect and perceives that others are in favor of it
    • the theory of planned behavior, which states that an individual is more likely to perform an action if he or she perceives having control over the action and situation
    • Bandura’s social-cognitive theory, which states that self-efficacy (i.e., confidence in one’s ability to perform an action as planned) directly influences an individual’s decision to engage in that action such that a high level of self-efficacy can motivate behavior toward action even when challenges are present
  • According to the HPM, behavioral outcomes are influenced indirectly by an individual’s characteristics and experiences (i.e., prior related behavior and the individual’s biologic, psychological, and sociocultural factors) and are directly influenced by behavior-specific cognitive factors and affect, which are classified as six modifiable variables:⁽⁹⁾
    • Perceived benefits of action (i.e., what the patient believes to be the rewards of committing to the health behavior)
    • Perceived barriers to action (i.e., what the patient believes to be preventing commitment to the health behavior)
    • Perceived self-efficacy (i.e., the patient’s self-confidence in the ability to successfully carry out the health behavior)
    • Activity-related affect (i.e., the patient’s emotional status and feelings before, during, and after performing the health behavior)
    • Interpersonal influences (i.e., the perceived role that persons who are involved in the patient’s life have on promoting or preventing the health behavior [e.g., the presence or absence of family support])
    • Situational influences (i.e., the perceived role that the patient’s environment has in promoting or preventing the health behavior [e.g., whether or not other, more attractive alternatives to the behavior are present])
  • According to Pender’s model, the patient’s commitment to the plan of action is affected by the presence and strength of competing demands (e.g., family commitments) and preferences (e.g., distractions); commitment to the plan of action is less likely to produce the desired behavior if competing demands need immediate attention and/or competing preferences are more desirable⁽⁹⁾
• The HPM has been applied in research studies and clinical practice as a tool for understanding and managing behaviors that impact health in various patient populations, age groups, and settings^(1,9)
  • In an integrative review of the literature on health promotion in adolescents published during the period 1995-2004 (which encompassed studies on asthma self-management, physical activity, and diet), investigators found that self-efficacy was the strongest predictor of health-promoting behavior in adolescents of diverse cultural backgrounds⁽¹¹⁾
  • In a study of 500 adolescent females in Iran, investigators found that the HPM variables predicted 71% of the differences in HRQOL among the study participants; self-efficacy (as measured by the Perceived Health Competence Scale [PHCS]) was identified as the single most important, direct predictor of participation in a health-promoting lifestyle⁽⁷⁾
  • In a Korean study of 596 patients with chronic cardiovascular disease, investigators found that self-esteem and health-promoting behaviors directly affected HRQOL; the HPM variables predicted 63% of the variance in HRQOL among study participants⁽²⁾
  • In a meta-synthesis of nine qualitative studies involving patients with diabetes, investigators sought a better understanding of the factors that contributed to patients’ perceptions of self-empowerment, which can lead to better diabetes self-management. Using the HPM, the investigators identified common factors in the categories of perceived barriers (e.g., inaccessibility of the language used in education regarding diabetes), activity-related affect (e.g., attitude regarding performing routine physical activity), interpersonal influences (e.g., perceived empathy of others), and situational influences (e.g., perceived hurriedness of clinician consultations) that should be addressed and corrected whenever possible to formulate effective, sustainable self-management plans for patients with diabetes⁽³⁾
  • HPM was successfully applied to improve dietary behaviors and nutrition of obese and overweight women, providing information about risk factors associated with obesity and healthy habits, in the cultural context of an Iranian community. Researchers reported a high participation rate in training sessions, intended to promote self-efficacy⁽⁵⁾
  • Researchers assessed the predictive power of the HPM on promotion of self-care behavior in hypertensive patients from a rural Iranian community. Self-efficacy and perceived benefits had an inverse correlation with the age of participants, mainly due to perceived barriers in older adults. The model had a predictive power of 71.4% of changes in systolic blood pressure⁽⁴⁾
• One point that emerges from the literature is that perceived self-efficacy is an important determinant of participation in health-promoting behavior and achievement of an improved HRQOL^(3,7,11)
  • As a trusted source of health information and support, nurses are in an optimal position to influence the self-efficacy variable of the HPM in everyday patient care through such interventions as^(7,10)
    • providing patient education about the benefits of engaging in certain lifestyle changes and about ways to overcome perceived barriers
    • modeling health-promoting behaviors and allowing for patient practice to build skills that are necessary for self-confidence
    • verbally encouraging health-promoting behaviors

What We Can Do

• Become knowledgeable about Pender’s HPM so that you can accurately assess your patients’ overall wellbeing and the factors that directly and indirectly contribute to their behaviors regarding health; share this knowledge with your colleagues
• Use the HPM as a systematic approach to assess your patients’ perceptions of and affect toward health-promoting behavior; use your assessment findings to collaborate in the development of individualized, patient-empowering plans of care for health promotion that encourage realistic, sustainable health-promoting activities
  • For examples of the use of Pender’s HPM as a clinical assessment and intervention tool, refer to Pender’s Health Promotion Model Manual at https://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf?sequence=1&isAllowed=y
• For more information about the use of self-efficacy ratings to determine patients’ perceived ability to perform health-promoting, self-care skills, see the series of Nursing Practice & Skills regarding patient, parent, and family education topics

References

1. Alkalaileh, M. A., Khaled, M. H. B., Baker, O. G., & Bond, E. A. (2011). Pender’s health promotion model: An integrative literature review. Middle East Journal of Nursing, 5(5), 12-22. (SR)

2. Han, K. S., Lee, S. J., Park, E. S., Park, Y. J., & Cheol, K. H. (2005). Structural model for quality of life of patients with chronic cardiovascular disease in Korea. Nursing Research, 54(2), 85-96. (R)

3. Ho, A. Y. K., Berggren, I., & Dahlborg-Lyckhage, E. (2010). Diabetes empowerment related to Pender’s Health Promotion Model: A meta-synthesis. Nursing & Health Sciences, 12(2), 259-267. doi:10.1111/j.1442-2018.2010.00517.x (R)

4. Kamran, A., Azadbakht, L., Sharifirad, G., Mahaki, B., & Mohebi, S. (2015). The relationship between blood pressure and the structures of Pender’s health promotion model in rural hypertensive patients. Journal of Education and Health Promotion, 4, 29. doi:10.4103/2277-9531.154124 (R)

5. Khodaveisi, M., Omidi, A., Farokhi, S., & Soltanian, A. R. (2017). The effect of Pender’s Health Promotion Model in improving the nutritional behavior of overweight and obese women. International Journal of Community Based Nursing and Midwifery, 5(2), 165-174. (RCT)

6. McCullagh, M. C. (2013). Health promotion. In S. J. Peterson & T. S. Bredow (Eds.), Middle range theories: Application to nursing research (3rd ed., pp. 224-234). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. (GI)

7. Mohamadian, H., Eftekhar, H., Rahimi, A., Mohamad, H. T., Shojaiezade, D., & Montazeri, A. (2011). Predicting health-related quality of life by using a health promotion model among Iranian adolescent girls: A structural equation modeling approach. Nursing & Health Sciences, 13(2), 141-148. doi:10.1111/j.1442-2018.2011.00591.x (R)

8. Pender, N. J. (2011). The Health Promotion Model manual. Retrieved June 13, 2018, from http://deepblue.lib.umich.edu/bitstream/2027.42/85350/1/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf (G)

9. Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice (6th ed.). Boston: Pearson. (GI)

10. Ronis, D. L., Hong, O., & Lusk, S. L. (2006). Comparison of the original and revised structures of the Health Promotion Model in predicting construction workers’ use of hearing protection. Research in Nursing & Health, 29(1), 3-17. doi:10.1002/nur.20111 (R)

11. Srof, B. J., & Velsor-Friedrich, B. (2006). Health promotion in adolescents: A review of Pender’s Health Promotion Model. Nursing Science Quarterly, 19(4), 366-373. doi:10.1177/0894318406292831 (SR)