pender's health promotion model essay

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Pender's Health Promotion Model

The Health Promotion Model was designed by Nola J. Pender to be a “complementary counterpart to models of health protection.” It defines health as a positive dynamic state rather than simply the absence of disease. Health promotion is directed at increasing a patient’s level of well-being. The health promotion model describes the multidimensional nature of persons as they interact within their environment to pursue health.

Pender’s model focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. The theory notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavior specific knowledge and affect have important motivational significance. The variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome, which makes it the end point in the Health Promotion Model. These 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 intended actions for promoting health.

The Health Promotion Model makes four assumptions:

• Individuals seek to actively regulate their own behavior.
• Individuals, in all their biopsychosocial complexity, interact with the environment, progressively transforming the environment as well as being transformed over time.
• Health professionals, such as nurses, constitute a part of the interpersonal environment, which exerts influence on people through their life span.
• Self-initiated reconfiguration of the person-environment interactive patterns is essential to changing behavior.

There are thirteen theoretical statements that come from the model. They provide a basis for investigative work on health behaviors. The statements are:

• 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 is increased.
• 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 health-promoting behavior.
• Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.
• 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.
• Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.

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The major concepts of the Health Promotion Model are individual characteristics and experiences, prior behavior, and the frequency of the similar behavior in the past. Direct and indirect effects on the likelihood of engaging in health-promoting behaviors.

Personal factors are categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered. Biological personal factors include variables such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance. Psychological personal factors include variables such as self esteem self motivation personal competence perceived health status and definition of health. Socio-cultural personal factors include variables such as race ethnicity, accuculturation, education and socioeconomic status.

Perceived benefits of action are the anticipated positive outcomes that will occur from health behavior. Perceived barriers to action are anticipated, imagined, or real blocks and costs of understanding a given behavior. Perceived self-efficacy is the judgment or personal capability to organize and execute a health-promoting behavior. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior.

Activity-related affect is defined as the subjective positive or negative feeling that occurs based on the stimulus properties of the behavior itself. They influence 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.

Interpersonal influences are cognition-concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences include: norms (expectations of significant others), social support (instrumental and emotional encouragement) and modeling (vicarious learning through observing others engaged in a particular behavior). Primary sources of interpersonal influences are families, peers, and healthcare providers.

Situational influences are personal perceptions and cognitions that can facilitate or impede behavior. They include perceptions of options available, as well as 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 behavior.

Within the behavioral outcome, there is a commitment to a plan of action, which is the concept of intention and identification of a planned strategy that leads to implementation of health behavior. Competing demands are those alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behavior over which individuals exert relatively high control.

Health-promoting behavior is the endpoint or action outcome directed toward attaining a positive health outcome such as optimal well-being, personal fulfillment, and productive living.

• Nola Pender: Health Promotion Model

Nola J. Pender (1941– present) is a nursing theorist who developed the Health Promotion Model in 1982. She is also an author and a professor emeritus of nursing at the University of Michigan. She started studying health-promoting behavior in the mid-1970s and first published the Health Promotion Model in 1982. Her Health Promotion Model indicates preventative health measures and describes nurses’ critical function in helping patients prevent illness by self-care and bold alternatives. Pender has been named a Living Legend of the American Academy of Nursing.

Table of Contents

Career and appointments, selected publications related to nola pender, awards and honors of nola pender.

• What is Health Promotion Model? 

Major Concepts of the Health Promotion Model

Personal factors, perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, situational influences, commitment to plan of action, immediate competing demands and preferences, health-promoting behavior, major assumptions in health promotion model, propositions, recommended resources, external links, biography of nola j. pender.

On August 16, 1941, Nola Pender was born in Lansing, Michigan, to parents who advocated education for women. Her first encounter with the nursing profession was when she was 7 years old and witnessed the care given to her hospitalized aunt by nurses. This situation led her to the desire to care for other people, and her goal was to help people care for themselves.

With her parents’ support, Nola Pender entered the School of Nursing at West Suburban Hospital in Oak Park, Illinois, and received her nursing diploma in 1962. In 1965, she received her master’s degree in human growth and development from the same university. She moved to Northwestern University in Evanston, Illinois, to obtain a Ph.D. in psychology and education in 1969. Pender’s dissertation research investigated developmental changes in the encoding process of short-term memory in children. Years later, she finished masters-level work in community health nursing at Rush University.

In 1962, Nola Pender began working on a medical- surgical unit and subsequently in a pediatric unit in a Michigan hospital. For 40 years at Michigan State University, she trained students at undergraduate and graduate levels and mentored many postdoctoral candidates.

Pender directed many studies of her Health Promotion Model with adolescents and adults, making her more active in nursing research. Pender and her research unit developed the program Girls on the Move , which studies and measures intervention results as it applies to use the model to encourage young people to perform active lifestyles.

Pender was and still supports nursing organizations where she devoted her time, service, and knowledge. She was the president of the Midwest Nursing Research Society from 1985 to 1987.

Aside from being the American Academy of Nursing president from 1991 to 1993, she was also a member of Research America’s Board of Directors from 1991 to 1993 and a member of the U.S. Preventative Services Task Force from 1998 to 2002.

Also, Pender was an Associate Dean for Research at the University of Michigan School of Nursing from 1990 to 2001. And as a co-founder of the Midwest Nursing Research Society, she has served as a trustee of its foundation since 2009.

Pender is presently a Professor Emeritus at Michigan State University. Following her retirement as an active professor, she devotes her time as an adviser for health research nationally and internationally. She shares her knowledge and experiences to improve the nursing profession further. She also serves as Distinguished Professor of Nursing at Loyola University School of Nursing in Chicago, Illinois.

As regards health promotion, Nola Pender has written and issued various articles on exercise, behavior change, and relaxation training. She also has served on editorial boards and as an editor for journals and books.

Pender is also known as a scholar, presenter, and consultant in health promotion. She has collaborated with nurse scientists in Japan, Korea, Mexico, Thailand, the Dominican Republic, Jamaica, England, New Zealand, And Chile.

By contributing leadership as a consultant to research centers and giving scholar consultations, Pender resumes influencing nursing. She also collaborates with the American Journal of Health Promotion editor, promoting legislation to support health promotion research.

• Health Promotion in Nursing Practice (6th Edition)
• Pender, Nola J. Study Guide for Health Promotion in Nursing Practice
• Philosophies and Theories for Advanced Nursing Practice
• Robbins, L.B., Gretebeck, K.A., Kazanis, A.S. and Pender, Nola.J. Girls on the Move
• Program to Increase Physical Activity Participation, Nursing Research, 2006
• Pender, Nola.J., Bar-Or, O., Wilk, B. and Mitchell, S. Self-Efficacy and Perceived Exertion of Girls During Exercise, Nursing Research, 2002
• Eden, K.B., Orleans, C.T., Mulrow, C.D., Pender, Nola.J. and Teutsch, S.M. Does Counseling by Clinicians Improve Physical Activity? A Summary of the Evidence for the U.S. Preventive Services Task Force, Annals of Internal Medicine, 2002
• Robbins, L.B., Pender, Nola.J., Conn, V.S., Frenn, M.D., Neuberger, G.B., Nies, M.A., Topp, R.V. and Wilbur, J.E. Physical Activity Research in Nursing, Nursing School Journal, 2001

Pender has received numerous recognitions and awards that include the 1972 Distinguished Alumni Award from Michigan State University School of Nursing. In 1988, she received the Midwest Nursing Research Society’s Distinguished Contributions to Research Award. She also obtained an Honorary Doctorate of Science degree from Widener University, Chester, Pennsylvania, in 1992.

In 1997, the American Psychological Association awarded her the Distinguished Contributions to Nursing and Psychology Award. She was awarded the Mae Edna Doyle Teacher of the Year Award from the University of Michigan School of Nursing the following year. In 2005, she received the Lifetime Achievement Award from the Midwest Nursing Research Society.

Pender was designated a Living Legend of the American Academy of Nursing in 2012. The award has only been awarded to nurses who have made outstanding contributions to the profession. Pender was the president of the academy from 1991 to 1993.

Nola Pender’s Health Promotion Model

Have you ever noticed advertisements in malls, grocery stores, or schools that advocate healthy eating or regular exercise? Have you gone to your local centers or hospitals promoting physical activities and smoking cessation programs such as “quit” activities and “brief interventions?” These are all examples of health promotion. The Health Promotion Model, developed by nursing theorist Nola Pender, has provided healthcare a new path. According to Nola J. Pender, Health Promotion and Disease Prevention should focus on health care. When health promotion and prevention fail to anticipate predicaments and problems, care in illness becomes the subsequent priority.

What is Health Promotion Model?

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 effect have important motivational significance. These variables can be modified through nursing 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 development stages. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail intended health-promoting actions.

Nola Pender’s Health Promotion Model theory was originally published in 1982 and later improved in 1996 and 2002. It has been used for nursing research, education, and practice. Applying this nursing theory and the body of knowledge that has been collected through observation and research, nurses are in the top profession to enable people to improve their well-being with self-care and positive health behaviors.

The Health Promotion Model was 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 help nurses know and understand the major determinants of health behaviors as a foundation for behavioral counseling to promote well-being and healthy lifestyles.

Pender’s health promotion model 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. It describes the multi-dimensional nature of persons as they interact within the environment to pursue health.

The model focuses on the following three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes.

Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness.

On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within illness constraints.

Individual characteristics and experiences (prior related behavior and personal factors).

Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences).

Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior).

Subconcepts of the Health Promotion Model

Personal factors are categorized as biological, psychological, and socio-cultural. These factors are predictive of a given behavior and shaped by the target behavior’s nature being considered.

• Personal biological factors.  Include variables such as age, gender, body mass index , pubertal status, aerobic capacity, strength, agility, or balance.
• Personal psychological factors. Include variables such as self-esteem , self-motivation, personal competence, perceived health status, and definition of health.
• Personal socio-cultural factors. Include variables such as race, ethnicity, acculturation, education, and socioeconomic status.

Anticipated positive outcomes that will occur from health behavior.

Anticipated, imagined, or real blocks and personal costs of understanding a given behavior.

The judgment of personal capability to organize and execute a health-promoting behavior. Perceived self-efficacy influences perceived barriers to action, so higher efficacy results in lowered perceptions of barriers to the behavior’s performance.

Subjective positive or negative feeling occurs before, during, and following behavior based on the stimulus properties of the behavior itself.

Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater its efficacy. In turn, increased feelings of efficacy can generate a further positive affect.

Cognition concerning behaviors, beliefs, or attitudes of others. Interpersonal influences include norms (expectations of significant others), social support (instrumental and emotional encouragement), and modeling (vicarious learning through observing others engaged in a particular behavior). Primary sources of interpersonal influences are families, peers, and healthcare providers.

Personal perceptions and cognitions of any given situation or context can facilitate or impede behavior. 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 behavior.

The concept of intention and identification of a planned strategy leads to the implementation of health behavior.

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

A health-promoting behavior is an endpoint or action-outcome directed toward attaining positive health outcomes such as optimal wellbeing, personal fulfillment, and productive living.

• Individuals seek to regulate their own behavior actively.
• 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 influences persons throughout their life span.
• Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.
• 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 the behavior’s actual performance.
• Greater perceived self-efficacy results in fewer perceived barriers to 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 is increased.
• 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 health-promoting behavior.
• Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.
• The greater the commitments to a specific plan of action, the more likely health-promoting behaviors will 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.
• Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and preferred over the target behavior.
• Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for healthy actions.

Strengths and Weaknesses

• The Health Promotion Model is simple to understand, yet diving deeper shows its complexity in its structure.
• Nola Pender’s nursing theory focused on health promotion and disease prevention, making it stand out from other nursing theories.
• It is highly applicable in the community health setting.
• It promotes the nursing profession’s independent practice, being the primary source of health-promoting interventions and education.
• The Health Promotion Model of Pender could not define the nursing metapradigm or the concepts that a nursing theory should have, man, nursing, environment, and health.
• The conceptual framework contains multiple concepts, which may invite confusion to the reader.
• Its applicability to an individual currently experiencing a disease state was not given emphasis.

Due to its focus on health promotion and disease prevention per se, its relevance to nursing actions given to ill individuals is obscure. But then again, this characteristic of her model also gives the concepts its uniqueness.

Pender’s principles paved a new way of viewing nursing care, but then one should also be reminded that nursing’s curative aspect cannot be detached from our practice.

Community health care setting is the best avenue in promoting health and preventing illnesses. Using Pender’s Health Promotion Model, community programs may be focused on activities that can improve people’s well-being. Health promotion and disease prevention can more easily be carried out in the community than programs that aim to cure disease conditions.

To fully adhere to a health-promoting behavior, he or she needs to shell out financial resources. This limits the application of Pender’s model. An individual who economically or financially unstable might have a lesser commitment to the planning of action, decreasing the ideal outcome of a health-promoting behavior even if the individual has the necessary will to complete it.

Although not stated in the model, for example, in the Intensive Care Unit, the health promotion model may still be applied in one way or another. This is projected towards improving health conditions and prevent further debilitating conditions. Diet modifications and performing passive and active range of motion exercises are examples of its application.

Recommended books and resources to learn more about nursing theory:

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• Nursing Theorists and Their Work (10th Edition) by Alligood Nursing Theorists and Their Work, 10th Edition provides a clear, in-depth look at nursing theories of historical and international significance. Each chapter presents a key nursing theory or philosophy, showing how systematic theoretical evidence can enhance decision making, professionalism, and quality of care.
• Knowledge Development in Nursing: Theory and Process (11th Edition) Use the five patterns of knowing to help you develop sound clinical judgment. This edition reflects the latest thinking in nursing knowledge development and adds emphasis to real-world application. The content in this edition aligns with the new 2021 AACN Essentials for Nursing Education.
• Nursing Knowledge and Theory Innovation, Second Edition: Advancing the Science of Practice (2nd Edition) This text for graduate-level nursing students focuses on the science and philosophy of nursing knowledge development. It is distinguished by its focus on practical applications of theory for scholarly, evidence-based approaches. The second edition features important updates and a reorganization of information to better highlight the roles of theory and major philosophical perspectives.
• Nursing Theories and Nursing Practice (5th Edition) The only nursing research and theory book with primary works by the original theorists. Explore the historical and contemporary theories that are the foundation of nursing practice today. The 5th Edition, continues to meet the needs of today’s students with an expanded focus on the middle range theories and practice models.
• Strategies for Theory Construction in Nursing (6th Edition) The clearest, most useful introduction to theory development methods. Reflecting vast changes in nursing practice, it covers advances both in theory development and in strategies for concept, statement, and theory development. It also builds further connections between nursing theory and evidence-based practice.
• Middle Range Theory for Nursing (4th Edition) This nursing book’s ability to break down complex ideas is part of what made this book a three-time recipient of the AJN Book of the Year award. This edition includes five completely new chapters of content essential for nursing books. New exemplars linking middle range theory to advanced nursing practice make it even more useful and expand the content to make it better.
• Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice This book offers balanced coverage of both qualitative and quantitative research methodologies. This edition features new content on trending topics, including the Next-Generation NCLEX® Exam (NGN).
• Nursing Research (11th Edition) AJN award-winning authors Denise Polit and Cheryl Beck detail the latest methodologic innovations in nursing, medicine, and the social sciences. The updated 11th Edition adds two new chapters designed to help students ensure the accuracy and effectiveness of research methods. Extensively revised content throughout strengthens students’ ability to locate and rank clinical evidence.

Recommended site resources related to nursing theory:

• Nursing Theories and Theorists: The Definitive Guide for Nurses MUST READ! In this guide for nursing theories, we aim to help you understand what comprises a nursing theory and its importance, purpose, history, types or classifications, and give you an overview through summaries of selected nursing theories.

Other resources related to nursing theory:

• Betty Neuman: Neuman Systems Model
• Dorothea Orem: Self-Care Deficit Theory
• Dorothy Johnson: Behavioral System Model
• Faye Abdellah: 21 Nursing Problems Theory
• Florence Nightingale: Environmental Theory
• Hildegard Peplau: Interpersonal Relations Theory
• Ida Jean Orlando: Deliberative Nursing Process Theory
• Imogene King: Theory of Goal Attainment
• Jean Watson: Theory of Human Caring
• Lydia Hall: Care, Cure, Core Nursing Theory
• Madeleine Leininger: Transcultural Nursing Theory
• Martha Rogers: Science of Unitary Human Beings
• Myra Estrin Levine: The Conservation Model of Nursing
• Sister Callista Roy: Adaptation Model of Nursing
• Virginia Henderson: Nursing Need Theory
• Alligood, M. R. (2013).  Nursing Theory-E-Book: Utilization & Application . Elsevier Health Sciences.
• Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2018).  Health promotion in nursing practice . Pearson Education Canada. [ Link ]
• Nola J. Pender – University of Michigan

Biography by: Wayne, G. 

6 thoughts on “Nola Pender: Health Promotion Model”

I am nursing instructor in school of nursing lady reading hospital Peshawar Pakistan.

My vision to work for the betterment of KP nurses.In future I will be complete Master in nursing and to educate student nurses and improve clinical practice and bedside nursing care.

Remind me!! Came here for hypothesis case seminar while studying master degree at Burapha university Thailand

Very explicit. I find this so helpful.

Respected, I am Ph. d. Scholar and I want to use the Health promotion model for my research work. this is my kind request please allow me to apply this theory and provide me citation of the theory.

Hi Dipak, Certainly, you don’t need specific permission to use the Health Promotion Model in your research. Just be sure to cite it properly to give credit to Nola J. Pender, the model’s creator.

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Applying the Pender’s Health Promotion Model to Identify the Factors Related to Older Adults’ Participation in Community-Based Health Promotion Activities

Hsuan-hui chen.

1 Nursing Department, Yang Ming Hospital, Taoyuan City 324005, Taiwan; wt.moc.oohay@cniarmij

Pei-Lin Hsieh

2 School of Nursing, Chang Gung University of Science and Technology, Chang Gung Medical Foundation, Associate Research Fellow, Taoyuan City 33303, Taiwan

Associated Data

Research data are not available because participant consent did not include sharing of data.

Aging societies have garnered global attention regarding issues related to older adults’ health promotion. This cross-sectional study aimed to identify factors associated with older adults’ participation in community-based health promotion activities. The Older Adults’ Health Promotion Activity Questionnaire was developed to collect data, and a total of 139 older adults were recruited from a community care center in Taoyuan City. Participants’ mean age was 72.7 years (SD = 6.0 years), 74.8% were females, 64.7% were married, 59% had a lower level of education, 51.8% had lower income, 59% reported their health status not good, and 76.3% had chronic disease. Our findings indicated that age, perceived benefits, and self-efficacy were identified as significant predictors of participation in health promotion activities. Among them, perceived benefits were found to have the strongest association with participation in health promotion activities (β = 0.305; p < 0.05). The findings showed that the Pender’s Health Promotion Model is useful to provide information for predicting and detecting significant factors related to older adults’ participation in community-based health promotion activities. By using this model as a framework, researchers can design more specific studies that are directed towards improving healthy lifestyles and detecting the key components of health-related behaviors among different age groups.

1. Introduction

The proportion of older adults (aged 65 and over) is gradually increasing in countries around the world because of declining fertility rates. It is expected that the global population of older adults will reach 2 billion by 2050 [ 1 ]. By the end of 2019, the aging index of Taiwan, which has been on the rise, reached 119.8; this value is higher than the benchmark value for an aging society according to the World Health Organization (WHO). More than 30% of older adults in Taiwan have two or more chronic conditions, such as diabetes, heart failure, arthritis, or dementia, that can lead to increased hospitalizations or nursing home stays [ 2 ]. Managing one’s health and being involved in health-promoting activities can have a positive impact on health, mortality, and quality of life.

Community-based health promotion activities have multiple benefits to improve older adults’ physical functions, spiritual satisfaction, and sense of accomplishment [ 3 ]. Engagement in health promotion activities lasting 12 weeks or longer is a critical component to lasting health effects as such activities have been reported to have significant positive effects on older adults’ physical, mental, and spiritual well-being [ 4 , 5 , 6 ]. Participation in health promotion activities is influenced by one’s cognition, experience, family, society, culture, etc. [ 7 ]. Important factors affecting older adults’ involvement in community-based health promotion activities include personal characteristics, perceived activity benefits, perceived activity barriers, perceived activity self-efficacy, situational factors, interpersonal relationship factors, and feelings toward activity participation [ 4 , 6 , 8 , 9 ]. Identifying the effective factors on participation in health promotion activities in older adults is necessary to improve this behavior [ 3 ].

The Health Promotion Model identifies factors that influence health behaviors. Pender’s Health Promotion Model is one of the most widely used models to identify and change unhealthy behaviors and promote health [ 10 , 11 ]. Predicting factors and explanatory constructs of health behavior in Pender’s model include perceived benefits, barriers, and self-efficacy; behavioral emotions; and interpersonal and situational influencers [ 12 ]. The various constructs have been introduced as the strongest predictors of nutritional and self-care behaviors in recent studies [ 13 , 14 ]. The reason for emphasizing the use of Pender’s Health Promotion Model is because this model explores, from a theoretical perspective, the factors and relationships that contribute to participation in community-based health promotion activities and enhanced health and quality of life among older adults.

Previous studies have suggested that older adults’ participation in health promotion activities is closely related to perceived activity benefits and barriers. In terms of perceived benefits, older adults have reported that participating in health promotion activities enhanced their overall mind–body fitness and physical conditions [ 7 , 8 , 15 ]. In addition, social support when participating in health promotion activities not only positively affects the physical and mental health of older adults but also plays an important role in reinforcing their continuous involvement in such activities [ 7 , 8 ]. In contrast, various activity barriers can adversely affect their enthusiasm in health promotion activities. Perceived activity barriers are negatively correlated with older adults’ involvement in health promotion activities [ 4 ], while those with fewer perceived activity barriers are more likely to participate in health promotion activities [ 16 ]. In Pender’s Health Promotion Model, the concept of perceived self-efficacy is included as part of behavior-specific cognitive and emotional factors. This is supported by multiple domestic and international studies, which reported that self-efficacy is an important factor that promotes an individual’s participation in health promotion behaviors and lifestyle [ 10 , 17 , 18 , 19 ].

Pender’s Health Promotion Model has been widely adopted to explore different health promotion behaviors [ 10 , 11 , 19 ] and has achieved concrete results. However, limited studies have utilized this model to investigate older adults’ engagement in community-based health promotion activities. Therefore, this study aimed to apply this model to identify the factors associated with older adults’ participation in community-based health promotion activities.

2. Materials and Methods

2.1. study design.

A cross-sectional design was employed, and a questionnaire survey was conducted at a community care center in Taoyuan City, Taiwan. The community care center operates during daytime hours (9am–4pm), Monday through Friday. The center provides health promotion activities including stretching or other gentle exercise, mental stimulation games such as bingo, creative expression through arts and crafts, and nutritious meals. At present, there are about 250 older adults who use this center. Data were collected between January and April 2020.

2.2. Participants

A total of 139 older adults were recruited from a community care center in Taoyuan City. The inclusion criteria were participating in health promotion activities once a week and continuous participation for more than 12 weeks, ability to communicate in Hokkien or Mandarin, and willingness to participate. Exclusion criteria were serious mental problems, including dementia, inability to communicate cogently, and inability to walk to the community care center.

2.3. Measure

The Older Adults’ Health Promotion Activity Questionnaire (see Appendix A ) was developed based on a comprehensive systematic review, following interviews with 47 older adults who had been randomly selected and a panel of four experts (two academics in health promotion and two gerontologists). Additionally, 12 older adults, who were not invited to the interview, were recruited to review the questionnaire for readability and comprehension. The questionnaire comprises three parts. The first part included demographic data such as gender, age, marital status, educational level, income, self-reported health status, and chronic disease. The second part was designed to explore the frequency of older adults’ participation in community-based health promotion activities (1 item). The respondents were asked to indicate their frequency using a 5-point Likert scale (very rarely = 1, rarely = 2, occasionally = 3, frequently = 4, very frequently = 5). The third part was the key part based on a five-dimensional Pender’s Health Promotion Model. It included statements regarding perceived benefits (19 items), perceived barriers (20 items), self-efficacy (10 items), social support (14 items), and activity-related affect (9 items). All items were rated on a 5-point Likert scale ranging from 1 (completely disagree/not confident at all) to 5 (completely agree/very confident). Higher scores indicate better benefits, self-efficacy, social support, and positive affects. All negatively worded items in the questionnaire were reverse-coded.

2.4. Validity and Reliability

The validity and reliability of the questionnaire were assessed. The content validity and face validity of the questionnaire were verified using the content validity index (CVI), based on ratings of item relevance by a panel of four experts. No item was eliminated in the CVI assessment, and all items had a score above 0.88. Only four items were revised for appropriateness. The preliminary questionnaire was pilot tested with 42 older adults. Cronbach’s alpha coefficient was used to evaluate the stability and internal consistency of the instrument. Cronbach’s alpha coefficients were reported ranging from 0.72 to 0.94 for all subscales (perceived benefits: α = 0.94; perceived barriers: α = 0.91; self-efficacy: α = 0.84; social support: α = 0.72; activity-related affect: α = 0.94), indicating acceptable level of internal consistency for each domain.

2.5. Statistical Analyses

Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26 (SPSS Inc., Chicago, IL, USA). Descriptive statistics (percentages of frequencies, means, and standard deviations) were calculated. An independent-samples t -test was used for the comparison of two independent groups; the comparison of three or more groups was performed using analysis of variance (ANOVA) test statistics. Pearson’s correlation analysis was conducted between older adults’ participation in community-based health promotion activities and the Health Promotion Questionnaire with all subscales. A multiple linear regression analysis was used to examine predictors associated with older adults’ participation in community-based health promotion activities. P values less than 0.05 were considered statistically significant for all tests.

The participants’ mean age was 72.7 years (range: 65–88), and 74.8% were females. Of all the elderly individuals, 64.7% were married, 59% had a lower level of education, 51.8% had lower income from their pension, and 59% reported their health status as not good. The majority of the elderly people participating in the study (76.3%) had chronic diseases. Mean scores of the Health Promotion Questionnaire with all subscales is shown in Table 1 .

Comparison of participants’ characteristics and the Health Promotion Questionnaire with all subscales ( N = 139).

USD: United States dollar; * p < 0.05.

There was a significant correlation between the participants’ perceived benefits mean scores and their gender. It was found that perceived benefits mean scores were significantly higher in females in comparison to males (t = −1.351, p = 0.033). Perceived barriers mean scores of those who were divorced or single (never married) were significantly higher than those who were married (F = 2.168, p = 0.002). There was a significant correlation between the participants’ self-efficacy mean scores, their gender, and self-reported health status. It was found that self-efficacy mean scores were significantly higher in females in comparison to males and in those who had reported health status as good in comparison to those who had reported their health status as not good (t = −1.725, p = 0.047; t = −4.622, p = 0.004). Activity-related affect mean scores of those who had a lower education level were significantly higher than those who had a higher education level (t = 0.434, p = 0.021). No significant correlations were found between social support mean scores and participants’ characteristics ( p > 0.05) (see Table 1 ).

The Health Promotion Questionnaire included all subscales and participation in community-based health promotion activities using Pearson’s correlation analysis. The results revealed that older adults’ participation in community-based health promotion activities was significantly correlated with perceived benefit ( r = 0.22, p < 0.05) and self-efficacy ( r = 0.17, p < 0.05) (see Table 2 ).

Pearson’s correlation analysis between participation in community-based health promotion activities and the Health Promotion Questionnaire with all subscales.

* p < 0.05.

A multiple linear regression analysis was performed to examine predictors associated with participation in community-based health promotion activities among the older adults. Multicollinearity among the independent variables was examined using correlation coefficients and variance inflation factor (VIF). No extreme coefficient value > 0.8 was found between the independent variables, indicating a low risk of multicollinearity. All independent variables had VIF ≥ 10 and tolerance ≥ 0.1, indicating no presence of multicollinearity. All variables, including the Health Promotion Questionnaire with all subscales, as well as the demographic characteristics of the participants, were entered as independent variables to predict the dependent variable, namely, older adults’ participation in community-based health promotion activities. Age, perceived benefits, and self-efficacy were identified as significant predictors of older adults’ participation in community-based health promotion activities (β = 0.202, p < 0.05, β = 0.305, p < 0.05, β = 0.060, p < 0.05, respectively). Among all the significant predictors, perceived benefits had the highest standardized regression coefficient (β= 0.305; p < 0.05) indicating participants who perceived higher benefits were more likely to have a higher participation in health promotion activities. Further, age and self-efficacy demonstrated relative higher contributions toward participation in health promotion activities. The results suggested that significant variables in the Pender’s Health Promotion Model were important in predicting the factors related to older adults’ participation in community-based health promotion activities. The model was significant and explained 35.3% of the variance of older adults’ participation in community-based health promotion activities (F =2.293, df = 8, 129, p < 0.05) with an adjusted R 2 of 0.249 (see Table 3 ).

Multiple regression analysis model examining predictors associated with participation in community-based health promotion activities ( N = 139).

R 2 = 0.353 (35.3%), adjusted R 2 = 0.249 (24.9%), * p < 0.05.

4. Discussion

The aim of this study was to apply the Pender’s Health Promotion Model to identify the factors associated with older adults’ participation in community-based health promotion activities. This study found that perceived benefits were the strongest predictor (β = 0.305; p < 0.05), with participants being more likely to engage in health promotion activities if their perceived benefits are high. Studies with systematic reviews have shown that the important predictor was typically perceived benefits when assessing the adherence of participants attending community-based exercise programs [ 8 , 20 ]. A study has been conducted to determine the effect of a multi-strategy program based on the Pender’s Health Promotion Model, to prevent loneliness of elderly women by improving social relationships. The results showed that perceived benefits and barriers were significant variables related to reducing loneliness in older women [ 21 ]. Furthermore, another study [ 22 ] on older adults’ health beliefs regarding the motivation to exercise, perceived benefits and barriers were the most direct determinants of increasing a high continuous participation rate. Although perceived barriers were not a significant predictor in our study, there is a need to focus on increasing awareness of community-based health promotion activities benefits while reducing the identified barriers.

Self-efficacy is an important determinant for complex activities and long-term changes in health behaviors [ 23 ]. This study is consistent with previous studies that cited the importance of self-efficacy in health promotion activities in older adults and demonstrated that older adults who have more confidence, are more competent to manage their health, and are more likely to regularly engage in health promotion activities [ 3 , 7 ]. Studies also found that self-efficacy is an indicator for predicting important health outcomes such as healthy eating, oral health, and hypertension prevention in different populations [ 24 , 25 ]. The findings support the importance of self-efficacy for engaging in community-based activities and should be considered in interventions to increase the continuous participation rate [ 7 ].

The results include significant differences between participants’ characteristics and the Health Promotion Questionnaire with all subscales included gender, marital status, educational level, and self-reported health status in this study. It was found that perceived benefits and self-efficacy mean scores were significantly higher in females in comparison to males and this is consistent with the findings of Seoa [ 26 ]. Studies found that women have a higher level of health knowledge and are more active in seeking health-related information than men do, which is thought to account for higher health-seeking behaviors [ 27 ]. Thus, gender is an important role in promoting health behavior. Meanwhile, we have found self-efficacy mean scores were significantly higher in those who had self-reported their health status as good in comparison to those who had self-reported their health status as not good. Since older people who perceive good health status tend to have higher self-efficacy, they may be more capable of looking after themselves and be more active in leisure activities, housework, and functional activities [ 9 ].

Married participants perceived significantly lower barriers than those who were divorced or single (never married) in this study. Married people may have the support from their spouse, so they perceive a lower level of barriers in participation of health promotion activities. Zhuori [ 28 ] suggests that with the support of family members, friends, and the public, older adults may be encouraged to participate in activities by attending recreational exercises, which in turn facilitates them to return to the society. Activity-related affect mean scores of those who had a lower education level were significantly higher than those who had a higher education level in this study, which is opposite to the findings of a previous study [ 29 ] and this suggested that it might be important to assess the impact of the interaction between self-efficacy and affect to ensure an effective health promotion program in further studies.

This study has some limitations. Data collection was limited to a particular care center in Taoyuan City for sampling convenience, resulting in a small sample size of merely 139 participants, who were surveyed only once. The data were cross-sectional which precludes inferences related to factors that affect older adults’ long-term participation in community-based health promotion activities. Moreover, as data were self-reported, there is a risk of self-report bias including social desirability and introspective ability. Further studies using experimental designs are needed to test causality in the associations among the measured variables in this study.

The results of this study show that the constructs of Pender’s Health Promotion Model can be used as a framework for predicting and detecting significant factors related to older adults’ participation in community-based health promotion activities. By using this model as a framework, researchers can design more specific studies that are directed towards improving a healthy lifestyle and detecting the key components of health-related behaviors among different age groups.

5. Conclusions

To conclude, age, perceived benefits, and self-efficacy were identified as significant predictors of older adults’ participation in community-based health promotion activities. Older adults perceived health promotion activities as beneficial, which in turn encouraged them to participate in them, resulting in a high participation rate. With an increase in older adults’ self-efficacy, they are more likely to regularly engage in health promotion activities. The results of this study can serve as a reference when developing health promotion plans for older adults.

Appendix A. The Older Adults’ Health Promotion Activity Questionnaire

Author contributions.

Conceptualization, H.-H.C. and P.-L.H.; methodology, H.-H.C.; software, H.-H.C. and P.-L.H.; validation, P.-L.H.; formal analysis, H.-H.C. and P.-L.H.; investigation, H.-H.C.; resources, P.-L.H.; data curation, H.-H.C.; writing—original draft preparation, H.-H.C. and P.-L.H.; writing—review and editing, P.-L.H.; visualization, H.-H.C.; supervision, P.-L.H.; project administration, H.-H.C. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethical Review Committee of Landseed International Hospital, Taoyuan, Taiwan (approval number: IRB19029B1).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Nursing theories

Open access articles on nursing theories and models.

Health Promotion Model

Introduction.

• 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 pursue health.

ABOUT THE THEORIST

• Nola J. Pender, PhD, RN, FAAN - former professor of nursing at the University of Michigan
• Visit her page at University of Michigan website: http://www.nursing.umich.edu/faculty-staff/nola-j-pender

The model focuses on following three areas:

Individual characteristics and experiences

Behavior-specific cognitions and affect

Behavioral outcomes

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 behavior.

 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 behavior chang

THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL

 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 is increased.

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 health-promoting behavior.

 Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.

 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 target behavior.

 Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.

THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL

Individual Characteristics and Experience

Prior related behaviour

Frequency of the similar behaviour in the past. Direct and indirect effects on the likelihood of engaging in health promoting behaviors.

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.

Personal biological factors

Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance.

Personal psychological factors

Include variables such as self esteem self motivation personal competence perceived health status and definition of health.

Personal socio-cultural factors

Include variables such as race ethnicity, accuculturation, education and socioeconomic status.

Behavioural Specific Cognition and Affect

PERCEIVED BENEFITS OF ACTION

Anticipated positive out comes that will occur from health behaviour.

PERCEIVED BARRIERS TO ACTION

Anticipated, imagined or real blocks and personal costs of understanding a given behaviour

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. 

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.

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.

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.

Behavioural Outcome 

COMMITMENT TO PLAN OF ACTION

The concept of intention and identification of a planned strategy leads to implementation of health behaviour. 

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

HEALTH PROMOTING BEHAVIOUR

Endpoint or action outcome directed toward attaining positive health outcome such as optimal well-being, personal fulfillment, and productive living.

Marriner TA, Raile AM. Nursing theorists and their work. 5th ed. Sakraida T.Nola J. Pender. The Health Promotion Model. St Louis: Mosby; 2005

Polit DF, Beck CT. Nursing research:Principles and methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2007

Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6th ed. Philadelphia: Elsevier Mosby; 2006. Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier Mosby; 2006.

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Pender’s Health Promotion Model

Introduction.

The utility of the prospects of lifestyle-based health promotion initiatives remains a phenomenology that is impacted by the adherence to the prescribed changes in behavior. However, the poor commitment to the prescribed behavioral changes recommended within a lifestyle intervention remains widespread over the long run, making the achievement of wellness a significant challenge (Mori, 2018). As presented in the literature, this explains the rationale behind the rise in chronic conditions that include cardiovascular diseases (CVD) such as cancers, respiratory infections, and diabetes that accounts for close to 59% of a pool of close to 57 million reported deaths annually and another global burden of disease that stands at 46%. As such, several lifestyle factors are considered significant in affecting the morbidity and mortality rates in several industrialized economies (Lathief & Inzucchi, 2016). As provided by the World Health Organization (2018), data reveals that the European region susceptible to hypertension, non-insulin-dependent diabetes, and cardiovascular conditions due to the lack of appropriate physical activities. The conditions account for over 600,000 of the recorded deaths within the region on an annual basis. Similarly, obesity and overweight issues are other risk factors associated with conditions such as type 2 diabetes, cardiovascular diseases, and specified types of cancers that affect 30 to 80% of the adults in these countries (Lathief & Inzucchi, 2016). This suggests the need for behavioral modification interventions in assisting individuals in improving and avoiding their unhealthy behaviors, serving as the reason for the selection of Pender’s health promotion model. Therefore, there is a need to highlight how Pender’s health promotion model may serve as a tool used by nurses in planning for behavioral modification measures and interventions that may assist in the prevention of unhealthy behaviors.

Pender’s health promotion model holds that individuals, as seen in the context of those with chronic conditions that include cardiovascular diseases (CVD), cancers, respiratory infections, and diabetes, have unique personal experiences and characteristics that may influence and affect their subsequent actions (Sevinç, 2016). A set of these variables inform their behavioral knowledge. This remains a factor that has a more substantial motivational effect and significance and can be modified by considering nursing actions. Moshki et al. (2020) establish that health-promoting behaviors remain the desired outcomes and the endpoint of the health promotion model. In this regard, it is arguable that health-promoting behaviors are focused on improving health, bettering the quality of life, and enhancing the functional ability of people in different stages (Moshki et al., 2020). The last behavioral demand revolves around the competing preferences and needs that derail the intended issues of health-promoting behaviors and actions.

Scope and Concept of the Model

Pender’s health promotion theory or model primarily defines health and its concept as a positive dynamic or state and not the absence of a health condition. As established by Alkhalaileh et al. (2011), Nola Pender’s Health Promotion theory was pioneered in 1982 before improving in 1996 and later in 2002. The idea is primarily used in education, in nursing research, and practice. On the other hand, the application of the nursing theory within the scope of the nursing issue raised in this case is informed by observations and research, a factor that accords nurses the capacity to improve the well-being, self-care, and positive health behaviors of different populations (Alkhalaileh et al., 2011). The concept of the Health Promotion Model as imbued in the prospects of Pender’s theory was equally designed as a complementary element to the models driven towards offering health protectionism. The model is designed to incorporate several behaviors posing the need to improve health and wellness within the lifespan of different populations of people. Its purpose is inspired by the need to enable nurses to know and understand the significant determinants and triggers of specific health behaviors. This factor acts as the foundation of behavioral counseling in promoting healthy lifestyles and well-being (Khoshnood et al., 2018). According to Chen & Hsieh (2021), the health promotion model as applied within this context may be designed and integrated to increase wellness among patients with chronic conditions that include cardiovascular diseases (CVD), cancers, respiratory infections, and diabetes levels of wellness through a description of the multi-dimensional nature of each client and how they interact with an environment in their pursuit for health and wellness.

Structure and the Unique Focus of the Model

As provided in the structure in Figure 1 below, Pender’s Health Promotion model focuses on three fundamental areas: individual experiences and characteristics, behavioral and specific cognitive effects, and the behavioral outcomes of a process. The unique features and experiences revolve around the factors that help patients with chronic conditions that include cardiovascular diseases (CVD), cancers, respiratory infections, and diabetes to shape their actions. As seen in Pender’s theory, the past activities of these population groups directly connect with their engagement in health-supportive and promoting behaviors (Shahroodi et al., 2020). However, the personal attributes and the habits of these population groups may serve as a barrier to adopting health-promoting behaviors.

Figure 1: Structure of Pender’s Health Promotion model

The second element in the model’s structures primarily involves the aspect of behavior-specific cognitions that mainly have a significant and direct impact on individual motivation to the prospects of change. As established in the context of this study, nursing interventions driven towards reinforcing the adoption of positive health behaviors may, in this case, be tailored to address positive change. The variables that may be used primarily include the practical barriers and benefits of positive actions, activity-related, and self-worth results. The third element encompasses a behavioral outcome (Seo & Kim, 2021). The beginning of the products commences when the patients suffering from chronic conditions that include cardiovascular diseases (CVD), cancers, respiratory infections, and diabetes commit to the necessary behavior change measures to make changes in their lives. The individuals at this phase require support, especially with the presenting barriers efforts intended to produce positive health-promoting behaviors (Seo & Kim, 2021). Given this, it is assumable that the rationale and unique goal of the health promotion model lies in the stimulation of behavioral change that may result in positive health results.

Implementation Plan

The unique rationale for the implementation of Pender’s Health Promotion Model in the management of patients with chronic conditions that include cardiovascular diseases (CVD), cancers, respiratory infections, and diabetes revolves around improving the health of the patients by enhancing their functional abilities while bettering the quality of their lives (Cangöl & Hotun Şahin, 2017). The achievement of this goal may be reached by considering the below-established steps.

Step 1: The Assessment Phase

The first step will revolve around the use of four surveys or questionnaires that will require the patients to fill and complete duly for a better understanding of their knowledge on chronic conditions that include cardiovascular diseases (CVD), cancers, respiratory conditions infections, their attitudes towards the needs and the healthcare professionals, and the lifestyle factors that may contribute to the conditions. The surveys will primarily involve the patient attitude survey, patient chronic conditions knowledge questionnaire, health belief questionnaire, and lifestyle survey (Cangöl & Hotun Şahin, 2017). The study outcomes will provide a grounded understanding of the factors to consider in introducing the patients to the change process.

Step 2: Education and the Barriers to Change

An assessment of these factors will provide the health care providers with the knowledge required in educating patients. The patients will be equipped with the necessary knowledge regarding the condition, making informed and calculated choices by setting goals on their health outcomes. The education process will play a fundamental role in increasing these patients’ autonomy (Sabooteh et al., 2021). As stated in Pender’s theory, perceived barriers may constrain the patient’s commitment to these actions . A perceived barrier phenomenon may deny the patient’s responsibility to these actions , a phenomenon shown in the surveys. Pender’s model supports the achievement of self-actualization primarily through behavioral modification and the adoption of the best healthy lifestyle choices. Therefore, the model’s success is contingent on the fulfillment of the stability and basic needs of the patients. One of the barriers that are likely to alter the outcomes of the process revolves around the socio-cultural, biological, and psychological factors (Sabooteh et al., 2021). Secondly, patients with unstable living conditions due to the lack of fundamental needs such as limited mobility and scarce financial resources may further offer a challenge in implementing this model. This factor requires additional attention in the adoption of primary health behaviors.

Step 3: Goals and Plan of Action

In this phase, propositions from the model that focus on the patients’ commitment to engaging in behaviors that may be used in driving valued benefits may be considered. The focus on the nurses and caregivers will be on reinforcing the essence of pairing individuals suffering from chronic conditions to develop a plan of care that will increase their autonomy and result in the best outcomes in adherence and compliance with the established measures (Sabooteh et al., 2021). As such, the goals of managing chronic conditions would consist of educating the patients on healthy eating habits, blood glucose control, engagement in physical activities, the maintenance of their health through regular checks, smoking and drinking cessation, vaccinations, and meeting in support groups.

Step 4: Follow-up

As presented in this study, the rise in chronic conditions account for close to 59% of approximately 57 million reported deaths annually. Another global burden of disease (which disease) stands at 46%. Per se, the implementation of Pender’s theory will play a fundamental role in remedying these conditions among patients who choose change as a path to forge positive health outcomes (Shahroodi et al., 2020). Therefore, follow-ups will play a fundamental role in the management of the patients, an aspect that will aid in assessing their goals and some of the impeding factors that need to be addressed or revised to achieve the best outcomes.

As evident in the findings of this study, lifestyle-based health promotion initiatives remain a phenomenology that is impacted by the adherence to the prescribed changes in behavior. However, the poor commitment to the prescribed behavioral changes recommended within a lifestyle intervention remain widespread. As a result, the tendency makes it challenging to achieve wellness. Pender’s Health Promotion model focuses on three fundamental areas: individual experiences and characteristics, behavioral and specific cognitions and effects, and the behavioral outcomes of a process. Consequently, it is assumable that the rationale and unique goal of the health promotion model lies in the stimulation of behavioral change that may result in positive health results.

Alkhalaileh, M. A., Bani Khaled, M. H., & Baker, O. G. (2011). Pender’s Health Promotion Model: An Integrative Literature Review.  Middle East Journal of Nursing ,  5 (5), 12–22. https://doi.org/10.5742/mejn.2011.55104

Cangöl, E., & Hotun Şahin, N. (2017). A Model of Breastfeeding Support: Motivational Interviews Based On Pender’s Health Promotion Model.  Hemşirelikte Eğitim ve Araştırma Dergisi . https://doi.org/10.5222/head.2017.098

Chen, H.-H., & Hsieh, P.-L. (2021). Applying the Pender’s Health Promotion Model to Identify the Factors Related to Older Adults’ Participation in Community-Based Health Promotion Activities.  International Journal of Environmental Research and Public Health ,  18 (19), 9985. https://doi.org/10.3390/ijerph18199985

Khoshnood, Z., Rayyani, M., & Tirgari, B. (2018). Theory analysis for Pender’s health promotion model (HPM) by Barnum’s criteria: a critical perspective.  International Journal of Adolescent Medicine and Health ,  0 (0). https://doi.org/10.1515/ijamh-2017-0160

Lathief, S., & Inzucchi, S. E. (2016). Approach to diabetes management in patients with CVD.  Trends in Cardiovascular Medicine ,  26 (2), 165–179. https://doi.org/10.1016/j.tcm.2015.05.005

Mori, K. (2018). Promotion and Challenge of Health and Productivity Management Initiatives.  Health Evaluation and Promotion ,  45 (2), 331–335. https://doi.org/10.7143/jhep.45.331

Moshki, M., Mohammadipour, F., Gholami, M., Heydari, F., & Bayat, M. (2020). The evaluation of an educational intervention based on Pender’s health promotion model for patients with myocardial infarction.  International Journal of Health Promotion and Education , 1–13. https://doi.org/10.1080/14635240.2020.1816487

Sabooteh, S., Feizi, A., Shekarchizadeh, P., Shahnazi, H., & Mostafavi, F. (2021). Designing and evaluating E-health educational intervention on students’ physical activity: Pender’s health promotion model application.  BMC Public Health ,  21 (1). https://doi.org/10.1186/s12889-021-10641-y

Seo, J. H., & Kim, H. K. (2021). Factors affecting the health-promoting behaviors of office male workers during the COVID-19 pandemic: Using Pender’s health promotion model.  The Journal of Korean Academic Society of Nursing Education ,  27 (4), 412–422. https://doi.org/10.5977/jkasne.2021.27.4.412

Sevinç, S. (2016). Lifestyle Modification in Individuals with Myocardial Infarction: Pender’s Health Promotion Model.  Journal of Cardiovascular Nursing ,  7 (14), 147–152. https://doi.org/10.5543/khd.2016.93064

Shahroodi, M. V., Sany, S. B. T., Khaboshan, Z. H., Orooji, A., Esmaeily, H., Ferns, G., & Tajfard, M. (2020). Psychosocial Determinants of Changes in Dietary Behaviors Among Iranian Women: An Application of the Pender’s Health Promotion Model.  International Quarterly of Community Health Education , 0272684X2097682. https://doi.org/10.1177/0272684×20976825

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Application of Pender’s Health Promotion Model

The health promotion model was introduced by N. J. Pender, who defined ‘health’ as an everchanging state. Moreover, her definition does not imply merely the absence of disease (Murdaugh, Pender, & Parson, 2018). The author’s health promotion ideas were aimed at improving patient’s well-being. The model suggested that the cognitive, physiological, and mental changes are possible once the health promotion interventions are defined. These interventions are primarily based on changing conduct. Therefore, its strategies can affect every layer of the population.

Pender’s model can influence the physiological condition of the ageing population due to the implementation of new behavioural patterns. For instance, in order to increase a level of physical activity among a group of 70-year-old ladies currently residing at the nursing home and having a sedentary lifestyle, there is a need to foster their self-efficacy. The central interventions would be active morning and evening walks, encouragement from their nurses, and disciplinary control. As a result, physical activity is dependent upon nurses’ supervision. Moreover, their self-efficacy grows due to the discipline they stick to.

Furthermore, as the model allows to create multiple behaviour patterns, it can solve the problem of eating disorders. For example, when a 63-year-old male having overweight issue resorts to the clinic, a nurse should step in specific strategies that would change his eating habits. Consequently, the nurse should create a model of behaviour that would lead the patient to realize the need to change their diet. For instance, explaining the benefits of eating fresh fruits containing glucose would help a client to cut down on sweets. Moreover, introducing physical exercises as a means to lose weight is also beneficial as it can increase his self-efficacy and self-discipline.

Murdaugh, C., Pender, N., & Parson, M. (2018). Health promotion in nursing practice. Pearson.

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Analysis of Pender’s Health Promotion Model, Essay Example

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Nola Pender is a revolutionary nursing theorist with a unique perspective regarding the nursing profession and the changes taking place throughout recent history with respect to health promotion. With this theoretical perspective in mind, patients have been able to manage a number of significant health concerns in a manner that is consistent with the continued growth and development of the practice environment. Nola Pender’s theory represents a means of understanding and acknowledging the challenges of healthcare practice and the overall continued development of the practice model to impact patient health and wellbeing in a manner that will have a lasting impact on patient outcomes. In addition, it provides an opportunity for advanced practice nurses to examine their roles in expanding health promotion to have a positive impact on the health and wellbeing of many patients. Therefore, the application of this theory to real-world settings is critical so that patients are able to thrive and to improve their health under the direction of nurses who are trained to provide high quality care and treatment to promote healing.

This course has been largely beneficial in my advanced practice nursing education and professional growth, as I have been able to acquire new knowledge regarding theories that are common to the nursing profession, yet are often difficult to understand and acknowledge as part of the practice routine. This course has opened my eyes to new ideas and concepts that may be applied to the nursing profession in unique ways that will have a positive and lasting impact on outcomes and demonstrate a need to explore the dimensions of care and treatment that have a direct impact on patients. I believe that this course has been enlightening because it has always been difficult for me to translate theories into practice in real-life settings, as there I have often experienced disconnect between these two concepts. As a result, I have learned that it is necessary to apply these concepts effectively to my own practice through an expansion of knowledge and resources that will influence my practice objectives and the actions that I take on behalf of my patients.

As I move forward in my practice, it is important to utilize the lessons that I have learned and the knowledge that I have acquired through this course. It is important to me to continue to develop my knowledge and skillset with respect to my patients and how they are cared for and treated.  From a professional perspective, I must continue to evolve and to make the most of the opportunities that I have been given, as I have focused on understanding theories such as Nola Pender and adapting those theories to a variety of situations within the nursing work environment. This process is instrumental in advancing my ability to be effective in meeting the needs of my patients and in supporting a dynamic where patient care quality is of critical importance. I believe that it is in my best interests as an advanced practice nurse to apply theories to my work and to better understand how patients might be feeling and what is required to improve their health. It is important to address these concerns and to make the most of each situation so that there are sufficient treatment alternatives that will have a positive impact on their health, wellbeing, and quality of life.

In order to achieve the course objectives, it is important to develop a strategy that will support a theoretical understanding of different issues and an opportunity to explore the different dimensions of patient care as related to these issues. Therefore, the application of theory to realistic situations is a critical factor in supporting the dynamics of patient care and what is required to ensure that theories are appropriately applied to meet patient needs. This course was effective in advancing the learning curve and in enabling patients to experience optimal recovery and quality of life for patients by recognizing how to enhance their lives and develop protocols to improve their health, one step at a time. Obtaining a better understanding of the different needs of the patients who require care and treatment will demonstrate an increased interest in health promotion and the overall development of new perspectives to improve quality. Providing examples regarding theoretical perspectives was particularly helpful in advancing this process and in recognizing the importance of developing strategies for improving patient care on a continuous basis.

At the beginning of this course, my expectations somewhat low because I was unsure what would happen when I began to learn about the different theories that impact direct patient care and treatment. It is often overwhelming to learn these concepts because they are largely unfamiliar and may be difficult to grasp at times; however, I recognized in the early part of the course that with the appropriate level of focus, I was able to grasp the different theories and be able to distinguish them from each other. On a personal note, my level of understanding of a concept is directly correlated to my level of interest, enthusiasm, and willingness to move forward with the concept as an important tool. I believe that although this is one of my learning weaknesses, it enables me to focus more effectively and to be mindful of the different challenges that I face as I continue to move forward with my educational pursuits.

The contributions of my peers have been largely instrumental in expanding my knowledge base within this course, as they have provided important tools and resources in allowing me to understand some of the theories that have been discussed. My peers have been largely effective in addressing my concerns and in supporting my understanding of the concepts of the course. They introduced experiences to the discussion that were particularly beneficial because they provided a means of exploring the application of these theories in real-life settings that bridge the gaps more effectively. This was very encouraging and provided a means of exploring the different dynamics of these theories and how they apply to the work environment in different ways.

In the future, I believe that this course will provide me with a strong foundation for applying theoretical principles in my work with patients and in a team setting. These theories must be applied in such a manner that will enhance my delivery of care and treatment to my patients, and also in addressing and solving complex problems at the nursing practice level. As a team, myself and my colleagues must be prepared to manage the different aspects of the work environment and to use course principles to ensure that patient care as effective as possible, given the difficulties associated with balancing patient care delivery with other key objectives. It is important to develop strategies within the context of nursing practice that will have a lasting impact on patients and which will facilitate theoretical applications effectively and consistently to meet expectations.

One of the most interesting theories that has evolved in nursing practice to date was established by Nola Pender in 1975, known as the Theory of Health Promotion. This theory offers a number of concepts that have become increasingly relevant to the nursing practice setting, given the increased challenges experienced by patients that impact their health and wellbeing (Syx, 2008). Pender’s theory is applicable to advanced practice nursing because it reflects the importance of shaping an environment where patient care and treatment are likely to impact quality of life in significant ways; therefore, it is important to understand the patient as a human being and the many characteristics that contribute to this process in order to effectively manage outcomes in a positive manner. There must be a greater emphasis on understanding how to improve health through promotional activities that will impact patients across many different variables and to be mindful of the issues that may have a direct influence on outcomes. From this perspective, Pender’s model, which largely emphasizes the importance of understanding the dynamics between the environment and human health, are a reflection of the need to improve health through a steady state and to consider health as much larger than merely freedom from illness (Petiprin, 2015).

Pender’s theory also embodies the dynamic between the person, the environment, nursing, health, and illnesses in order to accomplish the desired objectives (Pender, 2011). From this perspective, the human condition is a product of the associations between these different objectives and in supporting a clearer approach to treating patients to achieve a high level of symbiosis (Pender, 2011). At this juncture, nurses must be able to effectively collaborate with each other in order to enhance the lives of their patients, while also considering other factors that may contribute to effective outcomes and long-term health for patients (Pender, 2011). Health is largely a product of individual behaviors, accompanied by self-care objectives, along with social interactions and the development of relationships that may have a lasting impact on patients over the long term (Petiprin, 2015).

In accordance with the Health Promotion Model, there must be a greater emphasis on the person and health behaviors in order to have the desired level of impact that will make a difference and support the growth of the practice model in a positive manner (Pender, 2011). Furthermore, it is important to identify the areas where relationships between nurses and their patients may be positive contributing factors to patient health and wellbeing (Hendricks, 2015). From a nursing perspective, it is essential to create opportunities for patients to manage their health effectively and to be engaged in a positive and meaningful approach to recovery that supports the coordination of care and treatment to impact patients (Hendricks, 2015). Recognizing the value of patient care and treatment is essential to the discovery of applications of this model that will have lasting benefits (Nursing Planet, 2012). Pender’s approach to health promotion demonstrates a need to explore the dimensions of care and treatment that are recognized as part of her experiences in the scientific era, whereby discoveries were abundant and nursing practice benefited from change and progress within scientific research and its application to the practice setting (University of Michigan School of Nursing, 2015). The adoption of Nola Pender’s model to nursing practice fills an important void regarding health promotion that is not always addressed, particularly when there is an emphasis on the development of an effective strategy to accomplish the objectives of the nursing profession and to be mindful of the steps that are required to achieve growth at a high level. Health promotion activities must be a critical component of any discussion regarding patient health and wellbeing, as this process reflects a need to examine the context of care and treatment and what is required to ensure that patient health is optimized, given the conditions that are present. Patient health is challenged by the overall development of perspectives that influence the profession and which demonstrate the value of recognizing the patient as a person and the surrounding environment’s impact on health.

For a patient with diabetes or another chronic condition that requires continuous treatment, it is important to develop a strategy that will utilize the key priorities of health promotion in order to effectively manage the outcomes that will be achieved. Therefore, Nola Pender’s Health Promotion Model will demonstrate the importance of balancing health objectives with the environment and a need for greater acknowledgement of the human being and behaviors in advancing nursing-based objectives at a high level. Patients with a chronic illness must be provided with a platform to maintain their health and to promote healing; therefore, Pender’s model is designed to accomplish this objective and to make a difference in the lives of patients. At the same time, the model is grounded in the development of relationships that will influence outcomes and which will impact patient care at a high level. Nurses must be able to care for patients and to optimize their treatment plans with proven strategies that will influence behavioral change that is based upon prior evidence. In this context, nurses are able to be effective when they provide guidance, support, and knowledge that will have a significant impact on patient care and treatment at a high level, using a consistent approach to achieve this objective. This will be influential in supporting the need for collaborative care that is not only relationship-based, but is grounded in theoretical principles to achieve effective outcomes.

With the chosen scenario, one model that would be highly ineffective for this patient population is the concept of primary nursing, whereby a single nurse is responsible for providing care and treatment to the patient throughout the period of need, which translates into an experience that is grounded in a 1:1 relationship between nurse and patient (Current Nursing, 2012). This theory would not be applied successfully to the nursing practice environment for chronic disease because it is in direct contrast to Pender’s model, which emphasizes collaborative care and relationship development within a team setting. Therefore, the primary nursing model would not be an effective contributor to the overall development of a successful nursing environment that could have lasting benefits for the patient population who faces one or more chronic diseases (Current Nursing, 2012). Furthermore, this model is largely cost prohibitive because it requires nurses who are assigned to patients to essentially provide around-the-clock care to patients, which is the opposite of most areas of modern nursing practice that involve a team-based approach to nursing to promote a highly collaborative and communicative nursing environment. If a patient were to receive care from the same nurse throughout the course of treatment without any other interaction with other nurses, it is possible that the patient could experience setbacks if the nurse in charge does not have the knowledge, experience, or insight that is necessary to address the patient’s situation effectively and with the intent to improve his or her quality of life. In this context, it is important for nurses to be mindful of the issues related to patient care that influence outcomes and which impact their recovery.

As a professional nurse, it is important to identify the theories and concepts that will have a lasting impact on patient health, applying these approaches to meet patient needs across different areas. Therefore, it is important to identify these tools to develop strategies for growth that will translate into effective results for patients. When patients receive the best possible care and treatment that is available. Pender’s Model of Health Promotion offers a critical application of nursing-based concepts and knowledge that will have a lasting impact on health and wellbeing for patients. It is expected that this model will demonstrate a high level of influence on nurses in how they interact with patients on an individual basis and as a team. When nurses are able to break through patient walls and provide an environment where behavioral change is possible to improve health, this is an effective means of applying this theory to nursing-based practice and direct patient care.

For nurses who apply Pender’s model to the practice setting, it is important to address each of the metaparadigms of nursing theory in different ways in order to accomplish mutually beneficial goals and objectives in a positive and meaningful manner. To be specific, nursing practice objectives must be executed in a professional manner with a high level of consistency in order to be effective in meeting the goals and objectives of the practice setting, thereby maintaining a continuous approach to nursing care that promotes excellence and strength in communication, application, and knowledge. This reflects a need to explore the different dimensions of the nursing profession and what is required to meet the desired objectives, while also balancing the needs of patients in a timely and effective manner at all times.

Nurses must also take cues from the surrounding environment, which includes a patient’s overall experiences and level of understanding of his or her surroundings and how they impact their health in different ways (Bender & Feldman, 2015). There must be a successful strategy in place to explore the environment and how it impacts patient health, given the dimensions of this setting and what is necessary to facilitate effective treatment results (Bender & Feldman, 2015). Therefore, the delivery of patient care and treatment must be based upon cues and perspectives from the surrounding environment and how to administer patient care and treatment effectively and consistently (Bender & Feldman, 2015).

The person and health must be aligned so that there is a level of cooperation that will be effective in supporting optimal recovery and a positive and healthy dynamic. Under these conditions, it is necessary for nurses to effectively adapt to change and to be mindful of the issues that will impact health in different ways. It is important for the patient as a person to receive the care and treatment that is required to preserve health and to optimize the conditions under which patients are able to thrive. These factors will demonstrate a commitment to nursing-based care and treatment that supports the preservation of patient care quality as best as possible.

As a nursing professional, I must adopt a number of different perspectives to the practice environment in order to meet the goals and expectations that have been established. This reflects a need to explore the dimensions of nursing practice that will have lasting benefits for patients and which will encourage patients to modify their behaviors as necessary to improve their health. Health promotion is an essential component of all cultures and population groups; therefore, I must be prepared to apply this model to a variety of areas of the practice setting in order to accomplish the desired objectives in care and treatment. At the same time, I must be able to support the objectives of the model in advancing the needs of the patient population and in facilitating effective results that will have a lasting impact on patient health and wellbeing.

As a healthcare professional, I must embody the core values and beliefs of the nursing profession in a positive manner that will have a lasting impact on patient wellbeing. This includes the application of the model to patients with chronic illnesses, as this is a critical factor in their development and the expectations that are derived from this model (Chan, Chiu, Bezyak, & Keegan, 2012). The model must reflect a greater understanding and acknowledgement of nursing practice as a critical component of meeting patient needs, assessing the surrounding environment, and in making decisions that will positively impact the patient care setting (Raingruber, 2012). There must be a significant emphasis on the development of a framework to improve the health of all patients that is grounded in promoting positive behaviors that will translate into healthy outcomes at a high level (Raingruber, 2012).

Finally, as a professional nurse, my application of the theories and principles that I have learned through my coursework will demonstrate my grasp of the material and how this knowledge impacts my professional career goals and objectives. I strive to understand patient needs more effectively and to recognize patterns of care and treatment that could have a positive impact on their health, including the application of Pender’s model to their situations. This will impact the ability to make decisions on behalf of patients in a manner that is consistent with the objectives of the nursing profession and the overall understanding of ideas and frameworks to impact patient health through behavioral interventions, relationship development, and other tools that will improve health and wellbeing at a high level at all times.

Bender, M., & Feldman, M. S. (2015). A Practice Theory Approach to Understanding the Interdependency of Nursing Practice and the Environment: Implications for Nurse-Led Care Delivery Models.  Advances in Nursing Science ,  38 (2), 96-109.

Chan, F., Chiu, C. Y., Bezyak, J. L., & Keegan, J. (2012). Introduction to health promotion for people with chronic illness and disability.  Rehabilitation Counseling Bulletin ,  56 (1), 3-6.

Current Nursing (2012). Models of nursing care delivery. Retrieved from http://currentnursing.com/nursing_theory/models_of_nursing_care_delivery.html

Hendricks, K. (2015). Analysis of Pender’s Health promotion model. Retrieved from https://otterbein.digication.com/kathryn_hendricks_rn_msn_npbc/Application_of_Theory_Research

Nursing Planet (2012). Health promotion model. Retrieved from http://nursingplanet.com/health_promotion_model.html

Pender, N. J. (2011). Heath Promotion Model Manual. Petiprin, A. (2015). Health promotion model. Retrieved from http://www.nursing-theory.org/theories-and-models/pender-health-promotion-model.php

Raingruber, B. (2012). Health education, health promotion, and health: What do these definitions have to do with nursing.  Contemporary Health Promotion in Nursing Practice , 1-24.

Syx, R.L. (2008). The practice of patient education: the theoretical perspective. Orthopaedic  Nursing, 27(1), 50-54.

University of Michigan School of Nursing (2015). Nola J. Pender. Retrieved from http://nursing.umich.edu/faculty-staff/nola-j-pender

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Abstract – Pender’s Health Promotion Model

As healthcare providers we share the common goal in improving the health and well-being of our patients.   The concepts of the promotion of health and disease prevention are essential to our practice.  Pender’s Health Promotion model serves as a tool for nurses to plan behavioral modification interventions in order to assist in the improvement and prevention of unhealthy behaviors.  A major focus of nursing is encouraging health-promoting behaviors.  This model assists nurses in the achievement of optimum health promotion for their patients and communities.  The studies selected in this paper explored if Pender’s Health Promotion Model was able to assist in achievement of positive health promoting behaviors applied to a number of different population groups.

Pender’s Health Promotion Model 

The health promotion model was developed in 1982 by Dr. Nola J. Pender.  The theorist, Nola J. Pender, started her career as a diploma nurse and later went on to achieve her doctorate of philosophy in psychology and education (Butts & Rich, 2018, p.446).  Pender believed that the goal of nursing care was to help their patients achieve optimal health and well-being.  The model was created following Pender’s work examining health promoting and preventative behaviors.  The health promotion model claims that each individual’s characteristics and life experiences have a direct impact on their actions and decisions regarding their health (Butts & Rich, 2018, p.446).  Health is not defined solely as the absence of disease but the state of well-being.  Pender’s health promotion model has been revised since its first creation and has had significant influence on the work of other theorists (Butts & Rich, 2018, p.446).

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Pender’s health promotion model concentrates on three major categories: individual characteristics and experiences, behavior-specific cognitions and affect and lastly, the behavioral outcomes (Butts & Rich, 2018, p.446).  The first category explores the concept that each individual has his or her own set of characteristics and experiences, which in turn help shape their actions (Butts & Rich, 2018, p.446).  Pender emphasized that one’s past actions have a direct link to whether they would partake in future health-promoting behaviors (Butts & Rich, 2018, p.447).   Personal attributes and habits can also be a barrier to health-promoting behaviors.

The second category involves the behavior-specific cognitions and affect which have a direct impact on the individual’s motivation for change (Butts & Rich, 2018, p.447).   Nursing interventions can be tailored to these variables to assist in forming positive changes.  Variables include; the observed benefits and barriers to the action, self-worth, and the activity-related result.  The third category is the behavioral outcome (Butts & Rich, 2018, p.447).  The start of the outcome begins with the person committing to taking the steps necessary to make a change.  During this phase the individual must be supported with barriers addressed in order to produce a positive health-promoting behavior (Butts & Rich, 2018, p.447).   The goal of the health promotion model is to stimulate a behavioral change that results in a positive health outcome.

Major concepts in Pender’s health promotion model include; the person, their environment, health, and nursing (Butts & Rich, 2018, p.447).   The person is the central focus of the model.  The person’s experiences and attributes have a direct impact on future actions and decisions (Butts & Rich, 2018, p.448).  One must assess the learned behaviors we gain from our family and community environments.   These learned behaviors influence the individual’s ability to participate in health-promoting behaviors (Butts & Rich, 2018, p.448).  The environment includes the person’s physical, social, and economic conditions.  A healthy environment is free of toxins, has economic stability, and allows access to resources that promote healthy living (Butts & Rich, 2018, p.448).  How one defines health has a direct impact on the promotion of well-being and prevention of disease.  Through motivation the individual is able to prevent illness and promote healthy behaviors (Butts & Rich, 2018, p.448).  In order to foster positive health-promoting behaviors the nurse must take into account the individual’s self-worth, benefits for the change, environmental control, and any potential barriers to change.

Literature Review

In the article, “Predicting Physical Activity Among Urban Adolescent Girls: A Test of the Health Promotion Model,” Voskuil, Robbins, & Pierce (2019), sought to determine if the health promotion model would assist in predicting physical activity in the selected demographic group.  The health benefits of moderate physical activity are well established yet many young people are falling short in achieving optimal physical activity (Voskuil, Robbins, & Pierce, 2019).  The study collected information in regards to the individuals’ self-efficacy, enjoyment, social support, options, and commitment to physical activity.  Additional data including age, body mass index, and pubertal state were also collected.  The selected sample size was from eight different schools in low-socioeconomic, urban areas, included adolescent girls in the fifth through eighth grades.  The study followed the adolescent girls over a seventeen week period as they underwent a physical activity intervention.  The goal was to examine if the introduction of a physical activity intervention would result in lasting moderate-to-vigorous physical activity (Voskuil et al., 2019).

The researchers selected the health promotion model due to its previous success in exploring the explanations for health-promoting behavior in a number of different populations (Voskuil et al, 2019).  Voskuil et al. (2019) explain, “the HPM includes three groups of variables that influence behavior: (a) individual characteristics; (b) behavior-specific cognitions and effect; and (c) behavioral contingencies including a commitment to a plan of action” (p.393).   The study examined the relationship of the health promotion model on the prediction of moderate to vigorous physical activity among adolescent girls (Voskuil et al., 2019).  The results found that self-efficacy was the only factor to have a meaningful impact on the commitment to physical activity.  Surprisingly, the study did not find that social support, options for physical activity, or commitment to have a significant effect on commitment to moderate to vigorous physical activity (Voskuil et al., 2019).  In addition, there was no correlation to the measured biological factors of the girls.  Opening the study to other age groups, genders, and populations could further test the study’s theory (Voskuil et al., 2019).

In order to increase physical activity among this population interventions need to be put in place to assist in fostering self-efficacy.  According to Voskuil et al., (2019), “Intervention strategies shown to be effective for increasing PA self-efficacy include active online health games, encouragement from teachers, and use of a multidisciplinary team approach in the school setting” (p.405).  Within the health promotion model, self-efficacy was found to be a significant indicator for moderate-to-vigorous physical activity among adolescent girls.  School nurses play an important role in assessing the possible barriers of their student population and forming strategic steps to support physical activity in vulnerable individuals (Voskuil et al., 2019).

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In the article, “The Effect of a Multi-Strategy Program on Developing Social Behaviors Based on Pender’s Health Promotion Model to Prevent Loneliness of Old Women Referred to Gonabad Urban Health Centers,” the authors Alaviani, Khosravan, Alami, & Moshki (2015), explored applying Pender’s Health Promotion model to assist in the prevention of loneliness in elderly women.  Alaviani et al (2015), explains, “since the elderly are faced with problems related to social interactions and interpersonal relations, many of them define the aging period as a loneliness period and look at it as an unpleasant experience” (p.133).  The selected subject group included one hundred and fifty elderly Iranian women attending the Gonabad urban Health center for the treatment of moderate loneliness.  The methods involved a quasi-experimental study, the data was collected using the Russell’s UCLA loneliness questionnaire and questions were formed based on Pender’s Health Promotion Model (Alaviani et al., 2015).  Pender’s health promotion model bases its intervention framework on the assessment of the targeted population (Alaviani et al., 2015).  The selected subjects were placed into either the intervention or control groups.   Interventions involved therapy sessions and loneliness educational in-services.  The sessions aimed to improve the client’s social interactions and also to motivate self-efficacy.  The results indicated a reduction in loneliness in the subjects in the intervention group.

The study highlights that Pender’s health promotion model can be used as a tool for nurses to plan behavior modification interventions to improve and/or prevent loneliness (Alaviani et al., 2015).  By preventing loneliness in this population we can decrease the likelihood of depression and other mental health issues (Alaviani et al., 2015).  Possible solutions in combating loneliness include: having a pet, group therapy, counseling, music therapy, sharing memories, and training society to be more acceptable to the aging process (Alaviani et al., 2015).  Nurses can use the health promotion model in combination with these interventions to help initiate behavioral changes and ultimately prevent loneliness.

In the article, “ The Effect of Pender’s Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women,” the authors, Khodaveisi, Omidi, Farokhi, & Soltanian (2017), studied the effect of Pender’s health promotion model on the nutritional behaviors of overweight women.  Obesity is a chronic disease seen at an increasing rate worldwide.  In this quasi-experimental study, one hundred eight qualified women whom were admitted to the Fatemiyeh Hospital clinic in Iran were randomly placed in the experimental or the control group.  The health promotion model was chosen for this study due to its emphasis changing unhealthy behaviors and health promotion (Khodaveisi et al., 2017).

Data collection from the participants was obtained using questionnaires completed at the pre-test and post two-month period (Khodaveisi et al., 2017).  The training interventions included educational presentations, question and answer sessions, and group discussions .  The results from the study showed Pender’s health promotion model based training resulted in an improvement in nutritional behavior (Khodaveisi et al., 2017).  The study was successful in teaching the benefits of healthy nutrition.  Positive attitudes from the individuals and from their family members leads to longstanding improvements in nutritional behaviors.  In order to foster healthy lifestyles we need to continue to target risk factors and encourage health-promoting behaviors.  Khodaveisi, M. et al. (2017) explain, “Health-promoting behaviors include activities that enable people to monitor their health and are, therefore, useful to improve individual and community health” (p.166).  This study demonstrates the importance of the healthcare professional in influencing healthy nutritional behaviors and promoting health.  Educational programs should be tailored to emphasize the promotion of healthy living and nutrition (Khodaveisi et al., 2017).

Major assumptions of the health promotion model stress that the individual is in control of shaping and sustaining their health behaviors within their environment.  Healthcare providers play an important role and influence in the patient’s environment.  In order for a behavioral change to occur and be maintained it must be self-initiated (Butts & Rich, 2018, p.449).  One must consider the individual’s previous behavior and characteristics that can have a direct influence on future health-promoting behavior.  Perceived personal value or benefit, as well as, self-worth can be a driving focus to achieve participation (Butts & Rich, 2018, p.449).  A strong indication for commitment to health-promotion behavior can be achieved when others in their environment support and display the behavior.

The simplicity of the health promotion model enables it to be easily adapted in the community health setting (Butts & Rich, 2018, p.450).  We have a chance to improve a patient’s well-being and prevent disease when health-promoting behaviors are established in the community environment.  Due to its ease of use, the health promotion model is a valuable tool in the field of nursing research (Butts & Rich, p.450).  The use of Pender’s Health Promotion Model in the articles explored display how it can positively affect and improve health behaviors.  Today the value of healthy lifestyles and behaviors holds even higher significance as health insurance becomes out of reach for many individuals due to rising costs.  Pender’s health promotion model drives the nurse to tailor their education to meet the individual and environmental needs of their patient in order to initiate a health-promoting behavioral change (Butts & Rich, p.451).

• Alaviani, M., Khosravan, S., Alami, A., & Moshki, M. (2015). The Effect of a Multi-Strategy Program on Developing Social Behaviors Based on Pender’s Health Promotion Model to Prevent Loneliness of Old Women Referred to Gonabad Urban Health Centers.  IJCBNM ,  3(2),  132-140.
• Butts, J. B., & Rich, K. L. (2018).  Philosophies and Theories for Advanced Nursing Practice . Burlington, MA: Jones & Bartlett Learning.
• Health and Wellness (2016, November 17). Retrieved from https://nursekey.com/health-and-wellness-2/
• Khodaveisi, M., Omidi, A., Farokhi, S., & Soltanian, A. (2017).  The Effect of Pender’s Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women.  IJCBNM ,  5(2) , 165-174.
• Voskuil, V. R., Robbins, L. B., & Pierce, S. J. (2019). Predicting physical activity among urban adolescent girls: A test of the health promotion model.  Research in Nursing & Health ,  42 (5), 392–409.
• Figure 1. Pender’s Health Promotion Model.  Health and Wellness. (2016, November 17). Retrieved from https://nursekey.com/health-and-wellness-2/

Related FAQs

1. What is Pender’s health promotion Model?

Pender’s health promotion model 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. It describes the multi-dimensional nature of persons as they interact within the environment to pursue health.

2. What are the 5 health promotion models?

The 5 Approaches to Health Promotion

• Health Promotion Model (HPM) Pender’s Health Promotion Model is based on the idea that people’s experiences affect their health outcomes.
• Health Belief Model (HBM)
• Transtheoretical Model (TTM)
• Theory of Reasoned Action (TRA)
• Diffusion of Innovation Theory (DOI)

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Applying the Pender's Health Promotion Model to Identify the Factors Related to Older Adults' Participation in Community-Based Health Promotion Activities

Affiliations.

• 1 Nursing Department, Yang Ming Hospital, Taoyuan City 324005, Taiwan.
• 2 School of Nursing, Chang Gung University of Science and Technology, Chang Gung Medical Foundation, Associate Research Fellow, Taoyuan City 33303, Taiwan.
• PMID: 34639294
• PMCID: PMC8508522
• DOI: 10.3390/ijerph18199985

Aging societies have garnered global attention regarding issues related to older adults' health promotion. This cross-sectional study aimed to identify factors associated with older adults' participation in community-based health promotion activities. The Older Adults' Health Promotion Activity Questionnaire was developed to collect data, and a total of 139 older adults were recruited from a community care center in Taoyuan City. Participants' mean age was 72.7 years (SD = 6.0 years), 74.8% were females, 64.7% were married, 59% had a lower level of education, 51.8% had lower income, 59% reported their health status not good, and 76.3% had chronic disease. Our findings indicated that age, perceived benefits, and self-efficacy were identified as significant predictors of participation in health promotion activities. Among them, perceived benefits were found to have the strongest association with participation in health promotion activities (β = 0.305; p < 0.05). The findings showed that the Pender's Health Promotion Model is useful to provide information for predicting and detecting significant factors related to older adults' participation in community-based health promotion activities. By using this model as a framework, researchers can design more specific studies that are directed towards improving healthy lifestyles and detecting the key components of health-related behaviors among different age groups.

Keywords: Pender’s health promotion model; community-based health promotion activities; health promotion questionnaire; older adults.

• Cross-Sectional Studies
• Health Behavior*
• Health Promotion*
• Self Efficacy
• Surveys and Questionnaires

Utilizing Pender’s Health Promotion Model: Patient Education Case Study

Introduction.

The promotion of patient education is one of the core tasks of nursing experts. However, due to the presence of strongly held beliefs and a long-established lifestyle, patients may find it difficult to change their habits and develop a healthier outlook on life. In the case under analysis, J. P., a 65-year-old patient with diabetes, needs to be educated on the threats that his current habit of smoking combined with a rather complicated family history of diseases and disorders produce on his well-being. By utilizing Pender’s health promotion model, one will be able to establish a framework for J. P. to comply with when transitioning from his current state of health management to the desired one.

Primary and Secondary Healthcare Needs

Given the current situation with J. P., the necessity to manage the patient’s sugar blood levels is currently the main priority and the essential goal of the treatment process. Therefore, keeping J. P.’s glucose rates at the needed rate has t be viewed as the primary health need. However, given the development of several comorbid health concerns, as well as additional disorders, there are other health needs that can be defined as urgent.

As far as the secondary health needs of J. P. are concerned, the problem with his health literacy is evident. Namely, the presence of bad habits that include smoking and failure to undergo regular hospital checks to alleviate the threat of several critical conditions such as prostate cancer deserve a mentioning. Indeed, given the patient’s family history record, there may be a possibility of him developing prostate cancer due to the poor genetic disposition and his family history. Therefore, regular tests should be run to minimize the threat of prostate cancer and reduce the patient’s exposure to negative factors.

In addition, J. P. needs to be provided with a chance to increase his health literacy since he seems to be completely unaware of the threat that his current lifestyle represents for him. Given his current condition and his family history, J. P. is especially prone to developing additional health concerns, ranging from prostate cancer to heart disease. Therefore, the increase in the patient’s health literacy and awareness of his current condition should be regarded as another secondary objective. It is particularly important that the patient should fully realize the extent of the threat to which his present lifestyle leads. Thus, positive changes in the management of J. P.’s situation will emerge.

Patient’s Health Beliefs and How They Impact His Health Behaviors

Personal beliefs might not seem as relevant when introducing a patient to basic health requirements with which they have to comply in order to recover. However, in the case under analysis, the personal beliefs of the patient play a large role in shaping his chances for recovery. Namely, the fact that J. P. lacks health education significantly and assumes that health-related knowledge is irrelevant to anyone who is not a part of the healthcare industry is very troubling. Namely, the specified mindset is likely to prevent J. P. from developing awareness and health literacy needed to develop the required health awareness and insight.

The problem of building health literacy remains one of the foundational concerns in contemporary nursing and healthcare. On the one hand, the rise in the availability of information and the increase in the opportunity for nurse-patient communication have made it possible to improve health literacy rates. Namely, by addressing a broader audience, nurses have managed to eradicate harmful health myths in local communities (Svavarsdóttir, Sigurðardóttir, & Steinsbekk, 2016). On the other hand, the abundance of data makes it very difficult to distinguish between genuinely important and useful data and the one that perpetuates myths about healthcare, aggravating patients’ conditions (Rowe et al., 2019). Therefore, guidance and proficiency are crucial in establishing a health literacy course for patients.

Therefore, in the case of J. P., it is absolutely necessary to increase the extent of his health literacy. The rise in health awareness can be achieved by introducing the patient to essential standards for self-care and crucial health resources. Namely, the patient needs basic information about the factors that may become threats to his health, such as increased blood pressure and the environment that may cause it. In addition, the information about the drastic effects of smoking will be crucial in encouraging the patient to change his current lifestyle toward a healthier one.

Patient’s Health History: Information Synthesis

As emphasized above, the available history of the patient’s health and the records of his family’s health concerns lead to the necessity to introduce additional safety measures for preventing any aggravation in his current state. Therefore, the best practices for J. P. currently would include abandoning his smoking habit and following the prescribed strategy for managing his diabetes issue. Namely, it will be necessary to pursue the improvement of the patient’s quality of life and avoid the instances of hypoglycemia as a direct result of dehydration.

In addition, given J. P.’s family history, it is crucial to avoid the development of cardiovascular issues. The threat of CVD is particularly high at this point since high blood pressure is typically associated with diabetes and, therefore, may lead to serious CVD-related concerns unless attended to respectively. However, to control J.P.’s exposure to the risk of CVD, it is necessary to educate the patient about the factors that may entail changes in his heart rate and problems with his heart. Specifically, the issue of smoking as one of the foundational factors in the development of hypertension and CVD has to be abandoned once and for all.

Health Promotion Model: Summary

The current health promotion model that must be used to adders health threats faced by J. P. is grounded in the enhancement of the patient’s health literacy through exposure to communication with nurses and the analysis of the relevant information sources, including both digital and traditional ones. To encourage the patient to change their current mindset and shift toward a healthier lifestyle, Pender’s Health Promotion Model should be utilized. The suggested health promotion model is based on the premise of altering a patient’s health behavior through a series of minor changes to their attitude and perception of health-related problems. As a result, basic health literacy can be fostered in the target population, which will be critical for addressing the needs of J. P. In the case in point.

The model offered by Pender includes several major steps, which stem from the thirteen core statements that the model provides. Specifically, the model sets four major assumptions, which include an individual’s willingness to change their behaviors toward improved ones, interactions between individuals and the environment, nurses constituting an important part of individuals’ environment, and the need for self-directed reconfiguration of the lifestyle choices (Khodaveisi, Omidi, Farokhi, & Soltanian, 2017).

The model implies that individual characteristics and experiences, namely, learned behaviors and personal factors, shape behavior-specific cognitions and affect to produce behavioral outcomes (Khodaveisi et al., 2017). As seen from the assumptions listed above, the model relies heavily on an individual’s willingness to change, which means that a nurse has to establish a proper rapport with a patient and convince them about the necessity to improve their lifestyle and general well-being.

Applying Pender’s Health Promotion Model

In the case under analysis, the application of Pender’s Health Model will require establishing a health literacy promotion strategy that will introduce J. P. to crucial insights about his current health status and the dangers to which he exposes himself regularly. Specifically, by exposing the patient to the information about the possible outcomes of failing to lead a healthy lifestyle, one will set the platform for him, to recognize the importance of an improvement in his behavior. Afterward, the importance of interacting with the environment, namely, recognizing the threats to his health and the opportunities to learn about his condition, will have to be established.

The third step will involve reinforcing the communication between J. P. and a nurse educator, who will provide the patient with an opportunity to gain basic information and skills for maintaining proper health. Specifically, the management of blood pressure and especially the process of abandoning his smoking habit need to be seen as the priority of the treatment process apart from the established diabetes issue.

The fourth and final stage of the program will imply a change in the patient’s behavior and the voluntary transition to more conscious management of personal health needs. Specifically, it will be crucial for J. P. to recognize the necessity to quit smoking as a means of minimizing the threat of CVD development and alleviating the issues caused by his current condition, namely, type 2 diabetes. Moreover, the framework for controlling the patient’s transition and the further management of nurse-patient communication and collaboration will have to be established. The latter will become more manageable with the introduction of a digital communication channel through which a nurse will be able to address the entire community and each patient separately, including J. P.

Evaluation Plan

In order to control the process of managing J. P.’s needs, one will need an assessment tool for the evaluation of the treatment outcomes. Specifically, one will need to compare the extent of the patient’s awareness of the signs and symptoms that will signal him about the need to introduce an intervention to prevent threats to his health. Likewise, the patient will have to show a change in his perception of dieting and the related habits, including his understanding of the harmful effects of smoking. A drop in the daily intake of nicotine, preferably to zero, will be seen as the ultimate goal that J. P. will have to pursue in order to implement the change accordingly.

Since J. P. has been exposing himself to significant harm by smoking despite his current condition, his diabetes type 1 may be aggravated by the development of CVD or even the threat of prostate cancer. Since his family records show the presence of both diseases in his family members, it is necessary to focus on the prevention of the specific conditions in J. P. For this reason, changes in the patient’s dieting and especially the promotion of a healthier lifestyle, specifically, quitting smoking, have to be seen as a necessity. The described alterations in J, P.’s current health management approach will allow reducing the risks to which the patient has been exposed and manage the health issues related to diabetes.

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.

Rowe, C. A., Sirois, F. M., Toussaint, L., Kohls, N., Nöfer, E., Offenbächer, M., & Hirsch, J. K. (2019). Health beliefs, attitudes, and health-related quality of life in persons with fibromyalgia: Mediating role of treatment adherence . Psychology, Health & Medicine, 24 (8), 962-977. Web.

Svavarsdóttir, M. H., Sigurðardóttir, Á. K., & Steinsbekk, A. (2016). Knowledge and skills needed for patient education for individuals with coronary heart disease: The perspective of health professionals . European Journal of Cardiovascular Nursing, 15 (1), 55-63. Web.

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Bibliography

IvyPanda . "Utilizing Pender's Health Promotion Model: Patient Education." June 29, 2022. https://ivypanda.com/essays/health-promotion-project-an-obesity-case-study/.

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