Nola Pender
Overview of Health Promotion Model
 The health promotion model (HPM) proposed
by Nola J Pender (1982; revised, 1996) was
designed to be a “complementary counterpart
to models of health protection.”
 It defines health as a positive dynamic state not
merely the absence of disease. Health
promotion is directed at increasing a client’s
level of well being.
 The health promotion model describes the
multi dimensional nature of persons as they
interact within their environment to pursue
health.
 During her active research career, she
conducted research testing on the Health
Promotion Model with adults and adolescents.
 =She also developed the program “Girls on the
Move” with her research team and began
intervention research into the usefulness of the
model in helping adolescents adopt physically
active lifestyles, developing a number of
instruments that measure components of the
model.
 = In retirement, she consults on health
promotion research nationally and
internationally.
Teaching
 Dr. Pender has been a nurse educator for over
forty years. Throughout her career, she taught
baccalaureate, masters, and PhD students; she
also mentored a number of postdoctoral
fellows.
 In 1998, she received the Mae Edna Doyle
Teacher of the Year Award from the University
of Michigan School of Nursing.
 =She currently serves as a Distinguished
Professor at Loyola University Chicago, School
of Nursing.
The model focuses on following three areas:
1. Individual characteristics and experiences
PERSONAL FACTORS
These factors are predictive of a given behavior
and shaped by the nature of the target
behaviour being considered.
1. Personal biological factors
Include variable such as age gender body mass
index pubertal status, aerobic capacity, strength,
agility, or balance.
2. Personal psychological factors
 Include variables such as self esteem self
motivation personal competence perceived
health status and definition of health.
3. Personal socio-cultural factors
 Include variables such as race ethnicity,
accuculturation, education and socioeconomic
status.
2. Behavior-specific cognitions and affect
1. PERCEIVED BENEFITS OF ACTION
 Anticipated positive out comes that will occur
from health behaviour.
2. PERCEIVED BARRIERS TO ACTION
 Anticipated, imagined or real blocks and
personal costs of understanding a given
behavior
3. 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.
4. 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.
5. INTERPERSONAL INFLUENCES
 =Cognition concerning behaviours, beliefs, or
attitudes of the others. Interpersonal influences
include:
 a. norms (expectations of significant others),
 b. social support (instrumental and emotional
encouragement)
 c. modelling (vicarious learning through
observing others engaged in a particular
behaviour).
Primary sources of interpersonal influences are:
= families, peers, healthcare providers.
6. 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.
3. Behavioral outcomes
1. COMMITMENT TO PLAN OF ACTION
 The concept of intention and identification of a
planned strategy leads to implementation of
health behaviour.
2. 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
3. HEALTH PROMOTING BEHAVIOUR
 Endpoint or action outcome directed toward
attaining positive health outcome such as
optimal well-being, personal fulfillment, and
productive living.
HPM Assumptions
The HPM is based on the following assumptions, which
reflect both nursing and behavioral science
perspectives:
1. Persons seek to create conditions of living through
which they can express their unique human health
potential.
2. Persons have the capacity for reflective self-
awareness, including assessment of their own
competencies.
3. Persons value growth in directions viewed as positive
and attempt to achieve a personally acceptable balance
between change and stability.
4. Individuals seek to actively regulate their own
behavior.
5. Individuals in all their biopsychosocial complexity
interact with the environment, progressively
transforming the environment and being transformed
over time.
6. Health professionals constitute a part of the
interpersonal environment, which exerts influence on
persons throughout their lifespan.
7. Self-initiated reconfiguration of person-environment
interactive patterns is essential to behavior change.
HPM Theoretical Propositions
1. Prior behavior and inherited and acquired
characteristics influence beliefs, affect, and enactment
of health-promoting behavior.
2. Persons commit to engaging in behaviors from which
they anticipate deriving personally valued benefits.
3. Perceived barriers can constrain the commitment to
action, the mediator of behavior, and the actual
behavior.
4. Perceived competence or self-efficacy to execute a  It is highly applicable in the community health
given behavior increases the likelihood of commitment setting.
to action and actual performance of behavior.
 It promotes the independent practice of the
5. Greater perceived self-efficacy results in fewer nursing profession being the primary source of
perceived barriers to specific health behavior. health promoting interventions and education.

6. Positive affect toward a behavior results in greater Weaknesses

perceived self-efficacy, which, in turn, can result in
 The Health Promotion Model of Pender was not
increased positive affect.
able to define the nursing metapradigm or the
7. When positive emotions or affect is associated with a concepts that a nursing theory should have,
behavior, the probability of commitment and action is man, nursing, environment, and health.
increased.
 The conceptual framework contains multiple
8. Persons are more likely to commit to and engage in concepts which may invite confusion to the
health-promoting behaviors when significant others reader.
model the behavior, expect the behavior to occur, and
 Its applicability to an individual currently
provide assistance and support to enable the behavior.
experiencing a disease state was not given
9. Families, peers, and health care providers are emphasis.
important sources of interpersonal influences that can
Conclusion
increase or decrease commitment to and engagement
in health-promoting behavior.  Due to its focus on health promotion and
disease prevention perse, its relevance to
10. Situational influences in the external environment
nursing actions given to individuals who are ill is
can increase or decrease commitment to or
obscure. But then again, this characteristic of
participation in health-promoting behavior.
her model also gives the concepts its
11. The greater the commitment to a specific plan of uniqueness.
action, the more likely health-promoting behaviors are
to be maintained over time.

12. Commitment to a plan of action is less likely to

result in the desired behavior when competing
demands over which persons have little control require
immediate attention.

13. Commitment to a plan of action is less likely to

result in the desired behavior when other actions are
more attractive and thus preferred over the target
behavior.

14. Persons can modify cognitions, affect, and the

interpersonal and physical environments to create
incentives for health actions.

Strengths

 The Health Promotion Model is simple to

understand yet it is complex in structure.

 Nola Pender’s nursing theory gave much focus

on health promotion and disease prevention
making it stand out from other nursing theories.