LET’S DIVE DEEPLY!

1 Discussion Points: Read the case scenario and relate it to the theory
you’ve learned.

Amy 30 years old, married, now in the 3 rd month of her second pregnancy,
came to the Center for prenatal consultation. For her first pregnancy, she availed of
the services of a traditional birth attendant (hilot) that ended in a stillbirth in the
eight month of gestation. Working full time in a garment factory she claims that she
hardly has the time for regular prenatal visits. However, she says that she and her
husband want a healthy baby, which is the reason for her “early” consultation.

Apply HBM and Pender’s HPM in the situation given above.

Write your answer inside the box…

1. Health Behavior Model (HBM)

Behavior change theories are used to explain why behaviors occur or not occur and indicate
the ways in which we can most effectively change behaviors. One of the most widely models
used to study and change behavior is the Health Belief Model (HBM). The model is a
framework that seeks to understand, predict, and promote behavioral changes in people
through its six components, particularly in regard to the uptake of health services. The six
components are perceived susceptibility, perceived severity, perceived benefits, perceived
barriers, cues to actions, and self-efficacy. Based on the given scenario, each health belief
component can be applied to Amy’s situation.

The first component is the perceived susceptibility which consists of Amy’s perception of

acquiring a health issue or being harmed by not adopting a healthy behavior for her
pregnancy. Next, Amy’s perceived severity involves her evaluation of the seriousness or
impact of the health issue on her pregnancy such as her previous history of stillbirth. When
coupled with perceived susceptibility, they are termed as perceived threats. Since Amy
already had a history of stillbirth after availing the services of a traditional birth attendant
(hilot), she now perceives the possibility and severity of the health issue of having another
stillbirth if she will continue to avail those services in her second pregnancy. In that case,
Amy now has a clear understanding on the perceived threats that could happen in her
second pregnancy. As the nurse, I should supplement Amy with information and realistically
discuss risk data of the perceived threats based on her history of stillbirth by availing the
services of a traditional birth attendant. The next component are the perceived barriers,
these are the barriers, or costs, that Amy expects to encounter if she tries to change her
behavior. In this scenario, this would represent Amy’s claim on working at the garment
factory full time that she hardly has the time for regular prenatal visits. As the nurse, I
should help Amy identify the personal barriers that she will encounter when she comes for
regular prenatal visits. This identification process can be incorporated into a brainstorming
activity or personal journaling. Once we work on identifying the barriers, I can provide
opportunities for Amy to increase her confidence to come for regular prenatal visits. After
convincing Amy to overcome her perceived barriers, it is best to give examples that shows
immediate benefits with regards to coming to regular prenatal visits. This component is
known as Amy’s perceived benefits which will stress the importance of prenatal care to
achieve a successful labor and delivery process. Along with this, I can incorporate another
component which are the cues to action by informing Amy to incorporate visual reminders
of her prenatal visits through a calendar. In addition to this, Amy and her husband already
showed readiness to take action for them to have a healthy baby, it can be said that the
couple has developed self-efficacy by gaining confidence to visit the center for prenatal
consultation on what to do during pregnancy and preventing stillbirth. In this case, the key
in maintaining self-efficacy among the couple is to provide opportunities to demonstrate
their shift of behavior coupled with encouragement and reinforcement towards stressing the
important role of prenatal care visit to the Center for their second pregnancy.

2. Heath Promotion Model (HPM)

Health promotion is but one of the primary objectives in modern nursing. Health promoting
behaviors can lead to a patient’s overall sense of well-being as well as protection from
disease and chronic illnesses. Pender’s Health Promotion Model (HPM) plays a significant
role in the context of health problems which are caused by behaviors and are largely
preventable. Pender’s model focuses on three areas: individual characteristics and
experiences, behavior-specific cognitions and affect, and behavioral outcomes. Based on the
given scenario, each health promotion component can be applied to Amy’s situation.

The first component involves the personal factors and the prior related behaviors which are
important dimensions in understanding Amy’s individual characteristics and experiences. In
this case, Amy has past experiences of stillbirth in her first pregnancy due to availing the
services of a traditional birth attendant. This means that Amy’s history of stillbirth is a
personal factor that led her to visit the Center for prenatal consultation. In regards to that
this could also reflect the second component of behavior-specific cognitions and affect
wherein Amy has the characteristics and experiences that affect her behavior through
perceived self-efficacy and has perceived the benefits of having a prenatal consultation
during pregnancy. Consequently, the perceived barrier is described when Amy claims she
has no time for regular prenatal consultation because she works full time at a garment
factory. In addition to this, Amy’s perceived self-efficacy is gained when she believes that
they could have a healthy baby by coming early to the Center for prenatal consultation.
Within that 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
the health behavior of visiting the Center for regular prenatal visits.  As Amy continues to
have prenatal visits with her husband, her personal perception will be affected by the
interpersonal influence brought by her husband's thoughts about having a healthy baby as
they seek consultation. As a result, the goal of the HPM is met by helping Amy and her
husband prevent pregnancy complications through their behavior by pursuing health-
promoting behavior that she will gain from regular prenatal consultations for her second
pregnancy.