Nola J.

Pender
The Health Adaptation
Model
Background
Born in 1941 in Lansing, Michigan

School of Nursing at West Suburban Hospital in Oak,

Park, Illinois

She received her diploma in 1962 and began working on

a medical surgical unit in Michigan Hospital

1964- completed BS Nursing at Michigan State

University in East Lansing
M.A in human growth and development from
Michigan State University in 1965

Ph.D. In psychology and education in 1969 at north-

western university in Evanston, Illinois

Defining a goal of nursing care as the optimal health

of the individual

Conversation with Dr. Beverly McElmurry at North

Illinois University and reading High Level Wellness by
Halpert Dunn
1975- “ A Conceptual Model for Preventive Health
behavior

Original HPM was presented in 1st edition of the text

Health Promotion in Nursing Practice(1982)

Revised HPM- 1987

Last Revision- 1996- 4th edition of Health Promotion

in Nursing Practice
National Institues of Health –Northern Illinois
University in DeKalb (Susan Walker, Karen Secrist, and
Marilyn Frank-Stromborg)

Health Promoting Lifestyle Profile (Behavior of

working adults, older adults, cardiac rehabilitation
patients and ambulatory cancer patients)

Over 50 studies have tested the predictive capability of

the model for health promoting lifestyle, exercise,
nutrition, practices, use of hearing protection and
avoidance of exposure to environmental tobacco smoke
Stigma Theta Tau International

Professor and Associate Dean for Research at the

University of Michigan School of Nursing since 1990,
she promotes Nursing Science

1,) understanding how self efficay affects the exertion

and affective responses of adolescent girls to the physical
activity challenge

2.) developing an interactive computer program as an

intervention to increase physical activity among
adolescent girls
Theoretical Sources
Backgroung in Nursing, human development,
experimental psychology and education led her use a
holistic nursing perspective, social psychology and
teaching learning foundations for the HPM.

Central to the HPM is the Social Learning Theory of

Albert Bandura (self-attribution, self-evaluation and
and self efficacy)

Self efficacy is a central construct of HPM

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 wellbeing. The health promotion model
describes the multi dimensional nature of persons as
they interact within their environment to pursue healt
The model focuses on following three areas:

· Individual characteristics and experiences

· Behavior-specific cognitions and affect
· Behavioral outcomes

notes that each person has unique personal

characteristics and experiences that affect subsequent
actions.
ASSUMPTIONS OF THE HEALTH PROMOTION
MODEL
:
 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 lifespan.
 Self-initiated reconfiguration of person-environment
interactive patterns is essential to behavior chang
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.