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Historical Background of HPM
• The health promotion model (HPM), originally developed in the early 1980s by Pender (Pender, 1996; Pender, Murdaugh, & Parsons,2002, 2005) is a framework that serves as “a guide for exploration of the complex biopsychosocial processes that motivate individuals to engage in health behaviors directed toward the enhancement of health” (Pender, 1996, p. 51).
• The health promotion model represents a theoretical perspective that explores the factors and relationships contributing to healthpromoting behavior and therefore to the enhancement of health and quality of life. • Health promotion – define as a “behavior motivated by the desire to increase well being and actualize human health potential”.
Components of the HPM
The HPM classifies health behavior determinants into three specific propositional groupings: (a) Individual characteristics and experiences, (b) Behavior specific cognitions and affects, and (c) Behavioral outcome
.Individual Characteristics and Experiences.
socioeconomic status). psychological (e.g. • Personal Factors – categorized as biological (e.Individual characteristics and experiences. – Individuals who made a habit of a previous health promoting behavior. strength. education.g. balance). and sociocultural (e. and skill in health promoting actions. ethnicity.g. . knowledge. • Prior related behaviors – includes previous experience. selfesteem.. age. self motivation). race.
Infants • Infant parent attaching • Breastfeeding • Sleep patterns • Playful activity to stimulate development • Immunizations • Safety promotion and injury control Children • Nutrition • Dental checkups • Rest and exercise • Immunization • Safety promotions and injury control Adolescents • Communicating with the teen • Hormonal changes • Nutrition • Exercise and rest • Peer group influences • Self concept and body image • Sexuality
Elders • Adequate sleep • Appropriate use of alcohol • Dental/oral health • Drug management • Exercise • Foot health • Health screening recommendation • Hearing aid use • Medication instruction • Mental health • Nutrition • Physical fitness • Preventive health services • Safety precautions • Smoking cessation • Weight control
Behavior Specific Cognition and Affect
Behavior Specific Cognition and Affect
• Perceived benefits of action – anticipated benefits or outcomes ( e.g. physical fitness stress reduction) affect the persons plans to participate in health promoting behaviors and may facilitate continued practice. – Prior positive experience with the behavior or observations of others engaged in the behavior is a motivational factor.
• Perceived barriers to action – a persons perception about available to time, inconvenience, expense, and difficulty in performing the activity may act as barriers imagined or real. – Perceived barriers to action affect health promoting behavior by decreasing the individuals commitment to a plan of action.
• Perceived self efficacy – refers to the conviction that a person can successfully carry out the behavior necessary to achieve a desired outcome. . – Often people who have serious doubts about their capabilities decrease their efforts and give up. such as maintaining the exercise program to lose weight. whereas those with a strong sense of efficacy exert greater effort to master problems or challenges.
or un-pleasant? A positive affect or emotional response to a behavior is likely to be repeated and behaviors associated with negative affect are usually avoided. . enjoyable. and following an activity can influence whether a person will repeat the behavior again or maintain the behavior.• Activity related affect – the subjective feelings that occur before. during. – What is the individual’s reaction to the thought of the behavior? Is it perceived as fun.
• Interpersonal influences – interpersonal influences are persons perceptions concerning the behaviors, beliefs, or attitudes of others.
– Family peers and health professional are sources of interpersonal influences that can influence a persons health promoting behavior. – Interpersonal influence include expectation of significant others, social support (e.g. emotional encouragement), and learning through observing others or modeling.
• Situational influences - Situational influences are direct and indirect influences in health promoting behaviors and include perceptions of available options, demand characteristics, and the aesthetic features of the environment.
– An example of an individuals perception of available options can include easy access to healthy alternatives such as vending machines and restaurants that provide a healthful menu options.
Commitment to a plan of action
• Commitment to a plan of action involves two processes: commitment and identifying specific strategies for carrying out and reinforcing the behavior. Strategies are important because commitment alone often results in “good intentions” and not actual performance of the behavior
Immediate competing demands and preferences
• Competing demands are those behavior over which an individual has a low level of control. • Competing preferences are behaviors over which an individual has a high level of control, however, this control depends on the individuals ability to be self regulating or to not give in.
• Health promoting behavior, the outcome of the Health Promotion Model, is directed toward attaining positive health outcomes for the client. • Health promoting behaviors should result in improved health, enhanced in functional ability, and better quality of life at all stages of development.
ASSUMPTIONS AND THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL (HPM) 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 selfawareness, 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.
which exerts influence on persons throughout their lifespan. . Health professionals constitute a part of the interpersonal environment. Self-initiated reconfiguration of personenvironment interactive patterns is essential to behavior change. 7.6.
affect. and enactment of health-promoting behavior. Prior behavior and inherited and acquired characteristics influence beliefs. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits.HPM Theoretical Propositions Theoretical statements derived from the model provide a basis for investigative work on health behaviors. 2. The HPM is based on the following theoretical propositions: 1. .
a mediator of behavior as well as actual behavior. Perceived barriers can constrain commitment to action. . 5.3. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior. 4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior.
6. Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect. 7. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased. 8. 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.
9. 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. 10. Situational influences in the external environment can increase or decrease commitment to or participation in healthpromoting behavior. 11. The greater the commitment to a specific plan of 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 environment to create incentives for health actions.
. The HPM tells that the patient needs information about the health promoting lifestyles but also other type of support to make changes in his/her life.The process of changing lifestyle is not often easy and any patients need the support to make decision and to keep it.
End Created by: Jayson D. Tabamo RN All rights reserved 2008 .