NOLA J PENDER .

HEALTH PROMOTION MODEL

The health promotion model developed by Nola J Pender in the year 1982, was revised and presented in
its new for in the year 1996.

It is a framework that serves as a guide for exploration of the complex biopsychosocial process that
motivates the individual to encourage in healthy behaviors directed towards the enhancement of health.

The health promotion model classifies health behavior determinants into three specific propositional
groupings they are a) Individual characteristics and experiences b) Behavioral specific affects c)
Behavioral outcome.

Pender HPM adopted in this as a framework to understand a primi mothers journey towards positive
health promoting behavior for both her’s and her LBW baby.

A. INDIVIDUAL CHARACTERSTICS AND EXPERIENCES:

According to theorist the combination of individual characteristics and experiences is unique to
each person and importance of any characteristics, experiences or combination of them with the
behaviors under consideration both personal factors and prior related behavior.
In this undertaken study the personal factor was primi para who gave birth to LBW baby weight
between 1500-2499grams.
psychological factors were - Psychologically mother under stress, anxiety and low emotional
stability.
Stress because primi para mother not able to produce milk.
Anxiety towards handling of the baby.
Low emotional stability due to unable to breast feed her baby and also socio cultural factors
influence family income, education of mother, occupation and mass media from where she can
get knowledge about breast feeding and also there was a influence of the family and friends.
Prior related behavior : As she was primi mother, she was not having any experience as such and
no prior experience of breast feeding the LBW baby. Mother got some information, but her
knowledge was deficit regarding breast feeding and also she was having some false beliefs about
breast feeding , colustrum feeding , lactational diet and intake of water during lactation.

B. BEHAVIOUR-SPECIFIC COGNITIONS AND AFFECT:

Here the theorist classified behavioral specific cognitions under following headings.
1. Perceived benefits of action
2. Perceived barriers to action
3. Perceived self efficacy
4. Activity related affect
5. Interpersonal influences
6. Situational influences.

In this study the perceived barriers to action was the fear of unknown leading to feeling
of inability to breast feed the baby , mother is disinterested because she was not able to
produce enough milk and she was worried because baby was small.
By considering pretest and perceived barriers to action, intervention was planned.
Teaching the mother regarding breast feeding by charts, flashcard, model and
demonstrated the breast feeding technique to mother and also observation practice of
breast feeding .

 PERCEIVED BENEFITS TO ACTION:

Theorist explains perceived benefits may be moderate behavior both directly and
indirectly prior personal experiences with positive outcomes or observations of
others.
In this study Perceived barriers to actions are described as survival of the baby
through proper breast feeding and personal care by mother and she was able
breast feed effectively so that baby’s health status was improved.

 PERCEIVED SELF EFFICACY:

Pender explains Perceived self efficacy or once judgment of one’s ability to carry
out an identified action relates not a person’s skills but to that person’s
judgment about what can be accomplished with those skills.
The mother verbalizes her feelings and experiences she is able to breast feed the
baby independently as evidenced by establishment of lactation and strong mother
baby bonding.

 ACTIVITY RELATED AFFECT:

Activity related affect may vary from mild to quite and will be cognitively
labeled, recommended and continue to be associated with thoughts about the
particular behavior
Mother understands the breast feeding is very essential for baby’s survival so she
was completely involved to breast feed her baby hence encouraged to breast feed
the baby.

 INTERPERSONAL INFLUENCES:
Sources of these influences include family, peers, and health care providers as
primary sources and also includes norm or expectation of significant others.
Mother observed other mothers who were breast feeding to their baby and
interacts with other mother and also NICU staff nurses were helped the mother
while breast feeding and she was able to breast feed her baby.

 SITUATIONAL INFLUENCES:
According to theorist Situational influences include the options that are
perceived as being available, demand characteristics and environmental
characteristics.
Mother is made physically, psychologically comfortable by providing comfort
measures. they are privacy for breast feeding the baby, gown was provided, home
environment by providing comfortable chair and adequate pillows and hand
washing facility to prevent infection to baby.
IMMEDIATE COMPETING DEMANDS AND PREFERENCES:
Immediate competing demands and preferences are alternative behaviors that are
intrude into consciousness as possible courses of action immediately prior to
intended occurrence of planned health promoting behavior.
Mother understands the instructions given by the investigator and she was
actively participated.
She was convinced and learnt how to breast feed the baby.

COMMITMENT TO A PLAN OF ACTION:

Mother was interested and ready to comply with instructions immediately.

c) BEHAVIOURAL OUTCOME

The desired outcome is health promoting behavior. The purpose of Health

promoting behavior is for the client to realize positive health outcomes such as
improved functional ability or improved quality of life.

Health promotion behavior as evidenced by reassessment on 7 th day by post test

knowledge and practice of breast feeding which shows

 Strong mother and baby bonding

 LATCH was achieved L= Latch, A=Audible Swallowing,
T= Type of nipple, C=Comfort and H= Holding the baby.
 Mother exited and confident in breast feeding
 Able to breast feed without supervision.