THEORIES RELATED TO HEALTH PROMOTION

• Theory – a plausible or scientifically acceptable general principle offered to explain

observed facts.
• A hypothesis assumed for the sake of argument or investigation.
• Model – visual representation of the concept that work together to become a theory.
• A pattern of something to be made

A. Health Belief Models

• Rosenstock’s Health Belief Model
• Becker’s Health Belief Model
B. Health Locus of Control Model
C. PENDER’S Health Promotion Theory/Model
D. BADURA’S Self Efficacy Theory/Model
E. Health Behavior change model (Transtheoritical model of Behavior change)
F. Theory of planned behavior
G. Theory of Social behavior
H. Protection Motivation Theory
I. O’Donnell Model of Health Behavior

THEORIES RELATED TO HEALTH PROMOTION

Health Locus of Control

• Determines client action regarding health, and that health status is under one’s own
health or others control.
• Plays role in the client’s choices about health behaviors, can be used to predict which
people are at most likely to change their behavior.
• The result of the assessment of the health locus of control of a client can be used to plan
internal reinforcement training necessary to improve client’s effort towards better
health.

Types of Locus of Control:

1. Internal – People who believes that they have a major influence on their health status.
• Health is largely self- determined in this type of control
• Clients initiates for own health care, knowledge and adhere to prescribe health
care regimens.
2. External – People who believe that their health is largely controlled by outside forces.

Health Belief Model

1. Rosenstock’s Health Belief Model

• Health Belief Model is intended to predict which individual would/wouldn’t use

such preventive measures.
 • Assumed that good health is an objective common to all people.
• Emphasize on predicting individual preventive health behavior
• Based on an individual’s ideas about and appraisal or perceived benefits
compared to perceived barriers and costs of taking a health action.
• Suggest that a person’s susceptibility to a health threat and its seriousness
influence the decision to engage in a preventive health behavior.
• Helps to identify the strength and weakness of the individual that could affect
the success of a plan of action for disease prevention.

2. Becker’s Health Belief model

• Based on motivational theory
• Assumed that positive health motivation should be considered to attain good
health.
• Modifies the Health Belief Model of Rosenstock’s to include the following

Components:
• Individual Perception
• Modifying Factors
• Variables Likely to Affect Initiating Action/Likehood of Action

3. Pender’s Health Promotion Model

• Is a competence or approach-oriented model that depicts the multidimensional
nature of persons interacting with their interpersonal and physical environments
as they pursue health.
• Focused on health promoting behaviors rather than health protection or illness
prevention behaviors.

Variables of Health Promotion Model

1. Individual characteristics and experience – an individual’s unique factors or
characteristics and experiences will depend on the target behavior for health promotion

Includes the following:

A. Personal factor
• Biological
• Psychological
• Socio-cultural
B. Prior related behavior
• Previous experience
• Knowledge
• Skills in health promoting actions

2. Behavioral-specific cognitions and affect

 Constitute a critical core for intervention because this can be modified through nursing
interventions

Includes the following:

• Perceived benefits of action
– anticipated benefits or outcome affect the persons plan to participate in
health-promoting behaviors and may facilitate continued practice (can be
affected by experience/vicarious experience).
• Perceived barriers to action
– person’s perceptions about available time, inconvenience expense and
difficulty performing the activity may act as a barrier (decrease commitment to a plan of
action).
• Perceived self-efficacy
– the conviction that the person can successfully carryout the behavior
necessary to achieve a desired outcome (serious doubt about capabilities decrease
effort and give-up)
• Activity related affect
– the subjective feelings that occur before, during, and following an activity
influence a person to repeat again or maintain behavior.

3. Interpersonal influence – perception of the person concerning the behavior, beliefs or

attitudes of others.

1. Includes expectations of significant others, social support and learning through

observing others.
2. Sources of interpersonal Influences:
1. Family
2. Peers
3. Health professionals
3. (sources of interpersonal influence can affect the person’s health –promoting
behaviors)

4. Situational Influence – direct and indirect influence on health-promoting behaviors

1. A person is apt to perform health-related behaviors if the environment is
comfortable versus feeling of alienation.

Includes the following:

1. Perception of available options
2. Demand characteristic
3. Aesthetic features of the environment
4. Commitment to a plan of action
5. The interest of a person in carrying-out and reinforce health-promoting behaviors
Involves 2 process:
 1. Commitment-good intention
2. Identifying specific strategy- Actual performance of the behavior

5. Immediate competing demands and preferences

– situations that the person is experiencing in everyday life that could affect the control
of health-promoting behaviors.

Involves 2 types of control

A. Low control
B. High control

6. Behavioral outcome
1. Directed towards attaining positive health outcome for the client
2. Should result in improved health and better quality of life at all stages of
development.

Bandura’s Self-Efficacy Theory

• Self-efficacy theory of Albert Bandura

 
• Self- efficacy – perception/belief of a person about his own capabilities to produce
effect.
 
• Self-regulation – exercise of influence over one’s own motivation, thought process
emotional state and patterns of behavior.

Sources of self-efficacy
- Self efficacy is developed by four (4) main source of influence

4 main source of influence

1. Mastery of Experience/performance accomplishment
2. Vicarious Experience provided by social models
3. Social persuasion (Support/Motivation from significant others)
4. Reduction of stress reactions and alter negative emotional proclivities and
interpretation of physical and emotional traits.

Efficacy- Activated processes

There are 4 major psychological processes through which self-belief of efficacy affect human
functioning.
4 Major Psychological Processes:

1. Cognitive Process – thinking process, involve acquisition, organization and use of

information
• Most course of actions are initially organized in thought.
2. Motivational Process-cognitive generated
-Activation to action
Level of motivation
A. Choice of course of action
B. Intensity
C. Persistence of effort

Motivation processes is covered by 3 types of Self-Influence:

1) Self-satisfying
2) Self- dissatisfying reactions to one’s performance
3) Perceived self-efficacy
4) Readjustment of personal goal based on one’s progress

3. Affective Process – process regulating emotional state and elicitation of emotional

reactions.
- The stronger the sense of self-efficacy the bolder people are in taking on taxing and
threatening activities.

4. Selection Process – the choices the person make that cultivate different competencies,
interest and social network that determines life courses.

Health Behavior Change Model (Transtheoritical Model of Behavior Change)

• A cyclic phenomenon in which people progress through several stages.
• This model can be used in the assessment of the person’s readiness to perform
health-promoting behaviors through identifying the stages of behavior change.

3 Elements of Health Behavior Change Model

• Thought
• Action
• Time

Stages of Health Behavior Change:

1. Precontemplative stage – the person in this stage typically denies having a problem,
views others having a problem and therefore wants others to change their behavior
• Do not think about changing behavior, nor interested in information about the
behavior.
• May have previous experience of failures
• Takes months to years in precontemplation
 2. Contemplative stage- the person acknowledge having a problem, seriously consider
changing behavior actively gathering information and verbalizes plan to change the
behavior in the near future.
• The person may not be ready to commit to action
• Transition to the next stage of behavior change begins when the person is
observed of doing the following:

A. Focusing on the solution rather than the problem

B. Think more about the future than the past
Takes months to years in contemplation

3. Preparation stage – occurs when the person undertakes cognitive and behavioral
activities that prepare the person for change
• Making of final plans to accomplish the change
• Starting to take small behavioral changes

4. Action stage – occurs when the person actively implements behavioral and cognitive
strategies to interrupt previous behavioral patterns and adopt new ones.
• Requires the greatest commitment of time and energy.

5. Maintenance stage – integration of newly adopted behavior patterns into lifestyle.

• Last until person no longer experience temptation to return to previous
unhealthy behavior.
• Without strong commitment to maintenance a relapse to precontemplative or
contemplative stage may occur.

6. Termination/ Continual maintenance stage the ultimate goal where the individual has
complete confidence that the problem is no longer a temptation or threat.

Theory of Planned Behavior

• control of behavior is not always voluntary and that a type of behavior control
continuum exists with lack of control at one end and extending to total control at the
other end.
Components:
1) Resources
2) Support
3) Skills needed for certain behavior

Theory of Social Behavior

• introduce the concept of habit in that it distinguishes behavior under the individual’s
control from behavior that has become automatic or habit.
 • The likehood of health behavior action is further influenced by the connection between
physical arousal (physiologic effects, the habit has on the body) and Facilitating
conditions (supporting effects, favors the change).

Protection Motivation Theory

• is a Fear-driven model, proposed that a perceived threat to health activates thought

processes regarding the severity of the threatened event, the probability of its
occurrence, and coping mechanisms.
• Motivation to protect results from the perception of the threat and the ability or self-
efficacy for coping
• Oriented more towards disease prevention than health promotion.

Components:
1) Vulnerability
2) Severity
3) Response efficacy
4) Self-Efficacy

O’Donnell Health Behavior Model

• shows how intentions toward a particular behavioral beliefs, health values, belief in
those that prescribe or support referent (desired behavior) and motivation to comply
with the referents
• A composite of theory of planned behavior, theory of social behavior, health belief and
health promotion model