TABLE OF CONTENT

CONTENT PAGE

Assignment 2

1.0 Introduction

2.0 Discussion on the Comprehension of the Nola Pender

Health Promotion Theory

3.0 Discussion on the Application of Pender’s Theory in Planning Health

Promotion Activities in the Organization or in the Community

4.0 Conclusion
5.0 References

1
1.0 Introduction

According to (WHO, 2022), a new report from the Malaysian Ministry of Health (MOH)
and the World Health Organization (WHO), heart disease is the leading cause of death in
Malaysia. Based on statistics in Direct Health-care Cost of Noncommunicable Diseases in
Malaysia, hospitalizations, medical tests, medications, and primary care consultations for
noncommunicable diseases (NCDs), particularly cardiovascular diseases, diabetes, and cancer,
cost the Malaysian economy upwards of RM 9.65 billion per year. Heart disease also increase
in disease burden from 11.6% in 2000 to 17% IN 2022. From the report by WHO, heart disease
is a significant health issue in Malaysia, accounting for a higher number of deaths followed by
diabetes and cancer. This situation give high impact on the healthcare system and healthcare
expenditure.

Supported by (FMT, 2021), heart disease is still the leading cause of mortality in Malaysia,
accounting for 18,515 deaths out of a total of 166,507 deaths last year. The Malaysian Ministry
of Health must make concerted efforts to provide effective health promotion at all ages,
particularly to raise knowledge and awareness about the dangerous and leading cause of heart
attacks. As stated by Tan Sri Noor Hisham, Malaysia's ex-minister of health, "prevention is
better than cure" means it is preferable and easier to avoid and prevent a disease, illness, or
other occurrence than to stop or cure it once it has started (Merriam-Webster, 2023).

So, suitable with concept of “prevention is better than cure”, it is very importance early
prevention of heart disease among Malaysian, the Ministry of Health Malaysia provide early
detection through health promotion activities and programme. According to (Florida,T., 2023),
health promotion is the process of encouraging people to make healthy choices and motivating
them to follow through on their intentions based on human behavior theories. It is also
typically accomplished through strategy such as patient education and counseling. Based on
(Medical Development Division, 2020), a call from the Malaysian Ministry of Health to engage
in health screenings, health promotion and prevention programme is under the public health
services and the expenditure of this programme involved large budgeting and expenses.

So, in this assignment, will be critically discuss about health promotion, and one of the
health promotion models that will help in the design of health promotion including health
screening of every Malaysian citizen as well as the detection of early detection of chronic
diseases will be the Nola Pender’s’ health promotion model.

2
2.0 Discussion on the Comprehension of the Nola Pender Health Promotion Theory

Figure 1: Nola Pender Health Promotion Model

(PSYCH-MENTAL HEALTH HUB, 2023).

Figure 1.0 shows the Nola Pender Health Promotion Model that focuses on assisting people in
achieving a greater degree of well-being and providing health professionals with positive
resources to assist patients in achieving behavior-specific adjustments.

The Nola Pender Health Promotion Model is a well-known theory and model for promoting
health and disease prevention. The health promotion model is the way to help nurses to assess
the patient’s willingness and readiness in a way to make their life changes in order to achieve
good health. According to (Angelo, G., 2023), the health promotion model identifies
preventative health interventions and describes nurses' vital role in assisting patients in
preventing illness through self-care and comprehensive alternatives. The three-focus area in
this HPM is emphasizing the importance of individual characteristics and experiences,

3
behavior-specific cognitions and effects, and behavioral outcomes. In the individual
experiences, include relating to the pass behaviours as well as personal factors such as age, race
and ethnicity. Next, in the behavioral specific knowledge and affect components includes,
perceived benefit for the action which is address how improving health-behavioural when have
a passive and non-functional patient. Next, perceived barrier to action which is define the cost
to improving the lifestyle for example the increase cost of the oil virgin vegetables or the cost
being a fitness membership. Then, perceived self-efficacy meaning the patient’s self-confident
to make the changes into put the time in effort to improving their health and activity related-
affect which is the cause of changes of the patient feelings and mental state go through as they
progress to do healthy behaviours.

Interpersonal influences include the good and negative impacts of patients' families, the
cohorts, or colleagues, as well as social media. Next, the situational influences meaning a
health of patient’s environment and encourages or handers of their health behaviour. For
example, healthier patient will commit to following through with changing in their health-
behaviour in order to obtain their health promoting behaviour. Lastly, immediate competing
demands and preferences which is the potential of the patient to second guess of decision to
lead a healthy lifestyle.

According to (Alice, P., 2023), the purpose of the HPM by Nola Pender is not just to help
patients prevent sickness through their beliefs and attitudes, but also to provide ways for people
to achieve better health or values. Apart from this, the five key sections in Nola Pender’s
Health Promotion Model are person, environment, nursing, health and illness. Firstly,
individuals strive to actively control their own actions and behaviours. For example, a person
who has been taught from childhood to eat a lot of different side dishes that are high in fat,
sugar, and cholesterol, in other words, has become a habit of the person practice an unbalanced
diet. So, when a person has knowledge and awareness of the dangers of practicing such eating
habits, it is up to the person to decide an immediate action to change the behavior and to adopt
a good and balanced eating diet for better health and to avoid future disease.

Secondly, individuals, in all their biopsychosocial complexity, interact with the

environment, progressively transforming the environment as well as being transformed over
time (Alice, P., 2023). For example, COVID-19, that had spread across the world past 2 years
ago, has compelled everyone to wear face masks in order to avoid getting infected by the virus
through the respiratory system and until now, wearing mask outside the people’s house become

4
a habit. This phenomenon had indirectly trained people all around the world about the new
routine or habit that it is motivated by pandemic experienced. Supported from study by (Elena,
Badillo-G, et. al., 2021), higher mask use was expected after the COVID-19 pandemic due to
the risk of infection when attending major gatherings, restaurants, shopping malls, and
socializing outside the home. It is tough to change human habits that have been practiced
somethings for a long time such as wearing mask and keep their distance for one another
because this behaviour were motivated by fear of the pandemic that cause millions of deaths.

Third assumption by Nola Pender’s health promotion model based on (Alice, P., 2023), is
health workers, such as nurses, are part of the interpersonal environment that has an impact on
people throughout their lives. For example, nurses' interpersonal skills include listening to
patients, providing support, and connecting patients to services they may require, such as a
support group to help the patient manage their diagnosis, a chaplain to depend on, or just a
quiet moment together as patients share their thoughts and concerns. This dedication and
attention to detail enables each patient to enjoy a healthier physical, mental, and spiritual life.

Fourth assumption of Nola Pender health promotion is about self-initiated reconfiguration

of person-environment interacting patterns is required for behavior change. For example,
perceptions and cognitions of the person for any given scenario or setting can either help or
hinder behavior. Include impressions of available options, demand factors, and aesthetic
qualities of the location in which a certain health-promoting activity is intended to occur. This
assumption also called as situational variables that can have an impact on health behavior in
both direct and indirect ways.

According to the (WHO, 2023), health promotion is the process of enabling people to
increase control over, and to improve their health. Based on (Nola J. P., Carolyn, L. M. &
Mary, A. P., 2018), the health promotion model empowers each individual, who has unique
personal characteristics and experiences to choose their self-care plan which influence
subsequent actions. Health knowledge and practices are two critical components of health
literacy and promotion. These factors have a substantial impact on residents' daily lives and the
set of factors for behavioral specific knowledge and effect is highly motivating.

Nursing interventions can change these variables, that the desired behavioral objective and
endpoint in the Health Promotion Model is health-promoting behavior. Health-promoting
behaviours such as good eating habits should result in better health, increased functional

5
capacity, and a higher quality of life at all stages of development. The immediate competing
demand and preferences influence the final behavioral demand, which can derail intended
health-promoting acts (Nola J. P., Carolyn, L. M. & Mary, A. P., 2018).

In Nola Pender health promotion model, the behavioral outcomes are another critical aspect
of the model. These outcomes include the adoption of health-promoting behaviors,
maintenance of these behaviors over time, and the attainment of positive health outcomes. In
understanding the model, it is essential to explore the individual's characteristics and
experiences that influence health behaviors. Based on Pender's health promotion model, health
is "a positive dynamic state, not merely the absence of disease" (Current Nursing, 2023).

Apart from this, the health promotion aims in Nola Pender’s model also to improve a
client's overall well-being and it explains the multidimensional nature of people as they interact
with their surroundings in order to achieve health. Additionally, Pender's model recognizes the
importance of behavior-specific cognition and affect, which encompass the perceptions and
beliefs individuals have about their ability to engage in health-promoting behaviors and their
emotional response to these behaviors. Furthermore, Pender's model emphasizes the reciprocal
determinism that exist between individual characteristics and experiences, behavior-specific
cognition and affect, and behavioral outcomes.

The importance and benefit of integration of the Nola Pender's Health Promotion Model
in nursing practice are firstly, help in prevention of chronic health problems such as diabetes,
hypertension, End Stage Renal Failure, stroke and etc. Secondly, can improve quality of life by
practicing exercises, good eating habits such as healthy and balance foods, healthy lifestyle,
and good stress or anger management. Thirdly, health promotion model by Nola Pender also
create positive motivation and reinforcement in help patient more participate and carried out
the aspect of healthy lifestyle in the future by involving everyone in health education and group
activities in a harmonious atmosphere such as recreational activities, hiking, group
communication, familiarization sessions and other social activities that are beneficial at the
organizational and community level.

Fourthly, the health promotion model provides a foundation of nursing such as develop
new nursing protocol, interventions and policies based on outcomes from the health promotion
plan, new findings, or results from research, audit clinical, true source and data. Fifth, this

6
health promotion model become long term benefits, also as health-preventative measures and
health-promoting behaviours.

7
3.0 Discussion on the Application of Pender’s Theory in Planning Health Promotion
Activities in the Organization or in the Community

The planning for health promotion activities based on the Nola Pender Health promotion
Model, it is essential to consider the various components of the model and how they interact.
Based on study by (Nahid, et. al., 2022), the intervention using model of Nola Pender’s health
promotion done with the researcher provide the health promotion via online and various of
modern methods such as virtual online lectures, educational video clips, posters and pamphlets,
and the main content of the promotion sessions is to promote and improve adherence to
treatment in the areas of medication, diet, and physical activity. In-person sessions provided by
researcher that had set to an average of 45 min face to face and followed by next online
sessions to 15 min. This study is a program for improving treatment adherence in type two
Diabetes patients based on the health promotion model, and it contributes to a better
understanding of successful factors in type two Diabetes patient adherence to therapy. This
project's findings suggested for further applied to macro-diabetic planning.

Before starting the health promotion plan, nurses must do a clinical assessment for
example, in increase health activity for those people that practice sedentary lifestyle, first and
foremost, assess current stage of persons’ physical activity prior to behaviour. Ask the person
what attempts have made in the past to be physically active? What did he/she learn from the
experience? Then ask the personal influence that experienced by the individual to change their
lifestyle such as ask them What are the personal benefits of becoming more active? What
problems or barriers might they have trying to be more active. Ask also about their opinion
such as what physical activities that they enjoy the most?

Next, ask the person for evaluation or assessment their interpersonal influences such as
do any of your family members or friends expect you to be physically active? and is anyone in
your family or any of your friends physically active 2-5 times every week? If they answer yes,
so in positive manners, give encouragement and motivation to the person to keep strong for
involve in physical activity. If the answer no, please find the family members, relatives or
closest friend of the person to be supportive system in the physical activity of the person. After
clinical assessment had done to the person or target population, explain the plan of action to the
person and ask them whether they ready to set goals and develop a plan to become more active.
Then, after get the consent, nurses should procced to the steps of health promotion plan.

8
 In order to do clinical assessment to the client or a person, there have many tools or
instrument to measure health promotion model variables such as behavioural cognition and
affect by (Libow, L. S., 1981), interpersonal influences such as (Resnick, B., & Jenkins, L. S.,
2023), and situational influence by Lewin (1939) that proposed the notion of "life-space," an
individual's whole perceived psychological environment comprised of all contextual
components (e.g., events, objects, other people) within a specific time slice.

According to (Hsuan-Hui & Pei-Lin , 2021), there are some keys to consider for
applying Pender's Theory in planning health promotion activities. Firstly,
assessing individual characteristics and experiences. It is crucial to assess the individual
characteristics and experiences of the target population for effective promotion health strategy.
This is including the understanding their demographic variables, biological factors, and
psychological factors. For example, if the target population comprises predominately older
adults, interventions may need to address age related challenges and consider factors such as
physical limitation or chronic conditions.

Secondly, addressing behavior−specific cognitions and affect because the behavior-

specific cognition and affect component of Pender's model highlights the importance of
individual's beliefs, attitudes, and emotional responses towards the health-promoting behaviors.
Supported by (Laranjo, 2016), the individual qualities and experiences, activity-specific
cognitions and affect, and behavioral result are the three categories of factors impacting health-
promoting behavior. Besides, in planning health promotion activities, it is essential to identify
and address any misconceptions, negative belief, or emotional barriers that may hinder
behavior change. For example, if a community perceives healthy eating as expensive or time-
consuming, interventions can provide evidence-based information on affordable and
convenient healthy food options.

Thirdly, promoting behavioural outcomes such as personal factor includes the

individual's motivation, self-efficacy, and perceived benefits and barriers to behavioral change,
while environmental factors encompass the physical, social and cultural context in which
individual's live and make decisions about their health. According to (Angelo, G., 2023), the
ultimate goal of health promotion activities is to facilitate the adoption and maintenance of
health-promoting behaviors leading to positive health outcomes. It is important to consider the
influence of personal and environmental factors when planning the interventions.

9
Table 1.0: Promoting healthcare plan based on health promotion model by (Nola Pender, 2023)

Component of Health Promotion to prevent Heart Disease in Community of ‘M’

Aims / 1. To reduce weight until achieved normal Body Mass Index
Objective of 2. To increase awareness among people regarding the important to
Healthcare practice healthy life such as exercises, balance food intake, and
Promotion: maintain body weight in normal BMI.
3. Early detection of heart disease
Population: All citizen stays in ‘M’ location
Activities 1. Promoting “suku-suku separuh” and nutrition and a balanced diet.
Plan: 2. Regular Fitness and aerobic exercise programme.
3. Organize a weight management course at nearest hospital covered in
area of ‘M’ location
4. Screening measurement of body weight, BMI, blood investigation
(total cholesterol and blood glucose), vital signs and ECG (if needed)
for early detection of any abnormal and changes in haemodynamic
body systems.
5. Stop smoking programme for those have heavy habits smoking.
Distribution 1. Whatsapp group
of 2. Official E-mail such as Post Master Malaysia Ministry of Health
promotional through Gmail
flyers via: 3. Apps application such as tik-tok, instagram, facebook, tweeter and etc.
4. Distribution of hardcopy pamphlet to all targeted place such as
shopping mall, hospital, kindergarten, school, old folks, working
place and etc. in area of ‘M’.
Member of 1. Nurses from the higher to the lower authority (various positions) in
the nearest hospital or public health clinic.
promotion 2. Doctors/ specialist
committee: 3. Dietitian
4. Physiotherapist
5. Counsellor
6. Health Education Officer
7. Psychiatrist
8. Pharmacist
9. Motivator (motivational speaker)
10. Statistician

Evaluation: 1. Pre-data and post data health status

Based (Nola Pender, 2023), the criteria that the promoter must to assess and to look up
for preparation the targeted population and the content in promotion plan to be highlighted. In
this assignment, the targeted population is among patient in Hospital ‘M’ to prevent the heart
disease. The targeted population are in various age which is the adult, teenagers, and children.
The assignment requirement is to plan health promotion activities in organizations. Let’s take
the example of obesity among patients in general hospital leads to risk of heart disease.

10
 According to (Nola Pender, 2023), using the five health promotion steps defined in the
Nola Pender, the first step is to enhance personal skills, and in the table above, the member of
the promotion committee must have good knowledge and skills in deliver education to the
target population. The second step is to strengthen community action, that means, the activities
must support with enough budget and strategic plan activities to attract people to attend all the
activities provided such as give free t-shirt, free drinking and foods and also the attractive
activities such as hiking, kayaking, jungle tracking, fun run and also online games such as
‘kahoot’ to increase knowledge and deliver information in effective ways. Furthermore, in this
era of modernity, there are many online channels to deliver health education such as, for stop
smoking clinic, the patient that cannot attend face to face session of counselling, the patients
can attend online live video for live and direct communication between patient and therapist.
There is goes same as session for delivery health education, the session can be one to one or by
group of people.

The third step is to create supportive settings, such as group of heart disease patient that
already experienced the symptoms of heart attack and the members of this group can share the
experience to other to prevent the symptoms or progress of disease become more worst and to
spread the awareness. The fourth step is to construct healthy public policies, for example, as
reported by (Dawn, S., 2021), the Ministry of health Malaysia release the National Nutrition
Policy 2.0 that aim to increase and maintain the nutrition wellbeing of the people in Malaysia.
The fifth step is to reorient health systems which is to reassess the impact or outcome of the
health promotion and to reapply or reimplement again to the targeted people. All of the
promotion action plans a platform for community participation can be built in any
environment.

Reported by (Susan, T., Loo, S. B., & Rusli, N., 2021), the Ministry of Health is
committed to utilize all staff nurses in patient contacts to dramatically minimize persons' risk of
disease. This could result in fewer premature deaths, fewer years of illness, and lower costs to
society and the health-care system. Staff nurses have the chance to identify appropriate
moments and settings to connect with patients and assist them in improving their health and
well-being. Individuals can make healthier choices with the help of patient education and
excellent communication.

After implementing all the health promotion plan, nurses should follow up the person
achievement such as the weight nearly achieve or nor to the targeted BMI, the total cholesterol

11
blood result in normal range and also habits of smoking decrease daily to daily routine. Ask the
person or population what the problem that they encounter in trying to follow the plan as
scheduled or ask their opinion how they want to avoid these problems in the future. If the
person cannot answer openly, and still not giving good feedback, refer them to the specialist,
consultant, dietitian, or counsellor prior the problem that they have.

Individuals may face various barriers to following a health promotion strategy, such as
a work setting that requires their focus and attention, forcing them to continue their regular
smoking habit. For example, consider the lorry driver who traveled to a distant place to deliver
corporate packing and had to do so overnight. To avoid feeling sleepy, they consumed coffee,
nicotine, and unhealthy foods such as soda drink cans in order to stay awake on their route to
the destination.

12
4.0 Conclusion

The strength of Nola Pender's Health Promotion Model is its simplicity, yet delving further
reveals its intricacy in its structure. Aside from that, Nola Pender's nursing theory is unique in
that it focuses on health promotion and disease prevention, distinguishing it from other nursing
theories and making it very practical in the community health setting. Nola Pender's health
promotion model also encourages the nursing profession to be the major source of health-
promoting interventions and education.

However, there have some weakness in model of health promotion by Nola Pender. A few
of the model's weaknesses is that it does not specify the nursing metaparadigm or the notions
that a nursing theory should include, such as man, nursing, environment, and health.
Furthermore, the conceptual framework contains several concepts, which may cause confusion
for the reader, and its relevance to an individual now suffering from a disease state was not
emphasized. By understanding the model's components such as individual characteristic and
experiences, behavioral-specific cognition and affect, and behavioral outcomes, interventions
can be tailored to the specific needs of the target population. Implementing such activities in
organizations or communities can play a vital role in addressing the burden of cardiovascular
disease in Malaysia and reducing the associated healthcare costs.

In conclusion, the Nola Pender Health Promotion Model provides a comprehensive

framework for planning health promotion activities. By considering the factor such as personal
and environmental influences on behavioral, health promotion activities can effectively
promote the adaptation and maintenance of health promoting behaviors and contribute to
improved health outcomes.

3010 words

13
5.0 References

Alice, P. (2023, June 24th). Pender's Health Promotion Model. Retrieved from nursing-
theory.org: https://nursing-theory.org/theories-and-models/pender-health-promotion-
model.php

Angelo, G. (2023, July 2nd). Nursing Theories Guide: Nola Pender - Health Promotion Model.
Retrieved from nurseslabs.com: https://nurseslabs.com/nola-pender-health-promotion-
model/

Current Nursing. (2023, July 14). HEALTH PROMOTION MODEL. Retrieved from
currentnursing.com:
https://currentnursing.com/nursing_theory/health_promotion_model.html

Dawn, S. (2021). Govt reveals strategies to create healthy Malaysians. Malaysia: New Straits
Times.

Elena, Badillo-G, et. al. (2021). Global trends and predictors of face mask usage during the
COVID-19 pandemic. BMC Public Health, 2099.

Florida,T. (2023, July 4). 5 Health Promotion Models and How to Apply Them. Retrieved from
www.floridatechonline.com: https://www.floridatechonline.com/healthcare-
management/5-health-promotion-models-and-how-to-apply-them/

FMT. (2021). Heart disease remains the top killer in Malaysia. Malaysia: FMT Media Sdn.
Bhd.

Hsuan-Hui & Pei-Lin . (2021). Applying the Pender’s Health Promotion Model to Identify the
Factors Related to Older Adults’ Participation in Community-Based Health Promotion
Activities. PubMed Central, 9985.

Laranjo. (2016). Social Media and Health Behavior Change. Journal of science direct, 639.

Libow, L. S. (1981). A Rapidly Administered, Easily Remembered Mental Status Evaluation:

FROMAJE. In L. S. Libow, The Core of Geriatric Medicine (pp. pp. 85–91.). St. Louis:
Mosby Co.

14
Medical Development Division. (2020, May 5). Strategic Frameworks of the Medical
Programme MOH 2021-2025. Retrieved from ww2.moh.gov.my:
https://www2.moh.gov.my/moh/resources/Pelan_Strategik_KKM.pdf

Merriam-Webster. (2023, June 12). Prevention is better than cure. Retrieved from
www.merriam-webster.com: https://www.merriam-webster.com/dictionary/prevention
%20is%20better%20than%20cure

Nahid, et. al. (2022). Application of Pender’s health promotion model for type 2 diabetes
treatment adherence: protocol for a mixed methods study in southern Iran. Journal of
Biomed Central, 1056.

Nola J. P., Carolyn, L. M. & Mary, A. P. (2018). Health Promotion in Nursing Practice: 7th
Edition. America: Pearson Education.

Nola Pender. (2023, March 23). The Health Promotion Model. Retrieved from
nursing.umich.edu: http://nursing.umrich.edu/faculty-staff/nola-j-pender

PSYCH-MENTAL HEALTH HUB. (2023, July 18). Nola Pender Health Promotion Model.
Retrieved from pmhealthnp.com: https://pmhealthnp.com/nola-pender-health-
promotion-model/

Resnick, B., & Jenkins, L. S. (2023, June 26th). Self-Efficacy for Exercise (SEE) Scale.
Retrieved from www.sralab.org:
https://www.sralab.org/sites/default/files/2017-06/Self-efficacy%20for
%20exercise_Website_PDF.pdf

Susan, T., Loo, S. B., & Rusli, N. (2021). Health care delivery in Malaysia: changes,
challenges and champions. Journal of Public Health in Africa, 23.

WHO. (2022). The annual health-care cost of cardiovascular diseases, diabetes and cancer in
Malaysia exceeds RM 9.65 billion. Malaysia: World Health Organization
Representative Office for Malaysia, Brunei and Singapore.

WHO. (2023, June 15th). Health promotion. Retrieved from www.who.int:

https://www.who.int/health-topics/health-promotion#tab=tab_1

15