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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 THEORIES RELATED TO HEALTH PROMOTION Theories related to health promotion: 1. Penders Health Promotion Theory/Model 2. Banduras Self Efficacy Theory/Model 3. Health Belief Models Rosenstocks Health Belief Model Beckers Health Belief Model 4. Greens Precede-Proceed Model Penders Health Promotion Model - Is a competence or approach-oriented model that depicts the multideminsional 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 individuals 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. Behavioralspecific cognitions and affect - Constitute critical core for intervention because this can be modified through nursing interventions. Includes the following: A. Perceived benefits of action - anticipated benefits or outcome affect the persons plan to participate in healthpromoting behaviors and may facilitate continued practice (can be affected by experience/vicarious experience). B. Perceived barriers to action - persons perceptions about available time, inconvenience expense and

difficulty performing the activity may act as a barrier (decrease commitment to a plan of action). C. 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) D. Activity related affect - the subjective feelings that occur before, during, and following an activity influence a person to repeat again or maintain behavior. E. Interpersonal influence - perception of the person concerning the behavior, beliefs or attitudes of others. - includes expectations of significant others, social support and learning through observing others. Sources of interpersonal Influences: 1. Family 2. Peers 3. health professionals (sources of interpersonal influence can affect the persons healthpromoting behaviors) F. Situational Influence - direct and indirect influence on health-promoting behaviors. - 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 3. Commitment to a plan of action - The interest of a person in carrying-out and reinforce healthpromoting behaviors. Involves 2 process: 1. Commitment good intention 2. Identifying specific strategy actual performance of the behavior 4. Immediate competing demands and preferences Situations that the person is experiencing in everyday life that could affect the control of healthpromoting behaviors. Involves 2 types of control: 1. Low control Frias 2A 1/3

2. High control 5. Behavioral outcome - Directed towards attaining positive health outcome for the client - Should result in improved health and better quality of life at all stages of development. Banduras 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 ones 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. Strong sense of efficacy enhances human accomplishment and personal well-being in many ways. 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 Levels of motivation: Choice of course of action Intensity Persistence of effort - Motivation processes is covered by 3 types of SelfInfluence: a. Self-satisfying b. Self- dissatisfying reactions to ones performance

c. Perceived self efficacy d. Readjustment of personal goal based on ones 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. Self- Efficacy is concerned with peoples beliefs in their capabilities to exercise control over their own functioning and over events that affect their lives. Health Belief Model 1. Rosenstocks Health Belief Model - Health Belief Model is intended to predict which individual would/wouldnt 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 individuals ideas about and appraisal or perceived benefits compared to perceived barriers and costs of taking a health action. - Suggest that a persons 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. Beckers 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 Rosenstocks to include the following components: a. Individual Perception b. Modifying Factors c. Variables Likely to Affect Initiating Action/Likehood of Action Greens Precede-Proceed Model - Developed by Green, Kreuter, and associates. - The PRECEDE-PROCEED model provides a comprehensive structure for assessing health and quality-of-life needs and for designing, implementing, and evaluating Frias 2A 2/3

health promotion and other public health programs to meet those needs. PRECEDE (P redisposing, R einforcing, and E nabling C onstructs in E ducational D iagnosis and E valuation) outlines a diagnostic planning process to assist in the development of targeted and focused public health programs. Five steps or phases: 1. Phase one/Social Assessment involves determining the quality of life or social problems and needs of a given population. 2. Phase two/Epidemiological Assessment consists of identifying the health determinants of these problems and needs. 3. Phase three/Behavioral and Environmental Assessment involves analyzing the behavioral and environmental determinants of the health problems. 4. In phase four/Educational and Ecological Assessment the factors that predispose to, reinforce, and enable the behaviors and lifestyles are identified. The three types of influencing factors include: a. Predisposing factors which motivate or provide a reason for behavior; they include knowledge, attitudes, cultural beliefs, and readiness to change. b. Enabling factors which enable persons to act on their predispositions; these factors include available resources, supportive policies, assistance, and services. c. Reinforcing factors which come into play after a behavior has been initiated; they encourage repetition or persistence of behaviors by providing continuing rewards or incentives. Social support, praise, reassurance, and symptom relief might all be considered reinforcing factors. 5. Phase five/Administrative and Policy Assessment involves ascertaining which health promotion, health education and/or policy-related interventions would best be suited to encouraging the desired changes in the behaviors or environments and in the factors that support those behaviors and environments. PROCEED (P olicy, R egulatory, and O rganizational C onstructs in E ducational and E nvironmental D evelopment) guides the implementation and evaluation of the programs designed using PRECEDE. Four additional phases. 1. Phase six/Implementation the interventions identified in phase five are implemented.

2. Phase seven/Process Evaluation entails process evaluation of those interventions. 3. Phase eight/Impact Evaluation involves evaluating the impact of the interventions on the factors supporting behavior, and on behavior itself. 4. The ninth and last phase/Outcome Evaluation comprises outcome evaluationthat is, determining the ultimate effects of the interventions on the health and quality of life of the population. In actual practice, PRECEDE and PROCEED function in a continuous cycle. Information gathered in PRECEDE guides the development of program goals and objectives in the implementation phase of PROCEED. This same information also provides the criteria against which the success of the program is measured in the evaluation phase of PROCEED. In turn, the data gathered in the implementation and evaluation phases of PROCEED clarify the relationships examined in PRECEDE between the health or quality-of-life outcomes, the behaviors and environments that influence them, and the factors that lead to the desired behavioral and environmental changes. These data also suggest how programs may be modified to more closely reach their goals and targets.

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