Pender’s

Health Promotion Model

Presented by
Jessica Konopka, Nicky Reed, Nacole Shafer,
Cheryl Shapiro, & Sara Walters
Introduction
Purposes and Issues, questions or problems to solve

 Introduction - The purpose of this assignment is to chose a nursing model and evaluate the
model by critically thinking using the elements of reasoning. The nursing model that we have
chosen is the Health Promotion Model by Nola J. Pender. This model was chosen because of the
fact that the decisions and changes individuals make in their lives are affected by certain
modifying and cognitive-perceptual factors (Sakraida, 2010). One of the problems that
professionals can have is deciding which variables affect each individual the most. Each person
will have different variables and figuring out which ones can affect that particular individual is
one of the most important concepts in understanding how this model functions.

 Evaluation - The focus of this model is to look at factors that influence a persons’ health
promotion behavior. When Pender first started constructing the model, she studied how
individuals made decisions about their own health care (Sakraida, 2010). Certain factors
influenced the decisions and actions of individuals that were made to prevent disease and
promote a healthy lifestyle. Health is perceived differently by each person, but if each person
understood the importance and benefits of a healthy life-style, then that individual is more likely
to participate in health-promoting behaviors.
 Pender’s Health Promotion Model

Revised Health Promotion Model. (From Current Nursing (2010) Health Promotion Model. Retrieved from
http://currentnurisng.com/nursing_theory/health_promotion_model.html )
Assumptions and Point of view
Pender’s motivation for developing the Health Promotion
Model.

 Personal experience - As a young girl observed professional nurses caring for

her aunt and developed a belief that “the goal of nursing was to help people care
for themselves” (Sakraida, 2010, p. 434).

 Educational influences – A master’s degree in human growth and development

facilitated and interest in health over the human life span. A PhD in psychology
and education lead to thoughts about “how people think and how a person’s
thoughts motivate behavior” (Sakraida, 2010, p. 434).
Pender’s philosophic values about nursing and knowledge
development.
Pender has a strong belief in the benefits of nursing and knowledge
development shown through her involvement as a professional nurse.

 Contributions of research, teaching, presentations, and writings.

 The Health Promoting Lifestyle Profile, a study done at Northern Illinois University helped

to support the Health Promotion Model (HPM).

 Additional involvement in many other research studies and the facilitation of research in

nursing.
 Health Promotion in Nursing Practice textbook published to facilitate learning of the model

in the clinical setting.

 Publication of many articles related to the health promotion model and it’s use in the clinical

setting.
 Promotion of scholarly activity through her involvement with Sigma Theta Tau
international, Midwest Nursing Research Society, and the Cabinet on Nursing
Research of the American Nurses Association.
Influences of Pender’s philosophy

 Personal experiences
 Parents were advocates for women pursuing education.
 Family support of her going to school to become a Registered Nurse.

 Educational experiences
 Master’s degree in human growth and development helped her to develop a
holistic approach to health over the human lifespan.
 PhD in psychology and education led to ideas about how individual’s thoughts
influence behavior.
 Information and Concepts
Eleven major concepts of Nora Pender’s Health Promotion Model (2006).

Pender recognized that there are particular behaviors that promote individual ownership of prevention of illness and continued
awareness of personal health. The Health Promotion Model focuses on prior behavior and personal factors that contributed to
the
outcome.
Prior related
 behavior
A similar behavior in the past that can be direct or indirect effects of health promoting behaviors.

Personal
 factors
Biological, psychological, and socio-cultural are personal factors considered that are predictive of target behavior
being addressed.

Personal
 biological factors
Age, gender, body mass index, pubertal status, menopausal status, aerobic capacity, strength, agility and balance
are considered variables.

Personal
 psychological factors
Personal self-esteem, self-motivation, competence, perceived health status, and definition of health are analyzed
variables.

Personal
 sociocultural factors
Race, ethnicity, acculturation, education and socioeconomic status are included variables. Also considered are
behavioral-specific cognitions and affects that are indicative of nursing actions.
Information and Concepts
Perceived
 benefits of action
Anticipated positive outcomes from actions resulting in healthy behavior are perceived benefits.

Perceived
 barriers to action
Anticipated, imagined or real blocks from actions are perceived barriers. Also considered is personal cost of
the given behavior.

Perceived
 self-efficacy
Personal capability to organize and execute a health promoting behavior is perceived self-efficacy. An ability
to analyze personal barriers and creating action for these barriers demonstrates this capability.

Activity-related
 affect
Subjective positive and negative feelings that occur before, during and following behavior based on the
stimulus properties of the behavior itself.

Interpersonal
 influences
Influential cognitions are concerning behaviors, beliefs, or attitudes of others that directs ones thoughts.
Some influences include norms, social support, and modeling.

Situational
 influences
These are personal perceptions and cognitions of any given situation or context that can facilitate or impede
behavior. The perceptions can be available options, demand characteristics, and aesthetic features of the environment
that health-promoting behaviors are proposed to take place. Situational influences can be direct or indirect.
Information and Concepts
 Commitment to a plan of action
A description of commitment of intention and identification of a planned strategy the leads to
implementation of healthy behavior.
 Immediate competing demands and preferences
Competing demands are alternative behaviors over which individuals have low control. Competing
preferences are alternative behaviors over which individuals exert relatively high control.
 Health-promoting behavior
The end point or action outcome that is directed toward attaining positive health outcomes such as
optimal well-being, personal fulfillment, and productive living.

 Global concepts
The four global concepts are addressed in the Health Promotion Model as follows:
1. Human-being- Pender ascertains in her theory that individuals are responsible to create healthy choices
for their own human health potential. These persons must be able to reflect on their behaviors.
2. Environment- The individual creates an environment to pursue and maintain for optimal health.
3. Health- Pender encourages healthy prevenative behaviors throughout the lifespan.
4. Nursing- Nursing provides interpersonal influence to aid in commitment to healthy behaviors
Interpretation & Inference and Implications
& Consequences
Helping people change their lifestyle and move toward a state of optimal health. This
sums up the health promotion model (HPM). It is a simple model to comprehend
although it involves complex variables of behavior, biological and sociocultural factors.
The potential beneficial effects are not disputable. The difficulty lies in finding
methods of drawing people away from their risky behaviors and instilling healthy ones.

 Origins and Influences

 HPM is clearly influenced by the health belief and health-protecting behaviors
models. It was conceived by Nola Pender and undoubtedly reflects her education.
She holds a masters degree in human growth and development and a PhD in
psychology and education. It is holistic within the person and across the lifespan. It
could be summed up by the old saying; an ounce of prevention is worth a pound of
cure. In this light it is not unique to nursing, but when the necessary details are
added, it takes a caring nurse’s nature and preparation to apply to clients.
Interpretation & Inference and
Implications & Consequences
 Four Global Concepts
 An individual to an entire nationality is its targeted population.
 Environment acknowledged as a variable.
 HPM works best in a community health care setting. Here they can
focus on activities that can improve the well-being of people.
 Nurses help identify factors which work against participation in healthy
lifestyles and analyze factors in their life that contribute to their
participation.
 Narrow or Wide View
 HPM has a broad application base. This includes those with no current
health problems and those who have chronic diseases.
Interpretation & Inference and Implications
& Consequences
Examples
Geriatrics - “Older adults may underestimate their capabilities, inadvertently
leading them to engage in risky health habits such as stress, poor nutrition,
and physical inactivity (Byam & Salyer, 2010, p. 115)”. Meals on wheels is
an excellent example of promoting better nutrition for this group.
Low income families - Instruction about a balanced diet, exercise and the
importance of early detection of illnesses might even be added to food
pantries in the community.
Obstetrics – Increase in prenatal care.
Pediatrics – Well child checkups.
Conclusion
At a young age Pender believed that “the goal of nursing was to
help people care for themselves” (sakraida 2010, p. 434). Her
parents were very supportive of her wanting to become a registered
nurse. Her education has assisted her with how individual’s
thoughts influenced behaviors. The Health Promotion Model has 11
major concepts. The idea behind the model is helping people
change their lifestyles, and move toward a state of optimal health.
The model effects everyone, healthy or not. The problem is finding
a way to attract people to change a bad habit for a good one. The
following are scholarly journals and web-links that provide
additional information and evidence of how Pender’s model is
utilized in practice for further understanding of this nursing theory.
Resources and Web-links
 Scholary articles related to Pender’s Health Promotion Model

 Agazio, J., & Buckley, K. (2010). Finding a balance: health promotion challenges of military women.
Health Care for Women International, 31(9), 848-868. Retrieved from CINAHL database.

This journal discusses health promotion in military women. The military women used different tools to
evaluate factors effecting their performance in health promoting activities. Self-efficacy and
interpersonal influences most influence on health promotion. This article focused on working military
women meeting health promotion activities. It also concentrates on how to best support their ability to
participate in healthy behaviors.

 Byam-Williams, J.B. (2010), Salyer, J. Factors influencing the health-related lifestyle of community-
dwelling older adults. Home Healthcare Nurse, 28(2), p 115–121,
doi: 10.1097/NHH.0b013e3181cb5750

People are living longer, but are not necessarily healthier. This study examined factors influencing
health related life styles with a goal of increasing knowledge to encourage healthy lifestyles. Pender's
revised Health Promotion Model (HPM) guided the study. A self-administered questionnaire was
used to collect data. It points out that nurses in the community setting could function in supportive and
educational roles. This could be done in churches and senior apartments by developing strategies to
encourage older adults to use existing skills to practice more behaviors that contribute to a healthy
lifestyle.
Resources and Web-links
 Lannon, S. (1997). Using a health promotion model to enhance medication compliance. Journal of
Neuroscience Nursing,(29)3, 170-178. Retrieved from Health and Wellness Resource Center.

This article looks specifically at three individual case studies and how their compliance to seizure
medication for control of their epilepsy has an effect on their level of wellbeing. The author uses Pender’s Health
Promotion Model to look at how each factor relates to their compliance with antiepileptic drugs. This article
shows how Pender’s model is used in the clinical setting.

 Kelley, J. A., Sherrod, R. A., & Smyth, P. (2009). Coronary artery disease and smoking cessation

intervention by primary care providers in a rural clinic.  Online Journal of Rural Nursing & Health
Care, 9(2), 78-90.Retrieved from Academic OneFile  database.

This article discusses how Kelley, Sherrod, and Smyth (2009) did a study that was published in the Online
Journal of Rural Nursing and Health Care about smoking cessation intervention by primary care providers for
patients who smoke and have been diagnosed with coronary artery disease (CAD) within the past year. Nola J.
Pender’s revised Health Promotion Model was the basis and structure for this study. The study used different
factors that were then divided into three categories: biological, psychological, and sociocultural (Kelley et
al., 2009 p. 86). The biological factors were age and gender. The psychological factors included self-esteem,
self-motivation, and perceived health status. Sociocultural factors included race, education, and socioeconomic
status. The primary people that influence an individual’s health-promoting behavior are family, peers, and
health care providers. The study’s plan was to pressure the patients into making a commitment to quit smoking
which would hopefully show that the care providers could have an influence on the patients’ health-promoting
behaviors (Kelley et al., 2009 p. 86).
Resources and Web-links
 Srof, B.J., & Velsor- Friedrich, B. (2006). Health promotion in adolescents: a review of Pender’s health
promotion model. E-Journal of Nursing Science Quarterly, 19 (4), 366-373. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/16982726

This journal discusses teen-adolescents role from transition of parent managed care to self-care
responsibilities. Pender’s health promotion model is explored related to change in adolescent
behavior. Social cognitive theories are reviewed supporting Pender’s theoretical underpinnings. It
notes that further research is also recommended.
 Web-links
 http:// currentnursing.com/nursing_theory/health_promotion_model.html
Current Nursing. (2010). Health promotion model.
This website provides further information on the Health Promotion Model. It includes the concepts and how the model
works and relates to a patient’s level of wellbeing.
 http://nursingtheories.blogspot.com/2008/07/health-promotion-model-heuristic-device.html
Philippines Open University (2008), Health Promotion Model: Heuristic Device for Health Care Professionals.
Nursing theories blog spot.
This is a blog about nursing theories. It contains a full summery and is interactive for blog comments and questions.
 http://www.ehow.com/about_6367507_pender-nursing-theory.html

Ehow. (2010). Walter J. Johnson.

This web-link is a summary of the health promotion model. This summary is in basic terms so anyone could read it
and understand the article. At the end of the article it talks about Pender helping decreasing healthcare costs because
of this model.
 http://www.nurses.info/nursing_theory_midrange_theories_nola_pender.htm
Nurses.info. (2010). Nola J. Pender.
This website provides intellectual information that is proposed by Nola Pender regarding the Health Promotion Model.
Included are links to relevant books, articles, and Propositions.
 http://www.nursingtheory.net/mr_healthpromotion.html
Nursingtheory.net. (2005). Health promotion model.
This web-link provides information on places to search to find scholarly articles that are related to the Health
Promotion Model. It also discusses that multiples variables are the important concept in deciding which
variables would affect each individual.
Case Study
Sally , a 25 year old, Caucasian student wants to lose weight. She would like to
have more energy during the day. She is tired of seeing the scale in the 180s.
High blood pressure runs in her family. Her father has had three stents put into
his heart by the age of 50 and had a mild heart attack. Upon assessment her
blood pressure is 118/44 mmHg, height is 5’3”, weight 182 lbs. Sally States
that her stress level is high. She is unable to get a job, and has two children to
take care of. He husband works full-time making minimum wage. She is a non
smoker. She levels the office to have more blood work completed.

Questions
1. What evidence would show Sally is ready for weight loss management?
2. What are some perceived barriers and perceived benefits of action?
3. What are some personal factors that affect her weight loss and health?
4. What are some behavior options to go over with Sally?
Case Study
Answer Key

1. What evidence would show Sally is ready for weight loss management?
 She came to the office on her own

 She is tired of the scale being in the 180s

 Family history

2. What are some perceived barriers and perceived benefits of action?

 Perceived barriers
 Not having enough time or energy to exercise

 Not having money to buy healthy foods

 High stress level

 Perceived benefits of action

 More energy to play with children

 Healthier

 Decreased chances of heart disease

Case Study
Answer Key

3. What are some personal factors that affect her weight loss and health?
 Young adult

 BMI is obese

 Sees self as overweight

 Lower socioeconomic status

 Caucasian

 College education

4. What are some behavior options to go over with Sally?

 Help establish an exercise routine that fits into her schedule

 Set short and long term goals

 Schedule weekly weight checks

 Go over a healthy diet

 Talk about stress management

 Address any dietary concerns

References
 Byam-Williams, J.B. (2010), Salyer, J. Factors influencing the health-related lifestyle of community-
dwelling older adults. Home Healthcare Nurse. 28(2), p 115–121,
doi:10.1097/NHH.0b013e3181cb5750
 Current Nursing. (2010). Health Promotion Model. Retrieved from
http://currentnursing.com/nursing_theory/health_promotion_model.html
 Kelley, J. A., Sherrod, R. A., & Smyth, P. (2009). Coronary artery disease and smoking cessation
intervention by primary care providers in a rural clinic.  Online Journal of Rural Nursing & Health
Care, 9(2), 78-90. Retrieved from Academic OneFile database.
 Nursing Theory. (2010). Health Promotion Model. Retrieved from http://www.nursingtheory.net
/mr_healthpromotion.html
 Pender, N. J., Murdaugh, C. L., & Parsons, M. (2006). Health Promotion in Nursing Practice.
Upper Saddle River, New Jersey: Pearson Prentice Hall.
 Sakraida, T.J. (2010). Nola J. Pender: Health Promotion Model. In M. R. Alligood, & A. M. Tomey (Eds.),
Nursing Theorists and Their Work (pp.434-454) (7th ed). Maryland Heights, MO: Mosby Elsevier.