It is an idea that explains by using symbolic
and physical visualization
Symbolic model may be verbal, schematic or
Verbal models are worded statements
Schematic models may be diagrams,
drawings, graphs or pictures.
Te models help us in facilitate thinking about
concepts and relationships between them or
to map out research process.
They are made up of abstract and general
ideas and propositions that specify their
Concept: Complex mental formulation of an
object, properly, or event that is derived from
individual perceptual experience. It can be
Abstract or Concrete in nature.
Given by Edelman and Mandle, 2002
Holism acknowledges and respects the
interaction of a person’s mind, body and
spirit within the environment. Holism is an
antidote to the atomistic approach of
An atomistic approach takes things apart ,
examining the person piece by piece in an
attempt to understand the larger picture.
Holism is based on the belief that people (or
their parts) can not be fully understood if
examined solely in pieces apart from their
environment. Holism sees people as ever
charging systems of energy.
According to model, nurses using the nursing
process consider clients the ultimate experts
regarding their own health and respect client’s
subjective experience as relevant in
maintaining health or assisting in healing.
In holistic model of health, clients are
involved in their healing process, thereby
assuming some responsibility for health
Nurses recognize the natural healing abilities
of the body and incorporate complementary
and alternative interventions, such as music
therapy, reminiscence, relaxation therapy,
therapeutic touch, and guided imagery
because they are effective, economical,
complements to traditional medical care.
Model had its inception during 1950’s when
America developed polio vaccine.
Unwillingness of people to immunise the child
surprised health professionals
A model was developed by social psychologists &
other public health workers known as Godfrey
Hochbaum, Irwin Rosenstock and Stephen Kegels
The current dynamics controls an individual rather
than prior experiences- Kurt Lewis
Rosenstock proposed a health belief model
intended to predict which individuals would or
would not use such preventive measures as
screening for early detection of cancer.
Becker (1974) modified the health belief model to
include these components: individual perception,
modifying factors and variables likely to affect
Based on motivational theory.
Useful tool in developing programs for
helping people change to healthier lifestyles
and develop more positive attitude.
It postulates that health seeking behaviour is
influenced by person’s perception of threat
posed by the health problem and associated
with action aimed at producing threat.
The major determinant of preventive health
behavior is the avoidance of the diseases.
Perceived susceptibility to disease
Perceived seriousness of diseases
Cues to action
Perceived susceptibility: Perception of getting
a disease or condition.
Perceived seriousness: Perception that
disease state or condition is harmful & has
Perceived threat: Perceived susceptibility &
perceived seriousness combines to determine
Demographic variables Age, sex, race & ethnicity
Sociopsychological variables Social pressure or
influence from peers or other reference group
Structural variables: Knowledge about the target
disease and prior contact with it
Cues to action: Cues can be external or internal
Perceived benefit: Belief that health action is
of some value
Perceived barrier : Belief that health action
would be associated with hindrance.
Perceived barriers to
Likelihood of taking
preventive health action
HEALTH BELIEF MODEL(Becker:1974)
Cues to action
Individual perceptions Modifying factors Likelihood of action
Client motivation to become well.
Degree of lifestyle change necessary
Perceived severity of health care problem
Value placed on reducing the threat of illness
Difficulty in understanding and performing specific
Degree of inconvenience of illness or regimen.
Belief that the prescribed therapy will not help.
Complexity, side effects and duration of
Degree of satisfaction and type of
relationship with the health care providers.
Overall cost of prescribed therapy.
Model variables can be used as catalyst to
stimulate an action
Modification of client’s distorted perceptions
Reducing the barrier to action
Supporting positive actions
Preventive health behaviors: It includes health
promoting(e.g. diet, exercise and health
risk(e.g.smoking) behaviours as well as
vaccination and contraceptive practices.
Sick role behaviors: It refers to the
compliance with recommended medical
Understanding of regional culture of the
Incorporated in nursing curricula as an
aspect of client motivation, compliance or
desired health outcome
Flexibility in presenting course content
A parent will organize immunization for a
child if he/she:
◦ believes there is a danger of the child
contracting the disease (perceived
◦ believes that immunization is effective in
eliminating the danger (perceived benefits)
◦ trusts that the method is safe and has an
acceptable level of risk (possibly through
education and media information)
◦ has the means to access the vaccination service
(no barriers to behavior change)
Offers an important insight into explaining health
It is effective in promoting behavior change through the
alterations of patient’s perspectives.
Exclusively focused on individual determinants of
Does not acknowledge responsibility of the health
professional to reduce barriers to action
It places the burden of action exclusively on the client
Proposed by Nola J Pender (1982; revised,
Designed to be a “complementary counterpart
to models of health protection.”
Health as a positive dynamic state not merely
the absence of disease.
Health promotion is directed at increasing a
client’s level of wellbeing.
The model describes the multi dimensional
nature of persons as they interact within their
environment to pursue health.
Individual characteristics and experiences
Behavior-specific cognitions and affect
Health promoting behavior is the desired
behavioral outcome and is the end point in
Persons seek to create conditions of living
through which they can express their unique
human health potential.
Persons have the capacity for reflective self-
awareness, including assessment of their own
Persons value growth in directions viewed as
positive and attempts to achieve a personally
acceptable balance between change and
Individuals seek to actively regulate their own
Individuals in all their bio-psychosocial
complexity interact with the environment,
progressively transforming the environment and
being transformed over time.
Health professionals constitute a part of the
interpersonal environment, which exerts
influence on persons throughout their lifespan.
Self-initiated reconfiguration of person-
environment interactive patterns is essential to
Individual Characteristics and Experience
PRIOR RELATED BEHAVIOR :Frequency of the similar
behaviour in the past. Direct and indirect effects on
the likelihood of engaging in health promoting
PERSONAL FACTORS : Personal factors categorized
as biological, psychological and socio-cultural.
These factors are predictive of a given behavior and
shaped by the nature of the target behaviour being
Personal biological factors: Include variable such
as age gender body mass index pubertal status,
aerobic capacity, strength, agility, or balance.
Personal psychological factors: Include variables
such as self esteem self motivation personal
competence perceived health status and
definition of health.
Personal socio-cultural factors: Include variables
such as race ethnicity, education and
Behavioural Specific Cognition and Affect
PERCEIVED BENEFITS OF ACTION : Anticipated
positive out comes that will occur from health
PERCEIVED BARRIERS TO ACTION: Anticipated,
imagined or real blocks and personal costs of
understanding a given behaviour.
PERCEIVED SELF EFFICACY: Judgment of personal
capability to organise and execute a health-
ACTIVITY RELATED AFFECT: Subjective positive or
negative feeling that occur before, during and
following behavior based on the stimulus properties
of the behaviour itself.
INTERPERSONAL INFLUENCES : Cognition concerning
behaviours, beliefs, or attitudes of the others.
Interpersonal influences include: norms, social
support and modelling. Primary sources of
interpersonal influences are families, peers, and
SITUATIONAL INFLUENCES: Personal perceptions and
cognitions of any given situation or context that can
facilitate or impede behaviour. Include perceptions of
options available, demand characteristics and
aesthetic features of the environment.
COMMITMENT TO PLAN OF ACTION: The concept of
intention and identification of a planned strategy
leads to implementation of health behaviour.
IMMEDIATE COMPETING DEMANDS AND
PREFERENCES:Competing demands are those
alternative behaviour over which individuals have
low control because there are environmental
contingencies such as work or family care
responsibilities. Competing preferences are
alternative behaviour over which individuals exert
relatively high control, such as choice of ice cream
or apple for a snack
HEALTH PROMOTING BEHAVIOUR : Endpoint
or action outcome directed toward attaining
positive health outcome such as optimal well-
being, personal fulfillment, and productive
Helps in understanding how the consumers
can be motivated to attain the personal
Important for health planners of health care
delivery and those who provide care.
Primary tool for research.
Model has implications by emphasizing the
importance of individual assessment of the
factors believed to influence health behavior
Theory is simple to understand, clear and
It is highly generalisable to adult population.
Model can influence interaction between nurse
Relationships require further clarifications
Sets have interactive effects that result in action.
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