3. MEANING, TERMINOLOGIES
Nursing Theory is an organized and systematic articulation
of a set of statements related to questions in the discipline of
nursing.
Concepts are linguistic labels that are assigned to objects or
events and are the building blocks of theories.
Conceptual definitions describe and clarify the phenomenon
and explain how the concepts is exposed in empirical reality.
Theoretical statements or propositions are statements
about the relationship between two or more concepts and are
used to connect concepts to revise the theory
4. HEALTH PROMOTION MODEL
• Born in 1941 in lansing, Michigan.
Diploma in nursing from the west suburban Hospital School of
Nursing, Illnois.
B.S in Nursing and M.A in human Growth and development
Michigan University
Ph.D in Psychology and Education from Northwestern University,
Illinois in 1960.
5. Nola J Pender
She did a graduate level work in community health
Nursing at Rush university, Chicago.
Experience in medical -surgical nursing and pediatrics.
She held a faculty position in Illnois University and
university of Michigan from 1990 -2001.
She is professor Emiritus in the university of Michigan
School of Nursing and part-time Distinguished
Professor in Loyola University, Chicago.
The focus of her research career has been health
promotion.
6. Awards and Honours
• American Nurses Association book of the Year
• Distinguished research award from Midwest Nursing
Research society
• An American Psychological association Award for
outstanding contributions to nursing and health psychology
• The Mae Edna Doyle award for excellence in teaching ,
University of Michigan.
7. HISTORY
Pender(1969) began her research about how people make decisions
with her doctoral dissertation. It was first published in 1982.
HPM proposed a framework for integrating nursing and behavioural
science perspectives on factors influencing health behaviours
The framework offered a guide for exploration of the complex
biopsychosocial processes that motivate individuals to engage in
behaviours directed toward the enhancement of health.
The initial model had seven cognitive perceptual factors and five
modifying factors
8. Cognitive perceptual factors
Importance of health
perceived control of health
definition of health
perceived health status
perceived self efficacy
perceived benefits
perceived barriers
Modifying factors
demographic
characteristics
biologic
characteristics
interpersonal
influences
situational influences
behavioural factors
9. This model is an approach or competence oriented model rather
than one that include fear or threat as a key concept.
In the revised model , importance of health, perceived control of
health and cues to action were deleted . definition of health ,
perceived health status and demographic and biologic characteristics
were moved and included in a category labeled “personal factors”.
Three new variables, activity related affect, commitment to a plan of
action and immediate competing demands and preferences were
added to the model.
11. ASSUMPTIONS
• Person seek to create conditions of living through which
they can express their unique human health potential.
• Person value growth in directions viewed as positive and
attempt to achieve a personally acceptable balance
between change and stability.
• Individuals seek to actively regulate their own behavior.
• Individual in all their biopsychosocial complexity interact
with the environment, progressively transforming the
environment and being transformed overtime.
12. ASSUMPTIONS CONT….
• Health professional constitute a part of the
interpersonal environment, which exerts influence on
the persons through out their life span.
• Person have the capacity for reflective self awareness
including assessment of their own competencies
• Self initiated reconfiguration of person environment
Interactive patterns is essential to behavioural change.
13. Theoretical propositions
Prior behaviour and inherited and acquired characteristics influence beliefs, affect and
enactment of health – promoting behaviour.
Persons commits to engaging in behaviours from which they anticipate deriving personally
valued benefits.
Perceived barriers can constrain commitment to action, a mediator of behaviour as well as
actual behaviour.
Perceived competence of self-efficacy to execute a given behaviour increases the likelihood of
commitment to action and actual performance of the behaviour.
14. Theoretical propositionscont…
Greater perceived self-efficacy results in fewer perceived
barriers to a specific health behaviour.
Positive affect towards a behaviour results in greater perceived
self-efficacy, which can in turn, result in increased positive
affect.
When positive emotions are associated with a behaviour, the
probability of commitment and action is increased.
Persons are more likely to commit to and engage in health-
promoting behaviours when significant others model the
behaviour, expect the behaviour to occur, and provide
assistance and support to enable the behaviour.
16. HEALTH PROMOTION MODEL VARIABLE
Individual characteristics and experiences
• Prior related behavior
- Frequency of similar behaviour in the past.
- Direct and indirect effects on likelihood of engaging health
promoting behaviors.
• Personal factors
Personal factors categorized as biological, psychological and
sociocultural factors.
These factors are predictive of a given behaviour and shaped by the
nature of the target behaviour being considered.
17. HEALTH PROMOTION MODEL VARIABLEcont…..
Personal Biological Factors
• Include variables 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 definitions of health.
Personal Sociocultural factors
• Include variables such as Race, ethnicity, acculturation , education and
socioeconomic status4.
18. HEALTH PROMOTION MODEL VARIABLE
cont…..
• Behavioural specific cognition and affect
• Perceived benefits of action
• Anticipated positive outcomes that will occur from health behavior
• Perceived barriers to action
• Anticipated, imagined or real blocks and personal costs of understanding
a given behavior
• Perceived self efficacy
• Judgment of personal capability to organize and execute a health
promoting behavior.
19. • Activity related Affect
Subjective positive or negative feeling that occur before , during and following
behavior based on the stimulus properties of the behavior itself.
• Interpersonal influences
• Cognition concerning behavior, belief, attitude of the others.
• Inter personal influences include norms, Social support and modelling
• Primary sources of interpersonal influences are families, peers and health
care providers.
• Situational influences
• Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behavior
• Situational influence may have direct or indirect influences on health
behaviour.
20. • Behavioural outcome
• Commitment to plan of action
• The concept of intention and identification of a planned strategy leads to
implementation of health behavior
• Immediate competing demands and preferences
• Competing demands are those alternative behavior over which individuals
have low control because there are environmental contingencies such as
work or family care responsibilities .
• Health promoting behaviour
• End Point or action outcome directed toward attaining positive health
outcome such as optimal wellbeing, personal fulfillment and productive
living.
21. METAPARADIGM
Person
Refers to the individual who is the primary focus of the model.
Each person has unique personal characteristics and experiences that affect subsequent
actions.
It is recognized that individuals learn health behaviours within the context of the family and
the community.
22. Environment
Refers to physical, interpersonal and economic
circumstances in which persons live the quality of the
environment depends on the absence of toxic
substances, availability of restorative experiences
and accessibility
23. Health
Health is viewed as Positive high level state.
According to pender, the person’s definition of health
for himself or herself is more important than any general
definition of health.
24. Nursing
Doesnot specifically define nursing.
The role of nurse includes raising consciousness
related to health promoting behavior, promoting self
efficacy, enhancing the benefits of change, controlling
the environment to support.
25. ACCEPTANCE BY NURSING COMMUNITY
• Practice
Health promotion in nursing practice has proven to be a
primary resource in the addition of health promotion to the
practice of nursing.
• Education
Use widely among undergraduate and postgraduate
Clinical education
• Research
It is a tool for research retested the empirical precision of the
model
26. NURSING PROCESS
Assessment
- prior related behavior of the person
- personal factors ( biological, psychological and sociocultural
factors)
- Assessment can be guided by the individual characteristics and
experiences and the behaviour – specific cognitions and affect.
Nursing Diagnosis
The nursing diagnosis would be derived from the data collected
in relation to these areas but is not directly reflected in the model.
27. Planning
Planning occurs in developing the plan of action to which client
commits; again, the planning process is not directly reflected in the
model, although the outcome of that process is reflected in the plan of
action
Implementation
It is the actual incorporation of the health promoting behavior into the
patient’s routine and life.
Eg: Exercise regularly, eating healthy diet
29. CRITIQUE
Simplicity :-
simple to understand
clarity and lead to greater understanding of the complexity of healthy behavior
The language is clear and accessible to nurses.
Generality :-
It is highly generalized to adult population.
Empirical precision :-
Pender and other’s supported the model through empirical testing as a framework
for explaining health promotion.
30. STRENGTH
Its strong base in research.
Flexible
it also supports use in practice because looking at
all of the variables provides a more complete
picture of the client.
This completeness in turn should enhance the
possibilities of positive outcomes.
31. LIMITATION
It is a weakness for research as it is very difficult to
measure, let alone test, all of the variables in one study.
Without testing all the variable in one time, it is
impossible to ascertain fully how the variables influence
each other as well how they influence the outcome.
a holistic nursing focus, it is not limited to use by nurses.
spiritual is not included under personal factors.
33. •The Health Belief Model (HBM) is one of the first
theories of health behavior.
• It is a psychological model that attempts to explain
and predict health behaviours.
•This is done by focusing on the attitudes and
beliefs of individuals.
34. HISTORY
The Health Belief Model was first developed in the
1950s by Social Psychologists Hochbaum, Rosenstock
and Kegels working in the US Public Health Services
who wanted to explain why so few people were
participating in programs to prevent and detect disease.
The model was developed in response to the failure of a
free Tuberculosis (TB) health screening program.
35. Health belief model
HBM is a good model for addressing problem behaviors
that evoke health concerns
The health belief model proposes that a person's
health-related behavior depends on the person's
perception of four critical areas:
the severity of a potential illness
the person's susceptibility to that illness
the benefits of taking a preventive action
the barriers to taking that action.
36. CORE ASSUMPTIONS ANDSTATEMENTS
• The HBM is based on the understanding that a person will take
a health-related action if that person:
• Feels that a negative health condition can be avoided.
• Has a positive expectation that by taking a recommended
action, he/she will avoid a negative health condition.
• Believes that he/she can successfully take a recommended
health action.
37. Conceptual model
Individual Perceptions modifying factors likelihood of action
Perceived benefits versus
barriers to behavioural change
Likelihood of behavioural
change
Cues to action
- Education
- Symptoms
- Media information
Perceived threat of disease
Perceived susceptibility / seriousness
of disease
Age, sex, ethnicity, Personality
Socioeconomics Knowledge
38. MAJOR
COMPONENTS
/CONCEPTS
There are six major concepts in HBM:
1. Perceived Susceptibility
2. Perceived severity
3. Perceived benefits
4. Perceived costs
5. Motivation
6. Enabling or modifying factors.
39. • Perceived Susceptibility: refers to a person’s perception
that a health problem is personally relevant or that a
diagnosis of illness is accurate.
• Perceived severity: An individual’s perception of the
seriousness of a health condition if left untreated.
The combination of these is the perceived threat of the
health condition (emotive response is fear).
• Perceived benefits: Refers to the patient’s belief that a
given treatment will cure the illness or help to prevent it.
40. • Perceived Barriers : The perceived impediments to taking
action to improve a health condition.
• Perceived Costs: refers to the complexity, duration and
accessibility of the treatment.
• Cues to Action : Body or environmental events that trigger
the HBM . Those factors that will start a person on the way to
changing behaviour.
• Modifying factors: Include personality variables, patient
satisfaction, and socio-demographic factors.
• Self-efficacy : Personal belief in one’s own ability to do
something.
41. APPLICATION OF HBM
Health behaviours and subject populations.
Preventive health behaviour, which include health
promoting and health risk behaviours
Sick role behaviours, which refers to compliance with
recommended medical regimens, usually following
professional diagnosis of illness.
Clinical use, which includes physician visits for a
variety of reasons.
42. LIMITATION
• It does not account for a person's attitudes, beliefs, or other
individual determinants that dictate a person's acceptance of a health
behavior.
• It does not take into account behaviors that are habitual and thus
may inform the decision-making process to accept a recommended
action (e.g., smoking).
• It does not take into account behaviors that are performed for non-
health related reasons such as social acceptability.
43. LIMITATION
• It does not account for environmental or economic factors that may
prohibit or promote the recommended action.
• It assumes that everyone has access to equal amounts of information
on the illness or disease.
• It assumes that cues to action are widely prevalent in encouraging
people to act and that "health" actions are the main goal in the
decision-making process.
44. example
Concept Condom Use Education
Example
STI Screeing or HIV Testing
Perceived
Susceptibili
ty
Youth believes they can get
STIs or HIV or create a
pregnancy
Youth believe they may have been
exposed to STIs or HIV
Perceived
Severity
Youth believes that the
consequences of getting STIs or
HIV or creating a pregnancy
are significant enough to try to
avoid.
Youth believe the consequences
of having STIs or HIV without
knowledge or treatment are
significant enough to try to avoid.
45. Perceived
Benefits
Youth believe that the
recommended action of using
condoms would protect them
from getting STIs or HIV or
creating a pregnancy.
Youth believe that the
recommended action of getting
tested for STIs and HIV would
benefit them – possibly by allowing
them to get early treatment or
preventing them from infecting
others.
Perceived
Barriers
Youth identify their personal
barriers to using condoms (i.e.
condoms limit the feeling or they
are too embrassed to talk to their
partner about it) and explore
ways to eliminate or reduce these
barriers (i.e. teach them to put
lubricant inside the condom to
Youth identify their personalbarriers
to getting tested(i.e., getting to the
clinic or being seen at the clinic by
someone they know) and explore
ways to eliminate or reduce these
barriers (i.e., brainstorm
transportation and disguise options)
46. example
them to put lubricant inside the
condom to increase sensation
for the male and have them
practice condom
communication skills to
decrease their embarrassment
level)
transportation and disguise
options)
Cues to
action
Youth receive reminder cues
for action in the form of
incentives ( such as pencils
with the printed message “no
glove , no love”) or reminder
messages (such as messages in
the school newsletter)
Youth receive reminder cues for
action in the form of incentives
(such as a key chain that says,
“Got sex? Get tested!”) or
reminder messages (such as
posters that say, “25% of sexually
active teens contract an STI. Are
47. exampleCues to
action
Youth receive reminder cues for
action in the form of incentives
( such as pencils with the
printed message “no glove , no
love”) or reminder messages
(such as messages in the school
newsletter)
Youth receive reminder cues for
action in the form of incentives
(such as a key chain that says,
“Got sex? Get tested!”) or
reminder messages (such as
posters that say, “25% of sexually
active teens contract an STI. Are
you one of them? Find out now”).
Self –
efficacy
Youth confident in using a
condom correctly in all
circumstances
Youth receive guidance (such as
information on where to get
tested) or training (such as
practice in making an
appointment.)
48. Journal abstract
• Test of the Health Promotion Model as a Causal Model of
Commitment to a Plan for Exercise Among Korean Adults with
Chronic Disease
The purpose of this study was to test seven constructs (prior experience
of exercise, perceived health status, exercise benefits, exercise barriers,
exercise self-efficacy, social support for exercise, and options for
exercise) from the health promotion model (HPM) as a causal model of
commitment to a plan for exercise in a sample of 400 Korean adults
with chronic disease. The final model accounted for 54% of the variance
in commitment to a plan for exercise. Prior experience with exercise
and exercise benefits were the factors most highly related. Health
professionals can assess prior experience and emphasize personally
relevant benefits of exercise in designing intervention programs to help
Korean adults with chronic disease become more physically active
49. Journal abstract
• A review of the use of the health belief model for weight management.
The Health Belief Model (HBM) addresses the effects of beliefs on
health and the decision process in making behavioral changes.
Bowden, Greenwood, and Lutz (2005) identified it as one of the most
studied theories in health education, used with varying populations,
health conditions, and interventions. The model provides a
comprehensive framework for understanding psychosocial factors
associated with compliance. In this article, a summary of the limited
research found in a professional literature review of the Health Belief
Model as applied to weight management is offered. To qualify for
inclusion, an article had to be either an analysis or research performed
using the Health Belief Model to maintain a healthy weight or to lose
weight for the person already overweight or obese.
51. REFERENCES
• SONI S. Textbook of Advanced Nursing Practice. New Delhi: Jaypee
Brothers Medical Publishers; 2013
• Basheer PS, Khan YS. A concise textbook of advanced nursing practice.
Bangalore: EMMESS medical Publishers; 2012.
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Sixth edition.India: Dorling Kindersley India Pvt Ltd;2011.
• Basvanthappa BT. Nursing theories. New Delhi : Jaypee brothers ; 2007.
• Raj BED. Nursing Theories – A practical view. New Delhi : Jaypee
Brothers ; 2011.
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Elsevier publication ; 2013.
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