Critique of Pender's Health Promotion Model using Fawcett's Criteria

1. HEALTH PROMOTION MODEL
Critique Using Fawcett’s Criteria
Margaret Gibson, Ami Mehta, Lauren Renner, & Kaitlin
Woike

2. SIGNIFICANCE
 Definition: “context of the theory” (Fawcett, 2005)
 Why is the theory important and how does it
contribute to nursing practice? (Fawcett, 2005)
 Questions:
 Are the metaparadigm concepts and propositions
addressed by the theory explicit?
 Are the philosophical claims on which the theory is
based explicit?
 Is the conceptual model from which the theory was
derived explicit?
 Are the authors of knowledge from from adjunctive
disciplines acknowledged and biographical citations
given?
• (Fawcett, 1993)

3. METAPARADIGM
 Definition: “global concepts specific to a discipline
that are philosophically neutral and stable” (Peterson,
2009)
 Reciprocal Interaction: person is holistic and interacts
with environment; change occurs at differing rates at
differing times on life and cannot be predicted (Fawcett,
1995)

4. PHILOSOPHICAL VIEWS
 Reciprocal World View
 “Humans are viewed holistically, but parts can be
studied in the context of the whole. Human beings
interact with their environment and shape it to meet their
needs and goals.” (Pender, 2011)

5. CONCEPTUAL MODEL: PARENT THEORIES
 Expectancy Value  Social Cognitive
Theory Theory
 Fishbein & Ajzen  Bandura
 Patients will work  Self- efficacy:
towards goal they see “confidence the patient
as beneficial and has they can carry out
achievable (McCullagh, 2009) an action” (McCullagh, 2009)
 More self- efficacy
means a patient will be
more likely to do a
behavior (McCullagh, 2009)

6. APPROPRIATE
ACKNOWLEDGEMENT/CITATIONS
 Pender recommends using established frameworks
to assess patients and develop care plans
 North American Nursing Diagnosis Association
 Gordon‟s functional health patterns
 Health Promoting Lifestyles Profile II
 The nursing process
 Prochaska et al.‟s stages of change
 Acknowledgement of parent theorists, Fishbein &
Ajzen and Bandura
• (McCullagh, 2009)

7. INTERNAL CONSISTENCY
 Definition: “context and content of the theory” (Fawcett,
2005)
 Theorist‟s work is congruent (Fawcett, 2005)
 Questions:
 Are all elements of the work congruent?
 Do the concepts reflect semantic clarity and
consistency?
 Are there any redundant concepts?
 Do the propositions reflect structural consistency?
• (Fawcett, 1993)

8. ARE THE ELEMENTS CONGRUENT?
 The philosophical  Pender‟s definition of health
claims, parent theories, and  “actualization of inherent
the resulting propositions and acquired human
are all congruent potential through goal-
 Most nurses are familiar directed
with health as the absence behavior, competent
of disease and illness self- care, and satisfying
relationships with others”
 May be difficult for
nurses to define health
in this way, especially in
acute care
• (McCullagh, 2009)

9. CLARITY AND CONSISTENCY
 Semantics  There is no evidence of
 Terms used are redundancy
commonly understood  The theory is
and defined where
structurally sound and
necessary
based on well-
 Schematic is easy to
follow and understand
accepted and
 (McCullagh, 2009) published theories

10. PARSIMONY
 Definition: “content of theory” ( Fawcett, 2005)
 Theory is stated in “most economical way possible
without oversimplifying the phenomena of interest.”
(Fawcett, 2005)
 Question:
 Is the theory stated clearly and concisely?
• (Fawcett, 1993)

11. CLARITY AND CONCISENESS
 The model clearly explains the phenomena of
interest: people‟s perceptions and how their
perceptions affect behavior

12. TESTABILITY
 Definition: “content of the theory” (Fawcett, 2005)
 “Concepts can have operational definitions and
their propositions are amenable to direct empirical
testing.” (Fawcett, 2005)
 Questions:
 Can the concepts be observed empirically?
 Can the proposition be measured?
• (Fawcett, 1993)

13. OBSERVATION & MEASUREMENT
 “Specific instruments and experimental protocols
have been developed to observe the theory
concepts and statistical techniques are available to
measure the assertions made by the propositions.”
(Fawcett, 2005)
 Common instruments used with this model
 Questionnaires
 Lab results
 Blood pressure readings
 Scales

14. EMPIRICAL ADEQUACY
 Definition: “requires the assertions made by the
theory to be congruent with empirical evidence.”
(Fawcett, 2005)
 Should be supported by the literature and current
evidence (Fawcett, 2005)
 Question:
 Are the theoretical assertions congruent with empirical
evidence?

15. CONGRUENCY WITH CURRENT EVIDENCE AND
LITERATURE
 Model has been used in multiple settings and is
found in the literature
 Example from the literature
 Hearing protective devices: Kerr, Saik, Monsen, & Lusk (2007)
 Sample: construction workers
 Intervention: pre-test to assess knowledge on hearing
protection
 Test group received tailored education based on pre-test
responses
 Other group received conventional education
 Outcome: increase in number of construction workers using
hearing protection overall

16. PRAGMATIC ADEQUACY
 Definition: “utility of the theory for nursing practice.”
(Fawcett, 2005)
 Questions:
 Are education and special/skill training required prior to
application of the theory in clinical practice?
 For what clinical problems is the theory appropriate?
 Is it feasible to implement clinical protocols derived from
the theory?
 Are the nursing actions compatible with expectations for
nursing practice?
 Does the clinician have the legal ability to implement the
nursing actions?
 Do the nursing actions lead to favorable outcomes?
• (Fawcett, 1993)

17. EDUCATION AND SKILL REQUIREMENT
 No special education would be required, since
assessment, intervention development and
application, and outcome measurement are all a
part of the nursing process

18. APPROPRIATE APPLICATIONS TO PRACTICE &
FEASIBILITY
 Within the nursing  Feasible because it
scope of practice allows interventions to
 Health planning is be personal to each
essential, and including patient and increase
patient input can be likelihood of success of
useful achievement of goals
• (McCullagh, 2009)
 Reinforce strengths
 Address facilitators and
barriers
 Helps the patient stay
committed to goal(s)
• (McCullagh, 2009)

19. EXAMPLE FOR CARDIOVASCULAR DISEASE
 Williams, Wold, Dunkin, I  Intervention:
dleman, & Jackson  Pre-test with Healthier
(2004) People Health Risk
Appraisal using
 Sample: low income rural
participants‟ answers and
and urban African objective data (i.e. blood
American women pressure)
(LAAW) working for small  Compared to American
companies (less than 50 Heart Association (AHA)
employees) national sample
 Risk reduction
interventions took lifestyle
and culture into
consideration

20. RESULTS
 Pre-intervention  No difference between
 Larger percentages of any groups in blood
urban and rural LAAW pressure and physical
had higher fat intake activity
and greater BMI than  Urban LAAW had
AHA sample significantly lower mean
 Significantly larger
cholesterol and
percentage of rural significantly smaller
LAAW had elevated percentages with
cholesterol level than elevated cholesterol or
AHA sample high dietary fat intake
than rural LAAW

21. RESULTS
 Post- intervention  No significant change in
 Rural LAAW had BMI
significant drop in mean  Urban LAAW made not
cholesterol, significantly significant changes on
fewer with elevated any measures risk
cholesterol, and factors
significant decrease in
percentage with high
dietary fat intake
 No differences in mean
blood pressure and
percentage of physical
activity

22. IMPLICATIONS FOR PRACTICE
 Using customized interventions are useful and help
to make interventions the patient feels in valuable
and attainable
 More research and replication of these types of
studies are needed to test the intervention on a
larger scale
 Interventions need to be followed long term to
determine effectivness

23. REFERENCES
Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 189(2), 131-135. doi: 10.1177/0894318405274823
Fawcett, J. (1995). Analysis and evaluation of conceptual models of nursing (3rd Ed.) Philadelphia: F.A. Davis Company.
Fawcett, J. (1993). Analysis and evaluation of nursing theories. Philadelphia: F.A. Davis (36)
„Health Promotion Model‟ (2012). Nursing theories: A companion to nursing theories and models. Retrieved from
http://nursingplanet.com/health_promotion_model.html
Kerr, M.J., Savik, K., Monsen, K.A., & Lusk, S.L. (2007). Effectiveness of computer-based tailoring versus targeting to promote use of hearing protection. Journal
of Nursing Research, 39, 80-97.
McCullagh, M.C. (2009). Health Promotion. In S.J. Peterson & T.S. Bredow (3rd Ed), Middle Range Theories: Application to Nursing Research. (pp.224-234).
Philadelphia: Lippincott, Williams, & Wilkins.
Pender, N. (2011). The health promotion model manual. Retrieved from
http://deepblue.lib.umich.edu/bitstream/2027.42/85350/1/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf
Peterson, S.J. (2009) Introduction to the nature of nursing knowledge. In S.J. Peterson & T.S. Bredow (3rd Ed), Middle Range Theories: Application to Nursing
Practice. (pp.1-37). Philadelphia: Lippincott, Williams, & Wilkins.
Williams, A., Wold, J., Dunkin, J., Idleman, L., & Jackson, C. (2004) CVD prevention strategies with urban and rural african american women. Applied Nursing
Research, 17(3), 187-194. doi: 10.1016/j.apnr.2004.06.003