Health Promotion Model Pender's in Nursing Care

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Pender's Health Promotion Model in Nursing Care

Health Promotion Model Pender's in Nursing Care

Pender's Health Promotion Model,Nature of Healthy Behavior,Theoretical Proposition,Variables in Conceptual Map,Implementations of Pender's HPM,Applicability,Critique on Model,Strengths of Model.

Pender's Health Promotion Model

    Pender's Health Promotion Model (HPM) has been classified as a middle range theory. The model seeks to explain and predict how the complex interaction among perceptual and environmental factors influences the health-related choices that people make. 

    Specifically, Pender intended the focus of the model to be high-level wellness and health promotion, instead of disease prevention. The model has been used internationally as the basis for nursing research, practice, and education (Pender, 2001b, most frequently asked questions).

Nature of Healthy Behavior

    Pender's representation of healthy behavior is deductive in that it was originally based on concepts from the Health Belief Model, Expectancy Value Theory, and Social Cognitive Theory (Pender, 1982). 

    However, the model is also inductively formulated because over time Pender has made modifications based on research findings. Since her first published model in 1982, Pender has made two major revisions to her model resulting in a 1987 version and a 1996 version. 

    Changes were based on research that supported using fewer variables with more direct and indirect relationships. The assumptions of the Health Belief Model stress the interactive nature of client and environment. They include:

1. People desire conditions that facilitate the expression of their individual potential.

2. People have the capacity for self-awareness.

3. People value positive growth, and attempt to balance change and stability. 4. There is a natural human desire to control one's own behavior.

5. Humans both change their environment and are changed by it.

6. As part of the environment, health care workers influence others. 

7. Lasting behavior modification is based on self-initiated change (Pender, Murdaugh, & Parsons, 2002).

Theoretical Proposition 

    The theoretical propositions of the revised HPM state that characteristics and beliefs of an individual will influence the person's level of commitment and likelihood of demonstrating the health promotion behavior. 

    The HPM consists of nine groups of interrelated variables. Some of the variables that are proposed to indirectly and directly influence one's commitment to a healthy plan of action are past behavior and personal characteristics, positive emotions, perceived self-efficacy, perceived benefits and barriers, expectations of others, environment, and competing demands (Pender et al., 2002).

Variables in Conceptual Map

    In Pender's conceptual map (1996) related variables are clustered together and separated into three main categories. The antecedents to action are the Individual Characteristics and Experiences, which include variables that have been determined by past experiences, genetics, or biopsychosocial influence.     

    The majority of the other variables that are based on beliefs and outside influences are fused together under the heading Behavior Specific Cognitions and Affect. 

    Both of these groupings are related to the last cluster of variables termed the “behavioural outcome.” The desired outcome is the health promotion behavior, which is influenced by competing demands and making a commitment to changing behavior.

Implementations of Pender's HPM

    Pender's HPM has been used in research, clinical practice, and nursing education. Dozens of published nursing articles have used the model as a theoretical framework. 

    Research based on the HPM covers a variety of clinical applications such as the use of hearing protection, smoking cessation, exercise, sexual behaviors and contraceptive use, dietary goals and cholesterol levels, use of seat belts, job strain/absenteeism/productivity, and stress reduction. 

    Nursing implications derived from the HPM research offering specific nursing interventions that can be readily used in clinical practice. Information about how to promote healthy choices and lasting behavior modification is valuable to both health care professionals and the public. 

    Pender has also published an article specifically outlining health promotion recommendations for BSN, MSN, and PhD nursing curricula (Pender, Barkauskas, Hayman, Rice, & Anderson, 1992).


    The HPM offers a high degree of generalize ability to many diverse groups of people. Pender has consulted internationally in such countries as Japan, Korea, Dominican Republic, Jamaica, England, New Zealand, and Mexico (Pender, 2001a, Biographical sketch). 

    Currently the HPM is available in English, Spanish, Japanese, and Korean translations (Pender). Research based on the model has tested both males and females at all ages from preschool children to older adults. Research participants have been from a variety of settings including inpatient, outpatient, primary care, and community dwellings.     

    Most importantly, the research based on the HPM has not been limited to healthy subjects. Some populations that have been studied have included people diagnosed with CAD, HIV, asthma, cancer, hypertension, cognitive disorders, and chronic disease.

Critique on Model

    Past critiques of the model have suggested that Pender needs to further clarify interactions among the variables (Tillett, 1994). In her most recent revision, she has clustered and labeled the variables differently in order to specify relationships.     

    The HPM may also be inappropriate when nurses are interacting with clients who are cognitively impaired or unable to communicate. 

    Examples would include infants or individuals with severe neurological deficits. Overall, the predictive power of the model will always be limited by the inherent uniqueness and variation of each human's behavior.

Strengths of Model

    Strengths of the HPM include its use of concepts that are logical and basic, its generalizability, and its usefulness in research and clinical practice. 

    Pender's model also addresses the barriers to action that are important areas to focus nursing intervention. Lastly, Pender has taken a truly holistic approach, considering sociocultural, psychological, and biological variables. 

    The content of the HPM model is consistent with contemporary beliefs that health promotion is a national and international priority and a cost-effective alternative to sick care.

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