Self Efficacy Theory and Health Promotion Model In Nursing Education
What is Health Promotion Model (Revised)
The health promotion model (HPM), originally developed by Pender in 1987 and revised in 1996, has been primarily used in the discipline of nursing (Pender, 1996). The purpose of the model is to assist nurses in understanding the major determinants of health behaviors as a basis for behavioral counseling to promote healthy lifestyles (Pender, 2011).
The HPM describes major components and variables that influence health-promoting behaviors. This model helps to provide an understanding of whether people choose to engage in health-promoting behaviors (Pender, Murdaugh, & Parsons, 2002) and strongly sup ports the partner relationship between health-care provider and patient (Stewart, 2012).
Its emphasis on actualizing health potential and increasing the level of well being using approach behaviors rather than avoidance of disease behaviors distinguish this model as focusing on health promotion rather than disease prevention.
Sequence of Major Components of Health Promotion Model
The sequence of major components and variables is outlined as follows:
1. Individual characteristics and experiences, which consist of two variables prior related behavior and personal factors
2. Behavior specific cognitions and affect, which consist of perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity related affect, interpersonal influences, and situational influences
3. Behavioral outcomes, which consist of health-promoting behavior partially mediated by commitment to a plan of action and influenced by immediate competing demands and preferences.
The HBM and the HPM share several schematic similarities and one major difference, seen. Both models describe the use of factors or components that influence perceptions that may lead to positive health outcomes. How- ever, the HBM targets the likelihood of engaging in preventive health behaviors whereas the revised HPM targets the likelihood of engaging in health promotion activities.
Support for the HPM has been demonstrated by many research studies on a number of different population groups (Buijs, Ross-Kerr, Cousins, & Wilson, 2003; Hjelm, Mufunda, Nambozi, & Kemp, 2003; Ho, Berggren, & Dahlborg-Lyckhage, 2010: Mohamadian et al., 2011; Rothman, Lourie, Brian, & Foley, 2005; Srof & Velsor Friedrich, 2006).
One conclusion supported by the HPM literature is that perceived self efficacy is an important determinant of participation in health-promoting behavior and achievement of an improved health-related quality of life (Ho et al., 2010; Mohamadian et al., 2011; Srof & Velsor Friedrich, 2006).
What Is Self Efficacy Theory
Developed from a social cognitive perspective, self-efficacy theory is based on a person’s expectations relative to a specific course of action (Bandura, 1977a, 1977b, 1986, 1997). It is a predictive theory in the sense that it deals with the belief that one is competent and capable of accomplishing a specific behavior. The belief of competency and capability relative to certain behaviors is a precursor to expected outcomes.
Principles of Self Efficacy Theory
According to Bandura (1986, 1997), self efficacy is cognitively appraised and processed through four principal sources of information:
1.Performance accomplishments, as evidenced in self-mastery of similarly expected behaviors
2. Vicarious experiences, such as observing successful expected behavior through the modeling of others
3. Verbal persuasion by others, who present realistic beliefs that the individual is capable of the expected behavior
4. Emotional arousal, resulting from self-judgment of physiological states of distress
Bandura (1986, 1997) notes that the most influential source of efficacy information is previous performance accomplishments. Efficacy expectations that is, expectations relative to a specific course of action are induced through certain modes. Modes of induction include, but are not limited to, desensitization, self-instruction, exposure, suggestion, and relaxation.
Self-efficacy has proved useful in predicting the course of health behavior. Kaew hum manukul and Brown (2006) reviewed the literature from 11 studies and concluded that self-efficacy was the best predictor in an employee physical activity program and could be used in occupational health nursing.
Tung, Lu, and Cook (2010) used the transtheoretical model of change to study cervical cancer screening among Taiwanese women and determined that reinforcement of self efficacy was more important in this population than emphasizing the benefits of or decreasing the barriers to regular Pap screening. Callaghan (2005) studied relationships between self care behaviors and self efficacy in an older adult population (N = 235).
She found a significant relationship between self-care behaviors in older women and self efficacy, noting that nurses are in a key position to promote self care and healthy aging. Strachan and Brawley (2009) studied the eating habits of university students and staff. They found that self-efficacy was a strong predictor of healthy eating among this population. Singleton, Bienemy, Hutchinson.
Dellinger, and Rami (2011), in a descriptive correlational study of obesity in nursing students, identified that students who had higher body mass indexes (BMIs) had lower self-efficacy beliefs about regulating their exercise habits. In a study designed to measure the effectiveness of a training program for older adults in tended to improve memory and self-efficacy.
West. Bagwell, and Dark Freudeman (2008) found that memory improvement could be predicted based on self efficacy scores. Self- efficacy also has been linked with self- management of hypertension and diabetes mellitus (Jang & Yoo, 2012) and patient recovery after acute injury (Connolly, Aitkin, & Tower, 2014).
The use of self efficacy theory by the nurse as educator is particularly relevant in developing educational programs. The behavior specific predictions of this theory can be used for under standing the likelihood of individuals participating in existing or future educational programs. Educational strategies such as modeling, demonstration, and verbal reinforcement parallel modes of self efficacy induction.
Protection Motivation Theory In Nursing Education
Protection motivation theory explains behavioral change in terms of threat and coping appraisal (Prentice-Dunn & Rogers, 1986). These threat and coping appraisals embedded within the protection motivation theory are beneficial for understanding why individuals participate in behaviors that are unhealthy (MacDonell et al., 2013).
A threat to health is considered a stimulus to protection motivation. This linear theory includes sources of information (environmental and intrapersonal) that are cognitively processed by appraisal of threat and coping to engender protective motivation, which leads to intent and ultimately to action.
Influenced by crisis and self efficacy theories, protection motivation theory has been used to test antecedents to health behaviors such as drug abuse, AIDS, smoking, sun protection, and drinking behaviors. Wu, Stanton, Li. Galbraith, and Cole (2005) found that adolescent drug trafficking can be predicted by the overall level of health protection motivation.
These authors suggest that the theory be considered in the design of drug trafficking prevention pro- grams, Prentice Dunn, McMath, and Cramer (2009) found that protection motivation theory was useful in creating “readiness to change” sun protective intentions among young women.
Evidence based research can uncover motivational information that can be used to inform health educators in the design of educational programs that specifically target high-risk individuals or groups for selected risk behaviors. Protection motivation theory goes beyond the likelihood of action in the health belief model and self efficacy intent to promote actual health behavior action.
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