Monday, November 30, 2015

Nola.J.Pender Health Promotion Model 1982

Nola.J.Pender Health Promotion Model 1982
Nola.J.Pender was born in 1941 in Michigan. She earned diploma in nursing, B.S. in nursing, M.A. in human growth and development and PhD in Psychology and Education. She also did graduate level work in community health nursing at RUSH University, Chicago. The focus of her research was on health promotion. She did a research on ‘how people make decisions’ and based on this, initial version of Health Promotion Model (HPM) was published in 1982. She stated HPM as proposed a framework for integrating nursing and behavioral science perspectives as factors influencing health behaviors. The framework offered a guide for exploration of the complex biopsychosocial processes that motivate individuals to engage in behaviors directed towards the enhancement of health. The initial model had seven cognitive perceptual factors (importance of health, perceived control of health, definition of health, perceived health status, perceived self efficacy, perceived benefits and perceived barriers) and five modifying factors (demographic characteristics, biologic characteristics, interpersonal influences, situational influences and behavioral factors).
She identified the theoretical basis of the Health Promotion Model as drawing upon Social Cognitive Theory (Bandura, 1977). This theory emphasizes on self direction and self regulations are the abilities to direct and control one’s thinking and actions, perceptions of self efficacy involve one’s view of the personal ability to perform an identified set of actions. 
According to Pender et. al. (2006), Bandura identifies the following basic human capabilities;
  • Symbolization - The ability to process and transform experience to create internal models to guide actions in the future.
  • Forethought – The ability to anticipate possible consequences of potential actions and plan courses of action to achieve goals.
  • Vicarious learning - The ability to obtain rules for selecting actions through observation of others without using trial and error.
  • Self regulation- The ability to use internal standards and self evaluation to inspire and adjust behavior to external environment.
  • Self reflection – The ability to consider one’s own thought process and change them.
Assumptions of Revised Health Promotion Model
  • 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 o their own competencies
  • Person’s value growth in directions viewed as positive and attempts to achieve a personally acceptable balance between change and stability
  • Individuals seek to actively regulate their own behavior
  • Individuals in all their bio-psychosocial complexity interact with the environment, progressively transforming the environment and being transformed overtime
  • Health professionals constitute a part of the interpersonal environment, which influence on persons throughout their life span
  • Self initiated reconfiguration of person environment interactive pattern is essential to behavior change
Health Promotion Model (Revised Variables) 
Individual characteristics and experiences
The Individual characteristics and experiences divided into prior related behavior and personal factors. Prior related behaviors are important, as it is best for predicting the future behavior. The direct effect of prior behavior is possibly that of habit formation, since each time a behavior is performed, the habit is strengthened. The personal factors are described as biological (age, BMI and strength), psychological (self esteem and self motivation) and socio cultural (race, education and socio economic status) factors.  

Behavior specific cognition and affect
This includes perceived benefits of action, perceived barriers to action, perceived self efficacy, activity related affect, interpersonal influences and situational influences, all of which leads to a commitment to a plan of action and consideration of immediately competing demands and preferences. 

Perceived plan of action may be intrinsic benefits (feeling better) and extrinsic benefits (time to socialize while practicing the target behavior). Perceived barriers to action mean the barriers which influence action directly by blocking that action or indirectly by decreasing any commitment to act. The perceived ability to achieve a behavior is perceived self efficacy of; Can I do it?, What will happen if I do it?.

Activity related effect- There are three components to this affect; the act related emotional arousal, the self related self acting and the context related environment in which behavior occurs. Interpersonal influences are the person’s thoughts or beliefs about the behavior, attitudes and beliefs of others and may or may not accurately reflect those behavior, attitudes and beliefs. Situational influences include the options that are perceived as being available, demand characteristics and environmental features. For example, ‘no smoking’ sign is intended to discourage smoking. Commitment to plan of action initiates the behavior, to carry out a specific plan of action at a given time and place. Immediate competing demands and preferences are alternative behaviors that intrude into consciousness as possible courses of action immediately prior to the intended occurrences of a planned health promoting behavior. 

The variables of Health Promtion Model have strengths and limitations. It is strength for use in practice because looking at all of the variables provides a more complete picture of the client. The limitation of the model is lacking of the spiritual factors.

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