REMODELLING OF NOLA PENDERS HEALTH PROMOTION MODEL

A. The Health promotion Model by Nola Pender failed to provide a definition of the four
most important concepts that a nursing theory namely: Man, Nursing, Environment and
Health. As part of the remodelling, these concepts can be defined as:

a. Man A biopsychosocial being whether sick or well, which interacts with the
environment for the transformation leading to health promotion.

b. Nursing the provision of care by the health professionals being a part of the
interpersonal environment towards health promotion.

c. Environment All the factors that affect health of a person to include the nurse as part of
the environment.

d. Health The result of a behavior motivated to increase a persons well-being whether

sick or well to actualize human health potential.

B. Inclusion in its applicability to an individual currently experiencing a disease state.

Addition of knowledge and attitudes on diagnosis/illness and treatment or management as
part of the Behaviour-specific cognitions and affect.

MAJOR CONCEPTS

Health promotion is defined as behavior motivated by the desire to increase well-being and
actualize human health potential whether sick or well. It is an approach to wellness.

On the other hand, health protection or illness prevention is described as behavior motivated
desire to actively avoid illness, detect it early, or maintain functioning within the constraints of
illness.

Individual characteristics and experiences (prior related behavior and personal factors).

Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to

action, perceived self-efficacy, activity-related affect, knowledge, attitude, interpersonal
influences, and situational influences).

Behavioral outcomes (commitment to a plan of action, immediate competing demands and

preferences, and health-promoting behavior).

C. Definition of knowledge and attitude as part of behaviour-specific cognitions and

affect

SUBCONCEPTS

Personal Factors
Personal factors categorized as biological, psychological and socio-cultural. These factors are
predictive of a given behavior and shaped by the nature of the target behavior being considered.

a. Personal biological factors

Include variable such as age gender body mass index pubertal status, aerobic capacity, strength,
agility, or balance.

b. Personal psychological factors

Include variables such as self-esteem self-motivation personal competence perceived health

status and definition of health.

c. Personal socio-cultural factors

Include variables such as race ethnicity, acculturation, education and socioeconomic status.

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. Perceived

self efficacy influences perceived barriers to action so higher efficacy result in lowered
perceptions of barriers to the performance of the behaviour.

Activity Related Affect

Subjective positive or negative feeling that occur before, during and following behavior based on
the stimulus properties of the behavior itself.

Activity-related affect influences perceived self-efficacy, which means the more positive the
subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can
generate further positive affect.

Knowledge

Relates to the persons (sick or well) knowledge about his diagnosis or illness, treatment or
management whether without knowledge or highly knowledgeable which greatly influences a
persons commitment to a plan of action leading to the outcome behaviour of health promoting
behaviour.

Attitude

Pertains to the persons attitude towards his diagnosis or illness, treatment or management
whether negative or positive which greatly influences a persons commitment to a plan of action
leading to the outcome behaviour of health promoting behaviour.

Interpersonal Influences

Cognition concerning behaviors, beliefs, or attitudes of the others.

Interpersonal influences include: norms (expectations of significant others), social support

(instrumental and emotional encouragement) and modeling (vicarious learning through
observing others engaged in a particular behavior).

Primary sources of interpersonal influences are families, peers, and healthcare providers.

Situational Influences

Personal perceptions and cognitions of any given situation or context that can facilitate or
impede behavior. Include perceptions of options available, demand characteristics and aesthetic
features of the environment in which given health promoting is proposed to take place.
Situational influences may have direct or indirect influences on health behavior.

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 behaviors over which individuals have low control
because there are environmental contingencies such as work or family care responsibilities.

Competing preferences are alternative behaviors over which individuals exert relatively high
control, such as choice of ice cream or apple for a snack.

ASSUMPTIONS

Individuals seek to actively regulate their own behaviour.

Individuals in all their biopsychosocial complexity interact with the environment,

progressively transforming the environment and being transformed over time.
 Health professionals constitute a part of the interpersonal environment, which exerts
influence on persons throughout their life span.

Self-initiated reconfiguration of person-environment interactive patterns is essential to

behavior change.

PROPOSITIONS

Prior behavior and inherited and acquired characteristics influence beliefs, affect, and
enactment of health-promoting behavior.
Persons commit to engaging in behaviors from which they anticipate deriving personally
valued benefits.
Perceived barriers can constrain commitment to action, a mediator of behavior as well as
actual behavior.
Perceived competence or self-efficacy to execute a given behavior increases the
likelihood of commitment to action and actual performance of the behavior.
Greater perceived self-efficacy results in fewer perceived barriers to a specific health
behavior.
Positive affect toward a behavior results in greater perceived self-efficacy, which can in
turn, result in increased positive affect.
When positive emotions or affect are associated with a behavior, the probability of
commitment and action is increased.
A persons knowledge on illness/diagnosis and treatment or diagnosis greatly influence a
persons behaviour to commit to a healthy behaviour. The higher the knowledge, the
better the commitment to a plan of action for health promotion.
A persons attitude towards his illness or diagnosis influence the commitment to a plan
of action. The more positive the attitude, the more committed the person to the plan of
action for health promotion.
Persons are more likely to commit to and engage in health-promoting behaviors when
significant others model the behavior, expect the behavior to occur, and provide
assistance and support to enable the behaviour.
Families, peers, and health care providers are important sources of interpersonal
influence that can increase or decrease commitment to and engagement in health-
promoting behavior.
Situational influences in the external environment can increase or decrease commitment
to or participation in health-promoting behavior.
The greater the commitments to a specific plan of action, the more likely health-
promoting behaviors are to be maintained over time.
Commitment to a plan of action is less likely to result in the desired behavior when
competing demands over which persons have little control require immediate attention.
Commitment to a plan of action is less likely to result in the desired behavior when other
actions are more attractive and thus preferred over the target behavior.
Persons can modify cognitions, affect, and the interpersonal and physical environment to
create incentives for health actions.
 INDIVIDUAL BEHAVIOR-SPECIFIC BEHAVIORAL
CHARACTERISTICS COGNITIONS AND OUTCOME
AND EXPERIENCES AFFECT

Perceived
benefits of
action

Perceived
barriers to
action

Prior related Perceived self-

behavior efficacy Immediate competing
demands (low control)
Activity- and Preferences (high
related affect control)

Knowledge
(Diagnosis/illn
ess, treatment,
etc.)

Personal Attitude
Factors (Diagnosis/illn Commitment Health
(Biological, ess, treatment, to a plan of Promoting
Psychological etc.) action Behavior
and Socio-
cultural )

Interpersonal
influences
(Family, peers,
providers),
norms, support,
models

Situational
influences
(Options,
Demands
characteristics,
Aesthetics)