Running head: HEALTH PROMOTION MODEL

Penders Health Promotion Model

Pam Thompson
Bethel College

HEALTH PROMOTION MODEL

Penders Health Promotion Model

Nola J. Pender, born in Lansing, Michigan, had the desire to be a nurse since the age of 7
while watching a nurse care for her family member in the hospital (Alligood & Tomey, 2010).
After high school, Penders parents encouraged her to continue her education so she entered into
the School of Nursing at West Suburban Hospital in Illinois to fulfill her lifetime dream of
becoming a nurse. Receiving her nursing diploma in 1962, Pender began her career at a
Michigan hospital while working on her bachelor degree in nursing from Michigan State
University. Pender took an interest in health and human life span and decided to change her
career path pursuing her master and doctorate degrees in psychology and education (Alligood &
Tomey, 2010).
In 1975, shortly after the start of her family, Pender published a conceptual model
formulated from her interest and research in enhancing human health. This further led to the
development of the health promotion model (HPM) to represent a theoretical framework for
promoting good health behaviors and enhance the quality of life. Alligood and Tomey (2010)
stated her dedication to research helped to establish the National Center for Nursing Research in
the National Institutes of Health.
Pender further served as chairperson or president to many national organizations. One of
her most outstanding achievements was being appointed to serve on the U.S. Preventative
Services Task Force to review scientific evidence and recommend preventative services (Pender,
Murdaugh, & Parsons, 2006). Furthermore, she has received many awards and honors
throughout her career for her continued research and contributions in health promotion and
health policy.

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Theoretical Basis of Health Promotion Model

Pender et al. (2006) stated nurses are instrumental in evaluating and implementing
strategies to help promote healthier lifestyles and mannerisms in individuals. The HPM is
adaptable with nursing practice, academia, and research. The HPM is considered a multifaceted, middle-range theory that is used in different aspects of nursing practice, education, and
research. Pender developed the HPM from her foundational views on holistic nursing
perspective, social psychology, and learning theory. Through her research, Pender incorporated
different concepts within her framework using Banduras social cognitive theory (SCT) and
Feathers expectancy value theory (EVT) for human motivation as discussed below (Alligood &
Tomey, 2010).
Social Cognitive Theory
Banduras SCT, transformed from the social learning theory, is one of the most
influential learning theories for learning and development. SCT is used to explain human
behavior from environmental, personal, and behavioral factors that influence change in an
individuals behavior (McEwen & Wills, 2014). Self-efficacy is considered one of the major
components of SCT and can be derived from concepts of mastery (proficient through practice),
vicarious experience (observation of others), verbal persuasion (encourage performance), and
self-appraisal (reflection of self) (Wu & Chang, 2014). The higher the individuals self-efficacy
regarding a certain behavior, the more successful the intervention will be despite any challenges
that may arise. SCT has contributed to the success of many nursing interventions and is widely
used in nursing research related to health promotion, especially for adolescents (McEwen &
Willis, 2014).

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Expectancy-Value Theory
Feathers EVT is a model regarding human motivation in which an individuals action
towards a particular behavior is dependent on the value of the goal, the probability of success in
obtaining that goal, and the availability of obtainable knowledge (Pender et al., 2006). Also, the
more positive the individual views the circumstance, the greater the expectation that change will
occur. In addition, motivational significance for change is also determined by the expectancy
value of an individuals prior successes, beliefs, and evaluations (Pender et al., 2006).
Theoretical Concept of Interest
The HPM is simple and depicts various phases of the nursing process which is easy for
nurses to understand and use for health promotion (Masters, 2012). The HPM helps to
understand the persons unique characteristics and experiences that can influence behavioral
outcomes. One of the major components of the theory is perceived self-efficacy.
Perceived self-efficacy is ones judgement or belief in following through to complete a
certain task (Pender et al., 2006). Interventions with a theoretical foundation such as the HPM
can increase self-efficacy and enhance patient care outcomes. If a patient has a high self-efficacy
then the perceived barriers to action diminishes and can result in a positive effect (Pender, Baror, Wilk, & Mitchell, 2002).
Overview of the Health Promotion Model
Healthy behaviors need to become habit-forming so that the reaction is automatic and
patient can adhere to the plan. This model serves as a framework for nursing to develop and
implement interventions in the pursuit of obtaining healthy behavioral outcomes. The HPM can
also be applied to any definitive person, group, or ethnicity, and can be used for social or health

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promoting behaviors (Tuzcu, Bahar, & Gozum, 2015). There are three major aspects of Penders
HPM (see also Appendix A):
Individual Characteristics and Experiences

Each individuals characteristics and experiences can affect and influence the action plan:
o Prior behavior (lack of experience); and
o Personal factors of a persons biological (a persons strength), psychological (selfesteem), and sociocultural traits (ethnicity).

Behavior Specific Cognitions and Affects

These are anticipated variables that influence the individual and are applicable for
nursing interventions so that one can engage in health promotion activities :
o Perceived benefits of action possible outcomes of the health behavior action;
o Perceived barriers to action roadblocks that may occur;
o Perceived self-efficacy judgement of persons capabilities;
o Activity-related affect the effects of the activity (before, during, and after);
o Interpersonal influences those that can influence the action; and
o Situational influences personal perceptions (direct or indirect).

Behavioral Outcome

The outcome marks the beginning of the behavioral action:

o Commitment to plan of action Identification of the action plan and commitment to
the implementation of the planned behavior;
o Immediate competing demands and preferences alternative behaviors which one has
little control (other family commitments) and alternative behaviors which one has
more control (food selections); and

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o Health-promoting behavior is the end of the action outcome which provides a positive
health outcome (see also Appendix A) (Alligood & Tomey, 2010, pp. 438-439;
Pender et al., 2006).
Theory to Practice
Evaluating the effects of the HPM helps to understand the use of the model and if the
model is effective in positive outcomes. The HPM serves as a theoretical framework at
predicting and implementing health-promoting lifestyles. The following studies were reviewed
using Penders HPM.
Physical Activity Study
Sedentary lifestyle begins to increase as girls reach adolescence (Robbins, Gretebeck,
Kazanis, & Pender, 2006). Robbins et al. (2006) conducted a 12-week study with 77 girls from
two different middle schools to determine the effectiveness of a computerized physical activity
program with special, individual counseling. Each girl was given a computerized test to evaluate
individual characteristics and experiences based on the HPM model. The girls were then
randomly placed into two different groups. The invention group received the computerized
physical activity and special counseling while the control group received basic physical activity
information. The HPM was used along with trans-theoretical model to evaluate a physical
activity program for each girl in the intervention group to develop and action plan.
A comparison study of the results was performed by an outside professional source. The
only significant finding showed the intervention group had a better support system throughout
the intervention. There were some factors that limited the intervention and lead to the
determination that a more thorough invention could have changed the outcome of the study.
Quality of Life Study

HEALTH PROMOTION MODEL

Only recently did health researches place a much needed focus on adolescents to improve
quality of life. Adolescent girls play an integral role in the contribution to societys economic
and social outcomes. The purpose of this study was to evaluate positive influences that can
affect health-promoting lifestyles and enhance the individuals quality of life. Mohamadian et al.
(2011) selected 500 Iranian girls to participate in the study by a random sampling method. These
girls were surveyed by trained reviewers to assess the relationships between self-efficacy,
barriers, social support, and health-promoting lifestyles using Penders HPM and a path analysis.
Mohamadian et al. (2011) states there is a direct correlation between self-efficacy and the
students health-related quality of life. Mohamadian et al. (2011) further suggested the HPM
model could also be used to determine barriers that coincide with the quality of life.
Interventions based off of the HPM could be used to enhance the students quality of life. This
study could be further enhanced by using qualitative and quantitative studies that promote health
and wellness.
Diabetes Empowerment
Diabetes is a growing health concern and can complicate other disease processes. Trying
to manage this disease process can be quite challenging. Education, awareness, and self-care are
important factors for successful management of diabetes.
Ho, Berggren, and Dahlborg-Lyckhage (2010) performed a meta-ethnographic approach
using qualitative peer research reviews to gain an understanding of diabetes patients perception
of self-management. Ho et al. (2010) developed four central metaphors that influence successful
self-management: nurses competence and awareness, striving for control, a desire to share
experiences, and nurses attitude and ability to personalize. Ho et al. (2010) states the use of the

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HPM aims to improve clients health behaviors, empowers them to self-manage their diabetes,
and helps to eliminate barriers that may exist.
In all three studies, the researches all agreed the HPM serves as a framework for nursing
to develop and implement health-promoting interventions in the pursuit of health. It is
multifaceted and can be used to complement other models. The HPM will continue to guide
other research to influence health-promotion in nursing practice, academia, and research.
Theory Applicable to Practice, Research, or Education
The HPM is useful for practice, research, and education. Lakeland Health is evaluating
the current education process for patient compliance with chronic disease processes. If the HPM
was used as the theoretical foundation, it would help nursing understand any barriers the patient
may have that would prevent compliance of self-care management. Nursing could develop a
plan of action and include the patient and family through the process to work through those
barriers. Once the action plan is completed, a commitment to the implementation of the action
plan would be initiated by all parties for the behavioral event in health promotion. By involving
the patient and family in the planning phase, this would increase self-efficacy and create a sense
of ownership in the behavioral event empowering the patient to comply. In addition, it would
help the patient overcome or avoid any barriers that may inhibit a positive outcome for the
changed health behavior.
Conclusion
There is great concern over individual health in regards to unfavorable or unhealthy
lifestyle choices. Health promotion and disease prevention is an integral part of healthcare to
help keep individuals informed about their health and keep healthcare costs at a minimum. Nola
J. Pender is a middle-ranged theorist who, through her continual research and concern for

HEALTH PROMOTION MODEL

vulnerable individuals and populations, has created a theory that is instrumental for the health
and well-being of all individuals.
Her HPM serves as a theoretical framework that can have a positive effect on patient care
outcomes. When nursing assists an individual with behavioral strategies using this framework, it
can empower and guide them to make the necessary changes for their overall health and
wellness, enhancing the patients life. Individuals that positively transform their health behavior
creates autonomy and self-determination, which is also known as self-efficacy. Increasing an
individuals self-efficacy can increase the desire for health-promoting behavioral change and
adherence to the plan of action. This further leads to enhanced quality of life even when the
individual encounters barriers that would normally inhibit change (Clark et al., 2015). The HPM
can and will continue to provide a solid framework to influence change in future nursing.

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Robbins, L. B., Gretebeck, K. A., Kazanis, A. S., & Pender, N. J. (2006). Girls on the move
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Appendix A