NOLA PENDER Nursing is a career that continues to change with the ebb and flow of medical knowledge, tradition

of practice, and cultural view of health and medical care. Not only is it a career for millions but a passion, a strong network of peers, and a framework for caring for the sick and promoting their wellness. Throughout recent centuries and especially the last several decades many theorists have left their mark on nursing and helped shape what it has become and what it will be. Dr. Nola J. Pender is one of those theorists whose work is just beginning to shape aspects of current nursing practice and will continue to shape it more in the decades to come. Nola Pender was born in 1941 in Lansing, Michigan. Her experience as a nurse with health in general was very much like that found in any other place in America or the western world as a whole. This could be stated as: maintain the status quo until something breaks and then fix it. Regarding her practice Dr. Pen der states, Very early in my nursing career, it became apparent to me that health professionals intervened only after people developed acute or chronic disease and experienced compromised lives (Pender, 2003, 1). Obtained bachelors degree in 1964 and masters degree in 1965 both from Michigan State University Obtained Ph.D. from Northwestern University in 1969 Began studying health promoting behavior in the mid 1970s Awarded the Distinguished Alumni Award from the Michigan State University School of Nursing in 1972 Published the Health Promotion Model (HPM) in 1982 Received an Honorary Doctorate of Science degree in 1992 from Widener University Received a Lifetime Achievement Award from the Midwest Nursing Research Society in 2005 Authored numerous publications in texts and journals, including 3 editions of Health Promotion and Nursing Practice Co-founder of the Midwest Nursing Research Society Currently a Professor Emerita in the Division of Health Promotion and Risk Reduction at University of Michigan School of Nursing Currently serves as a Distinguished Professor at Loyola University Chicagos School of Nursing Currently retired and spends time consulting on health promotion research both nationally and internationally (All bullet points obtained from: (Nursing Theory, 2011) THE HEALTH PROMTION MODEL (HMP) Nola Penders Health Promotion Model (HPM) was created to serve as a multivariate paradigm for explaining and predicting health promoting component of lifestyle (Pender, 1990, p.326). The model is used to assess an individuals background and perceived perceptions of self among other factors to predict health behaviors. Before the HPM was published, another similar model had been developed which also took into account these factors to predict health behaviors. This model, the Health Belief Model (HBM), centered on the idea that fears or threat of disease is the predictor for positive health behaviors (Peterson & Bredow, 2009). Studies support the HBM as being a disease avoidance model (Galloway, 2003). Pender however, wanted to define health as not just being free of disease. Her definition of health includes measures taken to promote good health and includes the patients own view of themselves and their lifestyle (Peterson & Bredow, 2009). Taking into account her expanded view of health, she first published the HPM in 1982. In response to a particular study using her model, she then revised it in 1996 (Pender, 1996; Peterson & Bredow, 2009). Penders model is meant to be a guide for exploration of the complex biopsychosocial processes that motivate individuals to engage in behaviors directed toward the enhancement of health (Pender, 1996, p. 51). Pender created this model to be applicable to any health behavior in which threat is not proposed as a major source of motivation for the behavior (Pender, 1996, p. 53). Since the model does not rely on potential threat of disease as a source of motivation, it can be applicable in many more situations across the lifespan (Pender, 1996). Nola Penders Health Promotion Model explores three areas of a patients participation in health promoting activities: individual characteristics and experiences, behavior specific cognitions and affect behavioral outcome. (Nursing Theories, 2010; Somerall, 2010). These components lead to a logical progression of the concepts needed to improve health and health behaviors and support Bennett, Perry and Lawrence (2009) belief that health behaviors must be in control of the patient and mean something to the patient to be effective. Penders model is based on two theories of human behavior: expe ctancy value and social cognitive theory. The expectancy value theory states, people are more likely to work toward goals that are of value to them (Reed & Shearer, 2009, p 293). The primary component of the social cognitive theory is self-efficacy which is the confidence a person has in the ability to be successful in a task or action (2009). Penders model gives guidance to assessing the patient as to readiness to

learn, barriers to adherence and learning, interpersonal influences, benefits to health promotion and situational influences (2009). All these components support the success of promoting health behavior change. Penders model of degree of abstractness is a definite strength, allowing for the concepts developed for this said project to be utilized in other medical condition settings (2009). OVERVIEW OF HEALTH PROMOTION MODEL The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to be a complementary counterpart to models of health protection. It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a clients level of wellbeing. The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health. The model focuses on following three areas: 1. Individual characteristics and experiences 2. Behavior-specific cognitions and affect 3. Behavioral outcomes The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important motivational significance. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the HPM. Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail an intended health promoting actions. I.Major Concept A. Person Man has the ability to express human health potential and has the capacity for reflective selfawareness , including the assessment of his own competencies The importance of an individuals unique personal factors or characteristics and experiences will depend on the target behavior for health promotion. Personal factors are categorized as biological(age,strength,balance), psychological(self-esteem, self-motivation) and sociocultural (race, ethnicity,,education,socioeconomic status) B. Health Health promotion is defined as client behavior toward developing well being and actualizing human health potential. Health protection is client behavior geared toward preventing illness, detecting it early, or maintaining function. C. Nursing The trend toward health promotion has created the opportunity for nurses to strengthen the professions influence on health information, disseminate information that promotes an educated public and assist individuals and communities to change long-standing health behaviors. D. Environment Individuals are more apt to perform health promotion behaviors if they are comfortable with the environment versus feeling alienated. Environments that are considered safe as well as interesting facilitate health-promotion behaviors. ASSUMPTIONS OF THE HEALTH PROMOTION MODEL The HPM is based on the following assumptions, which reflect both nursing and behavioral science perspectives: 1. Persons seek to create conditions of living through which they can express their unique human health potential. 2. Persons have the capacity for reflective self-awareness, including assessment of their own competencies. 3. Persons value growth in directions viewed as positive and attempts to achieve a personally acceptable balance between change and stability. 4. Individuals seek to actively regulate their own behavior.

5. Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time. 6. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan. 7. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change. Health -promoting behavior Individual Characteristics and Experiences Prior Related Behavior - Frequency of the similar behavior in the past. Direct and indirect effects on the likelihood of engaging in health promoting behaviors. 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 behaviour being considered. Personal biological factors- Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance. Personal psychological factors - Include variables such as self esteem self motivation personal competence perceived health status and definition of health. Personal socio-cultural factors -Include variables such as race ethnicity, accuculturation, education and socioeconomic status. Behavior-Specific Cognitions and Affect Perceived Benefits of Action - Anticipated positive out comes that will occur from health behavior. Perceived Barriers to Action - Anticipated, imagined or real blocks and personal costs of understanding a given behaviour Perceives Self-Efficacy - Judgment of personal capability to organise and execute a healthpromoting behaviour. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior. Activity-Related Affect - Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behaviour 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. Interpersonal Influences 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 a Plan of Action - The concept of intention and identification of a planned strategy leads to implementation of health behavior Immediate Competing Demands and Preference - 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 Interventions for Health Behavior Change Raising consciousness Reevaluating the Self Promoting Self-Efficacy Enhancing the benefits of Change Controlling the Environment THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL Theoretical statements derived from the model provide a basis for investigative work on health behaviors. The HPM is based on the following theoretical propositions:

1. Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior. 2. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. 3. Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior. 4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior. 5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior. 6. Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect. 7. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased. 8. 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 behavior. 9. 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. 10. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior. 11. The greater the commitments to a specific plan of action, the more likely health-promoting behaviors are to be maintained over time. 12. 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. 13. 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. 14. Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.

MIDDLE RANGE THEORY EVALUATION PROCESS Adequacy The HPM adequately pulls together all of the factors that can motivate an individual to improve their health. Studies have shown that perceived self-efficacy, benefits, and barriers all play a role in predicting health behaviors (Pender, 1996). Srof & Velsor-Friedrichs (2006) analysis of the model also indicates that self-efficacy and the behavior specific cognitions are supported as a predictive variable in multiple studies. This in turn supports Penders model as an adequate predictor of health behavior since selfefficacy is a central theme in her model. One weakness in the theory is that the model may not be completely accurate in use for communities and families as a whole since the focus is on an individual

(Peterson & Bredow, 2009). According to Srof & Velsor-Friedrich (2006), the model may not be adequate for adolescents because of differences between adolescents and adults in independent decision making. Clarity The HPM is straightforward and easy to understand. It uses terms that are readily comprehended, and its propositional statements are presented clearly. The model is easily understood and the key concepts are clear, though the conceptual framework contains multiple concepts which may invite confusion to some reader but the definitions of the concepts are in an uncomplicated language and are understood by all health professionals. The phenomena addressed by the model are familiar to nurses, and most nurses will require minimal learning of new terms and concepts in order to use and understand the model. Her diagram clearly represents the relationships between the many factors involved in the patients behaviors and affects, and the outcomes/goals of health promotion. Although Pender has defined the difference between health promotion and health protection by eliminating threat of disease from her model, Peterson & Bredow (2009) point out that this may not always be easily distinguished in practice. Certain behaviors may be seen as both health-promoting and protection from disease. Threat of disease therefore may still be one motivation in certain health-promoting behaviors and it is unclear how this affects Penders model (Peterson & Bredow, 2009). Although one of Penders assumptions is that the health care provider can intervene in an individuals behaviors towards health promotion, it is unclear at which point(s) on the model the provider should intervene Consistency The terminology and definitions are consistent throughout the model with the health promoting behavior being the end goal. Each of the other concepts in the model either directly, or indirectly lead to this end point so that although there are many relationships between concepts, the overall goal remains clear. Logical development Pender based her model on the HBM and successfully addressed many of its criticism (Montgomery, 2002). Penders argument for removing threat from her model is also a logical step in acknowledging the modern definition of good health used by all health care providers as not being simply disease -free. It is also important to mention that Pender addressed results of studies using her model, and revised it to be more applicable to all populations (Peterson & Bredow, 2009). Level of theory development The HPM represents a middle range theory because it describes a specific phenomenon in healthcare practice with a concrete end goal. It also has been refined to focus on 10 determinants of behavior that can be assessed for each patient (Pender, 1996). This makes the theory less abstract than a grand theory and specific enough to use for research and healthcare settings. External Critism Complexity The model is limited to 11 key, clearly defined, concepts which keeps it from becoming too cluttered and complex. There are many relationships between each concept, many of them both directly and indirectly affecting the ultimate endpoint of health promoting behavior. The overall framework however is linear, and it is easy to distinguish the progression from personal backgrounds to cognitions and affect and finally to health promoting behavior. One possible weakness however in this linear approach is that it does not incorporate reciprocal relationships Bandura (creator of the social cognitive theory on which the HPM is founded) describes in his work (Srof & Velsor-Friedrich, 2006). Discrimination Due to its focus to health promotion and disease prevention per se, its relevance to nursing actions given to individuals who are ill are obscure. But then again, this characteristic of her model also gives the concepts its uniqueness. Health promotion is a unique role of nurses but it does have similarities with other models such as the HBM discussed previously. Galloway (2003) puts forth other theoretical models that describe health promotion including the Transtheoretical Model (TTM) and the Theory of Reasoned Action (TRA). The TTM however focuses mostly on the process of change and less on the factors that influence it. The TRA focuses more on behavioral intent and their attitudes towards performing a certain behavior. One study analyzed by Srof & Velsor-Friedrich(2006) used an approach combining the HPM with the TTM in adolescents. The study concluded that both models used together may have been more adequate at predicting dietary behaviors in adolescents than either model used alone (Srof & VelsorFriedrich, 2006). It is clear that more work needs to be done in testing the HPM in different populations.

Although similarities to these other models exist, in general the HPM is unique in that it distinguishes itself from other models by not counting threats or avoidance as a motivator for health promotion (Peterson & Bredow, 2009). Reality Convergence Not only are the concepts in the HPM well known to the health care field, health promotion has captured the attention of the general public as well. . A major strength of Penders Definition of health is that it offers an expanded view of health. This expanded view provides for greatly increased opportunities to improve client health, as it is not limited to absence of disease or even limitations in functioning or adaptation. For an instance, Penders positive view of he alth permits the development of nursing interventions that are not limited to decreasing risks for disease, but are aimed at strengthening resources, potentials and capabilities. This created broader opportunities for nurses to assist individuals, families and communities to achieve improved health, enhanced functional ability and better quality of life. The HPM is appealing to many nurses because it offers a view of health consistent with their motivation for pursuing the profession of nursing. Its holistic and humanistic view is congruent with many nurses own personal philosophy of health and nursing. The model reflects a belief that health care is more than treatment and prevention of disease, but involves creating conditions where clients can express their unique human potential. Pragmatic Peterson & Bredow (2009) state: Although the model identifies foci for nursing interventions, it does not explicitly describe how nurses can effect changes in client perceptions (p. 296). They are correct in that the model itself does not do this, but Penders book describes specific interventions to tailor plans to their patients including, reinforcing and identifying strengths in the individual, reiterating benefits of change, and identifying and setting specific goals. Pender also discusses using contracts with the nur se or selfcontracts so the patient can be independent in rewarding themselves when they choose certain actions. In this case the patient serves as the source of rewards instead of the nurse allowing the patient to be selfsufficient (Pender, 1996). The model does not outline specific ways to assess the patient to determine likelihood of action towards a behavior, but many instruments have been developed to do this using the HPM as a basis. Most of these, including the Health Promoting Lifestyles Profile (HPLP) that Pender recommends, are intended for adults rather than adolescents (Galloway, 2003). The HPLP is a 52 point questionnaire. This can be a problem in the adolescent population because of the comprehension needed and possibly large amounts of time needed to fill the questionnaire out accurately (Galloway, 2003). Pender does mention other instruments more appropriate to use for adolescents including RyanWegners Schoolagers Coping Strategies Inventory which measures stress-coping strategies, the Adolescent Life Change Scale, and the Adolescent Perceived Events Scale (Pender, 1996).Health Promotion Theory 11 Scope The scope of the theory is limited to predicting and identifying health promoting behaviors without including disease avoidance as a motivator for health behavior. But then the model does not limit itself to a specific type of health behavior performed, and therefore can be applied in a broad sense to many different settings. Pender (1996) discusses many different settings the theory can be used in including the workplace, schools, and hospitals but also in a broader scale including health promotion within families and in the community. Pender also outlines specific strategies in her book for constructing plans for individuals for health promotion. Specifics include nutrition information for individuals of all ages, exercise programs, and stress management. Significance Peterson & Bredow (2009) accurately note that this model has changed the focus of the role of the nurse from simply disease prevention to health promotion. Penders model is useful to the nurse because it helps expand their role to promote good health as opposed to just decreasing their risk for becoming ill. The nurses goals are now aimed at strengthening resources, potentials, and capabilities for each patient and providing resources and education to promote improved health and a better quality of life (Peterson & Bredow, 2009, p. 292). Not only does the model expand the role of the nurse, by focusing on self-efficacy, it also puts the patients health in their hands, allowing them to be agents of change. This model allows the patient and the nurse to work together towards a goal of a better quality of life. Utility

The model is very useful in that it takes into account each individuals behavior and preferences. This allows the nurse to develop a unique care plan that takes these behaviors into account. Pender (1996) recommends using the nursing process including using nursing diagnoses and modelbased assessments such as the Health Promoting Lifestyles Profile II. She outlines a multi-step process in developing a plan of care based on clients strengths and preferences. Peterson & Bredow (2009) draw from various studies to note that tailoring interventions has been f ound to increase intervention effectiveness (p. 297). Many other studies have also proved useful in explaining variances in behavior in health promotion (Peterson & Bredow, 2009). The HPM has been used successfully in several research studies.

I.Major Concept A. Person Man has the ability to express human health potential and has the capacity for reflective selfawareness , including the assessment of his own competencies The importance of an individuals unique personal factors or characteristics and experiences will depend on the target behavior for health promotion. Personal factors are categorized as biological(age,strength,balance), psychological(self-esteem, self-motivation) and sociocultural (race, ethnicity,,education,socioeconomic status) B. Health Health promotion is defined as client behavior toward developing well being and actualizing human health potential. Health protection is client behavior geared toward preventing illness, detecting it early, or maintaining function. C. Nursing The trend toward health promotion has created the opportunity for nurses to strengthen the professions influence on health information, disseminate information that promotes an educated public and assist individuals and communities to change long-standing health behaviors. D. Environment Individuals are more apt to perform health promotion behaviors if they are comfortable with the environment versus feeling alienated. Environments that are considered safe as well as interesting facilitate health-promotion behaviors. II. Key Concepts 1. Individual Characteristics & Experiences Prior related behavior Personal factors 2. Behavior Specific Cognitions & Affect Perceived benefits of action Perceived barriers to action o Perceived self-efficacy o Activity-related affect o Interpersonal influences o Situational influences 3. Behavioral Outcomes Commitment to a plan of action Immediate competing demands & preferences Health-promoting behavior III. Applicability 1. Nursing Practice Used as a basis for structuring nursing protocols and interventions. To assist people of varying cultural backgrounds to adopt healthy lifestyles Incorporating the findings of research about health promotion into clinical practice and protocols and into community partnerships and programs. To use the latest knowledge about behavior change and determinants of particular health or risky behaviors to develop anticipatory guidance and counseling protocols 1. Nursing Education

The Health Promotion Model of Nola Pender play an important role in nursing education. It contributed her concept theory on the present curriculum of nursing and part of core knowledge. These are the examples of contributions that are being used by the institutions and organizations. The American Association of Colleges of Nursing which accredits Baccalaureate and Masters Nursing programs includes health promotion, risk reduction and disease prevention as core knowledge. An accreditation organization, the ACCN (2008) for baccalaureate nursing programs which has a health promotion essential. This essential includes an education outcomes that requires nursing programs to prepare students to provide input regarding the development of policies to promote health, provide health teaching and health counselling, identify environmental factors that affect current or future health problems, and assess protective and predictive factors which influence the health of individuals, groups, and communities (AACN, 2008). 1. Nursing Research Encouraged other scholars to move in that direction long before health promotion and risk reduction became popular. A heuristic device that encourages scholars to look integratively at variables that have been shown to impact health behavior. The Health Promotion Model have used by the colleagues and the dissertations as guide research applied the model to overall health promoting lifestyle The HPM synthesizes research findings from nursing, psychology and public health into an explanatory model of health behavior that still must undergo further testing IV. Strengths and Limitations 1. A. Strengths It lessened the rate of mortality and morbidity It gives autonomy in providing care to themselves (patient) as they applied the health promotion model thus promotes independency. It develops the skills and behaviors of the patient in managing their own health 1. B. Limitations There are some factors than can be modified such as biological (example: Body mass index), psychological (example: self-motivation) and socio- cultural factors (example: education) that are predictive in given behaviors. The theory is focused on individual setting.

The conceptual framework identified for this project is Nola Penders Health Promotion Model. Penders model focuses on interventions that affect communities, therefore producing a healthier population. Pender defined health as not only the absence of disease, but a positive dynamic state of well being (1996). The HPM was proposed by Pender in 1982 and revised in 1996. The model illustrates the multifaceted nature of persons interrelating to their environment in pursuit of health. Pender (1996) reports three concepts that are central to this model individual characteristics and experiences, behavior specific cognitions and affect, and behavioral outcomes. Those studies utilizing the revised model indicate perceived self-efficacy, benefits, and barriers are better predictors of and have greater influence on health related behaviors (Pender,1996, pg.65) . While the HPM was developed to explain health promoting behaviors, it can also be used for health-protecting behaviors (Pender et al., 2002). This author used four criteria from Dudley-Brown (1997) to evaluate the HPM to ensure its suitability for the clinical issue at hand. First, the HPM has demonstrated fruitfulness as it describes new phenomenon and reveals relationships between existing phenomenon that were previously unknown. Secondly, it is widely accepted and been used by professions other than nursing. Thirdly, the model has been tested across cultures, includes culturally congruent beliefs, values, traditions, and expectations, lending itself to socio-cultural utility. Lastly, it is linguistically consistent, with logical order, clarity, and connectedness.

Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health."Health promotion has never been more important than it is in the present day. Nurses in education, practice, and research settings can participate in the advancement of health promotion not only to the mainstream but to the forefront of nursing practice. In the past, nurse educators have taught their patients how to manage illness; in the future, the focus is directed towards teaching people how to remain healthy. Nurses must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this knowledge to the public at large. As more people grow in their awareness of activities and actions that lead to good health and become knowledgeable about their own health status and the health of their families, the overall health of the population will improve significantly. Dr. Nola J. Pender is Professor Emeritus in the School of Nursing at the University of Michigan. She developed the Health Promotion Model that is proposed as a holistic predictive model of health-promoting behavior for use in research and practice. This model has been tested internationally with varying health behaviors. Dr. Pender has published many research articles. One of

her (Dr. Penders), current research focus is on testing the efficacy of a computerized phy sical activity counseling program for teenage and adolescent girls. Dr. Pender has authored a widely used text entitled, Health Promotion in Nursing Practice, (4th edition) which received the ANA Book of the Year Award for contributions to community health nursing. She has served as distinguished scholar at a number of universities. She received the distinguished alumni award from Michigan State University and holds an honorary doctoral degree from Widener University for her contributions to nursing research and health promotion. She has received many Distinguished Research Awards during the span of her nursing career. As the past-president of the American Academy of Nursing, Dr. Pender has also served as president of the Midwest Nursing Research Society. She served as a charter member of the National Advisory Council on Nursing Research. Currently, she is a member of the Board of Directors of Research! America, an organization committed to increasing public support for health research. Nola Pender consults nationally and internationally in health promotion and nursing research even in retirement. Dr. Nola J. Penders Health Promotion Model (HPM) (Pender, Murdaugh,& Parsons, 2006) that has been used in numerous studies to assess influences on health-promoting behaviors. These influencing factors are individual characteristics and experiences that include prior related behaviors and personal factors. Personal factors fall into three categories: biological, psychological, and sociocultural. Biological factors include variables such as age and gender. Psychological factors include variables such as selfesteem, self-motivation, and perceived health status. Sociocultural factors include such variables as race, educational level and socioeconomic status (Pender et al., 2006). Other influences are behavior specific cognitions and affect, perceived benefits of action, perceived barriers to action, perceived self-efficacy and activity related affect. Specifically, the interpersonal influences of the HPM are cognitions regarding the behaviors, beliefs, or attitudes of others. Whether real or not, primary sources of interpersonal influences that affect decisions made regarding health promoting behaviors are family, peers and healthcare providers. In HPM, interpersonal interaction influences health-promoting behavior directly and indirectly through social pressures or encouragement to commit to a plan. The Health Promotion Model which was developed by Dr. Pender is used internationally for research, education, and practice. During her active research career, she conducted research testing on the Health Promotion Model with adults and adolescents. She also developed the program Girls on the Move with her research team and began intervention research into the usefulness of the model in helping adolescents adopt physically active lifestyles, developing a number of instruments that measure components of the model. The Health Promotion Model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to be a complementar y counterpart to models of health protection. It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a clients level of well -being. This model (HPM), describes the multi-dimensional nature of persons as they interact within their environment to pursue health. The model focuses on following three areas: Individual characteristics and experiences, Behavior specific cognitions and affect, Behavioral outcomes. This model (HPM), notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important motivational significance. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the HPM. Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail an intended health promoting act synthesizes research findings from nursing, psychology and public health into an explanatory model of health behavior that still must undergo further testing. The various health promotion strategies and tools that Dr. Pender has developed can be used as a basis for structuring nursing protocols and interventions. Nurses in practice should focus on understanding and addressing variables that are most predictive of given health behaviors (Pender, 1975).