Pender's Health Promotion Model

The Health Promotion Model was designed by Nola J. Pender to be a “complementary counterpart to models of health protection.” It defines health as a positive dynamic state rather than simply the absence of disease. Health promotion is directed at increasing a patient’s level of well-being. The health promotion model describes the multidimensional nature of persons as they interact within their environment to pursue health.

Pender’s model focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. The theory notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavior specific knowledge and affect have important motivational significance. The variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome, which makes it the end point in the Health Promotion Model. These 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 intended actions for promoting health.

The Health Promotion Model makes four assumptions:

  1. Individuals seek to actively regulate their own behavior.
  2. Individuals, in all their biopsychosocial complexity, interact with the environment, progressively transforming the environment as well as being transformed over time.
  3. Health professionals, such as nurses, constitute a part of the interpersonal environment, which exerts influence on people through their life span.
  4. Self-initiated reconfiguration of the person-environment interactive patterns is essential to changing behavior.

There are thirteen theoretical statements that come from the model. They provide a basis for investigative work on health behaviors. The statements are:

  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. Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.


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The major concepts of the Health Promotion Model are individual characteristics and experiences, prior behavior, and the frequency of the similar behavior in the past. Direct and indirect effects on the likelihood of engaging in health-promoting behaviors.

Personal factors are 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. Biological personal factors include variables such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance. Psychological personal factors include variables such as self esteem self motivation personal competence perceived health status and definition of health. Socio-cultural personal factors include variables such as race ethnicity, accuculturation, education and socioeconomic status.

Perceived benefits of action are the anticipated positive outcomes that will occur from health behavior. Perceived barriers to action are anticipated, imagined, or real blocks and costs of understanding a given behavior. Perceived self-efficacy is the judgment or 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 behavior.

Activity-related affect is defined as the subjective positive or negative feeling that occurs based on the stimulus properties of the behavior itself. They influence 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 are 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 are personal perceptions and cognitions that can facilitate or impede behavior. They include perceptions of options available, as well as 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.

Within the behavioral outcome, there is a commitment to a plan of action, which is the concept of intention and identification of a planned strategy that leads to implementation of health behavior. 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 behavior over which individuals exert relatively high control.

Health-promoting behavior is the endpoint or action outcome directed toward attaining a positive health outcome such as optimal well-being, personal fulfillment, and productive living.