Gonzales, Karla Jane C.

II BSN 2

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
client’s 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:

 Individual characteristics and experiences

 Behavior-specific cognitions and affect
 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.

ASSUMPTIONS OF THE HEALTH PROMOTION MODEL

The HPM is based on the following assumptions, which reflect both nursing and behavioral science
perspectives:
 1.  Individuals seek to actively regulate their own behavior.
2.  Individuals in all their biopsychosocial complexity interact with the environment,
progressively transforming the environment and being transformed over time.
3.  Health professionals constitute a part of the interpersonal environment, which exerts
influence on persons throughout their lifespan.
4.  Self-initiated reconfiguration of person-environment interactive patterns is essential to
behavior change

THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL

 Individual Characteristics and Experience

 Prior related behaviour
 Frequency of the similar behaviour in the past. Direct and indirect effects on the likelihood
of engaging in health promoting behaviors.

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.

Precede-proceed model

Good programs based on models.  Models used by planners as means of structuring ; organizing
planning process. This lecture's focus is on the PRECEDE Predisposing, Reinforcing and Enabling
Constructs in Educational Diagnosis and Evaluation.

PROCEED stands for Policy, Regulatory and Organizational Constructs in Educational and
Environmental Development.

The model is theoretically grounded and comprehensive in nature. It combines planning,

implementation and evaluation. The greatness of the model is seen in that it takes into account the
multiple factors that shape health status and helps the planner arrive at a highly focused subset of
those factors as targets for evaluation.

PRECEDE also generates specific objectives and criteria for evaluation.

PROCEED - elaboration and extension of the administrative diagnosis step of PRECEDE.

The model begins with final consequences and works backward to causes. This forces the planner
to begin the planning process from the outcome end and encourages asking why before how
 Health Belief Model

History and Orientation

The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health
behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first
developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the
U.S. Public Health Services. The model was developed in response to the failure of a free
tuberculosis (TB) health screening program. Since then, the HBM has been adapted to explore a
variety of long- and short-term health behaviors, including sexual risk behaviors and the
transmission of HIV/AIDS.

Core Assumptions and Statements

The HBM is based on the understanding that a person will take a health-related action (i.e., use
condoms) if that person:

1. feels that a negative health condition (i.e., HIV) can be avoided,

2. has a positive expectation that by taking a recommended action, he/she will avoid a negative
health condition (i.e., using condoms will be effective at preventing HIV), and
3. believes that he/she can successfully take a recommended health action (i.e., he/she can use
condoms comfortably and with confidence).

The HBM was spelled out in terms of four constructs representing the perceived threat and net
benefits: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers.
These concepts were proposed as accounting for people's "readiness to act." An added concept,
cues to action, would activate that readiness and stimulate overt behavior. A recent addition to the
HBM is the concept of self-efficacy, or one's confidence in the ability to successfully perform an
action. This concept was added by Rosenstock and others in 1988 to help the HBM better fit the
challenges of changing habitual unhealthy behaviors, such as being sedentary, smoking, or
overeating.

Scope and Application

The Health Belief Model has been applied to a broad range of health behaviors and subject
populations. Three broad areas can be identified (Conner & Norman, 1996): 1) Preventive health
behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking)
behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer to
compliance with recommended medical regimens, usually following professional diagnosis of
illness. 3) Clinic use, which includes physician visits for a variety of reasons.

Table from “Theory at a Glance: A Guide for Health Promotion Practice" (1997)
Concept  Definition  Application

Define population(s) at risk, risk levels;

Perceived One's opinion of chances of personalize risk based on a person's
Susceptibility getting a condition features or behavior; heighten perceived
susceptibility if too low.
 One's opinion of how serious
Perceived Specify consequences of the risk and the
a condition and its
Severity condition
consequences are

One's belief in the efficacy of

Perceived Define action to take; how, where, when;
the advised action to reduce
Benefits clarify the positive effects to be expected.
risk or seriousness of impact

One's opinion of the tangible

Perceived Identify and reduce barriers through
and psychological costs of the
Barriers reassurance, incentives, assistance.
advised action

Strategies to activate Provide how-to information, promote

Cues to Action
"readiness" awareness, reminders.
Confidence in one's ability to Provide training, guidance in performing
Self-Efficacy
take action action.

Conceptual Model

Bandura's Theory Of Self-Efficacy

The Basic notion of Self-Efficacy centers on: not what one hopes to do - or
on what one says he/she will do, but on what one truly expects to do.

Confidence, in contrast, refers to firmness of belief, but not direction. I can

be supremely confident that I will succeed at an endeavor (I will
eventually win a tournament). Self-efficacy refers to the belief that one
can execute given levels of performance (a more specific notion).

According to Albert Bandura, self-efficacy is “the belief in one’s

capabilities to organize and execute the courses of action required to manage prospective
situations” (1995, p. 2). In other words, self-efficacy is a person’s belief in his or her ability to
succeed in a particular situation. Bandura described these beliefs as determinants of how people
think, behave, and feel (1994).

Since Bandura published his seminal 1977 paper, "Self-Efficacy: Toward a Unifying Theory of
Behavioral Change," the subject has become one of the most studied topics in psychology. Why has
self-efficacy become such an important topic among psychologists and educators? As Bandura and
other researchers have demonstrated, self-efficacy can have an impact on everything from
psychological states to behavior to motivation.

The Role of Self-Efficacy

Virtually all people can identify goals they want to accomplish, things they would like to change,
and things they would like to achieve. However, most people also realize that putting these plans
into action is not quite so simple. Bandura and others have found that an individual’s self-efficacy
plays a major role in how goals, tasks, and challenges are approached.

People with a strong sense of self-efficacy:

 View challenging problems as tasks to be mastered.

 Develop deeper interest in the activities in which they participate.
 Form a stronger sense of commitment to their interests and activities.
 Recover quickly from setbacks and disappointments.

People with a weak sense of self-efficacy:

 Avoid challenging tasks.

 Believe that difficult tasks and situations are beyond their capabilities.
 Focus on personal failings and negative outcomes.
 Quickly lose confidence in personal abilities (Bandura, 1994).

Sources of Self-Efficacy
How does self-efficacy develop? These beliefs begin to form in early childhood as children deal with
a wide variety of experiences, tasks, and situations. However, the growth of self-efficacy does not
end during youth, but continues to evolve throughout life as people acquire new skills, experiences,
and understanding (Bandura, 1992).

According to Bandura, there are four major sources of self-efficacy.

1. Mastery Experiences

"The most effective way of developing a strong sense of efficacy is through mastery experiences,"
Bandura explained (1994). Performing a task successfully strengthens our sense of self-efficacy.
However, failing to adequately deal with a task or challenge can undermine and weaken self-
efficacy.

2. Social Modeling

Witnessing other people successfully completing a task is another important source of self-efficacy.
According to Bandura, “Seeing people similar to oneself succeed by sustained effort raises
observers' beliefs that they too possess the capabilities master comparable activities to succeed”
(1994).

3. Social Persuasion

Bandura also asserted that people could be persuaded to belief that they have the skills and
capabilities to succeed. Consider a time when someone said something positive and encouraging that
helped you achieve a goal. Getting verbal encouragement from others helps people overcome self-
doubt and instead focus on giving their best effort to the task at hand.

4. Psychological Responses

Our own responses and emotional reactions to situations also play an important role in self-efficacy.
Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about
their personal abilities in a particular situation. A person who becomes extremely nervous before
speaking in public may develop a weak sense of self-efficacy in these situations. However, Bandura also
notes "it is not the sheer intensity of emotional and physical reactions that is important but rather how
they are perceived and interpreted" (1994). By learning how to minimize stress and elevate mood when
facing difficult or challenging tasks, people can improve their sense of self-efficacy.