Theories in Health Education

• Pender's Health Promotion Theory


  Holistic predictive model of Health-promoting behavior for use in research and practice, developed by Nola J. Pender in 1982 and revised in 1996

  
• Nola J. Pender


  • Professor Emeritus in the School of Nursing at the University of Michigan, and an advocate of health promotion
• Health Promotion

  Behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness.
• Health Protection or Illness Prevention

  Behavior motivated by the desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness.
• Sequence of major components and variables in Pender's Health Promotion Theory


  • 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, interpersonal influences, and situational influences)
  • Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior)

  
• Personal factors in Pender's Health Promotion Theory

  • Biological factors (age, gender, body mass index, pubertal status, aerobic capacity, strength, agility, or balance)
  • Psychological factors (self-esteem, self-motivation, personal competence, perceived health status and definition of health)
  • Socio-cultural factors (race, ethnicity, acculturation, education and socio-economic status)
• Perceived benefits of action

  Anticipated positive outcomes that will occur from health behaviour
• Perceived barriers to action


  Anticipated, imagined or real blocks and personal costs of understanding a given behaviour
• Perceived self-efficacy


  Judgement of personal capability to organize and execute a health-promoting 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
• Interpersonal influences


  • Norms (expectations of significant others)
  • Social support (instrumental and emotional encouragement)
  • Modeling (vicarious learning through observing others engaged in a particular behaviour)
• Situational influences

  Personal perceptions and cognitions of any given situation or context that can facilitate or impede behaviour
• Commitment to plan of action

  The concept of intention and identification of a planned strategy leads to implementation of health behavior

  
• Immediate competing demands


  Alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities
• Competing preferences


  Alternative behaviors over which individuals exert relatively high control, such as choice of ice cream or apple for a snack
• Assumptions of the Health Promotion Model

  • Individuals seek to actively regulate their own behavior
  • 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

  
• Theoretical propositions of the Health Promotion Model

  • 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
  • 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
  • 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

  
• Nursing Practice "We are moving toward an era of science-based practice in nursing that incorporates the latest findings from the behavioral and biological sciences into practice to assist people of varying cultural backgrounds to adopt healthy lifestyles." – Pender
• 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
• Self-efficacy


  The belief in one's capabilities to organize and execute the courses of action required to manage prospective situations
• Bandura's Social Cognitive Model


  • There are 3 factors that influence self-efficacy: Behaviors, Environment, and Personal/Cognitive factors
• Self-system


  A person's attitudes, abilities, and cognitive skills that play a major role in how we perceive situations and how we behave in response to different situations

  
• Four major sources of self-efficacy

  • Enactive mastery (experiences that provide feedback on learners' own capabilities)
  • Vicarious experiences (those that provide comparative information about the attainments of others such as observing successful expected behavior through the modeling of others)
  • Verbal persuasion (provides the learner with information about what others believe he or she is capable of doing)
  • Physiological states and internal feelings by which learners judge their ability to engage in the task at hand (emotional arousal through self-judgment of physiological states of distress, psychological responses)

  
• Social modeling


  Witnessing other people successfully completing a task
• Verbal persuasion


  Provides the learner with information about what others believe he or she is capable of doing
• Verbal persuasion


  People could be persuaded to believe that they have the skills and capabilities to succeed
• Verbal persuasion


  Getting verbal encouragement from others helps people overcome self-doubt and instead focus on giving their best effort to the task at hand and behavior
• Physiological states and internal feelings

  Learners judge their ability to engage in the task at hand
• Emotional arousal through self-judgment of physiological states of distress

  Psychological responses
• Psychological responses


  • One's own responses and emotional reactions to situations
  • Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about their personal abilities in a particular situation
• Example of physiological states and internal feelings


  • A person who becomes extremely nervous before speaking in public may develop a weak sense of self-efficacy in these situations
• 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"
• Learning how to minimize stress and elevate mood when facing difficult or challenging tasks

  People can improve their sense of self-efficacy
• The health belief model was developed in the 1950s by social psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal at the U.S. Public Health Service to better understand the widespread failure of screening programs for tuberculosis
• The health belief model has been applied to predict a wide variety of health-related behaviors such as being screened for the early detection of asymptomatic diseases and receiving immunizations