Nora Pender Model of Health Promotion

Healthcare Access

Advanced Nursing Practice

Nora Pender Model of Health Promotion:

Improving healthcare access to underserved diabetes patients in rural areas

The health promotion theory used to justify this project will by that of the Nora Pender Model of Health Promotion. The focus of this study will be upon expanding access of rural communities to healthcare. Pender's model stresses the need to work with patients to empower them to make positive life choices. When healthcare access is limited, it is essential that patients are given the tools to make empowering choices regarding their healthcare on a day-to-day basis. Rural patients are often hampered by access to both information and regular quality care. The model suggests that with knowledge and support provided by more accessible care at local clinics this can change.

The philosophy of the model is that health is "a positive dynamic state not merely the absence of disease" and that "health promotion is directed at increasing a client's level of well-being" ("Health promotion model," 2012). While "perceived barriers" can constrain positive actions on one hand, on the other hand the concept of "personally valued benefits" can change negative behaviors ("Health promotion model," 2012). The environment can enhance negative behaviors, including the patient's social environment (such as a culture that normalizes obesity, eating unhealthy foods and a lack of healthcare access) or it can normalize health-promoting activities. The goal is ultimately to engage in acts of positive social facilitation the latter.

A good example of the use of the health promotion model is in limiting the spread of diabetes in rural areas and also improving treatment of this chronic condition. "Compared to urban areas, rural areas experience a 17% higher diabetes prevalence rate" (Massey et al. 2010). Higher poverty rates combined with a decline of traditional manual labor-related jobs like farming have conspired to make the rate of diabetes particularly high in such communities. Furthermore, even compared to urban dwellers of similar incomes, patients suffering from diabetes in rural areas lack access to effective methods of control, resulting in more severe and more rapid degeneration of their health, ultimately costing both the patient and the healthcare system more over time. For example, "it is not uncommon for rural diabetes patients to have difficulty affording glucose meter strips for routine glucose self-monitoring or to have foregone screenings, such as eye examinations, that are crucial to the detection of diabetes-associated comorbidities" (Massey et al. 2010). Systemic barriers are compounded for minority populations which have household incomes 40-50% below rural white households (Massey et al. 2010).

This proposed intervention would enable the creation of low-cost mobile clinics specific for diabetes education and treatment. As well as making diabetes medications and supplies available to affected patients it would also offer nurse educators that could teach prediabetic patients about healthier ways to budget their food shopping and provide them with suggestions about how to incorporate exercise into their daily activities. Telemedicine has also been shown to be beneficial to diabetes patients. Glucose monitoring can take place through conferences between providers and patients over the phone and healthcare information can be regularly shared via email.