Pender's Health Promotion Model: Theory and Application

Introduction and Purpose of the Health Promotion Model

The Health Promotion Model (HPM) of nursing was originally developed out of frustration by nurse Nola J. Pender, who repeatedly witnessed that "health professionals intervened only after people developed acute or chronic disease and experienced compromised lives. Attention was devoted to treating them after the fact. This reactive approach did not reflect the philosophical beliefs of our predecessors in nursing who focused on maintaining conditions of healthy interaction between self and the environment" (Pender, 2003). The purpose of the theory was to reintroduce into nursing the concept that patients need to maintain a healthy lifestyle before chronic ailments take root. Healing the patient's lifestyle alongside treating the sick is the cornerstone of the model's mission.

Core Assumptions of the HPM

The Health Promotion Model is grounded in both its founder's nursing background and her academic study of the behavioral sciences. First and foremost, it holds that everyone, including patients, "seek to create conditions of living through which they can express their unique human health potential," and that people possess the capacity for reflective self-awareness — including assessment of their own competencies and the ability to change negative behaviors when they perceive the positive benefits of doing so (Pender, Murdaugh & Parsons, 2002). People intuitively "value growth in directions viewed as positive" and will willingly seek to actively regulate their own behavior, rather than needing others to determine it for them, once they understand how (Pender, Murdaugh & Parsons, 2002).

The model also holds that "individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time," and that "health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan" (Pender, Murdaugh & Parsons, 2002). In other words, a patient must take proactive steps to change his or her daily habits — such as altering the contents of the refrigerator, turning off the television, and going for a walk — even though a healthcare provider can offer helpful advice about balanced nutrition and exercise goals. The patient is always ultimately in control of his or her own life.

Fundamentally, the HPM assumes that "self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change" (Pender, Murdaugh & Parsons, 2002). In short, while there is a vital place for the nurse, the HPM's emphasis is on patient autonomy and the patient's fundamental desire to live a healthy lifestyle, rather than on the nurse engineering the patient's environment.

Key Concepts: Self-Efficacy and Behavioral Change

The underlying concept of the HPM is that people will engage in positive behaviors when they perceive they can gain positive rewards for those behavioral changes and when positive emotions become associated with the behavior. This can be as simple as the endorphin rush from a long, brisk walk. Perceived barriers, however, can constrain and prevent individuals from changing their behaviors just as much as — if not more than — real barriers. Once positive short-term benefits begin to accrue, greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior and supports long-term change.

The more a person sees him or herself as capable of changing, the greater the likelihood of positive changes over time. When small changes yield positive results, people are more likely to repeat those behaviors and develop a greater sense of self-efficacy. A healthcare provider can offer a needed push to initiate change, but it is up to both the individual and the provider to take note of the results, since it is the patient who must ultimately feel the sense of reward and integrate the behavioral change into a lasting lifestyle shift.