Wednesday, October 27, 2010

Health Promotion Model


http://currentnursing.com/nursing_theory/health_promotion_model.html

21SEP2010


INTRODUCTION

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 chang

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

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.

PERSONAL FACTORS
Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behaviour being considered.

Personal biological factors

  • Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance.

Personal psychological factors

  • Include variables such as self esteem self motivation personal competence perceived health status and definition of health.

Personal socio-cultural factors

  • Include variables such as race ethnicity, accuculturation, education and socioeconomic status.
  • Behavioural Specific Cognition and Affect

PERCEIVED BENEFITS OF ACTION

  • Anticipated positive out comes 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

Judgment of personal capability to organise and execute a health-promoting behaviour. 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

Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behaviour itself. Activity-related affect influences perceived 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

Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal influences include: norms (expectations of significant others), social support (instrumental and emotional encouragement) and modelling (vicarious learning through observing others engaged in a particular behaviour). Primary sources of interpersonal influences are families, peers, and healthcare providers.

SITUATIONAL INFLUENCES

Personal perceptions and cognitions of any given situation or context that can facilitate or impede behaviour. Include perceptions of options available, 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 behaviour.

Behavioural Outcome

COMMITMENT TO PLAN OF ACTION

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

IMMEDIATE COMPETING DEMANDS AND PREFERENCES

Competing demands are those alternative behaviour over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behaviour over which individuals exert relatively high control, such as choice of ice cream or apple for a snack

HEALTH PROMOTING BEHAVIOUR

Endpoint or action outcome directed toward attaining positive health outcome such as optimal well-being, personal fulfillment, and productive living.

REFERENCES

  1. Marriner TA, Raile AM. Nursing theorists and their work. 5th ed. Sakraida T.Nola J. Pender. The Health Promotion Model. St Louis: Mosby; 2005
  2. Polit DF, Beck CT. Nursing research:Principles and methods. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2007
  3. Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6th ed. Philadelphia: Elsevier Mosby; 2006.
    Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier Mosby; 2006.

Health promotion theories and models

http://www.healthpromotionagency.org.uk/Healthpromotion/Health/section5.htm

21SEP2010

There are a number of significant theories and models that underpin the practice of health promotion. It would be useful to make a differentiation between theories and models.

The following information has been adapted from Theory at a glance. A guide for health promotion practice. (Second edition). (US Department of Health and Human Services. National Institutes of Health. 2005.) For further information go to www.nci.nih.gov/theory

Theory

  • An integrated set of propositions that serves as an explanation for a phenomenon
  • Introduced after a phenomenon has already revealed a systematic set of uniformities
  • A systematic arrangement of fundamental principles that provide a basis for explaining certain happenings of life

Examples: Social Cognitive Theory, Theory of Planned Behaviour

Model

  • A subclass of a theory. It provides a plan for investigating and or addressing a phenomenon
  • Does not attempt to explain the processes underlying learning, but only to represent them
  • Provides the vehicle for applying the theories

Examples: Health Belief Model, Transtheoretical Model

The main models and theories utilised can be summarised as follows:

1. Those theories that attempt to explain health behaviour and health behaviour change by focusing on the individual.
Examples include:

  • Health Belief Model
  • Theory of Reasoned Action
  • Trans theoretical (stages of change) Model
  • Social Learning Theory

2. Theories that explain change in communities and community action for health.
Examples include:

  • Community mobilisation
    • social planning
    • social action
    • community development
  • Diffusion of innovation

3. Models that explain changes in organisations and the creation of health- supportive organisational practices.
Examples include:

Theories of organisational change

Summary of Theories: Focus and Key Concepts

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Theory

Focus

Key concepts

Individual Level

Stages of Change Model

Individual's readiness to change or attempt to change toward healthy behaviours

Precontemplation
Contemplation
Decision/determination
Action
Maintenance

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Health Belief Model

Person's perception of the threat of a health problem and the appraisal of recommended behaviour(s) for preventing or managing the problem

Perceived susceptibility
Perceived severity
Perceived benefits of action
Cues to action
Self-efficacy

Interpersonal Level

Social Learning Theory

Behaviour is explained via a 3-way, dynamic reciprocal theory in which personal factors, environmental influences and behaviour continually interact

Behaviour capability
Reciprocal determinism
Expectations
Self-efficacy
Observational learning
Reinforcement

Community Level

Community Organisation Theories

Emphasises active participation and development of communities that can better evaluate and solve health and social problems

Empowerment
Community competence
Participation and relevance
Issue selection
Critical consciousness

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Organisational Change Theory

Concerns processes and strategies for increasing the chances that healthy policies and programmes will be adopted and maintained in formal organizations

Problem definition (awareness stage)
Initiation of action (adoption stage)
Implementation of change
Institutionalization of change

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Diffusion of Innovations Theory

Addresses how new ideas, products and social practices spread within a society or from one society to another

Relative advantage
Compatibility
Complexity
Trialability
Observability

Stages of change

In the transtheoretical model as of 1997, change is a "process involving progress through a series of six stages"[

  • Precontemplation - "people are not intending to take action in the foreseeable future, usually measured as the next 6 months"
  • Contemplation - "people are intending to change in the next 6 months"
  • Preparation - "people are intending to take action in the immediate future, usually measured as the next month"
  • Action - "people have made specific overt modifications in their life styles within the past 6 months"
  • Maintenance - "people are working to prevent relapse," a stage which is estimated to last "from 6 months to about 5 years"
  • Termination - "individuals have zero temptation and 100% self-efficacy... they are sure they will not return to their old unhealthy habit as a way of coping"

In addition, the researchers conceptualized "relapse" (recycling) which is not a stage in itself but rather the "return from action or maintenance to an earlier stage

SINCERE THANKS TO PROF. RAMESH

2 comments:

  1. It was the first time my granddaughter came to me and confided about her battle with oral and genital herpes and her self destructive thoughts.
    A gaping vacuum of fear and love opened inside me. I knew what it felt like for her to be in such a situation. But after hearing how someone I loved so dearly struggled I have no option but to promise her help. I wanted to help in all possible ways. I sought counsels from an old and experienced nurse whom I've known to deal on natural herbs because I believed in nature. After hearing from me she smiled and before I could say another word she replied me there's cure but natural herbs. I don't care as long as my child is cured! I shouted. She told me about a doctor in Africa who has cured people of herpes. She gave me his email drutuherbalcure@gmail.com ,I contacted him immediately and then ordered medicine for my child which he sent through the UPS courier to me. My daughter started medication and the next day her mouth sores were physically healing and she told me it's working and within four weeks she testified to me that she was cured! I've always believed that nature has cure for any diseases and I'm happy to tell everyone my child is cured.
    Six months later we went for another test to be sure and here is the result,
    Six months after medications;
    Her hsv1&2 test results;
    Igm - 1.49
    IgG - 0.36
    She don't have any symptoms again and has moved on happily and is now in a serious relationship with her fiancee.

    ReplyDelete
  2. It was the first time my granddaughter came to me and confided about her battle with oral and genital herpes and her self destructive thoughts.
    A gaping vacuum of fear and love opened inside me. I knew what it felt like for her to be in such a situation. But after hearing how someone I loved so dearly struggled I have no option but to promise her help. I wanted to help in all possible ways. I sought counsels from an old and experienced nurse whom I've known to deal on natural herbs because I believed in nature. After hearing from me she smiled and before I could say another word she replied me there's cure but natural herbs. I don't care as long as my child is cured! I shouted. She told me about a doctor in Africa who has cured people of herpes. She gave me his email drutuherbalcure@gmail.com ,I contacted him immediately and then ordered medicine for my child which he sent through the UPS courier to me. My daughter started medication and the next day her mouth sores were physically healing and she told me it's working and within four weeks she testified to me that she was cured! I've always believed that nature has cure for any diseases and I'm happy to tell everyone my child is cured.
    Six months later we went for another test to be sure and here is the result,
    Six months after medications;
    Her hsv1&2 test results;
    Igm - 1.49
    IgG - 0.36
    She don't have any symptoms again and has moved on happily and is now in a serious relationship with her fiancee.

    ReplyDelete