Health promotion model and Health Belief model

nursing theories

1. HEALTH PROMOTION MODEL & HEALTH BELIEF MODEL Princy Francis M I st Yr MSc(N), jmcon

2. MEANING, TERMINOLOGIES Nursing Theory is an organized and systematic articulation of a set of statements related to questions in the discipline of nursing. Concepts are linguistic labels that are assigned to objects or events and are the building blocks of theories. Conceptual definitions describe and clarify the phenomenon and explain how the concepts is exposed in empirical reality. Theoretical statements or propositions are statements about the relationship between two or more concepts and are used to connect concepts to revise the theory

3. HEALTH PROMOTION MODEL Born in 1941 in lansing , Michigan. Diploma in nursing from the west suburban Hospital School of Nursing, Illnois . B.S in Nursing and M.A in human Growth and development Michigan University Ph.D in Psychology and Education from Northwestern University, Illinois in 1960.

4. Nola J Pender She did a graduate level work in community health Nursing at Rush university, Chicago. Experience in medical -surgical nursing and pediatrics. She held a faculty position in Illnois University and university of Michigan from 1990 -2001. She is professor Emiritus in the university of Michigan School of Nursing and part-time Distinguished Professor in Loyola University, Chicago. The focus of her research career has been health promotion.

5. Awards and Honours American Nurses Association book of the Year Distinguished research award from Midwest Nursing Research society An American Psychological association Award for outstanding contributions to nursing and health psychology The Mae Edna Doyle award for excellence in teaching , University of Michigan.

6. HISTORY Pender(1969) began her research about how people make decisions with her doctoral dissertation. It was first published in 1982. HPM proposed a framework for integrating nursing and behavioural science perspectives on factors influencing health behaviours The framework offered a guide for exploration of the complex biopsychosocial processes that motivate individuals to engage in behaviours directed toward the enhancement of health. The initial model had seven cognitive perceptual factors and five modifying factors

7. Cognitive perceptual factors Importance of health perceived control of health definition of health perceived health status perceived self efficacy perceived benefits perceived barriers Modifying factors demographic characteristics biologic characteristics interpersonal influences situational influences behavioural factors

8. This model is an approach or competence oriented model rather than one that include fear or threat as a key concept. In the revised model , importance of health, perceived control of health and cues to action were deleted . definition of health , perceived health status and demographic and biologic characteristics were moved and included in a category labeled “personal factors”. Three new variables, activity related affect, commitment to a plan of action and immediate competing demands and preferences were added to the model.

9. Theoretical basis Bandura’s Social Cognitive theory Feather’s Expectancy value theory Nursing perspective of Holistic Human Functioning

10. ASSUMPTIONS Person seek to create conditions of living through which they can express their unique human health potential. Person value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability. Individuals seek to actively regulate their own behavior. Individual in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed overtime .

11. ASSUMPTIONS cont …. Health professional constitute a part of the interpersonal environment, which exerts influence on the persons through out their life span. Person have the capacity for reflective self awareness including assessment of their own competencies Self initiated reconfiguration of person environment Interactive patterns is essential to behavioural change.

12. Theoretical propositions Prior behaviour and inherited and acquired characteristics influence beliefs, affect and enactment of health – promoting behaviour . Persons commits to engaging in behaviours from which they anticipate deriving personally valued benefits. Perceived barriers can constrain commitment to action, a mediator of behaviour as well as actual behaviour . Perceived competence of self-efficacy to execute a given behaviour increases the likelihood of commitment to action and actual performance of the behaviour .

13. Theoretical propositions cont … Greater perceived self-efficacy results in fewer perceived barriers to a specific health behaviour . Positive affect towards a behaviour results in greater perceived self-efficacy, which can in turn, result in increased positive affect. When positive emotions are associated with a behaviour , the probability of commitment and action is increased. Persons are more likely to commit to and engage in health-promoting behaviours when significant others model the behaviour , expect the behaviour to occur, and provide assistance and support to enable the behaviour .

14. Conceptual framework

15. HEALTH PROMOTION MODEL VARIABLE Individual characteristics and experiences Prior related behavior - Frequency of similar behaviour in the past. - Direct and indirect effects on likelihood of engaging health promoting behaviors. Personal factors Personal factors categorized as biological, psychological and sociocultural factors. These factors are predictive of a given behaviour and shaped by the nature of the target behaviour being considered.

16. HEALTH PROMOTION MODEL VARIABLE cont ….. Personal Biological Factors Include variables 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 definitions of health. Personal Sociocultural factors Include variables such as Race, ethnicity, acculturation , education and socioeconomic status 4 .

17. HEALTH PROMOTION MODEL VARIABLE cont ….. Behavioural specific cognition and affect Perceived benefits of action Anticipated positive outcomes that will occur from health behavior Perceived barriers to action Anticipated, imagined or real blocks and personal costs of understanding a given behavior Perceived self efficacy Judgment of personal capability to organize and execute a health promoting behavior.

18. Activity related Affect Subjective positive or negative feeling that occur before , during and following behavior based on the stimulus properties of the behavior itself. Interpersonal influences Cognition concerning behavior, belief, attitude of the others. Inter personal influences include norms, Social support and modelling Primary sources of interpersonal influences are families, peers and health care providers. Situational influences Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior Situational influence may have direct or indirect influences on health behaviour .

19. Behavioural outcome Commitment to plan of action The concept of intention and identification of a planned strategy leads to implementation of health behavior Immediate competing demands and preferences Competing demands are those alternative behavior over which individuals have low control because there are environmental contingencies such as work or family care responsibilities . Health promoting behaviour End Point or action outcome directed toward attaining positive health outcome such as optimal wellbeing, personal fulfillment and productive living.

20. META PARADIGM Person Refers to the individual who is the primary focus of the model. Each person has unique personal characteristics and experiences that affect subsequent actions. It is recognized that individuals learn health behaviours within the context of the family and the community.

21. Environment Refers to physical, interpersonal and economic circumstances in which persons live the quality of the environment depends on the absence of toxic substances, availability of restorative experiences and accessibility

22. Health Health is viewed as Positive high level state. According to pender , the person’s definition of health for himself or herself is more important than any general definition of health.

23. Nursing Doesnot specifically define nursing. The role of nurse includes raising consciousness related to health promoting behavior, promoting self efficacy, enhancing the benefits of change, controlling the environment to support.

24. ACCEPTANCE BY NURSING COMMUNITY Practice Health promotion in nursing practice has proven to be a primary resource in the addition of health promotion to the practice of nursing. Education Use widely among undergraduate and postgraduate Clinical education Research It is a tool for research retested the empirical precision of the model

25. NURSING PROCESS A ssessment prior related behavior of the person personal factors ( biological, psychological and sociocultural factors) Assessment can be guided by the individual characteristics and experiences and the behaviour – specific cognitions and affect. Nursing Diagnosis The nursing diagnosis would be derived from the data collected in relation to these areas but is not directly reflected in the model.

26. Planning Planning occurs in developing the plan of action to which client commits; again, the planning process is not directly reflected in the model, although the outcome of that process is reflected in the plan of action Implementation It is the actual incorporation of the health promoting behavior into the patient’s routine and life. Eg : Exercise regularly, eating healthy diet

27. Evaluation Based on the achievement of the action outcome

28. CRITIQUE Simplicity :- simple to understand clarity and lead to greater understanding of the complexity of healthy behavior The language is clear and accessible to nurses. Generality :- It is highly generalized to adult population. Empirical precision :- Pender and other’s supported the model through empirical testing as a framework for explaining health promotion.

29. STRENGTH Its strong base in research. Flexible it also supports use in practice because looking at all of the variables provides a more complete picture of the client. This completeness in turn should enhance the possibilities of positive outcomes.

30. LIMITATION It is a weakness for research as it is very difficult to measure, let alone test, all of the variables in one study. Without testing all the variable in one time, it is impossible to ascertain fully how the variables influence each other as well how they influence the outcome. a holistic nursing focus, it is not limited to use by nurses. spiritual is not included under personal factors.

31. HEALTH BELIEF MODEL

32. The Health Belief Model (HBM) is one of the first theories of health behavior. It is a psychological model that attempts to explain and predict health behaviours . This is done by focusing on the attitudes and beliefs of individuals.

33. HISTORY The Health Belief Model was first developed in the 1950s by Social Psychologists Hochbaum , Rosenstock and Kegels working in the US Public Health Services who wanted to explain why so few people were participating in programs to prevent and detect disease. The model was developed in response to the failure of a free Tuberculosis (TB) health screening program.

34. Health belief model HBM is a good model for addressing problem behaviors that evoke health concerns The health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas: the severity of a potential illness the person's susceptibility to that illness the benefits of taking a preventive action the barriers to taking that action.

35. Core Assumptions and Statements The HBM is based on the understanding that a person will take a health-related action if that person: Feels that a negative health condition can be avoided. Has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition. Believes that he/she can successfully take a recommended health action .

36. Conceptual model Individual Perceptions modifying factors likelihood of action Individual Perceptions Modifying Factors Likelihood of action Perceived benefits versus barriers to behavioural change Likelihood of behavioural change Cues to action Education Symptoms Media information Perceived threat of disease Perceived susceptibility / seriousness of disease Age, sex, ethnicity, Personality Socioeconomics Knowledge

37. MAJOR COMPONENTS /CONCEPTS There are six major concepts in HBM: 1. Perceived Susceptibility 2. Perceived severity 3. Perceived benefits 4. Perceived costs 5. Motivation 6. Enabling or modifying factors.

38. Perceived Susceptibility : refers to a person’s perception that a health problem is personally relevant or that a diagnosis of illness is accurate. Perceived severity : An individual’s perception of the seriousness of a health condition if left untreated. The combination of these is the perceived threat of the health condition (emotive response is fear). Perceived benefits : Refers to the patient’s belief that a given treatment will cure the illness or help to prevent it.

39. Perceived Barriers : The perceived impediments to taking action to improve a health condition. Perceived Costs : refers to the complexity , duration and accessibility of the treatment. Cues to Action : Body or environmental events that trigger the HBM . Those factors that will start a person on the way to changing behaviour . Modifying factors : Include personality variables, patient satisfaction, and socio-demographic factors. Self-efficacy : Personal belief in one’s own ability to do something .

40. APPLICATION OF HBM Health behaviours and subject populations. Preventive health behaviour , which include health promoting and health risk behaviours Sick role behaviours , which refers to compliance with recommended medical regimens, usually following professional diagnosis of illness. Clinical use, which includes physician visits for a variety of reasons.

41. limitation It does not account for a person's attitudes, beliefs, or other individual determinants that dictate a person's acceptance of a health behavior. It does not take into account behaviors that are habitual and thus may inform the decision-making process to accept a recommended action (e.g., smoking). It does not take into account behaviors that are performed for non-health related reasons such as social acceptability.

42. limitation It does not account for environmental or economic factors that may prohibit or promote the recommended action. It assumes that everyone has access to equal amounts of information on the illness or disease. It assumes that cues to action are widely prevalent in encouraging people to act and that "health" actions are the main goal in the decision-making process.

43. example Concept Condom Use Education Example   STI Screeing or HIV Testing Perceived Susceptibility Youth believes they can get STIs or HIV or create a pregnancy   Youth believe they may have been exposed to STIs or HIV Perceived Severity Youth believes that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.   Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. Perceived Benefits Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.   Youth believe that the recommended action of getting tested for STIs and HIV would benefit them – possibly by allowing them to get early treatment or preventing them from infecting others. Perceived Barriers Youth identify their personal barriers to using condoms (i.e. condoms limit the feeling or they are too embrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e. teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level)   Youth identify their personalbarriers to getting tested(i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options) Cues to action Youth receive reminder cues for action in the form of incentives ( such as pencils with the printed message “no glove , no love”) or reminder messages (such as messages in the school newsletter) Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”).   Self -efficacy Youth confident in using a condom correctly in all circumstances Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment.)  

44. Concept Condom Use Education Example   STI Screeing or HIV Testing Perceived Susceptibility Youth believes they can get STIs or HIV or create a pregnancy   Youth believe they may have been exposed to STIs or HIV Perceived Severity Youth believes that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.   Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. Perceived Benefits Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.   Youth believe that the recommended action of getting tested for STIs and HIV would benefit them – possibly by allowing them to get early treatment or preventing them from infecting others. Perceived Barriers Youth identify their personal barriers to using condoms (i.e. condoms limit the feeling or they are too embrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e. teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level)   Youth identify their personalbarriers to getting tested(i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options) Cues to action Youth receive reminder cues for action in the form of incentives ( such as pencils with the printed message “no glove , no love”) or reminder messages (such as messages in the school newsletter) Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”).   Self -efficacy Youth confident in using a condom correctly in all circumstances Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment.)  

45. example Concept Condom Use Education Example   STI Screeing or HIV Testing Perceived Susceptibility Youth believes they can get STIs or HIV or create a pregnancy   Youth believe they may have been exposed to STIs or HIV Perceived Severity Youth believes that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.   Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. Perceived Benefits Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.   Youth believe that the recommended action of getting tested for STIs and HIV would benefit them – possibly by allowing them to get early treatment or preventing them from infecting others. Perceived Barriers Youth identify their personal barriers to using condoms (i.e. condoms limit the feeling or they are too embrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e. teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level)   Youth identify their personalbarriers to getting tested(i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options) Cues to action Youth receive reminder cues for action in the form of incentives ( such as pencils with the printed message “no glove , no love”) or reminder messages (such as messages in the school newsletter) Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”).   Self –efficacy Youth confident in using a condom correctly in all circumstances Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment.)  

46. example Concept Condom Use Education Example   STI Screeing or HIV Testing Perceived Susceptibility Youth believes they can get STIs or HIV or create a pregnancy   Youth believe they may have been exposed to STIs or HIV Perceived Severity Youth believes that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.   Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. Perceived Benefits Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.   Youth believe that the recommended action of getting tested for STIs and HIV would benefit them – possibly by allowing them to get early treatment or preventing them from infecting others. Perceived Barriers Youth identify their personal barriers to using condoms (i.e. condoms limit the feeling or they are too embrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e. teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level)   Youth identify their personalbarriers to getting tested(i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options) Cues to action Youth receive reminder cues for action in the form of incentives ( such as pencils with the printed message “no glove , no love”) or reminder messages (such as messages in the school newsletter) Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”).   Self –efficacy Youth confident in using a condom correctly in all circumstances Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment.)  

47. Journal abstract Test of the Health Promotion Model as a Causal Model of Commitment to a Plan for Exercise Among Korean Adults with Chronic Disease The purpose of this study was to test seven constructs (prior experience of exercise, perceived health status, exercise benefits, exercise barriers, exercise self-efficacy, social support for exercise, and options for exercise) from the health promotion model (HPM) as a causal model of commitment to a plan for exercise in a sample of 400 Korean adults with chronic disease . The final model accounted for 54% of the variance in commitment to a plan for exercise. Prior experience with exercise and exercise benefits were the factors most highly related. Health professionals can assess prior experience and emphasize personally relevant benefits of exercise in designing intervention programs to help Korean adults with chronic disease become more physically active

48. Journal abstract A review of the use of the health belief model for weight management. The Health Belief Model (HBM) addresses the effects of beliefs on health and the decision process in making behavioral changes. Bowden, Greenwood, and Lutz (2005) identified it as one of the most studied theories in health education, used with varying populations, health conditions, and interventions. The model provides a comprehensive framework for understanding psychosocial factors associated with compliance. In this article, a summary of the limited research found in a professional literature review of the Health Belief Model as applied to weight management is offered. To qualify for inclusion, an article had to be either an analysis or research performed using the Health Belief Model to maintain a healthy weight or to lose weight for the person already overweight or obese.

49. assignment Write an assignment on applying health belief model and health promotion model for healthy life style.

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