Penders Health Promotion Model an Integrative Literature Review

Open Periodical of Nursing
Vol.08 No.07(2018), Article ID:86144,19 pages
10.4236/ojn.2018.87037

Health Promotion Model: An Integrative Literature Review

Ibrahim Aqtam¹, Muhammad Darawwad²

¹Ministry building of Health, Nablus, Palestine

²Schoolhouse of Nursing, The Academy of Jordan, Amman, Jordan

Copyright © 2018 by authors and Scientific Research Publishing Inc.

This work is licensed nether the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/past/four.0/

Received: July 3, 2018; Accustomed: July 21, 2018; Published: July 24, 2018

Abstruse

Groundwork: The Health Promotion Model (HPM) indicates that each person is a biopsychosocial animal that is partially shaped by the environment, but as well seeks to create an environment in which inherent and acquired homo potential can be fully expressed. The HPM is proposed as a holistic predictive model of health-promoting beliefs for use in research and practice. Purpose: The purpose of this review is to examine how the HPM has been applied in diverse research studies. Methods: An integrative review was used to detect studies that were guided by the HPM. Information search was between 2008 to 2018 using Google Scholar, Scopus, Web of Scientific discipline, Scientific discipline Direct, PubMed, Medline, CINAHL, EBSCO, Cochrane, ERIC, Joanna Briggs Institute and EBSCO host. The keywords used were Pender's and Wellness Promotion Model. Results: Seventeen studies were reviewed; most of them were quantitative studies. These studies discussed variables from the HPM. Well-nigh of the study variables were measured using instruments derived from the HPM. The results of the reviewed studies revealed that the HPM had predictive value in estimating health-promoting behaviors. Decision: The HPM was widely established in the nursing community and was implemented in nursing practice, education, and research. In add-on, the HPM constructs were used to hypothesize conceptual frameworks in many studies to predict health-promoting behaviors in many chronic diseases.

Keywords:

Pender's and Health Promotion Model, Wellness Promoting Behaviors, Women, Children, Workers, and Students

1. Introduction

The Health Promotion Model (HPM) was created past Pender in 1982 and was revised in 1987, 1996, and 2002. Pender's groundwork in nursing, human development, experimental psychology, and didactics led her to employ a holistic nursing perspective, social psychology, and learning theory as foundations for the HPM [1]. The Health Promotion Model (HPM) provides a framework to explain and predict specific health behaviors [2]. The HPM shows that each person is a biopsychosocial creature that is partially shaped by the environment, but besides seeks to create an surroundings in which inherent and acquired human potential tin be fully expressed [iii]. The HPM was originally developed to target individuals; however the framework can be used to target families, groups, or communities. The HPM comprises 3 primary areas that nurses can use to assess health promotion behaviors: 1) personal characteristics and experiences; 2) behaviors-specific knowledge and affect; and 3) behavioral outcome. Moreover, the HPM incorporates elements of the change process, including a commitment to a plan of action and acknowledgement of competing demands. The final outcome is engagement in health promotion behaviors [4]. Pender puts her efforts to develop a model that guide nursing order equally a whole through interactions at the individual level and biophysical processes that motivate individuals to participate in wellness-promoting behaviors leading to overall well-beingness [iii]. Pender'south model provides of import guides for nursing professionals as they focus on wellness promotion strategies for patients and for research aimed at prediction of health-promoting behaviors. Finally, HPM has been tested in unlike populations and settings. Furthermore, it was widely accepted by the nursing community and is currently used in nursing do, research and education [5]. For this reason, this literature review comes to examine how the HPM has been applied in various research studies.

ii. Methods

2.1. Search Strategy

In this review, the search was performed by different international databases including Google Scholar, Scopus, Web of Science, Science Direct, PubMed, Medline, CINAHL, EBSCO, Cochrane, ERIC, Joanna Briggs Institute and EBSCO host using the keywords of "Health Promotion Model", "Health-Promoting Behaviors", "Women's", "Children", "Workers", and "Students". Initially, separated with each new search added a new keyword until including all keywords. Later, these words were searched in combination with each other, starting with search process targeted main resources with no geographical limits and targeted disciplines other than nursing such as psychology, public wellness, and social works. Boolean operators (AND, OR) accept been applied separately and in combination with the keywords to expand, combine, or exclude keywords in a search to narrow downwardly the results and reach a more focused and productive results. Articles excluded from search those that focus on populations not comparable to nurses and articles published in languages other than English language. However, the searching process was limited to following inclusion criteria: 1) the article was published in a peer-reviewed nursing journal; ii) HPM was the conceptual framework or ane of the conceptual frameworks that guided the study; 3) the study was inquiry based; iv) full text article was nowadays; 5) commodity was published in English language linguistic communication; and 6) articles published between 2008 and 2018.

2.2. Overview of the Reviewed Studies

The electronic search revealed 40 articles; 23 articles were excluded because they were non enquiry-based articles or were not published in a peer-reviewed nursing journal. The 17 enquiry studies that met the inclusion criteria were retrieved and reviewed, where 16 of them used quantitative research methodologies [vi] - [21], and i used qualitative methodology [22]. Cantankerous-exclusive research pattern was the most commonly used design in the quantitative studies, and 2 studies used quasi experimental design [18] [xx], and one report used a randomized clinical trial [10] (Come across Effigy 1).

two.iii. The Purposes of the Reviewed Studies

There were wide variations in the purposes of the reviewed studies. Generally, the purposes of these studies tin can be categorized into ii main categories. The start category is the studies that described aspects of the HPM in different populations, while the second category is the studies that tested relationships either amongst different variables of HPM, or between selected HPM variables and other variables.

The first category included half-dozen studies which described the everyday physical activity habits of students and analyzed the exercise of concrete activeness and its determinant [6], identified and documented factors influencing the Intermittent Preventive Treatment (IPTp2) in pregnancy + uptake [12], examined facilitators

and barriers that migrant women in Turkey identified related to breast self-examination, clinical breast examination, and mammography [22], determined health promoting behaviors of university students in Jordan and factors influencing them [15], adamant the knowledge of and compliance with standard precautionary measures among nurses in Madonna University Instruction Infirmary [17], and examined the factors that may influence health responsibility, relationships, resilience, neighborhood perception, social support, and health promoting behaviors in adolescents, betwixt the ages of 13 and 18 years sometime [21]. All these studies contributed to understanding the awarding of HPM in different populations.

The second category included xi studies which evaluated the HPM equally a mean to predict concrete activity (PA) in a sample of Iranian boyish boys [7], compared perceived self-efficacy, do benefits, exercise barriers, and commitment to practise between patients diagnosed with osteoporosis and osteoarthritis, and assessing the influence of perceived do self-efficacy, exercise benefits, and barriers on delivery [viii], explored perceived exercise self-efficacy, benefits and barriers, and commitment to exercise amongst Jordanians with chronic illnesses [xiv], explored perception of exercise benefits and barriers among Jordanian patients' with End Stage Renal Disease (ESRD) [11], used HPM to provide insight into the relationship between dietary and fluid non-adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support amidst Jordanian patients with ESRD receiving hemodialysis [9], conducted an evaluation of an educational program based on the HPM and stages of change to improve physical activeness (PA) behavior among Iranian adolescents [10], used Pender'south HPM to depict and identify the predictors of health-promoting behaviors in Nepalese migrant workers in Korea [13], examined the psychometric properties of the Arabic version of Bandura'due south Practice Self-Efficacy scale (ESE-A) among Jordanian patients with different chronic diseases [16], assessed the effect of application of Pender's HPM on management of hypertension amidst adults in rural area [18], examined the impact of performing a HPM intervention on concrete activity of the health Volunteers [19], and investigated the effect of Pender's HPM to improve the nutritional beliefs of overweight and obese women admitted to Fatemiyeh Hospital clinics in Hamadan, Iran [20]. All these studies tested relationships among different variables of the HPM. Those studies revealed that testing relationships among dissimilar variables of the HPM will enhance the predictive ability of this model in predicting the wellness-promoting behaviors.

2.4. Sample of Populations

Different samples and populations were used in the reviewed studies. By and large, the samples and populations of these studies can be categorized into iv categories. The first category is the studies that recruited students with dissimilar level of pedagogy, 79 students in a public school [6], 515 boys from 100 junior loftier and high schools [7], 165 adolescents aged 13 - 15 years sometime from high schools [10], 525 university students receiving education from two governmental and i private universities [15], and 122 adolescents students betwixt the ages of 13 and xviii years quondam [21]. The second category is the studies that tested a samples and populations of chronic illness. The samples were 75 patients with a clinical diagnosis of osteoporosis and 75 patients with osteoarthritis [8], 190 patients with ESRD receiving hemodialysis [9], 190 patients with ESRD [xi], 402 outpatient with chronic illnesses [xiv], 272 patients with chronic illness [16], and 150 adults with hypertension [18].

The third category is the studies that target women with unlike wellness condition. The samples were 278 pregnant women who were at the 24th week or more of gestation, aged between fifteen and 49 years [12], 39 women who were older than twenty years [22], and 108 overweight women [20]. The last category is the studies that involved workers from different background. The samples were 169 immigrant workers [13], 102 nurses working in Madonna University Educational activity Infirmary [17], and 80 health volunteers [nineteen]. It can be noticed that studies involved a broad range of populations with different sample sizes in different settings. Using such different populations and settings indicated that the HPM is applicative and highly generalizable.

2.5. The Primal Variables

Many variables and concepts take been comprehensively discussed in the reviewed studies. Nearly of these variables are components of the HPM. Some studies discussed one or two variables. For case, some studies described the concrete activity of students and its determinants [6], identified factors influencing preventive treatment in pregnancy [12], determined health promoting behaviors amidst university students [xv], determined the cognition of and compliance with standard precautionary measures among nurses [17], and evaluated do self-efficacy amongst Standard arabic patients with chronic diseases by assessing the psychometric backdrop of the Standard arabic version of Exercise Self-Efficacy calibration (ESE-A) [16].

While other studies discussed more than than 2 variables utilized from HPM. For example, some studies evaluated the HPM concepts (perceived benefits, perceived barriers, do self-efficacy, enjoyment of PA, social support, and exposure to modeling, interpersonal norms, delivery to PA planning, competing demands) as a means to predict PA [7], compared perceived cocky-efficacy, practice benefits, practice barriers, and commitment to exercise between patients diagnosed with osteoporosis and osteoarthritis, and assessing the influence of perceived exercise self-efficacy, exercise benefits, and barriers to delivery [viii], used HPM and its stages of change to improve PA behavior amid adolescents [10], examined the touch of performing HPM intervention on PA of the wellness volunteers [xix], and used HPM to examine relationship betwixt dietary and fluid non adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support among patients with ESRD [ix]. Moreover, some studies explored perception of exercise benefits and barriers along with the factors associated with such perceptions among patients with ESRD [xi], assessed the human relationship between perceived practise self-efficacy, benefits and barriers, and commitment to exercise planning [14], used HPM to describe and identify the predictors of health-promoting behaviors among migrant workers [13], and examined facilitators and barriers that migrant women identified related to breast self-exam, clinical breast examination, and mammography [22]. Furthermore, some studies assessed the effect of application of HPM on direction of hypertension among adults [eighteen], investigated the result of HPM to improve the nutritional beliefs of overweight and obese women [20], and examined relationships among health responsibleness, resilience, neighborhood perception, social support, and health promoting behaviors in adolescents [21].

Testing relationships among variables of the HPM or with other variables in different settings and using different populations is very of import in exploring and validating the relationships and volition enhance the predictive value of the HPM.

2.6. Information Collection Methods

Self report method was used in all of the studies every bit a information collection method. Specifically, self administered questionnaires were used in nigh of the reviewed studies. Even so, ane report used interview for information collection [22], and other studies used several techniques to collect information such as self reported questionnaire, ascertainment, anthropometric evaluation, and measuring blood pressure [6] [18].

2.7. Measuring Instruments

Many instruments were used for data collection. The review of these studies revealed that all of the research instruments used were derived from the HPM. These instruments included Pender's Health-Promoting Behavior Scale, Pender's Commitment to a Plan of Action Scale, Pender's Perceived Benefits Calibration, Pender's Perceived Barriers to Action Calibration, and Pender's Preference Scale. All used instruments are presented in (Appendix A).

3. Results

The reviewed studies examined HPM in unlike settings, populations, and circumstances. So, the results of each written report are relatively unique and tin be generalized to people who share the same characteristics of the report population. Ane study institute that the first component "previous behaviors and personal factors" of Pender's theoretical model of health promotion tin be related to the daily routine of children and adolescents, focusing on physical activities [half dozen]. While, another report showed that, the HPM deemed for 37% of the variance in Physical Action (PA) but did not stand for a good information fit, there were significant pathways betwixt PA and self-efficacy, enjoyment, and PA modeling, the revised model that included the indirect furnishings of competing demands explained 34% of the variance in PA and represented a proficient data fit, and self-efficacy, commitment to planning, and enjoyment were linked to PA. Additionally, competing demands take an effect on PA [7].

Moreover, another study revealed that osteoporotic patients had significantly higher mean scores of commitment to plan, and college exercise self-efficacy, while the mean score of do benefit was higher in the osteoarthritis group. In addition, a significant positive correlations were found between commitment and perceived self-efficacy scores, and betwixt cocky-efficacy and perceived lack of barriers and exercise benefits in both groups, age was a negative predictor for delivery in osteoporosis group, while self-efficacy and lack of barriers were positive predictors, and in osteoarthritis group, cocky-efficacy was the only positive predictor of commitment [viii]. A unlike study amidst ESRD patients showed total delivery to nutrition guidelines and to fluid guidelines, depression had significant negative association with quality of life, and the results besides revealed a predictive model of but two variables: historic period and residual renal role for dietary non-adherence [9]. A like population with different variables study revealed that participants had significantly perceived more exercise benefits compared with do barriers [11].

Furthermore, a significant correlation has been plant between delivery to practise planning with barriers and benefits amongst chronically ill patients, and self-efficacy was not correlated with other variables [14]. From the other side, exercise cocky-efficacy among patients with different chronic illnesses was evaluated by assessing the psychometric properties of the Arabic version of Do Self-Efficacy calibration (ESE-A), the results showed significant correlation with weekly exercise frequency, duration, and evaluation of physical practice, and the ESE-A was plant to be a fit measure to evaluate exercise cocky-efficacy among Standard arabic patients with chronic diseases [xvi].

Nevertheless, differences in all HPM constructs, except activity-related touch on and social influences, were meaning between baseline and follow-up measurements, adolescents in the intervention as compared to the control group were placed in action (70%) or preparation (30%) stages at follow-up, and the results revealed that competing preferences, social norms, part models, and commitment to action plan tin can significantly predict PA behavior, and the model accounted for 22.5% of the variance in PA [10]. Moreover, a group of pregnant women aged between 15 and 49 years coming to public health facilities to place and document factors influencing the Intermittent Preventive Treatment in pregnancy (IPTp2) + uptake, the results indicated that 37.2% participants who had obtained less than IPTp2 and 53.5% who accessed IPTp2+ reported receiving support from their partners towards Antenatal Care (ANC) visits, and the relationship betwixt the uptake of IPTp services and cocky-reported take chances-perception was not significant, also the relationship between the uptake of IPTp and perceived seriousness of malaria infection during pregnancy was not meaning, while perception about the elapsing suggesting up to 95% chance that the uptake of IPTp significantly associated with the duration taken at the health facilities earlier receiving services, and the attitude of almost providers at the ANC facilities 99% hazard that the uptake of IPTp significantly associated with perceived attitudes of providers towards significant women attending ANC clinics (P = 0.000) [12].

Another report identified predictors of wellness-promoting behaviors among 169 workers, the results revealed that spiritual activity was the highest reported health-promoting beliefs, whereas physical activity was the least practiced beliefs, and self-efficacy was the only significant predictor of health-promoting behavior [13]. Furthermore, in a sample of 525 academy students receiving pedagogy from two governmental and one private universities in Hashemite kingdom of jordan, a pregnant differences found betwixt wellness-promoting behavior and educatee's age, gender, employment status, family income, university type, and faculty type, also significant differences found betwixt males and females on health responsibility and interpersonal relations, stress management, and spiritual growth [fifteen]. From the other side, a study based on HPM to direct health protection among 102 nurses working in pedagogy hospital, establish that cognition of respondents and their compliance with standard precautionary measures was in a higher place boilerplate. The majority of the nurses (80%) comply with both medical and surgical asepsis [17].

A different study aimed to appraise the effect of application of HPM on management of hypertension among 150 adults in Egypt, showed that there was statistical significant improvement among the written report group than the control group at the posttest of health-promoting behavior, and the highest mean score was in the posttest of nutrition dimension followed by medication adherence, stress management and concrete action, only smoking had no statistical meaning improvement [18]. Moreover, a significant deviation among 80 health volunteers in Iran constitute between the mean scores of physical activity and other structures of HPM in the experimental group after the intervention and its score before intervention [19]. Nevertheless, an experimental study to investigate the effect of Pender'southward HPM in improving the nutritional beliefs of 108 overweight and obese women visits hospital clinics in Islamic republic of iran, showed pregnant differences in the experimental group before and after the intervention in nutritional behavior, perceived benefits, perceived self-efficacy, commitment to activity, interpersonal and situational influences, beliefs-related touch on, and perceived barriers [20].

In another correlation study to examine the relationships betwixt health responsibleness, social support, resilience, neighborhood perception, and wellness behaviors among 122 adolescents betwixt the ages of 13 and eighteen years quondam, the results institute a meaning relationships between wellness responsibility and health promoting behaviors and between health responsibility and neighborhood perception, besides no relationships were plant betwixt the dependent variable of health responsibility and the independent variables of resilience and social support in this population [21].

Finally, a qualitative study used an interview guided by the Wellness Belief Model (HBM) and the Health Promotion Model (HPM) to examine facilitators and barriers among 39 women in Turkey related to breast self-examination, clinical breast examination, and mammography. Iii master themes were emerging: 1) knowledge and awareness nigh breast cancer; two) personal factors; and 3) medical service provider and social environs. Too the results showed that HBM and HPM were effective in explaining barriers and facilitators toward participation of women in screening behaviors. Additionally, lack of information, indifference, and cultural factors are the near important barriers of women [22].

four. Discussion

This integrative literature review showed that Pender's HPM tin can be used for conducting studies that predict effective benefits/barriers in health-promoting behaviors, detect impacts of intervention for improving health-promoting behaviors, examination this model, predict stage or level of change in related factor affecting wellness-promoting behavior, and to decide the relationship of variables associated with health-promoting behaviors.

The studies predicting effective benefit/barriers and the meaning determinants of health-promoting behaviors emphasized the fact that according to Pender's model, healthcare providers/professionals tin sympathize and address modifiable behavior-specific variables [23]. Therefore, they are ready to identify wellness benefits/barriers and recommend wellness-promoting behaviors guidance and social back up to all people. Likewise, they should consider these variables in interventions to increase healthy lifestyle. Applications of Pender's model guide the development of successful theory-based interventions and provided evidence of the effectiveness of several interventions based on this theory. Moreover, HPM is useful in decreasing risk factors of diseases, especially chronic diseases and symptoms, and promote salubrious lifestyle [24].

Finally, identifying wellness-promoting behavior and predicting phase of change related factors tin can affect health-promoting behavior, so HPM tin can exist very useful, especially to examine the similarities and differences among groups, and healthcare providers can use these similarities and differences to assess, identify and use constructive health-promotion programs, strategies and interventions [25].

v. Conclusion

The HPM has become prevalent in later years and might be practical in understanding wellness-promoting behaviors. Such integrated review showed that HPM is valid and applicable in different nursing settings. Direct or indirect influences of HPM predictors on health-promoting behaviors have been confirmed in this paper. Such an integrative review paper approves that HPM provides a framework to understand the factors and variables that influence the initiation of wellness-promoting behaviors in different settings with different populations. This newspaper shows that the effective employ of bear witness-based inquiry in nursing practice requires an integrated review such as our review paper.

Conflicts of Involvement

The authors declare no conflicts of interest regarding the publication of this paper.

Cite this newspaper

Aqtam, I. and Darawwad, M. (2018) Wellness Promotion Model: An Integrative Literature Review. Open up Journal of Nursing, 8, 485-503. https://doi.org/10.4236/ojn.2018.87037

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Appendix A: Studies Guided by Health Promotion Model (north = 17)

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