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Mrs.RAJESHWARI SIVAPROFESSOR
COLLEGE OF NURSING,CMC,VELLORE
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CONCEPTUAL MODELS CONCEPTS
Building blocks of a theory thatabstractly describe an object or
phenomenon BRICKS
Eg. Anxiety, Health, Adaptation
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MODELS Symbolic representations of a
conceptualization
Less formal attempts at organizing
phenomena than theories Deal with abstractions(concepts) that are
assembled by virtue of their advance to a
common theme Broadly presents an understanding of the
phenomenon of interest and reflects the
assumptions and philosophic views of themodels designer
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FRAMEWORK
FrameworkA framework is the overall conceptualunderpinnings of a study
THEORETICAL FRAMEWORKIf based on a theory
( Orems Selfcare theory)
CONCEPTUAL FRAMEWORK
If based on a specified conceptual model
( Systems model.. Input, process andOutput)
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HEALTH BELIEF MODEL
The HBM is essentially a concept thatintegrates psychological motivators withphysical and social settings.
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ORIGIN OF HBM
Initiated in 1952 by three socio-psychologists,Godfrey Hochbaum, Stephen Kegels and IrwinRosenstock.
1950's the society realized a need to preventdisease rather than cure it.
Through a series of studies over a decade theoriginators of the HBM conducted systematicstudies in order to present a mode of behaviorthat would help prevent health problems.
In 1952 Godfrey Hochbaum presented the first
research study that would provide theidentification of symptoms pointing towards achest x-ray in order for the early diagnosis of TB.[Brown, 1999]"
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HEALTH BELIEF MODEL
HBM includes General health motivation
Peoples response to illness
Compliance with medication
Health behavior
Illness behavior
Sick- role behavior
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HEALTH BEHAVIOUR Is any activity undertaken by individuals
who believe themselves to be healthy forthe purpose of detecting and preventing
disease in any asymptomatic stage
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HEALTH BEHAVIOUR-HEALTH BELIEFS
One is susceptible to health problems Health problems have undesirable
consequences
Health problems and their consequencesusually are preventable
If health problems are to be overcome,
barriers or costs have to be overcome
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PHASES OF HBM
Individual Perceptions Modifying Factors
Likelihood of Action
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Perceivedsusceptibility to
disease XPerceived seriousness(severity ) of disease X
DEMOGRAPHICVARIABLES
(age,gender,race,ethnicity,)
Sociopsychologic variables
(personality, social class,peer and reference group
pressure,etc.)STUCTURAL VARIABLES
(knowledge about the
disease, prior contact withthe disease,etc.)
Perceivedpreventive benefits
action minusPerceived barriers
to preventiveaction
Perceived threat of
disease X
Likelihood oftaking
recommendedpreventive health
action
Cues to action
Mass media campaignsAdvice from others
reminder postcard fromphysician or dentist
illness of family member
or friend newspaper ormagazine article
MODIFYING FACTORS LIKELIHOOD OF
ACTIONOL
INDIVIDUAL
PERCEPTIONS
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INDIVIDUAL PERCEPTIONS
TYPESPerceived Susceptibility
Perceived Severity
PERCEIVED THREAT OF DISEASE
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MODIFYING FACTORS
DEMOGRAPHIC VARIABLESAge, Gender, Educational level
SOCIOPSYCHOLOGIC VARIABLES
Social class, peer pressure, Personality
STRUCTURAL VARIABLES
Knowledge about the disease, priorcontact with the disease
CUES TO ACTION
Health advice, Illness of family
member,Mass media
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LIKELIHOOD OF ACTION
Perceived severity of health problem Perceived Benefits
Perceived Barriers
Self-efficacy
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ESSENTIAL FACTORS FOREFFECTIVENESS OF HBM
Readiness of individual to considerbehavioural changes to avoid disease or tominimize health risks
Existence and power of forces in theindividual s environment that urge changeand make it possible
Behaviors of the individual Each of these above factors are influenced
by personality, environment,past experience
with health services and health personnel
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EXAMPLES
Lifestyle modification among the obesewomen
Prevention of osteoporosis among
menopausal women Dietary modification among diabetics in
order to maintain glycemic levels
Health beliefs among Indian Muslimwomen towards mammography as ascreening procedure for breast cancer
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Perceivedsusceptibility to
disease XPerceived seriousness(severity ) of disease X
DEMOGRAPHICVARIABLES
(age,gender,race,ethnicitySOCIOPHYCHOLOGIC
VARIABLES
(personality, social class,peer and reference group
pressure,etc.)STUCTURAL VARIABLES
(knowledge about the
disease, prior contact withthe disease,etc.)
Perceivedpreventive benefits
action minusPerceived barriers
to preventiveaction
Perceived threat of
disease X
Likelihood oftaking
recommendedpreventive health
action
Cues to action
Mass media campaignsAdvice from others
reminder postcard fromphysician or dentist
illness of family member
or friend newspaper ormagazine article
MODIFYING FACTORS LIKELIHOOD OFACTIONOL
INDIVIDUALPERCEPTIONS
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HEALTH PROMOTIONMODEL
I committed myself to the proactive stanceof health promotion and disease prevention
with the conviction that it is much better toexperience exuberant well-being and preventdisease than let disease happen when it isavoidable and then try and cope with it.
Nola J. Pender, PhD, RN, FAAN
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HPM
The Health Promotion Model (HPM) proposedby Nola J Pender (1982; revised, 1996) wasdesigned to be a complementary counterpart tomodels of health protection.
It defines health as a positive dynamic state notmerely the absence of disease.
Health promotion is directed at increasing aclients level of wellbeing.
It describes the multi dimensional nature ofpersons as they interact within theirenvironment to pursue health.
It is a wellness oriented framework forexplaining and predicting the health promotingcomponents of life
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PURPOSE
Integrating nursing and behavioralscience perspectives on factors thatinfluence health behaviors.
Exploring the biophysical processes that
motivate individuals to engage in behaviorsdirected toward health enhancement
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Major concepts
Individual characteristics and experiencesPrior related behavior and personalfactors
Behavior - specific cognitions and affect
Perceived benefits of action Perceived selfefficacyActivity related affectInterpersonal influences
Situational influences Behavioral outcomes
Commitment to a plan of actionImmediate competing demands
PreferencesHealth promoting behavior
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COGNITIVE/PERCEPTUAL
FACTORS
MODIFYING
FACTORS
PARTICIPATION IN HEALTH-
PROMRTING BEHAVIORS
Importance of
Health
Perceived Control
of Health
Perceived
Self-Efficacy
Definition of
Health
Perceived Health
Status
Perceived
Benefits of Health
Promoting
Behaviors
Demographic
Characteristics
Biologic
characteristics
Interpersonal
Influences
Situational
Factors
Behavioral
factorsLikelihood
Engaging in
Health-Promoting
Behaviors
Cues to action
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(1987)
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THEORETICAL PROPOSITIONS OF THE
HEALTH PROMOTION MODEL
Prior behavior and inherited and acquired characteristicsinfluence beliefs, affect, and enactment of health-promoting behavior.
Persons commit to engaging in behaviors from which
they anticipate deriving personally valued benefits. Perceived barriers can constrain commitment to action, a
mediator of behavior as well as actual behavior. Perceived competence or self-efficacy to execute a given
behavior increases the likelihood of commitment to
action and actual performance of the behavior. Greater perceived self-efficacy results in fewer perceived
barriers to a specific health behavior. Positive affect toward a behavior results in greater
perceived self-efficacy, which can in turn, result in
increased positive affect. When positive emotions or affect are associated with a
behavior, the probability of commitment and action isincreased.
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THEORETICAL PROPOSOTION Persons are more likely to commit to and engage in health-promoting
behaviors when significant others model the behavior, expect thebehavior to occur, and provide assistance and support to enable thebehavior.
Families, peers, and health care providers are important sources ofinterpersonal influence that can increase or decrease commitment to and
engagement in health-promoting behavior.
Situational influences in the external environment can increase ordecrease commitment to or participation in health-promoting behavior
The greater the commitments to a specific plan of action, the more likely
health-promoting behaviors are to be maintained over time
Commitment to a plan of action is less likely to result in the desiredbehavior when demands over which persons have little control requireimmediate attention. 13. Commitment to a plan of action is less likely toresult in the desired behavior when other actions are more attractive and
thus preferred over the target behavior.
Persons can modify cognitions, affect, and the interpersonal and physicalenvironment to create incentives for health actions.
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AREAS OF FOCUS IN HPM
Individual characteristics and experiences Behavior-specific cognitions and affect
Behavioral outcomes
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MAJOR CONCEPTS
Individual Characteristics and Experience
Prior related behavior
Frequency of the similar behavior in thepast.
Direct and indirect effects on the likelihood
of engaging in health promoting behaviors.
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PERSONAL FACTORS
Biological factorsAge, gender, body mass index, pubertal
status, aerobic capacity, strength,
agility, or balance Psychological factors
Self esteem, self motivation, personal
competence, perceived health statusand definition of health.
Socio-cultural factors
Race ethnicity, acculturation, educationand socioeconomic status.
Behavioral Specific Cognition and Affect
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PRIOR RELATED BEHAVIOUR PERCEIVED BENEFITS OF ACTION
Anticipated positive out comes that will occur from
health behavior
PERCEIVED BARRIERS TO ACTION
Anticipated, imagined or real blocks and personalcosts ofunderstanding a given behavior
PERCEIVED SELF EFFICACYJudgment of personal capability to organize
and execute a health-promoting behavior.
Perceived self efficacy influences perceived barriers toaction so higher efficacy result in lowered perceptions ofbarriers to the performance of the behavior.
ACTIVITY RELATED AFFECTSubjective positive or negative feeling that occurred
before, during and following behaviorActivity-related affect influences perceived self-
efficacy
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INFLUENCES
INTERPERSONAL INFLUENCESNorms (expectations of significant others)Social support (instrumental and emotionalencouragement)
Modeling (vicarious learning throughobserving others engaged in a particularbehavior)Primary sources of interpersonal influences(families, peers, and healthcare providers)
SITUATIONAL INFLUENCESPerceptions of options availableDemand characteristics
Aesthetic features of the environment
Situational influences may have direct or indirectinfluences on health behavior.
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ASSUMPTIONS
Individuals seek to actively regulate theirown behavior.
Individuals in all their biopsychosocialcomplexity interact with the environment,progressively transforming the environment andbeing transformed over time.
Health professionals constitute a part of theinterpersonal environment, which exertsinfluence on persons throughout their lifespan.
Self-initiated reconfiguration of person-environment interactive patterns is essential tobehavior change
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EXAMPLES
Foot care practices of Diabetic clients
Promoting quality of life amonghospitalized elderly
Predicting Lifestyles in workplace ofworkers in steel industry
Effects of stress management amonghypertensive clients
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Perceivedsusceptibility to
disease XPerceived seriousness(severity ) of disease X
DEMOGRAPHICVARIABLES
(age,gender,race,ethnicity,)
Sociopsychologic variables
(personality, social class,peer and reference group
pressure,etc.)STUCTURAL VARIABLES
(knowledge about the
disease, prior contact withthe disease,etc.)
Perceivedpreventive benefits
action minusPerceived barriers
to preventiveaction
Perceived threat of
disease X
Likelihood oftaking
recommendedpreventive health
action
Cues to action
Mass media campaignsAdvice from othersreminder postcard from
physician or dentistillness of family memberor friend newspaper or
magazine article
MODIFYING FACTORS LIKELIHOOD OF
ACTIONOL
INDIVIDUAL
PERCEPTIONS
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Marriner TA, Raile AM. Nursing theorists and their work. 5th ed.Sakraida T.Nola J. Pender. The Health Promotion Model. St
Louis: Mosby; 2005
Polit DF, Beck CT. Nursing research: Principles and methods.
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Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6thed. Philadelphia: Elsevier Mosby; 2006.
Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis:
Elsevier Mosby; 2006.
Wills and McEwen(2007). Theoretical Basis for Nursing. 2nd
Edition. Philadelphia: Lippincott Williams and Wilkins.
Aonuevo, C., Abaquin, C., Balabagno, A., Corcega, T., Dones,
L., Kuan, L., et. al. (2000). Theoretical Foundation of Nursing.
Philippines: UP Open University
Kozier, B., Erb, G., Berman, A., Snyder, S. (2004).Fundamentals of Nursing: Concepts, Process, and Practice. 7th
Edition. Philippines: Pearson Education South Asia Pvt Ltd
University of Michigan School of Nursing (2006). Nora J. Pender
Site. Retrieved Jan 23, 2010 from
http://www.nursing.umich.edu/faculty/penderPender N J, S N Walker, K R Sechrist & M Frank-Stronbourg.
Nursing Research, 39, pp 326-332.
Thomas Butler.J,Principle of Health Education and Health
Promotion,Wadsworth / Thomson Learning,USA; 2001
REFERENCE
http://www.nursing.umich.edu/faculty/penderhttp://www.nursing.umich.edu/faculty/pender7/28/2019 Theoty Application in Research
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