Full Answer Section

1. • Perceived Barriers to Action: Beliefs about the impediments, costs, or difficulties associated with a health-promoting behavior (e.g., “I don’t have time to exercise,” “It’s too expensive to eat healthy”).
   • Perceived Self-Efficacy: Belief in one’s own ability to successfully execute a behavior (e.g., “I am confident I can stick to my medication schedule”). This concept is heavily influenced by Bandura’s Social Cognitive Theory.
   • Activity-Related Affect: Feelings or emotions experienced prior to, during, or after engaging in a behavior. These can be positive (enjoyment of exercise) or negative (discomfort, boredom) and influence future engagement.
   • Interpersonal Influences: Perceptions concerning the behaviors, beliefs, or attitudes of significant others (e.g., family, peers, healthcare providers). These include norms, social support, and modeling.
   • Situational Influences: Perceptions about the external context or environment that facilitate or impede behavior (e.g., availability of healthy food options, safe walking paths, access to healthcare services).
2. Commitment to a Plan of Action: The stated intention to carry out a specific health-promoting behavior. This is crucial for translating intention into action.
3. Immediate Competing Demands and Preferences: Alternative behaviors that are low in control for the individual (demands) or high in control (preferences) but compete with the planned health behavior. (e.g., a sudden family emergency (demand) versus choosing to watch TV instead of exercising (preference)).
4. Health-Promoting Behavior: The desired outcome, representing a positive health-related action or pattern of actions (e.g., regular exercise, healthy eating, stress management, preventative screenings).

Philosophical Basis or Worldview

Pender’s HPM operates from a humanistic and holistic worldview, with a strong emphasis on individual agency and self-efficacy. It aligns with a positive health orientation, moving beyond the disease model to focus on strengths and capacities for achieving optimal well-being. It is based on the idea that individuals are rational and actively seek to regulate their own behavior.

• Change: The theory views change as a dynamic, ongoing process influenced by a multitude of interacting factors. It suggests that changes in cognitions and affect can lead to behavioral change.
• Advancing Health: The HPM directly aims to advance health by focusing on health promotion rather than just disease prevention or treatment. It encourages nurses to identify factors that motivate individuals to enhance their well-being and take proactive steps to maintain health, rather than waiting for illness to occur.

Structural Aspects and Framework of the Theory

The HPM is structured as an interactional model, where various components interact to predict the likelihood of engaging in health-promoting behaviors. It’s often depicted as a conceptual flowchart:

1. Individual Characteristics and Experiences (prior behavior, personal factors) influence
2. Behavior-Specific Cognitions and Affect (perceived benefits, barriers, self-efficacy, activity-related affect, interpersonal influences, situational influences), which in turn lead to
3. Commitment to a Plan of Action.
4. This commitment is then acted upon, but it can be interrupted by Immediate Competing Demands and Preferences, ultimately leading to
5. Health-Promoting Behavior.

The framework is largely predictive and explanatory, aiming to understand why individuals engage (or don’t engage) in health-promoting behaviors. It’s a non-linear, dynamic model that allows for feedback loops, meaning a successful health-promoting behavior can influence future perceived self-efficacy or benefits.

Applicability in Clinical Practice

Area of Practice: As an APN in a primary care clinic in Kisumu, Kenya, working with clients with newly diagnosed or uncontrolled Type 2 Diabetes Mellitus.

Question the Theory Helps to Answer: “What factors influence a client’s decision and ability to consistently engage in lifestyle modifications (diet, exercise, medication adherence) necessary for managing Type 2 Diabetes in this specific cultural and socioeconomic context?”

Relationship to the Theory/Theoretical Model: The HPM provides a robust framework for assessing and intervening with clients newly diagnosed with Type 2 Diabetes.

• Prior Related Behavior: I would assess their past adherence to health advice, exercise habits, and dietary patterns. If they’ve successfully made health changes before (even minor ones), it indicates a capacity.
• Personal Factors: I’d consider age, gender, education level, current employment, and cultural dietary practices. For example, a client’s belief about traditional healing or staple foods like ugali and sukuma wiki would be crucial.
• Perceived Benefits: Do they truly believe that managing their diabetes will improve their quality of life, prevent complications (like blindness or limb loss, which are very real fears in this setting), or allow them to care for their families longer?
• Perceived Barriers: These are often significant in this setting:
  • Financial: Cost of healthy food, transportation to clinics, medication costs.
  • Time: Long working hours, family responsibilities.
  • Social: Family/community pressure to consume certain foods, lack of social support for healthy choices.
  • Knowledge: Misconceptions about diabetes or its management.
• Perceived Self-Efficacy: Do they believe they can cook healthy meals despite limited resources? Can they incorporate exercise into a busy day? Can they remember to take their medication daily?
• Activity-Related Affect: Do they find walking enjoyable? Do they dread the taste of “diabetic-friendly” foods?
• Interpersonal Influences: What do their family members think about their diet? Do community health volunteers support them?
• Situational Influences: Is there access to safe places for physical activity? Are affordable healthy food options readily available in local markets in Kisumu? Is there reliable transport to the health center for follow-up?

Is it appropriate for the practice setting and is it applicable? Absolutely appropriate and highly applicable. The HPM’s focus on individual motivation, perceived benefits/barriers, and self-efficacy directly addresses the challenges of chronic disease management in a resource-limited setting like Kisumu. It shifts the nursing focus from simply providing information to understanding the complex web of factors that truly drive behavior change. It respects individual agency while acknowledging environmental constraints.

Strengths and Weaknesses of the Theory

Strengths:

1. Focus on Health Promotion: It proactively encourages nurses to empower clients towards health, rather than just reacting to illness. This aligns perfectly with modern healthcare goals of prevention and wellness.
2. Client-Centered: The emphasis on perceived benefits, barriers, and self-efficacy makes the model inherently client-centered. It requires the nurse to understand the client’s unique perspective, rather than imposing external goals.
3. Comprehensive Factors: It incorporates a broad range of psychological, social, and environmental factors that influence behavior, providing a holistic view.
4. Empirical Support: The HPM has been extensively researched and validated across diverse populations and health behaviors (exercise, diet, smoking cessation, cancer screening, etc.). This makes it a credible and reliable framework.