The Health Promotion Model (HPM) is a framework designed to explain and predict the likelihood of a person engaging in health-promoting behaviors. Developed by nursing theorist Nola Pender, the model shifts the focus of health care from simply avoiding illness to actively pursuing a state of high-level wellness. It posits that individuals will commit to healthy actions when they perceive the benefits outweigh the barriers, and the model functions by identifying the specific factors that influence this decision-making process.
The Purpose of the Health Promotion Model
The fundamental aim of the Health Promotion Model is to move beyond the traditional disease-prevention mindset toward achieving a positive, dynamic state of health. Unlike models centered on fear or risk (like the Health Belief Model), the HPM is directed toward increasing a client’s level of well-being and enhancing their overall quality of life.
The model organizes the factors influencing health behaviors into three main categories that progressively lead to a behavioral outcome. These categories begin with relatively static elements, called Individual Characteristics and Experiences. The second group involves Behavior-Specific Cognitions and Affect, which are the changeable motivational factors that directly precede a health action. The final category is the Behavioral Outcome itself, representing the desired health-promoting behavior.
Individual Characteristics and Experiences
The first category in the HPM acknowledges that every person brings a unique history and set of fixed attributes to any health decision. These factors are not easily changed by a health intervention, but they significantly modify the way a person processes information about a potential health behavior. The most significant variable is “Prior Related Behavior,” which research consistently shows is the strongest predictor of future behavior. For instance, a person who regularly exercised in the past is far more likely to commit to a new fitness plan.
This category also includes “Personal Factors,” which are classified as biological, psychological, and sociocultural. Biological factors encompass stable traits like age, gender, and body mass index. Psychological factors include self-esteem and self-motivation, while sociocultural factors involve race, ethnicity, education, and socioeconomic status. These stable personal factors provide the foundational context for a person’s beliefs and attitudes regarding health.
Behavior-Specific Cognitions
This section contains the core predictive variables that are dynamic and highly susceptible to intervention. These cognitions and feelings represent the person’s immediate assessment of the target health behavior before they commit to an action. The HPM focuses on these variables because they directly influence a person’s motivation to change.
One key variable is the “Perceived Benefits of Action,” which refers to the anticipated positive outcomes resulting from engaging in the behavior. A person must believe that the physical, social, or economic rewards of the action are personally valuable. Conversely, “Perceived Barriers to Action” represent the real or imagined impediments that could prevent the person from acting. These barriers might include lack of time, financial cost, inconvenience, or perceived difficulty of the activity.
The person’s belief in their ability to successfully execute a health action is known as “Perceived Self-Efficacy.” High self-efficacy means a person is confident they can overcome obstacles and perform the behavior successfully, which strongly influences their persistence and effort. Another factor is “Activity-Related Affect,” which describes the subjective feelings experienced during or immediately after the health behavior. If a person anticipates pleasure from the activity, they are more likely to repeat it, whereas feelings of boredom or pain act as deterrents.
The decision to act is further contextualized by “Interpersonal Influences,” including the social support, expectations, and modeling provided by family, peers, and healthcare providers. These influences can either encourage or discourage the behavior based on the person’s social environment. Similarly, “Situational Influences” are external factors like the availability of resources, the physical environment, and the institutional setting. For example, having a gym nearby or a safe park to walk in provides a strong situational influence supporting physical activity.
Translating Theory into Health Practice
Healthcare professionals, particularly nurses and public health officials, use the HPM to design highly targeted interventions rather than relying on generic health advice. The model directs practitioners to first assess a patient’s Individual Characteristics and Experiences, such as their past success with quitting smoking or their current sociocultural beliefs about diet. This initial assessment provides the necessary baseline for personalized care.
The most actionable phase involves addressing the Behavior-Specific Cognitions, which are the dynamic factors that can be modified. For instance, if a patient perceives a lack of time as a “Perceived Barrier to Action” for exercise, the practitioner can work with them to reframe their schedule and identify specific, small time slots for activity. To boost “Perceived Self-Efficacy,” a nurse might use small, manageable goals to ensure early success, thereby building confidence in the patient’s ability to maintain the new behavior. By systematically identifying and modifying these cognitive variables, the HPM provides a clear strategy for promoting sustained behavioral change.