Evaluation of The Health Promotion Theory & Rationale for Using the Theory
Evaluation of The Health Promotion Theory
Significance of the Health Promotion Theory
The Health Promotion Theory aids nurses in providing efficient, individualized care to patients. The theory provides a framework and model for nurses to assess and influence health-promoting behaviors in their patients. The propositions of the theory are made explicit in the model (to access the model, please refer to the "ABOUT" section of this site). In the first column, prior behavior and personal factors are listed as predisposing factors for an individual's health promoting behavior. In the second column, perceived self-efficacy, perceived barriers, perceived benefits, interpersonal influences, and situational influences are areas that influence the health promoting behaviors of the individual. The final column describes commitment to an action as a prerequisite to a health promoting behavior (Peterson & Bredow, 2014). The author and creator of the theory is Nola Pender, a registered nurse with her bachelors, masters, and PhD degree (Peterson & Bredow, 2014).
While Pender’s theory provides nurses with interventions to impact health promotion, it does not specifically address how nurses can provide motivation to their patients. The theory assumes intrinsic client catalysts for change, which can not be always guaranteed. While the Health Promotion Theory does provide direction for caring for healthy individuals, it provides little direction on how to promote health in those that are already sick. Those battling chronic illness are often reluctant toward change. Lastly, this theory focuses on changing individual behaviors and perceptions but does not address societal and environmental factors that affect an individual's health.
While Pender’s theory provides nurses with interventions to impact health promotion, it does not specifically address how nurses can provide motivation to their patients. The theory assumes intrinsic client catalysts for change, which can not be always guaranteed. While the Health Promotion Theory does provide direction for caring for healthy individuals, it provides little direction on how to promote health in those that are already sick. Those battling chronic illness are often reluctant toward change. Lastly, this theory focuses on changing individual behaviors and perceptions but does not address societal and environmental factors that affect an individual's health.
Consistency and Clarity
The general goal of the Health Promotion Theory is clear as well as the inter-relatedness between the pathways that lead to the goal (Peterson & Bredow, 2013). The theory clearly emphasizes the predisposing factors that can influence an individual's health in column one. (To access the model, please refer to the "ABOUT" section of this site) The arrows that point from column one to column two demonstrate that the first column influences the second column. The second column labeled “behavior-specific cognitions and affect” lists perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity related affect, interpersonal and situational influences as factors that influence behavior. The arrows that point from column two to column three demonstrate that these factors influence an individual’s commitment to action and whether or not they engage in a health promoting behavior. The consistency of the theory is evident in that all facets of the theory support health promotion.
While the general goal of the Health Promotion Theory is clear as well as the inter-relatedness between pathways, the theory can be implemented diversely. For instance, while two clients need improved diabetes management, one might be motivated by the social support of his children while the other is motivated by his improved body image. While the end goal is clear, the perceived client motivations differ. The Health Promotion Theory is limited in clarity because health promotion goals can be subjective and not easily measured. While the diverse client motivators and subjective goal measures might limit clarity of the theory, they in no way affect the theory's impact and value.
While the general goal of the Health Promotion Theory is clear as well as the inter-relatedness between pathways, the theory can be implemented diversely. For instance, while two clients need improved diabetes management, one might be motivated by the social support of his children while the other is motivated by his improved body image. While the end goal is clear, the perceived client motivations differ. The Health Promotion Theory is limited in clarity because health promotion goals can be subjective and not easily measured. While the diverse client motivators and subjective goal measures might limit clarity of the theory, they in no way affect the theory's impact and value.
Adequacy
The Health Promotion Theory is adequate because it has the capability to be implemented for any setting or individual. The theory can be used in a variety of environments such as schools, workplaces, street communities, and even prisons (Peterson & Bredow, 2013). On an individual level, the Health Promotion Theory can be individualized to the client and the lifestyle changes that are most appropriate for them. For example, if an individual finds empowerment to make healthy choices through their children, this source of strength is reinforced. If an individual is reinforced by social support, they might be urged to join a workout class. The Health Promotion Theory can be implemented in diverse settings and for diverse people (Peterson & Bredow, 2013). Therefore, the implementation can create far-reaching effects.
While the Health Promotion Theory has the capability of being implemented in diverse settings and with diverse people, this implementation has not occurred yet on a significant level (Peterson & Bredow, 2013). Theory research and implementation in diverse areas is therefore encouraged. Another critique of the theory is that it is better suited for already healthy people. Individuals with long term chronic illnesses might struggle in gaining a sense of self-efficacy and determination to change. For instance, it is far easier for a non-diabetic to maintain a healthy weight than for a diabetic to loose weight. The Health Promotion Theory's emphasis on self-efficacy might help this population in making health changes.
While the Health Promotion Theory has the capability of being implemented in diverse settings and with diverse people, this implementation has not occurred yet on a significant level (Peterson & Bredow, 2013). Theory research and implementation in diverse areas is therefore encouraged. Another critique of the theory is that it is better suited for already healthy people. Individuals with long term chronic illnesses might struggle in gaining a sense of self-efficacy and determination to change. For instance, it is far easier for a non-diabetic to maintain a healthy weight than for a diabetic to loose weight. The Health Promotion Theory's emphasis on self-efficacy might help this population in making health changes.
Feasibility
The Health Promotion Theory has high feasibility; the theory can be implemented with ease. For instance, exercise does not require much financial input. Individuals can walk outside, go to the park, or do isometric exercises in their own home without having to pay for a gym membership. The nation is already pushing for a focus on preventative health as evidenced by the Affordable Care Act (Dejoy, Dyal, Padilla, & Wilson, 2014). This national push for health promotion can be attributed to the correlation between health promotion and long term cost savings (Robert Woo Johnson Foundation, 2013). Health promotion often does not cost much to implement and the cost savings are significant.
While promoting health for individuals requires little financial input, research does indicate that many of the determinants of health are related to money and resources (Raphael & Bryant, 2006). Individuals from a lower socioeconomic class have restricted access to healthy food, both geographically and financially (Bower, Thorpe, Rohde, & Gaskin, 2013). This population has more exposure to unhealthy lifestyles (drinking, smoking) and less awareness of the effects of these lifestyle choices. Additionally, those struggling financially tend to have limited excess time to devote to exercise due to working long hours or multiple jobs.
While promoting health for individuals requires little financial input, research does indicate that many of the determinants of health are related to money and resources (Raphael & Bryant, 2006). Individuals from a lower socioeconomic class have restricted access to healthy food, both geographically and financially (Bower, Thorpe, Rohde, & Gaskin, 2013). This population has more exposure to unhealthy lifestyles (drinking, smoking) and less awareness of the effects of these lifestyle choices. Additionally, those struggling financially tend to have limited excess time to devote to exercise due to working long hours or multiple jobs.
Testability
Testability refers to the ability to test and observe the concepts of the theory through empirical instruments. The Health Promotion Theory includes components that can be tested and measured empirically. Questionnaires can be distributed to measure self-efficacy at present. Longitudinal studies can be implemented to measure behavior change over time. The Exercise Benefits and Barriers Scale is an example of an instrument that has already been used to measure this theory's success (Pender, n.d.).
As the theory is very individualized, it is difficult to exclude all extraneous factors in research. For example, one diabetic might benefit from social support and join a gym while the other enjoys nature and walks outside. While both are working toward diabetes management, it is difficult to assess the success of the theory with such diverse interventions. Additionally, The Health Promotion Theory is poorly testable because self efficacy is subjective. Self efficacy is a perceived emotion and can be swayed by personal demeanor or mood. Lastly, most measures of the Health Promotion Theory discount the benefits of partial implementation of the intervention and often view behavior change as an “all or nothing” phenomenon.
As the theory is very individualized, it is difficult to exclude all extraneous factors in research. For example, one diabetic might benefit from social support and join a gym while the other enjoys nature and walks outside. While both are working toward diabetes management, it is difficult to assess the success of the theory with such diverse interventions. Additionally, The Health Promotion Theory is poorly testable because self efficacy is subjective. Self efficacy is a perceived emotion and can be swayed by personal demeanor or mood. Lastly, most measures of the Health Promotion Theory discount the benefits of partial implementation of the intervention and often view behavior change as an “all or nothing” phenomenon.
"The first wealth is health." Ralph Waldo Emerson
Rationale For Using The Health Promotion Theory
According to the Center for Disease Control and Prevention (2014), chronic illnesses are the leading cause of death and disability in the United States. One of the most common chronic illnesses is diabetes (Chronic Disease and Health Promotion, 2014). The Health Promotion Theory can be utilized by advanced practice nurses (APN) for proper management of chronic illnesses because it can "assist nurses in understanding the major determinants of health behaviors as a basis for behavioral counseling to promote healthy lifestyles (Pender, n.d.)."
The control of diabetes is a life-long commitment and it is vital that APNs assist patients in understanding the importance of appropriate management, provide resources for management, and help the patients to understand that they are ultimately accountable for their health. The APN can assess the underlying characteristics, experiences, assumptions, barriers, and promoters of the health of the patient. The advanced practice nurse can then assist the patient to understand these factors and utilize them to create an individualized health plan. The use of the Health Promotion Model focuses on the accountability of the individual related to management of their disease, and emphasizes the importance of multiple factors that can influence one’s achievement of health. Therefore, APNs should spend time not only on the treatment and prevention of a disease, but also on the development of human potential to manage their disease (Peterson & Bredow, 2013).
The Health Promotion Model acknowledges that an individual has the potential to control their chronic illness through the utilization of goals, self-care, and relationships (Peterson & Bredow, 2013). The APN in the outpatient setting can provide patient empowerment through education, goal creation, and accountability. It is important that the APN does not create the plan, but rather works with the individual in the creation of a health plan that acknowledges their own strengths and limitations (Peterson & Bredow, 2013). This approach will allow for the creation of feasibly achievable goals. The use of an individualized health plan can be particularly useful to control diabetes which is affected by diet, exercise, proper medication management, and proper support systems. In a study by Tay, et al. (2014), a low carbohydrate, low-saturated fat diet resulted in tighter glycemic control, improved blood glucose profile, and patients required fewer diabetes medications compared to a high carbohydrate, low saturated fat diet. This study demonstrates the importance of diet in proper management of diabetes, and thus, an area of influence for APNs and self-efficacy for the patient.
The control of diabetes is a life-long commitment and it is vital that APNs assist patients in understanding the importance of appropriate management, provide resources for management, and help the patients to understand that they are ultimately accountable for their health. The APN can assess the underlying characteristics, experiences, assumptions, barriers, and promoters of the health of the patient. The advanced practice nurse can then assist the patient to understand these factors and utilize them to create an individualized health plan. The use of the Health Promotion Model focuses on the accountability of the individual related to management of their disease, and emphasizes the importance of multiple factors that can influence one’s achievement of health. Therefore, APNs should spend time not only on the treatment and prevention of a disease, but also on the development of human potential to manage their disease (Peterson & Bredow, 2013).
The Health Promotion Model acknowledges that an individual has the potential to control their chronic illness through the utilization of goals, self-care, and relationships (Peterson & Bredow, 2013). The APN in the outpatient setting can provide patient empowerment through education, goal creation, and accountability. It is important that the APN does not create the plan, but rather works with the individual in the creation of a health plan that acknowledges their own strengths and limitations (Peterson & Bredow, 2013). This approach will allow for the creation of feasibly achievable goals. The use of an individualized health plan can be particularly useful to control diabetes which is affected by diet, exercise, proper medication management, and proper support systems. In a study by Tay, et al. (2014), a low carbohydrate, low-saturated fat diet resulted in tighter glycemic control, improved blood glucose profile, and patients required fewer diabetes medications compared to a high carbohydrate, low saturated fat diet. This study demonstrates the importance of diet in proper management of diabetes, and thus, an area of influence for APNs and self-efficacy for the patient.