BIOPSYCHOSOCIAL MODEL

A. PENDER’S HEALTH PROMOTION THEORY

Health Promotion Model has given health care a new direction. According to Nola J. Pender, Health Promotion and Disease Prevention should be the primary focus in health care, and when health promotion and prevention fail to prevent problems, and then care in illness becomes the next priority. She defined 2 concepts: health promotion & health protection.

Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness. On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness.

This model is moving towards understanding multi-faceted nature of persons correlating with their interpersonal nature and interacting with their interpersonal

& physical environments as they trail towards health.Because of the model, nurses have already advanced their health approaches, addressing not only the curative side, but as well as prevention of diseases & promotion of well-being. Application of this theory is varied and substantive on its own.

Pender’s Health Promotion Model

- Is a competence or approach-oriented model that depicts the multideminsional nature of persons interacting with their interpersonal and physical environments as they pursue health.

- Focused on health promoting behaviors rather than health protection or illness prevention behaviors.

Variables of Health Promotion Model1. Individual characteristics and experience

- An individual’s unique factors or characteristics and experiences will depend on the target behavior for health promotion.

Includes the following:A. Personal factor

Biological Psychological Socio-cultural

B. Prior related behavior

Previous experience Knowledge Skills in health promoting actions

2. Behavioral–specific cognitions and affect- Constitute critical core for intervention because this can be modified through

nursing interventions. Includes the following:A. Perceived benefits of action

- anticipated benefits or outcome affect the persons plan to participate in health-promoting behaviors and may facilitate continued practice (can be affected by experience/vicarious experience).

B. Perceived barriers to action- person’s perceptions about available time, inconvenience expense and

difficulty performing the activity may act as a barrier (decrease commitment to a plan of action).

C. Perceived self-efficacy- the conviction that the person can successfully carryout the behavior

necessary to achieve a desired outcome (serious doubt about capabilities decrease effort and give-up)

D. Activity related affect- the subjective feelings that occur before, during, and following an activity

influence a person to repeat again or maintain behavior.E. Interpersonal influence

- perception of the person concerning the behavior, beliefs or attitudes of others.

- includes expectations of significant others, social support and learning through observing others.

Sources of interpersonal Influences:1. Family2. Peers3. health professionals

(sources of interpersonal influence can affect the person’s health-promoting behaviors)

F. Situational Influence- direct and indirect influence on health-promoting behaviors.- a person is apt to perform health-related behaviors if the environment is

comfortable versus feeling of alienation.Includes the following:1. Perception of available options2. Demand characteristic3. Aesthetic features of the environment

3. Commitment to a plan of action- The interest of a person in carrying-out and reinforce health-promoting behaviors.Involves 2 process:1. Commitment – good intention2. Identifying specific strategy – actual performance of the behavior

4. Immediate competing demands and preferences

- Situations that the person is experiencing in everyday life that could affect the control of health-promoting behaviors.

Involves 2 types of control:1. Low control2. High control

5. Behavioral outcome- Directed towards attaining positive health outcome for the client- Should result in improved health and better quality of life at all stages of

development.

B. BANDURA’SSELF-EFFICACY THEORY

- Self-efficacy theory of Albert Bandura Self-efficacy – perception/belief of

a person about his own capabilities to produce effect.

Self-regulation – exercise of influence over one’s own motivation, thought process emotional state and patterns of behavior.

Sources of self-efficacy- Self efficacy is developed by

four (4) main source of influence4 main source of influence1. Mastery of Experience/performance accomplishment2. Vicarious Experience provided by social models3. Social persuasion (Support/Motivation from significant others)4. Reduction of stress reactions and alter negative emotional proclivities and

interpretation of physical and emotional traits.

“Strong sense of efficacy enhances human accomplishment and personal well-being in many ways.”

Efficacy- Activated processes- There are 4 major psychological processes through which self-belief of efficacy

affect human functioning.4 Major Psychological Processes:1. Cognitive Process

- Thinking process, involve acquisition, organization and use of information.- Most course of actions are initially organized in thought.

2. Motivational Process- Cognitive generated- Activation to action

Levels of motivation:

Choice of course of action Intensity Persistence of effort

- Motivation processes is covered by 3 types of Self-Influence:a. Self-satisfyingb. Self- dissatisfying reactions to one’s performancec. Perceived self efficacyd. Readjustment of personal goal based on one’s progress

3. Affective Process- Process regulating emotional state and elicitation of emotional reactions.- The stronger the sense of self-efficacy the bolder people are in taking on

taxing and threatening activities.4. Selection Process

- The choices the person make that cultivate different competencies, interest and social network that determines life courses.

“Self- Efficacy is concerned with people’s beliefs in their capabilities to exercise control over their own functioning and over events that affect their lives.”

C. BECKER’S HEALTH BELIEF MODEL

D. GREENE’S PRECEDE-PROCEED MODEL

- Developed by Green, Kreuter, and associates.- The PRECEDE-PROCEED model provides a comprehensive structure for assessing

health and quality-of-life needs and for designing, implementing, and evaluating health promotion and other public health programs to meet those needs.

- PRECEDE (P redisposing, R einforcing, and E nabling C onstructs in E ducational D iagnosis and E valuation) outlines a diagnostic planning process to assist in the development of targeted and focused public health programs.Five steps or phases:1. Phase one/Social Assessment – involves determining the quality of life or social

problems and needs of a given population.2. Phase two/Epidemiological Assessment– consists of identifying the health

determinants of these problems and needs.3. Phase three/Behavioral and Environmental Assessment – involves analyzing the

behavioral and environmental determinants of the health problems.

4. In phase four/Educational and Ecological Assessment – the factors that predispose to, reinforce, and enable the behaviors and lifestyles are identified.The three types of influencing factors include:a. Predisposing factors – which motivate or provide a reason for behavior; they

include knowledge, attitudes, cultural beliefs, and readiness to change.b. Enabling factors – which enable persons to act on their predispositions; these

factors include available resources, supportive policies, assistance, and services.c. Reinforcing factors – which come into play after a behavior has been initiated;

they encourage repetition or persistence of behaviors by providing continuing rewards or incentives. Social support, praise, reassurance, and symptom relief might all be considered reinforcing factors.

5. Phase five/Administrative and Policy Assessment – involves ascertaining which health promotion, health education and/or policy-related interventions would best be suited to encouraging the desired changes in the behaviors or environments and in the factors that support those behaviors and environments.

- PROCEED (P olicy, R egulatory, and O rganizational C onstructs in E ducational and E nvironmental D evelopment) guides the implementation and evaluation of the programs designed using PRECEDE.Four additional phases.1. Phase six/Implementation – the interventions identified in phase five are

implemented.2. Phase seven/Process Evaluation – entails process evaluation of those interventions.3. Phase eight/Impact Evaluation – involves evaluating the impact of the interventions

on the factors supporting behavior, and on behavior itself.4. The ninth and last phase/Outcome Evaluation – comprises outcome evaluation—that

is, determining the ultimate effects of the interventions on the health and quality of life of the population.

- In actual practice, PRECEDE and PROCEED function in a continuous cycle. Information gathered in PRECEDE guides the development of program goals and objectives in the implementation phase of PROCEED. This same information also provides the criteria against which the success of the program is measured in the evaluation phase of PROCEED. In turn, the data gathered in the implementation and evaluation phases of

PROCEED clarify the relationships examined in PRECEDE between the health or quality-of-life outcomes, the behaviors and environments that influence them, and the factors that lead to the desired behavioral and environmental changes. These data also suggest how programs may be modified to more closely reach their goals and targets.

BANDURA'S SELF EFFICACY IN HEALTH BEHAVIOR OF AN INDIVIDUAL

Psychologist Albert Bandura has defined self-efficacy as one's belief in one's ability to succeed in specific situations. One's sense of self-efficacy can play a major role in how one approaches goals, tasks, and challenges.

The theory of self-efficacy lies at the center of Bandura’s social cognitive theory, which emphasizes the role of observational learning and social experience in the development of personality. The main concept in social cognitive theory is that an individual’s actions and reaction in almost every situation is influenced by the actions which that individual has observed in others. People observe others acting within an environment whether natural or social. These observations are remembered by an individual and help shape social behaviors and cognitive processes. This theoretical approach proposes the idea that by changing how an individual learns their behaviors in the early stages of mental development could have a large impact on their mental processes in later stages of development. Since self-efficacy is developed from external experiences and self-perception and is influential in determining the outcome of many events, it is an important aspect of social cognitive theory. Self-efficacy represents the personal perception of external social factors. According to Bandura's theory, people with high self-efficacy —that is, those who believe they can perform well —are more likely to view difficult tasks as something to be mastered rather than something to be avoided.

Health behaviors such as non-smoking, physical exercise, dieting, condom use, dental hygiene, seat belt use, or breast self-examination are, among others, dependent on one’s level of perceived self-efficacy. Self-efficacy beliefs are cognitions that determine whether health behavior change will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and failures. Self-efficacy influences the effort one puts forth to change risk behavior and the persistence to continue striving despite barriers and setbacks that may undermine motivation. Self-efficacy is directly related to health behavior, but it also affects health behaviors indirectly through its impact on goals. Self-efficacy influences the challenges that people take on as well as how high they set their goals (e.g., "I intend to reduce my smoking," or "I intend to quit smoking altogether"). A number of studies on the adoption of health practices have measured self-efficacy to assess its potential influences in initiating behavior change. Often single-item measures or very brief scales (e.g., 4 items) have been used. It is actually not necessary to use larger scales if a specific behavior is to be predicted. More important is rigorous theory-based item wording. A rule of thumb is to use the following semantic structure: "I am certain that I can do xx, even if yy (barrier)”. If the target behavior is less specific, one can either use more items that jointly cover the area of interest, or develop a few specific sub-scales. Whereas general self-efficacy measures refer to the ability to deal with a variety of stressful situations, measures of self-efficacy for health behaviors refer to beliefs about the ability to perform certain health behaviors. These behaviors maybe defined broadly (i.e., healthy food consumption) or in a narrow way (i.e., consumption of high-fiber food).