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CHAPTER 21 Nola J. Pender 403

5. Individuals in all their biopsychosocial complexity 8. Persons are more likely to commit to and engage
interact with the environment, progressively trans- in health-promoting behaviors when significant
forming the environment and being transformed others model the behavior, expect the behavior
over time. to occur, and provide assistance and support to
6. Health professionals constitute a part of the inter- enable the behavior.
personal environment, which exerts influence on 9. Families, peers, and health care providers are
persons throughout their life spans. important sources of interpersonal influences
7. Self-initiated reconfiguration of person-environment that can increase or decrease commitment to and
interactive patterns is essential to behavioral change engagement in health-promoting behavior.
(pp. 54–55). 10. Situational influences in the external environ-
ment can increase or decrease commitment to or
participation in health-promoting behavior.
Theoretical Assertions 11. The greater the commitment to a specific plan of
The model depicts the multifaceted natures of persons action, the more likely health-promoting behav-
interacting with the environment as they pursue health. iors are to be maintained over time.
The HPM has a competence- or approach-oriented 12. Commitment to a plan of action is less likely to
focus (Pender, 1996). Health promotion is motivated result in the desired behavior when competing
by the desire to enhance well-being and to actualize demands over which persons have little control
human potential (Pender, 1996). In her first book, require immediate attention.
Health Promotion in Nursing Practice, Pender (1982) 13. Commitment to a plan of action is less likely to
asserts that complex biopsychosocial processes moti- result in the desired behavior when other actions
vate individuals to engage in behaviors directed toward are more attractive and thus preferred over the
the enhancement of health. Fourteen theoretical asser- target behavior.
tions derived from the model appear in the fourth edi- 14. Persons can modify cognitions, affect, and the
tion of the book, Health Promotion in Nursing Practice interpersonal and physical environments to cre-
(Pender, Murdaugh, & Parsons, 2002): ate incentives for health actions (pp. 63–64).
1. Prior behavior and inherited and acquired charac-
teristics influence beliefs, affect, and enactment of
health-promoting behavior. Logical Form
2. Persons commit to engaging in behaviors from The HPM was formulated through induction by use
which they anticipate deriving personally valued of existing research to form a pattern of knowledge
benefits. about health behavior. The HPM is a conceptual
3. Perceived barriers can constrain the commitment model from which middle-range theories may be de-
to action, the mediator of behavior, and the actual veloped. It was formulated with the goal of integrat-
behavior. ing what is known about health-promoting behavior
4. Perceived competence or self-efficacy to execute a to generate questions for further testing. This model
given behavior increases the likelihood of com- illustrates how a framework of previous research fits
mitment to action and actual performance of be- together, and how concepts can be manipulated for
havior. further study.
5. Greater perceived self-efficacy results in fewer per-
ceived barriers to specific health behavior. Acceptance by the Nursing Community
6. Positive affect toward a behavior results in greater
perceived self-efficacy, which, in turn, can result in Practice
increased positive affect. Wellness as a nursing specialty has grown in promi-
7. When positive emotions or affect is associated nence, and current state-of-the-art clinical practice
with a behavior, the probability of commitment includes health promotion education. Nursing profes-
and action is increased. sionals find the HPM relevant, as it applies across the