Health promotion models in nursing: Pender, the health belief model and stages of change
- Fundamental
These models explain why people adopt or avoid healthy behaviours, so the nurse can tailor education and support to each person.
What it is
Health promotion models help nurses understand the reasons behind health behaviour. Nola Pender's health promotion model (1980) places the person's characteristics and experiences, perceived benefits and barriers, self-efficacy and interpersonal support at the centre of health-promoting behaviour. The health belief model explains action through perceived susceptibility and severity, perceived benefits and barriers, cues to action and self-efficacy. The transtheoretical model describes stages of change, from not considering a change to maintaining it. Used together, they help the nurse choose what to say and when.
Key points
- Perceived susceptibility: how vulnerable the person feels to a condition.
- Perceived severity: how serious the person thinks its consequences would be.
- Perceived benefits and barriers: the advantages and the costs or obstacles the person sees in acting.
- Cues to action: internal or external triggers, such as a symptom or a campaign.
- Self-efficacy: confidence in being able to carry out the behaviour despite obstacles.
- Stages of change: people move at their own pace, often back and forth, without skipping stages.
Components
- Pender's model: individual characteristics and experiences, behaviour-specific beliefs (benefits, barriers, self-efficacy), interpersonal influences and the resulting health-promoting behaviour.
- Health belief model: perceived threat, the balance of benefits and barriers, cues to action and self-efficacy.
- Transtheoretical model: five stages, with relapse as a return to old behaviour rather than a stage.
What it is for
- Explain why two people with the same information behave differently.
- Guide the content and timing of health education.
- Help design counselling for hypertension, cardiovascular prevention, breastfeeding or tobacco cessation.
- Give a frame to evaluate whether an intervention changed beliefs and behaviour.
Three health promotion models at a glance
| Model | Key idea | What the nurse does |
|---|---|---|
| Pender's health promotion model | Behaviour depends on personal factors, perceived benefits and barriers, self-efficacy and support | Choose achievable goals, reduce barriers, build confidence and involve the support network |
| Health belief model | People act when they feel threatened, see more benefits than barriers and get a cue | Explain the real risk, show benefits, remove barriers and offer reminders |
| Stages of change | Change happens in stages and often with setbacks | Identify the stage and match the message: awareness, motivation, planning or relapse prevention |
In nursing practice
- Precontemplation: the person does not see a problem; the nurse raises awareness of risks without confrontation.
- Contemplation: the person is ambivalent; motivational interviewing explores reasons and lowers barriers.
- Preparation: the person plans to change soon; the nurse gives practical information and helps make a plan.
- Action and maintenance: the nurse supports, reinforces progress and plans how to handle triggers and relapse.
- A review of nursing studies in primary care found Pender's model used for home-visit education, breastfeeding, hypertension and healthy ageing.
Common mistakes
- Giving the same advice to everyone regardless of stage.
- Assuming that information alone changes behaviour.
- Seeing relapse as failure instead of part of the process.
- Setting goals the person does not believe they can reach.
Test yourself
Think of the answer, then tap the question to see it.
Which construct of the health belief model was added later and refers to confidence in performing a behaviour?
Self-efficacy.
What are the five stages of the transtheoretical model?
Precontemplation, contemplation, preparation, action and maintenance. Relapse can occur at any point and is not counted as a stage.
Which factors are central in Pender's health promotion model?
Personal characteristics and experiences, perceived benefits and barriers, self-efficacy and interpersonal support.
In which stage of change is motivational interviewing especially useful?
In contemplation, when the person is ambivalent about changing.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Use of the Health Promotion Model by Nursing in Primary Care: an integrative review (Santos MG et al.) (Revista Brasileira de Enfermagem (SciELO), CC BY 4.0, 2025); The Health Belief Model as an Explanatory Framework in Communication Research (Jones CL et al.) (Health Communication (PubMed Central), 2015); Nursing Health Promotion, 2.7 Behavioral Change (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2023).
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Representative model, for educational purposes only.