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Using Nola Pender’s Health Promotion Model, a program was developed to help prevent or manage obesity. This program can be enrolled in by any patient, but it is directed at patients who have a BMI over 25.0 and especially a BMI over 30.0 (CDC, 2018-b). The program is a one year program which allows the patient to use the information they are given in the beginning of the program about healthy diet and exercise to make their own plan to execute with the guidance of the program staff and peers of the program to help reach the goals of eating a healthy diet, exercising regularly, and maintaining a healthy weight (National Heart, Lung, and Blood Institute, 2018).
Throughout the program, the participants will regularly meet to discuss their progress and ask questions or concerns. The program is meant to set up a healthy lifestyle change that can impact throughout the participants life time.
Nola Pender in her book, Health Promotion in Nursing Practice, stated that the motivation for individuals to enhance well-being and fulfill their full potential is what guides health promotion (Alligood, 2018, p.
329). Nurses and nurse practitioners have the capability to help promotion healthy lifestyles and living and help prevent or treat existing health conditions through health promotion. In Pender’s theory, Health Promotion Model, she explains how patients can take an active role in managing their health behaviors by modifying the environment and circumstances around them (Alligood, 2018, p. 328). The purpose of this paper is to propose a program that can prevent or manage obesity in patients using the Health Promotion Model.
Obesity is a very significant problem today in the United States. According to the CDC (2018-a), in 2016, the prevalence of obesity in the United States was 93.3 million equaling 39.8% of Americans. Obesity can lead to certain health conditions such as stroke, type 2 diabetes, heart disease, and certain types of cancer that are known to be some of the leading causes of premature, preventable death (CDC, 2018-a). In 2008, the annual medical cost was $147 billion dollars for medical cost of obese patients in America (CDC, 2018-a). The CDC (2018-b) uses the BMI scale which looks at the person's weight in kilograms divided by the square of height in meters to show if a person has a high BMI, which indicates high body fat. The scale is broken down to show if your BMI is 25 to less than 30, it is within the overweight range, and if the BMI is 30 or higher, it is within the obese range (CDC, 2018-b).
Although obesity can be linked to non-modifiable factors such as genetics, modifiable factors such as dietary patterns, inactivity, physical activity, medications, and environment can cause or contribute to obesity (CDC, 2018-c). Obesity has been found by empirical evidence to cause diseases and illnesses such as coronary heart disease, gallbladder disease, stroke, dyslipidemia, hypertension, osteoarthritis, sleep apnea, mental illness, and body dysfunction (CDC, 2018-c). Due to the severity of issues that obesity can cause, it is imperative to help prevent and promote healthy living to Americans today. Along with community efforts and state and local programs, it is very important to make programs to educate and teach on ways to combat obesity or prevent it from being an issue in the patient’s we care for. Educating patients on a healthy BMI and ways to prevent and manage obesity will be used to propose a health promotion program based on Pender’s Health Promotion Model.
This community-based program based on health promotion is aimed at preventing, reducing the risk, and managing obesity in adults by addressing the modifiable factors that can lead to obesity or contribute to it. As obesity can affect anyone, this program can benefit any person willing to participate. The aimed participants of the study though would be people that have a BMI over 25.0 which is overweight, and especially people with a BMI over 30.0 which is the first class of obese (Mayo Clinic, 2018). Patient’s also with a family history of obesity are encouraged to participate in the program. The health promotion theory is to be used in congruence with regular physician visits and not meant to replace a physician's medical orders.
The health promotion program is a one-year program that starts with an initial screening, information on health promotion behavior changes at week 2, and follow up meetings every 2 weeks up to the 6-month mark, and then bi-monthly meetings to the one year mark. Though the program is only one year long, it is meant to serve as a lifelong program that can be carried on and followed up by at yearly routine physicals. The program is based on the National Heart, Lung, and Blood Institute’s recommendations of healthy eating, being physically active, and aiming for a healthy weight (National Heart, Lung, and Blood Institute, 2018). According to the CDC (2018-d), a healthy weight is considered a BMI of 18.5 to 24.9, exercise of at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity a week, or a combination of both, along with 2 days of strength training per week for adults and using a healthy eating plan are used as goals for this program.
The beginning of the program starts with the initial screening and sign-up. This can be referred to by the primary physician or can be the patient’s desire to live a healthier lifestyle. This informational screening will give patient’s enough information on the program to give informed consent to be participants. Patient’s will have an opportunity to hear the goals and outcomes of the program and ask any questions or voice any concerns at this time. The benefits that will be discussed during the initial screening of this program consists of: preventing or managing obesity, eating a healthy diet, improved body weight, and reduction of risk of comorbidities from obesity.
Upon signing up for the program, the participant will be given an informational packet on the program along with a Health Promoting Lifestyle profile and Exercise Benefits-Barriers Scale to complete before returning to their week 2 meeting. The Health Promotion Lifestyle profile is a 52 item, Likert scale instrument that has the six categories of health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management that can be used by the nurse to view an assessment of the lifestyle of the individuals in the program (Alligood, 2018, p. 327). The Exercise Benefits- Barriers Scale is a 43 item, Likert scale instrument that consist of a 29-item benefits scale and 14-item barrier scale that measures the perceptual and cognitive factors of perceived benefits and barriers to exercise (Alligood, 2018, p. 328). Baseline data such as age, gender, height, weight, BMI, vital signs, time of exercise in past week along with 24-hour diet recall will be collected during this time also. Pamphlets on healthy eating, exercises, and risks of obesity will be provided for the participants to view before they return for their 2-week meeting.
After 2 weeks, the patients will have had time to review information on obesity, risks of the problem, and ways to manage or prevent the epidemic in their own life. Nurses will also have time to review the patients’ Health Promotion Lifestyle profile and Exercise Benefits-Barriers Scale to create individualized recommendations and plans for each participant. For the next 6 months, every 2 weeks, the focus for the participants will be on the behavior change. At the group and individual meetings, participants will have the opportunity to share how their program is going, get tips on maintaining a healthy weight and exercise, be able to voice any concerns or problems that they are encountering, and share their feelings with other participants involved in the program. Participants are weighed, and BMI is calculated at every meeting and tracked throughout the program. One 24-hour diet recall is turned in to the sponsor every 2 weeks also to show what the normal intake is for the patient. Participants are encouraged to journal their feelings, strengths, and weaknesses during the program so that they may address them at meetings or share them with fellow participants. The goal of meetings every 2 weeks for 6 months is to reach a weight loss goal, exercise at least 150 minutes a week (CDC, 2018-d), and report healthier eating choices in everyday life.
The post intervention stage starts at the 6-month mark and continues to one year and beyond. Meetings will then be bi-monthly to maintain rapport and status with the participants and continue to encourage and monitor the patients progress. The second to last meeting, participants will again fill out the surveys and get weighed, vital signs, 24-hour diet recall, and exercise log to compare to the initial baseline information. The one-year meeting will help motivate and encourage continued progression with the program and to continue to follow up with the primary physician yearly where follow up can be continued.
The Health Promotion Model is a conceptual model, middle-range theory created by Nola Pender starting in 1982 (Alligood, 2018). Nola Pender’s background in nursing, psychology, human development, and education helped her use a holistic nursing perspective, learning theory, and social psychology as the foundation for her health promotion theory (Alligood, 2018, p. 325). Pender incorporated Albert Bandura’s social learning theory which stated that cognitive process is important in changing behavior and Becker’s health belief model which explains disease prevention behavior in creating her theory (Alligood, 2018, p. 325-326). Pender stated after her studies, her focus of nursing care to her was the optimal health of the individual (Alligood, 2018, p. 323). The Health Promotion Model is used by nurses to help determine health behavior factors that can be used for counseling to help promote healthy lifestyles. Pender believed that background factors can influence a patient’s health behavior and while using the model, nurses can collaboratively work with the patient in changing their behaviors to achieve health and well-being.
The first part of the model starts with the nurses looking at the “Individual Characteristics and Experiences” of the patient (Alligood, 2018, p. 328). The patients “prior related behavior” which is the frequency of the same or similar behavior that the patient has experienced in the past and the “personal factors: such as biological, psychological, and sociocultural” which can include age, gender, self-esteem, perceived health status, race, education, and socioeconomic status can be examined by the nurse (Alligood, 2018, p. 326). This concept stems from the theoretical assertion that prior behavior and characteristics (inherited or acquired) influence the patients’ beliefs and actions of health promoting behavior (Alligood, 2018, p. 329).
The next part of the Health Promotion Model looks at the “Behavior-Specific Cognitions and Affect” (Alligood, 2018, p. 328). The concepts in this section include the perceived benefits and barriers to action, along with perceived self-efficacy and activity-related affect, interpersonal and situational influences such as family, norms, support, options, aesthetics, and lastly the immediate competing demands and commitment to the plan of action” (Alligood, 2018, p. 328). This part of the model goes through the patient’s willingness and internal decision to attempt and achieve the health promoting behavior. The patient is asked to look how they feel about the behavior in the sense of positives and negatives, things that could stand in their way, and things that would influence the behavior.
The last part of the Health Promotion Model is the “Behavioral Outcome” which is the patient deciding to accomplish the health promoting behavior and starting a plan of action (Alligood, 2018, p. 328). This is the end goal of the model as the patient reaches their positive health outcome. The nurse can use the information gathered from the first two sections of the model to make an individualized plan for the patient to help accomplish this goal. The major assumption of this theory is that patients play an active role in managing their health behaviors by modifying their environmental context and that improved quality of life and well-being are goals of the behavioral outcome (Alligood, 2018, p. 328).
The Health Promotion Model believes that humans have the capability to decide for themselves to make life-changes, and with health professionals assistance, health behaviors can be modified to complete a behavior change. Prevention and health promotion are vital parts of well-being and as nurses, we can aim to help guide our patients using this theory to healthier behavior changes.
The Health Promotion Model can be used to develop this health promotion program to prevent or manage obesity in patients throughout the lifespan. Obesity has a few non-modifiable risk factors along with many modifiable. According to the Mayo Clinic (2018), the modifiable risk factors that contribute to obesity are family lifestyle, inactivity, unhealthy diet, certain medications, social and economic issues, smoking and lack of sleep. The non-modifiable risk factors of obesity include genetics, race, sex, and age (National Heart, Lung, and Blood Institute, 2018). According to Pender, demographic characteristics, interpersonal influences, situational factors, and behavioral factors are also modifying factors that can contribute to a patient’s health promoting behavior (Alligood, 2018, p. 325). An example of demographic characteristics would be patients that live in the South have a different diet and fluid intake than in the north. These diets usually include food high in salt and in fats. The CDC (2018-e) reported than in the southern states, it is the highest prevalence of obesity in the country at 32.4%. Along with the likelihood that the participants family and friends eat the same diet, the geographical location of residence can affect and put the participant at a higher risk for obesity. As assessment of the patient is done initially for this program, geographical location and normal diet can be looked at and discussed with the patient for behaviors to change.
The model begins looking at the individual characteristics and experiences of the patient (Alligood, 2018, p. 328). The assertion that prior behavior and characteristics influence affects, beliefs, and promotion health promoting behavior was one of the fourteen theoretical assertions Pender noted in her model (Alligood, 2018, p. 329). The theory suggest that past behavior is a good indicator that the behavior can continue unless altered. By examining the results of the initial screening and holding the participants accountable for their own actions, suggestion to alter the current behavior is enforced. When the participant writes in their journal to keep up with their feelings and concerns, and when exercise and food logs are filled out, the participant can be held to a higher level standard to themselves that they are in control of their health.
Personal factors such as biological, psychological, sociocultural are also determinants in their health behavior. The use of the Health Promoting Lifestyle Profile II and the Exercise Benefits-Barriers Scale are two ways that these areas can be tested. The Health Promoting Lifestyle Profile II (HPLP II) asks questions on the “present” way of life and answers are given by circling never, sometimes, often, or routinely. Some questions asked of the profile are: “Choose a diet low in fat, saturated fat, and cholesterol; follow a planned exercise program; get enough sleep; question health professionals in order to understand their instructions; and work toward long-term goals in my life” (Walker, Sechrist & Pender, 1995-a). Aghamolaci and Ghanbarnejad (2015) stated that the HPLP II is a highly applicable tool that is valid and reliable in assessing health promoting behaviors (p. 359). The Exercise Benefits-Barriers Scale (EBBS), like the HPLP II scale, asks the participant to circle an answer of strongly agree, agree, disagree or strongly disagree to questions such as: “I enjoy exercise; I will prevent heart attacks by exercising; exercising will keep me from having high blood pressure, and exercise helps me decrease fatigue” (Walker et al., 1995-b). In a study done in Iran using the EBBS, it was found that the scale was reliable and valid and that it was an exceptional tool to measure the barriers and benefits of physical activity” (Farahani et al., 2017, p. 4780).
The next part of the model is the “Behavior-Specific Cognitions and Affect” (Alligood, 2018, p. 328). From using the information gathered about the patients’ experiences and where they currently stand in the health-promoting behavior, nurses can now use this information and along with the client view perceived feelings about the behavior and ways to complete action. The concept of immediate competing demands and preferences can be used in to promote commitment to the program. The program is very specific about eating a healthy diet, exercising, and keeping up with their weight, but it allows the participant the preference of how they achieve these goals. During the bi-weekly meetings in the first 6 months, participants will bring their exercise log and food diary and be able to share with their peers about what is or is not working well with them. Advice and tips can also be shared among peers as they can share workout tips, recipes, stress relieving activities, and solutions to competing immediate demands.
The health promoting behavior outcomes set by this program are eating a healthy diet, exercising regularly, and achieving and maintaining a healthy weight. The CDC (2018-d) recommends a healthy diet consisting for fruits, vegetables, whole grains, lean meats, poultry, fish, beans eggs, food low in saturated fats, trans fats, cholesterol, salt and added sugar. The U.S. Department of Health and Human Services (2018) like the CDC suggests that adults should exercise at least two and a half hours each week or 30 minutes a day, along with muscle strengthening exercises at least 2 days a week to maintain a healthy weight. In a study done by Dandanell, Ritz, Verdich, Dela, and Helge (2017), it was found that repeated participation in weight loss programs that combined calorie restriction, daily physical activity for several hours a day, and behavioral counseling showed positive solutions for long term weight loss. While these outcomes are aimed at preventing or managing obesity, they are also all determinants of a healthy lifestyle. Though the program is only a year long, it is meant to be carried on throughout the participants life to maintain health and well-being.
As obesity is a significant problem in the United States, it is an issue that needs to be addressed as often as possible. It is very evident that the incidence and prevalence of obesity continues to rise, and interventions and promotion of health should be discussed at every healthcare provider visit. With this health promotion program, participants are encouraged to take their issue into their own hands through guidance of the program to start eating a healthy diet, exercising regularly, and get and maintain a healthy weight. The Health Promotion Model helps nurses to direct and enact change in the population they serve for overall wellbeing and health.
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