Situation: The provincial health office asks public health nurses to help plan health education programs for its municipalities for the next three years. For a program to increase physical activity among healthy adults, the nurses choose Pender's Health Promotion Model rather than the Health Belief Model (HBM). Which statement explains this choice?

Pender's model is a nursing model that explains behavior aimed at greater well-being through perceived benefits, barriers, self-efficacy, activity-related affect, and interpersonal and situational influences; it does not rely on fear or threat of disease. That suits healthy adults with no disease to avoid. Perceived threat is the basis of the HBM, stages belong to the Transtheoretical Model, and attitudes, subjective norms, and perceived behavioral control belong to the Theory of Planned Behavior.

Conceptual focus

The question asks you to differentiate Pender’s Health Promotion Model (HPM) from three other widely tested behavior-change frameworks. The correct answer is 2 because HPM explains wellness-oriented behavior through positive motivators rather than through fear of illness.

Pender’s model is built on the idea that people move toward health because they value well-being, not because they are running away from disease. This makes it especially appropriate for healthy adults who have no existing threat to avoid. The model organizes influences on health-promoting behavior into individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. Key modifiable factors include perceived benefits, perceived barriers, self-efficacy, activity-related affect, and interpersonal and situational influences ^[1][2].

Watch out! The Health Belief Model (HBM) does rely on threat appraisal. Its core predictors are perceived susceptibility and perceived severity, combined with perceived benefits and barriers. Option 3 describes HBM, not Pender’s model. For a program targeting healthy adults, threat-based messaging is less relevant because these individuals may not perceive themselves as susceptible to any disease.

Model	Core focus	Key constructs	Best fit for this program
Pender’s Health Promotion Model	Approach-oriented wellness behavior	Perceived benefits, barriers, self-efficacy, affect, interpersonal and situational influences	Healthy adults seeking greater well-being
Health Belief Model	Avoidance-oriented threat appraisal	Perceived susceptibility, severity, benefits, barriers, cues to action	Populations with a specific disease threat
Transtheoretical Model	Readiness to change over time	Stages of change, processes of change, decisional balance	Programs matched to a person’s stage
Theory of Planned Behavior	Intention as the immediate antecedent of behavior	Attitudes, subjective norms, perceived behavioral control	Behaviors strongly influenced by social pressure

Key point! Option 1 describes the Transtheoretical Model, which sorts people into precontemplation, contemplation, preparation, action, and maintenance stages. Option 4 describes the Theory of Planned Behavior, which explains behavior through attitudes, subjective norms, and perceived behavioral control. Neither is the reason the nurses selected Pender’s model.

The evidence supports HPM’s practical value in nursing and primary care. An integrative review found that HPM has been applied to dietary behaviors in people with hypertension, healthy aging, and breastfeeding support, demonstrating its flexibility across wellness-focused contexts . A quasi-experimental study using the Health-Promoting Lifestyle Profile II showed that a Pender-based nursing intervention improved healthy behaviors and quality of life in adults over 20 years of age . These applications share a common thread: they target people who are not primarily motivated by fear of a current disease but by the desire to enhance their health.

For a physical activity program in healthy adults, HPM directs the nurse to strengthen self-efficacy, highlight the positive feelings associated with activity, reduce perceived barriers, and mobilize social support. This approach aligns with the provincial health office’s goal of promoting wellness across municipalities rather than preventing a single disease.