# Situation: A nurse at a Barangay Health Station (BHS) runs a monthly health teaching class for adults with hypertension, several of whom smoke. After three sessions, most participants can explain that salt raises blood pressure and say they want to use less. At home, however, their families complain that the food is tasteless, and most participants go back to their usual cooking. Using the PRECEDE-PROCEED model, which factor should the nurse target NEXT? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=627100 > language: ko > subject: Nursing Practice I — Community Health Nursing ## 문제 Situation: A nurse at a Barangay Health Station (BHS) runs a monthly health teaching class for adults with hypertension, several of whom smoke. After three sessions, most participants can explain that salt raises blood pressure and say they want to use less. At home, however, their families complain that the food is tasteless, and most participants go back to their usual cooking. Using the PRECEDE-PROCEED model, which factor should the nurse target NEXT? ## 보기 1. Predisposing factors, such as the participants' knowledge and attitudes 2. Enabling factors, such as the cost and availability of low-salt foods 3. Environmental factors, such as the salt sold in nearby stores 4. Reinforcing factors, such as the responses of others after the behavior **✔ 정답** **정답: 4** ## 해설 Knowledge and intention, the predisposing factors, are already present. What stops the behavior is the negative response of family members after it is tried; the support or reward from others that keeps a behavior going is a reinforcing factor. The nurse should involve the families, for example by inviting them to a session so that they understand the change and praise and share the low-salt meals. ## 심화 해설 Understanding the PRECEDE-PROCEED framework The PRECEDE-PROCEED model organizes factors that influence health behavior into three broad categories. Predisposing factors are the internal knowledge, attitudes, beliefs, and intentions that motivate a person to act. Enabling factors are the resources, skills, and environmental conditions that make the behavior possible. Reinforcing factors are the feedback, rewards, or social responses a person receives after performing the behavior, which determine whether the behavior is maintained or abandoned. In this scenario, the participants have already demonstrated adequate knowledge and expressed a desire to reduce salt, so the predisposing component is largely satisfied. The problem emerges after the behavior is attempted: family members complain about the taste, and the participants revert to their usual cooking. This is a classic reinforcing-factor failure because the social response to the new behavior is negative rather than supportive. The correct next step is to target reinforcing factors, specifically by engaging family members so that their feedback becomes encouraging rather than discouraging. Why the other options are less appropriate now Option 1, predisposing factors, has already been addressed because the participants can explain the link between salt and blood pressure and state an intention to change. Option 2, enabling factors such as cost and availability of low-salt foods, is not the immediate barrier described in the situation; the family complaint about taste, not access or affordability, is what derails the behavior. Option 3, environmental factors related to salt sold in nearby stores, also does not match the stated reason for relapse. The scenario specifically identifies the family’s negative reaction as the trigger for returning to old habits, which places the problem squarely in the reinforcing domain. Key point! Reinforcing factors operate after a behavior occurs; they can either strengthen it through praise and shared participation or weaken it through criticism and social pressure. Family involvement as a reinforcing strategy The family is a powerful source of reinforcement for dietary changes in hypertension management. When family members understand why sodium reduction matters and are included in meal planning and tasting, they are more likely to offer positive feedback and share the low-salt meals rather than complain about them. A family self-management program can improve both hypertension management and adherence to sodium restriction by making the household an active partner in the behavior change. In a randomized controlled trial among people with hypertension and their family caregivers, a structured family self-management program led to better sodium consumption adherence compared with usual care, supporting the idea that family-level reinforcement is a modifiable and effective target. The nurse at the Barangay Health Station can apply this by inviting family members to a cooking demonstration or taste-testing session, teaching them how to season food with herbs and spices instead of salt, and encouraging them to praise the participant’s efforts. This converts the family from a barrier into a source of ongoing reinforcement. Linking reinforcement to sustained self-management Sustained hypertension self-management depends on more than initial knowledge. A path analysis guided by the PRECEDE-PROCEED model found that reinforcing factors are directly associated with hypertension self-management behaviors among older adults, alongside predisposing and enabling factors. This means that even when knowledge and intention are present, the absence of positive reinforcement can prevent the behavior from becoming a stable habit. In the scenario, the participants already possess the predisposing elements, but the reinforcing environment at home is actively working against them. The nurse’s next move should therefore be to reshape that environment by involving the people whose reactions matter most. Support from family and significant others is a frequently identified need among persons with chronic conditions who are trying to self-manage at home. Qualitative findings from a primary health care setting show that people living with hypertension and other chronic diseases explicitly request this kind of social support to sustain their self-management efforts. Clinical reasoning for the licensure exam When a question describes a gap between what a client knows and what the client actually does at home, the examiner is usually testing whether you can distinguish among the three PRECEDE-PROCEED factor types. Watch out! Do not automatically choose predisposing factors just because education is involved. If knowledge and attitude are already adequate, the problem lies elsewhere. In this case, the family’s complaint after the low-salt meal is attempted is the defining clue. That is a response to the behavior, not a precondition for it, so it falls under reinforcing factors. The nurse should involve the families, for example by inviting them to a session so that they understand the change and can praise and share the low-salt meals. This approach aligns with evidence that family-based interventions improve sodium adherence and that reinforcing factors are directly linked to self-management behaviors in hypertension. ## 임상 시나리오 Reinforcing Factors in Hypertension EducationEngaging Families to Sustain Low-Salt Behavior When participants already have knowledge and intention but revert after negative feedback, the next target is reinforcing factors. Family complaints about tasteless food are a negative social response that extinguishes the new behavior. Invite family members to a health teaching session so they understand the reason for low-salt meals and learn to praise and share the change. Positive reinforcement from household members helps maintain the behavior over time. CautionDo not assume that more education for the participants alone will fix the problem. The barrier is the family response, not a lack of participant knowledge. ## 핵심 개념 - **Predisposing factors** — Internal knowledge, attitudes, beliefs, and intentions that motivate a person to act. - **Enabling factors** — Resources, skills, and environmental conditions that make a behavior possible. - **Reinforcing factors** — Feedback, rewards, or social responses received after performing a behavior that determine whether it is maintained. - **PRECEDE-PROCEED model** — A planning framework that categorizes behavioral influences into predisposing, enabling, and reinforcing factors. ## 같은 주제 문제 - [Situation: A public health nurse at a Rural Health Unit (RHU) in an agricultural municipal…](https://mymerci.kr/pages/nclex_q.php?qn_id=627015) - [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).The nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=627057) - [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627095) - [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627096) - [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627097) - [Situation: The public health nurse at a Rural Health Unit (RHU) is planning a series of he…](https://mymerci.kr/pages/nclex_q.php?qn_id=627098) - [Situation: A nurse at a Barangay Health Station (BHS) runs a monthly health teaching class…](https://mymerci.kr/pages/nclex_q.php?qn_id=627099) - [Situation: A nurse at a Barangay Health Station (BHS) runs a monthly health teaching class…](https://mymerci.kr/pages/nclex_q.php?qn_id=627101) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._