# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627299  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

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?

## 보기

1. It sorts people into stages based on when they intend to change
2. It explains wellness behavior without relying on the threat of disease **✔ 정답**
3. It predicts action mainly from perceived susceptibility and severity
4. It explains behavior through attitudes, subjective norms, and perceived control

**정답: 2**

## 해설

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.

## 심화 해설

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.References (research sources)

- [1]Theory analysis for Pender's health promotion model (HPM) by Barnum's criteria: a critical perspective.Research articleKhoshnood Z, Rayyani M, Tirgari B (2018) · DOI: 10.1515/ijamh-2017-0160

- [2]Application and Effectiveness of the Nola Pender Model in Nursing: A Narrative Review.Research articleTorres ILR, Rojas DMP, Amell GL, Martínez SG. (2026) · DOI: 10.4103/ijnmr.ijnmr_442_24

## 임상 시나리오

Choosing Pender's Model for Healthy AdultsWellness promotion without disease threat
Pender's Health Promotion Model explains wellness behavior through positive motivators such as perceived benefits, self-efficacy, and activity-related affect. It does not rely on fear or threat of disease, making it suitable for healthy adults with no illness to avoid.

In contrast, the Health Belief Model predicts action mainly from perceived susceptibility and perceived severity. Threat-based messaging is less relevant when the target population does not perceive themselves as susceptible.

CautionDo not confuse Pender's model with the Transtheoretical Model, which uses stages of change, or the Theory of Planned Behavior, which uses attitudes, subjective norms, and perceived control.

## 핵심 개념

- **Pender's Health Promotion Model** — Nursing model explaining wellness-oriented behavior through perceived benefits, barriers, self-efficacy, affect, and interpersonal/situational influences without relying on disease threat
- **Health Belief Model** — Behavior model predicting action from perceived susceptibility, severity, benefits, and barriers, based on threat appraisal
- **Transtheoretical Model** — Model sorting people into stages of change based on readiness or intention to change
- **Theory of Planned Behavior** — Model explaining behavior through attitudes, subjective norms, and perceived behavioral control
- **Self-efficacy** — Confidence in one's ability to perform a behavior, a key modifiable factor in Pender's model

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