Nola Pender: Health Promotion Model

Nola J. Pender (1941– present) is a nursing theorist who developed the Health Promotion Model in 1982. She is also an author and a professor emeritus of nursing at University of Michigan. She started studying health-promoting behavior in the mid-1970s and first published the Health Promotion Model in 1982. Her Health Promotion Model indicates preventative health measures and describes the critical function of nurses in helping patients prevent illness by self-care and bold alternatives. Pender has been named a Living Legend of the American Academy of Nursing.

Biography of Nola J. Pender

Nola J. Pender
Nola J. Pender

Early Life

Nola Pender was born on August 16, 1941, in Lansing, Michigan to parents who advocated education for women. Her first encounter with the nursing profession was when she was 7 years old and witnessed the care given to her hospitalized aunt by nurses. This situation led her to the desire to care for other people and her goal was to help people care for themselves.

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With the support of her parents, Nola Pender entered the School of Nursing at West Suburban Hospital in Oak Park, Illinois, and receive her nursing diploma in 1962. In 1965, she received her master’s degree in human growth and development from the same university. She moved to Northwestern University in Evanston, Illinois, to obtain a Ph.D. in psychology and education in 1969. Pender’s dissertation research investigated developmental changes in the encoding process of short-term memory in children. Years later, she finished masters-level work in community health nursing at Rush University.

Career and Appointments

In 1962, Nola Pender began working on a medical-surgical unit and subsequently in a pediatric unit in a Michigan hospital. For 40 years at Michigan State University, she trained students at undergraduate and graduate levels and mentored many postdoctoral candidates.

Pender directed many studies of her Health Promotion Model with adolescents and adults which made her more active in nursing research. Pender and her research unit developed the program Girls on the Move, that studies and measures the results of intervention as it applies to use the model to encourage young people to perform active lifestyles.

Pender was and still is very supportive of nursing organizations where she devoted her time, service and knowledge. She was the president of the Midwest Nursing Research Society from 1985 to 1987.

Aside from being the president of the American Academy of Nursing from 1991 to 1993, she was also a member of Research America’s Board of Directors from 1991 to 1993, and a member of the U.S. Preventative Services Task Force from 1998 to 2002.

In addition, Pender was an Associate Dean for Research at the University of Michigan School of Nursing from 1990 to 2001. And as a co-founder of the Midwest Nursing Research Society, she has served as a trustee of its foundation since 2009.

Pender is presently a Professor Emeritus at Michigan State University. Following her retirement as an active professor, she devotes her time as an adviser for health research both nationally and internationally and shares her knowledge and experiences to further improve the nursing profession. She also serves as Distinguished Professor of Nursing at Loyola University School of Nursing in Chicago, Illinois.


As regards to health promotion, Nola Pender has written and issued various articles on exercise, behavior change, and relaxation training. She also has served on editorial boards and as an editor for journals and books.

Pender is also known as a scholar, presenter, and consultant in health promotion. She has worked in collaboration with nurse scientists in Japan, Korea, Mexico, Thailand, the Dominican Republic, Jamaica, England, New Zealand, And Chile.

By contributing leadership as a consultant to research centers and giving scholar consultations, Pender resumes influencing the field of nursing. She also collaborates with the editor of the American Journal of Health Promotion, promoting legislation to support health promotion research.

Selected Publications Related to Nola Pender

  • Health Promotion in Nursing Practice (6th Edition)
  • Pender, Nola J. Study Guide for Health Promotion in Nursing Practice
  • Philosophies and Theories for Advanced Nursing Practice
  • Robbins, L.B., Gretebeck, K.A., Kazanis, A.S. and Pender, Nola.J. Girls on the Move
  • Program to Increase Physical Activity Participation, Nursing Research, 2006
  • Pender, Nola.J., Bar-Or, O., Wilk, B. and Mitchell, S. Self-Efficacy and Perceived Exertion of Girls During Exercise, Nursing Research, 2002
  • Eden, K.B., Orleans, C.T., Mulrow, C.D., Pender, Nola.J. and Teutsch, S.M. Does Counseling by Clinicians Improve Physical Activity? A Summary of the Evidence for the U.S. Preventive Services Task Force, Annals of Internal Medicine, 2002
  • Robbins, L.B., Pender, Nola.J., Conn, V.S., Frenn, M.D., Neuberger, G.B., Nies, M.A., Topp, R.V. and Wilbur, J.E. Physical Activity Research in Nursing, Nursing School Journal, 2001

Awards and Honors of Nola Pender

Nola J. Pender
Image via University of Michigan Library

Pender has been the recipient of numerous recognition and awards that include the 1972 Distinguished Alumni Award from Michigan State University School of Nursing. In 1988, she received the Midwest Nursing Research Society’s Distinguished Contributions to Research Award. She also obtained an Honorary Doctorate of Science degree from Widener University, Chester, Pennsylvania, in 1992.

In 1997, the American Psychological Association awarded her the Distinguished Contributions to Nursing and Psychology Award. She was awarded the Mae Edna Doyle Teacher of the Year Award from the University of Michigan School of Nursing the following year. In 2005, she received the Lifetime Achievement Award from the Midwest Nursing Research Society.

Pender was designated a Living Legend of the American Academy of Nursing in 2012. The award has only been awarded to nurses who have made outstanding contributions to the profession. Pender was the president of the academy from 1991 to 1993.

Nola Pender’s Health Promotion Model

Have you ever noticed advertisements in malls, grocery stores, or schools that advocate healthy-eating or regular exercise? Have you gone to your local centers or hospitals promoting physical activities and smoking cessation programs such as “quit” activities and “brief interventions?” These are all examples of health promotion. The Health Promotion Model, developed by nursing theorist Nola Pender, has provided healthcare a new path. According to Nola J. Pender, Health Promotion and Disease Prevention should be the principal focus in health care, and when health promotion and prevention fail to anticipate predicaments and problems, then care in illness becomes the subsequent priority.

What is Health Promotion Model? 

The Health Promotion Model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have important motivational significance. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the endpoint in the Health Promotion Model. Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail intended health-promoting actions.

Nola Pender’s Health Promotion Model theory was originally published in 1982 and later improved in 1996 and 2002. It has been used for nursing research, education, and practice. Applying this nursing theory and the body of knowledge that has been collected through observation and research, nurses are in the top profession to enable people to improve their well-being with self-care and positive health behaviors.

The Health Promotion Model was designed to be a “complementary counterpart to models of health protection.” It develops to incorporate behaviors for improving health and applies across the life span. Its purpose is to assist nurses in knowing and understanding the major determinants of health behaviors as a foundation for behavioral counseling to promote well-being and healthy lifestyles.

Pender’s health promotion model defines health as “a positive dynamic state not merely the absence of disease.” Health promotion is directed at increasing a client’s level of well-being. It describes the multi-dimensional nature of persons as they interact within the environment to pursue health.

The model focuses on the following three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes.

Major Concepts of the Health Promotion Model

Health promotion is defined as behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness.

On the other hand, health protection or illness prevention is described as behavior motivated desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness.

Individual characteristics and experiences (prior related behavior and personal factors).

Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences).

Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior).

Subconcepts of the Health Promotion Model

Personal Factors

Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered.

  • Personal biological factors. Include variables such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance.
  • Personal psychological factors. Include variables such as self-esteem, self-motivation, personal competence, perceived health status, and definition of health.
  • Personal socio-cultural factors. Include variables such as race, ethnicity, acculturation, education, and socioeconomic status.

Perceived Benefits of Action

Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action

Anticipated, imagined or real blocks and personal costs of understanding a given behavior.

Perceived Self-Efficacy

Judgment of personal capability to organize and execute a health-promoting behavior. Perceived self-efficacy influences perceived barriers to action so higher efficacy results in lowered perceptions of barriers to the performance of the behavior.

Activity-Related Affect

Subjective positive or negative feeling that occurs before, during and following behavior based on the stimulus properties of the behavior itself.

Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate a further positive affect.

Interpersonal Influences

Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal influences include norms (expectations of significant others), social support (instrumental and emotional encouragement) and modeling (vicarious learning through observing others engaged in a particular behavior). Primary sources of interpersonal influences are families, peers, and healthcare providers.

Situational Influences

Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. Include perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. Situational influences may have direct or indirect influences on health behavior.

Commitment to Plan of Action

The concept of intention and identification of a planned strategy leads to the implementation of health behavior

Immediate Competing Demands and Preferences

Competing demands are those alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. Competing preferences are alternative behaviors over which individuals exert relatively high control, such as choice of ice cream or apple for a snack

Health-Promoting Behavior

A health-promoting behavior is an endpoint or action outcome that is directed toward attaining positive health outcomes such as optimal wellbeing, personal fulfillment, and productive living.

Major Assumptions in Health Promotion Model

  • Individuals seek to actively regulate their own behavior.
  • Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time.
  • Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span.
  • Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.


  • Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior.
  • Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits.
  • Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior.
  • Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior.
  • Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior.
  • Positive affect toward a behavior results in greater perceived self-efficacy, which can, in turn, result in increased positive affect.
  • When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased.
  • Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior.
  • Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior.
  • Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.
  • The greater the commitments to a specific plan of action, the more likely health-promoting behaviors are to be maintained over time.
  • Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention.
  • Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior.
  • Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.

Strengths and Weaknesses


  • The Health Promotion Model is simple to understand yet it is complex in structure.
  • Nola Pender’s nursing theory gave much focus on health promotion and disease prevention making it stand out from other nursing theories.
  • It is highly applicable in the community health setting.
  • It promotes the independent practice of the nursing profession being the primary source of health promoting interventions and education.


  • The Health Promotion Model of Pender was not able to define the nursing metapradigm or the concepts that a nursing theory should have, man, nursing, environment, and health.
  • The conceptual framework contains multiple concepts which may invite confusion to the reader.
  • Its applicability to an individual currently experiencing a disease state was not given emphasis.


Due to its focus on health promotion and disease prevention per se, its relevance to nursing actions given to individuals who are ill is obscure. But then again, this characteristic of her model also gives the concepts its uniqueness.

Pender’s principles paved a new way of viewing nursing care but then one should also be reminded that the curative aspect of nursing cannot be detached from our practice.

Community health care setting is the best avenue in promoting health and preventing illnesses. Using Pender’s Health Promotion Model, community program may be focused on activities that can improve the well-being of the people. Health promotion and disease prevention can more easily be carried out in the community, as compared to programs that aim to cure disease conditions.

For an individual to fully adhere to a health-promoting behavior, he or she needs to shell out financial resources. This limits the application of Pender’s model. An individual who economically or financially unstable might have lesser commitment to plan of action decreasing the ideal outcome of a health-promoting behavior even if the individual has the necessary will to complete it.

Although not stated in the model, for example, in the Intensive Care Unit, health promotion model may still be applied in one way or another. This is projected towards improving health condition and prevention of further debilitating conditions. Diet modifications and performing passive and active range of motion exercises are examples of its application.

See Also

Related articles for this nursing theory guide:


  • Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization & Application. Elsevier Health Sciences.
  • Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2018). Health promotion in nursing practice. Pearson Education Canada. [Link]

External Links

Biography by: Wayne, G. 

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