Pender's Health Research Articles

Design and acceptance of Rheumates@Work, a combined internet-based and in person instruction model, an interactive, educational, and cognitive behavioral program for children with juvenile idiopathic arthritis.

BackgroundJuvenile idiopathic arthritis (JIA) is a chronic rheumatic disease. Patients suffer daily discomforts such as pain, fatigue, stiffness, and mood disturbances. Their exercise capacity is decreased to a variable degree and physical activity levels may be impaired. To prevent long-term cardiovascular risks associated with JIA and medication, it is important to encourage physical activity. To achieve this we developed Rheumates@Work (R@W), a combined internet-based and in person instruction model, an interactive, educational, and cognitive behavioral program. The aim of this study is twofold: to describe the theoretical background and design of R@W based on Pender’s Health Promotion Model, and to assess its acceptance.MethodsWe enrolled 8 to 13-year-old JIA patients, from 3 outpatients clinics in The Netherlands, in R@W. Inclusion criteria were a low disease activity (VAS physician <20 mm), comprehension of the Dutch language and absence of relevant co-morbidity. We assessed acceptance by measuring the participants’ commitment to the program, the level of interaction on patient’s initiative (f.e. mails send by the patient), technical aspects and satisfaction. Commitment was defined as the percentage of participants that completed the assignments and how much encouragement the participants needed for this. Satisfaction was measured with an anonymous questionnaire concerning f.e. time investment and perceived benefits. Costs were monitored.ResultsOf the 64 patients we enrolled, 23 boys and 41 girls, 93.8 % completed the program. Participant-initiated interaction was seen in 10.7 %, 24.7 % send a mail because of technical problems. Eighty-two percent of the participants and 99 % of the parents liked the program, and 85 % of the participants indicated that they had learnt something, or quite a lot. Development costs of the program were low.ConclusionThe HPM is suitable for a behavioral intervention program such as R@W. Acceptance and satisfaction of R@W were high and the costs of the program were low.Trial registrationTrial Number: ISRCTN92733069Electronic supplementary materialThe online version of this article (doi:10.1186/s12969-015-0029-5) contains supplementary material, which is available to authorized users.

여성 결혼이민자의 유방암과 자궁경부암 검진행위에 영향을 미치는 요인

본 연구는 여성 결혼이민자의 유방암과 자궁경부암 검진행위를 파악하고 관련 요인을 규명함으로써 여성결혼이민자의 유방암과 자궁경부암 검진행위 증진 프로그램을 위한 기초 자료를 제공하려는 목적으로 시도되었다. 연구의 주요 변수로는 Pender의 건강증진모형에 포함된 변수를 사용하였으며, 이들의 측정을 위해 총 7개의 측정도구가 사용되었다. 연구대상자는 한국인 남자와 결혼하여 대구, 경북지역에 거주하고 있는 결혼이민 여성 157명이었다. 연구결과, 대상자의 유방암 검진 행위율은 유방촬영술 33.1%, 유방 자가검진 29.9%, 자궁경부암 검진 51%로 나타났다. 유방암 검진행위는 사회적지지가 1점 높아짐에 따라 1.25배, 지각된 유익성이 1점 높아짐에 따라 1.13배, 유방암 및 자궁경부암 교육경험이 있는 경우가 없는 경우보다 3.58배, 행동계획 수립이 1점 높아짐에 따라 1.24배 높아졌다. 자궁경부암 검진행위는 유방암 및 자궁경부암 교육경험이 있는 경우가 없는 경우보다 2.89배, 사회적지지가 1점 높아짐에 따라 1.23배, 지각된 장애성이 1점 높아짐에 따라 0.82배 낮아졌다. This study intended to identify the factors of breast and cervical cancer screening behaviors in married female immigrants and provide information for the development of intervention programs to promote the behaviors. Pender's Health Promotion Model was the conceptual framework of this study. The subjects of this study were 157 female immigrants living in Daegu and Gyeongbuk area. It was found that 33.1% of subjects had mammography, 22.9% of them did breast self-examination, and 51% of them had cervical cancer screening test. The breast cancer screening behavior increased 1.25 times as the score of social support increased one point, 1.13 times as the score of perceived benefit increased one point, 3.58 times when the subjects had experiences of breast and cervical cancer education, and 1.24 times as the score of action plan increased one point. The cervical cancer screening behavior increased 2.89 times when the subjects had experiences of breast and cervical cancer education, and 1.23 times as the score of social support increased one point. However, the cervical cancer screening behavior decreased 0.82 times as the score of perceived barriers increased one point.

Implementation of an epilepsy self-management protocol.

It is essential that patients with epilepsy receive educational information about their disease and its management, but there is dissatisfaction with the education received. The purposes of this evidence-based project were to examine the current knowledge level and disease management behaviors of patients with epilepsy in an outpatient clinic and to measure the effectiveness of implementing a self-management protocol using the Epilepsy Self-Management Scale (ESMS). Pender's health promotion model and Rogers' diffusion of innovation theory were used to guide the development and completion of this project. An evidence-based epilepsy self-management protocol was developed and implemented at an outpatient neurology clinic by an interprofessional clinic team that consisted of (a) evaluation of self-management behaviors (ESMS), (b) individual education using the ESMS and developed resources, (c) follow-up telephone call, and (d) measurement of outcomes of the self-management protocol (patient self-management [ESMS] and process). Twenty patients participated in all or portions of the protocol. Scores on the ESMS increased from preimplementation to postimplementation of the protocol (t = -2.67). Seizure management and information management were identified as the most difficult self-management areas. Recommended changes in protocol implementation include adding information about safety measures such as medical alert bracelets and driving to the educational packets. Follow-up telephone calls were discontinued because of difficulties reaching patients. The results of this study suggest that the ESMS is an acceptable tool for evaluating patients' self-management behaviors. Epilepsy self-management protocols need to include both verbal and written educational materials. Educating patients with epilepsy about positive self-management behaviors may lead to better health outcomes.

Relationship between expectations regarding aging and physical activity among middle aged adults in urban areas: based on the Pender's Health Promotion Model

The purpose of this study was to measure the level of expectations regarding aging (ERA) and identify relationship between ERA and physical activity of middle aged adults. Participants were middle aged adults who resided in the community in three cities in Korea. Data were collected using questionnaires that contained items on individual characteristic, International Physical Activity Questionnaires (IPAQ), and behavior-specific cognitive factors including ERA-12. Hierarchical multiple regression was conducted to examine whether ERA would predict physical activity by controlling other factors. The mean age of the participants was 51.1±6.9 years. The mean score for ERA (possible range=0 to 100) was 40.04±14.31. More than half of the participants (62.6%) were not engaged in health promoting physical activity. Gender, employment status and exercise confidence were associated with level of physical activity (F=7.14, p<.001, R²=.36). After controlling for individual factors and behavior-specific cognitive factors, ERA was independently related to physical activity (F=7.19, p<.001, R²=.38). The results demonstrate that individuals' belief about aging has effects on physical activity in Korean middle aged adults. Thus, nursing interventions which focused on ERA could help enhance physical activity in middle aged adults.

Knowledge and attitude of primigravidae mothers regarding prenatal attachment

A descriptive study was conducted to a Study to assess the knowledge and attitude of primigravidae mothers regarding prenatal attachment in selected Maternity Hospital, Bangalore. The objectives of the study is to assess the knowledge and attitude of primigravidae mothers regarding prenatal attachment, to correlate the knowledge and attitude of primigravidae mothers regarding prenatal attachment to associate the knowledge and attitude of primigravidae mothers regarding prenatal attachment with their selected demographic variables. Methods Nonexperimental descriptive study design was used to assess the level of knowledge and attitude of primigravidae regarding prenatal attachment in selected Maternity Hospital, Bangalore. In view of the nature of the problem and to accomplish the objectives of the study, structured questionnaire was prepared focusing on the level of knowledge and attitude of primigravidae mothers. Reliability of the tool was tested and validity was ensured in consultation with guide and experts in the field of medicine and nursing. The study was conducted in Hosahalli Referral Hospital, Vijayanagar M.C layout, Bangalore and 60 primigravidae mothers were selected by Nonprobability convenient sampling technique. Structured questionnaires were used to collect the needed data. Collected data was analyzed by using descriptive and inferential statistics. The conceptual framework used is Nola Pender's Health Promotion Model. Results Majority of the primigravidae mothers had moderate knowledge (61.7%) and favourable attitude (60.0%) regarding prenatal attachment. A significant correlation between knowledge and attitude among primigravidae mothers regarding prenatal attachment” was accepted. This may point out that the Maternity Health nurse to educate pregnant mothers regarding prenatal attachment.. A significant association of knowledge and attitude among primigravidae mother regarding prenatal attachment with their selected demographic variables” was accepted. This indicated that level of knowledge and attitude is influenced by some demographic variables.

Effects of Educational Intervention on Health-Promoting Lifestyle and Health-Related Life quality of Methamphetamine Users and Their Families: a Randomized Clinical Trial.

Background:Family-centered empowerment of drug and stimulant users is an effective program for a better response to treatment, prevention of treatment adverse effects, and promotion quality of life (QoL) and lifestyle in the process of discontinuing drug abuse.Objectives:This study aimed to determine the effects of educational intervention, based on family-centered empowerment and Pender's health promotion models, on health-promoting lifestyle and health-related QoL among methamphetamine users and their families.Patients and Methods:In a randomized clinical trial, methamphetamine users, who were admitted to Tehran University of Medical Sciences Substance Abuse Treatment Centers, were randomly allocated to three groups: a group for training of methamphetamine users who were in recovery phase (intervention group 1;95 subjects);a group for training of a family member of methamphetamine users who were in recovery phase (intervention group 2; 95 subjects); and a control group (95 subjects). A demographic checklist and a standard questionnaire covering health-promoting lifestyle, health-related QoL, self-efficacy, perceived affect, perceived social support, and perceived barriers dimensions were used to gather required data. Independent-samples t test, paired-samples t-test, and ANCOVA were used to analyze the data.Results:Analysis of covariance showed that after adjusting for effects of pretest scores, the difference between mean post-test scores of health-promoting lifestyle scale, health-related QoL scale, and all constructs of Pender's health promotion model (self-efficacy, perceived affect, perceived social support, and perceived barriers) in the intervention group 1 and control group were significant (P< 0.0001). In addition, changes in mean scores of lifestyle scale (42.4 ± 13.6), QoL scale (29.1 ± 14.2), self-efficacy (16.1 ± 2.6), perceived affect (16.1 ± 8), social support (35.4 ± 12.4), and barriers (17.2 ± 15.8) before and after intervention were significant in the intervention group 2 (P < 0.0001).Conclusions:Application of family-centered empowerment model among methamphetamine users and their families is practically feasible and can result in enhancement and improvement of their QoL, lifestyle, and health promotion model constructs.

Feasibility and Acceptability of an Internet-Based, African Dance-Modified Yoga Program for African-American Women with or at Risk for Metabolic Syndrome.

African-American (AA) women are the segment of the population that experiences the highest mortality from metabolic syndrome (MetS). Yoga decreases risk of MetS, yet there have been no yoga studies of AA women with or at risk for MetS. The purpose of this 4-week study was to test the feasibility and acceptability of a culturally tailored, Internet-based intervention, yogic dance (YD), using digital videos in a sample of AA women (ages 35-64) at risk for or with MetS. The investigators examined the rates of accrual, attrition, and reasons for attrition; the feasibility of using the Internet to deliver the intervention; the acceptability of the intervention as structured; and any other benefits and/or limitations of YD. The study used a single-group, mixed-methods design underpinned by social constructivist theory and Pender's Health Promotion Model. Twenty-four women provided consent to enroll in the study. After completing in-person semi-structured interviews and Internet-based measures, including the Physical Activity Readiness Questionnaire, and the modified International Physical Activity Questionnaire, consented participants engaged in 4-weeks of the yogic dance intervention via daily video-based instructions located on the study Web site. After the intervention, four women participated in focus groups to voice their perceptions of barriers to and benefits from YD and the acceptability of using the YD intervention. The investigators analyzed focus group data using content/thematic analysis and validated themes with baseline semi-structured interviews. The majority of the women (79%) found YD acceptable. Themes that emerged from the descriptive data include: (1) Culture is an important aspect of yogic dance; and (2) Increased social support would enhance yogic dance participation. The integrated results from this feasibility study will inform research exploring the complex correlates that influence health behaviors in AA women.

A Structural Model for the Practice of Life Safety Behavior in School-age Children

This study is an examination of the paths in which the primary factors of anxiety, impulsiveness, knowledge of life safety practice, attitudes towards life safety practice, interpersonal support, and self-efficacy from Pender's Health Promotion Model influence the practice of life safety behavior in school-age children. The sample consisted of 489 5th and 6th grade students recruited from five elementary schools in Seoul City and four provinces, South Korea. Data were analyzed using descriptive statistics, correlations, factor analysis, and structural equation modeling. Attitudes towards life safety practice, interpersonal support, self-efficacy and impulsiveness directly influenced practice of life safety behavior. Anxiety did not have a direct influence on practice of life safety behavior, but indirectly affected it. In this modified model, 52.0% of the practice of life safety behavior was explained by the primary factors. To facilitate the practice life safety behaviors in late childhood, a positive attitude towards life safety needs to be developed along with decreasing impulsiveness and enhancing self-efficacy.

Identify Risk Factors for Postnatal Depression among Antenatal Mothers - A Hospital Based Study

Aim : Identify the risk factors associated with postnatal depression among pregnant women and its outcome in a selected urban hospital in Bangalore. Method : A cross sectional study design was used with sample consisting of hundred pregnant women selected at convenience. The study was based on the conceptual framework of Pender's health promotion model. The risk factors of low self esteem, prenatal anxiety and depression, lack of social support, life stress and poor family relationship were measured using modified postpartum predictors inventory. Findings : Most prevalent risk factor for postnatal depression among pregnant women was prenatal anxiety and depression (81%) and the least prevalent risk factor was poor family relationships. The outcome area most affected was sleeping eating disturbances (mean %=40.5) and physical appearance (mean %= 22.23). Significant associations were noted between family income with life stress (p=0.013) and poor family relationships (p=0.017). Conclusion : Presence of certain risk factors in the antenatal period places the mother at a higher risk of developing postnatal depression and nurses should assess mothers at each contact for signs and symptoms of depression.

A Multinomial Regression Model of Risk for Falls (RFF) Factors Among Filipino Elderly in a Community Setting

The etiology of falls is multifactorial. Internationally, nurses are challenged to address this problem through assessment and intervention. Anchored on Pender's Health Promotion Model (1996) and the McGill Model of Nursing developed by Dr. Allen (Gottlieb & Rowat, 1987), a hypothesized model was grounded to explain the relationship of environmental safety, depression, autonomy, and support system to the risk for falls of the Filipino elderly in a community setting. This study was conducted to test a model that describes the relationship of environmental safety, depression, autonomy, and support system to the risk for falls of Filipino elderly found in the community setting. A six-part, multiaspect questionnaire was administered to 125 elderly respondents from a community in Bulacan, Philippines. Using descriptive analysis, the demographic profile of the respondents was characterized. Multinomial regression analysis was used to test the model. A model with adequate fit emerged (F-ratio = 6.071), which revealed that only environmental safety (standardized β = .28 and p value =.001) and depression (standardized β = .24 and p value =.006) significantly impacts the risk for falls; autonomy and support system did not display any statistical significance and were not considered direct determinants of the risk for falls. With the results of the study, the researchers look forward to the risk for falls being decreased and managed through early identification of the risk factors. Also, the model would contribute in the efforts of nurses as it serves as a guide on how environmental safety and depression among elderly Filipinos relate to the risk for falls.

Factors Influencing a Health Promoting Lifestyle in Spouses of Active Duty Military

The purpose of this study was to understand the factors influencing the health promoting behaviors (HPBs) of military spouses. Pender's Health Promotion Model provided the theoretical framework guiding this study. One hundred twelve female spouses were surveyed regarding their perceived health status, perceived stress, self-efficacy, social support, and participation in HPBs. Perceived health status, self-efficacy, social support, and HPBs were positively related, whereas perceived stress was negatively related. Hierarchical multiple regression analysis showed perceived stress and social support to be predictive of an overall health promoting lifestyle (HPLPII), with the full model explaining 49.7% of the variance.

Effect of nutrition education intervention based on Pender's Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students.

To determine the effectiveness of nutrition education intervention based on Pender's Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students. The quasi-experimental study based on Pender's Health Promotion Model was conducted during April-June 2011. Information (data) was collected by self-administered questionnaire. In addition, a 3 d breakfast record was analysed. P < 0·05 was considered significant. Two middle schools in average-income areas of Qom, Iran. One hundred female middle-school students. There was a significant reduction in immediate competing demands and preferences, perceived barriers and negative activity-related affect constructs in the experimental group after education compared with the control group. In addition, perceived benefit, perceived self-efficacy, positive activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, frequency and intakes of macronutrients and most micronutrients of breakfast consumption were also significantly higher in the experimental group compared with the control group after the nutrition education intervention. Constructs of Pender's Health Promotion Model provide a suitable source for designing strategies and content of a nutrition education intervention for improving the frequency and nutrient intake of breakfast consumption among female students.

Factors Associated with Physical Activity among Chinese Immigrant Women

This study was done to assess the level of physical activity among Chinese immigrant women and to determine the relationships of physical activity with individual characteristics and behavior-specific cognition. A cross-sectional descriptive study was conducted with 161 Chinese immigrant women living in Busan. A health promotion model of physical activity adapted from Pender's Health Promotion Model was used. Self-administered questionnaires were used to collect data during the period from September 25 to November 20, 2012. Using SPSS 18.0 program, descriptive statistics, t-test, analysis of variance, correlation analysis, and multiple regression analysis were done. The average level of physical activity of the Chinese immigrant women was 1,050.06 ± 686.47 MET-min/week and the minimum activity among types of physical activity was most dominant (59.6%). As a result of multiple regression analysis, it was confirmed that self-efficacy and acculturation were statistically significant variables in the model (p<.001), with an explanatory power of 23.7%. The results indicate that the development and application of intervention strategies to increase acculturation and self-efficacy for immigrant women will aid in increasing the physical activity in Chinese immigrant women.

Predictors of dietary and fluid non‐adherence in Jordanian patients with end‐stage renal disease receiving haemodialysis: a cross‐sectional study

The purpose of this study is to provide insight into the relationship between dietary and fluid non-adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support among Jordanian patients with end-stage renal disease receiving haemodialysis using Pender's health promotion model. Non-adherence to dietary and fluid restrictions is a leading cause of treatment failure and poor outcomes in end-stage renal disease. Yet, factors that interfere with the patients' ability to follow their dietary restrictions are unknown. A descriptive, correlational, cross-sectional design was used. Jordanian patients (n = 190) with end-stage renal disease receiving haemodialysis from three main Jordanian cities were included. The dialysis diet and fluid nonadherence questionnaire, Beck Depression Inventory-II, Quality Of Life Index, Dialysis Patient-Perceived Exercise Benefits and Barriers Scale, and the Multidimensional Perceived Social Support were employed to measure the key variables. Patients were more likely men with mean age of 48·2 ± 14·9. Only 27% of the patients showed full commitment to diet guidelines and 23% to fluid guidelines during the last 14 days. Depression (M = 18·8 ± 11·4) had significant negative association with quality of life (importance and satisfaction) (r = -0·60, r = -0·32, p = 0·001, respectively). Multiple hierarchal regressions revealed a predictive model of only two variables: age (B = -0·22, p = 0·05) and residual renal function (B = -0·23, p = 0·012) for dietary non-adherence. Non-adherence to diet and fluid guidelines association with individual characteristics, health perception and psychosocial variables should be investigated in a longitudinal design. Relationship of non-adherence with culture-related factors should deeply be assessed among Jordanian patients with end-stage renal disease receiving haemodialysis. Identification of the factors that may worsen dietary and fluid non-adherence may lead to improved therapeutic interventions within the mainstream of medical practice for Jordanian patients with end-stage renal disease receiving haemodialysis.

Implementation of an Epilepsy Self Management Protocol in an Outpatient Neurology Clinic (P01.061)

Implementation of an Epilepsy Self Management Protocol in an Outpatient Neurology Clinic (P01.061)

Effects of Vaginal Douching Education on Turkish Women’s Vaginal Douching Practice

Vaginal douching (VD) is a very common practice in Turkish culture. This practice is affected by individual and cultural characteristics. The aim of the research was to determine how the education based on Pender's health promotion model (HPM) affects women's decision to quit vaginal douche and the factors that cause women to continue VD practices. The HPM guided the 2-hr education process. The sample has 58 women. As a result, the model education-based HPM helped 69% of women to quit VD practice. It was also determined that education affected women who performed VD to feel clean and to comply with the religion but was less effective in women who had lower education or performed VD to comply with the husband's demand. Finally, the study showed that the education based on HPM affected the women to change their attitude toward VD and quit it.

Faith in Action

In 2009, female-headed households represented 29.9% (4.4 million) of all U.S. families, with many living below the poverty line. A church in Bowling Green, Kentucky, began a Single Mothers' Oil Change service, incorporating health screening by nurses using Pender's Health Promotion Model. Nurses are equipped to identify health barriers and offer health promotion guidance and social support to single, low-income women.

Registered nurses' beliefs of the benefits of exercise, their exercise behaviour and their patient teaching regarding exercise

Recommendations by experts have been in place for > 10 years encouraging every adult to participate in ≥ 30 min of daily moderate-intensity physical activity. Despite extensive research supporting the value of physical activity, only about one-third of all adults meet physical activity recommendations. Using Pender's Health Promotion Theory as the framework, this study was focused on the relationships between nurses' beliefs regarding the benefits of exercise, their exercise behaviour and their recommendation of exercise for health promotion or as part of a treatment plan. Results showed positive correlations between exercise benefits, physical activity and recommendation of exercise to patients. Nurses who believe in health promotion and embrace healthy behaviours are more likely to be positive role models and teach healthy behaviours to their patients. Recommendations for practice and future research are included.

Predicting health‐related quality of life by using a health promotion model among Iranian adolescent girls: A structural equation modeling approach

Predicting the significant determinants of health-related quality of life through the application of structural equation modeling in adolescents has received little attention in the health education and health promotion literature. The purpose of this study was to investigate the relationships between self-efficacy, barriers, social support, health-promoting lifestyle, and health-related quality of life among Iranian adolescent girls. Pender's health promotion model guided this study. This was a cross-sectional survey of 500 students who were recruited in Kashan, Iran. Their health-related quality of life was measured by using the Short Form Health Survey. A path analysis was conducted to predict the health-related quality of life determinants. The results indicated that 71% of the variance in health-related quality of life could be predicted by the variables. The results affirmed that self-efficacy was the most significant predictor of the students' health-related quality of life. It was concluded that interventions that are aimed at improving self-efficacy can lead to the enhancement of health-related quality of life among adolescent girls in the developing country of Iran.

Behavioral Outcomes of an Educational Program For Male Veterans with Peripheral Artery Disease

Peripheral artery disease (PAD) affects 8 to 12 million Americans. Untreated PAD results in leg pain, decreased quality of life, and amputation of the legs. Walking has been shown to improve functional impairment and decrease pain among persons with PAD. This study describes a two-group randomized trial that assesses the effectiveness of an educational program, “Vet Walk,” on change in walking distance and health outcomes. The intervention is based on Pender's Health Promotion Model. Fifty male veterans with PAD completed the Health-Promoting Lifestyle Profile II (HPLP II) and 6-Minute Walk test and were randomly assigned to a control group or an intervention group who attended “Vet Walk.” Both groups completed testing at 8 weeks post-intervention. Outcome variables were statistically analyzed for differences between the intervention and control groups. The adjusted mean distance walked in the 6-Minute Walk test for the intervention group increased from 875.5 ft to 1095.5 ft, while the control group increased its adjusted mean walking distance from 826.7 ft to 848.3 ft at 8 weeks, which was a statistically significant difference. There were no statistically significant differences in HPLP II total scores and physical activity subscale scores between the intervention and control group. Although pain decreased in the intervention group, the change was not statistically significant. Among this sample of veterans diagnosed with PAD, the education intervention, “Vet Walk,” proved effective in increasing distance walked and, although not statistically significant, decreasing pain experienced over an 8-week period.