Open Journal of Nursing, 2018, 8, 485-503

http://www.scirp.org/journal/ojn
ISSN Online: 2162-5344
ISSN Print: 2162-5336

Health Promotion Model: An Integrative

Literature Review

Ibrahim Aqtam1, Muhammad Darawwad2

Ministry of Health, Nablus, Palestine

1

School of Nursing, The University of Jordan, Amman, Jordan

2

How to cite this paper: Aqtam, I. and Abstract

Darawwad, M. (2018) Health Promotion
Model: An Integrative Literature Review. Background: The Health Promotion Model (HPM) indicates that each per-
Open Journal of Nursing, 8, 485-503. son is a biopsychosocial creature that is partially shaped by the environment,
https://doi.org/10.4236/ojn.2018.87037 but also seeks to create an environment in which inherent and acquired hu-
Received: July 3, 2018
man potential can be fully expressed. The HPM is proposed as a holistic pre-
Accepted: July 21, 2018 dictive model of health-promoting behavior for use in research and practice.
Published: July 24, 2018 Purpose: The purpose of this review is to examine how the HPM has been
applied in various research studies. Methods: An integrative review was used
Copyright © 2018 by authors and
Scientific Research Publishing Inc.
to find studies that were guided by the HPM. Data search was between 2008
This work is licensed under the Creative to 2018 using Google Scholar, Scopus, Web of Science, Science Direct,
Commons Attribution International PubMed, Medline, CINAHL, EBSCO, Cochrane, ERIC, Joanna Briggs Insti-
License (CC BY 4.0). tute and EBSCO host. The keywords used were Pender’s and Health Promo-
http://creativecommons.org/licenses/by/4.0/
tion Model. Results: Seventeen studies were reviewed; most of them were
Open Access
quantitative studies. These studies discussed variables from the HPM. Most of
the study variables were measured using instruments derived from the HPM.
The results of the reviewed studies revealed that the HPM had predictive val-
ue in estimating health-promoting behaviors. Conclusion: The HPM was
widely established in the nursing community and was implemented in nurs-
ing practice, education, and research. In addition, the HPM constructs were
used to hypothesize conceptual frameworks in many studies to predict
health-promoting behaviors in many chronic diseases.

Keywords
Pender’s and Health Promotion Model, Health Promoting Behaviors,
Women, Children, Workers, and Students

1. Introduction
The Health Promotion Model (HPM) was created by Pender in 1982 and was

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I. Aqtam, M. Darawwad

revised in 1987, 1996, and 2002. Pender’s background in nursing, human devel-
opment, experimental psychology, and education led her to use a holistic nurs-
ing perspective, social psychology, and learning theory as foundations for the
HPM [1]. The Health Promotion Model (HPM) provides a framework to explain
and predict specific health behaviors [2]. The HPM shows that each person is a
biopsychosocial creature that is partially shaped by the environment, but also
seeks to create an environment in which inherent and acquired human potential
can be fully expressed [3]. The HPM was originally developed to target individu-
als; however the framework can be used to target families, groups, or communi-
ties. The HPM comprises three primary areas that nurses can use to assess health
promotion behaviors: 1) personal characteristics and experiences; 2) beha-
viors-specific cognition and affect; and 3) behavioral outcome. Moreover, the
HPM incorporates elements of the change process, including a commitment to a
plan of action and acknowledgement of competing demands. The final outcome
is engagement in health promotion behaviors [4]. Pender puts her efforts to de-
velop a model that guide nursing society as a whole through interactions at the
individual level and biophysical processes that motivate individuals to partici-
pate in health-promoting behaviors leading to overall well-being [3]. Pender’s
model provides important guides for nursing professionals as they focus on
health promotion strategies for patients and for research aimed at prediction of
health-promoting behaviors. Finally, HPM has been tested in different popula-
tions and settings. Furthermore, it was widely accepted by the nursing commu-
nity and is currently used in nursing practice, research and education [5]. For
this reason, this literature review comes to examine how the HPM has been ap-
plied in various research studies.

2. Methods
2.1. Search Strategy
In this review, the search was performed by different international databases in-
cluding Google Scholar, Scopus, Web of Science, Science Direct, PubMed, Med-
line, CINAHL, EBSCO, Cochrane, ERIC, Joanna Briggs Institute and EBSCO
host using the keywords of “Health Promotion Model”, “Health-Promoting Be-
haviors”, “Women’s”, “Children”, “Workers”, and “Students”. Initially, sepa-
rated with each new search added a new keyword until including all keywords.
Later, these words were searched in combination with each other, starting with
search process targeted primary resources with no geographical limits and tar-
geted disciplines other than nursing such as psychology, public health, and social
works. Boolean operators (AND, OR) have been applied separately and in com-
bination with the keywords to expand, combine, or exclude keywords in a search
to narrow down the results and reach a more focused and productive results. Ar-
ticles excluded from search those that focus on populations not comparable to
nurses and articles published in languages other than English. However, the
searching process was limited to following inclusion criteria: 1) the article was

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 I. Aqtam, M. Darawwad

published in a peer-reviewed nursing journal; 2) HPM was the conceptual

framework or one of the conceptual frameworks that guided the study; 3) the
study was research based; 4) full text article was present; 5) article was published
in English language; and 6) articles published between 2008 and 2018.

2.2. Overview of the Reviewed Studies

The electronic search revealed 40 articles; 23 articles were excluded because they
were non research-based articles or were not published in a peer-reviewed nurs-
ing journal. The 17 research studies that met the inclusion criteria were retrieved
and reviewed, where 16 of them used quantitative research methodologies
[6]-[21], and one used qualitative methodology [22]. Cross-sectional research
design was the most commonly used design in the quantitative studies, and two
studies used quasi experimental design [18] [20], and one study used a rando-
mized clinical trial [10] (See Figure 1).

2.3. The Purposes of the Reviewed Studies

There were wide variations in the purposes of the reviewed studies. Generally,
the purposes of these studies can be categorized into two main categories. The
first category is the studies that described aspects of the HPM in different popu-
lations, while the second category is the studies that tested relationships either
among different variables of HPM, or between selected HPM variables and other
variables.
The first category included six studies which described the everyday physical
activity habits of students and analyzed the practice of physical activity and its
determinant [6], identified and documented factors influencing the Intermittent
Preventive Treatment (IPTp2) in pregnancy + uptake [12], examined facilitators

Figure 1. Search strategy and outcomes.

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I. Aqtam, M. Darawwad

and barriers that migrant women in Turkey identified related to breast

self-examination, clinical breast examination, and mammography [22], deter-
mined health promoting behaviors of university students in Jordan and factors
influencing them [15], determined the knowledge of and compliance with stan-
dard precautionary measures among nurses in Madonna University Teaching
Hospital [17], and examined the factors that may influence health responsibility,
relationships, resilience, neighborhood perception, social support, and health
promoting behaviors in adolescents, between the ages of 13 and 18 years old
[21]. All these studies contributed to understanding the application of HPM in
different populations.
The second category included eleven studies which evaluated the HPM as a
mean to predict physical activity (PA) in a sample of Iranian adolescent boys [7],
compared perceived self-efficacy, exercise benefits, exercise barriers, and com-
mitment to exercise between patients diagnosed with osteoporosis and os-
teoarthritis, and assessing the influence of perceived exercise self-efficacy, exer-
cise benefits, and barriers on commitment [8], explored perceived exercise
self-efficacy, benefits and barriers, and commitment to exercise among Jorda-
nians with chronic illnesses [14], explored perception of exercise benefits and
barriers among Jordanian patients’ with End Stage Renal Disease (ESRD) [11],
used HPM 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
ESRD receiving hemodialysis [9], conducted an evaluation of an educational
program based on the HPM and stages of change to improve physical activity
(PA) behavior among Iranian adolescents [10], used Pender’s HPM to describe
and identify the predictors of health-promoting behaviors in Nepalese migrant
workers in Korea [13], examined the psychometric properties of the Arabic ver-
sion of Bandura’s Exercise Self-Efficacy scale (ESE-A) among Jordanian patients
with different chronic diseases [16], assessed the effect of application of Pender’s
HPM on management of hypertension among adults in rural area [18], ex-
amined the impact of performing a HPM intervention on physical activity of the
health Volunteers [19], and investigated the effect of Pender’s HPM to improve
the nutritional behavior of overweight and obese women admitted to Fatemiyeh
Hospital clinics in Hamadan, Iran [20]. All these studies tested relationships
among different variables of the HPM. Those studies revealed that testing rela-
tionships among different variables of the HPM will enhance the predictive abil-
ity of this model in predicting the health-promoting behaviors.

2.4. Sample of Populations

Different samples and populations were used in the reviewed studies. Generally,
the samples and populations of these studies can be categorized into four cate-
gories. The first category is the studies that recruited students with different level
of education, 79 students in a public school [6], 515 boys from 100 junior high

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 I. Aqtam, M. Darawwad

and high schools [7], 165 adolescents aged 13 - 15 years old from high schools
[10], 525 university students receiving education from two governmental and
one private universities [15], and 122 adolescents students between the ages of
13 and 18 years old [21]. The second category is the studies that tested a samples
and populations of chronic illness. The samples were 75 patients with a clinical
diagnosis of osteoporosis and 75 patients with osteoarthritis [8], 190 patients
with ESRD receiving hemodialysis [9], 190 patients with ESRD [11], 402 outpa-
tient with chronic illnesses [14], 272 patients with chronic illness [16], and 150
adults with hypertension [18].
The third category is the studies that target women with different health sta-
tus. The samples were 278 pregnant women who were at the 24th week or more
of gestation, aged between 15 and 49 years [12], 39 women who were older than
20 years [22], and 108 overweight women [20]. The last category is the studies
that involved workers from different background. The samples were 169 immi-
grant workers [13], 102 nurses working in Madonna University Teaching Hos-
pital [17], and 80 health volunteers [19]. It can be noticed that studies involved a
wide range of populations with different sample sizes in different settings. Using
such different populations and settings indicated that the HPM is applicable and
highly generalizable.

2.5. The Key Variables

Many variables and concepts have been comprehensively discussed in the re-
viewed studies. Most of these variables are components of the HPM. Some stu-
dies discussed one or two variables. For example, some studies described the
physical activity of students and its determinants [6], identified factors influen-
cing preventive treatment in pregnancy [12], determined health promoting be-
haviors among university students [15], determined the knowledge of and com-
pliance with standard precautionary measures among nurses [17], and evaluated
exercise self-efficacy among Arabic patients with chronic diseases by assessing
the psychometric properties of the Arabic version of Exercise Self-Efficacy scale
(ESE-A) [16].
While other studies discussed more than two variables utilized from HPM.
For example, some studies evaluated the HPM concepts (perceived benefits,
perceived barriers, exercise self-efficacy, enjoyment of PA, social support, and
exposure to modeling, interpersonal norms, commitment to PA planning, com-
peting demands) as a means to predict PA [7], compared perceived self-efficacy,
exercise benefits, exercise barriers, and commitment to exercise between patients
diagnosed with osteoporosis and osteoarthritis, and assessing the influence of
perceived exercise self-efficacy, exercise benefits, and barriers to commitment
[8], used HPM and its stages of change to improve PA behavior among adoles-
cents [10], examined the impact of performing HPM intervention on PA of the
health volunteers [19], and used HPM to examine relationship between dietary
and fluid non adherence, depressive symptoms, quality of life, perceived barriers

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I. Aqtam, M. Darawwad

and benefits of exercise, and perceived social support among patients with ESRD
[9]. Moreover, some studies explored perception of exercise benefits and barriers
along with the factors associated with such perceptions among patients with
ESRD [11], assessed the relationship between perceived exercise self-efficacy,
benefits and barriers, and commitment to exercise planning [14], used HPM to
describe and identify the predictors of health-promoting behaviors among mi-
grant workers [13], and examined facilitators and barriers that migrant women
identified related to breast self-examination, clinical breast examination, and
mammography [22]. Furthermore, some studies assessed the effect of applica-
tion of HPM on management of hypertension among adults [18], investigated
the effect of HPM to improve the nutritional behavior of overweight and obese
women [20], and examined relationships among health responsibility, resilience,
neighborhood perception, social support, and health promoting behaviors in
adolescents [21].
Testing relationships among variables of the HPM or with other variables in
different settings and using different populations is very important in exploring
and validating the relationships and will enhance the predictive value of the
HPM.

2.6. Data Collection Methods

Self report method was used in all of the studies as a data collection method.
Specifically, self administered questionnaires were used in most of the reviewed
studies. However, one study used interview for data collection [22], and other
studies used several techniques to collect data such as self reported question-
naire, observation, anthropometric evaluation, and measuring blood pressure [6]
[18].

2.7. Measuring Instruments

Many instruments were used for data collection. The review of these studies re-
vealed that all of the research instruments used were derived from the HPM.
These instruments included Pender’s Health-Promoting Behavior Scale, Pend-
er’s Commitment to a Plan of Action Scale, Pender’s Perceived Benefits Scale,
Pender’s Perceived Barriers to Action Scale, and Pender’s Preference Scale. All
used instruments are presented in (Appendix A).

3. Results
The reviewed studies examined HPM in different settings, populations, and cir-
cumstances. So, the results of each study are relatively unique and can be genera-
lized to people who share the same characteristics of the study population. One
study found that the first component “previous behaviors and personal factors”
of Pender’s theoretical model of health promotion can be related to the daily
routine of children and adolescents, focusing on physical activities [6]. While,
another study showed that, the HPM accounted for 37% of the variance in Phys-

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ical Activity (PA) but did not represent a good data fit, there were significant
pathways between PA and self-efficacy, enjoyment, and PA modeling, the re-
vised model that included the indirect effects of competing demands explained
34% of the variance in PA and represented a good data fit, and self-efficacy,
commitment to planning, and enjoyment were linked to PA. Additionally, com-
peting demands have an effect on PA [7].
Moreover, another study revealed that osteoporotic patients had significantly
higher mean scores of commitment to plan, and higher exercise self-efficacy,
while the mean score of exercise benefit was higher in the osteoarthritis group.
In addition, a significant positive correlations were found between commitment
and perceived self-efficacy scores, and between self-efficacy and perceived lack
of barriers and exercise benefits in both groups, age was a negative predictor for
commitment in osteoporosis group, while self-efficacy and lack of barriers were
positive predictors, and in osteoarthritis group, self-efficacy was the only posi-
tive predictor of commitment [8]. A different study among ESRD patients
showed full commitment to diet guidelines and to fluid guidelines, depression
had significant negative association with quality of life, and the results also re-
vealed a predictive model of only two variables: age and residual renal function
for dietary non-adherence [9]. A similar population with different variables
study revealed that participants had significantly perceived more exercise bene-
fits compared with exercise barriers [11].
Furthermore, a significant correlation has been found between commitment
to exercise planning with barriers and benefits among chronically ill patients,
and self-efficacy was not correlated with other variables [14]. From the other
side, exercise self-efficacy among patients with different chronic illnesses was
evaluated by assessing the psychometric properties of the Arabic version of Ex-
ercise Self-Efficacy scale (ESE-A), the results showed significant correlation with
weekly exercise frequency, duration, and evaluation of physical exercise, and the
ESE-A was found to be a fit measure to evaluate exercise self-efficacy among
Arabic patients with chronic diseases [16].
Nevertheless, differences in all HPM constructs, except activity-related affect
and social influences, were significant between baseline and follow-up mea-
surements, adolescents in the intervention as compared to the control group
were placed in action (70%) or preparation (30%) stages at follow-up, and the
results revealed that competing preferences, social norms, role models, and
commitment to action plan can significantly predict PA behavior, and the model
accounted for 22.5% of the variance in PA [10]. Moreover, a group of pregnant
women aged between 15 and 49 years coming to public health facilities to iden-
tify and document factors influencing the Intermittent Preventive Treatment in
pregnancy (IPTp2) + uptake, the results indicated that 37.2% participants who
had obtained less than IPTp2 and 53.5% who accessed IPTp2+ reported receiv-
ing support from their partners towards Antenatal Care (ANC) visits, and the
relationship between the uptake of IPTp services and self-reported risk-perception

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I. Aqtam, M. Darawwad

was not significant, also the relationship between the uptake of IPTp and per-
ceived seriousness of malaria infection during pregnancy was not significant,
while perception about the duration suggesting up to 95% chance that the up-
take of IPTp significantly associated with the duration taken at the health facili-
ties before receiving services, and the attitude of most providers at the ANC fa-
cilities 99% chance that the uptake of IPTp significantly associated with per-
ceived attitudes of providers towards pregnant women attending ANC clinics (P
= 0.000) [12].
Another study identified predictors of health-promoting behaviors among 169
workers, the results revealed that spiritual activity was the highest reported
health-promoting behavior, whereas physical activity was the least practiced be-
havior, and self-efficacy was the only significant predictor of health-promoting
behavior [13]. Furthermore, in a sample of 525 university students receiving
education from two governmental and one private universities in Jordan, a sig-
nificant differences found between health-promoting behavior and student’s age,
gender, employment status, family income, university type, and faculty type, also
significant differences found between males and females on health responsibility
and interpersonal relations, stress management, and spiritual growth [15]. From
the other side, a study based on HPM to direct health protection among 102
nurses working in teaching hospital, found that knowledge of respondents and
their compliance with standard precautionary measures was above average. The
majority of the nurses (80%) comply with both medical and surgical asepsis [17].
A different study aimed to assess the effect of application of HPM on man-
agement of hypertension among 150 adults in Egypt, showed that there was sta-
tistical significant improvement among the study group than the control group
at the posttest of health-promoting behavior, and the highest mean score was in
the posttest of nutrition dimension followed by medication adherence, stress
management and physical activity, but smoking had no statistical significant
improvement [18]. Moreover, a significant difference among 80 health volun-
teers in Iran found between the mean scores of physical activity and other struc-
tures of HPM in the experimental group after the intervention and its score be-
fore intervention [19]. Nevertheless, an experimental study to investigate the ef-
fect of Pender’s HPM in improving the nutritional behavior of 108 overweight
and obese women visits hospital clinics in Iran, showed significant differences in
the experimental group before and after the intervention in nutritional behavior,
perceived benefits, perceived self-efficacy, commitment to action, interpersonal
and situational influences, behavior-related affect, and perceived barriers [20].
In another correlation study to examine the relationships between health re-
sponsibility, social support, resilience, neighborhood perception, and health be-
haviors among 122 adolescents between the ages of 13 and 18 years old, the re-
sults found a significant relationships between health responsibility and health
promoting behaviors and between health responsibility and neighborhood per-
ception, also no relationships were found between the dependent variable of

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 I. Aqtam, M. Darawwad

health responsibility and the independent variables of resilience and social sup-
port in this population [21].
Finally, a qualitative study used an interview guided by the Health Belief
Model (HBM) and the Health Promotion Model (HPM) to examine facilitators
and barriers among 39 women in Turkey related to breast self-examination,
clinical breast examination, and mammography. Three main themes were
emerging: 1) knowledge and awareness about breast cancer; 2) personal factors;
and 3) medical service provider and social environment. Also the results showed
that HBM and HPM were effective in explaining barriers and facilitators toward
participation of women in screening behaviors. Additionally, lack of informa-
tion, indifference, and cultural factors are the most important barriers of women
[22].

4. Discussion
This integrative literature review showed that Pender’s HPM can be used for
conducting studies that predict effective benefits/barriers in health-promoting
behaviors, detect impacts of intervention for improving health-promoting beha-
viors, test this model, predict stage or level of change in related factor affecting
health-promoting behavior, and to determine the relationship of variables asso-
ciated with health-promoting behaviors.
The studies predicting effective benefit/barriers and the significant determi-
nants of health-promoting behaviors emphasized the fact that according to
Pender’s model, healthcare providers/professionals can understand and address
modifiable behavior-specific variables [23]. Therefore, they are ready to identify
health benefits/barriers and recommend health-promoting behaviors guidance
and social support to all people. Also, they should consider these variables in in-
terventions to increase healthy lifestyle. Applications of Pender’s model guide
the development of successful theory-based interventions and provided evidence
of the effectiveness of several interventions based on this theory. Moreover,
HPM is useful in decreasing risk factors of diseases, especially chronic diseases
and symptoms, and promote healthy lifestyle [24].
Finally, identifying health-promoting behavior and predicting stage of change
related factors can affect health-promoting behavior, so HPM can be very useful,
especially to examine the similarities and differences among groups, and health-
care providers can use these similarities and differences to assess, identify and
use effective health-promotion programs, strategies and interventions [25].

5. Conclusion
The HPM has become prevalent in later years and might be practical in under-
standing health-promoting behaviors. Such integrated review showed that HPM
is valid and applicable in different nursing settings. Direct or indirect influences
of HPM predictors on health-promoting behaviors have been confirmed in this
paper. Such an integrative review paper approves that HPM provides a frame-

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I. Aqtam, M. Darawwad

work to understand the factors and variables that influence the initiation of
health-promoting behaviors in different settings with different populations. This
paper shows that the effective use of evidence-based research in nursing practice
requires an integrated review such as our review paper.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this pa-
per.

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[22] Tuzcu, A. and Bahar, Z. (2014) Barriers and Facilitators to Breast Cancer Screening
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[23] Ho, A.Y., Berggren, I. and Dahlborg-Lyckhage, E. (2010) Diabetes Empowerment
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[24] Kim, S.J. and Yoo, I.Y. (2016) Health Promotion Behavior of Chinese International
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Appendix A: Studies Guided by Health Promotion Model (n = 17)

Study
Citation Purpose Design Key Variables Instruments Results
Populations

The first component

To describe the
Interviews and “previous behaviors and
everyday
physical examination, personal factors” of
physical activity 79 children and
Previous behaviors profile of physical Pender’s theoretical
habits of students adolescents
Guedes et al. Cross-sectional and personal activity (gender, age model of health
and analyze the aged 6 to 18 years
(2009), Brazil design factors, and range, time spent promotion can be related
practice of in a public school
physical activities daily on sedentary with the daily routine of
physical activity in Brazil
activities, and body children and adolescents,
and its
mass index (BMI)) focusing on physical
determinants
activities

HPMHPM accounted for

37% of the variance in
Physical Activity (PA) but
did not represent a good
data fit. There were
significant pathways
between PA and
self-efficacy, enjoyment,
Physical activity and and PA modeling
psychosocial respectively (Β = 0.25, P <
variables—a modified 0.001), (B = 0.22, P <
To evaluate the Physical activity
version of the 515 boys from 0.01), and (B = −0.13, P <
Taymoori HPM as a means and psychosocial
Cross-sectional child/adolescent 100 junior high 0.05). A revised model
et al. (2010), to predict variables,
design activity log (CAAL; and high schools that
Iran physical activity Competing
Garcia, et al., 1995, in Iran included the indirect
(PA) demands
1997), Competing effects of competing
demands—Pender’s demands explained 34%
scale of the variance in PA and
represented a good data
fit. In the revised model,
self-efficacy, commitment
to planning, and
enjoyment were
associated with PA;
additionally, competing
demands influence PA

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 I. Aqtam, M. Darawwad

Continued
Osteoporotic patients had
significantly of
commitment to plan and
exercise self-efficacy, while
To compare Perceived exercise benefit was higher
perceived self-efficacy—perceive in the osteoarthritis group
self-efficacy, d exercise self-efficacy (P< 0.001). In addition,
exercise benefits, scale, Bandura (1997), significant positive
exercise barriers, Perceived benefits and correlations were found
75 patients with a
and commitment barriers to between commitment and
clinical diagnosis
to exercise Perceived exercise—exercise perceived self-efficacy
of osteoporosis
between patients self-efficacy, exercise benefits and barriers scores, and between
Hanan, S.A. Comparative and 75 patients
diagnosed with benefits, exercise scale Sechrist, et al. self-efficacy and perceived
and Sahar Y.M. cross-sectional with osteoarthritis
osteoporosis and barriers, and (1987), Commitment lack of barriers and
(2011), Egypt design at the Maternity
osteoarthritis, and commitment to a to a plan-commitment exercise benefits in both
Hospital, and Ain
to assess the plan to a plan for exercise groups (P< 0.001). Age was
Shams University
influence of scale, Pender (1996), a negative predictor for
Hospitals in Egypt
perceived exercise and adherence to the commitment in
self-efficacy, exercise—exercise osteoporosis group, while
exercise benefits, documentation record self-efficacy and lack of
and barriers on (developed by the barriers were positive
commitment researchers) predictors. In
osteoarthritis group,
self-efficacy was the only
positive predictor of
commitment
Diet and fluid
non-adherence—the
dialysis diet and fluid
nonadherence
questionnaire
(DDFQ), (Vlaminck,
et al., 2001),
To provide
Depressive
insight into the ESRD patients showed full
symptoms—the beck
relationship commitment to diet
depression
between dietary guidelines and to fluid
inventory-II (BDI-II),
and fluid guidelines. Depression had
Dietary and fluid (Beck, et al., 1996), A convenience
nonadherence, significant negative
nonadherence, Perceived quality of sample of 190
depressive association with quality of
depressive life—the quality of life patients diagnosed
symptoms, quality A descriptive, life (importance and
symptoms, quality index (QLI), (Ferrans with ESRD and
Khalil et al. of life, perceived correlational, satisfaction) (r = −0.60, r =
of life, perceived & Powers, 1985), being dialyzed in
(2012), Jordan barriers and cross-sectional −0.32, P = 0.001, respec-
barriers and benefits Perception of dialysis three major cities
benefits of design tively). Results also re-
of exercise, and patients regarding in Jordan:
exercise, and vealed a predictive model
perceived social exercise benefits and Amman, Zarqa
perceived social of only two variables: age
support barriers—the dialysis and Irbid
support among (Β = −0.22, P = 0.05) and
patient-perceived
patients with residual renal function for
exercise benefits and
end-stage renal dietary non-adherence (B
barriers scale
disease receiving = −0.23, P = 0.012)
(DPEBBS), (Zheng,
hemodialysis
et al., 2009), and
perceived social
support—the
multidimensional
perceived social
support scale (Zimet,
et al., 1988)

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I. Aqtam, M. Darawwad

Continued

A convenience
Perception of dialysis sample of 190
To explore
patients regarding patients
perception of
exercise benefits and diagnosed with Participants significantly
exercise benefits
Descriptive barriers—the dialysis ESRD ages ranged perceived more exercise
Darawad et al. and barriers Perceived exercise
correlational patient-perceived from 18 - 84 and benefits compared with
(2013), Jordan among benefits and barriers
design exercise benefits and being dialyzed in exercise barriers (t = 2.17,
Jordanian
barriers scale three major cities df = 187, P = 0.03)
patients’ with
(DPEBBS), (Zheng, in Jordan:
ESRD
et al., 2009). Amman, Zarqa
and Irbid

Perceived benefits and

barriers—the exercise
A convenience
benefits and barriers
sample of 402
Scale (EBBS), Significant correlation
To explore ages ranged from
(Sechrist, Walker, & between commitment to
perceived exercise 19 - 93 years with
Perceived exercise Pender, 1987), exercise planning with
self-efficacy, chronic illnesses
self-efficacy, Exercise barriers and benefits
benefits and Descriptive from four
Darawad et al. benefits and self-efficacy—the among chronic ill patients
barriers, and cross-sectional hospitals
(2014), Jordan barriers, and exercise self-efficacy (r = 0.1, r = 0.10, P =
commitment to design representing the
commitment to Scale (ESE), (Bandura, 0.001, respectively).
exercise among main healthcare
exercise planning 2006), and Self-efficacy was not
Jordanians with sectors in Jordan:
commitment to correlated with other
chronic illnesses governmental,
exercise planning variables
teaching, and
—the commitment to
private
a plan for exercise
scale, (Bandura, 2006)

Exercise profile
A convenience
(frequency, duration, Significant correlation
sample of 272
exercise activity, and with weekly exercise
To examine the patients with
health perception) frequency (r = 0.23, P <
psychometric chronic illness
—frequency, duration, 0.001), duration (r = 0.31,
properties of the from outpatient
and exercise P < 0.001), and evaluation
Arabic version of clinics (cardiac,
activity-researcher of their physical exercise (r
Bandura’s endocrine, and
Descriptive developed, and health = 0.39, P < 0.001). Also the
Darawad et al. Exercise renal) at four
cross-sectional Exercise self-efficacy perception ESE-A was found to be a
(2016), Jordan Self-Efficacy scale hospitals
design —(Mason-Hawkes & fit measure to evaluate
(ESE-A) among representative for
Holm, 1993), and exercise self-efficacy
Jordanian the major health
Exercise among Arabic patients
patients with care sectors in
self-efficacy—the with chronic diseases
different chronic Jordan: public,
Arabic version of (Cronbach’s alpha was
diseases. university
exercise self-efficacy 0.89 and split-half
-affiliated, and
scale (ESE-A), coefficient was 0.83)
private
(Bandura, 1997)

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 I. Aqtam, M. Darawwad

Continued

Physical
activity—stage of
changes scale,
Kearney, et al. (1999),
ability to
exercise—children’s
exercise self-efficacy
survey, Garcia et al.
(1995), perceived
benefits/barriers to
exercise—children’s Differences in all HPM
perceived constructs, except
benefits/barriers to activity-related affect and
exercise questionnaire social influences, were
Garcia et al. (1995), significant between
exercise norms, and baseline and follow-up
To evaluate of an social measurements (P < 0.01).
educational Physical activity, support-interpersonal Adolescents in the
program based benefits and variables scale, Garcia intervention as compared
on the health barriers of action, et al. (1995), to the control group were
165 adolescents
promotion self-efficacy, activity-related placed in action (70%) or
Sanaeinasab Randomized aged 13 - 15 years
model (HPM) activity-related affect-Robbins et al. preparation (30%) stages
et al. (2012) controlled trial old from high
and stages of affect, interpersonal (2004), competing at follow-up. Moreover,
schools in Iran
change to influences, and demands and the results revealed that
improve physical situational preferences-exercise competing preferences,
activity (PA) influences preference profile, social norms, role models,
behavior Pender et al.(1995), and commitment to
Situational influences action plan can
—situational significantly predict PA
influences options, behavior (P< 0.001). The
Pender et al. (1995), model accounted for
commitment 22.5% of the variance in
to a plan of action— PA
planning for exercise
scale, Pender et al.
(1995), Recall
PA—child/adolescent
activity log, Garcia et
al. (1997), and time of
PA—weekly physical
activity scale,
(developed by the
researchers)

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I. Aqtam, M. Darawwad

Continued

37.2% participants who

had obtained less than
IPTp2 and 53.5% who
accessed IPTp2+ reported
receiving support from
their partners towards
Antenatal Care (ANC)
visits, the relationship
between the uptake of
IPTp services and
self-reported
risk-perception was not
significant, the
relationship between the
Socio-demographic
uptake of IPTp and
To identify and and economic
278 pregnant perceived seriousness of
document factors Personal attributes, attributes, knowledge,
women who were malaria infection during
influencing the quality of services, health education
at the 24th week pregnancy was not
Mutulei intermittent Cross-sectional perceptions about a attendance, and
or more of significant, perception
(2013), Kenya preventive survey disease, and perceptions about
gestation, aged about the duration
treatment in health-promoting intervention-standard
between 15 and suggesting up to 95%
pregnancy behaviors survey questionnaire
49 years in Kenya chance that the uptake of
(IPTp2) + uptake (developed by the
IPTp significantly
researcher)
associated with the
duration taken at the
health facilities before
receiving services (P =
0.000), and the attitude of
most providers at the ANC
facilities 99% chance that
the uptake of IPTp
significantly associated
with perceived attitudes of
providers towards
pregnant women
attending ANC clinics (P
= 0.000)

Perceived health
status—a single item
Question (n.d),
Spiritual activity was the
perceived
highest reported
self-efficacy-perceived
To describe and health-promoting
health competence
identify the Perceived health behavior, whereas physical
scale (Smith,
Bhandari, P. predictors of status, perceived 169 Nepalese activity was the least
Cross-sectional Wallston, & Smith,
and Kim, M. health-promoting self-efficacy, and immigrants practiced behavior, and
design 1995), and
(2014), Korea behaviors in health-promoting workers in Korea self-efficacy was the only
health-promoting
Nepalese migrant behaviors significant predictor of
behaviors—
workers in Korea health-promoting
health-promoting
behavior (B = 0.22, P <
lifestyle profile II
0.05)
(HPLP II) (Walker &
Hill-Polerecky,
1996)

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 I. Aqtam, M. Darawwad

Continued

Three main themes were

emerged as a result of data
analysis: 1) knowledge and
awareness about breast
To examine cancer; 2) personal factors;
facilitators and and 3) medical service
barriers that provider and social
migrant women phenomeno- Perceived barriers, environment. Also the
39 migrant
Tuzcu, A. and in Turkey logical perceived results showed that HBM
women aged
Bahar, Z. identified related qualitative facilitators, and Interview and HPM were effective in
between 20 - 57
(2014), Turkey to breast (Focus group health-promoting explaining barriers and
years in Turkey
self-examination, method) behaviors facilitators toward
clinical breast participation of women in
examination, and screening behaviors.
mammography Additionally, lack of
information, indifference,
and cultural factors are the
most important barriers of
women

Significant differences
between health-promoting
behavior and student’s age,
To determine Health-promoting 525 university gender, employment
health promoting behaviors— students receiving status, family income,
behaviors of Cross-sectional Health-Promoting education from university type, and faculty
Shaheen et al. Health-promoting
university descriptive Lifestyle Profile II two governmental type (P < 0.01), significant
(2015), Jordan behaviors
students in Jordan design (HPLP II) (Walker & and one private differences between males
and factors Hill-Polerecky, universities in and females on health
influencing them 1996) Jordan responsibility and
interpersonal relations,
stress management, and
spiritual growth (P < 0.05)

Knowledge-five Knowledge of respondents

To determine the
questions (yes/no) 102 nurses and their compliance with
knowledge of and
answers (developed by working in standard precautionary
Grace, C. and compliance with Cross-sectional
Knowledge and the researchers) and Madonna measures was above
Sandra, E. standard descriptive
compliance compliance-4-items University average. Majority of the
(2016), Nigeria precautionary design
Likert scale Teaching Hospital nurses (80%) comply with
measures among
(developed by the in Nigeria both medical and surgical
nurses
researchers) asepsis

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I. Aqtam, M. Darawwad

Continued

Personal factors—6
closed ended
questions, Janet
(2011), prior related
behaviors-Hill-bone
blood pressure Statistical significant
medication improvement among the
compliance scale, study group than the
To assess the Kim, Hill, Bone, & control group at the post
Individual
effect of Levine (2000), test of health-promoting
characteristics and
application of behavior-specific behavior (P < 0.05). The
experiences,
Pender’s health Quasi cognition and affects- 150 adults with highest mean score was in
Hussein et al. behavior-specific
promotion model -experimental behavior-specific hypertension aged the posttest of nutrition
(2016), Egypt cognitions and
on management design cognition and affects 18 - 64 in Egypt dimension followed by
affect, and
of hypertension scale, Angelina (2012), medication adherence,
behavioral
among adults in health promoting stress management and
outcomes
rural area behavior (behavior physical activity but
outcome)—health smoking had no
promoting behavior statistically significant
scale, Glenn (2010), improvement (P < 0.05)
and physical
measurements—
anthropometric
measurements and
blood pressure

Perceived benefits,
self-efficacy and
Perceived benefits,
health-promoting Significant difference
To examine the self-efficacy and
behaviors, behavior, between the
impact of health-promoting
physical activity, mean scores of physical
performing health behaviors, behavior,
commitment, emotion activity and other
Rahimian et al. promotion model Cross-sectional physical activity, 80 health
and situational structures of HPM in the
(2016), Iran intervention on design commitment, volunteers in Iran
influences. and experimental group after
physical activity emotion and
perceived the intervention and its
of the health situational
—international score before intervention
volunteers influences and
physical activity (P < 0.001)
perceived barriers
questionnaire (IPAQ)
(n.d)

Perceived benefits, Perceived benefits, Significant differences in

perceived perceived the experimental group
To investigate the
barriers, perceived barriers, perceived before and after the
effect of Pender’s
self-efficacy, self-efficacy, intervention in nutritional
health promotion
behavior-related behavior-related 108 overweight behavior, perceived
Khodaveisi model (HPM) to Quasi
affect, interpersonal affect, interpersonal women visits benefits, perceived
et al. (2017), improve the -experimental
influences, influences, situational hospital clinics in self-efficacy, commitment
Iran nutritional design
situational influences, Iran to action, interpersonal
behavior of
influences, commitment to and situational influences,
overweight and
commitment to action and nutritional behavior-related affect,
obese women
action, and behavior—researchers and perceived barriers (P <
nutritional behavior developed inventories 0.001)

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 I. Aqtam, M. Darawwad

Continued
Health responsibility
—adolescent lifestyle
profile (ALP-R2)
Hendricks, Pender, &
Significant relationship
Hendricks, (2001),
was found between health
Resilience—brief
responsibility and health
resilience scale (BRS),
promoting behaviors (r =
Dalen, Wiggins,
0.733, P < 0.001) and
Health Tooley, Christopher,
To examine the between health
responsibility, and Bernard (2008),
factors that may 122 adolescents responsibility and
Ayres, C. and resilience, Social support—the
influence health Correlational aged 13 - 18 years neigborhood perception (r
Pontes, N. neighborhood multidimensional
responsibility study design in an urban = 0.163, P < 0.01).
(2018), USA perception, social scale of perceived
among setting in USA No relationships were
support, and health social support
adolescents found between the
promoting (MSPSS), (Zimet,
dependent variable of
Dahlem, Zimet, &
health responsibility and
Farley, (1988), and
the independent variables
neighborhood
of resilience and social
perception—perceived
support in this population
neighborhood
disorder scale
(PNDS), Ross &
Mirowsky, (2001)

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