Why Only One in Seven Wears Them: Applying Pender's Health Promotion Model to Hearing Aid Uptake Among Older Adults in Primary Care
[Student Name]
University of Phoenix
NRP/513: Clinical Applications of Theory and Research
Week 2 Assignment
[Instructor Name]
[Date]
The clinic and patient are composites written for a model paper.
In Week 1, I framed untreated hearing loss among older adults in my clinical site as a nursing problem. The gap is large: in a national sample of Americans over 50 whose hearing was measurably impaired, roughly one in seven wore hearing aids in a national sample (Chien & Lin, 2012). Obtaining and wearing hearing aids is a behavior, and a nursing theory of health behavior can help explain why so few older adults adopt it. This paper applies Pender's Health Promotion Model to the problem.
Why This Theory Fits
Pender's Health Promotion Model sets out to explain what moves people toward actions that raise their health and well-being (Pender et al., 2015). Unlike models focused on avoiding disease, it addresses behaviors pursued to enhance function and quality of life, which fits hearing aid use: the goal is better communication, participation and independence. The model also gives a central place to self-efficacy and to interpersonal and situational influences, both relevant to older adults deciding about hearing aids.
The Model's Concepts
The model has three groups of concepts (Pender et al., 2015). Individual characteristics and experiences include prior related behavior and personal factors such as age, income and cognitive status. Behavior-specific cognitions and affect include perceived benefits of action, perceived barriers, perceived self-efficacy, activity-related affect, or feelings about the behavior, and interpersonal and situational influences. The behavioral outcome is preceded by commitment to a plan of action and affected by competing demands and preferences.
Applying the Concepts: One Patient
Mrs. C., 78, a retired librarian, has moderate hearing loss on audiometry done two years ago. She did not buy hearing aids.
Prior related behavior: Mrs. C. tried a friend's hearing aid once and found it loud and whistling, an experience that shapes her expectations.
Personal factors: she lives on a fixed income, and Medicare did not cover the aids her audiologist recommended.
Perceived benefits: she agrees that hearing better would help at church but doubts it would help much at home, where she can turn up the television.
Perceived barriers: cost, the memory of whistling, and the belief that hearing aids make her look old.
Perceived self-efficacy: she is unsure she could manage the small batteries and controls with her arthritic fingers.
Activity-related affect: she feels embarrassed and a little sad when she thinks of wearing them.
Interpersonal influences: her daughter urges her to get them, which she experiences as nagging; her friends at church do not wear them.
Situational influences: the audiology clinic is 40 minutes away, and highway driving is something she gave up last year.
What the Evidence Says
Research on help seeking and hearing aid uptake supports the model's emphasis on perceptions. A review of the literature found that the degree of hearing loss and, especially, a person's own perception of hearing difficulty were among the factors most consistently associated with seeking help and obtaining hearing aids, while many demographic factors were not consistently related (Knudsen et al., 2010). What predicts action is not the audiogram in the chart but the difficulty the person believes she has. This finding aligns with Pender's focus on perceived benefits and barriers rather than objective measures alone.
How the Model Directs My Actions
Each concept points to an action. To strengthen perceived benefits, I would ask Mrs. C. to name the situations she misses most, such as conversations at church or with her grandson, and connect hearing aids to those, rather than to her audiogram. To reduce barriers, I would explain that over-the-counter hearing aids are now available at lower cost for adults with mild to moderate loss and that modern devices manage feedback far better than older ones. To build self-efficacy, I would arrange a demonstration of rechargeable devices, which avoid small batteries. To address affect, I would acknowledge her feelings about aging and normalize hearing aid use. To use interpersonal influence well, I would invite her daughter to support rather than pressure. To address the situational barrier, I would explore closer or remote options for fitting.
Competing Demands
Pender's model includes immediate competing demands and preferences, which can derail a plan at the last moment (Pender et al., 2015). For Mrs. C., the competing demand is her husband's recent heart surgery, which fills her calendar with his appointments. Any plan must fit around his care, perhaps by scheduling her device trial on days he does not have visits and by showing her that better hearing would help her follow his doctors' instructions too.
Why a Nursing Theory Rather Than Another Discipline's
Models from psychology, such as the health belief model, could also explain hearing aid uptake. I chose a nursing model because it was designed for nursing's goal of promoting health and well-being, includes feelings and relationships alongside beliefs and directs attention to what the nurse can do in the encounter.
Commitment to a Plan
Pender's model holds that commitment to a plan of action, with specific steps and timing, precedes the behavior (Pender et al., 2015). With Mrs. C., this means agreeing on a first step, such as trying a rechargeable over-the-counter device for 30 days with a return option, and scheduling a follow-up call.
A Second Patient, a Different Profile
The model's value shows when two patients with the same audiogram differ. Mr. O., 81, a retired machinist with similar hearing loss, bought hearing aids promptly. His prior behavior included years of wearing hearing protection at work, so he saw devices for hearing as ordinary. His wife, whose opinion he values, strongly supported him, and he felt confident with small tools. His perceived benefit was specific: he wanted to hear his great-grandchildren. Pender's concepts explain why he acted when Mrs. C. did not, even though their hearing tests look alike, and they warn me against assuming that one explanation and one intervention will suit every patient.
Measuring the Concepts
If I want to know whether my actions change the model's concepts, I need to measure them. Brief questions can assess perceived benefits, barriers and self-efficacy before and after a counseling visit, and the behavioral outcome can be measured by whether the patient obtains hearing aids within three months and how many hours a day she wears them. Many hearing aids record daily wearing time, which gives an objective measure of the behavior the model aims to explain.
Limitations of the Model
The model is built for voluntary behaviors and may underplay structural barriers such as cost and access, which for many older adults are decisive. It also assumes cognitive capacity to weigh benefits and barriers; some patients with hearing loss have cognitive impairment. I will address these limits by combining the model with system-level changes discussed in later weeks.
Conclusion
Pender's Health Promotion Model explains the low uptake of hearing aids as the product of perceived benefits and barriers, self-efficacy, feelings and interpersonal and situational influences, with commitment to a plan preceding action. Evidence that perceived difficulty drives help seeking supports this focus. For Mrs. C., the model turns a stalled referral into a series of specific actions a nurse practitioner can take.
References
Chien, W., & Lin, F. R. (2012). Prevalence of hearing aid use among older adults in the United States. Archives of Internal Medicine, 172(3), 292-293. https://doi.org/10.1001/archinternmed.2011.1408
Knudsen, L. V., Öberg, M., Nielsen, C., Naylor, G., & Kramer, S. E. (2010). Factors influencing help seeking, hearing aid uptake, hearing aid use and satisfaction with hearing aids: A review of the literature. Trends in Amplification, 14(3), 127-154. https://doi.org/10.1177/1084713810385712
Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2015). Health promotion in nursing practice (7th ed.). Pearson.
How this NRP 513 Week 2 example is structured
The NRP/513 Week 2 work usually asks students to apply a nursing theory to a clinical problem. This paper explains why the chosen theory fits, defines its concepts in plain terms, maps each to evidence and to one patient and ends with actions the theory suggests that a clinician would not otherwise take. Students search this week as NRP 513 Week 2, NRP513 Wk 2 or NRP/513 Wk 2; all three are the same assignment.
NRP/513 Week 2 questions, answered
What does NRP/513 Week 2 usually ask for?
Many sections ask students to select a nursing theory and apply it to a clinical practice problem, explaining how its concepts guide assessment and intervention.
What is Pender's Health Promotion Model?
A nursing model explaining health-promoting behavior through individual characteristics and experiences, behavior-specific cognitions and affect, such as perceived benefits, barriers and self-efficacy, and commitment to a plan of action.
Why use Pender's model for hearing aids?
Getting and using hearing aids is a voluntary health-promoting behavior influenced by beliefs, barriers, confidence, feelings and support, which are exactly the concepts the model addresses.
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