1. How did you become interested in health promotion?

Very early in my nursing career, it became apparent to me that health professionals intervened only after people developed acute or chronic disease and experienced compromised lives. Attention was devoted to treating them after the fact. This reactive approach did not reflect the philosophical beliefs of our predecessors in nursing who focused on maintaining conditions of healthy interaction between self and the environment. My doctoral preparation in psychology and cognitive processes furthered my interest in people's ability to take responsibility, make reasoned decisions and engage in competent self-care. Dr. Beverly McElmurry as my esteemed colleague at Northern Illinois University further sparked my thinking as we discussed her dissertation work on Health as the Basis of Nursing Curricula. I committed myself to the proactive stance of health promotion and disease prevention with the conviction that it is much better to experience exuberant well-being and prevent disease than let disease happen when it is avoidable and then try and cope with it.

2. What is your area of doctoral preparation?

I became interested in doctoral preparation when there were very few doctoral programs in existence. I completed a dual major doctoral degree in Psychology and Education in 1969 at Northwestern University. It was very apparent to me at the time that doctoral preparation was a pre-requisite to a productive research career. I found the science of psychology fascinating in terms of its rigor and methodological exploration of cognitive processes. It seemed that this preparation was most applicable to nursing as scientific knowledge in psychology could be used to help people restructure their cognitive world and their health behaviors. This has proven to be true.

3. What do you think has been the impact of your work on nursing research?

I believe that my work in health promotion has been direction setting for nursing research. I was committed to health promotion and encouraged other scholars to move in that direction long before health promotion and risk reduction became popular. My model is a heuristic device that encourages scholars to look integratively at variables that have been shown to impact health behavior. The HPM synthesizes research findings from nursing, psychology and public health into an explanatory model of health behavior that still must undergo further testing. Multiple variable models are needed to explain human health behavior. My own research, that of my colleagues and the dissertations and theses of multiple students have used the HPM to guide research. I have applied the model to overall health-promoting lifestyle but am primarily focused on applying the revised Health Promotion Model (Health Promotion in Nursing Practice, 3rd edition, Appleton & Lange) to exercise behavior among adolescents and young adults.

4. What do you think has been the impact of your work on nursing practice?

The various health promotion strategies and tools that I have developed and presented in the three editions of Health Promotion in Nursing Practice as well as the undergirding HPM model can be used as a basis for structuring nursing protocols and interventions. Nurses in practice should focus on understanding and addressing variables that are most predictive of given health behaviors. We are moving toward an era of science-based practice in nursing that incorporates the latest findings from the behavioral and biological sciences into practice to assist people of varying cultural backgrounds to adopt healthy lifestyles. Much more research must be done to tailor interventions to individuals rather than to group stereotypes. New and evolving computer technologies will enable health professionals to assess individuals effectively as a basis for personalized interventions.

5. Which of your accomplishments are you most proud of?

I am proud of the way in which my writings have encouraged nurses to become actively involved in creating the new sciences of health promotion and disease prevention. I believe that the future will be very bright and productive for nurses who direct their careers toward understanding disease prevention and health promotion processes. Most important, clients will benefit from health promotion interventions by developing skill and confidence in caring for themselves and dependent others enabling them to live healthier and more productive lives.

6. What are your current research activities?

My colleagues and I have just completed a study of the physical activity of adolescents and I am very interested in gender differences in exercise behavior. Female adolescents, in particular become sedentary very early in life. This predisposes them to less energetic living and chronic disease as they age. I will soon be publishing the results of work on the effects of school transitions on exercise behavior. The HPM has provided the theoretical model for this work.

7. Are you involved in global health initiatives?

Yes, I have become increasingly involved in global health initiatives. I have worked with scholars from Japan, China and Taiwan to develop health promoting lifestyle measures that are culturally appropriate for their country. Further, I have presented internationally to link the health promotion and risk reduction research that we are doing in the United States with the research of nurse scientists in other countries. I find that interest in health promotion is worldwide and globally unites nurses.

8. How does the Health Promotion Model influence Health Care Reform?

I believe that the Health Promotion Model has long pointed to new directions in health care. Health Promotion and Disease Prevention should be the primary focus in health care and specific services reimbursed through health insurance coverage both by private insurers and public insurers. When health promotion and prevention fail to prevent problems, then care in illness becomes the next priority. We do not know what impact health promotion can have on the health of the population as a whole until it is widely applied in programs and services throughout our nation. Health care reform is a paradigm shift to health promotion. Quality of care, access to care, and tracking and documenting of health promotive care are all integral to reforming the health care system in a way that is most productive for health care consumers. We cannot continue to let people become ill when we have the means to keep many people well--particularly when problems are environmentally and behaviorally induced. Health promotion and prevention should be CENTRAL to any transformations of the health care system.

9. What is the role of advanced practice nurses in health promotion?

The opportunities for advanced practice nurses in health promotion are absolutely astounding. Advance practice nurses must take the leadership in incorporating the findings of research about health promotion into clinical practice and protocols and into community partnerships and programs. I can think of nothing more exciting than to bring groups of researchers together with groups of advanced nurse practitioners to use the latest knowledge about behavior change and determinants of particular health or risky behaviors to develop anticipatory guidance and counseling protocols. Of course, "state of the science" care protocols must be developmentally and culturally appropriate. Advanced practice nurses can play a pivotal role in creating partnerships among scientists, practitioners and consumers to develop appropriate care strategies for specific populations. We must exercise caution in the application of research from one group to another group. For example, both the meanings and determinants of health behaviors are likely to differ across early, middle, late adolescence and adulthood. We must understand the dynamics of behavior through our research to build interventions with high potential effectiveness.

Page Last Modified: Friday, 04-Aug-2006 17:45:09 EDT
© 2003 University of Michigan School of Nursing