NURS 8114 Week 10 Theoretical Foundation Paper Example

A Theoretical Foundation for Addressing Parental Vaccine Hesitancy: Pender's Health Promotion Model, Stated as Expectations a Practice Change Could Observe

Student Name

College of Nursing, Walden University

NURS 8114: Theoretical and Scientific Foundations of Nursing

Instructor Name

Month Day, Year

A Theoretical Foundation for Addressing Parental Vaccine Hesitancy: Pender's Health Promotion Model, Stated as Expectations a Practice Change Could Observe

Problem Statement

At a composite suburban pediatric practice, a growing share of parents delay or decline one or more recommended vaccines for their children in the first two years of life. The problem statement accepted in Week 3 still holds: among parents of children under two seen for well-child visits, vaccine delay or refusal occurs at rates above the practice's target, and conversations about vaccines at these visits are inconsistent in how they begin and how clinicians respond when parents express concerns. Vaccine hesitancy has been defined as delay in acceptance or refusal of vaccines despite availability of services, and it varies across time, place and vaccines (MacDonald & SAGE Working Group on Vaccine Hesitancy, 2015).

The Model

Pender's health promotion model explains health-promoting behavior as the product of three groups of concepts (Pender et al., 2019). The first group, individual characteristics and experiences, holds what a parent brings to the visit: how that parent acted before on the same kind of decision, and personal factors such as age, schooling and culture. Pender places the most room for nursing to act in the middle group, which Pender labels behavior-specific cognitions and affect: the benefits a parent anticipates, the obstacles the parent sees, the parent's confidence in carrying the act through, the feelings attached to the act itself, the views of relatives, friends and clinicians, and the cues of the setting where the decision happens. Behavioral outcome includes commitment to a plan of action, the effect of immediate competing demands and preferences, and the health-promoting behavior itself.

The model applies to vaccination with one adjustment. Pender developed it for adults' own health behaviors, and here the behavior, vaccinating a child, is performed by a parent on behalf of someone else. The model's concepts still apply to the parent's cognitions and choices, but the outcome of interest is the child's vaccination status. That adaptation is stated here so that later measures are aimed at the parent's cognitions while the result is recorded in the child's record.

Why This Model Fits

The model fits because the problem's main mechanisms sit in its behavior-specific cognitions. Parents who hesitate often weigh perceived benefits against perceived barriers, such as worry about side effects; their decisions are shaped by interpersonal influences, including family, online communities and the clinician; and situational influences, such as how the conversation at the visit begins, affect what they decide. A review of the psychology of vaccination argues that what people think and feel about vaccines, their social processes and direct behavioral interventions all shape uptake, with interventions that act on behavior directly, such as presumptive recommendations and reminders, often more reliable than attempts to change beliefs alone (Brewer et al., 2017). Pender's model accommodates both, since it includes cognitions and situational influences.

Propositions Stated as Observable Expectations

In a DNP project, the model's propositions are not hypotheses awaiting a trial. They are expectations about what should happen in the practice if a change works as intended. Five expectations follow.

Expectation 1: Situational influence. If clinicians begin vaccine conversations with a presumptive statement, for example announcing that vaccines are due today, rather than a participatory question, more parents will accept vaccines at that visit. This expectation is grounded in research showing that presumptive openings were associated with higher acceptance than participatory ones, and that continuing to recommend after initial resistance was associated with more acceptance (Opel et al., 2013). The practice could observe it by auditing a sample of recorded or documented conversation openings and matching them to vaccines given.

Expectation 2: Interpersonal influence. If the clinician gives a clear personal recommendation, parents who report trusting their clinician will be more likely to vaccinate. The practice could observe it through a brief parent survey at the visit.

Expectation 3: Perceived barriers. If specific concerns, such as side effects or the number of shots, are named and answered, parents' perceived barriers will fall. Observable through a short validated hesitancy measure before and after the visit.

Expectation 4: Commitment to a plan. If parents who decline leave with a scheduled follow-up conversation, more will vaccinate within three months. Observable through scheduling and immunization records.

Expectation 5: Competing demands. If vaccines can be given at any visit, not only well-child visits, fewer delays will result from missed appointments. Observable through the share of vaccines given at sick or follow-up visits.

Limits of the Model for This Problem

The model has two limits here. First, it treats behavior as largely the result of individual cognitions, and it gives less attention to wider forces, such as misinformation online or local policy on school exemptions, that shape hesitancy at a community level. Second, it assumes a rational weighing of benefits and barriers, whereas some parents' refusal is rooted in identity or distrust that information does not easily move. The project will treat these limits as reasons to measure outcomes directly and not to assume that changing cognitions will change vaccination.

A third limit is practical rather than conceptual. The model has many concepts, and a small practice cannot measure all of them. Activity-related affect, for example, the feelings a parent has about the vaccine visit itself, such as dread of watching a child cry, is plausible and may matter, but measuring it reliably would require an instrument the practice does not have and time the visit does not allow. The foundation therefore names which concepts the project will measure, perceived barriers, interpersonal influence, situational influence and commitment to a plan, and which it will acknowledge without measuring, such as prior related behavior and activity-related affect. Stating that choice now keeps the later evaluation from claiming the whole model was tested when only part of it was.

How the Foundation Guides the Project

The foundation commits the later project to acting on situational and interpersonal influences first, since those are closest to what a practice controls, and to measuring both the parent's cognitions and the child's vaccination status. It leaves the choice of intervention open; the proposal will make it. But any intervention the project proposes should be traceable to one of the five expectations above, and its evaluation should be able to say which expectations were met and which were not.

References

Brewer, N. T., Chapman, G. B., Rothman, A. J., Leask, J., & Kempe, A. (2017). Increasing vaccination: Putting psychological science into action. Psychological Science in the Public Interest, 18(3), 149-207. https://doi.org/10.1177/1529100618760521

MacDonald, N. E., & SAGE Working Group on Vaccine Hesitancy. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161-4164. https://doi.org/10.1016/j.vaccine.2015.04.036

Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037-1046. https://doi.org/10.1542/peds.2013-2037

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2019). Health promotion in nursing practice (8th ed.). Pearson.