Health Promotion Model Clinical Assessment for Health Promotion Plan

Health Promotion Model

Clinical Assessment for Health Promotion Plan


Example:  Increasing Physical Activity


Assess current stage of physical activity [pre-contemplation (PC),

Contemplation (C), planning/preparation (P), action (A), maintenance (M)].Ifin stages C, P, or A, continue. Ifin stage M, reinforce positive behavior.  Ifin stage PC, reinforce benefits of physical activity, and assess readiness at a later time.


Prior Behavior


What attempts have you made in the past to be physically active?


Follow a 90-day Abs challenge






What did you learn fromthese experiences?

I am physically unfit





Personal Influences


What are the personal benefits of becoming more active?

Less fatigue and improved breathing





What problems (barriers) might you have trying to be more active?

I tend to drift away from the set plan thus am inconsistent. I am equally not totally committed to the           exercise.





1         2 3 4 5 6 7 8 9 10
Uncertain               Very Sure


How sure are you (self-efficacy) that you can overcome these barriers to being more active?





What physical activities do you enjoy most? (Activity-related affect)




Interpersonal Influences


Social Norms – Do any of your family members or friends expect you to be physically active?  Yes    No

If so, who?               No, not of them expect me to be physically active                       


Social Support – Who will encourage you to be active or be active with you?

My gym partner and my brother



Role Models – Is anyone in your family or any of your friends physically active 3-5 times every week?   Yes    No

If so, who, and what do they do?

None, I live with inactive persons when it comes to exercising






Where could you be physically active doing what you enjoy?

At work, at school during extra time at the field or gym. I prefer sport exercise.




Commitment to a Planof Action


Are you ready to set goals and develop a planto become more active?  Yes   No


Steps of Plan



Leg planks



Weight lifting



Competing Demands and Preferences (At Follow-up)


What problems did you encounter intrying to be more active?

The hard challenge was completion of the set exercises. For instance, leg planking is difficult to maintain for over five minutes.





How can you avoid these problems in the future?


I believe commitment to the plan will facilitate conformance to the exercise plan.



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