The PEN-3 model has been originally developed, to be adopted as a health education framework, to be used for disease prevention in the African countries. The model comprises of three dimensions of health beliefs and behaviors, which are related and dependent on each other. The second dimension of Educational Diagnosis of Health Behavior consists of perceptions, enablers and nurturers. Nurturers are the reinforcing factors which an individual may receive from significant others. The others in this respect represent extended families, peers, employers, health personnel, religious leaders and/or government officials (MissisipiStateUniversity, 2001).
Positive nurturers contribute to the prevention of diseases. These represent the supportive influences of the significant people, which have an impact on the behavior of the people in the community. For instance, some eating traditions like vegetarianism, community and events, spirituality and community norms like those preventing consumption of alcohol are positive nurturers that help alleviating chances of spread of any diseases in the community.
Negative nurturers are those, which may lead the individuals, families or communities to follow health practice, which may result in spreading of communal diseases. These nurturers include the values and relationships that examine the contexts of behavior. This examination extends to policy environment, income and wealth of individuals, communities and society. It also encompasses the position of women in society in relation to decisions about sexuality and the spiritual contexts of the health behavior that is being examined. Examples of negative nurturers include the many of the social arrangements, which form the foundation for inequity such as racism, differential housing and education that lead to negative practices, which ultimately result in poor health practices.
Existential nurturers are values and beliefs, which are passed on through generations in the communities, which have no negative or positive impact on the health aspects in the individuals, families or communities. Normally these nurturers are not taken into account by interventionists while pursuing the health practices in particular communities, since they do not have an impact on the health related practices of the communities. For example in any study relating to the social arrangements in South Africa when compared with other African countries racism should be given a priority in studying the cultural behavior of the people.
Thus, integrated patterns of human behavior, which encompass factors like language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups, are the possible sources of nurturers in a community. These represent unique shared values, beliefs and practices, which may have a direct association with the health-related behavior or they may possess an indirect association (US Department of Health, 2000). These factors have an influence to promote the acceptance and adoption of the practices, which have a great bearing on the health related behavior of the society. Therefore, it becomes important for the practitioners to study the nurturers carefully before they embark on any interventionist activities.
In our example of obesity among the African Americans, the perception of that “eating healthy” means giving up part of their cultural heritage acts as an important negative nurturer. Hence, they conform to the dominant culture by eating junk foods and become obese (James, 2004). This is an important attribute, which needs the attention of the healthcare educationists attending to the promotion of healthcare for this particular community. Another popular belief among Hispanics is that diabetes is caused by emotional trauma (Arcury, Skelly, Gesler, & Dougherty, 2004), which again is a negative nurturer to be taken care of in planning, any health education.
Arcury, T. A., Skelly, A. H., Gesler, W. M., & Dougherty, M. C. (2004). Diabetes meanings among those without diabetes: explanatory models of immigrant Latinos in rural North Carolina. Social Science Medical Journal , 59 (11), 2183-2193.
James, D. C. (2004). Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model. Ethnicity & Health , 9 (4), 349-367.
MissisipiStateUniversity. (2001). Health Education Models:HEALTH EDUCATION PLANNING MODELS — A REVIEW OF THE LITERATURE – PART II. Web.
USDepartmentofHealth. (2000). Assuring cultural competence in health care: Recommendations for national standards and outcomes-focused research agenda. Washington DC: US Government Printing Office.