The PEN-3 Model is used to assess the behavioral diversity impacting a culturally specific target population related to a health issue.
In this assignment, you will select a culturally specific target audience and a related health and wellness issue from the literature. For example, you might select diabetes or hypertension among African Americans or breast cancer among Hispanic women. Then you will assess health and wellness influences on the target audience using the domains of the PEN-3 Model.
NOTE: You will use the work completed in the Module 4 assignment in the Module 5 assignment.
Follow the steps to complete the assignment.
Step 1. Select the target audience from the literature for the PEN-3 Model assessment.
Step 2. In a Word document, use the domains of the PEN-3 Model to develop an outline of the domains as they relate to the selected target audience and health issue.
Example outline:
Cultural IdentityPerson(You may have as many points as needed.)Extended FamilyNeighborhoodRelationships and ExpectationsPerceptions(You may have as many points as needed.)EnablersNurturersCultural EmpowermentPositive(You may have as many points as needed.)Existential Negative PEN-3 MODEL
PEN-3 Model as a blueprint to assess the behavioral diversity of a target population. We will
cover the history, domains, and examples of each domain related to the model. Slide 2 What Is
the PEN-3 Model? • Original creation (1995): – Framework for health promotion and disease
prevention regarding HIV/AIDS in African countries (Pérez & Luquis, 2008) • Modern take: –
Applied in various situations since it permits examination of multiple behavioral factors in
cultures (Airhihenbuwa, 2007) • Diabetes • Diabetes prevention • Diabetes management • Breast
cancer self-examination • Malaria treatment In 1995, the PEN-3 model was created as a
framework for health promotion and disease prevention related to HIV/AIDS in African
countries (Pérez & Luquis, 2008). Now, the model is used for a variety of situations because it
allows health educators to examine multiple behavioral factors within cultures (Airhihenbuwa,
2007). Since its creation, the model has been used to assess knowledge of diabetes, diabetes
prevention, diabetes management, self-examination for breast cancer, treatment of malaria, and
many other interventions among different populations. Slide 3 Why It’s Important • Frameworks
are necessary for mapping out and understanding behavioral diversity factors influencing health.
– Accounting for culture is critical (Westerman, 2010). – Methods used in healthcare are being
impacted by individuals self-identifying as multicultural (Fitzsimmons, 2013). As health
educators, we need frameworks to assist us in developing programs to map out the various
behavioral diversity factors influencing health. Since culture is a large component of behavioral
diversity, it is important to utilize a framework that takes culture and other factors into account
(Westerman, 2010). It is also important to understand that several organizations are currently
seeing a different demographic. People are now self-identifying as multicultural, and that can
impact the methods used to address health interventions with them (Fitzsimmons, 2013). The
three domains are Cultural Identity, Relationships & Expectations, and Cultural Empowerment.
Each of these primary domains has three components.
Cultural Identity It has the three components of person, extended family, and neighborhood. It is
important to understand Cultural Identity because it is the interaction of several identities a person
experiences within the environment. The component of a person is how an individual identifies
himself within the culture. This can take on many different forms. For example, a person can be
Latino, gay, and speak English as a primary language while living in the United States. This
individual may identify himself according to the different components he experiences. He could
identify as Latino based on ethnicity, but then there is nationality, which could be Honduran. He
could also self-identify as being part of the gay culture because of sexual orientation. Finally, he
could identify as being American because of where he resides and his primary language of English.
How an individual self-identifies will also influence health behaviors because he participates in the
cultural practices, beliefs, values, norms, and behaviors with their claimed culture. The next aspect is
extended family. Family plays a large role in behaviors. For example, if parents view clinical
depression as a self-limiting illness, then they may not take their teenager to receive treatment.
Instead, they may encourage the teen to “snap out of it” and continue with life. This can lead to the
teen viewing depression as something to deal with as opposed to a treatable illness. In contrast,
families can also promote safety by teaching their teens to not text while driving. Each of these
examples is rooted in the beliefs, values, norms, and perceptions within the family. The last
component of this domain is the neighborhood. The neighborhood can also be viewed as the
community. The neighborhood in which a person lives is the environment, and it can either positively
or negatively influence behaviors. An example of a positive influence on health behavior would be an
inner-city community turning an alley into a park for children to play and participate in physical
activity. A negative influence on health behavior would be a community discouraging health educator
from implementing an HIV/AIDS awareness program at the community center.
Relationships & Expectations. The three components within this domain are perceptions,
enablers, and nurturers. Within the PEN-3 Model, the component perceptions consist of the
knowledge, attitudes, values, and beliefs in a culture that either encourage or hinder a behavior
change (Airhihenbuwa, 1995, 2007). For example, in a previously mentioned study, indigenous
cultures did not seek cancer screenings because of beliefs associated with cancer. Some groups
believed that they deserved the illness because they committed a wrongdoing to someone else, and
the disease was their punishment. As you can see, this belief influenced their behavior of not
receiving cancer screenings. The next component is labeled enablers. Enablers are the resources,
institutions, institutional support, and societal or structural factors either promoting or preventing
changes in health behaviors. For example, resources include access to healthcare. If an individual
has access to health insurance, he is more likely to receive treatments, medications, and
vaccinations because he has the resources to gain access. Institutions and institutional support
could be governing officials and governmental policies. An example would be the government
officials who established and implemented the Affordable Care Act. This law enabled young adults to
gain access to healthcare because parents can leave them on their employer’s health insurance until
they are 26 years of age (U.S. Department of Health and Human Services, n.d.). Examples of
societal factors include stigma which may prevent people receiving treatment for a mental illness.
Structural factors include having adequate frameworks and programs available within the healthcare
system for mental health treatments. The last component of the Relationships & Expectations
domain is nurturers. Nurturers are individuals or groups which can either encourage or hinder health
beliefs, health attitudes, and health behaviors. Examples of nurturers are family, friends, community
leaders, religious leaders, stakeholders, and educators. The relationship between parents and
children is an example of nurturers. Parents who eat healthy, exercise, and are active encourage or
nurture their children to do the same, and the children follow. The children carry on similar health
beliefs, health attitudes, and health behaviors as their parents. The same concept applies if children
are raised in a family with a sedentary lifestyle.
The last primary domain of thePEN-3 Model is Cultural Empowerment. The three components
within the Cultural Empowerment domain are positive, existential, and negative (Airhihenbuwa &
DeWitt Webster, 2004). Positive refers to culture promoting good health behaviors. For example, in
the Latino population, it is culturally encouraged to attend religious services. This is a positive aspect
to encourage spiritual health. Negative aspects within a culture discourage or hinder good health
behaviors. In office environments, it is customary to sit at a desk and work all day. This increases the
risk of heart disease, diabetes, and obesity which is a negative aspect. The existential aspects are
beliefs, practices, and behaviors, including health behaviors, that neither promote nor hinder health
behaviors. An example of an existential aspect would be the superstition that walking under a ladder
will bring bad luck to that person. Performing that act will neither promote nor hinder health behavior.
Can you see how all the pieces fit together to form behavioral diversity? As a health educator, you
have to be aware of all the pieces and take them into consideration when developing health
interventions for target populations.
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