Determinging support for the HNAP model : an integrative review of the literature

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Montana State University - Bozeman, College of Nursing


In 1998 Buehler, Malone, and Majerus used grounded theory to derive the Symptom Action Time-Line (SATL), a linear process involving self-care, lay care, and professional resources used by rural Montana women to respond to physical illness symptoms. In 2010 (O'Lynn), a literature review to determine the level of support for the SATL process resulted in a more circular model called the Symptom Action Process (SAP). An integrative literature review in 2012 was conducted to determine the level of support for the SATL and SAP models, resulting in a revision, named the Health Needs Action Process (HNAP) (Rasmussen, Winters, & O'Lynn, 2013). The HNAP differed from the SATL and SAP in that the term 'symptom' was replaced with 'health need' to reflect a broader spectrum of health demands including psychological needs. All three models, SATL, SAP, and HNAP, were based on studies in the United States (U.S.). The HNAP included studies with women-only and mixed gender samples. The lack of international and male-only samples in the previous work prompted this integrative literature review to determine support for the HNAP model. Key words from the models (rural, rural health, self-care, health needs, health/illness behavior, attitudes/beliefs about self-care, decision-making, self-assessment, alternative therapies, complimentary medicine, and home remedies) were used to search the literature published from 2004-2013 using CINAHL, MedLine, and Psych Info. International studies and those involving men only were included in the new search. Case studies, dissertations, and anecdotal reports were excluded from the integrative review. Inductive and deductive coding was used to identify existing and new concepts/themes. The sample consisted of 17 studies: 29% were from the U.S. (17 states); 71% were conducted outside the U.S. (10 countries). Study samples included 23.5% women, 11.5% men, 65% mixed gender; 29% elderly, 71% adult, 0% children/youth; 71% rural; and 29% compared rural with urban samples. This integrative review provides support for the HNAP model regarding the use of self-care, lay resources, and professional resources when responding to both physical and psychological health needs. Health care providers can use this knowledge to assist rural persons to successfully manage health needs both domestically and internationally.




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