The PEN-3 Model


In my final installment of models for health education I will talk about the PEN-3 model.  This model is not as well-known as some of the other models.  However, it has a very important use.  This model helps to identify specific cultural factors that are important to know to implement a health education program with diverse populations.  Dr. Collins Airhihenbuwa developed the PEN-3 model in 1990 (Airhihenbuwa, 1990).  The key thing to know about this model is that’s it’s meant for non-Western cultures.  It’s easier to implement a program in cultures closer to our own.  If the culture is vastly different, you first need to understand their motivations.

The PEN-3 Model has nine factors under three domains.  Each set of three factors spells out PEN.

Educational Diagnosis for Health Behavior (Airhihenbuwa, 1990)

  • Predisposing
  • Enabling
  • Nurturing

Cultural Appropriateness for Health Behavior

  • Positive
  • Exotic
  • Negative

Health Education

  • Person
  • Extended Family
  • Neighborhood

This model measures different influences on a person’s view of healthy behaviors.  Educational Diagnosis for Health Behavior looks at how the person views the influences on their health behavior.  Cultural appropriateness measures the positive, negative and what is deemed exotic.  The person may find something common to people in the United States is exotic to them.  Finally, Health Education measures the person, family and community influences on health behavior.

I used this model in my research with Iraqi immigrants.  I was able to understand what cultural factors influence their views on Michigan hazards.  One of the most interesting answer I received were for what an Iraqi immigrant deemed exotic in terms of Michigan hazards.  Most of the interviewees said a snowstorm was the most exotic.  To those of us who live in Michigan, snow is no big deal.  However, to a person who is from Iraq, snow is a bigger deal.  Snow is rare in Iraq, while Michigan gets around 18 events per year.


Do you have a diverse population you would like to understand better?  If you’re not familiar with the PEN-3 model, it’s worth using.  Understanding culture is an important part of a successful health education program.