Effectiveness of community health nurse-led health promotionstrategies for preventing non-communicable diseases: asystematic review

Abstract

Non-communicable diseases (NCDs) are among the most important public health challenges worldwide and are responsible for a substantial proportion of premature mortality, disability, reduced quality of life and healthcare expenditure. Cardiovascular diseases, cancers, diabetes mellitus and chronic respiratory diseases account for the majority of NCD-related morbidity and mortality. Although many NCDs are preventable through modification of behavioural and metabolic risk factors, prevention remains difficult because health behaviours are influenced by social, economic, environmental and cultural conditions. Community health nurses occupy a strategically important position between individuals, families, communities and primary healthcare systems. Their continuing contact with populations enables them to provide health education, risk assessment, lifestyle counselling, screening, behavioural support, referral, followup and community mobilisation. This systematic review examines the effectiveness of community health nurse-led and closely related community health worker-led health promotion strategies in preventing NCDs and reducing modifiable risk factors. A structured evidence synthesis was undertaken using evidence from PubMed-indexed systematic reviews, meta-analyses, primary studies and major World Health Organization technical documents addressing community-based NCD prevention, community nursing, nurse-led health promotion, community health workers, lifestyle modification, cardiovascular risk reduction, diabetes prevention, tobacco cessation, cancer screening and task-sharing. Evidence was synthesised narratively because substantial heterogeneity existed in intervention design, populations, outcomes, duration and healthcare settings. The review was guided by the principles of PRISMA 2020. Particular attention was given to blood pressure, lipid levels, glucose regulation, body weight, physical activity, smoking cessation, cancer screening, health knowledge, self-management and access to preventive services. The evidence indicates that community health nurse-led health promotion strategies can improve several modifiable NCD risk factors. Community-based interventions have demonstrated reductions in systolic and diastolic blood pressure, low-density lipoprotein cholesterol, triglycerides, fasting blood glucose and body weight, although effect sizes vary between programmes. Nurse-led hypertension interventions appear capable of producing clinically meaningful improvements in blood pressure and cardiovascular risk management. Community health worker involvement in smoking cessation has been associated with increased abstinence, while community-based interventions can improve physical activity and reduce sedentary behaviour. Community-based diabetes prevention programmes involving education, nutritional counselling, physical activity promotion, behavioural support and follow-up have shown improvements in glycaemic and anthropometric outcomes. Community health worker involvement also improves uptake of breast, cervical and colorectal cancer screening. The most effective programmes tend to be multicomponent, culturally adapted, repeated over time, linked to primary healthcare services and supported by supervision and referral mechanisms. Community health nurse-led health promotion represents an effective and potentially scalable approach to NCD prevention, particularly when integrated into primary healthcare and community systems. Nurses can contribute across the prevention continuum, from population education and risk assessment to screening, behaviour modification and continuing follow-up. However, implementation is affected by workload, workforce shortages, training, remuneration, supervision, referral pathways, access to diagnostic resources and social determinants of health . Future programmes should prioritise culturally appropriate, community-oriented, digitally supported and multidisciplinary models with measurable long-term outcomes.