Promoting nurse-led behaviour change to prevent cardiovascular disease in disadvantaged communities: A scoping review

Problem

Cardiovascular diseases (CVD) are the leading cause of death worldwide and they disproportionally affect people living in disadvantaged communities. Nurse-led behaviour change interventions show promise in preventing CVD. Knowledge regarding the nature and impact of such interventions in disadvantaged communities is limited. This review aimed to address this limitation.

Approach

A six-stage scoping review framework developed by Arksey and O’Malley, with revisions by Levac et al., was used. The search process was guided by the PRISMA Extension for Scoping Reviews (PRISMA-ScR) framework. Three electronic databases were searched (PUBMED/MEDLINE, CINAHL Plus, and Cochrane CENTRAL), and included studies were analysed using Braun and Clarke’s ‘Thematic Analysis’ approach.

Findings

Thirty studies were included. They investigated interventions to reduce overall CVD risk or to improve modifiable CVD risk factors (uncontrolled diabetes mellitus, hypertension, hypercholesterolemia, poor diet, lack of exercise, smoking and excessive alcohol consumption). The studies examined the efficacy and/or structure of these interventions and they described barriers that nurses faced. Five key areas were identified in the promotion of nurse-led behaviour change. These are (i) tailoring interventions to specific populations (ii) overcoming access difficulties (iii) encouraging patient engagement (iv) providing adequate training for nurses and (v) addressing barriers faced by nurses.

Consequences

Overall, the findings indicate that nurse-led behaviour change interventions for high-risk CVD patients in disadvantaged areas show much promise although there is considerable variation in the interventions employed and studied to date. Further research is needed to examine the unique barriers and facilitators of interventions for specific disadvantaged groups.