Healthy Heart, Healthy Life" Program on Cardiovascular Health Behaviors

Overview

This study evaluated the effect of the "Healthy Heart, Healthy Life" education program on the cardiovascular health behaviors of middle school students. A parallel-group, cluster-randomized controlled design was used, with the school as the unit of randomization. Two middle schools with similar sociodemographic characteristics were allocated 1:1 to the intervention or the control arm. Students aged 10 to 15 years attending these schools were enrolled. The intervention arm received the "Healthy Heart, Healthy Life" education program, delivered in a single day as four class hours of in-person interactive group sessions. The control arm received no program during the study period. Cardiovascular health behaviors were assessed at baseline, immediately after the program, and at the sixth month using the Cardiovascular Health Behavior Scale for Children (CHBSC) and the Visual Cardiovascular Health Behavior Questionnaire for Children (V-CHBQ).

Cardiovascular diseases are among the leading causes of mortality and morbidity worldwide. Although they are rare in childhood, the risk factors that underlie them, including unhealthy diet, physical inactivity, sedentary behavior, tobacco exposure and stress, are established during childhood and adolescence. Maintaining these risk factors at optimal levels during childhood is associated with lower cardiovascular morbidity and mortality in later life. Schools therefore provide an important setting for primary prevention, and school nurses have a key role in screening, early detection and health promotion. Intervention-based studies conducted with children remain limited, and most existing research is descriptive or based on adult samples. The "Healthy Heart, Healthy Life" program is a nurse-led, school-based education module developed by the researchers on the basis of the literature and reviewed by nine experts in pediatrics, cardiology, pediatric cardiology, pediatric nursing, psychiatric nursing and child psychiatry. The program content covers the structure and function of the cardiovascular system, recognition of cardiovascular diseases, cardiovascular risk factors, steps to protect cardiovascular health, early warning signs, and the importance of regular medical check-ups. It is delivered face to face in group sessions over a single day, comprising four class hours, using interactive teaching methods appropriate to the developmental level of middle school students. A cluster-randomized controlled design was used to prevent contamination between arms. The unit of randomization was the school. Two middle schools comparable in location, student profile and school size were allocated at a 1:1 ratio by an independent researcher using computer-based random number generation; the allocation list was concealed from the research team. Students meeting the eligibility criteria at each school were enrolled into the arm to which their school had been allocated. Outcome data were collected from both arms at baseline, immediately after the program, and at the sixth month. The study was conducted and reported in accordance with the CONSORT guideline.