A public health nurse is implementing a chronic disease management initiative for a diverse urban community with high rates of diabetes and hypertension. Which intervention would be most effective in promoting long-term behavior change and community engagement?

Peer-led support groups with cultural tailoring are most effective for long-term change as they provide ongoing support, address social determinants, and foster community engagement. Other options are one-time or lack sustainability.

Understanding the Priority: Sustainable Behavior Change vs. One-Time Information
The key to this question lies in distinguishing between passive information delivery and active, culturally embedded support systems. While all options have some merit, the NCLEX-RN prioritizes interventions that are evidence-based for creating sustained behavior change in chronic disease management. The provided systematic review and meta-analysis by Ko & Song ^[1] strongly supports that community-based participatory research (CBPR) models, which actively involve community members in design and delivery, are significantly more effective than traditional didactic approaches.

Why Option 4 is the Most Effective Intervention
Establishing peer-led support groups with culturally tailored education and partnerships directly operationalizes the core principles of community engagement identified in the evidence. This is not merely a support group; it is a structural intervention that builds self-efficacy and community capacity. The meta-analysis ^[1] demonstrates that CBPR interventions, which inherently rely on peer leadership and cultural tailoring, lead to clinically significant improvements in glycemic control (HbA1c reduction) and diabetes self-management behaviors. This approach transforms patients from passive recipients of care into active partners and educators, creating a sustainable, culturally congruent support network that persists long after a formal program session ends. The rapid evidence review by MacDonald et al. ^[2] reinforces this by highlighting that community-led strategies are a more effective alternative to traditional, top-down public health approaches for reducing health disparities.

Analysis of Incorrect Options

Option 1: Distribute educational pamphlets
Distributing pamphlets, even in multiple languages, is a passive, information-only strategy. The evidence brief by Gkiouleka et al. ^[3] explicitly notes that standard behavioral interventions are often less effective for disadvantaged groups and can inadvertently widen health inequalities. Pamphlets fail to address the critical barriers of limited resources, cultural mismatches, and inadequate support that the abstract by Ko & Song ^[1] identifies as reasons patients struggle with self-management. This is a low-level, awareness-focused intervention that does not build skills or provide ongoing support.

Option 2: Organize monthly health screenings
Health screenings are a secondary prevention measure focused on detection, not on the primary goal of promoting long-term behavior change for already diagnosed chronic conditions. While screenings can identify undiagnosed individuals, they do not equip the 35% of adults with diabetes or the 42% with hypertension with the self-management skills needed to control their conditions. The question asks for an intervention to manage existing chronic disease, making this a mismatch of intent.

Option 3: Provide one-time educational workshops
A one-time workshop, regardless of the topic, is a single, episodic encounter. The evidence consistently shows that behavior change requires sustained, longitudinal support. The scoping review by Woodward et al. on social prescribing highlights the importance of accessible, ongoing interventions for minority ethnic groups. A single workshop lacks the follow-up, social reinforcement, and problem-solving components that make peer-led groups effective. It fails to build the community engagement and empowerment that MacDonald et al. ^[2] identify as crucial for addressing health inequalities in underserved neighborhoods.

Integrating Evidence into Practice
The most effective public health intervention for this diverse, underserved community is one that builds internal capacity and resilience. By establishing peer-led groups, the nurse is applying a CBPR-aligned model that is culturally tailored and creates a partnership with the community. This directly addresses the "cultural mismatches" and "inadequate support" cited as barriers in the literature ^[1], while actively working to reduce, rather than reinforce, health disparities as called for by MacDonald et al. ^[2] and Gkiouleka et al. ^[3]. This strategy shifts the locus of control to the community, making behavior change a shared, culturally valued norm rather than an externally imposed directive.