# 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?

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> language: ko  
> subject: Next Gen NCLEX

## 문제

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?

The nurse is working with community leaders to address chronic disease prevention in an underserved neighborhood where 35% of adults have diabetes and 42% have hypertension. The population includes primarily Hispanic and African American families with limited healthcare access.

## 보기

1. Distribute educational pamphlets about diabetes and hypertension in multiple languages at community centers and local clinics.
2. Organize monthly health screenings at local churches and community centers
3. Provide one-time educational workshops on healthy cooking and exercise
4. Establish peer-led support groups with culturally tailored education and partnerships **✔ 정답**

**정답: 4**

## 해설

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.

## 심화 해설

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.References (research sources)

- [1]Promoting community engagement in type 2 diabetes management: a systematic review and meta-analysis of community-based participatory research interventions.Meta-analysis/systematic reviewKo G, Song Y. (2026) · DOI: 10.1186/s12889-026-27301-8

- [2]Community engagement and empowerment to address health inequalities: A rapid evidence review.Research articleMacDonald H, Martin M, Ghanchi A, Clark E, Lunn AD, Gkiouleka A, Harasgama S, Lamb D, Ford J. (2026) · DOI: 10.1016/j.puhip.2026.100773

- [3]Improving behavioural interventions in healthcare to address the needs of disadvantaged groups: A policy-focused evidence brief.Research articleGkiouleka A, Harasgama S, Pearce H, Johnson L, Kuhn I, Lunn AD, Lamb D, Torabi P, Vodden A, Engamba S, Birch J, Ghanchi A, Ford J. (2026) · DOI: 10.1016/j.puhip.2026.100780

## 임상 시나리오

Building Sustainable Community Health ProgramsFrom Passive Information to Active Peer Engagement
The most effective chronic disease interventions move beyond simple education to build community capacity and self-efficacy. Evidence shows that peer-led support groups with culturally tailored content result in clinically significant improvements, such as a 0.3-0.5% reduction in HbA1c.

Establishing these groups requires forming authentic partnerships with community leaders and organizations. The goal is to transform patients from passive recipients into active educators and support systems, creating a sustainable network that persists beyond a formal program's end.

CautionAvoid relying solely on passive materials like pamphlets or one-time workshops. These lack the ongoing social reinforcement and behavioral modeling necessary to change deeply ingrained lifestyle habits in underserved populations.

## 핵심 개념

- **Community-Based Participatory Research (CBPR)** — A collaborative research approach that equitably involves community members in the design and implementation of interventions to improve health outcomes.
- **Self-Efficacy** — An individual's belief in their capacity to execute behaviors necessary to produce specific performance attainments, crucial for chronic disease self-management.
- **Cultural Tailoring** — The process of adapting health interventions to fit the cultural context, values, and language of a specific group to increase relevance and effectiveness.
- **Peer-Led Support** — A model where trained community members with shared experiences provide ongoing education, emotional support, and role modeling to others managing similar conditions.

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