Healthy Heart, Healthy Life" Program on Cardiovascular Health Behaviors

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.

Inclusion criteria

• Aged 10 to 15 years
• Attending one of the middle schools included in the study
• No previous education on the study topic
• No diagnosis of heart disease
• Not currently receiving and not previously having received support (e.g. from a psychologist, psychiatrist or dietitian) related to heart health, physical activity, nutrition or stress management
• Written informed consent obtained from both the parent and the child

Exclusion criteria

• Hearing, visual or intellectual disability
• Absence of a signed parental consent form