Effectiveness of theory-based health education in reducing stress among nursing students: a systematic review and meta-analysis

Objective: To synthesize evidence on the effectiveness of theory-based health education interventions in reducing stress among nursing students. Methods: A systematic review and meta-analysis were conducted to examine the effect of theory-based health education intervention on stress in nursing students. A comprehensive search of Medline, PsycINFO, CINAHL, PubMed, and Scopus were performed on December 5, 2024, without restrictions on publication date. Eligible studies were identified and meta-analysis using a fixed-effect model was conducted to determine the effect size. The risk of bias was assessed by Joanna Briggs Institute critical appraisal checklist. The extent of theory applications was evaluated by a modified version of the Theory Coding Scheme. Results: Twelve studies involving 925 participants met the inclusion criteria, with eight studies included in the present meta-analysis. The findings suggest that theory-based health education interventions have a moderate effect on stress reduction, with a standardized mean difference (SMD) of −0.68, 95 % confidence interval (CI) [−0.83, −0.52], p < 0.001, Interventions incorporating multi-structural theoretical frameworks demonstrated a larger effect size (SMD = −0.84), 95 % CI [−1.09, −0.63], p < 0.001. Similarly, interventions with a higher intensity of theoretical application exhibited stronger effects (SMD = −0.64), 95 % CI [−0.81,−0.46], p < 0.001. Conclusion: Theory-based health education interventions were moderately effective in reducing stress among nursing students, with stronger effects observed in interventions that apply multiple theories and higher levels of theoretical integration. These findings highlight the importance of grounding stress reduction programs in well-developed theoretical frameworks.

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