A system-oriented narrative review of an integrated public health approach on the impact of health promotion programmes on reducing lifestyle-related diseases in Nigeria

Abstract

Lifestyle-related diseases (non-communicable diseases, NCDs), including diabetes, hypertension, obesity, and cardiovascular diseases, constitute a major and growing public health burden in Nigeria. Despite the implementation of multiple health promotion programmes, reductions in population-level risk factors and disease outcomes remain limited, suggesting that programme effectiveness is shaped by broader systemic interactions rather than isolated behavioural interventions. This narrative review examines the impact of health promotion programmes on lifestyle-related disease prevention in Nigeria using a systems-oriented public health lens. It synthesises evidence from 30 peer-reviewed studies and policy reports published between 2010 and 2025, identified through structured searches of PubMed, Google Scholar, WHO repositories, and grey literature sources. A thematic narrative synthesis was conducted, guided by health promotion frameworks and complex adaptive systems theory. Findings indicate that health promotion initiatives have contributed to improved awareness and modest behavioural change; however, their overall population-level impact remains constrained by reinforcing system dynamics. These include persistent poverty and urbanisation-driven risk exposure, fragmented governance structures, weak feedback mechanisms between implementation and policy learning, and limited integration across health and non-health sectors. The analysis further shows that interventions frequently operate in isolation, limiting their capacity to modify upstream determinants of health. The review identifies key system leverage points, including strengthening primary healthcare feedback systems, embedding community co-design mechanisms, and integrating real-time monitoring for adaptive programme redesign. It argues that effective NCD prevention in Nigeria requires shifting from linear programme implementation to iterative, feedback-driven and context-adaptive health promotion systems. The review concludes that addressing lifestyle-related diseases requires system reconfiguration rather than incremental programme expansion, aligning interventions with Sustainable Development Goal 3.4 on reducing premature NCD mortality.