HeartSmart: development and evaluation of a culturally tailored, theory-based cardiovascular health promotion programme for university students in a North-Central Nigerian university — a quasi-experimental pre-post study

Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality in sub-Saharan Africa, with hypertension as the primary modifiable risk factor. Despite a high and largely undetected hypertension burden, no culturally tailored, theory-based cardiovascular health promotion programme has been developed or evaluated for university students in North-Central Nigeria. This study reports the development and evaluation of the HeartSmart Programme, designed to address documented deficits in CVD knowledge, risk perception, and behavioural intentions. Methods A quasi-experimental single-group pre-test/post-test design was employed. Fifty purposively selected high-risk undergraduate students at the University of Jos (UNIJOS) completed validated ABCD Risk Perception Questionnaire assessments on the programme day. The HeartSmart Programme — a one-day, peer-delivered intervention comprising six evidence-based modules — was developed through systematic needs assessment grounded in Phase 1 baseline findings ( N = 1,300) and clinical cardiovascular assessment. Three theoretical frameworks (Health Belief Model, Social Cognitive Theory, Theory of Planned Behaviour) were explicitly operationalised into programme content. Paired-samples t-tests and Cohen’s d quantified pre-post changes. Results Significant improvements were observed across all four ABCD domains (all p ≤ 0.013). CVD knowledge demonstrated a large effect (d = 1.42; 73.0% to 93.3%; p < 0.001), with ‘good knowledge’ increasing from 26.0% to 90.0% of participants. Perceived benefits/exercise intentions showed a medium-large effect (d = 0.73; p < 0.001). Healthy eating intentions showed a small-to-medium effect (d = 0.48; p = 0.001). Perceived risk showed a small but significant effect (d = 0.36; p = 0.013). Programme fidelity was excellent: 98% content coverage, 100% retention, and satisfaction 4.74/5.00. Conclusions HeartSmart demonstrates that a brief, theory-based, culturally tailored CVD health promotion programme can achieve large knowledge improvements and meaningful attitudinal changes in high-risk university students at a North-Central Nigerian university. Findings are limited to immediate post-programme effects; longitudinal research is needed to assess behavioural and clinical translation. The programme offers a replicable, low-resource model for primordial CVD prevention in sub-Saharan African university settings.