Community-based nursing strategies for optimizing public health outcomes: a systematic review and meta-analysis

Community-based nursing (CBN) initiatives are being acknowledged widely as a necessary means of infusing preventive and chronic healthcare services into environments outside of hospitals. Nevertheless, the proof that is already available is still very much pieced together, and the size of their impact that can be measured on public health is not very evident. The main purpose of this research was to conduct a comprehensive evaluation of how effective nursing interventions in a community setting are for the three areas of health promotion, disease prevention, and chronic-disease management, regardless of the population or the context. The search for systematic reviews of studies in PubMed, Cochrane Library, CINAHL, Scopus, and Web of Science was narrowed down to the window between January 2000 and September 2025. The studies that were eligible for inclusion were those of randomized controlled trials, quasi-experimental, and cohort designs that compared community nurse-led interventions with the usual or no care. The assembled information was analyzed through a random-effects meta-analysis (DerSimonian–Laird model). The results were presented as standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs). The risk of bias was determined with RoB 2 and ROBINS-I, and the level of evidence was judged by GRADE. In total, 20 studies (n = 14,386 participants) were found to be eligible for inclusion criteria. The combined data analysis showed that the overall effect was moderate (SMD = 0.54, 95% CI 0.32–0.75, p < 0.001) and was in favor of CBN interventions. Subgroup analyses revealed that self-management behavior (SMD = 0.68), quality of life (SMD = 0.57), and patient satisfaction (SMD = 0.73) were significantly improved, while healthcare utilization was moderately reduced (SMD = − 0.42). The heterogeneity was at a moderate level (I² = 61%), however, the results of the sensitivity and meta-regression analyses were not affected by this and therefore, they still stand. The quality of the evidence was rated as being from moderate to high for different outcomes. Community-based nursing interventions yield consistent, statistically significant benefits for health behavior, quality of life, and service utilization. While causal inference is limited by mixed study designs and moderate heterogeneity, the evidence supports their integration into primary-care and public-health strategies. These interventions may be considered context-appropriate tools for optimizing population health outcomes through sustained, nurse-led community engagement.