Abstract: Entrepreneurship education (EE) has been widely integrated into higher education in low- and middle-income countries (LMICs) as a policy response to graduate unemployment, including within nursing education. However, evidence suggests that exposure to EE does not consistently translate into entrepreneurial intentions (EIs) among graduates. This narrative literature review examines the relationship between entrepreneurship education, self-efficacy, and entrepreneurial intentions among nursing students and graduates in LMICs, with particular attention to the moderating role of self-efficacy. The review synthesises empirical, conceptual, and policy-oriented studies published between 1997 and 2025 and is guided by intention-based theories, particularly the Theory of Planned Behaviour. Findings indicate that while entrepreneurship education consistently improves entrepreneurial awareness and knowledge, its direct effect on entrepreneurial intentions is weak and inconsistent. In contrast, entrepreneurship education demonstrates a more reliable influence on entrepreneurial self-efficacy, especially when implemented through experiential and practice-oriented pedagogies. Crucially, the review shows that self-efficacy conditions the effectiveness of entrepreneurship education, such that EE is more likely to translate into entrepreneurial intentions when graduates perceive themselves as capable of entrepreneurial action. In contexts characterised by structural constraints, weak ecosystems, and risk-averse professional norms, low self-efficacy can suppress intention formation despite EE exposure. The study concludes that entrepreneurship education in LMIC nursing contexts must be designed and evaluated as a psychologically mediated and context-sensitive intervention. Strengthening self-efficacy is central to closing the persistent gap between entrepreneurship education and entrepreneurial intention outcomes in LMICs.

Abstract: Entrepreneurship education has been widely adopted across higher education systems in Sub-Saharan Africa as a response to youth unemployment and constrained wage employment. Despite this expansion, entrepreneurial intentions among graduates remain persistently low, raising concerns about the effectiveness of entrepreneurship education implementation. This narrative literature review examines why the implementation of entrepreneurship education often fails to translate into entrepreneurial intentions, focusing on the mediating role of entrepreneurial attitude. The review synthesises empirical, conceptual, and policy-oriented studies published between 1991 and 2025. Guided by intention-based models, the synthesis shows that the implementation of entrepreneurship education frequently improves entrepreneurial knowledge and awareness but does not consistently foster positive entrepreneurial attitudes, the most proximal predictors of entrepreneurial intention. Pedagogical practices remain largely theory-driven and assessment-oriented, with limited emphasis on experiential, reflective, and affective learning, which are necessary for attitude formation. In Sub-Saharan Africa, this limitation is compounded by contextual constraints, including necessity-driven entrepreneurship, limited access to finance, weak institutional support, and high perceived risk, which further undermine the development of entrepreneurial attitudes. Methodologically, the literature is dominated by cross-sectional designs that insufficiently interrogate mediation pathways linking implementation processes to intention outcomes. Conceptually, this review foregrounds entrepreneurial attitude as the central mechanism explaining the persistent intention gap, rather than exposure to entrepreneurship education alone. The study concludes that without deliberate alignment of entrepreneurship education implementation toward attitude formation, entrepreneurship education is unlikely to generate sustained entrepreneurial intentions in Sub-Saharan Africa.