Joel Nyali

Mental health literacy (MHL) in Malawi is low. Mental illness is often attributed to substance abuse or spirit possession, resulting in stigma, maltreatmen

In Malawi, mental health resources remain limited while demand continues to rise, particularly among young people, resulting in a substantial treatment gap. Enhancing mental health literacy (MHL) is increasingly recognised as a preventive strategy to reduce the onset and escalation of mental disorders. MHL is commonly assessed through instruments evaluating knowledge, beliefs, self-help strategies, and help-seeking behaviours. Although previous studies in Malawi have explored mental health awareness, none have directly measured MHL among young people, and few have addressed the cultural adaptations necessary for contextual validity. Such adaptations are essential to support decolonising research practices and to generate accurate insights into local understandings of mental health. This explanatory mixed-methods study examined the applicability of a Portuguese-developed Mental Health Literacy Questionnaire (MHLq) among young people in rural Malawi. Quantitative data ( n = 107) were statistically analysed, followed by qualitative focus groups ( n = 7) to interpret and contextualise findings. The dataset yielded moderately high mean MHL scores, contrasting with participants’ perceptions that mental health literacy in Malawi remains low. Thematic analysis identified three central themes: (a) epistemic exclusion, (b) conceptual misfits, and (c) translation challenges. Findings highlight the need to adapt the MHLq to incorporate culturally relevant knowledge, linguistic nuance, and local conceptualisations of mental health. Avoiding psychiatric terminology that lacks direct Chichewa equivalents is particularly important. The study underscores the necessity of participatory, contextually grounded approaches for developing and validating MHL tools in low-resource, culturally diverse settings.

In Malawi, it is difficult to promote positive mental health due to poverty, cultural beliefs, and stigma associated with mental illness. Mental health literacy (MHL) is not integrated into the education system despite evidence suggesting educational settings as ideal to deliver MHL programmes. Stakeholder input is crucial during development of interventions. This paper reports on our work with diverse stakeholders to culturally adapt a MHL course (MHLc) for implementation in Malawi universities. The MHLc structure and content development involved focus group discussions (FGDs) with 44 Malawian youth from universities and youth organisations, a national MHL survey and a systematic review exploring adolescent substance use in Africa. The MHLc was delivered to 35 first‐year university students. Students’ MHL was assessed using two questionnaires before and 3 months after MHLc delivery during an evaluation session which also included FGDs with 20 participants to explore course satisfaction. MHL questionnaire responses were analysed using paired t‐tests and FGD transcripts were thematically analysed. Overall student attendance rate during the MHLc delivery was 92%. However, only 57% attended the evaluation session. Students’ MHL increased after course completion (pre and post scores were 116.7 and 117.9 respectively) however this change was not significant. Student feedback about the MHLc was positive. They highlighted acquiring considerable mental health knowledge and skills that they would utilise in their lives daily. A key challenge raised was disruption of course delivery due to electricity outages. The MHLc content was acceptable among university students with high attendance rates and positive feedback regarding impact on participants’ mental health knowledge and attitudes. This paper highlights the value of stakeholders’ input when designing mental health interventions. In future, we need to mitigate disruption of the MHLc delivery and consider incentives to reduce participant dropout at follow up points.