MENTAL HEALTH LITERACY (MHL) INTERVENTIONS WITH CULTURAL, RELIGIOUS OR SPIRITUAL ADAPTATION: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.35631/IJEPC.1164006Keywords:
Mental Health Literacy, Cultural Adaptation, Religious Adaptation, Spiritual Adaptation, Intervention, Systematic ReviewAbstract
Mental health literacy (MHL) interventions are increasingly adapted to reflect the cultural, religious, and spiritual backgrounds of diverse populations, as standard programmes may not adequately address local beliefs, language, stigma, and help-seeking practices. However, evidence on how such adaptations is designed, delivered, and evaluated remains fragmented across different settings and population groups. This systematic review aimed to synthesise current evidence on MHL interventions incorporating cultural, religious, or spiritual adaptation, with particular attention to the nature of adaptation, mechanisms of engagement, and intervention outcomes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. An advanced search was conducted in Scopus and Web of Science using combinations of the keywords “mental health literacy,” “intervention,” “spiritual,” and “cultural.” Studies were screened according to predefined inclusion and exclusion criteria, resulting in 21 primary studies included in the final synthesis. The findings were organised into three themes: (1) cultural adaptation centred on content, framing, and conceptual relevance; (2) trust, social infrastructure, and delivery as mechanisms of engagement; and (3) short-term effectiveness, implementation feasibility, and uncertain sustainability. Most interventions adapted existing programmes through language modification, culturally relevant examples, local explanatory models, spiritual or religious framing, and community-specific help-seeking information rather than complete programme redesign. Engagement was strengthened through trusted facilitators, faith leaders, community organisations, culturally familiar settings, and accessible digital or face-to-face delivery. The reviewed interventions generally reported improvements in mental health knowledge, confidence, stigma-related attitudes, and helping intentions, although evidence for sustained help-seeking, service use, and long-term behavioural change was limited. Overall, culturally, religiously, and spiritually adapted MHL interventions appear promising for improving relevance, acceptability, and short-term outcomes, but stronger longitudinal studies and clearer reporting of adaptation processes are needed to establish their long-term effectiveness and sustainability.
Downloads
References
Abe, J. S. (2013). Spirituality and culture: Implications for mental health service delivery to diverse populations. In F. A. Paniagua & A.-M. Yamada (Eds.), Handbook of multicultural mental health: Assessment and treatment of diverse populations (2nd ed., pp. 147–166). Elsevier Academic Press.
Adewuya, A. O., Olibamoyo, O., Lebimoyo, A., & Oladipo, O. E. (2026). Faith-based mental health awareness in Lagos: evaluating knowledge, stigma, and referral outcomes from the MeHPriC initiative. Social psychiatry and psychiatric epidemiology, 10.1007/s00127-026-03112-5. Advance online publication. https://doi.org/10.1007/s00127-026-03112-5
Baheretibeb Y, Soklaridis S, Wondimagegn D, Martimianakis MAT and Law S (2022) Transformative learning in the setting of religious healers: A case study of consultative mental health workshops with religious healers, Ethiopia. Front. Psychiatry 13:897833. doi: 10.3389/fpsyt.2022.897833
Bantjes J, Geldenhuys M, Van Zyl M, Page DT, Weis J, Louw KA, Shadwell R, Hunt X. Developing, piloting, and evaluating a psychological first aid training for medical students in South Africa. BMC Med Educ. 2026 Jan 24;26(1):295. doi: 10.1186/s12909-026-08616-x. PMID: 41578290; PMCID: PMC12911102.
Bapolisi, A., Foucart, J., Kabambi, D., Mirishe, R., Musa, E., Ruvunangiza, A., Bosomi, J., Bulabula, V., Ilunga, M., Kajibwami, E., Bapolisi, O., Nyalundja, A. D., Igega, M. H., Mwene-Batu, P., de Timary, P., & Khazaal, Y. (2026). Evaluating a Culturally Tailored Digital Storytelling Intervention to Improve Trauma Awareness in Conflict-Affected Eastern Congo: Quasi-Experimental Pilot Study. JMIR mental health, 13, e81291. https://doi.org/10.2196/81291
Barrera, M., Jr. and Castro, F.G. (2006), A Heuristic Framework for the Cultural Adaptation of Interventions. Clinical Psychology: Science and Practice, 13: 311-316. https://doi.org/10.1111/j.1468-2850.2006.00043.x
Codjoe, L., N’Danga-Koroma, J., Henderson, C., Lempp, H., & Thornicroft, G. (2023). Pilot study of a manualised mental health awareness and stigma reduction intervention for Black faith communities in the UK: ON TRAC project. Social Psychiatry and Psychiatric Epidemiology, 58, 1687–1697. https://doi.org/10.1007/s00127-023-02492-2
Costa-Cordella, S., Sieverson, C., Rossi, A., Grasso-Cladera, A., Díaz, M.V., & Byrne, G. (2025). Cultural Adaptation of the Lighthouse Parenting Programme: Mentalization-Based Treatment to Address Child Maltreatment. Journal of Child and Family Studies, 34, 2578 - 2587.
Crooks, C. V., Lapp, A., Auger, M., van der Woerd, K., Snowshoe, A., Rogers, B. J., Tsuruda, S., & Caron, C. (2018). A feasibility trial of Mental Health First Aid First Nations: Acceptability, cultural adaptation, and preliminary outcomes. American Journal of Community Psychology, 61, 459–471. https://doi.org/10.1002/ajcp.12241
Daass-Iraqi S, Garber-Epstein P, Roe D. Cultural Adaptation of the Illness Management and Recovery Intervention Among Israeli Arabs. Psychiatr Serv. 2021 Jul 1;72(7):848-852. doi: 10.1176/appi.ps.202000175. Epub 2021 Jan 12. PMID: 33430648.
Day A, Casey S, Baird M, Geia L, Wanganeen R. Evaluation of the Aboriginal and Torres Strait Islander Mental Health First Aid Program. Aust N Z J Public Health. 2021 Feb;45(1):46-52. doi: 10.1111/1753-6405.13064. Epub 2021 Jan 18. PMID: 33460196.
Duodu, P. A., Okyere, J., Wilson, D., Dosoo, A. K., Boakye, P., Simkhada, B., Barker, C., Gillibrand, W., & Simkhada, P. (2026). Co-creating dementia knowledge and action in Ghana: Evidence from a participatory stakeholder workshop. Palliative care and social practice, 20, 26323524261442208. https://doi.org/10.1177/26323524261442208
Ekblad, S. (2020). To increase mental health literacy and human rights among new-coming, low-educated mothers with experience of war: A culturally tailor-made group health promotion intervention with participatory methodology addressing indirectly the children. Frontiers in Psychiatry, 11, 611. https://doi.org/10.3389/fpsyt.2020.00611
Haidar, A., Nwosisi, E. & Burnett-Zeigler, I. The Role of Religion and Spirituality in Adapting Mindfulness-Based Interventions for Black American Communities: A Scoping Review. Mindfulness 14, 1852–1867 (2023). https://doi.org/10.1007/s12671-023-02194-5
Hammad, J., El-Guenuni, A., Bouzir, I., & El-Guenuni, F. (2020). The Hand of Hope: A coproduced culturally appropriate therapeutic intervention for Muslim communities affected by the Grenfell Tower fire. Journal of Muslim Mental Health, 14(2). https://doi.org/10.3998/jmmh.10381607.0014.202
Hays, K., & Aranda, M. P. (2016). Faith-based mental health interventions with African Americans: A review. Research on Social Work Practice, 26(7), 777–789. https://doi.org/10.1177/1049731515569356
Jerome, A., Allen Heath, M., Williams, M., Winters, R., & Cutrer-Párraga, E. A. (2023). Traversing trauma: Resilient women’s religious and spiritual stories of hope and strength. Professional Psychology: Research and Practice, 54(2), 177–187. https://doi.org/10.1037/pro0000491
Khatib, A., Laufer, A., Finkelstein, M., Gelkopf, M. (2025). Cultural Adaptation of the Mental Health Literacy Scale. International Journal of Mental Health Promotion, 27(1), 19–28. https://doi.org/10.32604/ijmhp.2024.057925
Mansfield, R., Humphrey, N., Patalay, P., Moore, A., & Stapley, E. (2021). Adaptation of a school-based mental health literacy curriculum: From Canadian to English classrooms. Global Mental Health, 8, e39. https://doi.org/10.1017/gmh.2021.38
Mantovani, N., Pizzolati, M., & Gillard, S. (2017). Engaging communities to improve mental health in African and African Caribbean groups: A qualitative study evaluating the role of community well-being champions. Health & Social Care in the Community, 25(1), 167–176. https://doi.org/10.1111/hsc.12288
Martinez, A. B., Lau, J. Y. F., Morillo, H. M., & Brown, J. S. L. (2024). ‘C’mon, let’s talk’: A pilot study of a mental health literacy program for Filipino migrant domestic workers in the United Kingdom. Social Psychiatry and Psychiatric Epidemiology, 59, 385–401. https://doi.org/10.1007/s00127-022-02405-9
McCleary JS, Horn TL. Processes for culturally adapting behavioral health interventions for people with refugee backgrounds: A scoping review. Am J Community Psychol. 2024 Mar;73(1-2):250-266. doi: 10.1002/ajcp.12709. Epub 2023 Oct 19. PMID: 37853807.
Morse, A. R., Smith, D. G., Clifford, R., Shrimpton, B., & Banfield, M. (2024). Starting conversations about mental health and wellbeing in Australian culturally and linguistically diverse communities. Health Promotion International, 39, daae099. https://doi.org/10.1093/heapro/daae099
Ramaiya, M. K., Fiorillo, D., Regmi, U., Robins, C. J., & Kohrt, B. A. (2017). A Cultural Adaptation of Dialectical Behavior Therapy in Nepal. Cognitive and behavioral practice, 24(4), 428–444. https://doi.org/10.1016/j.cbpra.2016.12.005
Ramos, Z., & Alegría, M. (2014). Cultural adaptation and health literacy refinement of a brief depression intervention for Latinos in a low-resource setting. Cultural Diversity & Ethnic Minority Psychology, 20(2), 293–301. https://doi.org/10.1037/a0035021
Rushing, C.S., Kelley, A., Bull, S., Stephens, D., Wrobel, J., Silvasstar, J., Peterson, R., Begay, C., Ghost Dog, T., McCray, C., Love Brown, D., Thomas, M., Caughlan, C., Singer, M., Smith, P., & Sumbundu, K. (2021). Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial. JMIR mental health, 8(9), e26158. https://doi.org/10.2196/26158
Schwartz L, Brunner D, Unternährer E, Stadler C. Feasibility and relatability of cultural adaptation amongst conflict-affected populations. J Migr Health. 2022 Sep 24;6:100134. doi: 10.1016/j.jmh.2022.100134. PMID: 36177092; PMCID: PMC9513255.
Shala, M., Morina, N., Burchert, S., Cerga-Pashoja, A., Knaevelsrud, C., Maercker, A., & Heim, E. (2020). Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Internet interventions, 21, 100339. https://doi.org/10.1016/j.invent.2020.100339
Shehadeh, M. H., Heim, E., Chowdhary, N., Maercker, A., & Albanese, E. (2016). Cultural Adaptation of Minimally Guided Interventions for Common Mental Disorders: A Systematic Review and Meta-Analysis. JMIR mental health, 3(3), e44. https://doi.org/10.2196/mental.5776
Sit HF, Ling R, Lam AIF, Chen W, Latkin CA and Hall BJ (2020) The Cultural Adaptation of Step-by-Step: An Intervention to Address Depression Among Chinese Young Adults. Front. Psychiatry 11:650. doi: 10.3389/fpsyt.2020.00650
Slewa-Younan, S., Guajardo, M. G. U., Mohammad, Y., Lim, H., Martinez, G., Saleh, R., & Sapucci, M. (2020). An evaluation of a mental health literacy course for Arabic-speaking religious and community leaders in Australia: Effects on posttraumatic stress disorder-related knowledge, attitudes and help-seeking. International Journal of Mental Health Systems, 14, 69. https://doi.org/10.1186/s13033-020-00401-7
Slewa-Younan, S., McKenzie, M., Thomson, R., Smith, M., Mohammad, Y., & Mond, J. (2020). Improving the mental wellbeing of Arabic-speaking refugees: An evaluation of a mental health promotion program. BMC Psychiatry, 20, 314. https://doi.org/10.1186/s12888-020-02732-8
Song, J. E., Ngo, N. T., Vigneron, J. G., Lee, A., Sust, S., Martin, A., & Yuen, E. Y. (2022). CHATogether: A novel digital program to promote Asian American Pacific Islander mental health in response to the COVID-19 pandemic. Child and Adolescent Psychiatry and Mental Health, 16, 76. https://doi.org/10.1186/s13034-022-00508-4
Sorenson, C., & Harrell, S. P. (2021). Development and testing of the 4-Domain Cultural Adaptation Model (CAM4). Professional Psychology: Research and Practice, 52(3), 250–259. https://doi.org/10.1037/pro0000370
Stoeckli, R. T., Berger, T., Aebersold, M., Zoellner, V., Haji, F., Hunziker, M., Jesus Ferreira, B., Hosmann, M., Burchert, S., Wabiszczewicz, J., Knaevelsrud, C., & Heim, E. (2025). A Digital Psychosocial Service (Sui App) for Arabic-Speaking Refugees in Switzerland: Development and Cultural-Contextual Adaptation Using a User-Centered and Participatory Approach. JMIR formative research, 9, e59905. https://doi.org/10.2196/59905
Stoll, E., Nething, E., Uhlig, S. M., Retka, J., von Finckenstein, K., Schwiebert, C., & Tomczyk, S. (2026). Reducing mental health stigma in the workplace: A mixed-method analysis of a quasi-experimental trial and the contextual role of personal values. Frontiers in Public Health, 14, 1758132. https://doi.org/10.3389/fpubh.2026.1758132
van Nieuw Amerongen, J. C., Ouwehand, E., Graaf, N. d., van Parijs, L., Schaap-Jonker, H., Braam, A. W., Verhagen, P. J., Rosmarin, D. H., & van den Brink, B. (2024). Introduction of Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) in The Netherlands: Translation and Adaptation of a Psychotherapy Protocol for Mental Health Care. Religions, 15(3), 253. https://doi.org/10.3390/rel15030253
Vang-Kue, M., McNeill, C., & Stephens, U. (2025). Improving mental health literacy and stigma among the Hmong. Journal of the American Psychiatric Nurses Association, 31(1), 83–88. https://doi.org/10.1177/10783903241277344
Wang, C., & Havewala, M. (2025). Cultural adaptation of youth mental health first aid training for Asian American parents. Journal of School Psychology, 110, 101448. https://doi.org/10.1016/j.jsp.2025.101448
Wright, B., Zhang, L., Meza, J. I., Rodriguez, L., Contreras, I., Terán, V., Young, A. S., Nuño, M., Dzou, T., Aguilar-Gaxiola, S., & Wells, K. B. (2026). Usability, relevance, and user engagement of a government-sponsored and community co-designed digital mental health website during the COVID-19 pandemic: A pilot study on Latino/a/x adults. JMIR Formative Research, 10, e72952. https://doi.org/10.2196/72952
Yoo, N., Kang, M., Lee, S.Y. et al. (2026). Effectiveness of a Virtual Mental Health Literacy Training for Korean American Church Leaders: Knowledge, Behavioral Intentions, and Confidence. Pastoral Psychol 75, 359–383. https://doi.org/10.1007/s11089-026-01308-9
