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Community Street Play Versus Facility-based Screening for Mental Health Literacy in Rural India: A Mixed-methods
Abhishek Ghosh1, Pragyapti Malav1, Blessy B George1
1Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background:
Community-based approaches to mental health literacy (MHL), including street theatre, remain underrepresented. No study has compared street play with primary care facility-based screening as parallel MHL strategies. This study evaluated the effectiveness and acceptability of structured street play compared with facility-based screening in rural Punjab, India.
Methods:
A mixed-methods quasi-experimental study with two non-randomized arms was conducted across ten primary care facilities in Mohali district. Adults in one block received a single 30-min street play (N = 102); those in the adjacent block underwent structured screening for depression, anxiety, and substance use by a non-specialist nurse using a validated mobile application (N = 100). Mental health knowledge schedule and attitudes to mental illness questionnaire were assessed at baseline and 1-month follow-up. Acceptability was measured using the theoretical framework of acceptability scale. Twelve qualitative interviews guided by the health belief model (HBM) explored participants' experiences.
Results:
Both arms showed significant improvements in knowledge (F = 9.788, p = .002) and attitudes (F = 4.841, p = .029) at follow-up, with no significant between-arm difference. A significant time × gender interaction (F = 12.262, p = .01) indicated that females who held more stigmatizing views at baseline showed greater attitudinal improvement than males. Post-intervention condition recognition was uniformly high, and acceptability exceeded 90%. Qualitatively, participants recognized susceptibility, severity, and benefits of help-seeking across all six HBM domains, with stigma, structural barriers, and increased self-efficacy reported.
Conclusions:
A single-session street play and facility-based screening produce comparable short-term improvements in MHL, supporting their integration as complementary demand-generation and case-identification strategies within the primary care mental health framework.
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