Assessing the Cross-Cultural Applicability of a Mental Health Literacy Questionnaire for Young People in Rural Malawi

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.