Using evidence in mental health policy agenda-setting in low- and middle-income countries: A conceptual meta-framework from a scoping umbrella review.

The purpose of this article is to close the gap in frameworks for the use of evidence in mental health policy agenda-setting in low- and middle-income countries (LMICs). Agenda-setting is important because mental health remains a culturally-sensitive and neglected issue in LMICs. Moreover, effective evidence-informed agenda-setting can help achieve, and sustain, the status of mental health as a policy priority in these low resource contexts. A scoping review of reviews of evidence-to-policy frameworks was conducted which followed PRISMA guidelines. Nineteen reviews met the inclusion criteria. A meta-framework was developed from analysis and narrative synthesis of these 19 reviews which integrates the key elements identified across studies. It comprises the concepts of evidence, actors, process, context, and approach which are linked via the cross-cutting dimensions of: beliefs, values and interests; capacity; power and politics; and, trust and relationships. Five accompanying questions act as a guide for applying the meta-framework with relevance to mental health agenda-setting in LMICs. This is a novel and integrative meta-framework for mental health policy agenda-setting in LMICs and, as such, an important contribution to this under-researched area. Two major recommendations are identified from the development of the framework to enhance its implementation. First, given the paucity of formal evidence on mental health in LMICs, informal evidence based on stakeholder experience could be better utilised in these contexts. Second, the use of evidence in mental health agenda-setting in LMICs would be enhanced by involving a broader range of stakeholders in generating, communicating and promoting relevant information

Contours of Positive Mental Health: An Exploratory Delphi Study from India

The need to broaden attention from a narrow focus on mental illness and pathology to investing in understanding and enhancing positive mental health is well recognized. The bulk of research on positive mental health tends to be largely based onwestern developed nationconceptualizations. This highlights the need to examine the construct of positive mental health in diverse socio-cultural contexts. Present study aimed at exploring indicators and dimensions of positive mental health in Indian adults. A two-step Delphi technique, involving a vignette-based tool was used for facilitating a contextualised understanding of indicators of positive mental health. The sample consisted of a panel of 35 experts from different regions of India, majority of whom had >10 years of professional experience. Using a bottom-up approach, content analysis of the emergent data in terms of responses of experts to 10 vignettes resulted in identification and operationalisation of 33 indicators which could be grouped under 13 dimensions. Comparisons with popular well-being frameworks indicated that eight of these could be considered newer dimensions. Though the remaining dimensions significantly overlapped with existing dimensions of well-being in the western literature; finer differences in their meanings and constituents were observed. Finding have implications for further research

Using cocreated visually informed community mental health education in low‐ and middle‐income countries: A case study of youth substance misuse in Assam, India

Abstract Introduction Our aim is to evaluate the visually informed community mental health education materials cocreated in our research on youth substance misuse in Assam, India, and to reflect on what we might learn for similar initiatives in low‐ and middle‐income countries. Methods Materials consist of: (i) images participants brought to the interview; (ii) 30 posters cocreated by participants to convey key messages from their interview; (iii) six short films on the implications of addiction, and (iv) an animation of our Pathways to Recovery model. We also created a community education package that incorporated these materials. We analyse feedback from three groups of events and a social media campaign, which drew variably across our materials and engaged a range of audiences. Results Outcomes indicate the cocreation process and focus on the visual was successful in promoting young people's voice, increasing awareness and has potential for stigma reduction. Our educational package was deemed useful in increasing awareness and has potential for prevention and treatment. Conclusions Our case study offers insights into community mental health education in low‐ and middle‐income countries, confirming the importance of cocreation, the usefulness of visual materials and the potential of social media campaigns while acknowledging the importance of local context in health messaging, particularly for stigmatized topics. Patient or Public Contribution Service users were involved in the cocreation of the materials evaluated in this study and contributed as presenters in one of the events reported. Members of the public took part in events in which the materials were shared and provided us with the feedback analysed in this article