Community Street Play Versus Facility-based Screening for Mental Health Literacy in Rural India: A Mixed-methods Quasi-experimental Study.

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.