Authors
Simon Ntumi, JOSHUA-LUTHER NDOYE UPOALKPAJOR & Daniel Gyapong Nimo
Publication Year
2025
Article Title
Culturally responsive assessment of help-seeking behavior among university students: a mediation-moderation analysis of cultural norms, mental health stigma, and digital engagement across cross-cultural contexts
Journal
BMC Psychology
Volume
13
Issue Number
922
Page Numbers
1-20
DOI
https://doi.org/10.1186/s40359-025-03256-0
Website Url
https://link.springer.com/article/10.1186/s4035...
Abstract

Help-seeking behavior for mental health issues among university students is shaped by cultural norms, stigma, and digital engagement. In many African contexts, cultural perceptions of mental illness remain highly stigmatized, posing barriers to seeking support. This study examined the mediating role of mental health stigma and the mod- erating effect of digital engagement in the relationship between cultural norms and help-seeking behavior among Ghanaian university students. A cross-sectional quantitative design using Structural Equation Modeling (SEM) was employed, with data from 1,067 students across five traditional public universities. Findings revealed that cul- tural norms significantly increased mental health stigma (β = 0.420, p < .001), which in turn reduced help-seeking behavior (β = -0.370, p < .001). A direct negative effect of cultural norms on help-seeking behavior was also observed (β = -0.210, p < .001). The indirect effect through stigma was significant (β = -0.155, p < .001), confirming the mediating role of stigma. Digital engagement moderated both the direct and indirect relationships. Specifically, it weakened the negative impact of stigma on help-seeking (β = 0.125, p = .002) and buffered the effect of cultural norms (β = 0.098, p = .005). Moderated mediation analysis further showed that digital engagement acted as a protective factor: stronger mediation was observed at lower levels of digital engagement (β = -0.198, p < .001) and weaker mediation at higher levels (β = -0.082, p < .001). These findings underscore the complex interplay of cultural and technological factors in mental health behaviors. The study highlights the need for culturally responsive mental health interventions and supports the integration of digital tools to reduce stigma and enhance help-seeking among university students.

Policy Contributions

From a policy standpoint, the results call for an urgent reform of institutional and national mental health strate- gies to reflect the shifting landscape of student behavior and technology use. At the institutional level, universi- ties should develop formal digital mental health strate- gies as part of their broader student welfare programs. This involves creating policies that support the safe, ethical, and effective use of digital mental health tools, while ensuring compliance with data protection laws and professional standards. National education and health ministries, in collaboration with ICT authorities, should facilitate public–private partnerships to fund the devel- opment or adaptation of culturally tailored digital tools. For example, local developers could work with mental health professionals to design apps in local languages, incorporating cultural idioms and metaphors that reso- nate with Ghanaian students. Further, mental health pol- icy should incorporate comprehensive stigma-reduction campaigns that go beyond awareness to foster behavio- ral and attitudinal change. These campaigns should chal- lenge traditional beliefs that equate mental distress with personal failure or weakness and promote narratives that frame help-seeking as a strength. Policies should also mandate training of university staff and faculty in recog- nizing signs of psychological distress and in promoting supportive environments. These capacity-building efforts will ensure that students are not only encouraged to seek help but are met with understanding and appropri- ate referral pathways when they do. Additionally, policy frameworks must ensure equity in digital access. Given that digital engagement was found to buffer the effects of stigma and cultural norms, bridging the digital divide particularly in rural and underserved regions is not merely a technology issue but a mental health imperative.

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