Community youth mental health awareness in Pakistan through the train-the-trainer model: Qualitative study of stakeholder perspectives

Background: Youth in low-resource settings such as Pakistan have high levels of unmet mental health needs. Mental health stigma and sparse resources are key barriers to accessing help. Aim: To capture end-users' and trainers' perspectives of youth mental health awareness in Pakistan informed by the Train-the-Trainer framework. Method: A qualitative research design was adopted, utilizing focus group discussions to hear the voices of those engaged in the study. Following the facilitation of four youth mental health awareness events in disadvantaged communities, five focus groups were conducted with 29 participants, i.e., mothers (n = 7 and n = 3), youth (n = 3 female and n = 7 male), and trainers (n = 9). Data were integrated and analysed through framework thematic analysis, which is a codebook approach to thematic analysis. Results: Three themes related to perceived individual, community and implementation enablers and challenges. Trainers, mothers and youth reported undergoing parallel processes of personal growth. Communities were viewed as sources of both stigma and solutions, through engagement and addressing contextual issues such as gender. Conclusion: Participants in community youth mental health awareness welcomed the opportunity to acquire and transfer new knowledge, but also identified required supports to engage and actively involve communities in Majority World Countries.