{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T17:19:32Z","timestamp":1778260772701,"version":"3.51.4"},"reference-count":55,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CESPU, CRL","award":["GI2-CESPU 2023"],"award-info":[{"award-number":["GI2-CESPU 2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Mental health literacy (MHL) is defined as the ability to obtain, understand, and use information to identify, manage, and prevent mental health problems and helps university health students to manage mental health challenges by reducing stigma, fostering resilience, and promoting coping strategies. Objectives: To assess MHL levels in Portuguese university health students and explore its relationship with academic life and psychosocial domains; Identify knowledge gaps and educational needs regarding a targeted MHL intervention. Methods: A convergent parallel mixed-methods study, involving collecting quantitative (online cross-sectional survey) and qualitative (focus group) data simultaneously, followed by a separate and integrative analysis. Results: Twenty-four students (75% female, mean age = 25.5) were included. Overall, differences were found in the MHL domains in terms of sex (p = 0.025), mental health history variables (p = 0.020; p = 0.044; p = 0.007), and a negative relation with academic environment satisfaction (rs = \u22120.571). Focus groups revealed the needs, gaps, and main characteristics for a targeted intervention. Integrative analysis used for data triangulation was possible and helped to converge and reinforce some of the data findings. Conclusions: This study highlights the importance of integrated methodological approaches to explore MHL among undergraduate health students. Also, it highlights the importance of promoting MHL through targeted interventions to enhance well-being and reduce distress in academic contexts.<\/jats:p>","DOI":"10.3390\/healthcare13070724","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T10:48:58Z","timestamp":1742899738000},"page":"724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Mixed Methods Approach to Understanding Mental Health Literacy Among University Health Students"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-9311","authenticated-orcid":false,"given":"Ana Isabel","family":"Teixeira","sequence":"first","affiliation":[{"name":"Nursing School of T\u00e2mega e Sousa, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"RISE-Health, Nursing School of Porto (ESEP), 4200-072 Porto, Portugal"},{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"UCIBIO\u2014Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1812-8913","authenticated-orcid":false,"given":"S\u00f3nia","family":"Martins","sequence":"additional","affiliation":[{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"RISE\u2014Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"ISSSP\u2014Higher Institute of Social Services of Porto, 4460-362 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3421-4854","authenticated-orcid":false,"given":"Sara","family":"Lima","sequence":"additional","affiliation":[{"name":"Nursing School of T\u00e2mega e Sousa, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"UCIBIO\u2014Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-7545","authenticated-orcid":false,"given":"Francisca","family":"Pinto","sequence":"additional","affiliation":[{"name":"Nursing School of T\u00e2mega e Sousa, IPSN-CESPU, 4560-485 Penafiel, Portugal"},{"name":"iHealth4Well-Being\u2014Innovation in Health and Well-Being\u2014Research Unit, IPSN-CESPU, 4560-485 Penafiel, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9867-6321","authenticated-orcid":false,"given":"T\u00e2nia","family":"Morgado","sequence":"additional","affiliation":[{"name":"RISE-Health, Nursing School of Porto (ESEP), 4200-072 Porto, Portugal"},{"name":"Pediatric Hospital of Health Local Unit of Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3045-043 Coimbra, Portugal"},{"name":"Nursing School of Coimbra, 3004-011 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2900-3972","authenticated-orcid":false,"given":"Olga","family":"Valentim","sequence":"additional","affiliation":[{"name":"RISE-Health, Nursing School of Porto (ESEP), 4200-072 Porto, Portugal"},{"name":"Nursing School of Lisbon (ESEL), 1600-096 Lisboa, Portugal"},{"name":"Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1080\/10410236.2015.1037423","article-title":"Why We Need the Concept of \u201cMental Health Literacy\u201d","volume":"30","author":"Jorm","year":"2015","journal-title":"Health Commun."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Miles, R., Rabin, L., Krishnan, A., Grandoit, E., and Kloskowski, K. (2020). Mental health literacy in a diverse sample of undergraduate students: Demographic, psychological, and academic correlates. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09696-0"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/jpm.12593","article-title":"Pathways linking mental health literacy to professional help-seeking intentions in Korean college students","volume":"27","author":"Kim","year":"2020","journal-title":"J. Psychatr. Ment. Health Nurs."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Cormier, E., Park, H., and Schluck, G. (2022). College Students\u2019 eMental Health Literacy and Risk of Diagnosis with Mental Health Disorders. Healthcare, 10.","DOI":"10.3390\/healthcare10122406"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/j.1751-7893.2011.00314.x","article-title":"Mental health literacy in higher education students","volume":"6","author":"Reavley","year":"2012","journal-title":"Early Interv. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e12603","DOI":"10.5812\/ijpbs.12603","article-title":"The mediator role of mental health literacy in the relationship between demographic variables and health-promoting behaviours","volume":"12","author":"Noroozi","year":"2018","journal-title":"Iran. J. Psychiatry Behav. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Carvalho, D., Sequeira, C., Querido, A., Tom\u00e1s, C., Morgado, T., Valentim, O., Moutinho, L., Gomes, J., and Laranjeira, C. (2022). Positive mental health literacy: A concept analysis. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.877611"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jad.2022.03.038","article-title":"Trends in college student mental health and help-seeking by race\/ethnicity: Findings from the national healthy minds study, 2013\u20132021","volume":"306","author":"Lipson","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s40596-014-0205-9","article-title":"College Students: Mental Health Problems and Treatment Considerations","volume":"39","author":"Pedrelli","year":"2015","journal-title":"Acad. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1177\/0706743715616609","article-title":"Mental health literacy: Past, present, and future","volume":"61","author":"Kutcher","year":"2016","journal-title":"Can. J. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1080\/09638237.2016.1276532","article-title":"Measurement properties of mental health literacy tools measuring help-seeking: A systematic review","volume":"26","author":"Wei","year":"2017","journal-title":"J. Ment. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e25592","DOI":"10.2196\/25592","article-title":"Mental Health Promotion and Stigma Reduction Among University Students Using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) Framework: Protocol for a Mixed Methods Study","volume":"10","author":"Fung","year":"2021","journal-title":"JMIR Res. Protoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"72","DOI":"10.31211\/rpics.2019.5.1.108","article-title":"Programa de primeiros socorros em sa\u00fade mental: Estudo piloto","volume":"5","author":"Loureiro","year":"2019","journal-title":"Rev. Port. Investig. Comport. E Soc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"24","DOI":"10.31211\/rpics.2020.6.2.184","article-title":"Primeira Ajuda em Sa\u00fade Mental: Contributo do programa para o incremento da literacia em sa\u00fade mental dos estudantes do ensino superior","volume":"6","author":"Loureiro","year":"2020","journal-title":"Rev. Port. Investig. Comport. E Soc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e51268","DOI":"10.2196\/51268","article-title":"The Effect of Digital Mental Health Literacy Interventions On Mental Health: Systematic Review and Meta-Analysis","volume":"26","author":"Yeo","year":"2024","journal-title":"J. Med. Internet Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e27745","DOI":"10.2196\/27745","article-title":"Understanding mental health app use among community college Students: Web-Based Survey study","volume":"23","author":"Borghouts","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1080\/07448481.2021.1925286","article-title":"Mental Health Fist Aid Improves Mental Health Literacy among College Students: A meta-analysis","volume":"71","author":"Liang","year":"2021","journal-title":"J. Am. Coll. Health"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Teixeira, S., Ferr\u00e9-Grau, C., Canut, T.L., Pires, R., Carvalho, J.C., Ribeiro, I., Sequeira, C., Rodrigues, T., Sampaio, F., and Costa, T. (2022). Positive Mental Health in University Students and Its Relations with Psychological Vulnerability, Mental Health Literacy, and Sociodemographic Characteristics: A Descriptive Correlational Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.20944\/preprints202202.0167.v1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13506","DOI":"10.1111\/inm.13506","article-title":"Determining the Mental Health Literacy Level of University Students and Examining Their Attitudes Towards Seeking Psychological Help","volume":"34","year":"2025","journal-title":"Int. J. Ment. Health Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1037\/0022-3514.57.6.1069","article-title":"Happiness is everything, or is it? Explorations on the meaning of psychological well being","volume":"57","author":"Ryff","year":"1989","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1037\/0022-3514.69.4.719","article-title":"The structure of psychological well-being revisited","volume":"69","author":"Ryff","year":"1995","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Michael, K., Schujovitzky, D., and Karnieli-Miller, O. (2024). The associations between resilience, selfcare, and burnout among medical students. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0309994"},{"key":"ref_23","first-page":"71","article-title":"A satisfa\u00e7\u00e3o com a vida acad\u00e9mica. Rela\u00e7\u00e3o com bem-estar e distress psicol\u00f3gico","volume":"6","author":"Nogueira","year":"2018","journal-title":"Rev. Port. Enferm. Sa\u00fade Ment."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"87","DOI":"10.12928\/psikopedagogia.v11i2.23607","article-title":"Academic major satisfaction as a predictor of Psychological Well-Being and psychological distress","volume":"11","author":"Cahyawulan","year":"2022","journal-title":"PSIKOPEDAGOGIA J. Bimbing. Dan Konseling"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zalazar-Jaime, M.F., Moretti, L.S., and Medrano, L.A. (2022). Contribution of Academic Satisfaction Judgments to Subjective Well-Being. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.772346"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Cao, F., Zhang, L., Li, M., and Xie, Z. (2024). Subjective well-being among PhD students in mainland China: The roles of psychological capital and academic engagement. Front. Psychol., 15.","DOI":"10.3389\/fpsyg.2024.1354451"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1177\/0033294121994568","article-title":"Exploring the relationship between students\u2019 academic success and happiness levels in the higher education settings during the lockdown period of COVID-19","volume":"125","author":"Moussa","year":"2021","journal-title":"Psychol. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100041","DOI":"10.1016\/j.ajpe.2022.10.009","article-title":"Grit, subjective happiness, satisfaction with life, and academic resilience among pharmacy and physical therapy students at two universities","volume":"87","author":"Saunders","year":"2023","journal-title":"Am. J. Pharm. Educ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1080\/07294360.2021.1906210","article-title":"Mental health and wellbeing of postgraduate researchers: Exploring the relationship between mental health literacy, help-seeking behaviour, psychological distress, and wellbeing","volume":"41","author":"Moss","year":"2021","journal-title":"High. Educ. Res. Dev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1037\/abn0000362","article-title":"WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders","volume":"127","author":"Auerbach","year":"2018","journal-title":"J. Abnorm. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"27","DOI":"10.21608\/ejhm.2021.209974","article-title":"Stress, anxiety, depression among medical undergraduate students at Benha university and their socio-demographic correlates","volume":"86","author":"Abed","year":"2021","journal-title":"Egypt. J. Hosp. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Agyapong-Opoku, G., Agyapong, B., Obuobi-Donkor, G., and Eboreime, E. (2023). Depression and Anxiety among Undergraduate Health Science Students: A Scoping Review of the Literature. Behav. Sci., 13.","DOI":"10.3390\/bs13121002"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10447-019-09382-w","article-title":"Dear mental health practitioners, take care of yourselves: A literature review on self-care","volume":"42","author":"Posluns","year":"2020","journal-title":"Int. J. Adv. Couns."},{"key":"ref_34","unstructured":"Creswell, J.W., and Plano Clark, V.L. (2018). Designing and Conducting Mixed Methods Research, Sage. [3rd ed.]."},{"key":"ref_35","unstructured":"APA\u2014American Psychology Association (2024, December 29). APA Style JARS for Mixed Methods Research (JARS\u2013Mixed). Available online: https:\/\/apastyle.apa.org\/jars\/mixed-methods."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1037\/a0025957","article-title":"Mental health literacy: Empowering the community to take action for better mental health","volume":"67","author":"Jorm","year":"2012","journal-title":"Am. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Campos, L., Dias, P., Costa, M., Rabin, L., Miles, R., Lestari, S., Feraihan, R., Pant, N., Sriwichai, N., and Yu, L. (2022). Mental health literacy questionnaire-short version for adults (MHLq-SVa): Validation study in China, India, Indonesia, Portugal, Thailand, and the United States. BMC Psychiatry, 22.","DOI":"10.1186\/s12888-022-04308-0"},{"key":"ref_38","first-page":"1","article-title":"Development and psychometric study of the academic life satisfaction scale (ALSS) in a higher education students sample","volume":"3","author":"Nogueira","year":"2019","journal-title":"Nurs. Healthc. Int. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1023\/A:1006824100041","article-title":"A measure of subjective happiness: Preliminary reliability and construct validation","volume":"46","author":"Lyubomirsky","year":"1999","journal-title":"Soc. Indic. Res."},{"key":"ref_40","first-page":"157","article-title":"Valida\u00e7\u00e3o transcultural da escala de felicidade subjectiva de Lyubomirsky e Lepper","volume":"13","year":"2012","journal-title":"Psicol. Sa\u00fade Doen\u00e7as"},{"key":"ref_41","first-page":"313","article-title":"O bem-estar psicol\u00f3gico em adultos: Estudo das caracter\u00edsticas psicom\u00e9tricas da vers\u00e3o portuguesa das escalas de C. Ryff","volume":"Volume V","author":"Ribeiro","year":"1997","journal-title":"Avalia\u00e7\u00e3o Psicol\u00f3gica: Formas e Contextos"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Lovibond, S.H., and Lovibond, P.F. (1995). Manual for the Depression Anxiety & Stress Scales, Psychology Foundation. [2nd ed.].","DOI":"10.1037\/t01004-000"},{"key":"ref_43","first-page":"229","article-title":"Contribui\u00e7\u00e3o para o estudo da adapta\u00e7\u00e3o portuguesa das escalas de ansiedade, depress\u00e3o e stress (EADS) de 21 itens de Lovibond e Lovibond","volume":"36","author":"Ribeiro","year":"2004","journal-title":"Psicol. Sa\u00fade Doen\u00e7as"},{"key":"ref_44","unstructured":"Nunnally, J.C. (1994). Psychometric Theory, Tata McGraw-Hill Education. [3rd ed.]."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1136\/bmj.314.7080.572","article-title":"Statistics notes: Cronbach\u2019s alpha","volume":"314","author":"Bland","year":"1997","journal-title":"BMJ"},{"key":"ref_46","unstructured":"Bardin, L. (2016). An\u00e1lise de Conte\u00fado, Edi\u00e7\u00f5es 70."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/tct.13145","article-title":"How to\u2026 do mixed-methods research","volume":"17","author":"Kajamaa","year":"2020","journal-title":"Clin. Teach."},{"key":"ref_48","unstructured":"Krueger, R.A., and Casey, M.A. (2015). Focus Groups: A Practical Guide for Applied Research, SAGE Publications. [5th ed.]."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.socscimed.2013.05.025","article-title":"Rethinking gender and mental health: A critical analysis of three propositions","volume":"92","author":"Hill","year":"2013","journal-title":"Soc. Sci. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1007\/s11121-021-01283-y","article-title":"The impact of mental health literacy training programs on the mental health literacy of tertiary students: A systematic review","volume":"23","author":"Reis","year":"2022","journal-title":"Prev. Sci."},{"key":"ref_51","first-page":"161","article-title":"Interventions to Promote Mental Health Literacy in University Students and Their Clinical Educators. A Systematic Review of Randomised Control Trials","volume":"4","author":"Lo","year":"2018","journal-title":"Health Prof. Educ."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"102199","DOI":"10.1016\/j.pmedr.2023.102199","article-title":"Exploring the relationship between mental health literacy and psychological distress in adolescents: A moderated mediation model","volume":"33","author":"Zhang","year":"2023","journal-title":"Prev. Med. Rep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1080\/87568225.2017.1312176","article-title":"Connectedness to campus and likelihood of help-seeking for suicidality among college women","volume":"31","author":"Samuolis","year":"2017","journal-title":"J. Coll. Stud. Psychother."},{"key":"ref_54","first-page":"215","article-title":"Enhancing Mental Health Literacy in University; Interactions between Student Initiatives and Counselor Strategies","volume":"12","author":"Wahyuni","year":"2024","journal-title":"Health Educ. Health Promot."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Yang, X., Hu, J., Zhang, B., Ding, H., Hu, D., and Li, H. (2024). The relationship between mental health literacy and professional psychological help-seeking behavior among Chinese college students: Mediating roles of perceived social support and psychological help-seeking stigma. Front. Psychol., 15.","DOI":"10.3389\/fpsyg.2024.1356435"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/7\/724\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:59:41Z","timestamp":1760029181000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/7\/724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":55,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["healthcare13070724"],"URL":"https:\/\/doi.org\/10.3390\/healthcare13070724","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]}}}