ArticleBMC nursing2026
Development and content validation of an anxiety-specific mental health literacy promotion programme for higher education students.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMental health issues among higher education students are a major public health concern, with anxiety among the most common. Anxiety can have negative academic, psychological, and social effects, including poorer academic performance and lower well-being. Despite its high prevalence, help-seeking remains limited, partly due to low mental health literacy (MHL), stigma, and difficulty recognising and interpreting symptoms. While MHL promotion programmes are available, few anxiety-specific interventions have been co-created with students and subjected to expert content validation in higher education settings. This study aimed to develop and validate the content of an anxiety-specific MHL promotion programme for higher education students.
methodsAn exploratory, qualitative study was conducted using participatory methods and guided by the PRODUCES framework. It comprised two sequential phases. Phase 1 included focus groups with students to explore their experiences, needs, and views on anxiety and MHL. Phase 2 consisted of a two-round modified e-Delphi study to reach expert consensus on the programme's structure, content, and implementation strategies.
resultsNineteen students participated in the focus groups, which identified six core domains that informed the initial programme design. The e-Delphi study was conducted in two rounds, each involving 18 experts. Expert evaluation revealed a high level of agreement on most programme components and suggested revisions to session duration, programme structure, delivery format, digital support, and practical activities. However, no consensus was reached regarding the proposed programme duration of eight weeks, which will be evaluated during pilot testing. The final programme comprises structured yet adaptable sessions designed to promote recognition of anxiety, develop self-regulation skills, reduce stigma, and encourage help-seeking behaviours.
conclusionsAn MHL promotion programme focusing on anxiety was developed through a structured, participatory process that incorporated student perspectives during the initial programme development and subsequent expert content validation. Grounded in mental health nursing practice, it is now ready for pilot testing to evaluate its feasibility, acceptability and preliminary effectiveness. It provides a flexible intervention framework to support the prevention and early identification of anxiety among higher education students, highlighting the importance of nurses in promoting mental health in higher education. CLINICAL TRIAL NUMBER: Not applicable.
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