Pathways from Mental Health Literacy to Help‐Seeking in Rural Communities: A Mediation Analysis of Attitudes and Patient Activation Following Community Education in Obudu LGA

Background: Rural mental health systems face demand–supply gaps and persistent stigma, thereby impeding timely use of care; community‐based education is advanced to improve literacy and behaviour.  Methods: A quasi‐experimental pretest–posttest evaluation contrasted an intervention with a comparison community in Obudu LGA. Literacy (causal beliefs, awareness), attitudes/stigma (social acceptance), activation (PAM), and behaviour (preferred help source, help‐seeking history) were measured. A parallel–serial mediation plan specified attitudes as a proximal mediator and activation as a distal mediator between literacy and help‐seeking, with bias‐corrected bootstrap confidence intervals and covariate adjustment.  Results: In the intervention arm, biological attribution increased from 7.45% to 32.29%, stress/trauma reached 31.25%, and supernatural attribution declined to 14.58%. Preferred help source re‐routed from traditional/religious providers to clinics/hospitals (χ2 = 39.58, p < 0.0001); help‐seeking history also shifted (χ2 = 11.65, p = 0.0029). Activation (PAM) did not increase significantly, suggesting a lagged mediator.  Conclusions: Findings support an attitude‐mediated pathway from literacy to help‐seeking, with activation likely to emerge after reinforcement; programme design should therefore centre stigma‐reducing, acceptance‐building components while adding booster contacts to cultivate activation.