Heterogeneity in intervention delivery mode

Examining delivery modalities across diverse economic contexts revealed significant global patterns in how MHL interventions were implemented and accessed. Among the reviewed studies, a notable pattern emerged in terms of delivery modes: 15 out of 24 interventions primarily utilized physical formats, often delivered through face-to-face sessions in school or community settings. This included programmes such as the Mental Health Gap Action Programme (mhGAP), the Human Library intervention and Silence is Deadly, which employed varied physical approaches including facilitator-led training, live presentations, in-person sharing of experience and open discussions (Calear et al., Reference Calear, Morse, Batterham, Forbes and Banfield2021; Chung and Tse, Reference Chung and Tse2022; Ekore et al., Reference Ekore, Abdulmalik, Ajuwon and Bella-Awusah2016). This physical mode of delivery appeared to offer several advantages for youth populations. In-person formats allow for real-time interaction with facilitators, enabling the immediate clarification of misconceptions, adaptive delivery in response to participants’ needs and reinforcement of learning through guided discussion (Jorm, Reference Jorm2012; Wei et al., Reference Wei, Hayden, Kutcher, Zygmunt and McGrath2013). These settings also facilitate peer engagement, which can foster group cohesion and reduce stigma through shared experiences (Gulliver et al., Reference Gulliver, Griffiths and Christensen2010). Many physical interventions incorporated experiential learning strategies such as role-playing, group discussions and scenario-based exercises, which have been shown to improve knowledge retention and develop practical skills in help-seeking and emotion regulation (Koller and Bertel, Reference Koller and Bertel2006; Pinfold et al., Reference Pinfold, Toulmin, Thornicroft, Huxley, Farmer and Graham2003).

There was also a marked geographical concentration from this review where digital interventions were more frequently implemented in high-income Western countries such as Australia, the United States and the United Kingdom. This pattern aligns with global trends in MHL research. For instance, a recent meta-analysis by Yeo et al. (Reference Yeo, Reich, Liaw and Chia2023) reported that digital MHL programmes are disproportionately concentrated in high-income Western countries, where broader infrastructural advantages make implementation more feasible. In the United States, for example, 85% of individuals own a smartphone and 77% have broadband access, enabling greater accessibility to digital interventions in these contexts. Reported advantages of digital delivery in these contexts likely reflect scalability, flexibility and infrastructure availability rather than the inherent superiority of digital formats. Self-paced programmes, such as MoodGYM, HOPE and the e-learning version of Mental Health First Aid (MHFA), allow participants to engage with content at their own pace and according to individual comprehension levels (Davies et al., Reference Davies, Beever and Glazebrook2018; O’Kearney et al., Reference O’Kearney, Gibson, Christensen and Griffiths2006; Tay, Reference Tay2022). Moreover, video-based formats and online modules are cost-effective and capable of reaching wide audiences. When digital programmes include interactive components or social contact (e.g., contact with a facilitator or credible presenter), they have shown outcomes comparable to in-person interventions in terms of improving knowledge, reducing stigma and promoting help-seeking (Conceição et al., Reference Conceição, Rothes and Gusmão2022; Koike et al., Reference Koike, Yamaguchi, Ojio, Ohta, Shimada, Watanabe, Thornicroft and Ando2018; Yeo et al., Reference Yeo, Reich, Liaw and Chia2023).

However, the increased reliance on digital formats creates significant equity concerns. Youths in low-resource settings may face limited internet access, lower levels of digital literacy and weaker infrastructure to support online platforms (WHO, 2022). Even within high-income settings, digital access is not equally distributed. Robin and colleagues (Robinson et al., Reference Robinson, Cotten, Ono, Quan-Haase, Mesch, Chen, Schulz, Hale and Stern2015) caution that broadband connectivity varies significantly by income level, educational attainment and rural versus urban residence. Additionally, digital content that lacks cultural or linguistic adaptation may be less relatable and less effective, particularly for minority or underserved groups (Ellis et al., Reference Ellis, Draheim and Anderson2022). This geographical concentration reflects the dominance of Western models in MHL research, potentially limiting global applicability and highlighting critical gaps in evidence from LMICs. The economic disparity between high-income settings favouring digital formats and LMICs with limited digital infrastructure presents substantial challenges for programme scalability and accessibility. In such contexts, physical formats or blended models combining digital and face-to-face elements may prove more appropriate and effective where technology access remains constrained.

In light of these considerations, the current findings support the use of a mixed delivery model as a viable and equitable approach. Hybrid programmes that combine the strengths of both digital and physical modes, for example, blending online modules with in-person classroom activities, can enhance accessibility while preserving the interpersonal benefits of face-to-face delivery (Wei et al., Reference Wei, Gilham and Kutcher2024). Crucially, the choice of delivery mode should be matched to local contexts and resource availability, with interactive digital interventions suited to high-income settings and physical formats remaining more practical in low-resource environments. A flexible, context-sensitive approach is essential for optimizing the global reach and impact of MHL programmes.

Distribution of MHL domains

The analysis of 24 included studies integrating Jorm’s (Reference Jorm2000) three core domains provided an insight into current content priorities and effectiveness approaches. The current review found that most programmes aligned with the core components of MHL. However, there was a marked emphasis on the dissemination of factual knowledge about mental health conditions. A majority of interventions focused on increasing awareness of symptoms, causes and evidence-based treatments for a wide range of mental health issues, including depression, anxiety, suicide, psychosis, schizophrenia, substance use and eating disorders (e.g., Hart et al., Reference Hart, Cropper, Morgan, Kelly and Jorm2020; Hart et al., Reference Hart, Morgan, Rossetto, Kelly, Gregg, Gross, Johnson and Jorm2022; Lipson et al., Reference Lipson, Speer, Brunwasser, Hahn and Eisenberg2014; Yamaguchi et al., Reference Yamaguchi, Ojio, Foo, Michigami, Usami, Fuyama, Onuma, Oshima, Ando, Togo and Sasaki2020). These programmes typically aimed to enhance the recognition of specific disorders by educating participants on symptom profiles, diagnostic criteria and available treatment options. For instance, Costin et al. (Reference Costin, Mackinnon, Griffiths, Batterham, Bennett, Bennett and Christensen2009) incorporated outcome measures related to depression recognition and help-seeking knowledge. However, their findings indicated no significant improvement in symptom recognition following a brief e-card intervention, highlighting the challenge of achieving substantive outcomes through short-form educational tools.

Attitudes towards mental illness, particularly stigma and willingness to seek help, emerged as the second most addressed domain. Roughly half of the reviewed programmes incorporated content or measured outcomes related to stigma reduction or the normalization of mental health help-seeking (e.g., peer norms, trust in professionals). Some of these interventions employed contact-based strategies, such as personal narratives or video testimonials from individuals with lived experience of mental illness, which are widely recommended for effectively reducing stigma (Seedaket et al., Reference Seedaket, Turnbull, Phajan and Wanchai2020). However, these components were not always integrated in a sustained or theoretically grounded manner, and stigma-related outcomes were frequently secondary rather than primary endpoints.

The domain of recognition, defined as the ability to identify when oneself or another person may be experiencing a mental health problem, was often implicitly covered within the broader knowledge category but rarely examined as a standalone target (e.g., Ahmad et al., Reference Ahmad, Leventhal, Nielsen and Hinshaw2020; Beaudry et al., Reference Beaudry, Swartz, Miller, Schweizer, Glazer and Wilcox2019; Ekore et al., Reference Ekore, Abdulmalik, Ajuwon and Bella-Awusah2016; Mcluckie et al., Reference Mcluckie, Kutcher, Wei and Weaver2014; Milin et al., Reference Milin, Kutcher, Lewis, Walker, Wei, Ferrill and Armstrong2016; Yamaguchi et al., Reference Yamaguchi, Ojio, Foo, Michigami, Usami, Fuyama, Onuma, Oshima, Ando, Togo and Sasaki2020; Wei et al., Reference Wei, Kutcher, Austen, Comfort, Gilham, MacDougall, McKenna, McKinnon, Thompson, Yeo, Zhang, Baxter and Matheson2022). A minority of studies explicitly assessed whether participants could accurately recognize symptoms of mental health issues or knew how and where to access appropriate services (e.g., Costin et al., Reference Costin, Mackinnon, Griffiths, Batterham, Bennett, Bennett and Christensen2009; Hart et al., Reference Hart, Cropper, Morgan, Kelly and Jorm2020; Lai et al., Reference Lai, Lien, Chen and Lin2022). This limited attention to recognition is important, given that accurate identification of mental health issues is a necessary precondition for effective help-seeking and early intervention.

A smaller subset of interventions incorporated components aimed at fostering positive mental health or the cultivation of skills related to emotional resilience, coping and stress management. Notably, only a limited number of studies (e.g., Lai et al., Reference Lai, Lien, Chen and Lin2022) explicitly incorporated components aimed at strengthening protective factors or teaching strategies for mental health maintenance, which are increasingly recognized as essential elements of a more holistic, strengths-based approach to MHL. This signals a persistent gap in the field, where many interventions remain deficit-oriented and fail to systematically promote mental wellness or resilience (Bjørnsen et al., Reference Bjørnsen, Espnes, Eilertsen, Ringdal and Moksnes2017; Kutcher et al., Reference Kutcher, Wei and Coniglio2016; Teixeira et al., Reference Teixeira, Coelho, Sequeira, Lluch i Canut and Ferre- Grau2019).

Cultural adaptation: A persistent blind spot

Assessment of cultural responsiveness across the reviewed interventions highlighted an important limitation in the current evidence base, but one that required careful interpretation given the geographical distribution of studies. As shown in Figure 3, most included interventions were implemented in high-income Western countries, where cultural adaptation may not be necessary in all cases. However, across the literature, explicit reporting of cultural or contextual tailoring was uncommon, including limited description of linguistic adaptation, culturally grounded framings of mental health and distress, or structured adaptation processes (e.g., stakeholder co-design, formative qualitative work or culturally specific case vignettes). Only five studies explicitly documented cultural adaptation (Ahmad et al., Reference Ahmad, Leventhal, Nielsen and Hinshaw2020; Calear et al., Reference Calear, Morse, Batterham, Forbes and Banfield2021; Conceição et al., Reference Conceição, Rothes and Gusmão2022; Raghavan et al., Reference Raghavan, Chandrasekaran, Paul, Pattabiraman, Mohan, Durairaj, Currie, Lilford, Furtato, Madan, Birchwood, Meyer, Sood, Chadda, Mohon, Shah, John, Padmavati and Iyer2024; Spagnolo et al., Reference Spagnolo, Murphy and Librera2008). This scarcity constrained interpretation of transferability and scalability, particularly for implementation in culturally and linguistically diverse youth populations and in low- and middle-income settings where explanatory models of distress, help-seeking pathways and service availability may differ substantially (see Figure 4).

Figure 4. Distribution of intervention delivery modes.

This limitation is particularly salient given the growing body of research underscoring the central role of culture in shaping how mental health is perceived, discussed and responded to (Kågström et al., Reference Kågström, Juríková and Guerrero2023). Many interventions adopted Western diagnostic categories, help-seeking norms and individualistic coping models, which may have variable cultural transferability across different sociocultural contexts. Mental health constructs such as depression, anxiety and psychosis are not necessarily understood, experienced or described in the same way across cultures (U.S. Department of Health and Human Services, 2001). For example, somatization often functions as an “idiom of distress” in cultures where overt emotional expression is inhibited and psychiatric stigma remains pervasive (Kleinman, Reference Kleinman1977). Additionally, the Western emphasis on self-disclosure and individual agency in help-seeking may not resonate in contexts where family-based decision-making or spiritual healing practices are predominant (Atilola, Reference Atilola2015; Furnham and Hamid, Reference Furnham and Hamid2014). When applied beyond their original contexts, MHL interventions that privilege Western models of mental health may risk marginalizing indigenous belief systems, alternative healing traditions and culturally specific idioms of distress (Bhatia and Ram, Reference Bhatia and Ram2009). Therefore, it is essential to understand culture not as a fixed or singular entity but as a complex, evolving tapestry of internalized values, social norms, behaviours and meaning-making systems (Kaiser and Kohrt, Reference Kaiser and Kohrt2019).

Only a minority of interventions in the current review (Ahmad et al., Reference Ahmad, Leventhal, Nielsen and Hinshaw2020; Calear et al., Reference Calear, Morse, Batterham, Forbes and Banfield2021; Conceição et al., Reference Conceição, Rothes and Gusmão2022; Raghavan et al., Reference Raghavan, Chandrasekaran, Paul, Pattabiraman, Mohan, Durairaj, Currie, Lilford, Furtato, Madan, Birchwood, Meyer, Sood, Chadda, Mohon, Shah, John, Padmavati and Iyer2024; Spagnolo et al., Reference Spagnolo, Murphy and Librera2008) explicitly integrated sociocultural tailoring by involving individuals with lived mental health experience in both programme design and delivery. This participatory approach enhanced cultural congruence and ensured that content resonated with participants’ local norms and values. These contact-based strategies sought to reduce stigma and foster relatability by embedding first-person narratives of navigating mental health challenges within the context of local services and community practices (Chung and Tse, Reference Chung and Tse2022; Fernandez et al., Reference Fernandez, Tan, Knaak, Chew and Ghazali2016; Spagnolo et al., Reference Spagnolo, Murphy and Librera2008). For example, Calear et al. (Reference Calear, Morse, Batterham, Forbes and Banfield2021) developed materials specifically to challenge prevailing masculine norms that impede help-seeking among adolescent males, thereby illustrating how gender-sensitive adaptations can improve both relevance and impact.

Additionally, differences in national healthcare systems and service availability further underscore the importance of contextual adaptation. As noted by WHO (2021), many LMICs experience limited governmental investment in mental health services, which restricts public access to adequate care. This structural barrier highlights the need for MHL interventions to include locally relevant information about accessible services and to address culturally embedded barriers to help-seeking. In sum, to maximize both acceptability and effectiveness, MHL interventions must be culturally responsive, incorporating the language, values and realities of the populations they aim to serve.

Beyond knowledge: Towards holistic and culturally responsive MHL

One of the most striking findings of this review is the disconnect between the inclusion of positive mental health content and the evaluation of corresponding outcomes: although eight interventions incorporated positive mental health or life-skills components, only one study explicitly measured positive mental health outcomes. This mismatch between intervention content and outcome measurement represented one of the clearest empirical gaps identified in the current evidence base and substantially limited conclusions about whether broader, strengths-based MHL approaches confer added benefit beyond traditional knowledge-focused models.

Taken together with the domain distribution and cultural adaptation findings, the current evidence emphasized the importance of interventions evolving beyond traditional frameworks. As identified in the present review, all 24 MHL interventions incorporated the delivery of mental health knowledge such as causes and risk factors of mental disorders, as well as pathways to care, as core psychoeducational content. This underscores the centrality of the knowledge domain in the design of MHL interventions. As highlighted in the preceding section, cultural responsiveness is equally essential. There is a growing need to conceptually broaden MHL beyond the narrow transmission of information about mental illness. Indeed, MHL is increasingly recognized as a multifactorial construct (Kutcher et al., Reference Kutcher, Bagnell and Wei2014). Although the relationship between mental health knowledge and stigma has been well documented (Evans-Lacko et al., Reference Evans-Lacko, Little, Meltzer, Rose, Rhydderch, Henderson and Thornicroft2010; Griffiths et al., Reference Griffiths, Christensen and Jorm2008; Hadlaczky et al., Reference Hadlaczky, Hökby, Mkrtchian, Carli and Wasserman2014), with lack of knowledge considered a contributor to negative attitudes and discrimination (Thornicroft, Reference Thornicroft2006), simply equipping individuals with information about mental illnesses does not necessarily result in stigma reduction or increased help-seeking intentions (Howard et al., Reference Howard, Griffiths, McKetin and Ma2018). Therefore, effective MHL interventions must move beyond knowledge transmission and adopt a more holistic approach.

One key limitation of the current MHL framework is its primary focus on identifying and understanding psychiatric conditions, with limited attention to mental well-being as a whole (Kutcher et al., Reference Kutcher, Wei and Coniglio2016). However, the absence of mental illness does not equate to the presence of mental well-being. Kutcher et al. (Reference Kutcher, Wei and Coniglio2016) redefined MHL to include “understanding of how to obtain and maintain good mental health,” highlighting that positive mental health is a crucial dimension alongside the recognition of mental disorders. Cultivating positive mental health can yield lasting benefits, fostering resilience and holistic well-being (Bjørnsen et al., Reference Bjørnsen, Espnes, Eilertsen, Ringdal and Moksnes2017; Bjørnsen et al., Reference Bjørnsen, Ringdal, Espnes, Eilertsen and Moksnes2018; Teixeira et al., Reference Teixeira, Coelho, Sequeira, Lluch i Canut and Ferre- Grau2019).

Among these interventions, positive mental health elements were incorporated through knowledge-based and/or skill-based approaches. For example, The Curriculum Guide included a module emphasizing positive mental health to build adolescents’ self-help competencies through classroom learning (Mcluckie et al., Reference Mcluckie, Kutcher, Wei and Weaver2014; Milin et al., Reference Milin, Kutcher, Lewis, Walker, Wei, Ferrill and Armstrong2016). Other interventions aimed to equip participants with coping and stress management strategies, skills for building healthy relationships (O’Kearney et al., Reference O’Kearney, Gibson, Christensen and Griffiths2006; Raghavan et al., Reference Raghavan, Chandrasekaran, Paul, Pattabiraman, Mohan, Durairaj, Currie, Lilford, Furtato, Madan, Birchwood, Meyer, Sood, Chadda, Mohon, Shah, John, Padmavati and Iyer2024; Wei et al., Reference Wei, Kutcher, Austen, Comfort, Gilham, MacDougall, McKenna, McKinnon, Thompson, Yeo, Zhang, Baxter and Matheson2022; Wei et al., Reference Wei, Gilham and Kutcher2024) and techniques for managing thoughts and emotions (Lai et al., Reference Lai, Lien, Chen and Lin2022; Tay, Reference Tay2022). Despite the inclusion of such content, only one study specifically evaluated positive mental health outcomes (Lai et al., Reference Lai, Lien, Chen and Lin2022). This points to a critical gap in the field and underscores the need for future research to systematically measure this dimension to understand the impact of interventions better.

On the basis of this synthesis, four interrelated domains emerge as essential for guiding the next generation of youth MHL interventions. First, culturally individualized frameworks must replace one-size-fits-all models: interventions should draw on local perspectives and indigenous knowledge systems so that definitions of wellness, distress and recovery resonate with community values and lived experience (Kutcher et al., Reference Kutcher, Wei and Coniglio2016). Second, programmes should expand their scope from illness identification to the active promotion of positive mental well-being; embedding strategies that build resilience, optimism and life-skills aligns with the Positive Mental Health Literacy (PMeHL) framework and supports holistic flourishing (Bjørnsen et al., Reference Bjørnsen, Espnes, Eilertsen, Ringdal and Moksnes2017; Carvalho et al., Reference Carvalho, Sequeira, Querido, Tomás, Morgado, Valentim, Moutinho, Gomes and Laranjeira2022). Third, content must move beyond basic symptom recognition to foster a deeper understanding of underlying risk factors, causal mechanisms and culturally specific expressions of distress, thereby acknowledging the complex interplay of social, environmental and cultural determinants. Finally, sustained efforts to reduce stigma and to cultivate help-seeking behaviours remain indispensable; interventions that explicitly address culturally embedded barriers and leverage trusted community networks will be most effective at creating inclusive, supportive environments for young people.

One of the studies included in this review by Raghavan et al. (Reference Raghavan, Chandrasekaran, Paul, Pattabiraman, Mohan, Durairaj, Currie, Lilford, Furtato, Madan, Birchwood, Meyer, Sood, Chadda, Mohon, Shah, John, Padmavati and Iyer2024) exemplified this comprehensive and integrative approach. Their intervention addressed general mental health knowledge, recognition of mental disorders and promotion of positive mental health. Importantly, it also facilitated open discussions on personal experiences and culturally embedded attitudes towards mental health. This enhanced both the flexibility and contextual relevance of the intervention. Their multifaceted design ensured that mental health promotion strategies were not only evidence-based but also culturally congruent. Therefore, adapting and extending beyond the current MHL framework offers a promising and conceptually coherent pathway forward that warrants systematic empirical evaluation.

Drawing on the findings of this review, it is timely to critically re-examine whether existing definitions of MHL sufficiently capture the lived realities of young people across diverse cultural contexts. Such an expansion may address identified limitations in current youth MHL interventions and warrants systematic empirical evaluation, particularly with respect to positive mental health, attitudinal change and long-term outcomes.

Methodological quality and risk of bias implications

Building on the effectiveness patterns described above, interpretation of these findings must be situated within the methodological quality of the evidence base. A critical finding of this review concerns the overall methodological quality of the included studies. Only two studies (8.3%) demonstrated low risk of bias, while half of the studies (50%) were rated as high risk, with the remainder (41.7%) having unclear risk assessments. This distribution highlights opportunities for strengthening the evidence base for youth MHL interventions. Notably, these methodological challenges are not unique to MHL research but reflect broader systemic issues in intervention research, where achieving high methodological standards remains challenging due to practical, ethical and resource constraints (Jilcha, Reference Jilcha2025; Reid et al., Reference Reid, Walker, Usher, Jackson, Shepherd and Marriott2024; Sanjari et al., Reference Sanjari, Bahramnezhad, Fomani, Shoghi and Cheraghi2014).

The methodological limitations primarily stemmed from inadequate randomization procedures, lack of allocation concealment, absence of blinding protocols and incomplete outcome data reporting. Many quasi-experimental studies lacked appropriate control groups, while several randomized trials failed to adequately describe their randomization methods or implement proper blinding procedures. These methodological considerations introduce potential for selection bias, performance bias and detection bias (Higgins et al., Reference Higgins, Green and Van Den2020), which may influence effect sizes and should be considered when interpreting reported outcomes.

The variation in methodological quality has important implications for interpreting this review’s findings. The effectiveness of interventions should be interpreted cautiously, recognizing that methodological factors may influence reported outcomes (Higgins et al., Reference Higgins, Green and Van Den2020). The heterogeneity in methodological approaches makes it challenging to draw definitive conclusions about which intervention components are most effective. These quality considerations are particularly relevant given the growing implementation of MHL interventions in educational and community settings (e.g., Amado-Rodríguez et al., Reference Amado-Rodríguez, Casañas, Mas-Expósito, Castellví, Roldan-Merino, Casas, Lalucat-Jo and Martín2022; Wei et al., Reference Wei, Hayden, Kutcher, Zygmunt and McGrath2013). While the current evidence base shows promise and provides valuable insights into intervention approaches, continued methodological strengthening holds potential to enhance the robustness of future recommendations. These methodological considerations, alongside subsequent study-specific limitations, should be kept in mind when interpreting this review’s findings.

Limitations and future directions

Five key limitations must be acknowledged in interpreting this review’s findings. First, focusing on Jorm’s (Reference Jorm2000) three-domain framework excluded interventions targeting prevention strategies or first-aid skills from the expanded framework, potentially underestimating the breadth of existing MHL approaches and their comprehensive benefits for youth. Second, restrictions on age range (15–24 years), exclusion of comorbid conditions, English-language publications and lack of grey literature search may have omitted culturally diverse research, particularly from non-Western contexts where mental health concepts differ significantly, thereby constraining global applicability. Third, substantial heterogeneity across study designs, intervention durations and outcome measures precluded meta-analytical synthesis and definitive effectiveness conclusions, making it difficult to identify optimal intervention components. Fourth, post hoc assessment of cultural adaptation using non-predetermined criteria may have led to inconsistent identification and underestimated true cultural responsiveness. Finally, inconsistent operationalization of MHL domains, with recognition frequently subsumed under knowledge, limited understanding of domain-specific contributions and effects.

Future research should prioritize the following recommended areas to advance the field. Conceptual development should focus on creating developmentally appropriate adaptations of the five-domain framework (Jorm, Reference Jorm2012) through staged approaches. Methodological standardization requires adopting validated outcome measures across all MHL domains, particularly for recognition and positive mental health components, to enable robust comparisons and meta-analysis. Cultural responsiveness should be enhanced through systematic development of culturally adapted interventions using participatory approaches with local stakeholders, while establishing explicit criteria for assessing cultural adaptation in future reviews. Global representation can be improved by including non-English databases, grey literature sources and diverse populations, including the consideration of broader age ranges beyond 15–24 years to capture the full spectrum of youth MHL interventions, with examination of age-specific patterns and developmental context influences. Longitudinal evaluation should incorporate long-term follow-ups to examine sustainability. Through these targeted improvements, future research can build a more inclusive, methodologically rigorous and culturally responsive evidence base serving diverse youth populations globally. Specifically, educators require evidence-based guidance on integrating culturally adapted MHL curricula within diverse educational contexts, while policymakers need robust effectiveness data to inform funding decisions and implementation strategies that address digital equity concerns across different economic settings. These stakeholder-specific recommendations are essential for translating research findings into sustainable, equitable practice.