A Behavioral Model Predicting Individuals’ Participation in Mental Health Promotion Programs: The Role of Health Beliefs and Self-Efficacy

Abstract

This study aimed to explain the behavioral pattern underlying individuals’ participation in mental health promotion programs and to identify the roles of health beliefs, self-efficacy, perceived barriers, and cues to action in shaping such participation. This qualitative study was conducted using thematic analysis. The participants were 24 adult residents of Tehran, Iran, selected through purposive maximum-variation sampling according to age, gender, education, marital status, and previous experience with mental health programs. Data were collected exclusively through individual semi-structured interviews lasting 45–75 minutes. Theoretical saturation was reached after the twenty-first interview, and three additional interviews were conducted to confirm the stability and comprehensiveness of the categories. All interviews were audio-recorded with participants’ consent, transcribed verbatim, and analyzed using NVivo 14. The analytical process included repeated familiarization with the data, generation of initial codes, development and revision of themes, definition of categories, and construction of an integrated behavioral model. Member checking, peer review, maximum-variation sampling, reflexive documentation, and an audit trail were used to enhance trustworthiness. Four main categories were identified: “threat appraisal and interpretation of psychological symptoms,” “evaluation of the benefits and barriers of participation,” “self-efficacy for initiating and sustaining participation,” and “cues to action, trust, and social support.” Perceived susceptibility and severity encouraged participation only when programs were considered beneficial, confidential, credible, accessible, and personally relevant. Financial costs, time limitations, stigma, uncertainty about program quality, fear of disclosure, and difficulties navigating services were major barriers. Participation-related self-efficacy emerged as the central mechanism transforming intention into actual behavior and reducing the negative influence of perceived barriers. Recommendations from trusted professionals, positive experiences of peers, family support, transparent information, and simple enrollment procedures functioned as important cues to action. Participation in mental health promotion programs is not a linear consequence of awareness or perceived need. It is produced through the interaction of threat appraisal, benefit–barrier evaluation, self-efficacy, trust, and social context. Mental health promotion initiatives should therefore combine literacy enhancement with practical skills training, stigma reduction, confidentiality safeguards, flexible delivery formats, culturally appropriate communication, and clearly defined pathways to participation. Strengthening individuals’ confidence in their ability to identify, access, and remain engaged with appropriate programs may be especially important for bridging the intention–behavior gap.