Culturally responsive assessment of help-seeking behavior among university students: a mediation-moderation analysis of cultural norms, mental health stigma, and digital engagement across cross-cultural contexts

Abstract

Help-seeking behavior for mental health issues among university students is shaped by cultural norms, stigma, and digital engagement. In many African contexts, cultural perceptions of mental illness remain highly stigmatized, posing barriers to seeking support. This study examined the mediating role of mental health stigma and the moderating effect of digital engagement in the relationship between cultural norms and help-seeking behavior among Ghanaian university students. A cross-sectional quantitative design using Structural Equation Modeling (SEM) was employed, with data from 1,067 students across five traditional public universities. Findings revealed that cultural norms significantly increased mental health stigma (β = 0.420, p < .001), which in turn reduced help-seeking behavior (β = -0.370, p < .001). A direct negative effect of cultural norms on help-seeking behavior was also observed (β = -0.210, p < .001). The indirect effect through stigma was significant (β = -0.155, p < .001), confirming the mediating role of stigma. Digital engagement moderated both the direct and indirect relationships. Specifically, it weakened the negative impact of stigma on help-seeking (β = 0.125, p = .002) and buffered the effect of cultural norms (β = 0.098, p = .005). Moderated mediation analysis further showed that digital engagement acted as a protective factor: stronger mediation was observed at lower levels of digital engagement (β = -0.198, p < .001) and weaker mediation at higher levels (β = -0.082, p < .001). These findings underscore the complex interplay of cultural and technological factors in mental health behaviors. The study highlights the need for culturally responsive mental health interventions and supports the integration of digital tools to reduce stigma and enhance help-seeking among university students.