Cultural Congruence in Mental Health Promotion: A Cluster-Randomized Controlled Trial on Integrating Javanese Local Wisdom (Kearifan Lokal) to Enhance Resilience and Reduce Stigma

Abstract

Mental health disparities persist in rural Indonesia, exacerbated by a lack of culturally appropriate interventions and high levels of stigma. This study aimed to evaluate the effectiveness of a novel psychoeducation program integrated with Javanese local wisdom (kearifan lokal) in improving psychological resilience and reducing mental health-related stigma. We conducted a two-arm, parallel-group, cluster-randomized controlled trial in 12 rural villages (desa) in the province of Yogyakarta, Indonesia. Villages were randomly assigned to either the intervention group (n=6 villages, 312 participants) or a wait-list control group (n=6 villages, 308 participants). The intervention, "Program Laras Jiwo" (Harmonious Soul Program), was a facilitator-led, 8-session group program co-designed with community members. It integrated standard psychoeducation with Javanese cultural principles such as gotong royong (mutual cooperation), tepo seliro (empathy), and narrative elements from wayang (shadow puppetry). The control group received general health information. Primary outcomes were resilience (Connor-Davidson Resilience Scale) and stigma (Depression Stigma Scale). Secondary outcomes included mental health literacy, help-seeking attitudes, and psychological distress. Data were collected at baseline, post-intervention (8 weeks), and 6-month follow-up. Linear mixed-effects models were used for analysis. At the 6-month follow-up, the intervention group demonstrated significantly greater improvements in resilience scores (Mean Difference [MD]: 15.8, 95% CI: 13.2 to 18.4; p < 0.001) and a significantly greater reduction in public stigma scores (MD: -8.5, 95% CI: -10.1 to -6.9; p < 0.001) compared to the control group. Significant positive effects were also observed for all secondary outcomes, including mental health literacy, help-seeking attitudes, and reduced psychological distress (p < 0.001 for all). In conclusion, integrating Javanese kearifan lokal into a community-based psychoeducation program is a highly effective strategy for enhancing psychological resilience and combating mental health stigma. This culturally congruent approach offers a scalable and sustainable model for reducing the mental health treatment gap in rural Indonesia and other similar contexts.