Abstract
Youth living in disadvantaged communities such as Mamelodi, a peri-urban settlement in the City of Tshwane in South Africa, have limited access to mental health services. Community-based interventions to promote mental health can play a crucial role in such contexts. This research aimed to empower young adults to promote mental health through peer-led interventions. Using action research, salient issues were identified to effect social change through collaboration. The local radio station and community organisations assisted with the recruitment of young adults (18–24 years) through snowball sampling. Seven out-of-school young adults joined the study as peer leaders. Eight project meetings were held between June and December 2023 to plan and implement an intervention aimed at improving the mental health literacy of their peers. During an interview at the community radio station, the peer leaders discussed the mental health challenges of youth. They created a video on depression and suicide, and a pamphlet containing information on mental health support, available on the community radio station’s Facebook page and their personal social media accounts. A large number of viewers accessed this information. Recordings of project sessions and a focus group discussion with the peer leaders were analysed using thematic analysis to explore their experiences of the project. Participation in the project contributed to the personal growth of the peer leaders, particularly the development of competence, confidence, and personal well-being, and a sense of psychological empowerment that enabled them to contribute to the lives of their peers. Their peers also benefitted, as they received mental health information and social support from the peer leaders. The research emphasises the value of peer-led interventions as a strategy to promote mental health literacy and emotional support among young people.
Keywords
Introduction
Young adults from disadvantaged communities in South Africa face various psychosocial and mental health challenges (Hadebe & Ramukumba, 2020; Mthembu, 2019). In underserved communities, these psychosocial challenges include poverty, unemployment, high levels of crime and violence, and substance abuse. More than half of young people aged between 18 and 24 years come from vulnerable homes and live below the poverty line (income of R604 per month), while 36% come from households in which nobody is employed (Mthembu, 2019; Renahy et al., 2018). In the second quarter of 2025, young people aged between 15 and 24, and 25 and 34 had the highest unemployment rates (62.2% and 40.5%, respectively), which were well above the official unemployment rate of 33.2% (Statistics South Africa, 2025). Approximately 3.6 million (35.2%) of the 10.3 million youth aged between 15 and 24 years were not in employment, education or training (NEET) in the second quarter of 2025 (Statistics South Africa, 2025).
In addition, young people in underprivileged communities are exposed to various forms of violence, including family and community violence (Donenberg et al., 2020; Mercy et al., 2017). Repeated exposure to violence can cause mental health symptoms, which can present in the form of post-traumatic stress, along with internalising and externalising behaviours (Richter et al., 2018). Psychosocial challenges, such as those cited above, can contribute to the high prevalence of substance abuse among young adults (Das et al., 2016; Mokwena & Setshego, 2021). Youth in disadvantaged communities have to deal with serious psychosocial issues that can negatively affect their mental health.
Extensive literature has documented the relationship between social issues and various mental health challenges (Lund et al., 2018). These issues are collectively referred to as the social determinants of mental health (Burns, 2015). Young adults who have to deal with such social issues show a high prevalence of mental health conditions, including depressive disorders, anxiety, substance use and eating disorders (Pillay, 2019). However, despite the high prevalence of mental health conditions in disadvantaged communities, young people in need have poor access to mental health services (Colizzi et al., 2020; Malope, 2021; Pillay, 2019).
Mental health promotion is thus crucial in contexts characterised by various psychosocial stressors and limited mental health resources (Colizzi et al., 2020), such as Mamelodi (Eskell-Blokland, 2014; Shaanika, 2020). Interventions to curb the impact of various stressors among young people in such contexts could contribute to improving their well-being (Colizzi et al., 2020).
In this context, the researchers aimed to empower a group of young adults in Mamelodi for civic engagement to promote the mental health of their peers through a peer-led intervention. A wealth of literature exists on the value of peer-led interventions to address health issues among adolescents (Atujuna et al., 2021; Duby et al., 2021; Frade & Tiroyabone, 2017; Rose-Clarke et al., 2019; Shahmanesh et al., 2021; Vostanis et al., 2024). Young people are more likely to share their concerns with their informal support networks, especially their peer group, because of common lived experiences, their developmental stage, mutual support and perceived safety (Vostanis et al., 2024). There is thus value in involving youth in mental health care settings in various roles, such as providing information and support. Peer-led interventions were found to benefit young people trained as peer leaders (Mokhine, 2019) and the participating young people, although findings on how they benefit from these interventions are inconclusive (Vostanis et al., 2024). Currently, there is a lack of research on peer-led interventions undertaken to promote the mental health of youth in resource-deprived contexts.
By conducting this research, the researchers aimed to explore:
How a peer-led intervention for mental health promotion contributes to the empowerment of young adults as peer leaders; and
How a peer-led intervention for mental health promotion contributes to the mental health of the peer leaders and their peers.
The concept of empowerment is a multi-level construct including developing control over one’s own life, gaining increased access to and control over resources, and democratic participation in one’s community (Perkins & Zimmerman, 1995; Rappaport & Seidman, 2000; Weidenstedt, 2016). In this research, the process of developing a peer-led intervention aimed to achieve the psychological empowerment of the peer leaders, specifically, a critical awareness of their environment, a sense of competence and confidence, and the skills required to mobilise existing resources to gain control through active participation in creating community change (Christens, 2012; Christens & Peterson, 2012; Kieffer, 1984).
Research methods
Research design
Participatory action research (PAR) was used, which involved collaboration between the peer leaders and those affected by social issues, to identify salient issues and develop possible solutions to bring about social change (Akhurst, 2022; Kemmis et al., 2014; Martin et al., 2019). As part of a reflection on the PAR process, a qualitative research approach was used to explore the peer leaders’ experiences of empowerment and their perception of the value of the intervention.
Participants
This study was based in Mamelodi, a peri-urban settlement east of the City of Tshwane (Ilunga et al., 2020). Permission to recruit participants interested in participating in the study was requested from the local community radio station and a number of non-governmental organisations (NGOs). The inclusion criteria for participation were: being between 18 and 24 years old, residing in Mamelodi, having completed Grade 12 and being actively involved in community projects. Seven young adults – four males and three females – volunteered to participate as peer leaders. Six were volunteers at a youth centre where they tutored high school learners, and one was a member of various civic organisations. They were informed that participation was entirely voluntary and that they could withdraw at any point.
Procedure
During eight project meetings, held between June and December 2023, the researcher, a clinical psychologist acting as the enabler, assisted the project group, serving as peer leaders, in identifying a social issue they wanted to address, exploring the issue and developing action plans to implement an intervention. The sessions were structured according to themes and specific working areas, as presented in Table 1. A WhatsApp group was created to facilitate communication between group members, to provide information, and regular feedback between sessions.
Outline of sessions.
The phases of the action research model (Susman & Evered, 1978), as they unfolded during the project meetings, are outlined below.
Phase 1: diagnosis
During the initial stages of the project, the peer leaders identified various salient challenges in their community, including exposure to violence and crime, substance abuse, unemployment and poverty, and limited mental health resources. They agreed that the identified challenges could have contributed to the high prevalence of mental health conditions, especially depression, among the youth. Since conversations with their peers at the youth centre revealed that their knowledge of mental health conditions such as depression was limited, the peer leaders decided that the intervention should aim to improve mental health literacy.
As part of the process, it was important for the peer leaders to have sufficient knowledge of mental health conditions, adaptive coping strategies and resources to improve their own mental health literacy. During the project meetings, particularly the problem exploration phase, the researcher shared information and resources on mental health and suicidality with the peer leaders. Examples of how conversations about these topics could be initiated and navigated were discussed in the group sessions.
Phase 2: action planning
The action planning phase included suggesting activities, gathering resources and approaching NGOs for assistance with the planned intervention. Each peer leader had a designated role and responsibility within the group. The initial plan was to enlist the support of an NGO specialising in mental health awareness to host a talk at a local secondary school, focusing on identifying symptoms of depression, available support structures and self-help strategies. When the NGO could not provide this service, the peer leaders decided to present a wellness talk at the youth centre where many of them worked. Each peer leader was assigned a specific topic for discussion. Unfortunately, the youth centre cancelled the wellness talk scheduled for the agreed-upon date, and they had to develop a new action plan. They decided to use media platforms to promote mental health literacy in their communities (as described in the action phase). While planning these interventions, the peer leaders informally shared the relevant information with their peers at the youth centre.
Phase 3: action
The project group launched the peer-led intervention on traditional and digital media platforms. They were interviewed at the community radio station as part of a health feature. During the interview, they focused on raising awareness of mental health challenges among the youth. They responded to questions such as: ‘What can be done to educate the community on mental health challenges?’ The interview was livestreamed on social media. As a next step, they created and posted a video and pamphlet on the community radio station’s Facebook page and on their individual social media accounts. The video, which aimed to raise awareness of depression and suicide, provided information on how to manage these challenges, and the pamphlet contained information on various resources, organisations and institutions that provide support for mental health challenges that youth may face. The video and pamphlet were posted online, with hashtags such as #mentalhealthmatters, #depression and #endthestigma.
Phase 4: outcome of the intervention
During the first 3 months, the video reached 1200 individuals and had 1108 impressions, while the pamphlet reached almost 500 individuals and had 444 impressions. Some young people who responded to these posts expressed the need to raise awareness about various psychosocial and mental health issues, and others indicated that they needed help. These responses indicated that the mental health literacy intervention had been received well and that there was indeed a need for more interventions to promote mental health literacy.
Phase 5: learning
During a focus group discussion to review the project, the peer leaders shared the lessons they had learnt from the process and discussed what they would do differently. The interview protocol contained questions such as: ‘How did you experience the process of developing the intervention?’, ‘What have you gained from developing the intervention?’ and ‘How did the young people of Mamelodi benefit from the intervention?’ The group discussion, facilitated by the researchers, was audio-recorded with the participants’ permission and was subsequently transcribed and analysed.
Data analysis
Data in the form of voice recordings from the eight project meetings and the focus group discussion held after the intervention were transcribed and analysed using thematic analysis (Braun & Clarke, 2013, 2020). An inductive process was used to identify themes. This process required familiarity with the data, generating initial codes, searching for and reviewing themes, and identifying the main themes. Lincoln and Guba’s criteria (Korstjens & Moser, 2017) were used to enhance the trustworthiness of the results. Specifically, data were analysed by two researchers who had to reach consensus on the interpretation. Member checking was done during the discussions and after data interpretation. The researchers kept a detailed audit trail of the research process and their interpretation of the results.
Ethical considerations
Ethical approval for this study was obtained from the Research Ethics Committee of the Faculty of Humanities at the University of Pretoria (HUM010/0922). The community radio station and the NGOs agreed to assist the researcher with the recruitment process. The peer leaders, as the project group, confirmed in writing that they had been informed of the purpose of the research and participated voluntarily. They gave permission for the sessions and focus group discussion to be recorded. All data were kept confidential as pseudonyms were used to anonymise the data. The researchers anticipated that the research process could trigger emotional distress in the participants, especially as in some instances it reminded them of their personal experiences. Participants were informed that the South African Depression and Anxiety Group has offered to provide counselling for any member of the group who might need it.
Results
From the data analysis, the researchers identified two main themes and several sub-themes (Table 2). The first theme refers to the peer leaders’ perception of how participation in the project contributed to their own personal development. The second theme highlights the peer leaders’ development of a sense of agency to promote change in their communities.
Themes and sub-themes.
The developing self
The sub-themes describing features of the peer leaders’ sense of self-development during the process are outlined below.
Shift in competence
At the start of the process, the peer leaders shared that they did not know how they could intervene in their communities:
I had some difficulties when it came to me engaging our youth because I knew that at some point, there’d be where I cannot actually offer or actually give them the proper guidance. (Kabelo)
Later in the process, the peer leaders’ sense of competence increased. They stated that they could help peers by directing them to organisations that offer mental health support:
I was giving them contacts. Contact this number and try to find assistance. And if you don’t actually find help, talk to me and I will try to assist you to get proper assistance. (Kabelo)
After repeatedly failing to convince an NGO to participate in their intervention, they realised that they were quite capable of implementing the intervention by themselves.
Increasing confidence
The peer leaders started to believe in their ability to positively influence their environment. They felt more confident about discussing mental health, and ready to commit to fostering change in their communities:
It helped me a lot as a person in the process of helping these young people psychologically, helping them to find mental health assistance. (Koketso) It gave me a go-ahead to act out of my comfort zone, because I am normally closed in. So, for me to actually talk, touch on various serious topics and all of that, it really means a lot to me. (Palesa) I think this project will help me to focus . . . ’cause [because] in my household there is a lot of gender-based violence going on. So, I am thinking of tackling that and helping out my community with that. (Tumelo)
Gaining knowledge
The peer leaders shared that they had developed a deeper understanding of mental health conditions, such as depression, and had learnt about available sources of mental health support:
I found out that there’s many types of depression, not only when someone is just feeling down . . . or post negative things on social media. I discovered that is only part of depression that affects mental health. (Sizwe) We got to learn about many aspects of depression, such as how to deal with it when you see the signs within yourself that are leading to depression. (Palesa) I thought mental health can only be helped by people from the department of health or psychiatrists. But as we were doing research, we found out there are many different kinds of help . . . (Koketso)
Personal well-being
Participation in the project may have contributed to aspects of the peer leaders’ well-being, mainly their psychological and social well-being. There were suggestions of increased self-awareness and improved emotion regulation skills, both of which are features of psychological well-being. They also learnt that it is important to take care of themselves while struggling to balance various demands, as they found it difficult at times to advocate for the well-being of their peers while they were facing their own challenges:
It actually helped. I can clearly say right now that it helped me to tackle my issues on how to build myself personally, my confidence, and all those stuff. (Koketso) This project helped me on a personal level, whereby I managed to be aware of myself, how to react in situations and how to feel and not let my emotions or thoughts overcome me. (Sizwe) I was not actually aware of why I am reacting in this manner. If others react this way, then why is my reaction different from the rest? (Kabelo)
The findings suggested that the peer leaders developed a sense of responsibility regarding the sharing of information about mental health and creating spaces for others to talk about their experiences. They developed an awareness of being valuable members of the community who were making a positive contribution:
Because I have this knowledge, I can sense when there’s an issue of mental health, which others don’t really understand. I must be that person to talk at home, at school, anywhere I find myself. I must talk to make them aware. (Mahlatse) I think creating safe spaces within our friendships, our families, our communities for people to feel comfortable talking to us about such issues. (Palesa)
The peer leaders felt proud that they were able to reach out and that their peers felt comfortable asking for their help. In this way, they contributed to the well-being of their peers:
I can see how the people I reached out to made progress. It makes me proud that I actually accomplished something that benefited not only myself, but someone else. So, even though this project started as a small group, it is expanding. I know that the people I reach out to become more comfortable asking for help. That actually makes me proud. (Sizwe)
The sub-themes identified highlight that the peer leaders experienced positive shifts in aspects of their self-development. At the start of the project, they questioned their own well-being and had limited confidence to foster change in their communities. Participation in the project contributed to their increased sense of competence, confidence, mental health literacy, and psychological and social well-being. The development of these competencies and a sense of well-being became the foundation from which they could actively participate in their communities as agents of change, as discussed next.
Agency: the self as a tool for change
This theme reflects the peer leaders’ perception of how participation in the project contributed to their sense of agency to promote change, while also instilling a sense of responsibility for such change in their communities.
Critical awareness of the environment
The peer leaders considered the most pressing challenges in their environment and critically examined their impact on themselves and their peers. This critical awareness developed from discussions during the project meetings and motivated them to engage in efforts to promote change:
I want to see that kind of change happening in our community. Our community is suffering, and brutally so, to be quite honest. (Kabelo)
They realised that mental health challenges are related to other social issues such as HIV/AIDS and gender-based violence:
Remember that mental health is not something separate and closed. Mental health challenges are caused by drugs, sexual things, teenage pregnancy, HIV/AIDS, and all sorts. (Koketso) In my community, we are experiencing a lot of gender-based violence daily. (Tumelo)
Mobilising community resources
The peer leaders were required to identify and mobilise existing resources to facilitate change. They had to request assistance from various stakeholders and maintain those connections to build a resource network to implement their project:
When I spoke with [organisation A], they were interested to help us to get more people and also, they said they wouldn’t mind talking about our project on their podcasts and their social media. And they said they would also like to join our meetings to see what’s happening . . . Also, [organisation B] said they are interested to be a part of this, to help, since they are also trying to deal with schools, whereby to promote school guidance. (Sizwe)
Mahlatse was also able to enlist the support of an organisation:
With them, it’s a good organisation to keep very close by, because they are in touch with other organisations, so it would be nice to actually clarify what we want from them. (Mahlatse)
The peer leaders realised that they could use their existing relationship with the youth centre to gain support for the project:
Through the resources [of the youth centre], we can include those learners so that they can participate. (Koketso)
Promoting mental health literacy among peers
The peer leaders described the most important benefits of the project for their peers (other young people) as receiving information and becoming aware of mental health challenges. This helped their peers to reflect on their own mental health and to understand themselves better:
Some were kind of emotional. When we explained that depression is this and this, you find that that person now actually finds out they are also dealing with this thing, depression. (Sizwe)
Being a source of support
The peer leaders provided emotional support to their peers and built a sense of community rooted in the idea that they did not have to confront their challenges alone. Their peers could share their experiences:
I think they have the sense that they are not alone. By you talking to them, they know that there is someone they can talk to about things. They know they are not alone. Another person might be experiencing the same thing. (Mahlatse)
Peer leaders felt that by being involved with their peers, they contributed to young people’s sense of well-being:
Our interaction with them, encouraging or trying to help, makes a difference in them. I saw an impact on them. They are different now, in how they are living their lifestyle compared to how they have been. (Sizwe)
As reflected above, the peer leaders developed awareness and understanding of the challenges their peers faced and identified and gathered resources they could enlist in their efforts to facilitate change. Their core interest was in fostering mental health literacy by offering their peers information, resources and support. The peer leaders’ own sense of agency developed from their engagements with their peers and the sense that they could influence some change in their communities.
Discussion
Based on the findings, it is suggested that peer-led interventions can be a strategy for empowering young adults as advocates for mental health literacy in resource-limited communities. The intervention and interaction with peers resulted in young people becoming more informed about mental health, knowing where they could find help, and feeling more supported.
During the process of intervention development, the peer leaders established a supportive network among themselves. They used the WhatsApp group for sharing information on mental health resources (such as workshops, surveys, worksheets, support groups) to learn adaptive coping. They exchanged occasional messages of support. Through participating in the peer-led intervention, the peer leaders expressed facets of psychological empowerment outlined by Kieffer (1984). Through active dialogue, they learnt about the challenges faced by their peers and the extent to which those challenges negatively affect mental health. This resulted in their critical awareness of the environment, which encouraged them to become involved. Initially, they doubted their ability to bring about change, but as the process continued, their confidence increased, as did their belief that they were capable of making a positive contribution to promoting mental health literacy of their peers. A similar study (Duby et al., 2021) showed how participation in a peer-led intervention contributed to peer leaders developing a critical awareness and feelings of self-efficacy.
In developing the peer-led intervention, the peer leaders explored and activated resources. To enlist support for the intervention, they utilised their existing connections (with local organisations, the youth centre, schools, media platforms, including the community radio station) to communicate relevant information. Resource mobilisation is seen as an indication of their developing sense of psychological empowerment (Kieffer, 1984; Malope, 2021; Zimmerman, 2000). In addition, the peer leaders increased their knowledge about mental health conditions such as depression, and where professional help could be accessed. To make a difference in their community, they shared this knowledge through social media and in their interactions with peers. The peer leaders indicated that they will continue working together to broaden their reach in the community by, for example, engaging various schools on mental health. Their continued commitment to the group is encouraging and presents opportunities for further involvement in community upliftment.
The peer leaders reported improvements in aspects of their psychological well-being, specifically increased self-awareness, emotional regulation skills and adaptive responses to their own emotions. While discussing mental health with their peers, they developed awareness of the positive contributions they were making to the well-being of others, which contributed to their own social well-being. Similar research documented how peer educators gained a large body of knowledge, gained confidence, improved decision-making and communication skills that strengthened their leadership skills and promoted their personal growth (Frade & Tiroyabone, 2017; Mokhine, 2019; Simmons et al., 2023; Vostanis et al., 2024).
A large audience noted the interventions they implemented through social media. Some responded by saying they needed help, while others wanted to participate in raising awareness of mental health issues. Young people who had contact with the peer leaders received information and emotional support. According to the peer leaders, peers learned how to identify mental health challenges in themselves and realised that they were not alone, but had someone to talk to. The focus of this research was primarily on the empowerment of peer leaders, rather than the impact of the intervention on their peers. In the literature, limited evaluations focus on the value of peer education for participants in low-resource settings in South Africa. The literature indicates that participants benefit mostly from gaining knowledge (Hay et al., 2024; Timol et al., 2016) and support networks that contribute to their emotional awareness (Swartz et al., 2012), as well as recognition and disclosure of mental health problems (Boucher et al., 2022). Duby et al. (2021) reported that peer support and positive role modelling improved participants’ self-esteem and Page et al. (2023) reported improvements in adolescents’ personal growth, self-efficacy and self-esteem. Various studies do not report benefits for participants/beneficiaries of peer-led interventions, mostly due to challenges in the implementation (Chinyama & Sibanda, 2020; Mokhine, 2019). The effectiveness of peer interventions depends largely on implementation strategies, stakeholder collaboration, peer educator training and supervision, and resources for implementation (Chinyama & Sibanda, 2020; Mokhine, 2019; Zulu & Netangaheni, 2025). These aspects need to be attended to in implementing peer-led interventions. It is possible that the current intervention positively affected participants, as it focused on knowledge transmission and support, and there was an age difference of at least 2 years between peer leaders and participants, as recommended by Mokhine (2019).
Limitations of the research included that it was conducted in a short time frame. A greater degree of empowerment and personal growth might have been observed among the peer leaders over a longer period. They might have implemented more extensive interventions to reach their peers and to increase their impact.
Since the core focus of this study was the empowerment of peer leaders, the effect of the peer-led intervention and how peers benefitted was not the focus of the research. Future studies may explore the efficacy of peer-led interventions on the mental health of both the peer leaders and their peers.
Although the peer leaders were eager to continue their efforts, there is no assurance at this stage that they will be able to sustain their interaction with peers without further support. The peer leaders could have benefitted from training in counselling skills, as they showed an interest in providing counselling. With further training and professional support, the role of the peer leaders can be extended.
Notwithstanding these limitations, this study contributed to discussions on the value of empowerment initiatives in resource-deprived contexts. It highlighted the value of empowering young adults to initiate change by becoming involved in their communities. Since the peer leaders indicated a desire to continue with the intervention, future studies can use findings from the literature (Boucher et al., 2022; Chinyama & Sibanda, 2020; Vostanis et al., 2024) to guide the implementation of interventions, to track the development of peer leaders’ empowerment process, and evaluate the effectiveness of the intervention.
Conclusion
This research explored the process of empowerment as demonstrated by a group of young adults involved in a peer-led intervention to promote mental health literacy among their peers. The peer leaders highlighted that the project contributed to their personal well-being and sense of competence to support their peers. The process of collaboration contributed to their heightened sense of psychological empowerment, specifically the development of a critical awareness of the environment, resource mobilisation skills, increased competence and a sense of mastery (Kieffer, 1984).
This study laid the foundation for future research and discussion on the empowerment of young adults to promote mental health among youth through peer-led initiatives in resource-deprived contexts. Peer leaders can mobilise their peer group and develop networks of support as a strategy to promote mental health literacy and emotional support among young people. With efficient training, supervision and resources, a peer-led intervention can be a strategy (among others) implemented to address mental health literacy and help-seeking in resource-limited areas.
Footnotes
Acknowledgements
The authors extend their gratitude to the organisations that assisted with the recruitment of the participants.
Ethical considerations
This study was approved by the Research Ethics Committee of the Faculty of Humanities at the University of Pretoria (Ref: 17072019(HUM010/0922). The researcher received permission from the community radio station and community organisations to recruit participants for the study.
Consent to participate
The participants gave written informed consent to participate in the study and that the results may be published anonymously.
Author contributions
The authors contributed towards the design and synthesis of the study and drafting of the manuscript. N.H. collected and analysed the data. M.V. provided oversight of the study and revision of the manuscript. Both authors approved the final manuscript.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.