MENTAL HEALTH PROMOTION ACTIONS BY HEALTH WORKERS SERVING THE RIBEIRINHO POPULATION IN AMAZONASABSTRACT
Objective: to identify the mental health promotion actions carried out by health workers serving the ribeirinho population in a municipality in the state of Amazonas.
Method: qualitative study using semi-structured interviews with 25 health workers employed at a Ribeirinho Family Health Unit and at the Centro de Atenção Psicossocial (Psychosocial Care Center - CAPS) located in a municipality in the middle Solimões region, in the northern part of the state of Amazonas, Brazil. Data were collected between August and September 2024. The analytical technique chosen for the qualitative data was Content Analysis as proposed by Bardin.
Results: the category that emerged from the organization and analysis of the collected data was: Mental health promotion actions for the ribeirinho population. Among the actions identified, the following stood out: user embracement, home visits, health education initiatives, prayer by the community leader, qualified listening, active search, the Community Health Worker (CHW) as a public policy operator during home visits, and referral.
Conclusion: mental health actions targeting ribeirinho populations have generated indispensable effects. Valuing local cultural traditions strengthens bonds between health workers and the community, and the implementation of actions such as conversation circles and internal groups has had a positive impact on well-being and on reducing the stigma associated with mental disorders. These outcomes highlight the importance of such actions in strengthening psychosocial care in vulnerable territories.
DESCRIPTORS:
Mental Health; Health Promotion; Primary Health Care; Rural Population; Health Workers
RESUMO
Objetivo: conhecer as ações de promoção de saúde mental desenvolvidas por trabalhadores de saúde em atenção à população ribeirinha em um município no interior do Amazonas.
Método: estudo qualitativo por meio de entrevista semiestruturada com 25 trabalhadores atuantes em uma Unidade de Saúde da Família Ribeirinha e no Centro de Atenção Psicossocial localizados em um município situado no médio Solimões na região norte do Estado do Amazonas, Brasil. Os dados foram coletados entre agosto e setembro de 2024. A técnica escolhida para análise dos dados qualitativos foi a Análise de Conteúdo proposto por Bardin.
Resultados: a categoria que emergiu da organização e análise dos dados coletados, sendo ela: Ações de promoção de saúde mental à população ribeirinha. Dentre as ações e destacam-se: acolhimento, visitas domiciliares, ações de educação em saúde, reza do líder da comunidade, escuta qualificada, busca ativa, agente comunitário de saúde como operador de política pública nas visitas domiciliares e encaminhamento.
Conclusão: as ações em saúde mental as populações ribeirinhas têm gerado influências indispensável. Valorizar as tradições culturais locais, fortalecer elos entre os trabalhadores de saúde e a comunidade, além da implementação de ações como as rodas de conversa e grupos internos têm refletido positivamente na melhoria do bem-estar e reduzir estigma relacionado aos transtornos mentais. Essa aquisição mostra a importância destas ações para o fortalecimento da atenção psicossocial em territórios vulneráveis.
DESCRITORES:
Saúde Mental; Promoção da Saúde; Atenção Primária à Saúde; População Rural; Trabalhadores da Saúde
RESUMEN
Objetivo: conocer las acciones de promoción de la salud mental desarrolladas por trabajadores de salud en atención a la población ribereña en un municipio del interior de Amazonas.
Método: estudio cualitativo mediante entrevista semiestructurada con 25 trabajadores que actúan en una Unidad de Salud de la Familia Ribereña y en el Centro de Atención Psicosocial ubicados en un municipio situado en el medio Solimões, en la región norte del estado de Amazonas, Brasil. Los datos fueron recolectados entre agosto y septiembre de 2024. La técnica elegida para el análisis de los datos cualitativos fue el Análisis de Contenido propuesto por Bardin.
Resultados: la categoría que emergió de la organización y análisis de los datos recolectados fue: Acciones de promoción de la salud mental para la población ribereña. Entre las acciones se destacan: acogida, visitas domiciliarias, acciones de educación en salud, oración del líder comunitario, escucha calificada, búsqueda activa, agente comunitario de salud como operador de política pública en las visitas domiciliarias y derivación.
Conclusión: las acciones en salud mental para las poblaciones ribereñas han generado influencias indispensables. Valorar las tradiciones culturales locales, fortalecer los vínculos entre los trabajadores de salud y la comunidad, además de la implementación de acciones como los círculos de conversación y grupos internos, ha repercutido positivamente en la mejora del bienestar y en la reducción del estigma relacionado con los trastornos mentales. Este hallazgo muestra la importancia de estas acciones para el fortalecimiento de la atención psicosocial en territorios vulnerables.
DESCRIPTORES:
Salud Mental; Promoción de la Salud; Atención Primaria de Salud; Población Rural; Trabajadores de la Salud
INTRODUCTION
The psychiatric reform movement brought about changes in mental health care and management models, with health workers and service users as its main protagonists, who began to take an active role in management processes and in developing mental health promotion actions1. Despite this progress, the stigma associated with mental health continues to exert a significant influence, contributing to delayed help-seeking, often when distress has already reached more advanced stages, particularly in rural areas.
The Amazon region stands out as an area that requires significant investment in care technologies capable of addressing the specificities of its territory. More than a context of challenges, it constitutes a strategic field of learning that integrates practices and knowledge drawn from different sociocultural backgrounds. Historically, ribeirinho communities have faced exclusion from access to health services, owing to the concentration of health actions in municipal headquarters2.
The Amazonian territory has been shaped by historical processes of colonization, which led to the invisibilization and hierarchization of knowledge systems and ways of life. Even so, it retains remarkable sociocultural, linguistic, and territorial diversity3. In the contemporary context, the intensification of extreme events, such as floods and droughts associated with climate change, has severely impacted ribeirinho communities, whose way of life is already intrinsically tied to the hydrological cycle. During dry seasons, territorial isolation compromises access to essential services, including health and education, while also exacerbating food insecurity, highlighting the overlapping historical, environmental, and social determinants that challenge the achievement of equity in public policies4,3.
Although the Política Nacional de Saúde Integral das Populações do Campo e da Floresta (National Comprehensive Health Policy for Rural and Forest Populations - PNSIPCF), established by Ordinance No. 2,866, of December 2, 2011, recognizes the social conditions and determinants that shape the health-disease process in these populations and proposes improvements in health conditions through actions that take into account specificities of gender, generation, race/color, ethnicity, and sexual orientation, significant challenges persist. Among them, the lack of healthcare coverage and the persistence of stigma related to the ways of life of ribeirinho communities, also known as Povos das Águas (Water People), stand out, as these communities continue to be overlooked in healthcare practices and care organization in many contexts5.
When integrating mental health into this context, it is essential to consider it as an inseparable part of overall health and well-being. Promoting mental health involves creating conditions that foster emotional balance, resilience, the strengthening of social bonds, self-esteem, and the capacity to cope with adversity. In remote areas, mental illness conditions show high prevalence; studies have demonstrated growth in mental illness among populations living in isolated areas, such as ribeirinho and indigenous communities6,7.
Regarding the distribution of mental illness cases in Brazil, significant regional variations have been observed, with the highest rates concentrated in the northern region of the country. Data presented by the Ministério da Saúde (Ministry of Health - MS) reveal that the suicide mortality rate among rural populations is three times higher than that observed in the general population, with the highest incidence recorded among individuals aged 10 to 19 years6,7. The state of Amazonas led the country for four consecutive years (2019 to 2022) in cases of mental disorders and suicides among ribeirinho and indigenous peoples, according to data from the Report on Violence Against Indigenous Peoples in Brazil, published by the Conselho Indigenista Missionário8.
In this context, mental health conditions are highly prevalent in this population, which calls for reflection on mental health promotion actions oriented to the living and health conditions of ribeirinho communities. To this end, it is necessary to consider several aspects, including social dynamics, the forms of coexistence that characterize everyday life in this setting, the traditional knowledge and practices of the population, and the informal resources that serve as therapeutic allies in healthcare for this community. In addition, it is essential to identify a range of challenges for mental health care and management within the Sistema Único de Saúde (SUS)9.
As a Brazilian state health policy, the SUS focuses on improving quality of life and affirming the right to life and health, and is aligned with reflections and movements in the field of health promotion10. Health promotion, as one of the strategies for producing health - that is, as a way of thinking and operating in coordination with other policies and technologies developed within the Brazilian health system - contributes to the development of actions that address social health needs10,11. For this process to take place, health workers, individuals, and other social actors must plan health-promoting practices that foster autonomy and expand individuals’ capacity to make free and informed choices11.
The incorporation of mental health promotion actions into Primary Health Care (PHC) will contribute to this transformation by offering better care coverage and greater potential for social inclusion for users. PHC is responsible for actions aimed at treatment, disease prevention, and health promotion and rehabilitation, including actions related to mental health promotion12. PHC is also the ideal setting for promoting mental health actions, given the ease of access for users and the territorial responsibility of teams in relation to the population served.
Mental health care in PHC enables the early identification of psychological and emotional disorders, such as depression, anxiety, and substance abuse, conditions frequently aggravated by the vulnerability characteristics found in ribeirinho areas. Through regular consultations, home visits, and collective activities, health workers have the opportunity to assess users’ emotional state and provide the necessary support12,9. Another relevant aspect is the promotion of health education practices that contribute to demystifying mental disorders, thereby reducing associated stigma. Initiatives such as workshops, conversation circles, and awareness campaigns help create a culture of embracement and respect for individuals facing mental health challenges, strengthening social bonds and trust in the health team13.
Furthermore, the integration across different levels of health care is crucial to ensuring care continuity. When needed, PHC can coordinate referrals to specialized mental health services, such as the Centro de Atenção Psicossocial (Psychosocial Care Center - CAPS). This coordinated care flow improves therapeutic outcomes and offers highly valuable support12.
Health workers are therefore considered to have significant potential to contribute to and foster mental health promotion actions and strategies within PHC. Accordingly, the objective of this study is to identify the mental health promotion actions carried out by health workers serving the ribeirinho population in a municipality in the state of Amazonas.
METHODS
This is a qualitative, descriptive, and exploratory study, part of a master’s dissertation entitled: “Promoção da saúde mental da população ribeirinha no interior do Amazonas.” The study was conducted in a municipality in the state of the state of Amazonas, within the PHC context, encompassing a Ribeirinho Family Health Unit and the CAPS. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to ensure the methodological rigor of the study14.
Access to the municipality is by river or air. The estimated population is 73,111 inhabitants, with 65.39% living in urban areas and 34.61% in rural areas. The municipality covers a territorial area of 57,970 km² and has a demographic density of 1.3 inhabitants/km²15.
The study included 25 health workers employed at the Unidade Básica de Saúde (Basic Health Unit - UBS) serving ribeirinho communities and at the CAPS in the municipality. These workers held higher education, technical, or high school education credentials and were approached in person, with the research proposal presented and an invitation to participate in the interview extended. Inclusion criteria were: being a health worker in PHC and CAPS who provides direct or indirect mental health care to ribeirinho communities. Exclusion criteria were: workers who did not provide mental health care to the ribeirinho population, and health workers who were on vacation, on leave, or on health-related absence during the data collection period.
Data collection took place in September 2024 and was conducted by the graduate student, a native of the Amazon region. Recruitment was carried out through a personal invitation extended by the graduate student at both units, with an explanation of the project and its objectives. The semi-structured interview was used as the data collection technique, following the signing of the consent form. Interviews were conducted individually at the workplace, in a private setting, with only the researcher and the worker present, and were scheduled in advance. They were audio-recorded, lasted a maximum of 20 minutes, and were conducted according to participants’ availability. Interviews were subsequently transcribed by the researcher, who then requested content validation from each participant. Participant anonymity was guaranteed using code names composed of the letter “E” followed by numbers from 1 to 25 (E1, E2, E3... E25), assigned randomly.
To support data processing and analysis, the interviews were transcribed and imported into Microsoft Word as primary documents. In order to address the study objective, a floating reading of the primary documents was performed, identifying the excerpts related to the guiding research question. Focusing on these extracts, a second reading was conducted, followed by coding. This coding process involved creating codes, grouping interview excerpts that supported each code, which then evolved into categorization and discussion of the results16.
The data analysis procedure was based on the stages of the Content Analysis method proposed by Bardin16, who defines it as “a set of communication analysis techniques aimed at obtaining, through systematic and objective procedures for describing message content, inferences of knowledge related to the conditions of production and reproduction of these messages.”
The analysis of the collected material led to the construction of the following category: Mental health promotion actions for the ribeirinho population.
The study was approved by the Research Ethics Committee for Human Subjects, based on Resolution No. 466/2012.
During the preparation of this article, the authors used ChatGPT, version GPT-5.3 (2026), to improve the writing and organization of the text, with the aim of enhancing the clarity, cohesion, and fluency of the academic writing; the tool was also used to organize the references. Following the use of this tool, the authors reviewed and edited the content in accordance with the scientific method and assume full responsibility for the content of the publication.
RESULTS
Mental health promotion actions for the ribeirinho population.
Analysis of the interviews revealed that activities are carried out across all units studied and by each of the workers. Among the mental health promotion actions by health workers serving the ribeirinho population, the following were highlighted: user embracement, home visits, health education initiatives, prayer by the community leader, qualified listening, active search, the Community Health Worker (CHW) as a public policy operator during home visits, and referral. These activities can be identified in the excerpts cited below.
Mental health promotion actions hold different meanings for each worker serving the population at the study site. E1 mentions that embracement is the first action that allows users to express their feelings and problems. In one excerpt from their account: [...] I think embracement is the first mental health action we carry out here at the unit, because people come in a vulnerable state, especially the ribeirinho residents who live far away and face many challenges. So I provide the most appropriate embracement possible so that the person can feel comfortable; I listen attentively without passing judgment.
E5, in turn, explains that they follow up with individuals through home visits. In an excerpt from their account, it is apparent that mental health is mentioned in the same category as health-promoting actions. [...] my follow-up consists of general home visits, and there are always patients with mental health needs, elderly ribeirinho residents who suffer from abandonment, adolescents going through some form of mental distress. It is during these visits that I identify the vulnerability and adopt an embracement approach so that the person can trust me; I try to encourage the autonomy and social reintegration of these individuals in the community.
It was also possible to observe that certain actions are mentioned in connection with social programs or with the type of team to which the professional belongs. E6 explains the procedure carried out with users followed by the Estratégia Saúde da Família (Family Health Strategy - ESF).
[...] because here, since we are part of the strategy, we already have those patients who need guidance, so the main actions involve mental health education, where talks are given to raise awareness about mental health, how to manage emotions, how to strengthen them, always valuing their own reality. We have some plans and goals to establish conversation circles with these patients. However, this has not happened yet, as some educational resources are still lacking, but it is a plan that I believe we will be able to implement within one or two months.
Another action highlighted by one of the interviewees in the ribeirinho community is the “prayer” (reza) led by the community leader, which is viewed as a therapeutic factor in mental health promotion and as a form of respect for Amazonian customs in the rural community. In this way, the community leader emerges as a wise figure, a bridge between everyday reality and the transcendental dimension. The leader thus becomes a factor of curative influence through their blessings. As highlighted by E12 and E25: [...] there is embracement, we try to help. Sometimes we take the person to the community leader to pray over them.
[...] I think it is important to respect the culture in the community. When the family asks us to take the person first to the leader for the prayer and the blessing, we respect and fulfill that request. Afterward, we take them to the city for evaluation by the doctors. I consider it essential to welcome this practice as a form of care and respect.
In the following excerpt, the community health agent from the rural area describes embracement, qualified listening, prayer, and referral as forms of mental health promotion action, given that they are customary practices in the community. E21 states: [...] We welcome them, talk with them, sometimes we pray because the family asks. Because we do not understand everything, do we? When we see that the case is beyond us, we bring them to terra firma (the city).
Furthermore, E08 mentions using active search to bring to the appointment users who renew their prescription to obtain medication but go a long time without attending the health unit for consultations. In an excerpt from their account: [...] when we see that a patient has not come to consultations for a long time, we go after them to find out what happened. Why are they only renewing the prescription? Then we talk with them and schedule a new appointment for them to come in.
E11 and E15, in turn, indicate in their accounts that the distinguishing feature of primary care lies in the work of the CHW, who, through home visits, acts as a public policy operator in mental health actions.
[...] you know, the actions are mostly focused on visits, right? The CHW visits are very important because they are in direct contact with the community. So I believe that the mental health actions they carry out happen during the visits, promoting well-being by being present in the community, listening to those who are not doing well, and offering ribeirinho residents health education on how to reach the CAPS (E11).
[...] I know that there are some community centers in the ribeirinho communities, and they gather there. Sometimes they invite healthcare providers to go there and give talks. But specifically, I do not know of any. Since they come once a month so that they can carry out the screening right there in the community. And the CHW passes information along, because they have open access here with us to report which patient is experiencing mental distress (E15).
Finally, it is also evident that there is a lack of awareness regarding mental health promotion practices. Workers tend to view such actions as something exclusive to psychologists and psychiatrists, as well as a function of the CAPS, since they seek to refer patients whose clinical management they are uncertain about, even when the situation does not actually require specialized care. In some cases, referral becomes the only alternative, as stated by E10: [...] generally, when we identify a patient who is in need, we embrace them. Then we talk with the patient and provide care, since it falls within nursing. And then we refer these patients to the psychologist and the psychiatrist. We have a psychologist and a psychiatrist who are always available to see patients, especially ribeirinho patients, since they do not have such easy access.
DISCUSSION
Based on the research findings, the discussion begins with an overview of the central role of PHC, particularly through the ESF, in caring for and developing mental health actions in rural territories, given its responsibility for incorporating the family as both the object and subject of care and health promotion, as well as for coordinating with the other components of the Rede de Atenção Psicossocial (Psychosocial Care Network - RAPS)17,12.
In this setting, PHC must account for the specificities of each individual and of the territory in which they are situated. Health workers’ role is therefore decisive, even in the face of challenges related to the shortage of professionals in many territories. Nonetheless, the identification and early recognition of changes in mental status, as well as embracement, must be carried out by the multidisciplinary team. The implementation of mental health promotion strategies has demonstrated positive results in screening and adequately managing cases of mental distress, particularly in rural areas17,18.
Based on the results, health workers highlight embracement as a strategy that promotes mental health actions, grounded in openness, trust, and co-responsibility, and present across the various spaces in which health workers engage with ribeirinho populations18,17. This bond contributes to the recognition of the health unit as a welcoming and effective space capable of promoting mental health, with the ribeirinho unit team perceived as a reference for addressing these demands.
The development of close, trusting relationships contributes to the unit being perceived as a point of support and comprehensive mental health care. This finding aligns with Brazilian studies conducted in PHC settings, which indicate that through embracement practices, observed and reported in interviews, users came to recognize the health unit as a mental health support space, reinforcing the role of embracement as a structural element of mental health promotion actions within PHC19,20.
Another relevant aspect is the role of home visits in reducing the stigma associated with mental health. A study on rural health care in southeastern Brazil highlights this same perspective21. These populations often hold cultural beliefs that hinder help-seeking, whether due to the distance of health services or the unavailability of transportation provided by the UBS, which in most cases does not materialize, restricting the scope of teams’ work in the territory21.
Despite this, home visits stand out as a powerful strategy in mental health actions. In this study, they were found to enable knowledge of the territory, the strengthening of bonds, and the identification of demands experienced by families, including social needs such as abandonment, contributing directly to community diagnosis. Similarly, a comparative study also demonstrates that this practice fosters trust and care continuity22. There is thus a convergence of findings, reinforcing home visits as a fundamental strategy for integrating mental health into comprehensive care and overall well-being, particularly in rural contexts22.
The discussion also extends to the social actions promoted by the CAPS and ESF, such as mental health education, support groups, and conversation circles, as essential strategies for broadening ribeirinho communities’ awareness. A national study23 shows that health education through conversation circles constitutes learning spaces that strengthen affective bonds and build trust among participants. This contrast demonstrates that, whereas in urban areas conversation circles serve as supplementary support to specialized interventions, in rural territories they frequently occupy a central role in mental health care, filling gaps in services and expanding the population’s access to welcoming and exchange spaces23.
It should be noted, however, that health promotion actions, particularly those focused on health education, must be oriented toward strengthening users’ autonomy and empowering them in relation to their health processes, both at the individual and collective levels. Nonetheless, this aspect can still be expanded and strengthened, given professionals’ accounts indicating that access to services, in some cases, occurs predominantly for prescription renewals, which may point to challenges in engagement and co-responsibility strategies. These actions are directly aligned with the Política Nacional de Promoção da Saúde (National Health Promotion Policy - PNPS)11, particularly in the knowledge dissemination axis. Furthermore, the articulation between local and scientific knowledge within educational practices is essential for the construction of care pathways that are more contextualized, sustainable, and culturally sensitive.
The articulation with community leaders and local agents has also proven equally relevant. These actors exert significant influence and can serve as operators in the implementation of mental health programs. National studies24,25 indicate that community leaders play a fundamental role in the work of PHC teams. The coordination between health workers and local leaders contributes significantly to the early identification of cases and to the population’s adherence to mental health promotion actions.
This study identified that CHWs played a central role in ribeirinho communities, having engaged with traditional practices by adopting and offering the “prayer” (reza), which holds great cultural and spiritual importance. Accordingly, these workers recognize that, for many people, prayer is not merely a religious practice but also a way of seeking emotional balance, comfort, and hope in times of difficulty25,26. By respecting and valuing these traditions, CHWs strengthen bonds with the community and promote self-care, while also providing guidance on how to access other health services when needed. This integrated approach contributes to a broader understanding of care26.
On the other hand, it should be noted that, although the CHW serves as a fundamental public policy operator in the territory, the totality of care responsibilities must not be attributed to them. Even though this professional plays a central role, particularly in geographically remote areas, and has greater sociocultural proximity to the community, which facilitates health literacy that is better aligned with the local context, it is essential to recognize them as a health worker who also needs adequate multidisciplinary institutional support, so as to prevent work overload. In this direction, the principles of the Ottawa Charter are invoked, which emphasize that health promotion is a shared responsibility among individuals, communities, professionals, health services, and governments, requiring coordinated actions for the construction of more equitable and effective health systems11.
It is also important to mention that referral was one of the actions used by health workers. It is, however, a fundamental step within the comprehensive care process, as it ensures that the person receives appropriate treatment at a critical moment. Studies27,28, nevertheless, indicate that health workers hold a limited view of mental health promotion, restricting their actions to individuals with mental disorders and focusing on general guidance about their needs and referrals to specialized services. Accordingly, when emphasizing referral as a mental health promotion action, it is essential to integrate it into a care network that values primary care, teamwork, and the use of community resources, thereby ensuring more effective and humanized care28.
The mental health promotion actions carried out by health workers for the ribeirinho population are fundamental, given the vulnerability and isolation conditions of these communities. Workers act as bridges between essential services and local realities, helping to minimize the impact of stressors such as infrastructure deficiencies, limited access to health care, and socioeconomic hardship9,29. Through these actions, the aim is not only to treat but also to prevent mental health problems, promoting well-being and strengthening community resilience.
These initiatives, carried out by trained professionals, also play a crucial role in raising awareness and reducing the stigma around mental health. Workers who understand the local culture and respect traditional knowledge can implement approaches that are more appropriate and adapted to the reality of ribeirinho communities. Activities such as conversation circles, emotional strengthening workshops, and community leadership training programs have the potential to empower ribeirinho residents, promoting autonomy and creating support networks that sustain community life30,19.
In addition, these actions represent an investment in the social and economic sustainability of these communities, directly impacting the collective organization of social bonds. In this way, workers who promote mental health become agents of transformation, contributing to the construction of healthier communities better equipped to face challenges. By fostering psychological and emotional well-being, these actions not only limit the incidence of mental disorders but also stimulate social participation and mutual cooperation. This creates a positive cycle of community development, in which mental health promotion becomes a pillar for quality of life and social equity.
CONCLUSION
This study aimed to identify the mental health promotion actions carried out by health workers serving the ribeirinho population in a municipality in the state of Amazonas. Based on the analysis, mental health promotion actions are carried out in all units examined and in ribeirinho communities. Among the mental health promotion actions identified, the following stood out: user embracement, home visits, health education initiatives, prayer by the community leader, qualified listening, active search, the CHW as a public policy operator during home visits, and referral.
Mental health actions have generated indispensable effects. Valuing local cultural traditions strengthens bonds between health workers and the community, and the implementation of actions such as conversation circles and internal groups has had a positive impact on well-being and on reducing the stigma associated with mental disorders. The integration among health services, local leaders, and community knowledge can enhance more effective actions, promoting a more equitable, comprehensive, and sustainable approach to mental health care for ribeirinho populations.
For these reasons, despite the advances and contributions of this study, the geographic scope, restricted to a single municipality, may limit the generalizability of the findings to other settings. Likewise, the perspective centered on health workers may not fully capture the perceptions of users and communities themselves. To deepen understanding of this phenomenon, studies are suggested that expand the scope of investigation, encompassing different territories and incorporating the voices of the population, in order to gain greater insight into their needs, cultural practices, and mental health demands.
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