Participatory ethnography for developing a culturally grounded and Posyandu integrated framework for community mental health promotion through physical activity

Abstract Introduction Integrating physical activity into community-based primary care offers a promising, low-cost strategy for mental health promotion in resource-limited settings. In Indonesia, Posyandu represents a trusted and scalable platform, yet theoretically grounded and culturally embedded implementation models remain scarce. Aim To co-create and theoretically operationalize a culturally grounded, Posyandu-integrated framework for community mental health promotion through structured physical activity. Methods A six-month participatory ethnography was conducted across six mental health Posyandu in urban and semi-urban Indonesia (January–June 2025). Data were generated through participant observation, in-depth interviews, and focus group discussions with 24 purposively selected participants (community members, cadres, nurses, and health officers). Thematic analysis was conducted following Braun and Clarke’s six-phase approach. The analysis was primarily informed by Social Cognitive Theory, with selected constructs from the Health Belief Model used to interpret behavioural mechanisms. Results Four interrelated themes were identified: (1) perceived psychosocial benefits (emotional regulation, sleep improvement, self-efficacy), (2) structural and gendered participation barriers, (3) peer-mediated behavioral reinforcement, and (4) cultural legitimization processes. Engagement was constrained by time, stigma, and gender norms, while sustained participation was facilitated through peer support and culturally embedded practices. Conclusion This study advances a culturally grounded, Posyandu-integrated framework that translates behavioural theory into actionable community-primary care mechanisms. By embedding structured physical activity into a trusted local platform through co-creation, the framework offers a feasible basis for future adaptation and scale-up in early-stage community mental health promotion within resource-limited settings.