Nursing Students’ Understandings of Mental Health: Illuminating the Structure of Awareness Using Phenomenographic Analysis

BACKGROUND: Variation in how nursing students conceptualise mental health (MH) has significant implications for curriculum design and patient care. While phenomenography is well-established for mapping such variation, clarity on how variations are derived is often lacking. Marton and Booth's (1997) structure of awareness (SoA) framework provides a method for sophisticated analysis of a concept and, in this study, was employed to derive the components and configuration of students' awareness. OBJECTIVE: This study aimed to illustrate and advance the application of the SoA framework in phenomenographic analysis, uncovering both the range and the formation of undergraduate nursing students' understandings of MH. METHODS: A qualitative, phenomenographic design was employed. Nineteen diverse undergraduate nursing students from an Australian Bachelor of Nursing program participated in individual, semi-structured interviews. Data were analysed using Dahlgren and Fallsberg's 7-phase process, with systematic application of Martin and Booth's SoA framework to each emergent category. RESULTS: Seven hierarchical categories of description were identified, representing a progression from fear-based and stigma-based views to holistic, inclusive conceptions of MH. Each category's SoA foregrounded different aspects of MH, reflecting influences such as cultural context, personal experience, and educational exposure. CONCLUSIONS: Applying the SoA framework enriched phenomenographic analysis by revealing not only what students understood about MH but how their awareness was constructed and enacted. The insights assisted in the development of targeted strategies to enhance MH literacy, reduce stigma, and support the development of holistic, person-centred care in nursing education.