The design team worked closely with the research team to create a layout which worked to showcase all the details for the framework, using colours and illustrations to depict and differentiate levels, groups, and determinants.
We presented the draft tool during a workshop at SPHR’s Annual Scientific meeting in April 2021. 61 people participated in an online workshop. After an introduction to the online tool, participants were invited to explore the tool and make suggestions on how to make the final version more useful and accessible.
The online prioritisation exercise also had challenges. While each participant was able to take as much time as they needed to complete the prioritisation, there was little context provided to inform their decision on how to rank each determinant. The online survey was helpful in that it permitted a higher number of stakeholders to participate, however, there was limited ability to discuss broader conceptual issues or provide context and clarification to participants in the online format.
When observed as a whole, it was apparent that the distribution of determinants was not equal between the levels. While the individual level boasted 21 determinants, the family, community, and structural levels have far fewer: 9, 12, and 13 respectively. While the literature on public mental health widely recognises the importance of higher-level determinants, the preponderance of determinants at the individual level may reflect a bias in measurement and research.
The nuanced detail that was included in the public mind maps was also distinct from the academic and grey literatures in many cases. For example, the mind maps emphasised that myriad aspects of education, including accessibility, inclusion, quality, and completion, were all determinants of public mental health.