Literacy and mental health: A feasibility and acceptability study among women in a low-income urban setting in North India

Introduction Literacy is a determinant of mental health, wellbeing, and social participation. Although literacy interventions improve educational and socioeconomic outcomes, their effects on mental health and social participation are poorly evidenced. We aimed to assess the feasibility and acceptability of a group-based literacy and numeracy intervention and explore its effects on literacy, mental health, numeracy, wellbeing, and social participation. We also estimated implementation costs. Methods We conducted a mixed-methods study using an uncontrolled pre-post design among women in low-income urban communities in Lucknow, India. A total of 115 women were recruited to a 17-week group literacy intervention using the Accelerating Learning for All literacy intervention. Outcomes measured at baseline, midline, and endline used literacy and numeracy assessments and validated scales of mental distress, wellbeing, and social participation. Quantitative data were analysed using multilevel mixed-effects models. Qualitative interviews and focus groups were analysed thematically. Costs were calculated per participant. Results The intervention was feasible and acceptable with functional recruitment of 71% (82/115), 74/82 participants (90%) completed it (retention), and mean attendance of 69% of scheduled sessions. In multilevel mixed-effects models, mean literacy scores increased by 29.5 (95% CI: 23.6, 35.3) between baseline and endline, while mean mental distress (SRQ20) decreased by 3.4 (95% CI: 2.2, 4.6), mean mental wellbeing (WEMWBS) improved by 2.6 (95% CI: 0.1, 5.1), while social exclusion (P scale) declined by 4.1 (95% CI: 1.6, 6.5). Qualitatively, participants described greater confidence, autonomy, financial literacy, and social support. Implementation enablers included local facilitators. Implementation cost was US$25 per participant. Conclusion This low-cost literacy intervention was feasible and acceptable for women in low-income urban communities in India. Findings provide preliminary evidence of improvements in literacy, mental health, and social participation. Controlled studies are needed to establish causal effects, long-term outcomes, and scalability.