ABSTRACT:
Adolescent mental health in Pakistan is shaped by embedded gender norms, cultural stigma, and limited access to contextually relevant mental health education. Girls are often socialized to silence emotional distress, while boys are encouraged to suppress vulnerability, contributing to gender-differentiated mental health outcomes and barriers to help-seeking. Many interventions rely on Western psychological models that insufficiently account for cultural, gendered, and structural realities, resulting in limited engagement.

OBJECTIVES:
This study proposes a theoretical and conceptual framework to examine whether participatory co-design with adolescents can produce gender-sensitive and culturally appropriate mental health education and tools in Pakistan. The framework integrates Critical Race Theory (CRT) and Gender and Development (GAD) perspectives to analyze power relations, gendered socialization, and cultural–structural contexts influencing adolescent mental health. CRT contributes a focus on structural inequality, historical context, and the centrality of marginalized voices, while GAD foregrounds the social construction of gender roles and the need for gender-transformative approaches. Framework: Three interrelated concepts guide the framework: (1) gendered socialization, examining how patriarchal norms shape emotional expression and mental health experiences; (2) cultural–structural context, addressing stigma, access barriers, and postcolonial influences on mental health systems; and (3) co-design and adolescent participation, operationalized through participatory methods that position adolescents as co-creators rather than passive recipients of interventions.

METHODS:
A participatory action research (PAR) study using iterative co-design (human-centered design/EBCD) with adolescents, followed by a mixed-methods feasibility pilot to evaluate acceptability, cultural fit, and gender-responsiveness of the co-created intervention. Outcomes: By centering adolescents’ lived experiences, this approach aims to enhance relevance and equity in mental health interventions while challenging harmful gender norms. The framework contributes to global public health by offering culturally grounded model for adolescent mental health promotion in LMICs and postcolonial contexts. Findings will inform the design of scalable, gender-responsive mental health education strategies rooted in adolescents' participation.