BACKGROUND:
Mental health stigma remains a major barrier to effective mental health promotion and prevention, particularly for people experiencing social, economic, or structural disadvantage. While numerous stigma-reduction initiatives have been developed, many remain limited by top-down designs and insufficient engagement of stakeholders and people with lived experience, particularly in diverse social and cultural contexts. This highlights the need for participatory approaches that actively involve affected communities in the design of stigma-reduction strategies.

METHODS:
This qualitative study explored stigma-reduction strategies co-created through scenario-based workshops conducted in six European countries (Denmark, Italy, Germany, the Netherlands, Lithuania, and Switzerland) within the ADVANCE project. Workshops engaged various stakeholders, including end-users, health professionals, decision-makers, and representatives of umbrella organisations. Workshop transcripts were analysed using a deductive–inductive thematic approach, enabling the identification of both shared and context-specific strategies across countries.

RESULTS:
Six overarching strategies were identified: (1) promoting non-stigmatising communication; (2) fostering empowerment and social contact; (3) providing mental health education and raising awareness; (4) tailoring intervention sites and selecting appropriate actors; (5) ensuring inclusive recruitment, activities, and evaluation; and (6) upholding ethical principles and practices. Non-stigmatising and inclusive communication were advocated as stigma reduction strategies across all six countries. Context-specific strategies included equity-relevant needs by different population groups, including the use of digital tools for youth, intergenerational contact for older adults, and culturally sensitive communication for migrant populations. Despite contextual diversity, a broadly shared understanding of stigma-reduction principles was observed across stakeholder groups.

CONCLUSIONS:
By shifting the focus from predominantly individualised or expert-driven responses toward inclusive, participatory, and preventive strategies, this study provides contextually grounded and practice-oriented evidence for stigma reduction in mental health promotion. The findings highlight co-creation as a transformative approach for addressing mental health stigma while advancing social inclusion, equity, and responsiveness to local contexts in public health interventions.