Determinants of birth preparedness and complication readiness among postpartum women in Bugembe, Jinja City, Eastern Uganda: a community-based cross-sectional study.

International organizations place great emphasis on the social determinants of health. Institutions such as the World Health Organization (WHO) regard them as the key to improving the overall health and quality of life of populations, and have consequently defined health not merely as the absence of disease or suffering, but as a state of complete physical, mental, and social well-being []. Dr. Brock Chisholm, the first Director-General of the World Health Organization, once said, “There is no true physical health without mental health.” Meanwhile, the “Special Action Plan for Comprehensively Strengthening and Improving Student Mental Health Work in the New Era (2023–2025),” jointly issued by the Ministry of Education and 16 other departments, emphasizes the need to place mental health work in a more prominent position []. Mental health refers to a state of sound adaptation at the cognitive, emotional, and behavioral levels, serving as the foundation for normal life and learning []. College students are in a critical transitional phase from adolescence to adulthood. Psychological distress and mental health issues that arise during this specific developmental stage can have far-reaching impacts on their growth trajectory if not addressed in a timely manner. Particularly among college students, multiple challenges—including difficulties adapting to new environments, intensified academic competition, complex interpersonal relationships, confusion regarding self-identity, and pressure regarding future employment—have led to a continuous increase in psychological stress. Consequently, mental health issues have become particularly prominent, urgently requiring joint attention and effective responses from society, schools, and families. In recent years, school belonging has garnered increasing attention in the fields of education, health, sociology, and psychology. Research indicates that school belonging serves as a significant protective factor for college students and plays a crucial role in enhancing their mental health [].A strong sense of school belonging helps boost students’ motivation and engagement in their studies, improves attendance, and ultimately leads to better academic performance. However, research on the relationship between school belonging and college students’ mental health requires further exploration, and there are still many areas that need to be investigated.Therefore, building on existing research, this study further integrates behavioral and cognitive pathways to construct a chained mediation model examining the relationship between school belonging and college students’ mental health, and explore potential pathways linking the two.Unlike previous studies that focused solely on a single mediating variable, this study attempts to systematically explain the relationship between school belonging and mental health by examining both behavioral and cognitive pathways, with the aim of providing a more targeted theoretical basis for mental health interventions in higher education institutions. School belonging refers to a student’s sense of being a part of the school community, believing that they are welcomed and respected by others within the school, and that they are valued by others []. Mental health refers to a state of well-adjusted functioning at the cognitive, emotional, and behavioral levels, and serves as the foundation for normal life and learning []. Mental health is not only a guarantee of personal well-being but also a fundamental element in building a harmonious society. Research indicates that individuals with a high sense of school belonging experience more positive emotions, which contributes to their mental health []. The theory of stage-environment fit posits that, as students are at different developmental stages, they have varying developmental needs; therefore, schools should provide learning environments suited to these stages to facilitate smooth individual development []. If the environment provided by the school does not align with students’ developmental needs, it will have adverse effects on their motivation, interests, educational values, attitudes, and mental health []. Empirical research from 2014 indicates a significant positive correlation between poor school adjustment and the incidence of psychological disorders; that is, individuals with low levels of school belonging consistently exhibit more psychological problems and intense depressive symptoms []. Conversely, individuals with high school belonging benefit from personal well-being and mental health, and this supports the formation of adolescent self-identity and group development []. Furthermore, longitudinal studies have found that groups with high school belonging not only experience a significant reduction in subjective physical discomfort but also show a marked trend toward alleviation in psychological risk indicators such as hostility, fear, and paranoia []. This cross-cultural body of evidence sugge