What do we know about men’s help-seeking and health service use?

In the Western world, the health of men is poorer than that of women, mortality rates are higher and men use health services less often than women, even when reproductive services have been accounted for.1-5 In fact, being male is a significant risk factor for early mortality in developed countries.6,7 Before age 50 years, for every 10 premature female deaths, 16 men die prematurely, predominantly from cardiovascular disease, accidents, suicide and neoplasms.6 Men are also more susceptible than women to mortality related to climate.8

Rates of morbidity and mortality are useful in establishing that men’s health should be monitored more closely. Men’s help-seeking behaviour and use of health services deserves increased attention. Although men’s help-seeking is known to be problematic, there is scant research to suggest how and why this is so.4,9 Rather, it is assumed that men are less interested in or concerned about their health, and therefore may be less likely to seek help for health-related problems.

Help-seeking is considered to be the recognition of a health concern together with the range of actions that result, one of which is health service utilisation. The interchangeable use of terms such as doctor, health service, health service provider and health care system make comparisons between studies complex. Nevertheless, regardless of definitions, men consult doctors (specifically general practitioners) less often than women do.1-3,10-15 More generally, men use all services within the health care system to a lesser extent than women,14,16 and women have a greater acceptance of, and consequently use of, health care services.17,18

Men are often blamed for being poor consumers of health services, and are thus seen to be victims of their own behaviour.2,3,9,19,20 We need a different view to that which positions men as “behaving badly”.21,22 Various commentators have offered suggestions to counteract victim blaming, including ones related to using a gender-relations approach, a population health approach, a salutogenic approach and/or a social marketing approach.13,22-24 Little empirical evidence using these approaches has emerged in the Australian context. Equally noteworthy is that the skills of health service providers can sometimes fail men.11,25-27 Policy advocates have also indicated that inadequate attempts to develop state and national men’s health policies and lack of available resources, for both researchers and practitioners, are to blame for the poorer health status of men.28 However, it is unproductive to apportion blame.

In this article, we explore why men are viewed as reluctant to seek help and why they use health services less, and the consequences this has for health service delivery and the development of programs tailored for men.

There are a number of interesting observations relating to the pattern of help-seeking and health service utilisation by men. First, the initial approach by men for seeking help for health-related issues tends to be indirect.1 Men tend to view their partners and friends as a primary resource for help.24 Innovative ways to engage men in preventive health discussion have been offered, particularly in relation to environments where men congregate, such as sporting venues, workplaces and pubs.17,22,24

In circumstances where men do seek primary health care, they are more likely than women to focus on physical problems and are less likely to disclose mental and emotional problems.13 Men also appear to spend less time with physicians during their health visits than women, and receive less advice from physicians about changing risk factors for disease, particularly during general checkups.2 Based on the perspectives of family physicians, a number of systematic barriers that prevent men from seeking help from health services have been identified. These include lack of time, poor access opportunities, having to state the reason for a visit, and the lack of a male care provider.1

These observations highlight two significant issues. First, consideration should be given to how health practitioners behave when interacting with men. Second, we need to consider the personal experiences of men when they speak of their health. Therefore, it is important to understand how help-seeking behaviour among men has been explained throughout existing scholarship.

The social construction of masculinity acts as an important influence on health and illness, and one that may both prescribe and limit men’s lives.1-4,9,13,15,22,25,26 Sociologists have implied that specific behaviour associated with traditional forms of masculinity is likely to be hazardous to men’s health.29 Dominant masculine cultures and values may negatively affect patterns of illness and men’s experiences and behaviour.15 Stoicism and suppression of emotion, for example, are values often associated with masculine gender role socialisation.9 Adherence to patriarchal masculine characteristics, such as superiority, independence, self-reliance and dominance, may also act as a barrier to men appropriately accessing and using health services.9,16,20,22,25,29,30

Men are also influenced by cultural stereotypes to ignore screening and preventive health care, and to delay help-seeking for symptoms.3,9,19 This results in men underutilising health services aimed at early intervention.9,20,31 Subsequently, poor health-seeking behaviour results in poor health care use among men, which limits their access to information and restricts opportunities for health promotion interaction and primary care use.17,31

The social factors that shape men’s help-seeking behaviour have been explained above, yet much research in this area fails to address biology. Male biology needs to be considered as a fundamental factor in understanding men’s health behaviour. Traditionally, men’s health has been constituted by diseases of the male reproductive organs — primarily prostate and testicular health, but has more recently focused on erectile dysfunction.9,12,14 Although these health concerns are specific to the biology of men, the margins of difference between both men’s and women’s rates of death and disease,13,28,32 may also have a biological basis.

A biologically determinist approach to the differences between men’s and women’s health experience focuses on structural, physiological and pathological reasons as to why men are more susceptible to a number of diseases than women.21,22,33 For example, hormonal differences between men and women have been used, at least in part, to explain variations in male susceptibility to disease.31,34,35 Evolutionary pressures toward optimal reproductive outcomes for men have promoted an increase in the prevalence of genes that promote male risk-taking and competitive ability at the expense of decreased investment in repair capacity and disease prevention.36,37 The higher rates of fatal and non-fatal accidents for boys have been partially attributed to a particular pattern of motor and cognitive regulation, leading to a misjudgement of risk.38

An alternative to the separation of biological and sociocultural approaches to men’s health status is to focus on the interplay between sociocultural and biological factors in health and illness.9 This is often described as a biopsychosocial understanding, and it may provide a more useful approach in addressing the health needs of men more appropriately.9,21 Our approach to investigating men’s help-seeking and health services use draws on a public health framework that acknowledges the complex ways in which physiological differences are shaped by, and shape, culture. The tendency for males to take risks, for example, is associated with higher rates of violence, fatal accidents and the use of alcohol or illicit drugs.38 The reasons why young men, particularly, are risk-takers involve biological factors such as age and hormonal influences, but these factors are mediated by cultural pressures to present a particular masculine identity to the world. The extent to which this behaviour is related to the tendency to delay or avoid help-seeking, and how this behaviour is shaped or can be modified by socialisation, remains to be determined and ought to be a key focus for research. Nevertheless, few studies have explored men’s help-seeking from a public health perspective, particularly using qualitative methods like those that are now widespread in women’s health studies.9,16,21

Recognising the value of adopting a public health approach to address these disciplinary boundaries will assist in improving the health of Australian men. Further data from both quantitative and qualitative studies are required, using multidisciplinary and interdisciplinary approaches and involving all stakeholders.9,18