Abstract

Background

The reasons for men not to seek healthcare seem similar across the world. They avoid going for regular medical check-ups, and preventive care and often disregard symptoms or delay seeking medical attention when sick, in pain, or even when their lives are in danger.

Methods

This study sought to explore the views of men on factors contributing to poor health-seeking behavior among men in Mopani, Vhembe, and Capricorn district municipalities in Limpopo Province. A qualitative descriptive design was used and individual semi-structured interviews were used to collect data in May and June 2024 from 21 men who were purposively selected. Collected data were audio recorded and transcribed verbatim for analysis. Tech鈥檚 eight steps were used to analyse data and guide the development of emerged main themes and sub-themes. Trustworthiness was ensured through credibility, confirmability, dependability, and transferability. Ethical approval was obtained from the University of Venda research ethics committee with Ethics Approval Number: FHS/21/PH/26/1215.

Results

Self-medication, fear of knowing own health status, peer and community elders鈥� influence, stigma, and masculinity beliefs were among the reasons participants avoided utilizing health services. Educational and health promotional campaigns, challenging societal norms, and employing more nurses were suggested as strategies to improve men鈥檚 health-seeking behaviour.

Conclusions

It is evident from the findings that several factors contribute to men鈥檚 poor health-seeking behaviour including visiting health facilities to seek needed healthcare services. Self-treating of disease at hand, fear of knowing own health status, use of traditional healers, and sticking to cultural values are among the factors that contribute to men鈥檚 poor health-seeking behaviour. There is a need to challenge societal norms and how men are raised as factors that contribute to poor health-seeking behaviour among men.

Background

Men experience poor health outcomes across different health issues including obesity and sexually transmitted infections (STIs). They also experience high rates of mortality and morbidity compared to women [1]. The urgency of responding to health concerns differs between men and women [2]. The study by Dowden et al. (2019) [3] indicates that it is common for men to only seek care during emergencies or in the later stages of preventable illnesses. They avoid going for regular medical check-ups, and preventive care and often disregard symptoms or delay seeking medical attention when sick, in pain, or even when their lives are in danger [4].

In some countries, access to free services remains a significant challenge to receiving quality healthcare in resource-limited settings and is a cause of the underutilization of healthcare by men [5]. However, in South Africa, Primary Health care (PHC) services are provided at no cost at public health facilities, yet men in South Africa continue to utilize underutilized public healthcare services. As a result, men display more chronic health conditions and die more frequently than women from the main causes of death [6]. Moreover, the majority of men remain undiagnosed for HIV and other sexually transmitted diseases (STDs) due to the underutilization of health services [7]. Previous studies show that, although it is difficult for men to seek health care services at a time when it is required, it is a common practice for them to engage in highly risky behaviour which further exposes them to deadly diseases, such as STDs, lung cancer, and mental illness.

If poor health-seeking behaviour persists among the general population, including men, the commitment made towards achieving the Sustainable Development Goal (SDG) 3 of ensuring health for all at all ages, through the promotion of health and provision of quality healthcare services, will be negatively affected [8]. Despite the availability of studies conducted by Mekonnen et al. (2022), Mthembu (2015), and Uwimana et al. (2023) [9,10,11] On factors contributing to men鈥檚 poor health-seeking behaviour, there is less evidence on studies conducted within Limpopo province in Mopani, Vhembe, and Capricorn district municipalities.

Due to the growing concern about poor utilization of health care services by men, it is important to gather information to determine factors contributing to poor health-seeking behaviour among men. This study aimed to explore the views of men on factors contributing to their poor health-seeking behaviour in the Limpopo Province, South Africa. We report findings from 21 men interviewed to find out reasons they did not attend health facilities to utilize public health care services.

Methods

Study design, setting, and participants

A qualitative descriptive study was conducted in the Mopani, Vhembe, and Capricorn districts. A qualitative explorative design was used to explore the views of men on factors contributing to poor health-seeking behavior and allowed the researchers to gather detailed information. The qualitative design also allowed the researchers to probe reasons that were not clear and allowed participants to express their views on what could be done to enable them to engage in public health care services. This study was conducted in Mopani, Vhembe, and Capricorn District Municipalities of Limpopo Province. There are 454 clinics, 26 community health centers, and 41 Hospitals, with some being specialized, tertiary, district, and regional hospitals [12]. Most of the residents in Limpopo take about 15鈥�29听min to reach the nearest health facility [13]. Consulting traditional healers is another health treatment option available, and it has been practiced for decades. The study consisted of men who were aged 18 years and older and did not visit health facilities to utilize health services when faced with health conditions and illnesses that needed a healthcare intervention. Males who regularly visited health facilities to utilize health services were excluded together with males who did not consent to participate in the study.

Sampling and data collection

A combination of communities with low and high utilization of public health care services were targeted from Mopani, Vhembe, and Capricorn Districts. Men aged 18 and older were targeted because they hold a personal responsibility to seek health-related assistance when faced with an illness. A purposive sampling technique was used to select men who never visited public healthcare facilities to utilize healthcare services, and the sample size was determined by data saturation at 17, and an additional 4 men were further interviewed to verify if no new information emerged. Semi-structured interviews were used to collect data during May and June 2024, and a tape recorder was used to record the interviews. The interview schedule was developed by researchers after a literature review, identified gaps, and research questions. The interview schedule was sent to experts in the field for review to ensure the credibility of the collected data. The main questions were 鈥淲hat do you think are the reasons men do not visit health facilities to utilize healthcare services when sick or have conditions that require healthcare intervention?鈥�, 鈥淎s men what do you do to get help when you become sick apart from consulting at health facilities?鈥� and 鈥淲hat do you think should be done to encourage men who do not visit health facilities when sick or have a condition requiring health care intervention to visit health facilities?鈥� as shown in supplementary file A. The interview schedule was developed in English language and translated into Xitsonga, Tshivenda, and Sepedi languages by experts in these languages. The translation was done to allow participants to express views in their languages because the majority speak the above-mentioned languages. Pretesting of the interview schedule was done to determine if the questions were understandable and would enable the participants to provide required responses, and no issues were identified on the data collection tool. Researchers set appointments with men who consented to participate in the study and utilized times that were convenient to the participants. Before interviews, researchers reminded the participants about set appointments and asked if the participants had questions about the study as a way of building relationships with participants to enhance participants comfortability to open up during interviews. On average the interviews lasted between 25听min and 45听min. Prior appointments were set with participants to allow participants to utilize their convenient times. Interviews were conducted at the homes of participants as they felt comfortable in their respective homes.

Data analysis

Collected data were transcribed verbatim by the researchers in Microsoft Word and for Xitsonga, Tshivenda, and Sesotho transcripts were translated to English by language experts in the aforementioned languages. The English transcripts were then read in detail several times, and then codes and themes were manually developed. An independent coder was also engaged for expert guidance and validation of codes and themes that were generated.

Results

The results are presented based on the factors viewed as contributing to poor health-seeking behaviour among men and suggested strategies to improve men鈥檚 health-seeking behaviours. There were a total of two themes that came out of the data gathered from the 21 participants as shown in Table听1. A total of four sub-themes emerged from the two main themes as shown in Table听2.

Table 1 Sociodemographic profile of participants

Theme 1: factors contributing to poor health-seeking behaviour among men

Sub-theme: behavioural factors

Self-medication

The participants reported that they self-medicate when faced with illnesses. They use herbs and over-the-counter medication to cure a disease rather than going to a health facility. The participants further reported that they examine the disease they find themselves with, and the outcome determines whether they visit a health facility or not because they believe that some diseases do not need one to visit a health facility.

Participants said:

鈥淚 run to the pharmacy and buy pills because we are afraid to go to public health facilities because our secret or health status is not safe in most cases, I prefer to self-diagnose when I have a problem, I Google and go to the pharmacy and buy medication鈥� Participant 12, male 34 years old;

鈥�When I have a flue, I go to a spaza shop and buy a med lemon and grandpa and drink, or I steam by boiling water and put Vicks after I will feel ok鈥� Participant 14, male 25-years-old;

鈥沦辞尘别迟颈尘别蝉, when I have a headache that I do not know the causes, there are traditional herbs that I burn and inhale. The headache will stop, and I feel that I am okay without going to the doctor.鈥� Participant 1, 34-year-old male.

Fear of knowing own health status and disease screening

The study findings revealed that men are afraid to undergo screening tests to find out about their health statuses because they do not trust themselves, and as a result, they rely on their partners to know their health statuses.

Participant said:

鈥淲e men have a belief that when a woman is pregnant, they check her this and that, those diseases that we are afraid to know in time that we have them, a woman will find out鈥� Participant 7, Male, 32-year-old;

鈥�Let鈥檚 say I work here, and she works at home, and then I go home, and I hear she is going out with other men. Do you think I will go to the clinic to get a test? No, I cannot go. I am afraid because I do not know if she is sick or not鈥� Participant 15, Male, 41-year-old.

Table 2 Emerged themes

Use of traditional healing services and belief in traditional herbs

The study found that participants consulted traditional healers and used traditional herbs to deal with illnesses or conditions rather than consulting at health facilities. The participants reported that they believed traditional herbs are more effective than Western medicine. They also believed that Western medicine provided in health facilities was not powerful enough to cure a disease compared to traditional herbs.

Participants said:

鈥淭here was a time when I was sick, I did not go to the clinic, I went to a traditional healer to get help鈥� Participant 3, male,33-year-old;

鈥�We believe that pills are not powerful enough to clean drop completely, we believe that traditional herbs are the ones that can cure the disease, that is what makes men not go to clinic to get help in such diseases鈥� Participant 1, male 34-year-old;

鈥淲e men trust African herbs. We think pills do not help us. That is what makes men not be many in hospitals and stay at home because we use African herbs鈥� Participant 16, male,38 years old;

鈥�Most men prefer to use traditional medicine, sometimes is a treatment that is aligned with certain religious beliefs鈥� Participant 12, a male 34-year-old.

Lack of patience

The participants in this study indicated that they cannot stay longer at health facilities and join long queues to see a clinician. They expressed that they want quick service as waiting too long at the facility consumes their time.

Participants said:

鈥沦辞尘别迟颈尘别蝉 as men we are impatient, if I go to the hospital at 8, by 10 I feel it is too late to be still there. Let鈥檚 say the nurse is busy with the patient, men expect that in 10 minutes she is done with the patient so that he goes in. So, if the nurse takes 30 minutes, they think the person took too long鈥� Participant 8, male,30-year-old;

鈥淎nother thing is that men are not people of patience, when they get to the clinic and find long queues, they are not people that will persevere and wait for the queue at the clinic or the hospital鈥� Participant 16, male 38-year-old.

Sub-theme: socio-economic factors

Peers and community elders鈥� influence

The current study revealed participants indicated their friends laughed at them for visiting health facilities to consult and cooperate by showing female clinicians affected areas on their private parts during treatment sessions. Participants also reported that their friends gave them advice, suggested herbs, and medication, and shared experiences on how to deal with the disease. Moreover, the participants indicated that their friends encouraged them to consult traditional healers rather than going to a health facility to consult. The participants also consulted elders within their communities seeking advice on how to deal with certain illnesses and conditions faced at the time.

Participants said:

鈥�In most cases, we men when we are drinking, we talk in our groups where we meet as men, when one has a problem as we talk, one would say I once had that problem, and I have dealt with it in this way, or I know so-and-so who can help you. That is what we men do and find ourselves not going to clinics or hospitals鈥� Participant 9, male, 38-year-old;

鈥淎nother thing is that we men rely on friends or older people whom we think might know about the diseases we have. In the previous years, I once asked elders when I had flue, and they suggested certain herbs and I got them and boiled and drank, and I got cured鈥� Participant 18, male 44-year-old.

The stigma attached to utilizing health services

The current study revealed that participants avoided going to health facilities because of fear of being judged, laughed at, and seen as weak for consulting at health facilities, as a result, men feel embarrassed to consult. Participants reported that attending health facilities for consultation was seen as women鈥檚 behaviour in their communities. To avoid being judged and laughed at, participants verbalized keeping their health issues secret by staying away from health facilities.

Participants said:

鈥淚 can say men are very shy people, men are people who do not want people to know their affairs like their status of health. So, they think that when they go to hospital everybody will see them, and they will be judged for going to the clinic labelled as having certain disease, and they do not want that鈥� Participant 12, male 34-year-old;

鈥淲hat makes us not go to the clinic is an embarrassment, people will say I saw you there, I won鈥檛 have peace of mind鈥� Participant 7, male, 32-year-old;

鈥淲e men are afraid of being laughed at, in most cases, women are in the forefront when there is something or diseases鈥� Participant 3, male,33-year-old.

Sub-theme: cultural factors

Sticking to cultural values

The current study findings discovered that participants avoided going to health facilities to consult because as men they felt uncomfortable showing their private parts to female clinicians. Based on the culture of participants, it is taboo for a man to expose his private parts to a female who is not his wife.

Participants said:

鈥淢en tell themselves that they will not take off clothes for female nurses, they cannot be treated by female nurses, they have pride that they cannot take off clothes for female nurses鈥� Participant 8, male, 30-year-old;

鈥淭he issue here is that as a person when I think that another woman who is not my wife will see my private parts, based on my values, based on my culture it is not good for me to take off my trousers, although they want to help me, according to my culture I do not feel comfortable鈥� Participant 3, male,33-year-old.

Masculinity believes

In cultures of participants, men are perceived as strong and are expected to be resilient even during tough times. Participants also indicated that they were raised and trained to be strong. They avoided utilizing health care services because they did not want to be seen as weak. To conform to masculinity beliefs and societal expectations, participants became stubborn and sacrificed their health to meet societal expectations of being strong.

Participants said:

鈥淲e as men or any men tell ourselves that we are strong, or our body is strong and is not like the body of women, that is what men tell themselves that coughing does not need one to run to the doctor or clinic, it is something that will pass鈥� Participant 1, male 34-year-old;

鈥淯s on our nature, even when we were growing up, we were trained to be strong, as you are strong you will not run to the hospital when you are sick in most cases. Just like me, in a year can I go once or twice鈥� Participant 8, male, 30 years old.

Theme 2: strategies to improve men鈥檚 health-seeking behaviour

Sub-theme: suggested strategies to improve public health care services utilization by men

Implement educational and health promotion campaigns

The current study findings indicate that educational and health promotion campaigns could also be used to encourage men to utilize public health care services. The campaigns could future multidisciplinary teams who are experts in health issues affecting men and provide health education to men. The campaigns could be conducted through community outreach, workplaces, radio stations, and television to address barriers to public health care services utilization among men.

Participants said:

鈥淎lso conduct awareness campaigns by male nurses where men will be taught and encouraged to go to clinics and hospitals and be informed that there are changes where there are male sections. And men will not wait in long queues to see a clinician, that will make it simple for men to go to health facilities to get health services鈥� Participant 13, male, 48-year-old;

鈥淲hat I can say is that DOH should send its people to go around communities conducting awareness campaigns and teach men about the importance of going to hospitals when they have diseases and the same time encourage them not to have pride that they are men, and therefore they will not visit health facilities to receive health services鈥� Participant 11, male, 30-year-old.

Building more health facilities and introducing male-dedicated sections

The current study findings revealed that more health facilities should be built especially in communities where there is none to promote easy access to health services and reduce waiting times at facilities that are serving many communities. Participants also suggested that male dedicated sections at health facilities should be introduced to serve men and this section will consist of male clinicians reserved to provide health services to male patients.

Participants said:

鈥淭his one I will place it on DOH, let them try by all means that in villages and places, there should be enough clinics and hospitals so that patients do not have to spend too much time鈥� Participant 9, male, 38-year-old;

鈥淟ike at hospital there is a room for children, so if we as men too in every clinic can have a room where we get help so that men can go and get help鈥� Participant 8, Male, 30-year-old.

Employ more male-motivated clinicians

The current study findings revealed that there is a need to recruit more males in the nursing profession to accommodate male patients when visiting healthcare facilities. Participants also suggested that employees should be motivated so that they can be able to treat patients well.

Participants said:

鈥淎t hospitals or clinics, they should add male nurses and have a section where men will consult鈥� Participant 13, male, 48-year-old;

鈥淚 will also say to our nurses, especially public clinics and hospitals, treat patients well, because once you harshly talk with a patient, when the patient is out he will talk about it that a nurse said these words to me, even the others when they get sick they will be afraid to go clinic because they think the nurses will be hash on them鈥� Participant 9, male, 38-year-old.

Challenge societal norms and upbringing of men

The current study findings also suggest that society鈥檚 view of men as strong beings should be challenged so that men are also viewed as beings that need help when faced with health conditions and other situations. The way men are raised should also be changed such that men are not groomed and taught to be strong as this affects their health-seeking behaviour when faced with health conditions.

Participant said:

I think if we can change the way that men are being raised. The upbringing of men, even the social standards would change because most social standards are based on how we came over some time, whatever we were told as we grow up, ends up being a norm, and it ends up being a part of our values,鈥� Participant 6, male, 30-year-old.

Discussion

Based on this study鈥檚 findings, participants were of different ages with the youngest being 25 while the oldest was 52-year-old. Eleven participants were married while ten were single, and they held different educational levels ranging from primary to tertiary. Twelve of the participants were employed, one was self-employed and eight were unemployed. Participants had a variety of reasons not to visit public health facilities to utilize provided services. The reasons were classified as behavioural, socio-economic, and cultural factors. Participants believed that they were strong and ignored the disease at hand. The participants reported buying over-the-counter medication at spaza shops and pharmacies and utilizing herbs to self-treat illnesses they faced. They believed that there are diseases that do not need one to consult at health facilities because they can be managed. These findings are supported by Olanrewaju et al. (2019 [14] who discovered that men prefer self-medication and other alternatives before going to see healthcare professionals.

Participants feared knowing their own health status and screening for diseases, and as a result, they avoided consulting public health facilities to keep their health issues secret. Participants relied on their partners who would go for disease screening to know their health status. These findings are in line with the findings of Mak et al. (2016) [15] who found that men in their study reported fear of knowing about their health status, particularly HIV status, and relied on their partner鈥檚 test results as a proxy for their status rather than to test themselves. In another study by Camlin et al. (2016) [16] men avoided testing for HIV due to the associations of HIV with sexual promiscuity, and the concerns they had surrounding their potential risks due to marital infidelities This implies that men still find it difficult to accept health issues that may be affecting them and open up about their health issues to significant others. They think they will be judged or blamed and may be seen as weak for utilizing health facilities. This makes it difficult to curb the spread of transmittable diseases such as STIs as participants remain undiagnosed due to their low engagement with health care services. Those who may be diagnosed with an illness, are likely not to receive support when enrolled in a treatment course because partners and close friends are not aware of the health condition one may be dealing with. Participants consulted traditional healers to address health conditions, and their actions were influenced by their trust in traditional herbs that they worked better than Western medicine. Opting for traditional healers was also influenced by a lack of trust in public health workers to safeguard participants鈥� health statuses. This implies that participants lacked information about the efficacy of Western medication in curing diseases that men are likely to face. These findings are in line with the findings of Mak et al. (2016) [15] who found that men preferred traditional healers for care rather than consulting at health facilities. The findings are also supported by Uwimana et al. (2023) [10] who found that men in their study reported not having trust in the public health care workers. It implies that strategies to instil public trust in health workers should be strengthened and continuously monitored. Participants also avoided utilizing public health facilities because they did not want to take treatment for a long time. This explains why men do not finish treatment courses when diagnosed with conditions that require them to be put on treatment. These study findings are supported by Nagaddya Lubega et al. (2015) [4] who found that many people including men never complete the prescribed dose or even use the right medicine for specific illnesses. Participants reported being impatient during facility visits which implies that participants considered other alternatives rather than visiting public health facilities when faced with an illness to avoid spending time waiting at the facility before getting assistance. These findings concur with the findings of Mthembu (2015) [9] who discovered that men who were participants in his study avoided visiting public health facilities because of the long waiting period before getting assisted.

Participants consulted their peers and elders instead of visiting health facilities. Consulting close friends and elders for help during times of sickness puts participants at risk of being misinformed about the solution to the sickness as those giving advice might not be a qualified health professional. Some of the herbs and substances recommended for use have not been assessed to establish if they are safe for use and may affect participants鈥� health. This implies the need to encourage participants to avoid consulting peers and other unqualified persons when faced with an illness other than consulting at health facilities.

The findings revealed that the culture of participants influenced them to avoid using public health services because they did not want to be seen as weak and felt uncomfortable presenting private parts for physical examination by female nurses. This means that men who conform to their cultural values and masculinity beliefs that a real man does not fall sick and are strong are likely not to seek health care when faced with a health condition. Presenting private parts to a female who is not a participant鈥檚 partner remains one of the key issues affecting participants when there is a need to visit public health facilities for sexual health services. This means male nurses to serve men should be added to public facilities and dedicated to male patients. These findings concur with findings from Nagaddya Lubega et al. (2015) [4] who found that men who believe in masculinity did not seek health care when faced with illnesses, and Mak et al. (2016) [15] who discovered that men in their study reported feeling embarrassed to have their private parts physically examined by young female nurses and resulted in men not disclosing true reasons for their visit and became hesitant to seek health care.

Participants suggested the implementation of educational and health promotion campaigns to address issues about men鈥檚 health and barriers to healthcare utilization. The campaigns could be delivered through community outreach, workplaces, radio stations, and television. Building more health facilities and introducing male-dedicated sections was also proposed. Male-dedicated sections are hoped to encourage participants to utilize public health services. The findings also indicate that recruiting more male clinicians was suggested as another strategy that could be used to encourage participants to utilize public health services. Participants also suggested challenging societal norms that discourage me from engaging with public health services.

This current study shared information on factors contributing to poor health-seeking behaviour among men in Mopani, Vhembe, and Capricorn district municipalities of Limpopo province which are rural districts and did not include foreign nationals. Future research could focus on men residing in townships and foreign nationals. For practice, myths around the effectiveness of Western medicine compared to traditional herbs should be addressed so that participants possess correct information about the effectiveness of Western medicine in curing diseases that men are likely to face. There is a need to incorporate culture when developing policies that guide the provision of primary health care services to men.

Strengths and limitations of the study

The main strength of this study was its ability to identify behavioural factors contributing to men鈥檚 poor health-seeking behaviour which in most of the conducted studies, did not come out well as this study described the factors. Most of the previous studies identified factors attributed to culture and socio-economic factors. Regarding limitations, the researchers did not have enough funds to travel to participants who were located in remote areas within the study setting which resulted in the exclusion of those participants. The researchers believe that such participants would have shared a different view on factors contributing to men鈥檚 poor health-seeking behaviour in their areas which might be different from views shared by interviewed participants. Furthermore, this study focused on men residing in rural areas and the findings on factors contributing to men鈥檚 poor health-seeking behaviour may not apply to men residing in urban areas.

Conclusion

This study pointed out several factors that contribute to men鈥檚 poor health-seeking behaviour. Self-treating of disease at hand, fear of knowing own health status, use of traditional healers, consulting friends and elders within the community, as well as sticking to cultural values are among the factors that contribute to men鈥檚 poor health-seeking behaviour. Educational and health promotion campaigns, introducing male-dedicated sections in health facilities, and employing more male-motivated clinicians have been recommended as some of the ways that could improve men鈥檚 health-seeking behaviour. There is also a need to challenge masculinity beliefs as some of the factors that contribute to poor health-seeking behaviour among men. Community education could also help reduce stigma attached to using health facilities and more men could find it easy to visit health facilities. Suggested strategies should be piloted with proper monitoring and evaluation to see if men鈥檚 health-seeking behaviour improves.