Men’s views on factors contributing to their poor health-seeking behavior in Limpopo Province, South Africa

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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. 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’s eight steps were used to analyze 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 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’s health-seeking behavior. Conclusions: It is evident from the findings that there are several factors that act as barriers for men to seek health care services at public health facilities. There is a need to challenge societal views of men and masculinity beliefs to improve men’s health-seeking behavior. Factors Health care services Health-seeking behavior Men Views Introduction and 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 of [ 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 behavior which further exposes them to deadly diseases, such as STDs, lung cancer, and mental illness. If poor health-seeking behavior 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 [ 9 , 10 , 11 ] on factors contributing to men’s poor health-seeking behavior, 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 behavior among men. In this study, 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. A qualitative descriptive study was conducted in the Mopani, Vhembe, and Capricorn districts. A qualitative design was used to describe 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. Study Setting 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 15–29 minutes to reach the nearest health facility [ 13 ]. Consulting traditional healers is another health treatment option available, and it has been practiced for decades. Study Population and Sampling 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 help 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. Data Collection Tools 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 in English language and translated into Xitsonga, Tshivenda, and Sepedi languages by experts in these languages and was used to guide the interviews. The translation was done to allow participants to express views in their languages because the majority speak above mentioned languages. On average the interviews lasted between 25 minutes to 45 minutes. 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 Management and 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 behavior among men and suggested strategies to improve men’s health-seeking behaviors. There were a total of two themes that came out of the data gathered from the participants. A total of four sub-themes emerged from the two main themes (Table 1 ). Theme 1 Factors contributing to poor health-seeking behavior among men Sub-theme: Behavioral factors Self-medication The participants indicated that they self-medicate when faced with illnesses. They buy over-the-counter medication at spaza shops and pharmacies and utilize it to cure the disease at hand rather than going to a health facility. The participants further believe that they examine the disease they find themselves with and that determines if one will visit a facility or not because they believe that there are some diseases that do not need one to visit a health facility. Participants said: “In some conditions, I exercise on diseases like flue and steam to fight flue in that way, another thing is I 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” (Participant 12, male 34 years old) “Most men believe that there are diseases that do not need hospitals or clinics. I just do not know which knowledge they were using to see that this disease does not need a hospital or clinic, if you do something the disease will go away” ( Participant 17, Male 39 years old) Fear of knowing own health status and disease screening The study findings revealed that men are afraid about undergoing screening tests to find out about their health status, as a result, men rely on their partners to know their health status. They indicated that they believe that once their partners test negative, it means they are also fine and do not have the disease their partners screened for. Participant said: “What mostly makes us, we 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. There is a belief that a woman will find out. Especially when she is pregnant, she will be tested always and go through the process” (Participant 7, Male, 32 years old) Use of traditional healing services and belief in traditional meds The study found that participants used traditional healing to deal with illness or conditions over consulting at health facilities. The participants reported that they believed that traditional herbs are more effective than Western medications. They believe that Western medication that is provided in health facilities freezes the disease rather than curing the disease. Participants also lacked trust in health workers. The traditional meds were inhaled, drank, and consumed through steaming. The participants further indicated that they believed traditional healers were knowledgeable. The participants also indicated that they avoid going to health facilities to avoid having prescribed and given medication that they need to take for longer periods. As a result, they opt for traditional healers where they are given herbs that they will take for a short period. Participants said: “I am saying this because even myself there was a time I was sick I did not go to the clinic, I went to a traditional healer to get help ” (Participant 3, male,33 years old) “A person feels that he is coughing and fails to run to the hospital to get help and tells himself that is better I make traditional meds by myself or traditional medicine and drink and get cured” (Participant 1, male 34 years old) “We men trust African medicine. 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 medicines ” (Participant 16, male,38 years old) “I tell myself that if I go to the clinic, they will give me pills and I will have to take pills the whole week, but I know that if I go to a traditional healer for drop (gonorrhea), I know in 1 or 2 days I will be ok” (Participant 19, Male, 46 years old) Lack of patience The participants in this current study indicated that they cannot stay longer at health facilities and join long queues to be seen by a clinician. They expressed that they want quick service as waiting too long at the facility consumes their time. Participants said: “Sometimes 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's 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 too long” (Participant 8, male,30 years old) “Another thing is that men are not people of patience like when they get to the clinic and find long queues, they are not people that will bear and wait for the queue at the clinic or at the hospital” ( Participant 16, male 38 years old) Sub-theme Socio-economic factors Peers and community elders’ influence The current study revealed participants indicated their friends laughed at them for visiting health facilities to consult and cooperate such as showing female clinicians affected areas on their private parts during treatment sessions. Participants also reported that their friends gave them advice, suggested medication, and shared experiences on how to deal with the disease. The participants also reported their friends encouraged them not to agree to show female clinicians their private parts when affected during treatment sessions. Moreover, the participants indicated that their friends encouraged them to utilize traditional healing services 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 conditions that men faced at the time. Participants said: “ ehh I can say ehh 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, he will say I have 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 ” (Participant 9, male, 38 years old) “Another thing is that we men rely on friends or older people whom we think might have knowledge about the diseases we have. In the previous years, I once asked one of them when I had flue and suggested certain herbs and I got them and boiled and drank and I got cured ” (Participant 18, male 44, years 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 faculties for consultation was seen as women’s behavior 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: “I 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 the person will judge them that they are going to the clinic because they have a certain disease and they do not want that” (Participant 12, male 34 years old) Participants said: “What makes us not go to the clinic is an embarrassment, people will say I saw you there, I saw you there, I won’t have peace of mind” ( Participant 7, male, 32 years old) “We men are afraid of being laughed at, in most cases, women are in the forefront when there is something or diseases ” (Participant 3, male,33 years 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 reported that they felt they would be judged by female nurses after seeing their private parts. Participants also indicated that they do not want to be touched by female nurses. Participants said: “Men tell themselves that they will not take off clothes for women they cannot be treated by women, they have bride that they cannot take off clothes for women” (Participant 8, male, 30 years old) “When a men have a wound on their private parts, most men are afraid to take off their trousers for the female person to examine” (Participant 13, male, 48 years old) “The 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 trouser although they want to help me, according to my culture I do not feel comfortable” (Participant 3, male,33 years 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: “We 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 ” (Participant 1, male 34 years old) “Us 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 you can go once twice” (Participant 8, male, 30 years old) Table 1 Emerging themes Theme Sub-themes Categories Views of men on factors contributing to poor health-seeking behavior among men Behavioral factors -Self-medication -Fear of health status and disease screening -Use of traditional healing services and believe in traditional meds -Lack of patience during facility attendance socio-economic factors -Peer, family, and community influence -Stigma attached to utilizing health services Cultural factors -Sticking to cultural values -Masculinity believes Strategies to improve men’s health-seeking behavior Suggested strategies to improve men’s public health services utilization -Implement educational and Health promotion campaigns -Build more health facilities and introduce of male dedicated sections -Employ male motivated clinicians -Challenge societal norms and masculinity beliefs Theme 2:Strategies to improve men’s health-seeking behavior 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 multi-disciplinary teams who are experts in health issues affecting men and provide health education to men. The campaigns could be conducted through community outreach, workplace, radio stations, and television to address barriers to public health care services utilization among men. Participants said: “Also 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 ques to see a clinician, that will make it simple for men to go to health facilities to get health services” (Participant 13, male, 48 years old) “What 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 ” (Participant 11, male, 30 years 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: “This 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” ( Participant 9, male, 38 years old) “Like at hospital there is a room for children, this consultation rooms not mix, so if us as men too in every clinic can have a room where we get help so that men can go and get help” (Participant 8, Male, 30 years 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: “At hospitals or clinics, they should add male nurses and have a section where men will consult” (Participant 13, male, 48 years old) “I 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” (Participant 9, male, 38 years old) Challenge societal norms and upbringing of men The current study findings also suggest that society’s 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 behavior 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 a period of time, whatever we were told as we grow up, ends up being a norm and it ends up being a part of our values,” (Participant 6, male, 30 years old) Discussion Based on this study's findings, participants had a variety of reasons not to visit public health facilities to utilize provided services. The reasons were classified as behavioral, 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 manage on their own. These findings are supported by [ 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 [ 15 ] who found that men in their study reported fear of knowing about their health status, particularly HIV status, and relied on their partner’s test results as a proxy for their status than to test themselves. In another study by [ 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 action 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' 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 [ 15 ] who found that men preferred traditional healers for care rather than consulting at health facilities. The findings are also supported by [ 10 ] who found that men in their study reported not having trust in the public health care workers. It implies that strategies to instill 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 [ 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 [ 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' 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’s 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 [ 4 ] who found that men who believe in masculinity did not seek health care when faced with illnesses, and [ 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 pertaining to men’s 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 in information on factors contributing to poor health-seeking behavior 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 PHC services to men. However, the study was limited because the researchers did not have enough funds to travel to some participants that were located in some remote areas within the study setting and such participants were then excluded due to their accessibility, thus the researchers believe that those participants in remote areas would have also shared views on factors affecting seeking health-seeking behaviors in their areas which might be different from views shared by interviewed participants. The researchers also had limited time to engage with participants due to delays in getting permission to access participants from the headmen of the communities. This study focused on men residing in rural areas and the findings may not be applied to men residing in urban areas. Conclusion It is evident from the findings that several factors act as barriers for men to seek health care at public health facilities. Personal beliefs, traditional practices, culture, and society play a significant role in men’s health-seeking behaviors. If the barriers are not addressed, men are likely to continue to lag behind in seeking care during illness. There is a need to challenge societal views of men and masculinity beliefs, employ more male nurses in public health facilities, and improve staff conduct to improve men’s health-seeking behavior. Abbreviations PHC Primary Health Care STDs Sexually Transmitted Diseases Declarations Ethical Approval and Consent to Participate The study was conducted guided by guidelines outlined in the Helsinki Declaration and ethical approval was granted by the University of Venda's Ethics Clearance Committee (Ethics Approval Number: FHS/21/PH/26/1215). Permission to conduct the study was obtained from traditional leaders (headmen and chiefs) of sampled communities. Individual male participants gave informed consent to participate in the study prior interview. Consent for publication Not Applicable Availability of data and material Not applicable Competing Interests The authors declare that they do not have a competing interest Funding This project was supported by the National Research Foundation (NRF). The funder paid for tuition fees related to these PhD studies of author 1. However, the researchers covered for resources needed to execute the study. Authors' contributions L Chavalala contributed to the formulation of the study, drafting protocol, data collection, analysis, interpretation of data, and drafting of the manuscript. Rachel Tsakane Lebese contributed to designing the protocol, validating transcripts, interpreting data, and drafting the manuscript Lufuno Makhado contributed to designing the protocol, validating transcripts, interpreting data, and drafting the manuscript References Word Health Organization. Global Health Observatory. In: Organization WH, ed. Geneva. 2018. Australian Institute of Health and Welfare. 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Sex Health. 2016;13(3):265–74. https://doi.org/10.1071/SH15244 . Camlin CS, Ssemmondo E, Chamie G, El Ayadi AM, Kwarisiima D, Sang N, Kabami J, Charlebois E, Petersen M, Clark TD, Bukusi EA, Cohen CR, Kamya R, Havlir M, SEARCH Collaboration. Men missing from population-based HIV testing: insights from qualitative research. AIDS Care. 2016;28(Suppl 3):67–73. PMID: 27421053; PMCID: PMC5749410. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 Jan, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 20 Sep, 2024 Editor assigned by journal 19 Sep, 2024 Submission checks completed at journal 19 Sep, 2024 First submitted to journal 16 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5099686","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":356837304,"identity":"2abc250d-701f-41d9-a805-b2c30a330801","order_by":0,"name":"Lazarros Chavalala","email":"data:image/png;base64,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","orcid":"","institution":"University of Venda","correspondingAuthor":true,"prefix":"","firstName":"Lazarros","middleName":"","lastName":"Chavalala","suffix":""},{"id":356837309,"identity":"e348bc19-3758-45e2-8680-41a2b58b5c59","order_by":1,"name":"Rachele Tsakane Lebese","email":"","orcid":"","institution":"University of Venda","correspondingAuthor":false,"prefix":"","firstName":"Rachele","middleName":"Tsakane","lastName":"Lebese","suffix":""},{"id":356837310,"identity":"706ac0b0-8f8d-4c04-b3f7-dc43aadcc738","order_by":2,"name":"Lufuno Makhado","email":"","orcid":"","institution":"University of Venda","correspondingAuthor":false,"prefix":"","firstName":"Lufuno","middleName":"","lastName":"Makhado","suffix":""}],"badges":[],"createdAt":"2024-09-16 21:41:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5099686/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5099686/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-21283-9","type":"published","date":"2025-01-08T15:57:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73694054,"identity":"7a334b1f-2de7-49d9-895e-eee7c85d0245","added_by":"auto","created_at":"2025-01-13 16:10:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":895046,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5099686/v1/cd05abea-bb88-4385-bf50-b2c1f8fe4c2b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Men’s views on factors contributing to their poor health-seeking behavior in Limpopo Province, South Africa","fulltext":[{"header":"Introduction and background","content":"\u003cp\u003eMen 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 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The urgency of responding to health concerns differs between men and women [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The study of [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] 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 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 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 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. 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 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, the majority of men remain undiagnosed for HIV and other sexually transmitted diseases (STDs) due to the underutilization of health services [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. 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 behavior which further exposes them to deadly diseases, such as STDs, lung cancer, and mental illness.\u003c/p\u003e \u003cp\u003eIf poor health-seeking behavior 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 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Despite the availability of studies conducted by [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] on factors contributing to men\u0026rsquo;s poor health-seeking behavior, there is less evidence on studies conducted within Limpopo province in Mopani, Vhembe and Capricorn district municipalities.\u003c/p\u003e \u003cp\u003eDue 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 behavior among men. In this study, we report findings from 21 men interviewed to find out reasons they did not attend health facilities to utilize public health care services.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eStudy design.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA qualitative descriptive study was conducted in the Mopani, Vhembe, and Capricorn districts. A qualitative design was used to describe 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.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eThis 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 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Most of the residents in Limpopo take about 15\u0026ndash;29 minutes to reach the nearest health facility [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Consulting traditional healers is another health treatment option available, and it has been practiced for decades.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003eA 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 help 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.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eSemi-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 in English language and translated into Xitsonga, Tshivenda, and Sepedi languages by experts in these languages and was used to guide the interviews. The translation was done to allow participants to express views in their languages because the majority speak above mentioned languages. On average the interviews lasted between 25 minutes to 45 minutes. 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.\u003c/p\u003e\n\u003ch3\u003eData Management and Analysis\u003c/h3\u003e\n\u003cp\u003eCollected 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.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe results are presented based on the factors viewed as contributing to poor health-seeking behavior among men and suggested strategies to improve men\u0026rsquo;s health-seeking behaviors. There were a total of two themes that came out of the data gathered from the participants. A total of four sub-themes emerged from the two main themes (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1 Factors contributing to poor health-seeking behavior among men\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme: Behavioral factors\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section4\"\u003e \u003ch2\u003eSelf-medication\u003c/h2\u003e \u003cp\u003eThe participants indicated that they self-medicate when faced with illnesses. They buy over-the-counter medication at spaza shops and pharmacies and utilize it to cure the disease at hand rather than going to a health facility. The participants further believe that they examine the disease they find themselves with and that determines if one will visit a facility or not because they believe that there are some diseases that do not need one to visit a health facility.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;In some conditions, I exercise on diseases like flue and steam to fight flue in that way, another thing is I 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\u0026rdquo;\u003c/em\u003e (Participant 12, male 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Most men believe that there are diseases that do not need hospitals or clinics. I just do not know which knowledge they were using to see that this disease does not need a hospital or clinic, if you do something the disease will go away\u0026rdquo; (\u003c/em\u003eParticipant 17, Male 39 years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFear of knowing own health status and disease screening\u003c/h2\u003e \u003cp\u003eThe study findings revealed that men are afraid about undergoing screening tests to find out about their health status, as a result, men rely on their partners to know their health status. They indicated that they believe that once their partners test negative, it means they are also fine and do not have the disease their partners screened for.\u003c/p\u003e \u003cp\u003eParticipant said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;What mostly makes us, we 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. There is a belief that a woman will find out. Especially when she is pregnant, she will be tested always and go through the process\u0026rdquo;\u003c/em\u003e (Participant 7, Male, 32 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eUse of traditional healing services and belief in traditional meds\u003c/h2\u003e \u003cp\u003eThe study found that participants used traditional healing to deal with illness or conditions over consulting at health facilities. The participants reported that they believed that traditional herbs are more effective than Western medications. They believe that Western medication that is provided in health facilities freezes the disease rather than curing the disease. Participants also lacked trust in health workers. The traditional meds were inhaled, drank, and consumed through steaming. The participants further indicated that they believed traditional healers were knowledgeable. The participants also indicated that they avoid going to health facilities to avoid having prescribed and given medication that they need to take for longer periods. As a result, they opt for traditional healers where they are given herbs that they will take for a short period.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I am saying this because even myself there was a time I was sick I did not go to the clinic, I went to a traditional healer to get help\u003c/em\u003e\u0026rdquo; (Participant 3, male,33 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;A person feels that he is coughing and fails to run to the hospital to get help and tells himself that is better I make traditional meds by myself or traditional medicine and drink and get cured\u0026rdquo;\u003c/em\u003e (Participant 1, male 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We men trust African medicine. 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 medicines\u003c/em\u003e\u0026rdquo; (Participant 16, male,38 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I tell myself that if I go to the clinic, they will give me pills and I will have to take pills the whole week, but I know that if I go to a traditional healer for drop (gonorrhea), I know in 1 or 2 days I will be ok\u0026rdquo;\u003c/em\u003e (Participant 19, Male, 46 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLack of patience\u003c/h2\u003e \u003cp\u003eThe participants in this current study indicated that they cannot stay longer at health facilities and join long queues to be seen by a clinician. They expressed that they want quick service as waiting too long at the facility consumes their time.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes 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's 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 too long\u0026rdquo;\u003c/em\u003e (Participant 8, male,30 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Another thing is that men are not people of patience like when they get to the clinic and find long queues, they are not people that will bear and wait for the queue at the clinic or at the hospital\u0026rdquo; (\u003c/em\u003eParticipant 16, male 38 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme Socio-economic factors\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003ePeers and community elders\u0026rsquo; influence\u003c/h2\u003e \u003cp\u003eThe current study revealed participants indicated their friends laughed at them for visiting health facilities to consult and cooperate such as showing female clinicians affected areas on their private parts during treatment sessions. Participants also reported that their friends gave them advice, suggested medication, and shared experiences on how to deal with the disease. The participants also reported their friends encouraged them not to agree to show female clinicians their private parts when affected during treatment sessions. Moreover, the participants indicated that their friends encouraged them to utilize traditional healing services 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 conditions that men faced at the time.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eehh I can say ehh 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, he will say I have 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\u003c/em\u003e\u0026rdquo; (Participant 9, male, 38 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Another thing is that we men rely on friends or older people whom we think might have knowledge about the diseases we have. In the previous years, I once asked one of them when I had flue and suggested certain herbs and I got them and boiled and drank and I got cured\u003c/em\u003e\u0026rdquo; (Participant 18, male 44, years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eThe stigma attached to utilizing health services\u003c/h2\u003e \u003cp\u003eThe 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 faculties for consultation was seen as women\u0026rsquo;s behavior in their communities. To avoid being judged and laughed at, participants verbalized keeping their health issues secret by staying away from health facilities.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I 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 the person will judge them that they are going to the clinic because they have a certain disease and they do not want that\u0026rdquo;\u003c/em\u003e (Participant 12, male 34 years old)\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;What makes us not go to the clinic is an embarrassment, people will say I saw you there, I saw you there, I won\u0026rsquo;t have peace of mind\u0026rdquo; (\u003c/em\u003e Participant 7, male, 32 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We men are afraid of being laughed at, in most cases, women are in the forefront when there is something or diseases\u003c/em\u003e\u0026rdquo; (Participant 3, male,33 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Cultural factors\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eSticking to cultural values\u003c/h2\u003e \u003cp\u003eThe 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 reported that they felt they would be judged by female nurses after seeing their private parts. Participants also indicated that they do not want to be touched by female nurses.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Men tell themselves that they will not take off clothes for women they cannot be treated by women, they have bride that they cannot take off clothes for women\u0026rdquo;\u003c/em\u003e (Participant 8, male, 30 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When a men have a wound on their private parts, most men are afraid to take off their trousers for the female person to examine\u0026rdquo;\u003c/em\u003e (Participant 13, male, 48 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The 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 trouser although they want to help me, according to my culture I do not feel comfortable\u0026rdquo;\u003c/em\u003e (Participant 3, male,33 years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eMasculinity believes\u003c/h2\u003e \u003cp\u003eIn 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.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We 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\u003c/em\u003e\u0026rdquo; (Participant 1, male 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Us 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 you can go once twice\u0026rdquo;\u003c/em\u003e (Participant 8, male, 30 years old)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEmerging themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eViews of men on factors contributing to poor health-seeking behavior among men\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBehavioral factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-Self-medication\u003c/p\u003e \u003cp\u003e-Fear of health status and disease screening\u003c/p\u003e \u003cp\u003e-Use of traditional healing services\u0026nbsp;and believe in traditional meds\u003c/p\u003e \u003cp\u003e-Lack of patience during facility attendance\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esocio-economic factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-Peer, family, and community influence\u003c/p\u003e \u003cp\u003e-Stigma attached to utilizing health services\u003c/p\u003e\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCultural factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-Sticking to cultural values\u003c/p\u003e \u003cp\u003e-Masculinity believes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStrategies to improve men\u0026rsquo;s health-seeking behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuggested strategies to improve men\u0026rsquo;s public health services utilization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-Implement educational and Health promotion campaigns\u003c/p\u003e \u003cp\u003e-Build more health facilities and introduce of male dedicated sections\u003c/p\u003e \u003cp\u003e-Employ male motivated clinicians\u003c/p\u003e \u003cp\u003e-Challenge societal norms and masculinity beliefs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2:Strategies to improve men\u0026rsquo;s health-seeking behavior\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme Suggested strategies to improve public health care services utilization by men\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section4\"\u003e \u003ch2\u003eImplement educational and health promotion campaigns\u003c/h2\u003e \u003cp\u003eThe 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 multi-disciplinary teams who are experts in health issues affecting men and provide health education to men. The campaigns could be conducted through community outreach, workplace, radio stations, and television to address barriers to public health care services utilization among men.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Also 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 ques to see a clinician, that will make it simple for men to go to health facilities to get health services\u0026rdquo;\u003c/em\u003e (Participant 13, male, 48 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;What 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\u003c/em\u003e\u0026rdquo; (Participant 11, male, 30 years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eBuilding more health facilities and introducing male-dedicated sections\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;This 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\u0026rdquo; (\u003c/em\u003eParticipant 9, male, 38 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Like at hospital there is a room for children, this consultation rooms not mix, so if us as men too in every clinic can have a room where we get help so that men can go and get help\u0026rdquo;\u003c/em\u003e (Participant 8, Male, 30 years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eEmploy more male-motivated clinicians\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eParticipants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;At hospitals or clinics, they should add male nurses and have a section where men will consult\u0026rdquo;\u003c/em\u003e (Participant 13, male, 48 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I 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\u0026rdquo;\u003c/em\u003e (Participant 9, male, 38 years old)\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eChallenge societal norms and upbringing of men\u003c/h2\u003e \u003cp\u003eThe current study findings also suggest that society\u0026rsquo;s 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 behavior when faced with health conditions.\u003c/p\u003e \u003cp\u003eParticipant said:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI 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 a period of time, whatever we were told as we grow up, ends up being a norm and it ends up being a part of our values,\u0026rdquo;\u003c/em\u003e (Participant 6, male, 30 years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on this study's findings, participants had a variety of reasons not to visit public health facilities to utilize provided services. The reasons were classified as behavioral, 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 manage on their own. These findings are supported by [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] who discovered that men prefer self-medication and other alternatives before going to see healthcare professionals.\u003c/p\u003e \u003cp\u003eParticipants 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 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] who found that men in their study reported fear of knowing about their health status, particularly HIV status, and relied on their partner\u0026rsquo;s test results as a proxy for their status than to test themselves. In another study by [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] 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\u003c/p\u003e \u003cp\u003eParticipants consulted traditional healers to address health conditions, and their action 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' 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 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] who found that men preferred traditional healers for care rather than consulting at health facilities. The findings are also supported by [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] who found that men in their study reported not having trust in the public health care workers. It implies that strategies to instill 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 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] 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 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] who discovered that men who were participants in his study avoided visiting public health facilities because of the long waiting period before getting assisted.\u003c/p\u003e \u003cp\u003eParticipants 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' 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.\u003c/p\u003e \u003cp\u003eThe 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\u0026rsquo;s 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 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] who found that men who believe in masculinity did not seek health care when faced with illnesses, and [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] 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.\u003c/p\u003e \u003cp\u003eParticipants suggested the implementation of educational and health promotion campaigns to address issues pertaining to men\u0026rsquo;s 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.\u003c/p\u003e \u003cp\u003eThis current study shared in information on factors contributing to poor health-seeking behavior 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 PHC services to men. However, the study was limited because the researchers did not have enough funds to travel to some participants that were located in some remote areas within the study setting and such participants were then excluded due to their accessibility, thus the researchers believe that those participants in remote areas would have also shared views on factors affecting seeking health-seeking behaviors in their areas which might be different from views shared by interviewed participants. The researchers also had limited time to engage with participants due to delays in getting permission to access participants from the headmen of the communities. This study focused on men residing in rural areas and the findings may not be applied to men residing in urban areas.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIt is evident from the findings that several factors act as barriers for men to seek health care at public health facilities. Personal beliefs, traditional practices, culture, and society play a significant role in men\u0026rsquo;s health-seeking behaviors. If the barriers are not addressed, men are likely to continue to lag behind in seeking care during illness. There is a need to challenge societal views of men and masculinity beliefs, employ more male nurses in public health facilities, and improve staff conduct to improve men\u0026rsquo;s health-seeking behavior.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary Health Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexually Transmitted Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical\u0026nbsp;Approval\u0026nbsp;and\u0026nbsp;Consent\u0026nbsp;to\u0026nbsp;Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted guided by guidelines outlined in the Helsinki Declaration and ethical approval was granted by the University of Venda\u0026apos;s Ethics Clearance Committee (Ethics Approval Number:\u0026nbsp;FHS/21/PH/26/1215). Permission to conduct the study was obtained from traditional leaders (headmen and chiefs) of sampled communities. Individual male participants gave informed consent to participate in the study prior interview. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u0026nbsp;for\u0026nbsp;publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot\u0026nbsp;Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability\u0026nbsp;of\u0026nbsp;data\u0026nbsp;and\u0026nbsp;material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting\u0026nbsp;Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;authors declare\u0026nbsp;that they do not have a competing interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was supported by the National Research Foundation (NRF). The funder paid for tuition fees related to these PhD studies of author 1. However, the researchers covered for resources needed to execute the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL Chavalala contributed to the formulation of the study, drafting protocol, data collection, analysis, interpretation of data, and drafting of the manuscript.\u003c/p\u003e\n\u003cp\u003eRachel Tsakane Lebese contributed to designing the protocol, validating transcripts, interpreting data, and drafting the manuscript\u003c/p\u003e\n\u003cp\u003eLufuno Makhado contributed to designing the protocol, validating transcripts, interpreting data, and drafting the manuscript\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWord Health Organization. Global Health Observatory. In: Organization WH, ed. 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PMID: 27421053; PMCID: PMC5749410.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Factors, Health care services, Health-seeking behavior, Men, Views","lastPublishedDoi":"10.21203/rs.3.rs-5099686/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5099686/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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. 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\u0026rsquo;s eight steps were used to analyze 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\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSelf-medication, fear of knowing own health status, peer and community elders 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\u0026rsquo;s health-seeking behavior.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eIt is evident from the findings that there are several factors that act as barriers for men to seek health care services at public health facilities. There is a need to challenge societal views of men and masculinity beliefs to improve men\u0026rsquo;s health-seeking behavior.\u003c/p\u003e","manuscriptTitle":"Men’s views on factors contributing to their poor health-seeking behavior in Limpopo Province, South Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-11 15:18:23","doi":"10.21203/rs.3.rs-5099686/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-20T12:32:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-19T11:29:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-19T11:28:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-09-16T21:39:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e5671a9-240e-4650-86d0-95e6f2c3370b","owner":[],"postedDate":"November 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:04:12+00:00","versionOfRecord":{"articleIdentity":"rs-5099686","link":"https://doi.org/10.1186/s12889-025-21283-9","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-01-08 15:57:51","publishedOnDateReadable":"January 8th, 2025"},"versionCreatedAt":"2024-11-11 15:18:23","video":"","vorDoi":"10.1186/s12889-025-21283-9","vorDoiUrl":"https://doi.org/10.1186/s12889-025-21283-9","workflowStages":[]},"version":"v1","identity":"rs-5099686","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5099686","identity":"rs-5099686","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}