Ecological model of Australian Indigenous men’s health

Authors McCabe MP, Mellor D, Ricciardelli LA, et al.

Review Date June 2015

Citation American Journal of Men’s Health 2015; DOI: 10.1177/1557988315583086 [Epub ahead of print]

Background

Indigenous men’s health is significantly poorer than that of non-Indigenous men in Australia; life expectancy is 11.5 years shorter. To close this gap it is important to understand the facilitators and barriers to health among Indigenous men. An ecological approach to understanding Indigenous health recognises both lifestyle and societal factors, and enables the design of intervention and prevention programs that are socially and culturally appropriate.

Aim

To assess young Indigenous Australian men’s lifestyle and societal systems that shape their healthy eating and physical activity using Bronfenbrenner’s (1994) ecological model.

Methods

This study used a participatory action research (PAR) framework; Indigenous men and researchers worked together to understand health from the perspective of Indigenous men. Indigenous men from three remote, regional and metropolitan locations in Australia were invited to participate in focus groups and semi-structured interviews about their perception of ‘health.’

Results

One-hundred and fifty men aged 18-35 years participated in the study; the authors give no further demographic information.

The men stated that being fit and healthy was important to them. This was often discussed in relation to their role as a father; they wished to be present to care for their families and able to participate in physical activities with their children. An additional motivating factor to be healthy was ‘closing the gap’ between the life expectancy of Indigenous and non-Indigenous men.

While many of the men felt strongly about the role of an Indigenous man being that of a leader that teaches traditional ways to younger generations, it was noted that women have had to take over these roles due to men’s alcohol and substance abuse, legal problems, and poorer health.

Peer pressure from family and friends was spoken of as both a facilitator and barrier to being healthy. Being encouraged to participate in healthy activities and behaviours was positive:

“If I didn’t have the boys with me I probably wouldn’t done it. We used to go for a run, kick the footy, play footy with each other, do weight sessions, and just keep each other busy…It was really good having those mates physically for my wellbeing.”

However, being pressured into engaging in activities associated with poor health was not:

“Oh yeah umm things like peer pressure. There’s more peer pressure in Aboriginal society. [Smoking] makes them look cool, their mates are doing it so they copy it.”

Separated families and lack of employment often resulted in men feeling isolated and having low self-esteem which was sometimes associated with alcohol and substance abuse as a coping mechanism. Lack of support and financial income made it difficult for men to be healthy:

“If you haven’t got employment like you know, cause of the sky high food [cost] and that, you know, you’re just buying the cheap brand or can’t get like fruit and vegies or that as well.”

Participants reported instances where their access to health services and activities (e.g. sport) were restricted due to them being racially profiled as lazy, drunk and violent.

“Racism, that’s a big issue. Especially in Australia. It’s like if you even go into a shop you get looked down as nothing. That’s why half the people don’t go to the supermarket.”

Many reported being treated poorly by health care professionals and that most health care organisations lacked cultural awareness. Experiences of racism were also noted as preceding alcohol and substance abuse.

Men valued community-based health programs and spoke positively of those that put a meal or activity on for no cost to them. They also spoke of the importance of sport (either watching or participating) as bringing together the community and providing an alternative to social activities often associated with poor health.

Conclusion

From an ecological perspective, the authors state the themes which had the most meaning to men were the outer systems of culture as represented by community, racism and the role of the Indigenous man. The inner system of family were important but were nested within this outer system. The findings of this study support the need for community-based (rather than individualistic) approaches to promoting health behaviour in Indigenous men.

Points to Note

1. Indigenous men have considerably poorer health than non-Indigenous men; it’s important to understand the factors that contribute to this from the perspective of Indigenous men.
2. Focus groups and interviews were conducted with 150 young Indigenous men about their perception of facilitators and barriers to their health.
3. Facilitators included supportive family and friends, and the desire to be an active father and community leader. Barriers included racism among the public and health care professionals, peer pressure and unemployment.
4. The lack of demographic description given makes it difficult to determine whether a diverse sample of men was recruited (a key component of quality qualitative research).
5. The findings of this study support the need for community-based (rather than individualistic) approaches to promoting health behaviour in Indigenous men.

Website: www.ncbi.nlm.nih.gov/pubmed/25891391