A systematic review of the factors associated with delays in medical and psychological help-seeking among men

Authors Yousaf O, Grunfeld EA, & Hunter MS

Review Date June 2014

Citation Health Psychology Review, 2013; doi: 10.1080/17437199.2013.840954

Background

Many studies have documented low rates of medical help-seeking among men. This has been associated with poorer health outcomes in men such as diagnosis delay, higher mortality rates, and increased burden on the healthcare system. Lower rates of help-seeking are particularly pronounced when it comes to mental health and emotional well-being. While many studies have examined male help-seeking barriers there has been no systematic review and synthesis of the literature conducted. Such a review could inform the development of evidence-based strategies to facilitate prompt help-seeking among men.

Aim

The aim of this paper was to systematically review both qualitative and quantitative studies examining professional medical help-seeking barriers in men.

Methods

The Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were used to conduct the systematic review. Papers that used either qualitative or quantitative methodologies to identify at least one medical help-seeking barrier in men with regards to mental or physical health were included in the review. Four medical databases were searched (PsycINFO, Medline, Embase, PsychARTICLES). Only papers written in English were included.

Results

Forty-one papers were included in the review; 22 were quantitative (questionnaire-based) and 19 were qualitative (focus groups and semi-structured interviews). The total number of participants across all studies was 27 787 aged between 15 and 80+ years of age. While the studies were carried out in various countries (e.g., Japan, Ghana, Australia), the overall sample was predominantly White males.

Numerous help-seeking barriers—divided into psychological factors and contextual factors by the reviewers—were identified. Four themes, appearing in multiple papers using various methodologies and samples, were worthy of special attention:

1. Embarrassment, anxiety, distress, and/or fear related to using health services: This stemmed from unfamiliarity with health services and ‘medical culture,’ and adherence to ideas about masculinity that imply men are ‘weak’ for seeking help.
2. Need for emotional control: Some men felt that by worrying about their symptoms they were ‘losing control’ of their emotions and therefore their masculinity; this was particularly relevant to seeking mental health care.
3. Viewing symptoms as minor and insignificant: This often resulted from men’s lack of knowledge about symptoms and low interest in their body and health.
4. Poor communication/rapport with health professionals: Men were uncomfortable with health professionals who were not polite, rushed without explaining important information, used medical jargon, and lacked sensitivity to their needs.

Conclusion

Overall, the findings of this review suggest that adherence to traditional masculinity norms reduces men’s medical help-seeking behaviour. Health organisations and individual health professionals need to take into account the current misconceptions around masculinity and health when considering policy and practice related to the health care of men. Further, even though there are limitations inherent with short consultation times, health professionals need to demonstrate sensitivity to their patients’ individual needs and ensure information is provided in an easy-to-understand manner.

Points to Note

1. Men’s low rate of medical help-seeking has been associated with diagnosis delay, higher mortality rates, and increased burden on the health care system.
2. This is the first systematic review to examine barriers that inhibit men’s medical and psychological help-seeking.
3. Most studies were conducted in high-income, Anglophone countries and the overall sample was predominantly White males. As such, these findings may not generalise to populations for whom healthcare is a rare commodity.
4. The experiences and needs of men who do not identify as heterosexual were not identified within this paper. Caution should be taken when applying these findings to this population.
5. Health organisations and individual health professionals need to address the prevalent misconceptions around masculinity and seeking health care.

Website: http://www.tandfonline.com/doi/abs/10.1080/17437199.2013.840954#.U6S2svmSySo