Examining Men's Health Behavior in South Africa. A Study at the University of KwaZulu-Natal

Masterarbeit , 2022 , 101 Seiten

Gesundheit - Public Health

The present study explores the health-seeking behavior and use of health care services among male students at the University of KwaZulu-Natal, Howard College campus in South Africa.

To gain an understanding of why men underutilize health care services, many researchers have looked at the factors that influence men's health-seeking behaviours. South African men have been neglected in the health-seeking process. The overall objective of this research is to provide insights into factors affecting their utilisation of health care services and men’s healthcareseeking behaviour. The study used a qualitative research technique to better understand the health-seeking behaviour of male students at the University of KwaZulu-Natal, Howard College campus, drawing on 30 in-depth interviews conducted with male students aged 18 and above.

There were a variety of health care facilities available to the men. However, men preferred private health care services but were unable to access these services due to their unemployed status. Further, most men reported not seeking medical attention as soon as they felt ill. These results highlight the need for men to have access to health care. To improve men's use of health care services and behavioural healthcare-seeking behaviour, additional healthcare interventions are needed.

Table of Contents

Acknowledgements

Abstract

Abbreviations and acronyms

CHAPTER ONE: INTRODUCTION
1.1 Background of the study
1.2 Motivation for the study
1.3 Aims of the study
1.4 Research questions
1.5 Theoretical framework
1.6 Organisation of the dissertation

CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
2.2 Men's health-seeking behaviour
2.2.1 The Influence of masculinities
2.2.2 Men's experience with a medical professional
2.3 Factors facilitating the use of health services
2.3.1 Students general health requirements
2.3.2 Masculinity and the gendered nature of public health care
2.3.3 Health seeking process
2.3.4 Condom use among adolescents and young adults
2.3.5 Stigma
2.4 Factors inhibiting the use of health services
2.4.1 Socio-demographic factors influencing health-seeking
2.4.2 Geographic location
2.4.3 Socioeconomic status
2.4.4 Mental health in university students
2.4.5 Male gender and men's health
2.4.6 Age
2.4.7 The urge to get better
2.4.8 Social support
2.4.9 Mass media
2.4.10 Culture
2.4.11 The use of the internet for health consultations
2.5 Summary

CHAPTER THREE: METHODOLOGY
3.1 Introduction
3.2 Study setting
3.3 Research design
3.4 Sampling
3.5 Data collection methods and process
3.6 Data analysis methods
3.7 Ethical considerations
3.8 Limitations of the study
3.9 Summary

CHAPTER FOUR: RESULTS
4.1 Introduction
4.2 Sample characteristics
4.3 Reasons for seeking health care
4.4 Men's view of health services
4.5 Factors facilitating use of health services
4.5.1 Location
4.5.2 Transport
4.6 Factors inhibiting use of health services
4.6.1 Long waiting periods
4.6.2 Finances
4.6.3 Absence of male health workers
4.6.4 Confidentiality
4.6.5 Socialisation
4.6.6 The significance of health care assistance
4.6.7 Availability of services
4.7 Opportunities and barriers influencing the change of behaviour
4.7.1 Awareness
4.7.2 The influence of peers
4.7.3 Health care provider attitudes
4.7.4 Modern and traditional treatment
4.8 Overcoming the barriers
4.9 Summary

CHAPTER FIVE: DISCUSSION, CONCLUSION, AND RECOMMENDATION OF THE STUDY
5.1 Introduction
5.2 Discussion
5.3 Recommendations
5.4 Conclusion

BIBLIOGRAPHY

Appendix 1

Acknowledgements

Firstly, I want to thank myself for not giving up.

My greatest thanks go to my supervisor, Professor Pranitha Maharaj, who guided me, contributed to my research and was consistently supportive of me.

ABSTRACT

To gain an understanding of why men underutilize health care services, many researchers have looked at the factors that influence men's health-seeking behaviours. South African men have been neglected in the health-seeking process. The overall objective of this research is to provide insights into factors affecting their utilisation of health care services and men's healthcare­seeking behaviour. The study used a qualitative research technique to better understand the health-seeking behaviour of male students at the University of KwaZulu-Natal, Howard College campus, drawing on 30 in-depth interviews conducted with male students aged 18 and above.

There were a variety of health care facilities available to the men. However, men preferred private health care services but were unable to access these services due to their unemployed status. Further, most men reported not seeking medical attention as soon as they felt ill. These results highlight the need for men to have access to health care. To improve men's use of health care services and behavioural healthcare-seeking behaviour, additional healthcare interventions are needed.

Keywords: University of KwaZulu-Natal, Howard College campus, Health seeking behaviour, Male students, Utilisation of health care services.

Abbreviations and Acronyms

illustration not visible in this excerpt

CHAPTER ONE: INTRODUCTION

1.1 Background of the study

Men are generally more hesitant than women to seek medical care and advice and use healthcare services (O'Brien et al., 2005). Men's delayed use of healthcare is frequently cited as a contributing factor to their lower life expectancy when compared to women (White and Witty, 2009). Their underutilization of healthcare is framed as a societal issue because men are likely to get sick (O'Brien et al., 2005). Men are perceived as uninformed, uninterested, and lacking ambition regarding their health concerns (O'Brien et al., 2005). According to Courtenay (2000), men's conduct has to change to improve their health, because their health-seeking and facility utilization is seen as problematic. According to Courtenay (2000), there are a variety of elements that influence one's health such as ethnicity, economic class, gender, and healthcare access. Gender appears to be an important element in determining one's health and lifespan (Courtenay, 2000). Gender inequalities in health conditions suggest a variation in life expectancy between men and women.

Numerous studies suggest that men have a lower life expectancy than women (Courtenay, 2000; Kalben, 2002). Men are more susceptible to heart disease, cancer, severe chronic illness, and deadly illnesses, according to health research conducted in the United States of America, all of which contribute to men's reduced years of life (Kalben, 2002).

The majority of research undertaken in developing and developed nations reveals that there are gender differences in seeking health care as well as in general views and understandings of health and illness (Michael and Hearn, 2005). According to Mokdad et al.'s (2004) research, variable health behaviours are responsible for almost half of all morbidity and mortality. Men's major deadly illnesses, such as heart disease and cancer, are caused by these modifiable behaviours (Mokdad et al., 2004). Men have a lower life expectancy than their female counterparts in many parts of the world (Courtenay, 2003). Men die younger than women in the same age group in the United States, and studies reveal that African American men die roughly 7 years younger than females in the same age group (Kalben 2002). According to Statistics South Africa (2021), South African women have a life expectancy of 64.6 percent, while South African men had a life expectancy of 59.3 percent, which does not consider the impact of HIV/AIDS in South Africa.

According to Statistics South Africa's mid-year population estimates males in South Africa have a shorter life expectancy than females. In 2021, life expectancy at birth was expected to be 58.3 years for males and 64.6 years for females. Males continue to outlive their female counterparts in terms of life expectancy. Females are expected to live an average of 71.3 years in 2016, while males will live an average of 64.6 years (Statistics South Africa, 2020). Males are considerably more prone than women to engage in behaviour that puts their health in jeopardy (Courtenay, 2003). Courtenay (2003) argues that behaviour differences between men and women are to blame for men's lower life expectancy. He justifies his theorization by suggesting that men participate in sporting activities, occupations, modes of transportation, drinking and drug use are more prevalent among men than among women (Courtenay, 2003). According to Courtenay, (2003) men are more likely to own a weapon and to be involved in a fight, resulting in a reduction in their life expectancy.

Men's health-seeking behaviours are influenced by cultural norms regarding masculinity, according to research on gender dynamics and health in connection to masculinity. Gender research aims to learn more about the link between men's health-seeking behaviours and how they understand sickness, as well as how these characteristics contribute to the underutilization of health care. According to Mahalik et al. (2007), men are also less likely to utilize preventative measures, and they die from diseases that are treatable if symptoms are detected early and health care is sought. According to Courtenay (2003), despite having a shorter life expectancy and a greater death rate, males are less likely to seek care until late in the course of their sickness. Men's use of primary health care is still low in several countries, although it is geographically, financially, and culturally accessible to communities and delivers more customized care to the poor (Doherty and Govender, 2004). According to Myburgh (2011), women visit public health care facilities substantially more frequently than men. Research into masculinity and its impact on men's health has revealed several behaviours that men engage in that are known to be harmful to their health (Courtenay, 2003). However, some evidence suggests that because these harmful behaviours are socially formed, they may be changed (Courtenay, 2003).

Several health indicators indicate that men's health is seen as poor in developed countries. According to the literature, the dominant masculine language followed by my males may harm their health (Courtenay, 2005), as it impacts how men view and understand health, their health behaviours, and ultimately their health-seeking behaviours (Courtenay, 2005). The purpose of this study was to learn more about men's health-seeking behaviour to better understand and work toward improving men's health and eliminating health disparities.

The global trend of males underutilizing health care services is not limited to South Africa. Letsela and Ratele (2009) performed a survey in South Africa and found that the majority of males interviewed said they never go for health care check-ups, while 37 percent said they do. A total of 76 percent of individuals who do not go for health check-ups said they ultimately do when they are unwell, while 24 percent never go at all (Letsela and Ralete, 2009). As a result, several researchers have focused on men's health to better understand men's health behaviours and the underutilization of health care services in both the developing and developed worlds. Furthermore, it is said that males are more prone than women to participate in health-damaging behaviours such as smoking, excessive alcohol consumption, poor nutrition, lack of exercise, and adherence to safety standards such as the usage of seat belts (Courtenay, 2003).

Several diseases, such as HIV/AIDS, and tuberculosis, as well as violent crime, make up this burden of disease and are among the challenges facing the country (Negotiated Service Delivery Agreement, 2010-2014). Approximately 8.2 million people of all ages in South Africa are thought to be HIV-positive, and among adults 15 to 49 years of age, HIV prevalence is estimated at 19.5 percent of the population (Statistics South Africa, 2021). According to South Africa's 2011 national figures on HIV prevalence, roughly 8.2 million persons in the country are HIV positive (Statistics South Africa, 2021). HIV prevalence is substantially higher in young women than in young males, especially among those aged 20 to 24. (Human Sciences Research Council, 2008). In 2008, HIV prevalence in women aged 20 to 24 years was more than four times higher than in men of the same age (Human Sciences Research Council, 2008). Although women are more likely than males to be infected with HIV, women are more likely to seek medical help. Women are also more likely to use free counselling and testing services and to be enrolled in antiretroviral treatment programs that are very active (Myburgh, 2011). In comparison to males, this improves their chances of survival. This raises questions about men's health. In South Africa, men's low usage of HIV services is a major concern.

According to the country's constitution, in South Africa, health care is considered a human right. Everyone in South Africa is entitled to health care (Statistics South Africa, 2017). Both the public and private healthcare sectors ensure that healthcare services are available and that resources are accessible. South Africa's democratic government assures equal access to primary health care to increase society's wellbeing (South Africa Human Rights Commission, 2017).

According to Statistics South Africa (2013), healthcare-seeking behaviour refers to a specific activity performed by a sick individual who requires medical attention. Cultural, economic, and societal factors all have an impact on how people utilize and receive healthcare services. Gender, age, socioeconomic background, and demographic group, as well as family, friends, and neighbourhood, all have an impact on how individuals seek health care (Statistics South Africa, 2013).

Gender diversity is one of the most important social determinants influencing healthcare­seeking behaviour. Macionis and Plummer (2008), regard gender as a social construct. It is a crucial tool in determining how individuals in cultures view themselves, interact with others, and influence behaviour. According to Mooney et al. (2011), there is a link between health difficulties, life expectancy, and individual behaviour. Gender roles, including men's and women's expected behaviour and obligations, are also part of the latter concept.

Courtenay (2000) mentions that various socio-cultural events are linked to and have an impact on health-seeking behaviour. Women are more likely than men to seek out health services and put into practice health-promoting strategies. Men are more prone to engage in dangerous behaviours such as substance misuse, smoking, drinking, eating a bad diet, fighting, injuries, and driving recklessly (Courtenay, 2000). Men's health is impacted by these behaviours. This suggests that men are less concerned about their health than women.

Seeking medical help has a positive impact on one's well-being. People who seek medical help are more likely to obtain timely diagnosis and treatment. The vast majority of males do not seek medical help. In South Africa, women and children are more likely to seek medical help (Statistics South Africa, 2013). This reveals a disparity in health-care-seeking behaviour: females are more likely than males to seek and acquire necessary diagnoses and treatment. As a result, this is probably one of the reasons why women in the country live longer on average than males. This has ramifications for human development, altering current and future generations life expectancies.

Cornell (2013) argues that despite their dominant position in society, men are subjected to discrimination. In some healthcare institutions, men are treated unfairly, limiting their access to services (Cornell, 2013). Men's needs and rights are frequently overlooked. Women are given a lot of attention and interventions since they have historically been marginalized. Access to healthcare services is unequally distributed between men and women (Cornell, 2013). The development of women's health is receiving more financing and action. Compared to men, women have unrestricted access to health facilities and programs. Women's issues are prioritized in South Africa, for example, women, children, and people with disabilities have an organization and a variety of programs (Cornell, 2013). Women's and children's welfare are promoted through these programs. Gender equality and women's empowerment are highlighted in the third Millennium Development Goal (Cornell, 2013). Men's health difficulties are not given enough attention in this regard.

Studies argue that there is a gender gap in healthcare utilization (Bertakis et al., 2000). The way people seek health care is influenced by a variety of socioeconomic circumstances. According to Cornell (2013), men have limited access to health care to some extent. As a result, limited availability, as well as other circumstances, may harm men's behaviour.

Non-use of school-based health centres or a preference for non-school-based health centres might be due to a variety of circumstances. According to a study conducted at Stellenbosch University in South Africa to determine medical students preferred sources of non-occupational post-exposure prophylaxis of HIV services, more than two-thirds of the students interviewed preferred to access these services from sources other than the university campus clinic due to HIV-related stigma and discrimination (Ncube et al., 2014). Booth et al. (2004) found that more than half of students at an Australian tertiary school avoid campus health services due to embarrassment, confidentiality concerns, the preference for a provider of the same gender, and a lack of knowledge about the breadth of health services offered on campus.

Health-seeking behaviour is intimately tied to an individual's socio-cultural ideas about the etiology of illness, and it is curability. Young individuals have reduced rates of death, illness, and medical use. However, many of their health problems go untreated or unnoticed. These might include risky habits including drug and alcohol abuse, inappropriate sexual activity, smoking, and mental health issues like depression and suicidal thoughts (WHO, 2009).

Even though health is an important aspect of an individual's well-being, it is still a sensitive subject, particularly when it comes to males and the concept of masculinity. It is critical to grasp the categories of health, health-seeking, and masculinity to investigate health and health­seeking in connection to masculinity. According to the World Health Organization (2008), health is also determined by other biological and social factors, as well as interactions with germs and poisons that directly cause sickness or organ system failure. The World Health Organization defines health as the state of complete physical, mental, and social well-being (WHO, 2010). Both organizations take a holistic approach to health, considering not just biological but also social factors.

The series of corrective acts that individuals attempt to correct perceived ill health is characterized as health-seeking behaviour (Rahman et al., 2001). Health-seeking behaviour, according to Rahman et al. (2001), occurs when symptoms are characterised first, and then a strategy for therapeutic action is developed. The authors claim that identifying symptoms does not lead to timely medical attention. Treatment selection is influenced by several factors, including the kind of illness, the severity of the illness, pre-existing beliefs about the underlying cause, the accessibility and variety of therapeutic alternatives, and their perceived effectiveness (Rahman et al., 2001).

According to McKinlay (2005), males are less likely to gain the confidence to seek preventative health care since they are not socialized into the health culture from an early age. Gender dynamics of gender socialization have a role in the choice to seek health care, as do socio­economic, political, and cultural issues. Men's health-seeking behaviours are influenced by cultural norms regarding masculinity. This study aims to learn more about the link between men's health-seeking behaviours and how men understand sickness, as well as how their characteristics contribute to the underutilization of health care. Men are also less likely to utilize preventative measures, according to Mahalik et al. (2007), and they die from diseases that are treatable if symptoms are detected early and health care is sought. Despite having a shorter life expectancy and a greater mortality rate, according to Courtenay (2003), males are less likely to seek care until late in the course of their sickness.

Men's use of primary health care is still low in several countries, although it is geographically, financially, and culturally accessible to communities and delivers more customized treatment to the poor (Doherty and Govender, 2004). According to Myburgh (2011), the number of men visiting public health care facilities is much lower than the number of women. Research on masculinity and it is influence on men's health has revealed several behaviours that men engage in that are known to be harmful to their health (Courtenay, 2003). Courtenay (2003) claims that because these harmful behaviours are socially formed, they may be changed.

1.2 Motivation of the study

There is a limited focus on men's health. It has been almost three decades since scholars released initial literature concerning men's health (Courtenay, 2000). It has encouraged the researcher to do a study that would explore health-seeking behaviours among male students at the University of KwaZulu-Natal, Howard College campus. Students' production is directly proportional to their health, hence, health is a significant resource. Students' academic performance may suffer if they are unable to access the campus's available health services. Men are rarely studied as individuals who require health care assistance. Nothing much has come out of the men's health movement for nearly thirty years (Courtenay, 2000). Men's health movement has indicated slow development compared to women's health movement at that time. Women's health organization remains progressive because it is associated with social movements that oppose experiences of inequality and marginalization of women. Women communicate and organize associations at the grassroots level to address various women's health issues. On the other hand, men have been working in isolation. This explains the significant attention to women's health issues and experiences.

It was also discovered that when symptoms such as intense pain and persistence arise, men are more likely to see the condition as serious. As a result, males began to search for the underlying health problem and, as a result, seek therapy. According to Galdas, Cheater, and Marshall (2007), males seeking medical care are motivated by a breach of their pain threshold and intolerance of suffering.

Several university students abuse drugs, and alcohol and engage in dangerous sexual activities with little consideration of the consequences of their actions. Individual demands differ from person to person, students engage in a variety of health-seeking behaviours and face problems in meeting their health needs (Cornell, 2013). Students conduct and, as a result, their health is influenced by their surroundings (Cornell, 2013).

In certain healthcare institutions, males are treated unfairly, limiting their access to services (Cornell, 2013). Men's needs and rights are frequently overlooked. Male students needs and rights are frequently disregarded. Female pupils receive a lot of attention and interventions. Access to healthcare services is unequally distributed between men and women (Cornell, 2013). The development of women's health is receiving more financing and action. In comparison to males, women have unfettered access to health facilities and programs. Women's issues are prioritized, in South Africa, for example, women, children, and people with disabilities have an organization and a variety of programs that directly addressed their concerns. Women's and children's well-being are improved as a result of these programs. There is a strong emphasis on the development of gender equality and women's empowerment. Men's health concerns are not prioritized in this way.

1.4 Aims of the study

The overall objective of this study is to shed insights into the health-seeking behaviour of male students at the University of KwaZulu-Natal, Howard College campus. The specific objectives are:

- To determine attitudes of male students to their health.
- To explore the factors facilitating and inhibiting health care utilization among male students.
- To ascertain the opportunities and constraints for improving health-seeking behaviour among male students.

1.5 Research questions

The study is guided by the following key questions:

- What are the attitudes of male students towards their health?
- What are the factors facilitating and inhibiting the use of health services among male students?
- What are the opportunities and constraints for changing health-seeking behaviour among male students?

1.6 Theoretical framework

The health care utilization model

The Andersen healthcare utilization model is used in this study to better understand how male students use health services. The model was created to help individuals understand and assess their use of health services in terms of multiple functions of their inclination to use health services, circumstances that facilitate or impede their use of health services, and their overall need to be cared for in health services (Jahangir et al., 2012). As a consequence, the researcher can make inferences about health-seeking habits among male students at the University of KwaZulu-Natal, Howard College campus.

Figure 1.1: The model of health care utilization

illustration not visible in this excerpt

Source: Andersen (1965)

This model was best suited to delve into health-seeking behaviours, which helps determine the relationship between healthcare usage and predisposing, enabling, and need factors. The health behaviour model, according to Andersen (1965), is largely regarded as a trustworthy technique for analyzing healthcare utilization, which helps to compensate for some of the flaws of the health belief model. It is a model that seeks to show the factors that influence how individuals use health care. Three dynamics regulate how individuals utilize health care, according to the paradigm: predisposing factors, enabling factors, and need factors (Andersen, 1965).

According to the Andersen healthcare utilization model, healthcare use is a conditional and sequential function of three sets of factors: predisposing factors, enabling factors, and necessity. Individuals propensity to use health services is represented by predisposing factors, enabling factors, and need factors, which include self-perceived health, chronic diseases, and constraints on one's capacity to perform tasks (Andersen, 1968).

The concept offers an explanatory process or causal ordering in which exogenous elements may be exogenous, certain enabling resources are essential but not sufficient conditions for use, and some needs must be specified for use to occur. Demographic factors such as age and gender are biological imperatives that indicate the possibility of individuals needing health care among the predisposing qualities (Hulka and Wheat, 1985).

The capacity to cope with presenting difficulties and commanding resources to deal with these problems, as well as how healthy or unhealthy the physical environment is likely to be, are all elements that shape social structure. Education, employment, and ethnicity are among the traditional metrics used to determine the social structure. The approach has been criticised for failing to include social networks, social interactions, and culture enough (Guen-Delman, 1991).

People's knowledge, values, and attitudes regarding health and health services, as well as their subsequent perceptions of need and use of health services, are referred to as health beliefs. One way to explain how social structure influences enabling resources, perceived need, and eventual usage is through health beliefs. Many studies using the behavioural paradigm have not adequately conceived and assessed health beliefs, according to social psychologists (Becker and Maiman, 1983).

Enabling factors are resources or methods that allow a person to gain access to healthcare services (Andersen, 1995). Individuals health-care utilization is influenced by their socioeconomic level. The model represents one's capacity to get healthcare services, income may be a decisive factor in healthcare access. The type of insurance and it is accessibility or affordability is determined by one's economic situation. Health care is also facilitated by social standing, family, relatives, and friends, as well as the availability of health resources (Andersen, 1995).

Characteristics such as age, gender, religion, global health assessment, past experiences with sickness, formal education, general attitudes toward health care, and information about the condition can all be predisposing factors in the model (Jogin and Albal, 2014). A person who feels that health services are an effective therapy for a disease, for example, is more inclined to seek treatment, and vice versa.

The model has also been criticised for failing to account for culture and social interaction, although Andersen claims that this social structure is already factored into the predisposing traits component (Andersen, 1995). Another point of contention was the overemphasis on need, which was done at the expense of health values and social structure. But, according to Andersen (1995), necessity is a social construct. This is why perceived and assessed needs are separated. Another flaw in the approach is that it focused on healthcare usage or the adoption of health outcomes as a binary component that might be present or absent. Other models of assistance­seeking consider the type of aid source, such as informal sources. More recent research has expanded on health-seeking behaviours by using the internet and other non-face-to-face sources.

1.5 Organisation of the dissertation

This dissertation is composed of five chapters. Chapter one is the introductory chapter which outlines the background and motivation of the study, aims, and objectives, as well as a conceptual framework guiding the study. This chapter provides a broader picture of the research. The second chapter is the literature review which presents the relevant literature about the topic such as the various perspectives on factors affecting the use of health care services. The third chapter is the methodology which discusses the study context, data collection techniques including sampling, ethical considerations, and limitations of the study. The fourth chapter presents the qualitative results of the study. This chapter reports the research findings collected through the use of questionnaires. The final chapter provides a discussion of the main findings of the research. It also provides recommendations and possible steps to address the issue.

CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction

This chapter focuses on the review of national and international literature on male students health and their health-seeking behaviours. It examines factors that hinder men's utilization of health care facilities, determining their reasons for delaying health-seeking, their conceptions of manhood, their understanding of illness, and if these concepts are contributing to the underutilization of health care. There has been limited research on health-seeking behaviour among students. Although women have a longer life expectancy than men, it has long been assumed that women have better health, have greater rates of morbidity and disability, and utilize health services more frequently than men. Women and men differ not merely in genetics, but also in the duties and obligations that society expects from them (Lahelma et al., 2001).

2.2 Men's health-seeking behaviour

Several studies have shown that men are hesitant to seek medical care (White, 2001; Gough, 2013) and are less likely to seek treatment from their general practitioner when ill (Office for National Statistics, 2011), except at extremely later stages of illness (Health and Social Care Centre, 2009). It has also been observed that men often present at later stages in the course of an illness or when the condition has reached a more critical stage (European Commission, 2011). Furthermore, men are less likely to seek help if they are having mental health concerns (Corney, 1990).

Men also tend to participate in other health detrimental behaviours, such as substance misuse, risk-taking, and avoiding preventative services, which can also be detrimental to their health (European Commission, 2011). Men's health has become the focus of much research as a result. However, men's health remains a poorly understood area, what is unclear is why men engage in unhealthy behaviours, which are culturally acceptable and seen as normal by many. This view gives men the freedom to disengage or maintain their disengagement if left unaddressed (Gough, 2006).

According to Hearn (2001), men have most of the social determinants in their favour, particularly access to economic and political resources, due to societal power inequalities between men and women. Despite this, men have a shorter life expectancy and higher death rates for all major causes of death over the world (Hearn, 2001). Men's behaviour based on masculinity standards is detrimental to their health (Baker et al., 2014). Men are less likely to receive treatment, and support services due to hegemonic masculinity norms that link illness with weakness and weakness with emasculation (Sonke Gender Justice, 2013).

Research in Southern and Eastern Africa shows the impact that these masculine conceptions inflict on men (MacPherson et al., 2014). The 2010 Global Burden of Disease survey found that women have longer life expectancies than men in Sub-Saharan Africa, with men surviving on average 5.3 years less than women (Institute for Health Metrics and Evaluation, 2010). As a result of hegemonic masculine norms, men are at greater risk of getting sick and do not engage in health-promoting behaviours, such as getting tested, accepting their HIV status, and following nurse advice (Baker et al., 2014). According to Cornell et al. (2011), most domestic and international antiretroviral treatment-related policies and programs in Africa are still dismissive of men.

2.2.1 The Influence of masculinities

According to Courtenay (2000), men express their emotions as a sign of weakness and deny emotions as signs of masculinity. Hegemonic masculinity is defined by Connell (1995), as dominant ideas about what it means to be a 'real man', as shown by stoicism, the appearance of strength, courage, and risk-taking. The culturally rooted social norms of men are said to affect their behaviour, such as men who avoid seeking healthcare as a demonstration of their masculinity (Banks, 2001). As looking after one's health has been socially constructed as a feminine endeavour (Courtenay, 2000), a man who challenges these norms runs the risk of being branded ‘deviant' (Dolan, 2010). According to Courtenay (2000), men who deny the need for help within the health sphere are shaping male norms of masculinity, such as, 'when a man says, "I have not seen my doctor in years", he is simultaneously portraying a health practice and situating himself within a masculine framework'. That said, a singular definition of gender and masculinity is unhelpful, as many men adopt a mixture of both healthy and unhealthy behaviours within a masculine framework (O'Brien et al, 2005). Participation in physical activity and sports can, for example, express health-related masculinity, thus not all masculine behaviours are harmful (O'Brien et al, 2005).

It seems that when men accept the typical model of masculinity, which assumes they are uninterested in their health, they are portrayed as belonging to a homogeneous group of people who behave the same in every situation, which is not the case (Galdas et al., 2004). Gough (2006) suggests that even using the term ‘men's health' assumes that all men are the same. This has led to the concept of hegemonic masculinity being heavily criticized by many researchers (Connell and Messerschmidt, 2005). Rather than looking for factors other than gender to explain the presence of hegemonic masculinity, there are concerns that researchers often try to confirm its existence in the data they collect (Connell and Messerschmidt, 2005). A further concern is that all enactments of masculinity are viewed as damaging to health, a view that has been contested by some (O'Brien et al, 2005).

2.2.2 Men's experience with a medical professional

Medical consultations seem to favour men, even though women are perceived to be overusing healthcare facilities and presenting with non-serious health conditions. Courtenay (2000) looked at gender variations in behaviours that affect health and life expectancy in the adult population in the United States. The study found that women's medical consultations lasted much longer than men's, while men were given fewer and shorter medical explanations (Courtenay, 2000). Moreover, men received less health information than women about how to perform self-examinations, with 29 percent of men reporting self-examinations for testicular problems and 86 percent of women for breast problems, respectively (Courtenay, 2000). These methods raise the possibility of sexism in medical discussions (Roter and Hall, 1997, cited in Courtenay, 2000).

Although the evidence is ambiguous, several health communications research has shown that female practitioners are preferred because of their communication style (Buller, 1987). Women providers are seen as more patient-centred, egalitarian, and concerned with psychosocial elements of health (Roter and Hall, 1998). However, it should be noted that making comparisons solely based on gender is insufficient. Furthermore, it has been discovered that the views of healthcare workers have an impact on men's usage of healthcare services (Robertson and Williamson, 2005). In the United Kingdom, a qualitative study of ten male general practitioners aged 35 to 53 years examined their experiences with male patients health­seeking behaviour (Hale et al, 2010). The study focused on male general practitioners assessments of their patient's health problems, as well as their perspectives on how and why they decide to seek care. It also investigated whether general practitioners own beliefs about health and health behaviours influenced their consultations with male patients (Hale et al, 2010).

The study found that general practitioners had a good view of working men who had limited contact with healthcare facilities (Hale et al., 2010). Patients show hegemonic masculinity through non-attendance, according to respondents, with one general practitioner adding, "the working men come in with stuff that prohibits them from working" (Hale et al., 2010, p. 706). Non-working men who saw their general practitioner more regularly, on the other hand, were disciplined, implying that they appeared with 'fake' health problems. This viewpoint is reflected in a general practitioner's account, in which he compares non-working men to women and minimizes their presence (Hale et al., 2010). According to Hale et al. (2010), general practitioners viewed women as overusing healthcare facilities and having too much spare time, as evidenced in their observation that 'non-working men have the same attendance pattern as non-working women'. General practitioners, on the other hand, justified attendance if men presented in a masculine context, such as preserving a stoic identity, being forced to come by a spouse, or expressing that the visit would be postponed until the problem became real (Hale et al., 2007). As these examples demonstrate, gender stereotypes can creep into medical consultations. Hale et al. (2007) found that some men believed male general practitioners held negative attitudes toward their use of healthcare services, a conclusion supported by other studies.

2.3 Factors facilitating the use of health services

2.3.1 Students general health requirements

Late adolescence and early adulthood are often highly healthy stages of life. However, young individuals of this age are predisposed to certain health difficulties, and some of them may be intensified by attending university. For many years, alcohol use among students has been a source of worry, since the combination of being in an institution with thousands of other young people, inexpensive alcohol promotions, and a lack of adult supervision may be a dangerous combination (Wechsler and Nelson, 2008). Similarly, 99 percent of adult smokers began before the age of 24, and the presence of a high number of peers in school settings may enhance the “contagion” of smoking behaviour (Levinson et al., 2007).

Students at universities are also likely to use recreational drugs, though it is hard to say if they use more than they would in other settings for young people in this age range (Ajayi and Somefun, 2020). In certain respects, the controlled atmosphere of the school setting may maintain a lid on some elements of overuse, and additional monitoring and specific services may be more readily available than in non-student groups of comparable ages (Ajayi and Somefun, 2020). It is also worth mentioning that all these dangerous health habits have been on the decline in recent decades (Hagell et al., 2015). Encouraging appropriate sleep habits among students is a well-known difficulty. One-quarter of secondary school students do not get adequate sleep, and the problem persists throughout their academic careers (Liu, Liu, Owens, and Kaplan, 2005). According to an American poll, 27 percent of students are in danger of at least one sleep issue, with the risk being greatest among those in ‘academic trouble' (Gaultney, 2010). As a result of interaction with large numbers of other young people, students may be susceptible to coughs, colds, and respiratory illnesses. Student support websites contain numerous anecdotes of 'end of termites and 'fresher's flu' as a result of lack of sleep, overindulging, minor illnesses, and job pressure causing stress on the body and health (Gaultney, 2010). The university community also faces specific risks due to specific communicable diseases, for instance, the current guidance suggests that all new students should be immunized against Meningitis W, following an increase in its occurrence among student populations in the United Kingdom (National Health Service, 2016).

Several studies suggest one in ten men in the age range 14 to 24 years suffers from a mental disorder severe enough to require treatment, with general population studies estimating an even higher number (Green et al., 2005). According to a National Union of Students survey (2013), 20 percent of students reported having a mental health condition, of which most are men. Although they are more vulnerable to suicide than women, men find it difficult to talk about mental health. There is also evidence that demand for mental health services at colleges and universities is rising (Storrie et al., 2010). Some of the health problems men are likely to suffer from are prostate cancer, stroke, heart disease, etc.

2.3.2 Masculinity and the gendered nature of public health care

Studies by Hausmann-Muela, Ribera, and Nyamongo (2003) found that in both the developed and developing worlds, men's and women's public health care utilization patterns varied considerably. It is undeniable that women use healthcare facilities more frequently than men. According to Myburgh (2011), the availability of reproductive healthcare services in public health care centres could account for men's disproportionate use of health care services compared to women, and it also indicates that health care facilities are viewed as favouring women, making them a gendered place. Women attend health-care facilities for a variety of reasons, including childcare, family planning, and pregnancy, reinforcing the assumption that a clinic is a gendered place because more services are geared toward women (Myburgh, 2011).

Furthermore, according to a report by the Sonke Gender Justice Project (2008), cited in (Myburgh, 2011), neither men nor women see the clinic as a friendly environment in the context of the often overburdened and under-resourced public health clinics in South Africa, but both groups see the clinic as largely a female domain (Sonke Gender Justice Project, 2008). According to Myburgh (2011), because clinics are frequented mostly by women, they have the potential to become a hostile environment for men, and often the majority of staff in the clinic holding positions as nurses or counsellors are women. Women dominate health care not just as patients, but also as clinic employees (Myburgh, 2011). Men are required to divulge personal information to female employees during consultations, which involves openness and honesty, and this might represent a threat to the prevailing masculine culture (Myburgh, 2011).

Studies conducted in South Africa among the local IsiXhosa-speaking population have shown that men do not view it as culturally appropriate to discuss specific concerns with women regarding sexual or genital issues (Myburgh, 2011). Such talks are necessary for the therapeutic context, especially when one is suffering from a sexually transmitted illness. When men seek medical help, they are forced to address culturally taboo topics with women, which might be a key role in men's underutilization of medical services (Myburgh, 2011). Myburgh (2011) goes on to say that men's use of public health care might be interpreted as a sign of weakness associated with femininity, which is in direct opposition to the masculine character.

Men's reluctance to use healthcare facilities is linked to held masculine ideals. According to Courtenay (2003), there is evidence that masculinity is seen as offering a sense of immunity across cultures. Men are socialized to be self-sufficient, not to show their feelings openly, and not to seek help when they are in need. Furthermore, Courtenay (2003) mentions that male socialization and their socially created masculine identities have been blamed for the disparities in healthcare utilization between men and women. Men's manly identities and behaviours are heavily shaped by society's idea of what a man is. Men's perception and interpretation of their health, and consequently their use of health care services, are defined by society's notion of manhood (Courtenay, 2003).

2.3.3 Health seeking process

According to Smith et al. (2006), health-seeking is considered to be the acknowledgement of a health issue, as well as the variety of behaviours that follow, one of which is health care consumption. In the literature, health-seeking behaviour and sickness are viewed as a complex interaction of several information sources that impact residents perception of illness and their health-seeking behaviours (Uzma et al., 1999). From a holistic perspective, health-seeking behaviour is seen as an integral aspect of a person's family or community's identity, affected by social, personal, and cultural experiences (Uzma et al., 1999).

According to Rahman (2000), health-seeking is not a simple individual action that can be explained by a single model of health-seeking behaviour since there are several social aspects to consider before seeking health treatment. (MacKian, 2003, citing Tipping and Segall, 1995) The study found that patients decisions to attend a particular health care facility are influenced by a combination of personal needs, societal pressures, health care professionals activities, and the availability of services in the locality (MacKian, 2003). Health care accessibility seems to depend less on physical facilities at a particular location than on men's refusal to use health care services in certain situations. Pearson and Makadzange (2008) argue that health-seeking should be understood as a complex junction of multiple social and cultural norms that are routinely practiced throughout civilizations, rather than a single individual's decision to seek care.

According to Pearson and Makadzange's (2008) study, there is a way to seek health in poor nations that influences whether an illness is considered natural or supernatural. They claim that there is an initial stage in which symptoms and conditions are identified. The second step involves gathering information and obtaining guidance. The third stage involves locating and obtaining treatment.

In cultures where the illness is attributed to supernatural forces, such as angry ancestors or evil spirits, it is connected to immoral social and sexual behaviour and the individual affected is stigmatized (Pearson and Makadzange, 2008). When looking at the setting of industrialized countries, religion influences health-seeking behaviour (Pearson and Makadzange, 2008). This demonstrates that a variety of circumstances influence an individual's decision to seek medical help. Cessaly and Cheatham (2007) conducted research in North Carolina that supports the hypothesis that spiritual considerations may influence health-seeking in industrialized countries. The study shows that religion plays a significant impact in seeking medical help (Cessaly and Cheatham, 2007). According to Cessaly and Cheatham (2007), health care is sought for the sake of maintaining the body as a temple and keeping it clean and healthy. On the other side, sickness was seen to be God's judgment for all misdeeds. It is important to consider spirituality while seeking treatment because it can either help or hinder access to health care (Cessaly and Cheatham, 2007).

2.3.4 Condom use among adolescents and young adults

South Africa has the largest number of youths living with HIV globally in 2020, largely because its adolescents and young adults bear the greatest burden of the HIV and AIDS epidemic (Statistics South Africa, 2020). According to the Joint United Nations Programme on HIV/AIDS, HIV-related deaths among teenagers may be on the rise despite recent statistics indicating a stable pandemic (UNAIDS, 2021). Approximately 13.7 percent of the South African population is estimated to be infected with HIV (Statistics South Africa, 2020). In 2021, there are estimated to be approximately 8.2 million people living with HIV (Statistics South Africa, 2020). South Africa is well known for its high teenage pregnancy rate. In 2008, more than 30 percent of young South Africans gave birth before age 20 despite the decrease in total fertility over time (Willan, 2013). Unintended pregnancies and HIV infection have serious consequences for demographic outcomes such as mortality and fertility (Statistics South Africa, 2009). Furthermore, teen pregnancy disrupts learning chances, depriving young women of critical training for future productivity, and perhaps delaying a country's demographic dividend (Jewkes, Morrell, and Christofides, 2009).

The risk of undesired pregnancy, HIV infection, and other sexually transmitted illnesses increases with unprotected sexual activity (Zuma et al., 2010). Many parts of a country's population are affected by HIV and AIDS, as well as teenage pregnancy. HIV and AIDS patients are more likely to get opportunistic infections, increasing mortality rates and reducing life expectancy (Bearinger et al., 2007). Life expectancy, for example, decreased from 60 years in 1990 to 1995 owing to an increase in deaths from HIV and AIDS from 2005 to 2010 in Lesotho, where an estimated 25 percent of the population has HIV (UNPD, 2004).

Studies conducted in South Africa indicate that teenagers and young adults are likely to engage in risky sexual behaviour. A study conducted by the Human Sciences Research Council (2012) found that an increasing percentage of teenagers are engaging in sexual activities early, with multiple partners, and using condoms inconsistently. According to the Joint United Nations Programme on HIV/AIDS (2020), the percentage of young males aged 15 to 24 years old who used condoms during their most recent sexual experience dropped from 85.2 percent in 2008 to 67.5 percent in 2012. Condom use declined from 44.1 percent to 36.1 percent among men ages 25 to 49 years during the same period (UNAIDS, 2020).

Despite being told of condom use's benefits, low condom usage has been found among clinic participants in KwaZulu-Natal province with high HIV prevalence (Hartung et al., 2002). Despite widespread HIV/AIDS awareness, condom use was uncommon and self-perceived HIV infection risk was low (Maharaj, 2006). A woman's assessed risk of HIV transmission from her partner was the strongest predictor of condom use among married or cohabiting couples in KwaZulu-Natal province (Hartung et al., 2002). The lack of awareness of the risk of HIV transmission was one of the barriers to condom use identified in focus groups with young men and women aged 13 to 25 (MacPhail and Campbell, 2001). South African teenagers are exposed to the apparent danger of inconsistent condom usage, but there is little research on self-risk perception and condom usage consistency among youth. A large number of teenagers are pregnant in the Western Cape province, indicating a high level of unprotected sexual activity (Dinkelman and Leibbrandt, 2007). Despite the province's low HIV rate, adolescent pregnancy remains a serious concern (Dinkelman and Leibbrandt, 2007). African and Coloured communities in urban Cape Town consistently show gaps in income and income, as well as poor educational performance rather than in any other region in South Africa (Kleinschmidt and Pettifor, 2007). In poor areas, teenagers are exposed to a wide range of risk factors for sexual behaviour because of the wide socioeconomic divides. The risk factors for condom use have been discussed in isolation in other studies without considering factors at the individual, family, and community levels that contribute to the risks (Scorgie et al., 2012). Thus, the causes for South Africa's low condom use and high HIV infection rates may not be well understood, hindering a comprehensive approach to HIV prevention, particularly among adolescents and young adults (Van Loggerenberg et al., 2012).

2.3.5 Stigma

The stigma attached to HIV/AIDS exists in some parts of South Africa, and it can impede efforts to increase HIV/AIDS prevention measures, such as voluntary counselling and testing (Smith, 2011). Around 36.3 million people living with HIV lived in Sub-Saharan Africa in 2020, which represents 63 percent of all HIV-positive individuals in the world (WHO, 2020). Researchers studied the impact of false beliefs about HIV/AIDS on men's health and found that they had a detrimental effect. Kalichman and Simbayi (2004) found, for instance, that 11 percent of people living in a Black slum in Cape Town believed that AIDS was caused by spiritual forces, 21 percent were unsure, and 68 percent did not believe that. When people believe that HIV/AIDS is caused by the supernatural or spirits they have a much greater misunderstanding of the disease and are more likely to advocate disgust and socially sanction stigmatizing ideas about people with HIV/AIDS (Muller, 2014). South Africa's rural areas are likely to have more traditional ideas regarding the disease's putative cause. To prevent HIV transmission, social support, receive psychological and maintain adequate health, and receive appropriate medical care, men living with HIV will consider this misconception about the causes of the disease to be an obstacle. As Skinner and Mfecane (2004) document, HIV/AIDS patients face stigma and prejudice just as they do in any other group. Men are adversely affected by this belief, which undermines community functions as well as HIV prevention and treatment efforts.

2.4 Factors inhibiting the use of health services

2.4.1 Socio-demographic factors influencing health-seeking

Several factors have been identified as potential health hurdles, including an individual's economic status as well as their socio-demographic status (Shaikh and Hatcher, 2008). Geographic location, socioeconomic status, work status, and educational level are some of these determinants. Age, gender, cultural customs, beliefs, and marital status all have an impact on health-seeking behaviour. According to Shaikh and Hatcher (2008), cultural practices and beliefs have persisted independent of age, family socioeconomic situation, or educational level.

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• Autor: Tronic Sithole (Autor:in)
• Erscheinungsjahr: 2022
• Seiten: 101
• Katalognummer: V1370333
• ISBN (PDF): 9783346904102
• ISBN (Buch): 9783346904119
• Sprache: Englisch
• Schlagworte: Health seeking behaviour, Male students, Utilisation of health care services