The socio-ecological determinants of help-seeking practices and healthcare access among young men: a systematic review

Abstract

Delayed engagement with health services is a key contributor to poorer health outcomes experienced by men. Patterns of health service usage which reduce the opportunity for disease prevention and health promotion appear to be especially prominent amongst young men. To identify the multiple and intersecting determinants of young men’s help-seeking practices and health services usage, this review uses the social ecological model (SEM) to guide a critical synthesis of the literature on barriers and facilitators experienced by young men in accessing health services. A systematic review was conducted across five databases (MEDLINE, Embase, PsychINFO, CINAHL and Scopus). Included studies presented primary data regarding young men’s (12–24 years) barriers and/or facilitators to seeking and accessing health care. Thirty-one studies (24 qualitative and 7 quantitative) underwent data extraction, quality appraisal and thematic analysis under the guiding framework of the SEM. Seven key themes were constructed, encapsulating the perceived barriers and facilitators to help-seeking and accessing health care experienced by young men, including masculine attitudes, health literacy, social pressure, service accessibility, economic factors, service characteristics and cultural attitudes. These findings highlight the complex interplay between the individual, interpersonal, organizational and societal factors impacting young men’s healthcare engagement. They also illuminate avenues for multifaceted, context-specific interventions to enhance healthcare accessibility for this group, including addressing health literacy gaps, providing culturally sensitive care and reducing cost barriers.

Contribution to Health Promotion.

• This review pinpoints key barriers and facilitators to help-seeking and accessing health care experienced by young men.

• Through employing the SEM, the review offers a comprehensive lens to understand multi-level factors impacting healthcare engagement.

• Insights from this review can guide the development of strategies tailored to young men, aiming to enhance their healthcare access and ultimately improve their health outcomes.

BACKGROUND

Men’s health is a significant issue that warrants urgent attention. Globally, undetected or ineffectively managed disease results in men living, on average, nearly 5 years less of ‘healthy life’ than women (WHO, 2021). Men also constitute the majority of deaths from suicide, are more likely to experience cardiovascular disease and are at higher risk for premature mortality (Pirkis et al., 2016; WHO, 2018; AIHW, 2020, 2022).

A key contributor to the poorer health outcomes experienced by men is insufficient and untimely engagement with health services (Baker, 2016). The decision for men to formally seek health information or services is often delayed by a period of self-monitoring and is dependent on the perceived seriousness of the symptoms experienced (Smith et al., 2008a; Yousaf et al., 2015; Adam et al., 2019). When men do attend health services, they seek support later in their illness, leave significant health issues unattended and are more likely to somatize psychological concerns (Vincent et al., 2018). These patterns of engagement with health services appear to be especially prominent amongst young men (Rickwood et al., 2005; Rice and Baker, 2017; Vincent et al., 2018).

Despite experiencing high rates of psychological distress and suicide, young men are less likely than older men to value preventative mental healthcare practices and have among the lowest rates of professional help-seeking for mental health of any group across the lifespan (Rickwood et al., 2005; Burke and McKeon, 2007; Judd et al., 2012; Rasmussen et al., 2018; Rice et al., 2018a; Rice et al., 2018b; Smith et al., 2023). Similarly, research considering the distinct attitudes and behaviours of young men in relation to managing their physical health suggests that young men often adopt norms and practices that hinder disease prevention and early detection (Vincent et al., 2018; Smith et al., 2023). Notably, a trend of disengagement from health services for men often begins during adolescence and persists through adulthood (Smith et al., 2006; Marcell et al., 2007). This is particularly concerning given the critical role that early diagnosis and intervention play in reducing morbidity (White et al., 2011; Yousaf et al., 2015; Rice et al., 2018b). Therefore, it is crucial to understand and address the factors affecting young men’s health service engagement to improve both immediate and long-term health outcomes.

Research has identified psychological and behavioural factors that reduce men’s engagement with health services (Galdas et al., 2005; Yousaf et al., 2015; Mursa et al., 2022). There has been recognition that lower engagement with health information and services by men may be related to adherence to traditional masculine ideals (O’Brien et al., 2005; Smith et al., 2008a). Specifically, it is posited that masculine traits of strength, self-reliance and independence are inconsistent with the expression of vulnerability required to seek help from a health professional (Courtenay, 2000). However, there is little consensus regarding how existing health systems and health promotion efforts may be adapted to better accommodate young men as they navigate these masculine ideals (Baker, 2019). Moreover, while there has been a focus on individual-level factors that impede men’s healthcare engagement, the broader social, cultural and environmental determinants remain less well-defined (MacDonald, 2016).

The social ecological model (SEM) has been widely adopted in public health and provides a means of understanding the complex and contextual factors that influence young men’s help-seeking behaviours (McLeroy et al., 1988; Lounsbury and Mitchell, 2009). Originating from the seminal work of Bronfenbrenner (1979), SEM has evolved to provide a nuanced lens for understanding how various levels of an individual’s environment—ranging from personal to societal—interact and influence behaviour. In this context, the SEM is a theoretical approach that recognizes the dynamic interplay between individuals and their environment and acknowledges individuals as active agents engaged in a continuous reciprocal exchange with their surroundings (Bronfenbrenner, 1979, 1989). Approaches that focus solely on individual-level factors can be limiting; they may fail to account for the systemic influences that shape young men’s attitudes and behaviours. In contrast, SEM allows for a multidimensional understanding, expanding the scope from individual choices to interpersonal relationships, community norms, organizational factors and larger societal dynamics (McLeroy et al., 1988; Lounsbury and Mitchell, 2009).

This approach is particularly relevant to our study as young men’s help-seeking behaviours are not solely a product of individual decision-making but a composite of influences ranging from personal beliefs to cultural norms and systemic constraints (Baker, 2019). The SEM helps in identifying leverage points across these multiple layers, which is vital for crafting more targeted and effective interventions. Consequently, the SEM has found widespread application in addressing various health determinants, including health literacy and engagement with primary health care (Lounsbury and Mitchell, 2009; Wharf Higgins et al., 2009; McCormack et al., 2017; Mengesha et al., 2017).

By adopting the SEM as a guiding framework, this review aims to synthesize evidence concerning the influences upon help-seeking and health service usage by young men, thereby contributing to an understanding of the factors that need to be addressed to promote timely service engagement, prevention and early detection in this population group.

METHODS

A systematic review was conducted in accordance with PRISMA guidelines (Page et al., 2021). The review was registered with PROSPERO (No. CRD42022371740). A PRISMA checklist is presented in Appendix 1. This review integrated both quantitative and qualitative findings to enable a thorough examination of multi-level barriers and facilitators to young men’s help-seeking behaviours.

Literature search

A search strategy was developed in collaboration with an experienced academic liaison librarian and keywords and MeSH terms were adapted for suitability to each database. Search terms captured four key concepts: (i) barriers/facilitators, (ii) help-seeking behaviour, (iii) healthcare access and (iv) men (see Appendix 2), and were used in the systematic searches of selected databases, namely, MEDLINE, Embase, PsychINFO, CINAHL and Scopus. The search was launched in November 2022. Additionally, backward and forward reference searching of retrieved papers was used to identify further studies of interest.

Eligibility criteria

A study was included in the review if it presented primary findings regarding young men’s (12–24 years) barriers and/or facilitators to seeking and accessing health care. Only studies published in peer-reviewed journals in the English language between 2002 and 2022 were considered for inclusion. This period was chosen to capture contemporary issues, including the impact of internet and social media use on help-seeking and health service engagement (Ybarra and Suman, 2006; Best et al., 2016). Studies that did not analyse data from young men separately were excluded. The full list of inclusion and exclusion criteria is available in Appendix 3.

Study selection

In total, 13,175 studies were identified from database searches and hand searching. After duplicates were removed, two independent reviewers (R.P. and J.K.) screened 6544 abstracts and 204 full text articles. A third reviewer was consulted (B.S.) to resolve any disagreement and reach a final decision. The study selection process is summarized in Figure 1.

Fig. 1:

PRISMA flowchart of study selection process.

Data extraction and quality assessment

A standardized form was piloted and used to extract data from included studies for the appraisal of study quality and evidence synthesis. Information extracted included: (i) author and publication; (ii) country of study; (iii) study aims; (iv) sample size and participant characteristics; (v) health service setting; (vi) data collection methods; (vii) data analysis; (viii) findings related to influences upon help-seeking and health service usage. For quantitative studies, details of statistical analyses were recorded. For qualitative studies, discussion topics and major questions explored were recorded. Two review authors (R.P. and J.K., R.P. and B.S. or R.P. and P.P.) extracted data independently for each paper. Discrepancies were resolved through discussion between the two reviewers, with a third reviewer being consulted where necessary.

The quality of all included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists for qualitative research and cross-sectional studies, respectively (JBI, 2020). Quality assessment was conducted independently by two reviewers (R.P. and J.K., R.P. and B.S. or R.P. and P.P.) for each paper. Discrepancies were resolved through discussion between the two reviewers before a final quality rating was decided upon. Each study was given a quality rating based on total score of low (0–3 for qualitative and 0–2 for quantitative studies), moderate (4–6 for qualitative and 3–5 for quantitative studies) or high (7–10 for qualitative and 6–8 for quantitative studies). No studies were excluded from the review because of quality.

Data synthesis

A narrative synthesis was conducted, drawing on the framework and techniques described by Popay et al. (2005) and Thomas and Harden (2008). This approach was chosen because of the descriptive nature of results and the heterogeneity of methodologies among included studies. Quantitative data were transformed into ‘qualitized data’ to enable the integration of evidence from quantitative and qualitative studies (Lizarondo et al., 2020). This involved the conversion of the quantitative results into textual descriptions of reported barriers and facilitators. Qualitative and ‘qualitized’ data were then reorganized to group findings according to reported barriers and facilitators. An iterative process was used to refine these initial codes into the overarching barrier and facilitator themes and organize them into the appropriate domains of the SEM (individual, interpersonal, organizational and societal).

Analyses were led by the primary author (R.P.) and informed by regular discussions with other reviewers (J.K./B.S./P.P.) regarding the interpretation of codes and themes. This was an iterative process involving subsequent discussions to facilitate the refinement of the themes identified.

RESULTS

In total, 31 studies were included for synthesis: 24 studies provided qualitative data and 7 provided quantitative data (Supplementary Table S1 and Table 1). A total of 14 studies were conducted in the United States, 6 in Australia, 5 in the United Kingdom, 3 in Canada and 1 each in New Zealand, the Republic of Ireland and Norway. In terms of health service context, most studies focused on mental health (n = 17), while 10 focused on sexual health, 3 on physical health and 1 on general primary health care. Most studies (n = 23) only sourced data directly from young men. However, eight studies included perspectives from individuals closely associated with young men, such as parents, peers and healthcare professionals. Notably, findings were similar for both groups of participants.

Table 1:

Quantitative study characteristics

Author/country	Aim(s)	Participants	Health service setting	Data collection	Data analysis	Quality rating	Summary of findings
Biddle et al. (2004) United Kingdom	Investigate and compare the help-seeking behaviour of mentally distressed young men and women.	560 young men (16–24 years)	Mental health services	Self-completed questionnaire	Multivariate logistic regression examining whether exposure variables are more prevalent among help-seekers	5 moderate	The strongest predictors of help-seeking by men were higher severity of mental disorder, previous help-seeking for psychological or emotional problems, and awareness of own problems.
Cole and Ingram (2020) United States	Examine how self-stigma and gender role conflict in men impact the utilization of different types of help-seeking behaviours for depression	313 men (18–22 + years) attending a large Midwestern university	Mental health services for depression	Self-report measures	Structural equation models looking at relationships between gender role conflict (GRC) and self-stigma of seeking help (SSOSH) and help-seeking for depression	6 high	Both SSOSH and GRC were associated with a lower likelihood of using informal supports and a higher likelihood of avoidance, while SSOSH was also associated with a lower likelihood of seeking professional help for depression.
DeBate et al. (2018) United States	Examine the relationships between mental health literacy, mental health attitudes, subjective norms about mental health treatment and stigma in relation to intention to seek support from mental health services.	1242 men (mean age of 25 years) who are students attending a large research university in the southern United States	Mental health services	Self-completed online survey	Mediation models looking at the influence of stigma on the relationships between health literacy and attitudes towards seeking help with intention to seek professional mental health services.	6 high	There were weak positive relationships between information, motivation and behavioural skills (intention to seek professional mental health services); and stigma was found to mediate these relationships.
Hussen et al. (2015) United States	To examine psychosocial correlates of engagement in HIV care at different stages along the continuum for young gay/bisexual men and other men who have sex with men.	132 young black gay/bisexual and other men who have sex with men (16–24 years)	Health care for HIV	Self-report measures	Logistic regression . Exposure variables: negative self-image component of HIV stigma, ethnic identity affirmation and employment status . Outcome variables: missed health care for HIV appointments in the last 3 months, seeking health care on the day of HIV diagnosis	7 high	Poor self-image was negatively associated with early care-seeking on the day of diagnosis. Being employed and higher ethnic identity affirmation were positively associated with appointment adherence. Poor self-image was a significant predictor of having more missed appointments.
Marcell et al. (2007) United States	Test the ability of modifiable and nonmodifiable factors to predict health care use by adolescent men. Specifically focused on the relationship among beliefs about masculinity, parental communication and health-care use.	A racially and ethnically representative household sample of 1677 men (15–19 years)	Physical examination by regular care provider	In-person interview and self-completed questionnaire	Logistic regression. Exposure variables: beliefs about masculinity, serious illness or injury, age, health insurance and parental communication about reproductive health. Outcome variable: physical examination by doctor in past 12 months	4 moderate	Adolescents were more likely to have engaged in health care use in the past year if they had a serious illness, communication about reproductive health with both parents and health insurance. They were less likely if they had more traditional beliefs about masculinity and were 19 years old as opposed to 15 years old.
Pederson and Vogel (2007) United States	Examine the mediating roles of self-stigma and distress disclosure on the relationship between gender role conflict and willingness to seek counselling for psychological and interpersonal concerns.	575 men who are students attending a large midwestern university (18–40 years)	Mental health services	Self-report measures	Structural equation model. Exposure variables: gender role conflict (GRC), self-stigma regarding counselling, comfort with distress disclosure, attitudes towards seeking counselling. Outcome variable: willingness to seek counselling (WSC).	4 moderate	GRC and attitudes to counselling have a direct path of association with WSC. GRC also has indirect pathways of association to WSC via self-stigma and attitudes, as well as comfort with disclosure and attitudes.
Wasylkiw and Clairo (2018) Canada	Explore the role of masculine norms and self-compassion in men’s help-seeking for mental health	166 men who are students attending a small Atlantic Canadian university. (mean age of 19.46 years)	Mental health services	Survey	Structural equation models looking at relationships between masculinity and propensity to seek professional mental health services.	6 high	Men who were more likely to adopt traditional masculine norms had less favourable attitudes to help-seeking, but athletes (and not non-athletes) with higher self-compassion had more positive attitudes towards help-seeking.

Quality ratings

Among the quantitative studies, 4 received a ‘high’-quality rating, while the remaining 3 were rated as ‘moderate’ quality. For qualitative studies, 16 were considered ‘high’ quality, 6 were classified as ‘moderate’ quality and 2 were ‘low’ quality.

Within qualitative papers of ‘low’ and ‘moderate’ quality, there was often ambiguity regarding the appropriateness of the chosen methodological paradigm. Furthermore, there was commonly a lack of clarity regarding participant representation and whether participant responses and viewpoints had been adequately and equitably presented within the results. Additionally, the consideration of how the researcher’s cultural and theoretical background could potentially impact data collection and interpretation was often absent. Among quantitative studies, a common limitation was a lack of identification and management of potential confounding factors within the analysis.

Thematic analysis

The thematic analysis identified seven overarching barrier and facilitator themes across the SEM categories of ‘individual’, ‘interpersonal’, ‘organizational’ and ‘societal’ domains (Table 2).

Table 2:

Summary of themes according to SEM domains

Socio-ecological domain	Theme	Number of studies reporting themea
		Barrier	Facilitator
Individual	Masculine attitudes	27	5
	Health literacy	18	6
Interpersonal	Social pressure	13	12
Organizational	Service accessibility	6	5
	Service characteristics	12	16
Societal	Economic factors	5	2
	Cultural attitudes	25	1

^aNot mutually exclusive counts as studies could report on both barriers and facilitators.

Individual domain

Determinants of help-seeking behaviour and health service usage at the individual level were commonly reported across studies. These were synthesized into two primary themes: masculine attitudes and health literacy. Among these studies, six used quantitative methodologies and 24 used qualitative. All studies reporting individual-level determinants demonstrated ratings of ‘moderate’ to ‘high’ quality, except for Ferrari et al. (2018) and Omura et al. (2006) which both received a ‘low’-quality rating. However, each of these studies identified barriers to help-seeking (i.e. fear of appearing weak or vulnerable, inadequate health literacy) that were observed in several studies rated as ‘high’ quality (Timlin-Scalera et al., 2003; Lindberg et al., 2006; Garcia et al., 2014; Tang et al., 2014; Su et al., 2016; Clark et al., 2018; Lynch et al., 2018; Sagar-Ouriaghli et al., 2020; MacDonald et al., 2021).

Masculine attitudes

Subscribing to masculine values and attitudes was reported as a barrier to help-seeking in 22 qualitative studies. In these studies, young men often associated help-seeking with a compromised sense of masculinity (Kalmuss and Austrian, 2010; Buzi and Smith, 2014; Tang et al., 2014; Ewert et al., 2016; Clark et al., 2018; Lynch et al., 2018). They reported feeling pressure to be ‘strong’ (Timlin-Scalera et al., 2003; Kalmuss and Austrian, 2010; Buzi and Smith, 2014; Tang et al., 2014; Ewert et al., 2016; Ferrari et al., 2018; Rasmussen et al., 2018; Sagar-Ouriaghli et al., 2020) and consistently expressed a belief that engaging in help-seeking is a sign of weakness (Pearson, 2003; Timlin-Scalera et al., 2003; Lindsey et al., 2006; Hutchinson and Winsome, 2012; Buzi and Smith, 2014; Tang et al., 2014; Ewert et al., 2016; Su et al., 2016; Clark et al., 2018; Ferrari et al., 2018; Rasmussen et al., 2018; Rice et al., 2018a; Sagar-Ouriaghli et al., 2020; Meechan et al., 2021). A respondent from one study highlighted this belief, stating, ‘Because they have to keep their name “man.” They’ve got to be strong’ (Buzi and Smith, 2014). In some instances, young men reported avoiding help-seeking out of fear of receiving a formal diagnosis (Kalmuss and Austrian, 2010; Wilson et al., 2012; Marcell et al., 2017; Lynch et al., 2018; Rasmussen et al., 2018; Meechan et al., 2021). Instead of seeking help, young men endorsed a preference for self-managing symptoms (Timlin-Scalera et al., 2003; Lindberg et al., 2006; Lindsey et al., 2006; Kalmuss and Austrian, 2010; Buzi and Smith, 2014; Garcia et al., 2014; Tang et al., 2014; Samuel, 2015; Clark et al., 2018; Lynch et al., 2018; Meechan et al., 2021) to avoid ‘burdening’ others (Timlin-Scalera et al., 2003). Reframing the discourse and terminology around help-seeking and accessing health services to be congruent with masculine values was identified as a potential facilitator (Lynch et al., 2018; Sagar-Ouriaghli et al., 2020).

The quantitative studies describing masculine attitudes as a determinant to help-seeking highlighted the influence of gender role conflict (GRC), self-stigma and conformity to masculine norms. Hussen et al. (2015) found that negative self-image was a significant predictor of an increased rate of missed appointments among young black men who have sex with men living with HIV. Pederson and Vogel (2007) identified that experiencing GRC is associated with reduced willingness to seek counselling, with GRC’s impact mediated through self-stigma. These findings aligned with those of Cole and Ingram (2020), who observed that self-stigma predicted increased avoidant behaviours and reduced willingness to engage in help-seeking. Additionally, experiencing GRC was associated with diminished willingness to engage in informal help-seeking behaviours and an increase in avoidant behaviours (Cole and Ingram, 2020). Marcell et al. (2007) found that those holding more traditional beliefs about masculinity were less inclined to use health services (Marcell et al., 2007). Similarly, Wasylkiw and Clairo (2018) observed that adherence to traditional masculine norms predicted less favourable attitudes towards help-seeking due to self-stigma. Wasylkiw and Clairo (2018) also identified that self-compassion could act as a facilitator for help-seeking, independent of masculinity.

Health literacy

Inadequate health literacy was identified as a barrier to help-seeking across 17 qualitative studies. In these studies, young men described having difficulty identifying symptoms and lacked awareness of the need for treatment (Timlin-Scalera et al., 2003; Lindberg et al., 2006; Omura et al., 2006; Kalmuss and Austrian, 2010; Wilson et al., 2012; Garcia et al., 2014; Ewert et al., 2016; Su et al., 2016; Marcell et al., 2017; Clark et al., 2018; Lynch et al., 2018; Sagar-Ouriaghli et al., 2020; MacDonald et al., 2021). One health professional who worked closely with young men described this reluctance and lack of awareness, stating, ‘They think they know it all. They think they don’t need it. They don’t want to admit that they might need it. It clashes with that image and their personal communication style’ (Garcia et al., 2014). In addition, young men reported having low understanding and familiarity with available health services and how these could be accessed (Timlin-Scalera et al., 2003; Lindberg et al., 2006; Hutchinson and Winsome, 2012; Samuel, 2015; Ewert et al., 2016; DeBate et al., 2018; Lynch et al., 2018; Rice et al., 2018a; Sagar-Ouriaghli et al., 2020). Enhancing awareness of when symptoms warrant treatment was highlighted as a factor supporting help-seeking and health service access (Timlin-Scalera et al., 2003; Garcia et al., 2014; Lynch et al., 2018; Sagar-Ouriaghli et al., 2020).

One quantitative paper identified health literacy as a barrier to help-seeking. In their investigation, DeBate et al. (2018) explored the relationship between mental health literacy and intention to seek professional mental health services among 1242 males attending college. They established that mental health literacy predicted intent to seek professional mental health services, with self-stigma acting as a mediator of this relationship (DeBate et al., 2018).

Interpersonal domain

Fewer studies reported factors influencing help-seeking and health service access at the interpersonal level. These factors can generally be classified as experiences of different types of social pressure. Among the studies reporting factors at the interpersonal level, 17 employed qualitative methodologies and one used a quantitative design. Additionally, a higher proportion of studies obtained data from informants closely associated with young men, with 6 studies gathering insights from these informants and 12 studies directly engaging with young men only. Most of the studies reporting interpersonal determinants were rated as being ‘high’ quality (n = 12), while the remainder were rated as ‘moderate’ quality.

Social pressure

Fear of negative evaluation from family members and peers was a major barrier reported by young men across studies. Qualitative findings highlighted that young men consistently expressed concern that seeking help from health services might lead to a loss of status and ostracism from their peers (Pearson, 2003; Timlin-Scalera et al., 2003; Lindberg et al., 2006; Lindsey et al., 2006; Hutchinson and Winsome, 2012; Wilson et al., 2012; Tang et al., 2014; Samuel, 2015; Clark et al., 2018; Lynch et al., 2018; Rasmussen et al., 2018; Rice et al., 2018a; Meechan et al., 2021). A participant reflected this concern by stating, ‘It’s harder for boys ’cause they’ve got images and stuff. You don’t want to ruin your images with your mates’ (Pearson, 2003). These findings were most prominent in studies investigating help-seeking in mental health and sexual health settings and when peers or family members had negative attitudes towards men’s help-seeking (Timlin-Scalera et al., 2003; Lindsey et al., 2006; Tang et al., 2014; Samuel, 2015; Lynch et al., 2018; Rasmussen et al., 2018; Meechan et al., 2021). Conversely, receiving encouragement and support from peers and family members was the most frequently endorsed facilitator for help-seeking and health service access across studies (Timlin-Scalera et al., 2003; Lindsey et al., 2006; Kalmuss and Austrian, 2010; Wilson et al., 2012; Garcia et al., 2014; Tang et al., 2014; Samuel, 2015; Marcell et al., 2017; Sagar-Ouriaghli et al., 2020). Additionally, having knowledge of other men’s help-seeking behaviours and engagement with health services was also endorsed as a facilitator (Tang et al., 2014; Clark et al., 2018; Lynch et al., 2018).

In the only study reporting quantitative findings on social pressure as a determinant for help-seeking and health service access, Marcell et al. (2007) found that parents communicating with their sons about reproductive health was predictive of these practices among young men.

Organizational domain

Eighteen studies reported factors influencing help-seeking and health service usage at the organizational level. These were predominantly service characteristics and aspects of service accessibility. Among these, 17 studies employed qualitative methodologies, while one study used a quantitative design. A smaller proportion of studies obtained data from informants closely associated with young men (N = 4), compared with those gathering insights directly from young men only (N = 14). In terms of research quality, 14 studies were rated as ‘high quality’, while the remaining were considered ‘moderate quality’.

Service accessibility

The location of health facilities was identified as both a potential facilitator and barrier to help-seeking. Remote and isolated locations were cited as barriers due to the logistical challenges they pose (Pearson, 2003; Hutchinson and Winsome, 2012; Buzi and Smith, 2014). However, a public and highly visible location was also identified as a barrier because of reduced discretion and possible lack of confidentiality (Pearson, 2003; Hutchinson and Winsome, 2012; Buzi and Smith, 2014). Instead, young men endorsed a preference for health services that are situated in accessible but discrete locations (Lindberg et al., 2006; Hutchinson and Winsome, 2012; Buzi and Smith, 2014; Su et al., 2016; Clark et al., 2018). Long waiting times were reported as another barrier (Lindberg et al., 2006; Sagar-Ouriaghli et al., 2020), while having opening hours outside of business hours (9 am–5 pm) was endorsed as a facilitator (Buzi and Smith, 2014). One quantitative study identified service accessibility as potential facilitating factors for young men engaging in help-seeking and service usage (Biddle et al., 2004). This study found that young men experiencing a possible minor mental disorder were more likely to seek help from a GP if they had previously engaged in help-seeking behaviours (Biddle et al., 2004).

Service characteristics

The willingness of young men to engage with health services was consistently reported to be influenced by the clinical and cultural characteristics of those services. Concerns about privacy and confidentiality, particularly the possibility of being seen by known others at the health service, were frequently expressed as a significant barrier to engagement (Pearson, 2003; Timlin-Scalera et al., 2003; Lindberg et al., 2006; Hutchinson and Winsome, 2012; Ewert et al., 2016; Su et al., 2016; Marcell et al., 2017; Clark et al., 2018; Rice et al., 2018a; Sagar-Ouriaghli et al., 2020). The anxiety around confidentiality and ensuing gossip is demonstrated in one participant’s remark, ‘Yeah, if you go into the clinic, all the rumours start. People would start to talk. Everyone at school would know [about the clinic visit] and talk about you. They’d be looking at you when you walk in [to school]’ (Lindberg et al., 2006).

Furthermore, negative previous experiences of help-seeking (Buzi and Smith, 2014), perceived disrespect from staff (Lindberg et al., 2006) and a lack of personal connection with clinicians (Lindberg et al., 2006; Hutchinson and Winsome, 2012; Buzi and Smith, 2014; Garcia et al., 2014; Sagar-Ouriaghli et al., 2020) were reported as barriers to help-seeking and engagement. In contrast, characteristics such as staff being perceived as male friendly (Buzi and Smith, 2014; Su et al., 2016; Rice et al., 2018a; Sagar-Ouriaghli et al., 2020), respectful (Lindberg et al., 2006; Hutchinson and Winsome, 2012; Buzi and Smith, 2014), and capable of establishing meaningful connections with young men were described as potential facilitators of engagement (Hutchinson and Winsome, 2012; Buzi and Smith, 2014; Rice et al., 2018a).

Some young men reported barriers to engagement, perceiving health services as primarily oriented towards women, which might be attributed to the prevalence of women-oriented promotional materials, the lack of men-specific services or having staff that are predominantly women (Pearson, 2003; Su et al., 2016; Rice et al., 2018a). Additionally, services were perceived as excessively clinical or intimidating, potentially due to an overly formal or sterile environment, or stringent procedural protocols (Pearson, 2003; Su et al., 2016; Rice et al., 2018a). Health services that managed to create a comfortable yet informal atmosphere by incorporating entertainment in waiting rooms and facilitating engagement through alternative venues or outdoor activities, especially when engaging boys in an office environment proved challenging, were reported as facilitators of engagement (Lindberg et al., 2006; Hutchinson and Winsome, 2012; Buzi and Smith, 2014).

Among school-aged males, the association between health services and disciplinary action was reported as being a barrier (Hutchinson and Winsome, 2012; Rice et al., 2018a). Conversely, health services that promoted autonomy, and allowed usage without teacher or parental permission were perceived as encouraging both help-seeking and engagement (Hutchinson and Winsome, 2012; Rice et al., 2018a). Among men with diverse sexual and cultural backgrounds, having clinicians capable of delivering culturally sensitive care was reported as a facilitator (Hussen et al., 2015; Griffin et al., 2018).

Societal domain

Societal-level determinants of help-seeking from health services were frequently reported across studies. These determinants are categorized into two themes: economic factors and cultural attitudes. Of the studies reporting determinants at this level, 23 used qualitative methods, while 5 used quantitative methods. A total of eight studies reported insights from informants closely associated with young men, and 20 gathered data directly from young men only. In terms of research quality, 18 studies were rated as ‘high’, 9 as ‘moderate’ and 2 as ‘low’ (Omura et al., 2006; Ferrari et al., 2018). Both ‘low-quality’ papers highlighted the role of stigma as a barrier to help-seeking (Omura et al., 2006; Ferrari et al., 2018), which was also reported in a number of ‘high-quality’ studies (Timlin-Scalera et al., 2003; Lindberg et al., 2006; Garcia et al., 2014; Su et al., 2016; Marcell et al., 2017; Clark et al., 2018; DeBate et al., 2018; Rice et al., 2018a; Wasylkiw and Clairo, 2018; Cole and Ingram, 2020).

Economic factors

The financial cost of attending health services was identified as a barrier to help-seeking and accessing health care among young men (Kalmuss and Austrian, 2010; Buzi and Smith, 2014; Ewert et al., 2016; Marcell et al., 2017; Griffin et al., 2018). This cost is compounded by the loss of income and inconvenience associated with taking time off work to attend health services which are usually not open outside of usual business hours (Buzi and Smith, 2014). Having health insurance was identified as a facilitator (Marcell et al., 2017). Hussen et al. (2015), the only quantitative study reporting economic factors as a determinant, found that employment positively influenced medical appointment adherence among young gay and bisexual men living with HIV. Notably, almost all studies focusing on economic factors originated in the United States (Kalmuss and Austrian, 2010; Buzi and Smith, 2014; Hussen et al., 2015; Marcell et al., 2017; Griffin et al., 2018). An exception was an Australian study by Ewert et al. (2016), who found that the cost was a barrier to healthcare access only for international students, not for their Australian counterparts.

Cultural attitudes

The stigma of seeking health care was a recurring barrier identified among young men (Timlin-Scalera et al., 2003; Lindberg et al., 2006; Omura et al., 2006; Pederson and Vogel, 2007; Kalmuss and Austrian, 2010; Wilson et al., 2012; Garcia et al., 2014; Samuel, 2015; Su et al., 2016; Marcell et al., 2017; Clark et al., 2018; DeBate et al., 2018; Rice et al., 2018a; Wasylkiw and Clairo, 2018; Cole and Ingram, 2020). It was commonly reported that feelings of shame and embarrassment were related to perceptions of weakness or vulnerability for seeking help (Lindberg et al., 2006; Lindsey et al., 2006; Kalmuss and Austrian, 2010; Buzi and Smith, 2014; Garcia et al., 2014; Samuel, 2015; Ewert et al., 2016; Su et al., 2016; Rasmussen et al., 2018; Rice et al., 2018a). This is reflected in the observation of one participant’s statement about a young man they knew who did not seek help before he died by suicide: ‘He must have felt so embarrassed … so embarrassed he would rather die’ (Rasmussen et al., 2018).

Specific subgroups reported unique cultural barriers: gay men cited fears of homophobic responses from health providers (Griffin et al., 2018; Lynch et al., 2018) and men of diverse cultural backgrounds were discouraged if clinicians had different cultural characteristics from them (Lindsey et al., 2006; Meechan et al., 2021). The only study which identified how cultural attitudes could act as a facilitator was conducted with Chinese young men in New Zealand (Omura et al., 2006), which identified the benefit of promoting more open discussion of sexual health for help-seeking and service usage by this population group.

The quantitative research on cultural factors underscores the complex interplay between self-stigma, masculinity and GRC in influencing help-seeking behaviours. DeBate et al. (2018) found that stigma served as a mediator in the relationships between information, motivation and intention to seek professional mental health services. Pederson and Vogel (2007) reported that GRC directly influenced willingness to seek counselling, with the impact of this factor mediated through self-stigma and attitudes towards disclosure. This aligns with the study by Cole and Ingram (2020), which found that self-stigma is linked to a reduced likelihood of both informal and professional help-seeking for depression, as well as increased avoidant behaviours. Wasylkiw and Clairo (2018) observed that the effect of masculine norms on help-seeking was partially driven by self-stigma. Overall, these studies highlight how cultural attitudes convey social norms (largely about masculinity) and generate forms of stigma that act as deterrents to help-seeking.

DISCUSSION

To our knowledge, the present review is the first to systematically collate and synthesize the literature on the distinct influences upon help-seeking and health service access among young men. The multiple perspectives provided by the SEM have revealed the depth and complexity of influences on young men’s help-seeking behaviours, highlighting the need for multifaceted strategies to enhance their engagement with health services.

The findings of this review underscore the influence of masculinity beliefs on young men’s help-seeking in relation to their health needs. Specifically, internalized ideals about strength and self-reliance, a core aspect of traditional masculinity, act as a substantial barrier to health service use and can be understood within the SEM as an important individual-level determinant that is influenced by wider cultural norms. This insight corroborates extensive research highlighting the conflict between traditional masculinity and expressions of vulnerability associated with help-seeking across all age groups (Galdas et al., 2005; Yousaf et al., 2015; Mursa et al., 2022). Interestingly, among older men, traditional masculinity can sometimes act as a facilitator for seeking health care. This is particularly true for those who see their health as directly tied to their ability to provide for their families (O’Brien et al., 2005; Peak and Gast, 2014). This suggests a potential direction for future research: exploring the circumstances under which masculine attitudes might encourage rather than discourage health service engagement.

Inadequate health literacy was another salient barrier at the individual level of the SEM. Young men have been found to struggle to recognize symptoms and lack awareness of appropriate treatments, further exacerbating their reluctance to engage with health services. Furthermore, research indicates that low health literacy continues to be a barrier to men accessing health services across their lifespan (Ashley et al., 2020; Mursa et al., 2022), underscoring the potential benefits of early interventions in this area. Enhancing health literacy through targeted educational initiatives, such as interactive workshops and digital programs, has shown effectiveness in improving health service usage, and this review provides support for the tailoring of these interventions for young men (Berkman et al., 2011; Oliffe et al., 2019).

Within the interpersonal SEM domain, peer group pressures were identified as a salient barrier. This barrier appears to be intrinsically linked to young men’s aspiration to preserve masculine ideals of strength and independence. The societal image of men as resilient and self-sufficient forms a backdrop against which being seen seeking health care by peers may equate to admitting vulnerability, causing embarrassment and perceived failure to meet these masculine ideals (Courtenay, 2000). This barrier appears most pronounced in relation to seeking help for sexual and mental health needs, possibly due to the heightened sensitivity and stigma in these areas. However, the limited number of studies focusing on physical health help-seeking makes it challenging to draw comprehensive comparisons across different health issues and service types. In contrast, support from family and peers served as a notable facilitator, indicating the significant potential of social networks in positively shaping help-seeking (Latkin and Knowlton, 2015). This impact is more pronounced in younger age groups, regardless of gender (Gulliver et al., 2010; Radez et al., 2021) and tends to be less significant in older men (Yousaf et al., 2015; Mursa et al., 2022). The emphasis young men place on peer conformity may explain the prominence of this facilitator in the literature (Ciranka and Van den Bos, 2019).

The review has illuminated the significant organizational influences impacting young men’s health service engagement, confirming the value of adopting a social ecological perspective that recognizes broad and interrelated determinants, beyond individual beliefs and attitudes (MacDonald, 2016). It is clearly important to address elements like privacy, confidentiality and staff friendliness as these influence the comfort levels of young men in health settings, which aligns with existing literature on male-friendly health services (Smith et al., 2008b; Cutcliffe et al., 2013). Additionally, attention to the needs of young men from diverse social and cultural backgrounds is essential for enhancing the utilization of health services among a wider cohort of young men. This necessitates a shift in focus towards culturally sensitive care and consideration of alternative channels of outreach and engagement, including sporting and religious organizations and community events (Bird et al., 2019; Abotsie et al., 2020; McGrane et al., 2020).

It has also been found here that determinants at the societal level of the SEM are instrumental in shaping young men’s help-seeking and health service engagement. Economic barriers, particularly the financial cost of healthcare services, were emphasized, especially in the context of the United States. This is potentially indicative of systemic issues arising from the absence of a universal healthcare system (Vladeck, 2003). The identification of cultural influences that conveyed stigma and generated embarrassment and shame, revealed the processes by which masculinity norms are reinforced and internalized and affect young men’s help-seeking behaviours. This aspect of societal influence, as seen through the SEM lens, intertwines with interpersonal and individual levels, where self-stigma and societal expectations shape personal health decisions. These findings, reinforced by quantitative studies, highlight the need for multifaceted solutions that extend beyond the healthcare system to broader social and economic reforms.

The review reveals methodological homogeneity in the existing studies, with a predominance of qualitative studies and a focus on young men’s attitudes rather than behaviours. While these studies provide valuable insights, their findings are vulnerable to participant response bias and interpretive limitations. This underscores a need for more diverse research approaches, including quantitative, mixed methods and longitudinal studies which consider young men’s help-seeking behaviours as well as their stated attitudes. Additionally, the limited inclusion of stakeholder (e.g. service provider) perspectives in these studies suggests an opportunity to expand the scope of research to incorporate diverse viewpoints that may provide insights about interpersonal, organizational and societal influences on young men’s health service engagement.

Moreover, the existing research has primarily focussed on mental and sexual health help-seeking, with few studies examining other aspects of physical health. While young men often exhibit good health status (ABS, 2021), it is important to acknowledge that disconnection from health care for many men is a process beginning in adolescence, reducing opportunities for preventative health care across the lifespan (Rice et al., 2018b). Therefore, there is a need for future studies about young men’s attitudes and preferences towards physical health services, as this could provide insights into promoting proactive health management and preventive healthcare engagement. It will be valuable if this research explores the determinants of help-seeking across health issues and service types, which will provide the evidence base for appropriate interventions in different organizational contexts. In addition to these issues related to the methods and scope of the studies included in this review, it is important to acknowledge other limitations, including the restriction to English-language publications and studies published in high-income countries. Future research could explore the experiences of young men across different cultural contexts and socioeconomic backgrounds to provide a more holistic understanding of healthcare barriers and facilitators.

CONCLUSION

This review highlights the myriad barriers and facilitators young men encounter when help-seeking and engaging with health services. By adopting a social ecological framework, the review has identified key determinants within individual, interpersonal, organizational and societal domains. These findings highlight the importance of working in congruence with masculine attitudes, improving health literacy, leveraging social networks and optimizing service characteristics to enhance young men’s engagement with healthcare services. These insights derived from the SEM’s multi-level perspective offer a foundational understanding for developing effective strategies that consider the full spectrum of influences and will contribute to better health outcomes among young men. Further research and targeted interventions are essential to create healthcare systems that are inclusive, accessible and responsive to the needs

Appendix 1

Section and topic	Item #	Checklist item	Reported on page #
TITLE
Title	1	Identify the report as a systematic review.	1
ABSTRACT
Abstract	2	See the PRISMA 2020 for Abstracts checklist.	2
INTRODUCTION
Rationale	3	Describe the rationale for the review in the context of existing knowledge.	3, 4
Objectives	4	Provide an explicit statement of the objective(s) or question(s) the review addresses.	3, 4
METHODS
Eligibility criteria	5	Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses.	5, Appendix 3
Information sources	6	Specify all databases, registers, websites, organizations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted.	5
Search strategy	7	Present the full search strategies for all databases, registers and websites, including any filters and limits used.	Appendix 2
Selection process	8	Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.	5, 6
Data collection process	9	Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.	6
Data items	10a	List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which results to collect.	6
	10b	List and define all other variables for which data were sought (e.g. participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information.	6
Study risk of bias assessment	11	Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.	6
Effect measures	12	Specify for each outcome the effect measure(s) (e.g. risk ratio, mean difference) used in the synthesis or presentation of results.	n/a
Synthesis methods	13a	Describe the processes used to decide which studies were eligible for each synthesis (e.g. tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).	6
	13b	Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions.	6
	13c	Describe any methods used to tabulate or visually display results of individual studies and syntheses.	6
	13d	Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.	6
	13e	Describe any methods used to explore possible causes of heterogeneity among study results (e.g. subgroup analysis, meta-regression).	n/a
	13f	Describe any sensitivity analyses conducted to assess robustness of the synthesized results.	n/a
Reporting bias assessment	14	Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).	n/a
Certainty assessment	15	Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.	n/a
RESULTS
Study selection	16a	Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.	7
	16b	Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.	n/a
Study characteristics	17	Cite each included study and present its characteristics.	7
Risk of bias in studies	18	Present assessments of risk of bias for each included study.	n/a
Results of individual studies	19	For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g. confidence/credible interval), ideally using structured tables or plots.	n/a
Results of syntheses	20a	For each synthesis, briefly summarize the characteristics and risk of bias among contributing studies.	7–15
	20b	Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary estimate and its precision (e.g. confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect.	n/a
	20c	Present results of all investigations of possible causes of heterogeneity among study results.	n/a
	20d	Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results.	n/a
Reporting biases	21	Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed.	n/a
Certainty of evidence	22	Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed.	n/a
DISCUSSION
Discussion	23a	Provide a general interpretation of the results in the context of other evidence.	16–19
	23b	Discuss any limitations of the evidence included in the review.	18
	23c	Discuss any limitations of the review processes used.	18
	23d	Discuss implications of the results for practice, policy and future research.	16–19
OTHER INFORMATION
Registration and protocol	24a	Provide registration information for the review, including register name and registration number, or state that the review was not registered.	5
	24b	Indicate where the review protocol can be accessed, or state that a protocol was not prepared.	5
	24c	Describe and explain any amendments to information provided at registration or in the protocol.	n/a
Support	25	Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review.	20
Competing interests	26	Declare any competing interests of review authors.	20
Availability of data, code and other materials	27	Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review.	n/a

From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.

Appendix 2

SEARCH TERMS SCOPUS

Barrier* OR enable* OR facilitat* OR determinant* OR factors OR motivat* OR correlate* OR delay* OR obstacles OR correlates AND (seek* W/3 (help OR care OR health* OR treatment* OR support* OR medical)) OR helpseek* OR help-seek* AND (medical OR ‘health care’ OR healthcare OR ‘primary health’ OR ‘health service’ OR gp OR ‘general practice*’ OR ‘family practice*’ OR counsel*) W/3 (access* OR utilis* OR utiliz* OR underutili* OR engage*) AND men OR man OR male* OR men’s

SEARCH TERMS MEDLINE

Barrier* OR enable* OR facilitat* OR determinant* OR factors OR motivat* OR correlate* OR delay* OR obstacles OR correlates OR ‘Social Determinants of Health’/ OR Socioeconomic Factors/ AND (seek* adj3 (help OR care OR health* OR treatment* OR support* OR medical)) OR helpseek* OR help-seek* OR Help-Seeking Behavior/ AND (medical OR ‘health care’ OR healthcare* OR ‘primary health’ OR ‘health service’ OR gp OR ‘general practice*’ OR ‘family practice*’ OR counsel*) adj3 (access* OR utilis* OR utiliz* OR underutili* OR engage*) OR Health Services Accessibility/ AND men OR man OR male* OR men’s OR Men/

SEARCH TERMS PSYCHINFO

Barrier* OR enable* OR facilitat* OR determinant* OR factors OR motivat* OR correlate* OR delay* OR obstacles OR correlates OR Treatment Barriers/ OR exp Socioeconomic Status/ AND (seek* adj3 (help OR care OR health* OR treatment* OR support* OR medical)) OR helpseek* OR help-seek* OR Help Seeking Behavior/ OR Health Care Seeking Behavior/ AND (medical OR ‘health care’ OR healthcare* OR ‘primary health’ OR ‘health service’ OR gp OR ‘general practice*’ OR ‘family practice*’ OR counsel*) adj3 (access* OR utilis* OR utiliz* OR underutili* OR engage*) OR Health Care Utilization/ OR Health Care Access/ AND men OR man OR male* OR men’s OR exp Human Males/

SEARCH TERMS EMBASE

Barrier* OR enable* OR facilitat* OR determinant* OR factors OR motivat* OR correlate* OR delay* OR obstacles OR correlates AND (seek* adj3 (help OR care OR health* OR treatment* OR support* OR medical)) OR helpseek* OR help-seek* OR Help Seeking Behavior/ AND (medical OR ‘health care’ OR healthcare* OR ‘primary health’ OR ‘health service’ OR gp OR ‘general practice*’ OR ‘family practice*’ OR counsel*) adj3 (access* OR utilis* OR utiliz* OR underutili* OR engage*) OR Health Care Utilization/ OR Health Care Access/ AND men OR man OR male* OR men’s OR male/

SEARCH TERMS CINAHL

Barrier* OR enable* OR facilitat* OR determinant* OR factors OR motivat* OR correlate* OR delay* OR obstacles OR correlates OR MH ‘Socioeconomic Factors+’ AND (seek* N3 (help OR care OR health* OR treatment* OR support* OR medical)) OR helpseek* OR help-seek* OR MH ‘Help Seeking Behavior’ AND (medical OR ‘health care’ OR healthcare* OR ‘primary health’ OR ‘health service’ OR gp OR ‘general practice*’ OR ‘family practice*’ OR counsel*) N3 (access* OR utilis* OR utiliz* OR underutili* OR engage*) OR MH ‘Health Services Accessibility+’ AND men OR man OR male* OR men’s OR MH ‘Men’ OR MH ‘Male’

Appendix 3

	Inclusion criteria	Exclusion criteria
Population	Men aged 12–24 years. The age range adopted is consistent with how the Australian Institute of Health and Welfare defines ‘young person’ (Australian Institute of Health and Welfare, 2021).	Men who are institutionalized or with psychosocial needs (e.g. addiction) which prevent them from seeking or accessing health care.
	Men who are members of the general community, or university, or school students.
Exposure	Studies reporting barrier and facilitator determinants in-line with the SEM domains (intrapersonal, interpersonal, organizational, environmental and public policy).
Outcome	Help-seeking practices and healthcare access among young men.	Studies which do not consider either help-seeking practices or healthcare access among young men.
Type of study	Qualitative or mixed methods primary studies. Quantitative primary studies measuring cross-sectional or longitudinal associations between exposure and outcome.	Literature reviews or other forms of evidence synthesis.
Limits	Studies published in peer-reviewed journals in the English language between 2002 and 2022. This period was chosen to capture contemporary issues, including the impact of internet and social media use on engagement and help-seeking (Ybarra and Suman, 2006; Best et al., 2014).	Studies focusing on symptomology or ongoing management of specific conditions.
		Studies which do not analyse data from men separately.
	Studies reporting on high-income economy countries as determined by the World Bank (The World Bank, 2022)	Studies reporting on low and middle-income economy countries as determined by the World Bank (The World Bank, 2022)

Australian Institute of Health and Welfare. (2021). Australia’s Youth. Canberra: AIHW. Retrieved from https://www.aihw.gov.au/reports/children-youth/australias-4youth/contents/introduction.

Best, P., Manktelow, R., & Taylor, B. (2014). Social Work and Social Media: Online Help-Seeking and the Mental Well-Being of Adolescent Males. British Journal Of Social Work, 46(1), 257–276. https://doi.org/10.1093/bjsw/bcu130.

The World Bank. (2022). World Bank Country and Lending Groups. The World Bank. Retrieved from https://datahelpdesk.worldbank.org/knowledgebase/articles/906519#High_income.

Ybarra, M., & Suman, M. (2006). Help seeking behavior and the Internet: A national survey. International Journal Of Medical Informatics, 75(1), 29–41. https://doi.org/10.1016/j.ijmedinf.2005.07.029.

AUTHOR CONTRIBUTIONS

R.P., B.S., P.P. and J.K. all made a major contribution to the conception and design of the project. All authors contributed to the development of the search strategy, study selection, data extraction, quality assessment and analysis. R.P. led the data analysis and was a major contributor in the drafting of the manuscript. B.S., P.P. and J.K. were instrumental in critically reviewing and revising the manuscript. All authors have read and approved the final manuscript and have agreed to submit it.

FUNDING STATEMENT

The authors wish to acknowledge the funding support for the lead author from the Men of Malvern and Healthy Male.

CONFLICT OF INTEREST STATEMENT

There are no conflicts of interest to report in relation to this manuscript.