Men’s perspective on barriers and challenges towards accessing healthcare services in the City of Mbombela, Mpumalanga Province, South Africa

Abstract

Background

Men’s healthcare-seeking behaviour is a demanding global issue with important effects on health and wellbeing. This study aimed to explore barriers and challenges among men towards accessing healthcare service in the City of Mbombela, Mpumalanga Province, South Africa.

Methods

A qualitative descriptive study with an explorative design was conducted to explore men’s healthcare seeking behaviour. Data was collected using in-depth interviews with 20 men purposively selected. Interviews were recorded, transcribed verbatim and analysed using thematic analysis, following Baun and Clarke’s six step framework to ensure a systematic and thorough approach. Data saturation was monitored and confirmed during the analysis process. An independent coder was engaged to provide professional guidance and validation of codes and emerged themes. ATLAS.ti software (version 23.0.0) was used to support data organisation and analysis.

Results

The study revealed that interviews with 20 men aged 18–49 years highlighted reluctance to access healthcare among men was influenced by several elements. These components included personal factors (anxiety, fear, and stigma), healthcare system barriers (long waiting times, unfriendly treatment), and societal expectations around masculinity and health-seeking behavior.

Conclusion

It is evident that this study highlights on personal, social, and cultural factors hindering men from accessing healthcare. The findings inform strategic context-specific interventions highlighted to improve men’s health outcomes. Promote health equity, community-based health programming, integration of workplace health programmes, male-centered support programs, to inform global goals and department of health policy.

Introduction

Men’s healthcare-seeking behavior is a difficult global issue, with important effects on health and well-being [1]. Men are often less likely to seek medical attention, leading to delayed diagnoses, poor health outcomes, and increased mortality rates [2, 3]. Research in United Kingdom has shown that men are more likely to engage in risk-taking behaviors, such as smoking and substance abuse, which negatively impact their health [4, 5].Similarly, in Africa, men are consistently experiencing higher mortality rates than women with same higher rates of risk behaviours that include poor diet [6]. Studies have highlighted various barriers to men’s healthcare-seeking behaviors, including traditional masculine norms, stigma, financial constraints and limited access to healthcare services [7–10].However, there were a need for context-specific research to understand the unique challenges faced by men in accessing healthcare services in the City of Mbombela, a marginalised area characterised by cultural and traditional practices that may influence men’s health seeking behavior as well as socioeconomic challenges such as poverty and unemployment [11]. The study aims to examine the barriers and challenges men face in accessing healthcare services in the region. Exploring the local context and finding gaps on knowledge and practice, this research will inform strategies to report these barriers and improve men’s health outcomes, adding to healthier and beyond equitable society.

Methods

Study design and setting

A qualitative descriptive study with an explorative design was conducted in the City of Mbombela, Mpumalanga Province. This approach enabled exploration of barriers and challenges faced by men in accessing healthcare services from the men’s perspective. An interview guide was developed to explore these barriers and challenges, covering demographic information, barriers and challenges, traditional gender roles and opportunities, healthcare services information, health, and well-being, and uplifting men to seek healthcare.

Sampling and data collection

Purposive sampling was used to select 20 men who could provide in-depth insights into barriers and challenges. Data saturation was determined at 16 men, and an additional four men were interviewed to verify if no new information emerged. Semi-structured interviews were used to collect data, and a tape recorder was used to record the interviews. The IDI interview guide was developed in English language and translated into Swati by languages by experts. The translation was done to allow participants to express their views Swati language, which is the dominant language in the setting. Interviews lasted between 25 and 45 min and were conducted at participant’s homes or workplaces.

Data analysis

Data were collected, transcribed verbatim, and analyzed using inductive thematic approach, to understand patterns and themes. An independent coder was engaged for professional guidance and validation of codes and themes. Data analysis followed Braun and Clarke’s six-step framework, to ensure a logical process. The data was manually coded with relevant features using ATLAS.ti version 23.0.0. software. Codes were studied to ascertain patterns and themes addressing the research question. Themes were refined, defined, and named to capture the data’s substance. Findings were written up, combining rich examples to support themes. A complete audit trace was continued, documenting analytical decisions, data collection, and methodological choices, improving dependability.

Results

The participants age ranges from 18 to 49 years. Only four participants were married, while sixteen were never married and they held diverse educational levels ranging from primary to tertiary. Thirteen of the participants were employed and seven were unemployed (Table 1).

Table 1.

Socio-demographic characteristics of adult men

Participants	Age	Marital status	Level of education	Employment status
1	49	Married	Tertiary	Employed
2	23	Never married	Primary	Unemployed
3	29	Never married	Tertiary	Employed
4	26	Never married	Secondary School	Unemployed
5	32	Never married	Tertiary	Employed
6	32	Never married	Tertiary	Employed
7	27	Never married	Secondary School	Unemployed
8	21	Never married	Matric	Unemployed
9	39	Married	Secondary School	Employed
10	48	Married	Tertiary	Employed
11	33	Married	Tertiary	Employed
12	27	Never married	Matric	Employed
13	19	Never married	Matric	Employed
14	18	Never married	Matric	Unemployed
15	20	Never married	Tertiary	Employed
16	19	Never married	Matric	Employed
17	18	Never married	Matric	Unemployed
18	20	Never married	Matric	Employed
19	18	Never married	Matric	Unemployed
20	21	Never married	Tertiary	Employed

The study found two main themes: men’s perspectives on barriers and challenges towards accessing healthcare services and proposed strategies to improve men’s access to healthcare facilities. Three sub-themes emerged from the two main themes as shown in Fig. 1 on the relationship between themes and Table 2 provide a summary of emerging themes.

Fig. 1.

Relationship between themes and the outcome goal

Table 2.

Summary of emerged themes, sub-themes, and categories

Theme	Sub-themes	Categories
1. Men’s perspective on barriers and challenges.	Personal factors	• Anxiety and fear of unknown • Self-care and making enquiries • Reliance on traditional home remedies • Financial constraints • Fear of diagnosis, stigma, and discrimination
	Barriers and challenges amongst men in accessing healthcare	Healthcare facilities Barriers • Unfriendly treatment and hostile environment • Long waiting time and poor service quality Community-Based Services concerns • Gender norms associated with men’s illness as weakness • Stigma and anxiety attached to healthcare services
2. Strategies to improve men’s access to healthcare services and health-seeking behaviour.	Proposed strategies to improve men’s access to healthcare facilities	• Normalize and promotion of self-care through HIV self- testing • Community-based health education using male role models or male peers • Financial accessibility through mobile clinics and workplace programs • Confidential, privacy and male-friendly services • Integration of traditional health and modern health practices • Online mental health support services • Reduction of waiting time • Taking health services to where men are, • Recruitment and training more of male health advocates

Theme 1: men’s perspective on barriers and challenges

Men experienced anxiety and fear when seeking healthcare, often due to anticipated diagnoses or clinical environments. They preferred self-care practices and informal sources of information, reflecting a desire for autonomy and control over their health.

Regarding the personal concerns, men delayed seeking healthcare due to anxiety about potential diagnoses, fear of being judged, and reliance on traditional home remedies. Financial constraints and stigma also deterred them from accessing healthcare services. Furthermore, men perceived public healthcare facilities as unfriendly and hostile, with extended waiting times and poor healthcare services. Community-based services are also limited, with men associating illness with weakness and stigma. Some of participants maintained:

“I delay seeking healthcare due to anxiety about the visit itself and fear of potential diagnoses.” (Male 19, 18 years).

“I prefer to do my own enquiry and consider alternative treatments before visiting a doctor.” (Men 17, 18 years old).

“As a man, I sometimes feel that seeking healthcare is seen as a sign of weakness, which makes me more sceptical and hesitant to go.” (Men 1, 49 years old).

Reliance on traditional home remedies

Men relied on traditional home remedies, first and only visit a doctor if their conditions did not improve to seeking healthcare services. In addition, participant’s perspective on masculinity and health, had shown that men hold the belief that instead of relying on clinic-prescribed medication, they used herbal remedies to maintain their strength and health. Some of participant expressed themselves as quoted:

“I first use home remedies if feeling unwell, then a doctor if not getting better.” (Male 1, 49 years).

" I think a strong and healthy man should not take medication in the clinic but should take herbs to make us strong as men should not get sick easily.” (Male 2, 23 years).

Financial challenges

The participants emphasised the cost of transportation and limited financial resources to travel to healthcare facilities, utilise mobile clinics and workplace programs where applicable. These was confirmed through some participants quotations:

“I think financial concerns and the cost of travelling to access healthcare, services often make me hesitant to seek healthcare.” (Men 17, 18 years old).

“I don’t have money for transport to visit healthcare facilities and I hardly see any mobile clinics and no workplace programs.” (Male 4, 26 years).

Fear of diagnosis, stigma, and discrimination

Participants reported fears of identification of diseases, stigma, and discrimination, as constraining factors in seeking healthcare. In addition, participants reported fear of being judged, as they had concerns about encountering people from their community and being judged.

" I think, there’s a stigma that affect me as men from not seek healthcare, which leads to not going to these facilities.” (Male 6, 32 years).

“I am afraid of stigma and discrimination because I do not want to see and be seen by people from the community and the clinic, hence, I don’t want to go to nearby clinic.” (Male 4, 26 years).

Sub-theme: barriers and challenges factors

Healthcare facilities issues

The participants expressed that healthcare facilities discouraged men from seeking healthcare assistance. The men recognised facilities that were unfriendly, due to perception about public healthcare facilities that were hostile environment for men. Participant further, reported on extended waiting time and poor healthcare services because of inadequate healthcare services that discouraged men. These were confirmed through participants quotations:

" I think public healthcare facilities can be hostile to males.” (Male 1, 49 years).

" I think long waiting times are a serious challenge in public health facilities.” (Male 2, 23 years).

" I think sometimes, I don’t get the help in the clinic that one need, which discourages me from seeking healthcare.” (Male 4, 26 years).

Community-based services

The findings indicated that participants associated men’s illness with weakness, stigma and anxiety surrounding men’s health issues. This were added to their anxiety, participants suggested the need for the provision of essential services, especially in rural areas.

“I think being sick symbolizes weakness as a man.” (Male 1, 49 years).

" I think stigma definitely adds to my anxiety. Men are expected to be strong and not show weakness.” (Male 19, 18 years).

" I think CHWs provide essential services, especially in underserved areas. I now appreciate their role in educating the community and linking people to healthcare.” (Men 18, 20 years old).

Theme 2: proposed strategies to improve men’s access to healthcare facilities

Men suggested interventions to address barriers men face in accessing health care which include reducing waiting time, taking health services to where men are, recruiting and training male health advocates and peer educators, and collaborating with traditional health practitioners and providing mobile clinics and community services. Some of the participants expressed thus:

" I think healthcare clinics reception should be well-managed to prevent long waiting times.” (Male 1, 49 years).

“I think mobile clinics or community services would save us time and travel costs.” (Male 19, 18 years).

" I think recruitment and training male health advocates, men peer educators from our community to talk to men about health issues would make a big difference.” (Men 18, 20 years old).

" I think partnership with traditional health practitioners to offer health screenings and wellness programs would be beneficial.” (Men 18, 20 years old).

Discussion

The study’s findings provide important insight into the complex factors influencing men’s healthcare -seeking behaviour in the City of Mbombela. Through the lens of Connell’s theory of hegemonic masculinity, it is evident that traditional masculine norms play a significant role in shaping men’s reluctance to seek care [12] The study’s findings concur with previous research highlighting the impact of masculinity, cultural and traditional practices on men’s health seeking behaviour [13, 14] The findings reveal that personal factors, such as anxiety and fear, play an essential role in deterring men from seeking healthcare. These findings are supported by studies that show that men’s health-seeking behavior influenced by their perceptions of masculinity and the potential threat to their masculine [13, 14]. The preference for self-care practices and alternative treatments also reflects a desire for autonomy and control over one’s health, which is consistent with previous research [7, 15]. The reliance on the traditional home remedies and herbal treatment is also consistent with broader Sub-Saharan African literature, where culture and traditional practices shape health seeking behaviour [13, 15]. Furthermore, participants shared views about seeking healthcare was considered as a sign of weakness, which is consistent with previous research on masculinity and health [16, 17].

Our findings indicated that financial constraints, with the cost of transportation and limited financial resources due to lack of mobile clinics and workplace programs are barriers to accessing healthcare [10, 18]. Furthermore, fear of diagnosis with diseases, stigma, and discrimination were also dominant constraints to seeking healthcare, as previously highlighted by other studies [13, 15]. The extended waiting times and poor healthcare services discourages men from accessing healthcare services, which is consistent with previous research on the need for male-friendly healthcare services [14, 19].

The study’s findings have essential suggestions for policy and practice. To improve men’s access to healthcare facilities, specific intervention could include integration of workplace health programs targeting men. For example, workplace healthcare service for screening of hypertension, Tuberculosis, HIV/AIDS, counselling for stress, reducing stigma related through sensitization campaigns. In addition, policy recommendations for Department of Health and local municipalities, on enhancing policies and programs encouraging male-friendly healthcare services, reducing waiting times, and improving care quality could enrich men’s healthcare experiences. Furthermore, linkage to National Strategic Plan (NSP) 2023–2028 and SDG 3 (health and wellbeing), which are strategies aligning to promote men’s health and wellbeing. The study findings suggests some strategic interventions to improve men’s access to healthcare facilities. These are reducing waiting times, taking health services to where men are, recruiting and training more male health advocates, and collaborating with traditional health practitioners, providing mobile clinics [20, 21]. The study’s proposed strategic interventions, offer promising solutions to improve men’s access to healthcare facilities.

Strengths and limitations

The delivery of in-depth understandings into men’s perspectives on barriers and challenges was identified as a primary strength. The qualitative design allows for a level of understanding of the essential factors that impact men’s healthcare-seeking behaviors. Additionally, the study is context-specific, providing perceptions that are applicable to a particular local municipality, and the findings may inform interventions tailored to the needs of the community. Despite these strengths, the study has some limitations. One limitation is the small sample size, which may not be representative of the larger population of men in the local Municipality. The study’s findings may not be generalizable to other populations due to the particular cultural, social, and economic characteristics of the study setting. Additionally, the study relies on self-reported data, which may be subject to biases and social desirability effects. The study’s use of only one data collection method (in-depth interviews) may also not offer an inclusive understanding of the research topic.

Conclusion

The present study provides valuable perceptions into the barriers and challenges faced by men in the City of Mbombela, Mpumalanga Province, South Africa. The findings highlight the challenging relationships of personal, social, and cultural factors that influence men’s healthcare-seeking behaviors. Personal factors, such as anxiety and fear, play a vital role in deterring men from seeking healthcare. While societal expectations and stigma around men’s health concerns further exacerbate the problem. The study also identifies several barriers and demanding factors, including financial constraints, limited access to healthcare services, and unfriendly healthcare facilities. These barriers inhibit men from accessing healthcare services. The study’s findings have essential effects for department of health policy. The proposed strategic interventions, such as reducing waiting times, taking health services to where men are, recruiting and training more male health advocates, and collaborating with traditional health practitioners and providing mobile clinics and community services to improve men’s access to healthcare facilities.

Author contributions

All authors (Jonas Mahlapahlapa Langa; Tshifhiwa Sinky Netshapapame; Daniel Ter Goon) confirm that all stages of the research and manuscript writing were conducted collaboratively and that they support the results.

Funding

The work reported herein was made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development. The content hereof is the sole responsibility of the authors and does not necessarily represent the official views of the SAMRC.

Data availability

The datasets used and analysed during the current study available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and Ethical approval was obtained from University of Limpopo Ethics Committee with the code (TREC/110/2024:PG) on 20 May 2024.

Consent for publication

Informed consent was obtained from all the participants involved in the study.

Competing interests

The authors declare no competing interests.