‘You only care when it hurts’ - men’s engagement with their health: a qualitative interview study in Lower Austria

Abstract

Background

Compared with women, men have a lower life expectancy, engage more frequently in risky health behaviours, underuse preventive healthcare services, and are less likely to attend routine health checks or seek mental health support. Their low participation rates indicate they show less interest in health promotion. Existing literature on barriers and facilitators to men’s participation in health promotion programmes focuses on older adults from English-speaking countries. The present study’s aim was to identify the preferences, attitudes, and barriers related to participation in community-based health promotion among young and middle-aged men in Lower Austria.

Methods

We conducted a qualitative exploratory study using semi-structured interviews with 28 men aged from 15 to 29 or 45 to 65 years living or working in Lower Austria with a low to medium education level and little or no prior experience with health promotion programmes. Participants were recruited using a maximum-variation sampling strategy through conventional recruitment and opportunistic outreach in everyday settings. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.

Results

Overall, men favoured health promotion offers that genuinely interested them, addressed a concrete need, offered a clear purpose and personal benefit, and used engaging formats and credible facilitators. When these conditions were unmet, participation was perceived as unnecessary or unappealing. In addition to lack of time, insufficient information about existing offers, and a low perceived need, traditional masculine gender norms emerged as a key barrier to health promotion programme participation, as participation, especially in mental health, was associated with weakness. Contrastingly, positive role models, gentle social pressure, and training alongside other men reduced hesitation and facilitated participation. Three groups of men emerged: self-organised, sceptical, and undecided but interested, the latter representing the greatest potential for engagement.

Conclusions

Men’s health promotion offers should promote a clear purpose and personal benefit and use engaging formats with credible, relatable facilitators. Interventions and strategies must be co-designed to ensure men’s genuine interest and address their concrete needs. Gender-responsive strategies should prioritise undecided men, embed programmes in familiar social contexts, emphasise well-being and quality of life rather than the triggering term health, and integrate mental health in a non-stigmatising way.

Background

In many European countries, gains in life expectancy have slowed since 2011. This development is linked to reduced progress in lowering mortality from cardiovascular diseases and cancers as well as slower improvements in major risk factors, such as high low-density lipoprotein (LDL) cholesterol and elevated blood pressure. At the same time, high body mass index (BMI), unhealthy diets, heavy alcohol consumption, and physical inactivity remain widespread [1].

Men are disproportionately affected by premature mortality. Men have consistently higher mortality rates than that of women, especially between the ages of 15 and 39, where suicide, behavioural risks, and occupational hazards play a significant role [2]. Men also tend to underestimate health risks and engage more frequently in harmful behaviours, including smoking, heavy episodic drinking, and unhealthy eating [3, 4]. In Austria, men consume more meat, while women consume fruit and vegetables more often. Only in the area of physical activity do men more commonly meet World Health Organization (WHO) recommendations [5]. Austrian data further indicate that socioeconomic status strongly shapes health behaviours, with both income and education influencing risk patterns [6]. Individuals with lower or intermediate education levels smoke more frequently, and obesity rates are highest among those with low educational attainment [5].

Men also underuse preventive healthcare services and often delay seeking treatment—patterns associated with traditional masculine norms [7–9]. Compared with women, they are less likely to attend routine health checks or seek support for mental health concerns [10–12]. Women more consistently adopt preventive and health-promoting behaviours [13].

Health promotion programmes are structured interventions designed to enable individuals and communities to improve health by preventing disease, supporting healthier behaviours, and addressing individual and social determinants of health [14, 15]. These programmes encompass a wide range of activities, including community-based initiatives, such as smoking cessation groups, nutrition or cooking courses, and physical activity groups; workplace interventions addressing stress, musculoskeletal health, or corporate fitness; and population-level campaigns or health promotion activities in schools, such as healthy eating policies and physical activity programmes. Approaches may range from single interventions to comprehensive strategies implemented across communities or workplaces [16, 17].

Despite the potential benefits, engaging men in health promotion remains challenging, particularly among those with lower socioeconomic status [18–20]. Participation rates in health promotion activities among men are low, e.g., in Lower Austria ranging between 8% and 20% in seminars and workshops and around 17% in a long-term lifestyle programme with weekly sessions on nutrition, physical activity, and mental well-being. Men’s representation in longer-term community engagement activities, such as membership in local committees that coordinate and support health promotion and prevention activities at the municipal level (the so-called ‘Healthy Community Working Groups’) is only 22% (personal communication with Eva Kostial 9.12.2025). International data show that participation in weight-loss programmes was below one-quarter, with referrals to these programmes as low as 11% [21].

Existing systematic reviews have mainly synthesised the barriers and facilitators to men’s participation in health promotion programmes among older populations, such as in men over 60 [22]. Traditional masculine gender roles, instructors’ and other participants’ genders, and a too-narrow focus of health promotion programmes were found to be barriers. Conversely, existing social relationships and social networks were found to be strong facilitators for recruiting men into health promotion programmes [22]. Another previous systematic review analysed the role of men’s sheds, community-based spaces that bring men together to engage in joint activities, in improving health and well-being in men over 50 [23].

To address the gaps concerning younger and middle-aged men, we recently conducted a rapid qualitative evidence synthesis examining the perceived barriers and facilitators to participation in (mental) health promotion programmes as well as communication strategies that may enhance men’s engagement [24]. Almost all of the included studies originated from English-speaking countries (92%, 72 of 78), and none were conducted in Austria.

Methods

Aim of the study

The aim of the present study was therefore to identify the preferences, attitudes, and barriers related to the use of health promotion services in healthy communities among young and middle-aged men in Lower Austria.

Study design

We conducted a qualitative exploratory study among men to investigate their preferences, attitudes, and barriers related to leading a healthy lifestyle and to the use of health promotion services in healthy communities in Lower Austria [25]. With around 1.7 million inhabitants, Lower Austria is located in the north-east of Austria and is the largest of Austria’s nine federal states by area [26]. This research was carried out and is subsequently reported following the guidelines depicted in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [27]. The Ethics Committee of the University for Continuing Education Krems reviewed and approved all processes and contents of this research project (EK_GZ_20_2024–2027).

Interest holder involvement

Our cooperation partner, the Lower Austrian health promotion initiative ‘Tut gut!’ (translated as ‘Does you good!’) was involved in several stages of the research project. The partners jointly agreed on the study aims and discussed the interview guide, and ‘Tut gut!’ provided support in developing recruitment strategies and distributing flyers to the target group.

Recruitment and sampling

Eligible participants were men aged between 15 and 29 or between 45 and 65 years living or working in Lower Austria with little or no participation in health promotion activities. We aimed to recruit men from rural and urban areas with lower socioeconomic backgrounds, hence, we focused on men with lower formal education levels and migration backgrounds. To meet these eligibility criteria and to ensure diversity in the men’s perspectives and experiences, a maximum-variation strategy was applied [28]. We created a sampling grid and estimated that 22 to 30 interviews should be sufficient for our purposes. This sample size was informed by the aim of capturing a broad range of perspectives across the predefined participant characteristics rather than by achieving data saturation. Consistent with Braun and Clarke’s reflexive thematic analysis approach [29, 30] we did not use data saturation as a criterion for determining sample size. Instead, we sought to generate a sufficiently rich and diverse dataset to address the research questions and support meaningful theme development.

To achieve the planned sample and account for the participants’ varying approachability, two recruitment strategies were applied: conventional interviews and opportunistic outreach approach. For the conventional interviews, participants were primarily recruited via a digital flyer containing a QR code linking to an online registration form (MS Forms), where individuals provided sociodemographic information used for sampling. The flyer was disseminated through social media posts and distributed in primary care settings and communities. This data was transferred to the sampling grid and participants were selected. To reduce participation barriers, an opportunistic outreach approach was additionally employed [31]. Interviews were conducted on site in various settings such as a car dealership, a military recruitment centre, a beekeeping association, and a barbershop. After obtaining verbal consent from local contact persons, the men were approached and interviewed directly in the selected settings. The demographic information was entered in the sampling grid afterwards.

Data collection

Five trained researchers (male and female) conducted the interviews in German between May and June 2025. The interviewers had no prior relationship with the participants. Before the data collection, the participants received written information about the study objectives and procedures and provided written informed consent.

The data were collected using a semi-structured interview guide informed by a prior literature review [24] and the aims of the study. We prepared versions of the guide according to the interview type (conventional vs. opportunistic outreach approach), allowing flexibility while ensuring the coverage of key domains. We tested the face validity of the interview guide within the research team and pilot-tested it with two men prior to field use. The pilot interviews were only conducted for quality assurance purposes, were not audio-recorded or transcribed, and not included in the analysis. We made further necessary amendments after the initial interviews. The interview guide is available upon request from the corresponding author.

The participants for the conventional interviews were selected iteratively based on predefined sampling criteria and contacted via email. We excluded nine potential participants as they did not fulfil the inclusion criteria. One contacted man refused to participate. The opportunistic interviews were conducted in person in quiet locations to ensure confidentiality, and some of the conventional interviews via videoconference. Interviews had a mean duration of 47 min (range 28–90 min) for the conventional interviews and 22 min (range 11–38 min) for the opportunistic outreach interviews. The non-participation rates were not documented in the opportunistic outreach approach.

All interview participants received financial compensation for their time. Participants in the conventional interviews were offered a €30 gift card, while participants in the opportunistic outreach interviews received a €15 gift card, reflecting the shorter duration of these interviews. All interviews were audio-recorded, transcribed verbatim, and pseudonymised prior to analysis. Transcripts were de-identified by replacing all names and other identifiable details with alphanumeric codes.

Data analysis

Four trained researchers analysed the interview transcripts using qualitative thematic analysis [29, 32]. This approach enabled the systematic identification, analysis and interpretation of key themes. The analysis followed an iterative process and combined inductive and deductive coding approach. The transcripts and field notes were first carefully read to achieve familiarisation with the data and gain an overall understanding of participants’ perspectives. The text was then segmented into meaning units, defined as words, short passages, or statements expressing a coherent idea. Initial coding was conducted inductively, after which the codes were organised into higher-order categories and themes. Theme development was guided by the topics identified in the preceding literature review [24], while additional themes were generated through an iterative and detailed discussion process within the research team. Data management and coding were supported by the MAXQDA software [33].

Throughout the analysis, team discussions functioned as a form of peer debriefing, allowing the researchers to critically review coding decisions, challenge interpretations, and ensure that the resulting themes accurately reflected the participants’ perspectives.

After the primary analyses, we conducted an additional subgroup analysis to explore the similarities and differences between the age groups. Unless otherwise specified in the Results section, the findings apply to both age groups.

As part of the thematic analysis, we compared participants’ attitudes towards and perceived need of health promotion, current health-related behaviours, and openness to participation in organised health promotion offers. This cross-case comparison revealed three distinct patterns, which we conceptualised as self-organised, sceptical, and undecided but interested men.

Research team and reflexivity

The research team comprised seven members, with five involved in the data collection (JD, DH, UG, NM, AP) and four in the data analysis (JD, UG, CKK, IM). Most interviewers had prior experience with qualitative interviews, while less experienced team members received training before the data collection.

Throughout the study, the team reflected on their positionality and potential influence on the data collection and interpretation. We were aware that gender dynamics, social expectations, and our perspectives as women, feminists, and health researchers could shape our interactions with the male participants. To address this, a male interviewer was included for the opportunistic interviews; the subsequent analysis indicated no thematic differences.

Conducting interviews with men required adjusting our usual perspectives on health promotion research, which often emphasise women and gender-focused frameworks. We approached the study with careful reflexivity to explore men’s specific needs and health-related behaviours without assumptions. Five of the research team members (NM, DH, JD, CKK, UG) were already involved in the prior literature review [24], and this could have influenced the data collection during the interviewing or the data coding during the data analysis in the sense that we were more sensitive to already discussed themes in the literature.

Continuous self-reflection and critical team discussions were used to ensure transparency and rigour in the data collection and analysis.

Results

Characteristics of the participants

A total of 28 men participated in the qualitative interviews, including 12 conventional face-to-face or online interviews and 16 outreach face-to-face interviews. Participant characteristics are presented in Table 1. All interviewees identified as men. The sample achieved a balanced representation of the two target age groups, with 42.9% (n = 12) aged 15–29 years and 46.4% (n = 13) aged 45–65 years. Participants were recruited from both rural and urban areas and mainly had low to medium educational attainment. Most were employed (67.9%, n = 19), worked in manual occupations (60.7%, n = 17), and 14.3% (n = 4) reported a migration background.

Table 1.

Sociodemographic characteristics of the interview participants (n = 28)

	n	%
Age group
15–29 years	12	42.9
30–44 years	1	3.6
45–65 years	13	46.4
> 65 years	2	7.1
Number of residents in hometown
< 2.500 residents	10	35.7
2.501–10.000 residents	9	32.1
> 10.000 residents	9	32.1
Highest level of education
Compulsory schooling	4	14.3
Apprenticeship	10	35.7
Vocational secondary school	3	10.7
General secondary school, higher vocational school	8	28.6
University, university of applied sciences	3	10.7
Migration background
Yes	4	14.3
No	24	85.7
Employment status
Unemployed / in training	2	7.1
Employed	19	67.9
Apprenticeship	3	10.7
Pupil / student	2	7.1
Retired	2	7.1
Field of employment
Manual labour	17	60.7
Non-manual trades	9	32.1
Both	2	7.1

Men’s attitudes towards health and health promotion

Men’s attitudes towards health in general

Good health is fundamental

For almost all of the men interviewed, health had a high priority and was perceived as a fundamental prerequisite for quality of life. It enabled participation in everyday life, the experience of social relationships, and the fulfilment of obligations. At the same time, the men emphasised that the importance attributed to health cannot always be practically realised in daily life, as routines, life priorities, and obligations make this difficult.

Health as physical fitness, mental well-being, and the basis for daily functioning

The men interviewed predominantly described health using simple, everyday language and often conceptualised it in a deficit-oriented manner as the absence of negative physical conditions, such as pain. Health was frequently equated with physical well-being and closely associated with physical fitness. Statements such as ‘feeling comfortable in one’s own body’ or ‘being physically fit’ illustrated this understanding. Older men emphasised maintaining autonomy and preserving their current state of health, whereas younger men focused more strongly on present physical functional capacity.

‘Being mobile, being mentally fit—so not being sad or down somehow—and really, above all, being mobile. Being able to go up a mountain, being able to get up in the morning, just being physically fit overall.’ (CI08 [conventional interview 08], Pos. 13 [Position line 13 in the transcript], manual occupation, younger)

In addition to physical health, some men emphasised the importance of mental health. Generally, mental health was described as the ability to talk openly about worries and problems, but the men also focused on the positive aspects of mental health, such as encompassing energy, motivation, and the ability to perceive positive aspects of life as well as self-worth and the desire to engage in activities:

‘I think it’s also very important that, again and again, every single day, we notice that there’s something beautiful in life. Even if it’s just something small, so that mentally you stay in a place where things are okay.’ (BA01 [beekeeping association interview 01], Pos. 13, manual occupation, older)

Participants across both younger and older age groups emphasised that mental health should receive greater attention in the public sphere and suggested that men should also be allowed to experience and express emotions such as despair:

‘Exactly. Not showing any weakness, not crying for example, just always staying strong. And what I really can’t understand at all is why this rumour is even spread around, because we’re only human after all.’ (MR01 [military recruitment centre interview 01], Pos. 44, manual occupation, younger)

Beyond this, health also has a social dimension: it enables activities, social participation, and the fulfilment of roles within family and circles of friends. Thus, health was perceived by the men as a functional prerequisite for assuming responsibility. In particular, the ability to work plays a central role, as one man mentioned:

‘And if that’s not the case, then the whole thing just grinds to a halt. You’re part of a system and you have to fulfil your tasks in a way that things work properly.’ (CI04, Pos. 41, non-manual occupation, older).

Men’s attitudes towards participation in health promotion programmes

From scepticism to positive attitudes

The interviewed men showed varying degrees of interest and willingness to participate in health promotion programmes. Negative attitudes were often justified by a lack of interest or the idea that such programmes are primarily aimed at ‘lazy’ people, those who are already in particularly poor health, or those who are unable to take care of their own health. These views reflect traditional role models, according to which men are responsible for their own health. Many men reported that they only made time for health promotion once health problems had already occurred.

In contrast, men with a positive attitude towards health promotion offers recognised that participation requires commitment, effort, and time, but also brings advantages. Regular participation is seen as an opportunity to gain more energy, build knowledge about healthy behaviour in everyday life, and use preventive programmes to detect diseases at an early stage:

‘So, you just have to get out of your comfort zone, you need a bit of discipline at the beginning, that’s clear. But once you’ve got a routine going, it gets much easier anyway. If you take things into your own hands, then courses and programmes can definitely support that, but you still just have to do it.’ (CI02, Pos. 88, non-manual occupation, older)

Some men also expressed interest in health promotion measures at school or work, as these enable low-threshold participation and can promote health-conscious behaviour at an early stage.

‘Yeah, I think a lot more should be done in schools, so that you really take more of it on board early on, and it just becomes normal, and then maybe men would do more as well.’ (CI03, Pos. 195, non-manual occupation, older)

Physical activity and nutrition considered as relevant topics

The men sampled were particularly interested in fitness and physical activity, often in combination with healthy eating and the use of dietary supplements. In addition, stress reduction and mental health played a central role.

Facilitating factors for and barriers to men’s participation in health promotion programmes

Factors related to the health promotion offer

Content, format, and trust in facilitators matters

The interviewed men frequently perceived existing health promotion offers as insufficiently tailored to them. Activities such as yoga, meditation, or cooking classes were commonly perceived as ‘female-oriented’ and not aligned with their interests. Men preferred being approached in ways that fit their everyday lives—for example, barbecuing rather than cooking classes or targeted exercise programmes rather than broad beginner courses. Many also emphasised that physical activity programmes should gradually increase in structure and intensity to avoid overwhelming newcomers.

A central barrier was the unclear personal benefit of participation. The men expressed that they would only attend if the content clearly sparked their interest or met a concrete need. Offers became more attractive when they clearly targeted a concrete goal—such as training for a running event, improving diet, or reducing stress—and when the content addressed men’s specific interests or needs.

Participants favoured informal, interactive workshop formats with opportunities for discussion rather than purely didactic lectures. The men stated that they were unlikely to participate when the content felt irrelevant, did not go beyond basic information, or offered no new insights, including for more experienced participants.

‘It was far too simple. Basically, they tried to create an offer for the general public, and because it was for everyone, it just wasn’t interesting for me.’ (CI11, Pos. 62, manual occupation, younger)

For the younger men in particular, fun, a relaxed atmosphere, and relatable communication with the facilitators were important. For this age group, municipal health promotion offers were described as less attractive compared to those embedded in everyday activities, such as sports or fitness settings.

Trust was strengthened when the offers came from reputable, non-profit, or official organisations or when they had a good reputation. Many men also preferred offers recommended by trusted persons, such as friends or acquaintances.

‘Well, if someone gives you a tip and someone I know says, “That’s really great, you should check it out”, then that’s obviously much more motivating. No question about it.’ (CI02, Pos. 201, non-manual occupation, older)

For many men, the role of the facilitator was central. The facilitator’s competence and ability to provide practical guidance made it easier for the men to adopt health-promoting behaviour. While some men reported taking female facilitators less seriously, most stated that the facilitator’s gender did not matter; rather, expertise—clearly communicated in programme descriptions—was decisive. Opinions differed regarding the value of prominent facilitators: some found well-known personalities motivating, while others did not consider this relevant.

A positive group atmosphere was also seen as important: participants stressed the need to feel comfortable with both the facilitators and other group members. Knowing that other men, especially peers from their social environment, took part increased men’s openness to participation. Several men preferred participant groups with members that were similar to themselves. This included interest in gender-segregated formats for male-specific topics (e.g., prostate health).

Being informed about offers

Many men simply do not know which health promotion offers exist near them—whether in their municipality or workplace, or through health insurance providers. Information must be actively disseminated; flyers alone are insufficient. Older men in particular stated that physicians should play a stronger role in informing them about relevant offers.

Time, place, setting, and structural conditions

Unfavourable scheduling—such as during working hours or without flexible hours—was seen as a barrier. While some appreciated regular appointments, others, especially younger men, preferred flexible participation options due to variable work schedules.

‘Time is definitely the issue, because all these sessions are always on the same weekday, at the same time. And my job just isn’t regular. I can plan one week ahead, sure, but I can’t tell you where I’ll be on a Wednesday in early July, yeah. That makes it really hard to organise things or plan ahead. And then you just stop going if you’re, I don’t know, only there half the time.’ (CI10, Pos. 103, non-manual occupation, older)

Geographical distance also mattered. Online formats, however, were not acceptable to everyone, particularly older men. In rural areas with limited public transport, proximity is crucial, for example, when offers are located directly in the municipality setting.

Younger men identified schools as an important access point. Through school physicians or psychologists and compulsory workshops, health promotion topics could be introduced at a low threshold.

Older men and younger working men benefit from offers integrated into the workplace. Crucially, participation must be possible during working hours and be supported by supervisors. Mandatory participation, however, is viewed critically.

‘Maybe even having the offers directly at the workplace. Because then that hurdle is gone—having to somehow scrape time together on top of everything else. If it’s offered during working hours, or combined with work, then you come 20 minutes earlier or stay 20 minutes longer and do some kind of exercise session. That could really be the key to success, I think, I could imagine.’ (CI10, Pos. 178, non-manual occupation, older)

Two men from non-manual occupations particularly emphasised the importance of anonymity, especially for mental health–related support. They also described online anonymity as facilitating openness and enabling discussions of sensitive topics.

Monetary incentives were described as attractive especially by men in non-manual occupations. Desired incentives included tax benefits or subsidies from employers or health insurers. Free offers or prize-based incentives were also appealing to some.

‘I’d find it ideal if taking care of your health was financially supported. When you’re sick, basically everything gets paid for—and those are enormous amounts of money. Every CT scan, every MRI costs a fortune. Chemotherapy costs thousands of Euros. And a lot of that could be prevented if people were motivated to do something beforehand, before illness even develops. Like at least partly covering therapeutic massages or giving subsidies for gym memberships. Stuff like that. Yes, that should be supported.’ (CI02, Pos. 159, non-manual occupation, older)

Personal factors

Inner resistance, lack of motivation, excuses, positive role models, and personal goals

A recurring barrier was the men’s own inner resistance (often referred to in German as the ‘innerer Schweinehund’)—a lack of personal will to change but also skipping routines and lack of motivation. Others simply did not wish to engage in such activities or lacked the awareness that maintaining health is important even at a young age or in the absence of symptoms. Some men also noted that conversations with physicians often fail to clearly emphasise the importance of health-promoting behaviours.

‘Health is important, and you should build something into your life, but let’s be honest, the excuse for doing nothing is always found faster than the motivation to actually do something.’ (CI12, Pos. 36, manual occupation, older)

Positive role models or gentle social pressure were described as potential ways to break this negative spiral. Two younger men highlighted competitive dynamics among peers as particularly motivating for physical activity. At the same time, many men acknowledged that perceived external barriers were sometimes used as excuses to mask a lack of motivation.

Personal goals also played a role; men stressed that a genuine willingness to change is necessary to adopt healthier behaviours. Older men in particular emphasised the value of routines, such as regular gym visits or abstaining from alcohol and nicotine, in sustaining health-promoting practices. They also noted that physical activity and investing in one’s health can bring enjoyment and a sense of reward.

‘But like I said, I don’t need a reward. Life itself is the reward for me.’ (CI02, Pos. 128, non-manual occupation, older)

No perceived need for health promotion offers or awareness only when symptoms arise

Several men expressed no perceived need for health promotion offers because they felt they were already managing their health effectively and expected no additional benefit.

‘I know where I’d get the information if I needed it. Right now, I don’t really see a need.’ (CI10, Pos. 99, non-manual occupation, older)

The men described a range of personal strategies they used to maintain their health, including physical activity (both sports and daily movement), social contact, hobbies, time in nature, healthy eating, adequate sleep, and mindful use of alcohol or nicotine.

These men considered themselves healthy and already behaved health-consciously—particularly with regard to diet and physical activity:

‘I eat enough, I’m not underweight and I don’t have mental health problems. I don’t need this, so I don’t go.’ (MR03, Pos. 129, manual occupation, younger)

Some men preferred to take responsibility themselves and organise their own activities, such as going to the gym with friends or initiating group-based exercise.

Interviewer: ‘You mentioned the gymnastics group earlier. What motivated you to join back then?’

Participant: ‘I started it.’ (CI12, Pos. 182–183, manual occupation, older)

In others the absence of symptoms or physical discomfort reinforced the view of not needing health promotion.

‘Well, as long as nothing hurts when you get up in the morning, everything’s fine, really.’ (BA01, Pos. 33, manual occupation, older)

For some men, the lack of interest was more general; even when information about health promotion offers reached them, for example via email, they did not engage with it.

A few older men reported that their motivation to change came only after experiencing serious illness or chronic symptoms, which made them more aware of the long-term benefits of preventive action. Overall, support or participation in health promotion offers was often only considered when health problems became unavoidable, and self-management was no longer sufficient.

Social and cultural aspects

Gender norms and shame

Participation in health promotion offers was often associated with weakness and perceived negatively. Participants described a fear of being seen as lacking willpower, and traditional norms, such as the expectation that ‘men handle everything alone’, were deeply rooted across the age groups.

‘In general, men have a very strong ego. They admit things to themselves very, very late, usually when it’s already too late, don’t they? So, I think even if you offered a workshop like that, not many would come, because they don’t want to admit it to themselves. That’s the problem with the male ego.’ (MR05, Pos. 237, manual occupation, younger)

When asked about their ability to talk openly about mental health problems, almost half of the men, particularly older participants and those in non-manual occupations, reported experiencing difficulties. Many described a reluctance to speak about mental health issues, worries, and burdens, often motivated by a desire to avoid placing emotional strain on others. This hesitation was frequently linked to a perceived responsibility for family well-being, positioning emotional restraint as an expected part of their role, or to the feeling that discussing mental health would be awkward.

‘No. I think we, we’re just different. My personal opinion. I think we, we men swallow our problems, compared to women. Because the burden lies on our shoulders, I tell you—bluntly put.’ (CD06 [car dealership interview 06], Pos 58, non-manual occupation, younger)

This sense of shame also prevented men from speaking openly about themselves or their ‘weaknesses’ in group settings, partly due to the fear of being judged negatively. Many did not want to admit that they needed support, especially for mental health issues. Shame and the taboo around showing vulnerability remained substantial barriers to open discussion and engagement in health promotion activities.

‘You don’t see that when you’re caught in this whirlpool today, where it’s all about performing from morning to night, yeah. And very often you just suppress it and say, “Well, I can’t show that on the outside”, because then you’d be showing weakness, not strength, yeah. And that’s just how our society is built, yeah.’ (BA01, Pos. 58, manual occupation, older)

Positive role models and influence of the social circle

Men’s social circles can strongly facilitate participation. Having friends explain or recommend programmes increased motivation, and attending together was often a key enabler; the commitment to a friend could encourage men to participate.

‘Probably only if someone I know has already been there and, well, says it’s cool. Or if I went with a friend. I wouldn’t really go alone.’ (BS01 [barbershop interview 01], Pos. 43, manual occupation, younger)

Seeing other male participants reduced the men’s hesitation, particularly for programmes typically attended by women. Training together toward a shared goal, such as preparing for a running event, was also described as highly motivating.

‘I think, there are men who’d go to yoga anyway—but I wouldn’t. And other men don’t know that either, and then they’re even more hesitant and don’t dare to go there. I think, If they knew, like, three neighbours go too, then, yes, they’d be more likely to go. So, I think visibility is really important, yeah.’ (CI08, Pos. 190, manual occupation, younger)

Family also influences men’s health behaviour. Involving families, for instance, by offering joint activities such as group walks, could have positive effects.

Clubs and associations were especially relevant in rural areas (e.g., fire brigades, dance or sports clubs). For younger men in particular, shared achievements within these groups were motivating, and such contexts naturally integrated physical activity, healthy routines, and social connection into everyday life.

‘[A]nd in the fire brigade, I would say, moving your body was kind of a side effect. Everyone met up, there were nine of us, and every week we spent two hours doing something together.’ (CI09, Pos. 133, manual occupation, younger)

Within friend groups or clubs, certain individuals motivate others to participate in events or physical activity—either directly or by acting as role models whose visible progress inspires imitation.

Older active individuals also served as important role models for maintaining physical fitness.

‘[B]ut I tell you, you regularly meet 70- or 80-year-olds on the mountain where I live, and that’s a massive motivation. So, when you see how fit they are, and then you come up here and see that, it’s a completely different world. That is something.’ (CI08, Pos. 97, manual occupation, younger)

A summary of all the facilitators of and barriers to men’s participation in health promotion offers is provided in Table 2.

Table 2.

Overview of the facilitators and barriers for men to participate in health promotion offers

Facilitating factors	Barriers
Factors related to the health promotion offer
Adequate methods • Interactive formats and discussion • Communication ‚at eye level’ without moralising • Q&A sessions • Fun • Slow progression of workouts • Tracking personal change through simple self-observation Offers target a concrete goal	Inadequate methods/content • Indoctrinating • Too unspecific • Not individualised • Nothing new • Online fitness • Unclear personal benefit Men feel like they don’t need general health promotion offers
Link to a trustworthy organisation or person • Doctors • Friends • Municipality	Untrustworthy organisations • Incompetent
Programme facilitators • Competence is most important • Most men don’t care about gender • Being on the same wavelength • Someone with similar experiences • Someone famous	Programme facilitators • Some men don’t perceive women as adequate
Similarity of attendees • Age, gender, fitness level • Participation of peers	Other Attendees • Women in men-specific topics • Elderly persons only
	Missing information of existing health promotion offers
Timing • Compatible with working hours • Regular schedule • Weekend courses	Timing • Waiting lists • Early afternoon workshops
Integration in school/work/sport activities Close proximity of offerings High quality • Needs to be established in advertisements	Content does not feel adequate for men • New trends • Only for women • Meditation, yoga, cooking
Anonymity	Too much data taken
Financial • Free courses • (Partially) paid by employer • Chance to win • Insurance benefits • Tax reduction	Financial • Too expensive
Personal factors
• Motivation • Personal goals • Intrinsic motivation • Regaining fitness • Fun • Routine • Prevent diseases • Competitive thinking	Lack of motivation • Feel healthy • Tiredness • No will to change • Alcohol or drug problem • Laziness • Finds excuses everywhere Lack of knowledge about the importance
Content sparks interest • Health problem already present • Personal interest	Lack of interest Usefulness is not seen • Already taking care of health promotion themselves
Voluntary participation is preferred	Mandatory
Timing • Flexible timing	Lack of time • Taking time off work for health promotion makes them feel guilty • Self-employed • Long work travels • Other commitments more important
Social and cultural aspects
Local role models • Celebrities • Friends • Clubs or associations • Personal contact • Best agers	Masculine role models • Show/admit no weakness • Focus on work • Don’t listen to own needs • Men are not allowed to have worries • Shameful to admit problems • Scared of judgement Lack of role models who take health promotion seriously
Group activities/dynamics • Family • Friends • Positive peer pressure	Masculinity and norms • Main earner needs to focus on work • Yoga isn’t for men • Health promotion is only for women • Cooking isn’t for men • Don’t want to be lectured by others • Afraid of doing it wrong • Only accepting help when all else has failed
Motivation and/or recommendation from • Wives • Friends • Colleagues Common goals (running team)	Fear of stigmatisation • Taking part in health promotion means I can’t do it myself • Weak willed High pain and suffering threshold • It’ll go away Ego is in the way of getting help early
Programmes focused on stress	No engagement in local community
Peer support • Motivation • Celebrating victories • Overcoming internalised shame	Focus on self-management Pandemic
Information from physicians • Health system should focus on health promotion more than on curing and managing illness	Mistrust in formal offers Masculine work settings • Health not a topic

In summary, the men often perceived existing offers as insufficiently tailored to them and lacking a clear personal benefit for participation. They were mostly interested in engaging and fun formats delivered by credible facilitators that they could relate to. When these conditions were not met, participation was perceived as unnecessary or unappealing. Other barriers were a lack of information about health promotion offers or unfavourable scheduling and geographical distance. The men’s own inner resistance to engage in such activities was an often-mentioned barrier, but positive role models in the men’s social circle or gentle social pressure was described as motivating factors. Others described no need for health promotion or stated that they did not see any additional benefit, especially without the absence of physical symptoms. Another group of men did not have the need for organised community health promotion offers because they preferred to take responsibility themselves and organise their own activities. Masculine gender norms were amongst the greatest barriers because taking part in health promotion offers was often associated with weakness and perceived negatively, especially when dealing with mental health issues. Training together or seeing other male participants reduced the men’s hesitation to take part in the offers.

Reaching men for health promotion programmes

Health at the intersection of motivation and guilt

Several of the interviewed men described the term health as adequate for encouraging engagement with health promotion programmes. Other interviewees emphasised that the term was perceived as insufficient, as health is commonly associated with illness and therapeutic interventions. For some participants, the term health was associated with negative emotions and a sense of personal responsibility or self-blame.

‘And that will probably always trigger a little nerve reaction, when you see the word health, because it gives you a guilty conscience in some way, even if it’s only subconscious, yeah.’ (CI02, Pos. 165, non-manual occupation, older)

Some interviewees proposed reframing health promotion programmes using terms such as physical and psychological well-being or quality of life to avoid these negative connotations.

Appropriate information channels for programme promotion

To identify effective information channels, we asked the men to share information on any health programmes they remembered. Most were able to name specific campaigns; a third reported on campaigns aimed to promote healthy lifestyle or prevention. Programmes were recalled if the men had already engaged with the same topic, and if the topics were seen as attractive and useful, were promoted with short and precise wording, and were repeated frequently (e.g., vaccination campaign), and if they used memorable catch phrases or jingles. Some health-related information was negatively remembered, particularly when it stemmed from sources perceived as unserious (e.g., nutritional supplement advertisements in podcasts).

Answers varied in regard to the information channels for specific health promotion programmes. Some men would appreciate gaining information from friends or acquaintances, while others preferred information from trusted sources such as their family doctor.

‘So, I’d definitely take recommendations from friends differently. I think, there is, you don’t recommend something if it’s not cool. Would definitely carry more weight.’ (CI08, Pos. 131, manual occupation, younger)

Personal contact at street festivals or awareness days generated divergent responses among the participants; some perceived it as helpful for familiarising themselves with the programmes, whereas others did not regard personal promotion positively.

Clear age differences became apparent in regard to social media: while older men did not see social media as relevant communication platforms, younger men stated that they could be reached through channels such as TikTok, YouTube, or Instagram. Older men preferred using the internet for specific searches in cases where they were interested.

‘For me personally, what matters is that the information is easy to find, accessible, and prepared in a way I can read and understand it—at the moment when I actually need it and look for it. Not when someone else thinks they need to create a need in me. Maybe that’s the wrong way of seeing it, but that’s just how it is.’ (BA02, Pos. 126, manual and non-manual occupation, older)

Attention to health risks is essential

Some of the men, especially the younger participants, viewed their health risk as minimal and felt little personal vulnerability to illness. One pointed out that this attitude needs to be addressed in health promotion campaigns.

‘Ehm, how should I put it? Making them understand that you’re not indestructible, I guess. So, at my age, you don’t really believe that yet. You think there’s still time, you push it aside, say “It’ll be fine,” and well, “It’s not that bad,” and “I’ll just carry on and anyway, because it works anyway.” I think that’s what it is for most people.’ (CI09, Pos. 230, manual occupation, younger)

Open dialogue about mental health is insufficient

Regarding mental health, several participants highlighted the need to frequently address this topic and share information. This approach aims to normalise this discussion and foster more opportunities for open conversations about personal concerns.

‘I think you mustn’t get tired of talking about mental health, addressing it, creating offers, yes. It think it’s one of the central issues, yeah. What I find really good at the moment are campaigns on the radio, for example, saying, “Talk about it, don’t swallow it.” Or, which I find really important, bringing it into the public conversation.’ (CI10, Pos. 216, non-manual occupation, older)

Discussion

Health has a high priority for the interviewed men. They see health mostly as physical fitness or the absence of negative physical conditions, but also as mental well-being and a basis for daily functioning. Attitudes towards participation in health promotion offers ranged from scepticism to positive attitudes, where the men were mostly interested in physical activity and nutrition topics but also stress reduction and other mental health topics.

The men often perceived existing health promotion offers as poorly tailored to their needs and lacking clear personal benefits. They preferred engaging formats delivered by credible facilitators that they could relate to; otherwise, participation was seen as unnecessary or unappealing. Additional barriers included limited information, inconvenient timing, geographical distance, and personal reluctance to engage. While some men reported no perceived need—particularly in the absence of physical symptoms—others preferred to manage their health independently rather than participate in organised programmes. Traditional masculine norms emerged as a major barrier, as participation, especially in relation to mental health, was associated with weakness and was therefore viewed negatively and as inappropriate for men. Shame, the taboo surrounding the display of vulnerability, and fear of negative judgement still further hinders engagement because many men think that they need to cope with problems by themselves and not seek help. This pattern was apparent regardless of the interviewees’ age, a finding that aligns with the findings of our recent rapid qualitative evidence synthesis: Across a wide age range of men, gender norms were identified as one of the main barriers to men’s participation in health promotion programmes [24]. Also, in a recent systematic review on the impact of traditional masculinity norms on men’s willingness to seek mental health support [34], the authors identified several key barriers to seeking help for mental health issues among men, with one recurring theme being the fear of judgement and concerns about the social perception of being less masculine. Traditional masculinity norms were consistently linked to a wide range of negative mental health outcomes among men [34].

Social constructions of masculinity shape men’s perceptions of health and illness and their behaviours. Multiple masculinities reflect a social diversity shaped by age, race, ethnicity, culture, class, and sexuality. Hence, hegemonic masculinity and traditional beliefs about manhood are strong predictors of individual risk behaviour over the life course [35].

In our study, we found that a key facilitator for participation in health promotion offers, or for taking care of one’s own health, was encouragement from friends or trusted acquaintances. Recommendations or explanations from people within men’s immediate social networks, knowing that other similar men are participating, and a gentle social pressure by their inner social circle can be particularly motivating. It has been shown that social support serves as a crucial buffer against the negative effects of traditional masculinity norms on health behaviours [36]. However, a systematic review showed that adherence to gender role norms (e.g., around toughness, stoicism) was generally associated with poorer mental health, while the endorsement of certain ‘masculine’ attributes (e.g., self-reliance, ambitiousness, assertiveness) was generally associated with better mental health [37].

With the social environment being so influential for men’s health-promoting behaviour, embedding programmes within existing clubs, associations, or familiar social settings is therefore seen as especially promising. These settings can be used to foster positive masculine behaviours through peer support and role modelling, which we have also shown in our recent qualitative evidence synthesis [24]. In particular, sport clubs have been suggested in the previous literature as promising avenues for engaging men in health promotion [38], particularly among middle-aged men [39]. Furthermore, a recent mixed-methods study showed that community sport settings can be utilised to engage rural men in behavioural health programmes [40].

Three types of men regarding health promotion activities

Along with the results from our interview study, we found that there are three groups of men regarding participation in health promotion activities: the self-organised, the sceptics, and the undecided: interested but not yet active. The self-organised men already actively manage their health autonomously and self-organise health-promoting behaviours. For this group, no action is needed. The sceptics reject and oppose structured programmes or health promotion offers in general, or they are at the least very sceptical towards them. As they resist taking part on principle, there is limited potential to motivate them. Therefore, investing time in getting them to participate in health-promoting offers is most likely a wasted effort. The third group are the undecided men. They are interested in health, but not yet active. There lies the greatest potential for impact. These are the men that can be motivated with the right interventions.

Suggestions for future health promotion offers for men

In general, based on our findings, we propose the following suggestions for successful health promotion efforts:

• Co-design interventions and strategies to ensure men are genuinely interested, their needs are met, and a concrete need is addressed.

• Offer content that describes a clear purpose and personal benefit for the men involved in order to be interesting to them and to foster prolonged engagement.

• Use engaging formats and approaches with credible facilitators.

• Embed mental health topics within general health promotion programmes to make it easier for men to start talking about mental strain and challenges.

• Leverage values such as resilience and self-efficacy within campaigns, and showcase modern male role models who prioritise health and social connection.

• Highlight terms such as well-being and quality of life in communication and messaging and instead of health or health promotion.

A recent scoping review concluded that participatory methods and gender-responsive approaches can work synergistically with sensitivities to the ways in which masculinities influence health behaviours and engagement to create programmes that are informed by the needs and perspectives of men [41].

Strengths and limitations

Our study has several strengths and limitations. It included two key age groups (15–29 and 45–65 years) and successfully reached men with lower levels of formal education from diverse occupational backgrounds, including both manual and non-manual work. By combining conventional and outreach interviews, the participants were recruited across a variety of everyday settings, broadening the range of perspectives captured and enabling access to men who may not otherwise have participated in the study. This approach may have reduced the sampling bias associated with recruiting only persons who actively sign up for an interview about health and health promotion. However, the use of two interview approaches resulted in differences in interview length, with outreach interviews generally being shorter than conventional interviews. While this may have influenced the depth of individual accounts, both interview types contributed to the identified themes. In addition, other demographic groups, such as queer men, were not represented in the sample, meaning that these perspectives were not captured. We interviewed men from Lower Austria only, and the findings should therefore be interpreted as reflecting the perspectives of the men included in this study rather than Austrian men more broadly.

Participants were informed at the beginning of the interview that the study broadly addressed health-related topics and that there were no right or wrong answers. Nevertheless, social desirability bias cannot be fully ruled out.

Conclusion

Engaging men in health promotion programmes remains a significant public health challenge given men’s higher mortality rates and their underuse of preventive services. This study identified traditional masculine gender norms—including associations of help-seeking with weakness, shame surrounding vulnerability, and beliefs in self-reliance—as persistent barriers across age groups, interacting with practical obstacles such as insufficient information, time constraints, and limited perceived relevance.

However, men’s social networks emerged as powerful facilitators. Recommendations from trusted friends, knowledge that similar peers participate, and gentle social pressure can motivate engagement. Programmes embedded within existing sports clubs, associations, and workplace settings appear especially promising for normalising health-promoting behaviours through peer support and role modelling.

We identified three distinct groups of men: self-organised men who independently manage their health, sceptical men who reject structured programmes, and undecided men who show interest but lack activation. This final group represents the greatest opportunity for intervention. Successful strategies should co-design programmes with male participants to ensure relevance, clearly communicate personal benefits and concrete goals, employ engaging formats with credible and relatable facilitators, and consider reframing messaging from health terminology, which is associated with physical health or illness for many, to well-being and quality of life, and at the same time integrate mental health issues in a non-stigmatising way.

These insights provide actionable guidance for developing gender-responsive health promotion initiatives that acknowledge how masculinities shape health behaviours while leveraging social dynamics to improve men’s engagement and long-term health outcomes.

Abbreviations

BA

Beekeeping association

BMI

Body mass index

BS

Barbershop

CD

Car dealership

CI

Conventional interview

COREQ

Consolidated Criteria for Reporting Qualitative Research

LDL

Low-density lipoprotein

MR

Military recruitment centre

WHO

World Health Organization

Authors’ contributions

UG conceived the study idea and led the project planning and conduct. JD, NM, and UG developed the study protocol. NM, JD, and UG prepared the recruitment, sampling, and interview guides. JD, NM, AP, DH, and UG carried out the qualitative interviews. IM, JD, CKK, and UG coded and analysed the data. UG, CKK, IM, JD, AP, NM, and DH drafted the manuscript. All authors read and critically revised the manuscript for important intellectual content and approved the final manuscript.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.