Table 4.

Factors impacting health seeking behaviors

Study	Health Services	Attitudinal	Knowledge	Other
Hughes 2004 [33]	Distance to services and lack of transport. Lack of traditional healing services. Difficulty getting an appointment. Would like to be able to call a doctor 24-hours a day on a toll-free number for anonymous advice for personal and sensitive health concerns. Lack of specialty services in rural areas. Past experiences of personal interactions with health personnel (positive and negative). Lack of Native Hawaiian health professionals. Physicians need to listen more, have a sense of humor and be more honest.	Fear, shame, embarrassment and distrust. Too embarrassed to seek help for sexual health problems, substance misuse and mental health services. Preventative visits are reassuring. Reluctant to find out something is wrong. Discomfort with some procedures. Less shame if you don’t know the service provider.	Lack of information on services from health institutions and clinics. Participant’s knowledge of the importance of annual health checks.	Financial issues; cost and health insurance coverage. Feeling rushed, ignored or discriminated against because of their insurance coverage. Conflicting priorities. Lack of reminders. Medical bureaucracy. Difficulty finding parking.
Isaacs et al. 2012 [34] & Isaacs et al. 2013 [35]	Having to wait for an appointment. Past negative experiences with health services/ hospitals. Lack of trust with hospitals and health services. Lack of confidentiality. Racial discrimination within services.	Distrust of health services and staff. Shame contacting services. Fear of hospitals and health services. Need to safe-guard their role in society. Peer pressure. Stigma. Fear of being labelled ‘mental’ by community. Perceived need to be ‘strong’.	Difficulty recognizing mental health problems.	Availability of alternative coping strategies; alcohol and other substances.
Adams et al. 2013 [26]	Lack of culturally appropriate health services. Culturally appropriate and gender specific staff required.	Shame, embarrassment and low self-esteem limits ability to talk about health problems. Fear of lack of confidentiality. Stigma about sexual health problems.	Limited education about erectile dysfunction is available.