“I feel more comfortable speaking to a male”: Aboriginal and Torres Strait Islander men’s discourse on utilizing primary health care services

Abstract

BackgroundAboriginal and Torres Strait Islander men have the highest morbidity and mortality rates, and lowest rates of health service utilization in Australia. There is a current perception that Aboriginal and Torres Strait Islander men are disinterested in their health. This study aimed to identify the perceived motivators, barriers and enablers of Aboriginal and Torres Strait Islander men’s utilization of primary health care services, explore their experiences and obtain suggestions from them as to how services could be modified to improve utilization.MethodsThis study utilized the principles of Indigenist Research Methods. Semi-structured interviews with Aboriginal and Torres Strait Islander men (N = 19) took place in South Australia and far north Queensland. Participants were asked about their experiences with primary health care services, including what they could remember as a child. A thematic analysis of the qualitative data was completed without the use of computer software.ResultsFeelings of invincibility, shame, being uncomfortable, fearful, along with long waiting times, having a lack of knowledge, and culturally inappropriate staff/services were all found to be barriers to service utilization. Enabling factors included convenience, the perceived quality of the service, feeling culturally safe and/or a sense of belonging, and having a rapport with staff. Motivation for attending primary health care services included going when feeling sick/unwell, attending a particular service (dental or sexual health), visiting for check-ups and preventative health and family encouragement.This study also highlights strategies surrounding logistical factors, promotion of services and improved communications, having culturally appropriate services and providing gender specific services all of which were suggested by the participants to improve service utilization.ConclusionContrary to common misperceptions, this study demonstrated that most of the Aboriginal and Torres Strait Islander men participants were motivated to engage with primary health care services for preventative health care. Even though there were men that fitted the stereo-type who avoid doctors, there were usually underlying reasons and barriers accounting for this reluctance. This study suggests that if primary health care services commit to better understanding the barriers, enablers and motivators their cohort of men face, then utilization could be greatly improved.

Listen, understand, collaborate: developing innovative strategies to improve health service utilisation by Aboriginal and Torres Strait Islander men

“…The available data detailing Aboriginal and Torres Strait Islander health service use is patchy 17,18 ; however, most indicates that Aboriginal and Torres Strait Islander men use PHCSs at lower rates than their female counterparts, especially for preventative healthcare. Many authors suggest Aboriginal and Torres Strait Islander men tend to delay care, often presenting at a time of advanced or serious illness 1,10,11,19 . Yet, access and utilisation are a function of multiple, complex and interacting factors that enable (or inhibit) Aboriginal and Torres Strait Islander men from accessing and using available care.…”

“…Currently, Aboriginal and Torres Strait Islander men are viewed as being disinterested in their health, thus, the blame is being placed on the individuals themselves for their under‐utilisation of PHCSs. In contrast to this misconception, studies have found that Aboriginal and Torres Strait Islander men are interested in their health but many face significant barriers that hinder access 1–7 . In response, Aboriginal and Torres Strait Islander men have identified strategies for PHCSs to reduce barriers and increase their use, which fundamentally includes working with local men to develop innovative strategies 1,5‐7 …”

Time to stop flogging a dead horse?

“…This may be reflected in primary health care service reports, records and Medicare claims, but it cannot be further from the truth. Instead, Aboriginal and Torres Strait Islander men are interested in their health and want to engage with primary health care services, and herein lies the challenge . Health services must be willing to ask the Aboriginal and Torres Strait Islander men of their community how they want to utilise the service and how it, in turn, can better accommodate and respond to their hopes, wants and needs.…”

“…Aboriginal and Torres Strait Islander men need to and want to define their own future, which is critical to turning this situation around . A recent qualitative study presented the perspectives of Aboriginal and Torres Strait Islander men on their motives, barriers and enablers regarding their utilisation of primary health care services . Addressing some of the barriers identified would be a good starting point.…”

“…Instead, Aboriginal and Torres Strait Islander men are interested in their health and want to engage with primary health care services, and herein lies the challenge. 4 Health services must be willing to ask the Aboriginal and Torres Strait Islander men of their community how they want to utilise the service and how it, in turn, can better accommodate and respond to their hopes, wants and needs. Subsequently, health services must also be able to make the appropriate changes to improve access and, ultimately, men's health outcomes.…”