Health literacy and health service use among Australian men
Health literacy & health service use among Australian men
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The health of men in Australia is an ongoing concern. Adult males have a heightened risk of mortality and an increased likelihood of experiencing numerous adverse health issues such as cardiovascular disease, some types of cancer (e.g. bowel, skin), and diabetes (Department of Health, 2019). A key contributor to these poorer outcomes is less contact with health care services among males compared to females. Men are more likely to think that their health is fine or that they are able to independently manage health concerns, possibly as a result of conforming to masculine norms (Milner, Shields, & King, 2019). In Western countries, men are less inclined to take certain actions to maintain their health and wellbeing than females, such as annual check-ups, and they also typically use health services less frequently (Mansfield, Addis, & Mahalik, 2003; Smith, Braunack-Mayer, & Wittert, 2006).
A number of factors influence why people do - and do not - interact with the health care system, including differing health beliefs, perceptions and preferences regarding the use and benefits of accessing professional support (Courtenay, 2002; Smith et al., 2006). Health service use is also influenced by 'health literacy', which is the ability to obtain, understand and use information for achieving optimal health outcomes (World Health Organization [WHO], 2016). Crucially, levels of health literacy among the Australian population appear to be low - Australian Bureau of Statistics (ABS) estimates indicate that only around one-third of Australians have sufficient ability to actively engage with health care providers, and just over one-quarter (26%) of the population find it 'always easy' to navigate the country's health care system (ABS, 2018b). This means that many Australians who would benefit from engaging with health services might be unable to do so.
Limited empirical research has investigated how different factors, such as health literacy, play a role in how men perceive and engage with professional support. There is also limited research on why Australian men are less likely to engage in help-seeking behaviours and access services when needed; for example, what are common barriers or impediments to health service use for males in Australia?
This chapter investigates patterns of health care use among Australian men. It focuses on beliefs about and preferences of health and service engagement, common health information sources, and types of services accessed. Barriers to professional support and factors associated with lower engagement with - and support from - the health care system among adult Australian males, are also explored. An improved understanding of these areas can help address gaps in service utilisation and provision and promote better health outcomes among Australian men.
Health care beliefs, preferences and information seeking
A better sense of how Australian men value and perceive their own health, and how, why and when they access available services, could inform targeted health promotion activities and policy to improve health literacy and enhance access to appropriate information and health care for those who need it.
To examine health beliefs and information seeking among men, in 2013/14, adult Ten to Men (TTM) participants were asked whether they agreed or disagreed with certain statements about their health, and from who or where they typically sourced health information. While the vast majority of Australian men (95%) considered health to be important (Figure 4.1), not all were taking steps to optimise health outcomes. Only around two-thirds of adult Australian males reported actively looking after their health. Further, around 8 in 10 men only visited the doctor when unwell, and approximately 4 in 10 avoided talking about their health.
There were some differences in the health beliefs, perspectives and values of Australian men by age. For example, compared to those in the 18-24 age group, a higher proportion of men aged 35-57 worried about their health (39% vs 50-53%, respectively). Similarly, visiting a doctor only when unwell was more common among men aged 18-24 years (82-85%) than older men aged 45-57 (73%). A greater proportion of younger men aged 18-24 were more likely to visit the doctor only when pushed (41%) compared to those aged 35-57 (29-34%).
There were minimal variations in health care beliefs and preferences among Australian men by other key socio-demographic characteristics such as marital status and area-level disadvantage. For example, married men (38%) were slightly less likely to say that they avoided talking about health compared to divorced (45%) or separated men (51%).
Notes: n = 13,085. Percentages are those who agreed with each statement.
Source: TTM data, Wave 1, adult cohort, weighted
Credit: Ten to Men 2020
In terms of other health care preferences, most men (76%) did not have a preference regarding the gender of their doctor. However, 14% preferred a male doctor for 'certain things' (i.e. it was not vital to always have a male doctor), 8% always preferred a male doctor, and a small minority - 2% - always preferred a female doctor.
Around 77% of adult Australian males typically made their own medical appointments. Partners organised medical appointments for around 17% of men.
Key health-related information sources
In 2013/14, TTM participants commented on where they typically first sought health-related information from when they had a health concern (Table 4.1).
Adult males most commonly sought health-related information from someone related to them when they had a health concern - more than 4 in 10 men in any age group reported seeking health information from family members (including a partner/spouse) in the first instance.
The internet was the second most common source of health-related information among men aged 18-34 years (one-quarter reported first accessing the internet in relation to a health concern), while for those aged 35-44 and 45-57 years, a doctor or nurse was the second most common source of health-related information (24% and 34% respectively).
Highlighting generational differences in technological preferences, the internet was not a popular primary source of health-related information among older males in 2013/14 - only around 15% of those aged 45-57 first went online for health information over other options.
Notes: Percentages are those who said yes to each source option. 'Family members' include partners and spouses. 95% Confidence Intervals provided in supplementary materials.
Source: TTM data, Wave 1, adult cohort, weighted
Health literacy among Australian men
Health literacy is an important predictor for access of different types of health services such as health screenings, vaccinations, medication use and hospitalisations (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011). Given low levels of health literacy among the Australian population in general (ABS, 2018b; Australian Institute of Health and Welfare [AIHW], 2018), an improved understanding of health literacy among certain population subgroups could inform targeted programs and strategies to improve help-seeking behaviours and access to appropriate health care when needed (ABS, 2018b; Oliffe et al., 2019). Relevant research involving men's health literacy has largely focused on assessing health literacy related to specific diseases or conditions, as opposed to general health-related decision making, service engagement and help-seeking behaviours (Oliffe et al., 2019).
This section aims to fill some of these information gaps by examining TTM participants' responses to three scales from the Health Literacy Questionnaire (HLQ) (Osborne, Batterham, Elsworth, Hawkins, & Buchbinder, 2013; see Box 4.1):
- Ability to find good health information
- Ability to actively engage with health care providers
- Feeling understood and supported by health care providers.
These scales assess how people understand, communicate and engage with the health care system in relation to changing health circumstances.
Box 4.1: Health Literacy Questionnaire (HLQ)
The HLQ is a self-report measure comprising a number of subscales that cover the full construct of health literacy.
One of the subscales is the ability to find good health information. Its items include:
- Find information about health problems
- Find health information from several different places
- Get information about health so you are up-to-date with the best information
- Get health information in words you understand
- Get health information by yourself.
There are five response options for each item, with response values ranging from 0 to 4: 0 = 'cannot do', 1 = 'very difficult', 2 = 'quite difficult', 3 = 'easy', and 4 = 'very easy'. A higher score on this subscale (total range: 0-20) indicates better ability to access reliable, diverse and up-to-date health information.
A second subscale is the ability to actively engage with health care providers. Its items include:
How easy or difficult are the following tasks for you to do now?
- Make sure that health care providers understand your problems properly
- Feel able to discuss your health concerns with a health care provider
- Have a good discussion about your health with doctors
- Discuss things with health care providers until you understand all you need to
- Ask health care providers questions to get the health information you need.
As above, there are five response options for each item, with response values ranging from 0 to 4: 0 = cannot do', 1 = 'very difficult', 2 = 'quite difficult', 3 = 'easy', and 4 = 'very easy'. A higher score on this subscale (total range: 0-20) indicates better engagement with health care providers and feeling empowered about client-provider relations.
A third subscale is feeling understood and supported by health care providers. The items are:
How strongly do you agree or disagree with the following statements?
- I have at least one health care provider who knows me well
- I have at least one health care provider I can discuss my health problems with
- I have the health care providers I need to help me work out what I need to do
- I can rely on at least one health care provider.
There are five response options for each item, with response values ranging from 0 to 3: 0 = 'strongly disagree', 1 = 'disagree', 2 = 'agree', and 3 = 'strongly agree'. A higher score on this subscale (total range 0-12) indicates more trust in health care providers for advice, and feeling more supported by - and engaged with - them.
In 2015/16, the majority of Australian men (85% of 18-60 year olds) found it 'quite' or 'very easy' to find information about health problems (Table 4.2). Most could get it by themselves and from several different sources. More than 8 in 10 men also found it easy to remain up-to-date with the best health information, and to get it in an easily understandable language. Notably, there were no variations in the abilities of Australian men to independently identify reliable and current sources of health information by age.
Notes: Percentages are those who said 'quite easy' or 'very easy' for each statement. 95% Confidence Intervals provided in supplementary materials.
Source: TTM data, Wave 2, adult cohort, weighted
Successfully engaging with and navigating the health care system can be facilitated by health care professionals who are supportive and trustworthy, and who provide useful and timely advice.
In 2015/16, most Australian men felt engaged with health care providers. Around 8 in 10 Australian men aged 18-60 years could 'quite' or 'very easily' make health care providers understand their problems, have good discussions about their health with doctors, and ask health care providers questions to get more health information (Table 4.3). Similarly, 8 in 10 men found it easy to discuss their health concerns with health care providers, and to clarify what they did not understand.
In terms of feeling supported, in 2015/16, around 7 in 10 men had at least one health care provider who they could rely on, discuss their health problems with, and who could help them understand information and make good decisions about their health. Just over half of Australian men (55%) had at least one health care provider who knew them well (Table 4.3).
While most adult males aged 18-60 felt engaged and in control of their relationships with health care providers, a small proportion did not feel this way. Around 2 in 10 men reported not proactively seeking and clarifying information (Table 4.2), being unable to share health concerns, and not seeking clarification from health care providers (Table 4.3). Moreover, 3 in 10 men did not have a reliable health care provider they could discuss their health concerns with or use as a source of health advice (Table 4.3). These findings are important: indicating that, although most adult males have sufficient health literacy to access appropriate and timely health care, a significant minority of Australian men are not able to effectively engage with health care services and access and understand health-related information.
Notes: Percentages in the top panel are those who said 'quite easy' or 'very easy' for each statement; and percentages in the bottom panel are those who said 'agree' or 'strongly agree' for each statement. 95% Confidence Intervals provided in supplementary materials.
Source: TTM data, Wave 2, adult cohort, weighted
Factors associated with low service engagement and support
To understand the factors that impede men's ability to engage with, and feel supported by, health care providers in Australia, this section details associations between various socio-demographic and psychosocial characteristics of Australian males (18-60 years) and the continuous scores of two HLQ subscales (Table 4.4):
- Ability to actively engage with health care providers (a lower score indicates poorer abilities to engage)
- Feeling understood and supported by health care providers (a lower score indicates reduced levels of support/understanding).
A number of factors were associated with reduced levels of engagement with, and of feeling understood and supported by, health care providers among Australian men. Younger age, residing in outer regional areas (vs major cities), having only a high school education or less (vs university degree), having a greater number of financial hardships, and having middle-to-high conformity to masculine norms were each associated with both a reduced ability to actively engage with health care providers and lower levels of feeling understood and supported by health care providers.
In contrast, men from CALD backgrounds reported feeling better supported by the health care system compared to those from English-speaking backgrounds. Compared to employed men, those who were unemployed and those out of the labour force were also significantly more likely to report having health care providers who they felt supported by and trusted for advice.
Non-heterosexual men were significantly more likely to say they were unable to engage with health care providers than heterosexual men.
Having private health cover was associated with higher levels of engagement and of feeling understood and supported by health care providers. Further, compared to men with no physical health conditions, those with one or more chronic physical health condition were also more likely to feel engaged with, and supported by, health care providers, which possibly reflects greater involvement with the health care system due to health concerns.
Notes: ASGS = Australian Statistical Geography Standard; SEIFA = Socio-Economic Indexes for Areas; CALD = Culturally and Linguistically Diverse; *** p < 0.01, ** p < 0.05, * p < 0.10. SE = robust standard error. a For a one unit change in the explanatory variable (age, Indigenous status, etc.), one would expect a β unit change in the outcome variable (HLQ score), assuming that all other variables in the model are held constant; b 'Financial hardships' was assessed according to having a shortage of money for medical care, being unable to pay for a prescription, being unable to pay bills on time, being unable to pay mortgage/rent on time, asking for financial help from others, and limited availability of fruit and vegetables. c The extent of conformity to traditional masculine roles was measured with the Conformity to Masculine Norms Inventory (CMNI) (Mahalik et al., 2003). The CMNI is comprised of 22 items that capture notions of winning, emotional control, risk taking, violence, dominance, sex, self-reliance, primacy of work, power over women, homosexuality, and pursuit of status. It is answered on a four-point scale (0 = strongly disagree, 1 = disagree, 2 = agree, 3 = strongly agree); scores range from 0-66, with higher scores indicating greater conformity with masculine norms. The score distribution was divided into quantiles with classifications of Low, Middle, and High conformity.
Source: TTM data, Wave 2, adult cohort, balanced sample; unweighted
Health service use among Australian men
Types of health services accessed
Despite Australian men often having poorer health outcomes compared to women, they typically access health services less often (AIHW, 2019). In 2018/19, Australian men claimed an average of 14 Medicare services per person, compared to 19.5 Medicare services per person among women (AIHW, 2019). A possible explanation for this discrepancy, as previously noted, is that Australian males tend to visit a doctor only when unwell. Ten to Men findings also indicate that they often view their parents, partners and friends as a primary resource for health information over professional options (see 'Health care beliefs, preferences and information seeking'). While women also commonly source health information from family members and via social networks, perhaps even more so than men (Ek, 2015), a key difference appears to be that men often do not take the extra step of accessing professional support.
To improve our understanding of health care engagement patterns among Australian men, this section examines their use of key health services such as general practitioners (GPs), specialists, dentists and psychologists in 2015/16. Having ongoing contact with such health professionals promotes trust between providers and health care consumers, and can be crucial for the prevention, management and treatment of health issues (ABS, 2018a).
In 2015/16, a GP was the most commonly accessed health service among adult Australian males. More than 7 in 10 Australian men had consulted a GP at least once in the past 12 months for their own health. Rates were significantly higher for older men; 79% of 35-44 year olds and 86% of 45-60 year olds had visited a GP in the past 12 months, compared to 71% of Australian men aged 18-24 and 73% of those aged 25-34 (Figure 4.2).
Notes: n (18-24) = 1,306; n (25-34) = 1,979; n (35-44) = 2,968; n (45-60) = 4,384. Percentages are those who said yes to each service option. Brackets above/below bars represent 95% Confidence Intervals.
Source: TTM data, Wave 2, adult cohort, weighted
Credit: Ten to Men 2020
Although it is generally recommended to have at least an annual dental check-up to help prevent oral problems such as cavities, and for identifying emerging concerns (AIHW, 2016), only around one-third of Australian men aged 18-44 had visited a dentist in the past 12 months in 2015/16. A slightly higher proportion of men aged 45-60 - 4 in 10 men - had visited a dentist in the past year at this time.
Consultations with other specialists were also higher among older versus younger men in 2015/16 - around 3 in 10 (31%) men aged 45-60 years had consulted a specialist in the past 12 months, compared to fewer than 2 in 10 (16%) men aged 18-24 years. Visits to other health professionals such as pharmacists, physiotherapists, chiropractors, psychologists and nurses were rare - less than 2 in 10 men in any age group had visited these health professionals in the past 12 months, although there was an increasing trend in visits with age (Figure 4.2).
Apart from visiting health professionals when a health concern emerges, it is also important that men engage in preventive health check-ups (i.e. for a general check-up and not because they are sick or injured). This is especially important if they are at higher risk for poor health outcomes or they are above the age of 40.
In 2015/16, only around 4 in 10 Australian men visited a GP at least annually for preventive reasons (Table 4.5). The rate of preventive check-ups was higher among older age groups - around 6 in 10 men aged 45-60 years visited a GP at least once per year for preventive reasons, compared to one-third of men aged 18-34 years.
Notes: Percentages are those who said yes to the option. 95% Confidence Intervals provided in supplementary materials.
Source: TTM data, Wave 2, adult cohort, weighted
Private health insurance
Being able to afford visits to health care providers is a key determinant of seeking care. In 2013, 16% of adult Australians said they had forgone health care due to cost in the previous year (Corscadden et al., 2017). In Australia, Medicare provides access to free or subsidised treatment by frontline health professionals such as doctors and public hospitals under the Medicare Benefits Schedule.Private health insurance can further facilitate or fund health care use when not fully - or partially - covered by Medicare (in the case of specialists, for example), or when being treated in a private hospital. Not having private health insurance could therefore preclude engagement with the health care system.
In 2015/16, more than 4 in 10 (46%) Australian men aged 18-24 years and more than half (55%) of Australian men aged 25-34 had private health insurance. Health insurance was more common among older men - around 6 in 10 (62%) of those aged 35-57 had it in 2015/16. It should be noted that a higher rate of private health insurance among older Australian males could be expected given the Medicare levy surcharge, which is charged to Australian taxpayers without an appropriate level of private hospital cover who also earn above a certain income and are aged 31 years or over.
Having health insurance appears to be associated with a greater likelihood of accessing health services that typically require out-of-pocket expenses. In 2015/16, among men who had private health insurance, around one-quarter - 27% - had visited a specialist in the past 12 months, compared to one-fifth - 20% - of those without private health insurance.
There was some socio-demographic variation in the types of men who had private health insurance; in particular, those with greater levels of disadvantage were typically less likely to have private health cover, including men with lower education, and those who were unemployed or out of the labour force. Accordingly, men living in disadvantaged neighbourhoods (as per SEIFA classifications) and those experiencing financial hardships were significantly less likely to have private health insurance. Men who were not married and those living in regional areas were also significantly less likely to have private health insurance.
Only 25% of Indigenous men had private health insurance compared to 59% of non-Indigenous men. Forty-three per cent of non-heterosexual men had private health insurance compared to 59% of heterosexual men.
Characteristics associated with service use (GP)
As highlighted in previous sections, some men find it difficult to engage and establish good relationships with health care providers. Understanding who these men are is crucial for designing and implementing targeted interventions and education resources to help them access appropriate services to meet their needs, and to feel empowered and supported when accessing health care.
Research has shown that men with low education levels and those located in non-metropolitan areas are less likely to effectively engage with the health care system (Clouston, Manganello, & Richards, 2017; Davey, Holden, & Smith, 2015; Geller et al., 2006). Some evidence suggests that the level of conformity to masculine norms may also be an important predictor of men's ability to engage with, and feel supported by, health care providers (Milner et al., 2019).
This section builds on the current evidence and examines a wide range of factors associated with health care use among Australian men; specifically, having visited a GP in the past 12 months at Wave 2 (2015/16). GPs were the focus of this analysis because they are often the first point of contact for health issues due to factors including low cost and high levels of familiarity, accessibility and availability compared to other service types. GPs are also important sources of health education and preventive health care (Steering Committee for the Review of Government Service Provision, 2016).
Table 4.6 details associations between various socio-demographic and psychosocial characteristics of adult males (18-60 years) and reporting at least one visit to a GP in the past year.
Younger age was associated with a significantly lower likelihood of having visited a GP in the past 12 months. Men in inner and outer regional areas of Australia had a 30-35% lower likelihood of recently visiting a GP.
Compared to single men, those who were married or living in de-facto relationships had about 18% higher likelihood of visiting a GP in the past 12 months. Men from CALD backgrounds had around 21% lower likelihood of going to a GP in the past 12 months. There was no significant association between Indigenous status and visiting a GP.
Socio-economic factors were also shown to influence engagement with GPs among adult males in Australia. Those out of the labour force had a nearly 34% higher likelihood of visiting a GP in the past 12 months compared to those who were employed. Experience of financial hardship (such as not being able to pay bills and/or mortgage/rent, being unable to pay for a prescription) was also associated with a greater likelihood of visiting a GP.
Compared to those without private health insurance, men with private health cover had close to a 40% higher odds of going to a GP in the past 12 months. Compared to men with no physical health conditions, those with at least one had more than triple the odds of visiting a GP in the past 12 months.
Compared to men with low conformity to masculine norms, those with higher conformity to masculine norms had around a 12% lower likelihood of visiting a GP in the past 12 months. Finally, men who reported better ability to actively engage with health care services had a higher likelihood of visiting a GP in the past 12 months.
Notes: aOR = adjusted Odds ratio; ASGS = Australian Statistical Geography Standard; SEIFA = Socio-Economic Indexes for Areas; CALD = Culturally and Linguistically Diverse; HLQ = Health Literacy Questionnaire;*** p < 0.01, ** p < 0.05, * p < 0.10. SE = robust standard error. a 'Financial hardships' was assessed according to having a shortage of money for medical care, being unable to pay for a prescription, being unable to pay bills on time, being unable to pay mortgage/rent on time, asking for financial help from others, and limited availability of fruit and vegetables. b The extent of conformity to traditional masculine roles was measured with the Conformity to Masculine Norms Inventory (CMNI) (Mahalik et al., 2003). The CMNI is comprised of 22 items that capture notions of winning, emotional control, risk taking, violence, dominance, sex, self-reliance, primacy of work, power over women, homosexuality, and pursuit of status. It is answered on a four-point scale (0 = strongly disagree, 1 = disagree, 2 = agree, 3 = strongly agree); scores range from 0-66, with higher scores indicating greater conformity with masculine norms. The score distribution was divided into quantiles with classifications of Low, Middle, and High conformity.
Source: TTM data, Wave 2, adult cohort, balanced sample, unweighted
4 See www.ato.gov.au/individuals/medicare-levy/medicare-levy-surcharge/#:~:tex...(MLS,earn%20above%20a%20certain%20income.&text=The%20base%20income%20threshold%20(under,singles%20and%20%24180%2C000%20for%20families.
Understanding barriers to using health care among Australian men
In addition to factors such as poor health literacy and lack of private health insurance precluding access to health care, a wide range of other personal, social and structural barriers to service use exist for males, including excessive wait times and limited hours of operation and availability of services (Smith et al., 2006). Previous research has indicated that barriers to health service use affect males differently depending on their age, sexual orientation, education, employment and ethnicity (Buckley & Lower, 2002; Rockloff & Schofield, 2004; Schlichthorst, King, Turnure, Phelps, & Pirkis, 2019); however, this research has typically focused on specific subpopulations of men, such as those residing in rural or remote areas and men with mental health problems, as opposed to larger samples of more diverse groups of males.
This section, therefore, examines a number of barriers to the use of health care with a nationally representative sample of Australian men aged 18-60 years. It also identifies the socio-demographic characteristics associated with an increased likelihood of experiencing these barriers.
When TTM participants were asked to indicate why they had not accessed health care when needed, options to choose from included: no service in the area, long wait time/no appointments, not taking new patients, cost, decided not to seek care, too busy/other responsibilities, transportation problems, and language problems (Figure 4.3). Understanding the reasons why some men do not receive health care when needed, and their characteristics, is important for the development of resources and interventions to improve their engagement with the health care system.
Notes: n = 685. The 'Other' category includes barriers such as 'Not a resident', 'Work/Busy at work' and 'Waiting for health insurance'.
Source: TTM data, Wave 2, adult cohort, weighted
Credit: Ten to Men 2020
In 2015/16, around 7% of Australian men had needed health care in the last 12 months but could not get it. For more than half of adult males (around 52% in 2015/16), cost was a reason for not getting health care when needed (Figure 4.3). Around one-third (35%) experienced long waiting lists or a lack of available appointments. Having no service/s in the area was a barrier to health care use for 14% of men.
At the same point in time, around 16% of Australian males decided not to seek health care despite acknowledging that they had needed it, and around 15% decided not to seek health care because they were too busy or due to other responsibilities.
Around 7% of men reported other barriers to health care use such as being busy at work, a lack of skilled doctors or because they were waiting for health insurance.
Importantly, there were only minimal variations in the experience of each of the individual barriers by age. This suggests that the nature of barriers faced by Australian men is quite similar regardless of age or life stage.
Men who experience barriers to health care access
Table 4.7 presents results from a multivariate analysis that examined associations between the recent experience of health care barriers in 2015/16 (i.e. not being able to get health care when needed in the past 12 months) and socio-demographic and economic characteristics among adult males.
Findings indicated that several socio-demographic factors increased the risk of experiencing barriers to health service use. Compared to men living in cities, those in outer regional locations had a 40% higher likelihood of experiencing barriers to health care. Compared to men living in neighbourhoods of low disadvantage, those in high disadvantage areas had a 33% higher likelihood of experiencing barriers to health care use. There were also indications that race and ethnicity affected access to health care; specifically, adult males who identified as Indigenous and men from CALD backgrounds had around 70% higher odds of experiencing barriers to health service use than non-Indigenous and non-CALD men.
Men with one or more physical health condition such as diabetes, arthritis or cardiovascular or respiratory disease had a 47% higher likelihood of experiencing barriers to health service use. This is problematic given that such men might be in greater need of professional support.
Of all the factors considered, financial situation had the strongest effect on the likelihood of experiencing barriers to health care among Australian men in 2015/16. Overall, more than one in four (26.8%) adult males experienced at least one financial hardship. Men with at least one financial hardship had triple the odds of experiencing barriers to health care compared to those with none. There appeared to be a dose-response relationship; that is, the odds of experiencing health service use barriers increased considerably with the number of financial hardships experienced. These findings are in line with the cost of health care being the most common barrier to health service use among Australian men (see Figure 4.3).
Other socio-economic factors such as employment status and having private health insurance had no, or only a marginally, significant effect on the probability of facing barriers to health service use. Similarly, masculine norms did not have a significant impact on the probability of facing barriers to health service use.
Notes: aOR = adjusted Odds Ratio; ASGS = Australian Statistical Geography Standard; SEIFA = Socio-Economic Indexes for Areas; CALD = Culturally and Linguistically Diverse; *** p < 0.01, ** p < 0.05, * p < 0.10; Experiencing barriers to health services was indicated by being unable to get health care when needed in the last 12 months. SE = robust standard error. a 'Financial hardships' was assessed according to having a shortage of money for medical care, being unable to pay for a prescription, being unable to pay bills on time, being unable to pay mortgage/rent on time, asking for financial help from others, and limited availability of fruit and vegetables. b The extent of conformity to traditional masculine roles was measured with the Conformity to Masculine Norms Inventory (CMNI) (Mahalik et al., 2003). The CMNI is comprised of 22 items that capture notions of winning, emotional control, risk taking, violence, dominance, sex, self-reliance, primacy of work, power over women, homosexuality, and pursuit of status. It is answered on a four-point scale (0 = strongly disagree, 1 = disagree, 2 = agree, 3 = strongly agree); scores range from 0-66, with higher scores indicating greater conformity with masculine norms. The score distribution was divided into quantiles with classifications of Low, Middle, and High conformity.
Source: TTM data, Wave 2, adult cohort, balanced sample, unweighted
Rates of help seeking and health service use are generally lower among males compared to females. To better understand this discrepancy, this chapter explored the beliefs and preferences of Australian men regarding health service use, in addition to their health literacy in relation to effectively understanding, communicating and engaging with service providers. It also identified the types of health services accessed by Australian men, barriers to professional support, and the characteristics of adult males who were less likely to engage with the health care system.
Overall, there appear to be inconsistencies between how Australian men value their health and view their ability to engage with health services and how they actually interact with the health care system. Many men view seeking health care as a response only to being unwell (i.e. not for preventive purposes). Indeed, around one-third - 3 in 10 men- did not see a GP in the past 12 months, and less than half - around 4 in 10 men - saw a GP for a preventive health check-up in a given year. This is despite the vast majority of Australian men saying their health is important to them.
Across all age groups of adult males, informal sources for obtaining health-related information regarding a health concern were preferred to engaging with professionals; for example, a family member was the most common primary or first source for health-related information above other options including GPs and the internet. Although an increasing number of people are using the internet to meet their health information needs, international studies have found that males are less likely to source health information online compared to females (Bianco, Zucco, Nobile, Pileggi, & Pavia, 2013; Dickerson et al., 2004). Online care is not always an adequate replacement for in-person service provision but enhancing rates of internet usage for the purposes of sourcing health information and help seeking among Australian males could help overcome barriers to professional support among this group more generally, and facilitate timely access to health care and pertinent information (e.g. by increasing knowledge of available services). This could be especially beneficial for older Australian men, given TTM findings indicating they were less likely to access the internet for the purpose of accessing health information, and those who live in areas with limited services (men residing in regional areas were less likely to have visited a GP in the past year).
It should be noted that rates of internet use for sourcing health information and help seeking could now have become more common among Australian males, given that Wave 1 of TTM was conducted in 2013/14. Indeed, a substantial increase in telehealth usage in Australia during the COVID-19 pandemic has shifted access to remote and online services around the country (Department of Health, 2020). Regardless, promoting and supporting the use of available digital health services, such as Head to Health (an online national mental health service),is acknowledged as a means of addressing access issues among Australian males in the National Men's Health Strategy 2020-2030. This is an area that will be further explored using Wave 3 data collected throughout 2020/21.
In 2015/16 around 7% of Australian men had needed health care in the past 12 months but had been unable to get it. This was most commonly attributed to cost and high waiting times. Highlighting a common theme throughout this chapter, the findings of multivariable analyses indicated that men with an increased likelihood of experiencing barriers to health care were typically more socio-economically vulnerable or marginalised; for example, living in areas of high disadvantage (vs low disadvantage) and experiencing a greater number of financial hardships were significantly associated with experiencing barriers to health care use in the past year. This is a crucial gap, given that socio-economic disadvantage is generally associated with poorer health (e.g. higher rates of obesity, tobacco smoking, lung cancer, diabetes and suicide) (Department of Health, 2019). These findings suggest that improving access to health care for males who experience disadvantage should be a policy priority.
There were indications that race and ethnicity affected access to health care among Australian men; indeed, those who identified as Indigenous and men from CALD backgrounds had around 70% higher likelihood of experiencing barriers to health service use than non-Indigenous and non-CALD men. This is especially problematic given that such men are more likely to experience a number of different health concerns, including chronic issues covered elsewhere in this report, such as depression, diabetes and overweight and obesity. Further, only 25% of Indigenous men had private health insurance compared to over half - 59% - of non-Indigenous men.
Other national studies have found similar differences in the rates of private health insurance by Indigenous status (AIHW, 2015), indicating a glaring gap in equity for this group. Accordingly, Medicare data from 2015/16 show that, while claim rates for GP visits were 10% higher among Indigenous versus non-Indigenous Australians, claim rates for specialist services were 43% lower (AIHW, 2018), which likely reflects difficulties in accessing specialist providers for people who identify as Aboriginal or Torres Strait Islander. Crucially, Indigenous Australians access hospitals for potentially preventable conditions at a rate three times higher than non-Indigenous Australians (specifically, 69 per 1,000 vs 23 per 1,000, respectively) (AIHW, 2018). Addressing barriers to certain types of professional support for this group is one vital component of improving the health of Indigenous Australians in general. It could also alleviate the strain experienced by frontline services due to limited access to other health care providers, such as specialists.
These findings build on previous research to enhance our understanding of some of the reasons why men in Australia generally have lower levels of engagement with health service providers than women, which likely leads to poor health outcomes. They provide an indication of which subgroups of men are less likely to share their health concerns and are more likely to experience barriers to professional support. Health campaigns could aim to improve rates of health service use among Australian males by educating men about how and when to engage with appropriate and available services. To this end, researchers have suggested that, to address the specific health needs of this group, the health care system needs to be more targeted in terms of their health messages and other communication with men and how care is delivered (Smith et al., 2006).Progress in this area could help build client-provider trust and enhance feelings of support and confidence among Australian men with regard to health service engagement.
Further research with the TTM cohort will help determine trajectories in health service use and health outcomes over time among males who are less likely to engage with the health care system.
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