Clinical summary guide

Engaging Aboriginal and Torres Strait Islander men in primary healthcare services

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Aboriginal and Torres Strait Islander men, as a group, are among the most disadvantaged in Australia when it comes to health.

Increasing access to culturally safe services, health workers and health information is key to engaging Aboriginal and Torres Strait Islander men in the primary healthcare system.

This article provides strategies to improve how services and health professionals support the holistic wellbeing of Aboriginal and Torres Strait Islander men in their community. 

Barriers to accessing health services for aboriginal and torres strait islander men

There are a number of barriers that affect the way Aboriginal and Torres Strait Islander men engage with the health system and access health services, in particular, the pathway from one service to another when managing multiple health issues. 

Societal barriers:

  • Illness-related stigma

  • Gender differences in health.

  • Racism and discrimination

Cultural barriers:

  • Traditional gender-related lores

  • Masculinity and gender roles

  • Language and gender barriers

  • Beliefs around causation.

Logistical barriers:

  • Lack of transport

  • Appointment times conflicting with family and community priorities e.g. ceremonies.

Health system barriers:

  • Limited access to specialist services and treatment

  • Complicated referral process

  • Too few (male) health professionals, which leads to patients seeing many different doctors

  • Medical terminology and jargon.

  • No specific mens access at clinic

Financial barriers:

  • Difficulties in meeting health service costs.

Individual barriers:

  • Knowledge or perception of the illness

  • Previous illness experience

  • Low prioritisation of preventative healthcare

  • Lack of understanding and embarrassment

  • Self-esteem and confidence.

  • Employment

Strategies for health services to engage men from remote communities

The cultural diversity of Aboriginal and Torres Strait Islander communities means that what works in one setting may not work in another. 

For example, remote communities may have a stronger need for a male-specific space compared with urban settings where there is likely greater integration and interaction with non-Indigenous people. Seeking feedback from the community is important.

Overcoming language and health system barriers

In remote communities, English is often the second language and men may not be familiar with a clinical environment. 

The following strategies can help overcome these barriers:

  • Identify, acknowledge and consult with “cultural bosses” and community male elders

  • Gain local knowledge from men’s groups through consultation and documentation of their needs and issues

  • Plan services with input from local men, make health fun.

  • Consider having an after-hours clinic or mobile/outreach service to visit men in their workplaces or at men’s places to increase access for those who cannot regularly attend clinic appointments during daytime operating hours

  • Check the patient register for the proportion of adult and young men attending

  • Involve male Aboriginal and Torres Strait Islander Health workers and practitioners and traditional healers in outreach services in communities. For example, 715 health checks with the footy team, at workplaces, men’s places, if confidentiality is not compromised.

Using remote clinics effectively

Where remote clinics are available, these strategies can increase engagement with Aboriginal and Torres Strait Islander men:

  • Get male Aboriginal and Torres Strait Islander Health workers and practitioners to help organise outreach services in the community, or in appropriate spaces such as men’s areas.

  • Have male-orientated clinics to help men feel comfortable. If the environment feels ‘foreign’ then men may be less likely to engage with doctors or be upfront in providing information.

  • Where appropriate, plan and involve family members in the consultations so that the family understands the medical treatment and can provide support if needed.

  • Provide flexible delivery, such as telemedicine, home visits or after-hours services.

  • Engage the local community by holding a clinic meet-and-greet or open day so that men can meet the staff. If feasible, arrange a tour of the clinic and its functions, led by the IHP.

  • Develop and co-design men’s health promotion resources, such as posters and brochures that include artwork or imagery of local men. If the content is specific to men’s business, place posters in public male restrooms.

  • Respect Aboriginal and Torres Strait Islander men and their cultural values. For example, it is important for men (and women) to enter and leave a clinic without passing through a shared reception, particularly when they present for more sensitive health concerns.

Culturally appropriate engagement

The strategies can assist health services to engage men appropriately by identifying and valuing culture:

  • Undertake an informal community consultation process to better understand the health care service needs of local men, if not already documented by other services or the men themselves

  • Learn protocols from local health workers on how to access and engage men or men’s groups

  • Set up a male-specific clinic in a dedicated men’s space

  • Where possible, have more male Aboriginal and Torres Strait Islander Health workers and practitioners and men’s counselling programs to support men, and go out into the community to encourage access to health services

  • Engage the local community by holding a clinic meet-and-greet or open day so that men can meet the staff. If feasible, arrange a tour of the clinic and its functions, led by the IHP.

  • Encourage doctors to stay for the long haul to develop trust and help men feel comfortable

  • Minimise waiting times where possible and encourage men to bring a male IHW, a family member or friend to an appointment to help translate

  • Advise the patient beforehand of additional costs when being referred to other health services and clinics

  • Integrate Follow-up Care Plans as part of ongoing care to ensure the patient has followed treatment and understands when they need to come back for results or re-testing

  • Promote Aboriginal and Torres Strait Islander men and women who work in the health service to build empowerment and encourage community members to return to the health service.

Strategies for gps and other health professionals to engage aboriginal and torres strait islander men

For many men, attending a health service can be a negative experience. For example, when blood or urine collection is needed. Trying to make the visit a pleasant experience will help ensure that men return and feel comfortable to open up about health concerns, particularly more sensitive and personal issues. 

Men will often talk to their family and friends when they have had a positive health experience — word-of-mouth is one of the best ways to encourage Aboriginal and Torres Strait Islander men to attend health services.

Most health professionals intuitively communicate well with patients. But when building rapport with Aboriginal and Torres Strait Islander men, these additional strategies may be helpful:

  • Work on developing trust — lifestyle behaviour change may only come after a long, trusting relationship has developed between the patient and doctor

  • Involve a male Aboriginal and Torres Strait Islander Health workers who may help to identify issues before the appointment

  • Check when the man had his last annual health assessment and take the opportunity while he is at the clinic to repeat it if it has been longer than 12 months

  • Reinforce confidentiality and ensure all health discussions are private and not in open spaces such as reception areas

  • Provide simple, clear and accurate explanations of common medical terms and procedures to help reduce a patient’s fears and anxieties about his health care. This may include locally developed material using imagery that men can relate to.

Supporting cultural respect

Adopting a holistic approach to Aboriginal and Torres Strait Islander health is important. This includes not just the physical wellbeing of an individual but also the social, emotional and cultural wellbeing of the whole community.

Working in the Aboriginal and Torres Strait Islander health sector can be challenging for doctors and healthcare professionals who have been educated in a Western approach to health service provision.

It is important that non-Indigenous health professionals delivering services to Aboriginal and Torres Strait Islander people undergo cultural competency training.

This provides valuable insight into Aboriginal and Torres Strait Islander perceptions and the basic tools to avoid cultural pitfalls. When cultural respect is shown and real progress can be made.

To support cultural competency training, health professionals can also:

  • Practice in a service that allows longer consultation times e.g. half-hour consultations to build relationships and provide useful knowledge

  • Stay in the community for the long haul to accumulate knowledge of people and backgrounds

  • Take opportunities to visit remote communities and learn some of the local languages

  • Seek advice and learn from the experience of other health professionals and local Aboriginal and Torres Strait Islander Health workers and practitioners.

Cultural respect is particularly important for older Aboriginal men. Health professionals should take a considered approach to sensitive subjects, such as sexual health.

Strategies to talk about sexual health with aboriginal and torres strait islander men

Aboriginal and Torres Strait Islander men can find it hard to open up and discuss personal and sensitive health issues, particularly if they see someone other than their usual doctor. If a man visits the same doctor regularly and feels comfortable with them, he is more likely to initiate discussion.

For sexual health matters, it is particularly important for health professionals to be aware of cultural protocols.

Here are some strategies and considerations for discussing sexual health with Aboriginal and Torres Strait Islander men:

  • Provide a safe, private and comfortable environment that supports open dialogue

  • Confidentiality is a major concern of Aboriginal and Torres Strait Islander men, particularly when family and community members work for the health service they use. Seek approval from the client when referring to other allied health service providers including traditional healers and Aboriginal and Torres Strait Islander Health workers and practitioners

  • Men may not open up in the first consultation — it may take time to build trust — but balance is also needed to take advantage of opportunistic discussions

  • For older men, more care should be taken in approaching sensitive issues. However, when the conversation has started, men are often interested in discussing their sexual health

  • Ask about erectile function for men with cardiovascular risk factors. Use simple analogy and resources (such as brochures, flip-charts, videos and visual aids) to help explain the links between erectile dysfunction and chronic disease

  • Incorporate questions into annual health checks such as: “Have you got any sexual difficulties?” or “About half of men with diabetes will have difficulty getting an erection — is that a problem for you?”

  • Sometimes men have erectile problems when taking prescribed medication for other health issues. It is important to explain to men why this may happen and think about other treatment options if erectile problems are a concern

  • Raise awareness about lifestyles that may contribute to erectile dysfunction, like smoking and heavy drinking

  • Think about making the consulting room more inclusive for talking about sensitive issues. For example, a model or pictures of the male pelvis might help initiate discussion

  • Consider the sensitivity of physical examinations, such as DRE, for men with a history of being sexually abused.

Healthy Male would like to thank the Aboriginal and Torres Strait Islander Male Health Reference Group for guidance and input into the development and ongoing review of this guide.

References

Wenitong et al., 2014. Engaging Aboriginal and Torres Strait Islander men in primary care settings. Medical Journal of Australia

Engaging Aboriginal and Torres Strait Islander men in primary healthcare services

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