Background: Many major causes of disease burden and health risk factors in men are lifestyle-related and amenable to early interventions. Male-specific morbidities such as sexual dysfunction are common but often under-reported by male patients during consultations. These health risk factors and male morbidities are prevalent in primary care settings, but they are rarely discussed. Yet, primary care doctors (PCDs) are well positioned to offer health check-ups during consultations. Therefore, there should be an effort to develop or improve the uptake of men’s health check-ups in primary care settings. An understanding of how PCDs negotiate this is crucial to this process as health care provider factors are implicated as one of the reasons for men’s poor engagement with preventive health care.
Objectives: The objective of this study was to explore the determinants and process of decision making by PCDs in undertaking health check-ups for male patients in Malaysia. This study also aimed to quantify the average impact of each determinant and rank its significance on the doctors’ decision-making processes in men’s health check-ups.
Methodology and methods: A mixed-method approach was adopted in this study. Phase I, an exploratory phase of the study, has utilised grounded theory methods to construct a theoretical framework in explaining the determinants and the decision-making process for initiating check-ups in men. This framework informed the conceptualisation of phase II, which has utilised a quantitative approach to identify the significant determinants from a representative sample of PCDs. In this phase, a cross-sectional survey with multiple regression analyses was undertaken to examine and quantify the relationship between the determinants and outcome variables – the doctors’ intention to undertake health check-ups for male patients. Fifteen regression models were constructed based on five topics concerning men’s health and three contexts (acute minor complaint, follow-up and health check-up visits) for each of the topics.
Results: Fifty-two PCDs from the private and public settings were interviewed in phase I and 198 doctors (a response rate of 70.4%) completed the questionnaire in phase II. The concept of men’s health was new to many PCDs, and yet many PCDs were already managing many illness concerns related to men. The concept was best depicted as an unresolved jigsaw puzzle, in which an understanding of the concept was fragmented. PCDs balanced the weight of perceived male patients’ receptivity versus medical importance before engaging male patients in health check-ups. If the patients were perceived to be receptive to health check-ups, PCDs would engage them. However, if PCDs felt a particular men’s health issue to be important, they placed less emphasis on their perceived patients’ receptivity to discuss that health issue in their decision making. However, the perception of receptivity relied mainly on assumptive and subjective assessments of the taboos surrounding the topics of men’s health and men’s help-seeking behaviour. From the overall results of regression analyses, the perception of receptivity was noted to be the most frequent significant determinant in the decision-making process among the 15 models, and it often has the highest regression coefficient in the models. The attitude towards the medical importance of men’s health check-ups ranked second in the list of frequent significant determinants. Other important determinants included perceived external barriers and personal competency in offering men’s health check-ups. However, these played a lesser role in the doctors’ decision making to engage male patients in undertaking health check-up.
Conclusions: The concept of men’s health is relatively new among Malaysian PCDs. The doctors’ decision making to engage male patients in health check-ups is a complex process. It is influenced by both their personal experience and societal perceptions about men’s help-seeking behaviour, and in particular their perception of male patients’ receptivity to health check-ups, which can be unfounded. This potentially creates miscommunication between PCDs and male patients in the clinics. Therefore, in addition to addressing knowledge deficiency and external barriers to men’s health check-ups, efforts should also be made to bridge this communication gap.