Using the Nominal Group Technique to Inform Approaches for Enhancing Men’s Utilization of Sexual and Reproductive Health Services
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Setting
2.2. Study Design
2.3. Study Participants
2.4. Sampling Strategy
3. Eligibility—Inclusion and Exclusion Criteria
3.1. Inclusion Criteria
3.2. Exclusion Criteria
4. NGT Process
- What are men’s barriers/hindrances to using SRH services in health establishments (i.e., anything that prevents or discourages men from seeking medical help for their SRH conditions)?
- What can be done to motivate or encourage men to use SRH services (to come to clinics/hospitals when experiencing SRH problems)?
- What are the implications (adverse effects or complications) of the underutilization or non-utilization of SRH services?
5. Data Management
6. Data Analysis
7. Results
7.1. Quantitative Findings
7.1.1. Characteristics of Study Participants
7.1.2. Phase 1: Experts’ Perspectives on the Men’s Barriers to SDRH Service Utilization
Men’s Barriers to SRH Service Utilization | Priority Assigned by Participants 1 = Low Priority 5 = Highly Priority | Total Number of Voting Scores and Percentage (%) | ||||
---|---|---|---|---|---|---|
A | B | C | D | E | 25 (100) | |
Lack of awareness/Knowledge (of available services and of one’s own conditions—e.g., whether it is an illness or aging) | 5 | 5 | 5 | 5 | 5 | 25 (100) |
Hindered by female HCWs’ presence—men prefer male HCWs | 5 | 5 | 4 | 5 | 4 | 23 (92) |
Staff attitudes—stigmatizing HCWs’ responses (unfriendly services) | 3 | 5 | 5 | 4 | 5 | 22 (88) |
Perceived lack of privacy and confidentiality—fear of visiting health facilities | 4 | 3 | 5 | 5 | 4 | 21 (84) |
Inconvenient and long waiting operational times | 4 | 3 | 4 | 4 | 4 | 19 (76) |
Expectation to be an economic provider—choosing to work rather than seek help. | 4 | 4 | 3 | 3 | 4 | 18 (72) |
No proper health facilities—lack of equipment and staff with expertise | 3 | 3 | 4 | 4 | 3 | 17 (68) |
Inability to recognize potential risk—perceived low-risk attitude—wanting to self-treat. | 2 | 3 | 4 | 3 | 3 | 15 (60) |
The construction of gender norms and masculinity (upbringing)—embarrassed to be seen in health facilities (would rather go to traditional healers)—and inability to express emotions | 3 | 2 | 3 | 3 | 3 | 14 (56) |
7.1.3. Phase 2: Experts’ Perspective on the Strategies
Intervention Strategies to Enhance Men’s Utilization of SRH Services | Priority Assigned by Participants 1 = Low Priority 5 = Highly Priority | Total Number of Voting Scores and Percentage (%) | ||||
---|---|---|---|---|---|---|
A | B | C | D | E | 25 (100) | |
Improve awareness—through public talks and social media (radio, TV, adverts), men’s forums, community-based models (izimbizos) organized by community leaders (izindunas), and campaigns in hospitals (where health education sessions occur in the morning) and men’s social leisure spaces. | 5 | 5 | 5 | 5 | 5 | 25 (100) |
Male-centered health services—men-only clinics that are more specialized (in terms of training) and male-friendly | 5 | 4 | 5 | 5 | 5 | 24 (96) |
Training of HCWs to increase their knowledge about SRH conditions and how to deal with men | 4 | 5 | 4 | 5 | 4 | 22 (88) |
Teach men to express their vulnerability—that is, being sick is normal and to speak up and seek medical help—and destigmatize attending health facilities. | 4 | 5 | 3 | 4 | 5 | 21 (84) |
Encouraging multisectoral stakeholder engagement—departments dominated by men working together | 3 | 4 | 4 | 4 | 5 | 20 (80) |
Target traditional healers—to refer patients if they are unable to help | 4 | 3 | 4 | 3 | 4 | 18 (72) |
Ensure convenient operational times at health facilities | 4 | 4 | 3 | 3 | 3 | 17 (68) |
Ensuring sustainability of SRH services rendered for men in facilities | 3 | 4 | 3 | 3 | 3 | 16 (64) |
Encourage role modelling of prominent persons who have survived SRH conditions | 3 | 2 | 3 | 4 | 2 | 14 (56) |
7.2. Qualitative Findings
7.2.1. Thematic Analysis of Barriers to SRH Service Utilization and Intervention Strategies
7.2.2. Barriers to SRH Service Utilization
“A: Lack of awareness means men do not know where these clinics are or where they can seek help. Alternatively, some men are not aware that they have treatable conditions … Some men are unaware of their disease or illness … they may think they are growing old or have been bewitched.”—“C: Men do not know that health facilities have SRH services.
“B: Men’s distrust for the clinics leads them to rather consult a traditional healer, who will give them some traditional medicine to help them.”
“B: Although they may be men-friendly clinics or services, they are mostly run by females. Men would normally prefer to be attended by male HCWs.”
“D: Other barriers include perceived unfriendly and stigmatizing responses from HCWs, such as “Why did you not use a condom?”
“A: The clinics are so crowded, and there is no privacy. Men feel embarrassed to open up to someone who may be younger than them or a female doctor. Men may shy away and rather go to sangomas (diviner/traditional healer), which might be more accommodating than the hospital.”
“B: Waiting more than 3 h becomes a problem for men. For example, taxi drivers do not like to wait. Once they come to the clinic, they want to be seen and leave immediately.”
“C: Inconvenient operational times in health facilities can be a barrier. In most cases, men are at work during the day. When they come back, our clinics are already closed.”—“Long waiting times can be a deterrent … Men do not want to wait. Once the queue is long, they only wait for minutes and then leave the facility without getting the help they want.”
“D: Men are expected to go and find jobs and get money to provide for their families. So, if their health problems compete with the expectation to go and find jobs, they tend to go and look for jobs and get money. So, their health seeking gets to be compromised in that way.”
“A: Sometimes, there is no equipment to do an investigation on men … and no staff interested in looking at SRH conditions.”—“B: Sometimes, men do not get what the medical help they need in the health facility … the medication they want is not always available, and end opts to consult traditional healers.”
“C: Men tend to delay seeking help early … they shy away from visiting the health facilities until the late stages of the disease.”—“E: Men’s inability to recognize the potential risk can prevent them from seeking help early … Men tend to self-diagnose or self-treat … relying on themselves to try and solve the problem … either by using traditional medicines or just talking to friends.”
“B: Men’s upbringing influences their health-seeking behaviors. Men are taught to be strong, so they are reluctant to visit a clinic.”—“D: Some men who hold traditional masculinities or are older would often be reluctant to be attended by young and female HCWs.”—“E: Men’s difficulty expressing emotions hinders them from seeking help.”
7.2.3. Strategic Interventions to Motivate Men’s Utilization of SRH Services
“A: Improve the SRH service awareness among men … This can be done through public talks, public forums, churches, hospitals, places of leisure, and social media.”—“F: Create community awareness campaigns (izimbizo) by engaging Izindunas (local community leaders), who will organize men in their formation, such as “Isibaya Samadoda (traditional ‘military’ ranks)”
“A: Another point is getting proper men’s health services in health facilities and specialized clinics with more knowledgeable HCWs who attend workshops, proper equipment, and proper medication.”—“E: Established male-friendly clinic to make men feel comfortable and calm when visiting facilities.”
“C: Government must train HCWs to capacitate them with knowledge about SRH services.”—“E: Train HCWs on how to treat men because they are different types of men, e.g., how to engage with traditional men in a culturally sensitive way, so that they can find the space welcoming.”
“E: We need to teach men and boys that they can express their emotions and vulnerability and that being sick is normal and being human. Help men to construct health-promoting masculinities that will enable them to embrace their vulnerability; that is, everyone can be sick, and proper manhood and boyhood are demonstrated when seeking medical help if one is ill. To change the mentality that being sick is unmanly.”
“C: We need to have a governmental multisectoral engagement … where the Department of Health needs to work together with other departments, especially departments dominated by men and boys, to health educate and encourage men to use SRH services.”
“F: Target traditional healers because they always claim to help even if they cannot anymore … Encourage them to refer men to seek medical help if they cannot help them after trying.”
“A: You can also get role models. For example, a renowned personality may publicly divulge their condition.”
“B: We need men-friendly services that only cater to men at convenient hours to accommodate men returning from work and during the weekends.”
“C: We need to ensure the sustainability of SRH services rendered for men in the facilities.”
8. Discussion
9. Strengths and Limitations
10. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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ID | Sex | Age Range (Years) | Highest Qualification | Title | SRH Service Work Experience |
---|---|---|---|---|---|
A | Male | 60–65 | Bachelor of Medicine and Bachelor of Surgery (MBChB), Urologist | Consultant Urologist and Honorary Clinical Lecturer at UKZN | 18 |
B | Male | 40–45 | Diploma in Nursing Science and Midwifery. | Head Nurse Championing Men’s Health in PHC | 9 |
C | Female | 40–45 | Master of Public Health | KZN Provincial Health Men’s Health Coordinator | 6 |
D | Male | 40–45 | PhD in Public Health | Associate Professor at the School of Public Health, Wits University Specialist. Scientist at the Gender and Health Research Unit and SAMRC. Honorary lecturer in Public Health at UKZN. | 15 |
E | Male | 30–40 | PhD in Medicine | Senior Scientist in the HIV Mucosal Immunology Laboratory at CAPRISA. Honorary lecturer in the Department of Medical Microbiology at UKZN | 12 |
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Nyalela, M.; Dlungwane, T. Using the Nominal Group Technique to Inform Approaches for Enhancing Men’s Utilization of Sexual and Reproductive Health Services. Int. J. Environ. Res. Public Health 2024, 21, 711. https://doi.org/10.3390/ijerph21060711
Nyalela M, Dlungwane T. Using the Nominal Group Technique to Inform Approaches for Enhancing Men’s Utilization of Sexual and Reproductive Health Services. International Journal of Environmental Research and Public Health. 2024; 21(6):711. https://doi.org/10.3390/ijerph21060711
Chicago/Turabian StyleNyalela, Mpumelelo, and Thembelihle Dlungwane. 2024. "Using the Nominal Group Technique to Inform Approaches for Enhancing Men’s Utilization of Sexual and Reproductive Health Services" International Journal of Environmental Research and Public Health 21, no. 6: 711. https://doi.org/10.3390/ijerph21060711