Evaluation of Health Awareness and Perceived Health Status among Men in Limpopo Province, South Africa

1. INTRODUCTION

Men's health is a holistic, comprehensive approach that addresses the physical, mental, emotional, social, and spiritual life experiences and health needs of men throughout their lifespans [1]. Men's health has emerged as an important public health concern requiring new healthcare interventions and increased resources. Men's health outcomes are problematic globally, regionally, and nationally. Traditionally, men’s health problems have been related to sexual and urinary systems. However, the health needs of men extend beyond reproductive organs and include all problems that they face, especially those that are more serious in the male population. This includes lifestyle behaviours that are considered personal and private [2]. Male life expectancy was 3.6 years shorter than female life expectancy in the UK in 2015. Men take more risks with their health and are less likely than women to be aware of disease symptoms [3]. Men’s health, including both general and sexual health, has often been neglected, consequently impacting morbidity and mortality [4].

Men have been observed to use primary care services less frequently than women, with likely impacts on health outcomes. Pinkhasov et al. (2010) [5] indicate that men in the United States utilise healthcare services and visit doctor’s offices less often than women. Moreover, men are also less likely to seek preventive care, hospice care, and dental care visits and have fewer hospital discharges compared to women [5]. Men who spend a long duration infected by diseases such as STIs untreated have an increased chance of HIV infection, becoming severely ill, and dying from the disease [6]. Bibiano et al. (2019) [7] attest that men display more chronic health conditions and die more frequently than women from the main causes of death. Globally, 52% of all deaths recorded in 2012 from Non-Communicable Diseases were male, and males were more likely than females to die prematurely from Non-Communicable Diseases (NCDs) in almost every country [8].

Knowledge about behaviours, including health-seeking ones, has implications for engagement in preventive behaviours, including health-seeking behaviour in men. However, most studies that sought to uncover factors in men’s poor health-seeking behaviour focus much on what prevented men from engaging in health-seeking behaviour, including utilising available health services. For instance, studies conducted by Mthembu (2015) [9] and Uwimana et al. (2023) [10] focused on factors influencing the health-seeking behaviour of men. Their studies did not focus on assessing the knowledge men hold about their general health as a factor that can impact their seeking behaviour. Therefore, it is not known if men have enough knowledge about their general health and how they view their health. This study aimed to assess health awareness and perceived health status among men, contributing to an understanding of men’s poor health-seeking behavior as a global public health concern. In this study, the researchers report on the study of 387 men whose knowledge of health awareness and perceived health status was assessed.

2. MATERIALS AND METHODS

3. RESULTS

A total of 400 questionnaires were distributed, and 387 were correctly filled out and returned with a response rate of 97%. The average age of respondents was 36 years, with the youngest respondent being 18 years and the oldest being 71 years old. There were about 10 years of differences in the age of most respondents, as indicated by a standard deviation of 10.38. About 66% of respondents were single, and 44% held tertiary qualifications. Moreover, about 59% were unemployed, while 62% lived with extended family members. Most (41%) men lived in the Mopani district, and 65% were Christians, as shown in Table 1.

3.5. Association between Health Awareness and Use of Health Services

Awareness of cancer being the leading cause of death in men was associated with the use of health services(p<0.001). Moreover, awareness of undergoing regular screening tests was associated with the use of health services(p<0.001). There was also a statistically significant association between awareness of blood in urine as a symptom of prostate cancer and the use of health services (p<0.001). Health awareness on the recommended period of physical activity per week, regular screening tests, diminishing testosterone levels with age, men’s nutritional needs, and risk of smoking were not associated with the use of health services among men (p>0.05) as presented in Table 4.

Table 3.

Health Awareness	Level of Education						-	Pearson X2 value Phi and Cramer’s V (P-value)	N
	Never been to School	Did not Finish Primary	Primary	Did not Finish Secondary School	Secondary School	Been to Tertiary but did not Finish	Tertiary
Cancer is the leading cause of death among men								18.1 00.219 (0.006)	377
Yes	5	5	20	13	79	15	134
No	0	0	8	4	53	6	35
More men die from lung cancer than any other type of cancer								10.7 0.168 (0.095)	382
Yes	3	0	15	12	82	12	87
No	2	5	14	5	53	9	83
Men only need 1 hour of physical activity per week								9.59 0.159 (0.143)	382
Yes	5	4	17	11	74	8	86
No	0	1	12	6	61	13	84
Men should undergo regular screening tests								4.20 0.105 (0.649)	380
Yes	2	3	17	12	73	12	83
No	3	2	12	5	61	9	86
Testosterone levels in men diminish with age.								5.30 0.118 (0.505)	381
Yes	3	4	15	14	85	12	101
No	2	1	14	3	51	8	68
Men have different nutritional needs than women.								6.63 0.132 (0.356)	380
Yes	3	3	11	12	69	11	100
No	2	2	17	5	66	10	69
Sitting in a hot tub can decrease a man's sperm count.								4.21 0.105 (0.648)	382
Yes	3	3	13	10	67	14	87
No	2	1	16	7	70	7	82
Men are more likely than women to die from injury in the workplace.								16.5 0.208 (0.011)	384
Yes	3	4	19	11	79	17	76
No	2	1	10	6	58	4	94
Men are more likely than women to attempt suicide								15.28 0.199 (0.018)	384
Yes	2	4	15	13	64	15	108
No	3	1	14	4	73	6	62
Smoking increases the likelihood of lung cancer								7.62 0.141 (0.267)	385
Yes	4	3	19	13	103	16	105
No	1	2	10	4	35	5	65
Blood in urine is one of the symptoms of prostate cancer								2.72 0.85 (0.842)	381
Yes	4	3	20	12	89	13	100
No	1	2	9	5	47	8	68
Men should examine their testicles regularly								10.27 0.165 (0.114)	379
Yes	3	4	15	11	83	18	93
No	1	1	14	6	50	3	77
It is normal to have pain when urinating								6.15 0.127 (0.406)	383
Yes	2	1	16	12	64	9	85
No	3	4	13	5	73	12	84
It is normal for men to have problems with an erection								4.35 0.106 (0.629)	385
Yes	1	3	16	12	74	11	94
No	4	2	13	5	64	10	76
Drinking too much alcohol is good for men’s health								46.6 0.349 (<0.001)	384
Yes	3	2	17	11	48	8	122
No	2	3	12	6	90	13	47

Table 4.

Health Awareness	Use of Health Services		Pearson X2 value Phi &Cramer’s V (P-value)
	Yes	No
Cancer is the leading cause of death among men			10.86 0.171 (<0.001)
Yes	130	139
No	70	34
More men die from lung cancer than any other type of cancer			4.18 0.105 (0.041)
Yes	121	88
No	79	88
Men only need 1 hour of physical activity per week			0.002 0.002 (0.962)
Yes	108	95
No	93	81
Men should undergo regular screening tests			13.4 0.189 (<0.001)
Yes	123	75
No	76	100
Testosterone levels in men diminish with age			0.161 0.21 (0.688)
Yes	125	107
No	74	69
Men have different nutritional needs than women			0.161 0.068 (0.688)
Yes	117	91
No	82	84
Sitting in a hot tub can decrease a man's sperm count			0.64 0.013 (0.800)
Yes	103	91
No	99	83
Men are more likely than women to die from injury in the workplace			1.81 0.69 (0.178)
Yes	115	88
No	87	88
Men are more likely than women to attempt suicide			0.107 0.17 (0.743)
Yes	117	99
No	85	77
Smoking increases the likelihood of lung cancer			4.64 0.111 (0.031)
Yes	150	112
No	53	64
Blood in urine is one of the symptoms of prostate cancer			13.27 0.188 (<0.001)
Yes	144	93
No	57	81
Men should examine their testicles regularly			0.465 0.035 (0.495)
Yes	121	102
No	76	74
It is normal to have pain when urinating			0.200 0.023 (0.655)
Yes	97	89
No	104	87
It is normal for men to have problems with an erection It is normal for men to have problems with an erection			0.353 0.31 (0.552)
Yes	108	99
No	95	77
Drinking too much alcohol is good for men’s health			6.262 0.129 (0.012)
Yes	98	108
No	104	68

4. DISCUSSION

This study assessed health awareness and perceived health status of men in Mopani, Vhembe, and Capricorn district municipalities of Limpopo province. Men in this study knew about cancer being the common disease that kills men and lung cancer being prevalent among the male population and its risk factors. They were also knowledgeable about the importance and need to undergo regular screening tests. These findings align with those of Dlamini et al. (2022) [13], where participants demonstrated awareness of lung cancer and its risk factors.Moreover, men were also aware that testosterone levels diminish with age. The knowledge can be attributed to their literacy level and access to health information both on social media and educational programs that provide information about men’s health, such as the MINA program [14]. However, a particular concern is that men continue to underutilize health services that offer screening services.This suggests that there are some reasons and factors that make men not participate in screening services offered at health facilities.

Furthermore, the study revealed that men were aware that blood in the urine is a symptom of prostate cancer and that they should regularly examine their testicles. This study's findings differ from the findings of Maladze et al., (2023) [15], who found that men in their study demonstrated inadequate knowledge about prostate cancer and the majority had never undergone a prostate cancer screening. This indicates that some men miss out on educational programs and health information about men’s health, while others have access to it. However, a study conducted [16] found that 91.7% of men in their study had heard of prostate cancer, while 93% had never undergone testing for it. This suggests that while some men may lack in-depth knowledge about prostate cancer, they are at least aware of its existence.The study also discovered that men were aware that they have specific national needs as men and are at high risk of gaining belly weight compared to women. This suggests that men are aware that their behaviors and lifestyle choices contribute to gaining abdominal weight, which impacts their health. This is supported by a study by Donnachie et al. (2023) [17], which found that men in their study expressed a desire to enhance their body build or size and reported deliberate attempts to achieve a healthy weight. Furthermore, men in this study recognized that sitting in a hot tub can adversely impact sperm count levels.. This indicates that when men gather in social circles, they discuss topics related to manhood and share information about reproductive health, including sexual matters. Moreover, men in this study were aware that they were more likely to die from work-related injuries than women. This suggests that men understand the risks associated with their often physically demanding work, which can lead to harm or death, as it is sometimes a necessity. Stergiou-Kita et al. (2015) [18] assert that men accept the risks in their work and endure pain without complaint, which contributes to the loss of life from workplace injuries. Men in this study knew that, they are more likely to commit suicide compared to women. This suggests that men know that they have challenges in making rational decisions, mostly find it difficult to deal with stressful situations, and are likely to end their lives. However, despite the knowledge men hold regarding the likelihood of taking their own lives, they are less likely to seek help and healthcare services. This is supported by the South African Society of Psychiatrists (SASOP) cited in a study [19] which indicated that among the 703,000 people dying every year in South Africa, the suicide rate for men is 12.6 per 100,000, which is significantly higher than that of women at 5.4 per 100,000. This suggests that men still require skills to enhance their problem-solving abilities, enabling them to cope with stressful situations and prevent the risk of suicide.

The results also indicated that men were aware that experiencing pain during urination is not normal. This suggests that men recognize pain when urinating as a potential health issue and understand the importance of seeking medical attention.Poor knowledge about the impact of excessive alcohol consumption on one's health was observed in this study. The findings align with those of Valdez et al. (2018) [20], who found that the cultural normalization of heavy drinking in men's social circles makes it difficult to view it as problematic behavior. This suggests that men do not perceive excessive alcohol consumption as a health risk. It also implies that, in social settings where men gather, they may share inaccurate information about the impact of alcohol on health. This raises concerns about the conversations men have in these spaces, as well as the interpretation of health-related messages on alcohol containers and bottles. This also raises concerns about whether alcohol consumers read the health messages on alcohol bottles and containers. When men face issues with alcohol abuse, they tend to seek advice from friends or close drinking buddies rather than consulting a healthcare professional. A peer's advice can significantly influence a man's health-seeking behavior [20]. This finding is consistent with the study by [21], which highlights that, for many men, excessive alcohol consumption is closely linked to perceptions of masculinity.

Healthcare workers were the main source of health information for men. This study's findings concur with the findings of Alduraywish et al. (2020) [22], who discovered that doctors were chosen as the first source of information by the majority of the participants, and they were completely trusted by most of the participants. This complements the health education that healthcare workers provide during treatment sessions and educational campaigns at health facilities and the effectiveness thereof. The internet emerged as the second main source of health information for men. The findings contrast with those of Alduraywish et al. (2020) [22], who found that Internet searches were not considered the primary or secondary source of health information. This discrepancy may be attributed to differences in the literacy levels between the men studied in their research and those in the current study. The findings of the current study suggest that men use the internet to self-diagnose when faced with a condition they do not understand, which may influence them not to visit health facilities to seek assistance. The internet is another platform that can be used to disseminate information about men’s health, as most men prefer it for accessing health information. The men in this study perceived their health status to be in good condition. This suggests that perceptions of health status may play a role in men’s health-seeking behavior, as they may not feel the need to seek health services when they believe their health is good. Overall, the results of this study indicated that men possess adequate knowledge about their health and perceive their health status to be in good condition.The findings of this study differ from those of Dovel et al. (2020) [23], where men’s limited use of health services resulted in minimal exposure to health education. However, although men had adequate knowledge about issues that affect their health, such knowledge was not associated with the use of health services, and only two components of the health awareness tool influenced the use of health services. This suggests that although men possess knowledge about health issues that are likely to affect them, such knowledge does not influence their use of health services. The study findings of Fish et al. (2019) [24] indicated that men who delayed seeking treatment perceived their symptoms as non-troublesome and recurrent, seeking help only when the condition became severe. In another study by Tshuma et al. (2024) [25], lack of education was a barrier to seeking help at health facilities. In this study, given the fact that men had adequate knowledge of health awareness, however, this knowledge did not influence their use of health services. The factors identified by Fish et al. (2019) [24] could be among the reasons why men in this study had health awareness, yet it did not influence their decision to use health services. Furthermore, the study was limited by delays in obtaining permission from headmen to access communities and men, which resulted in respondents being given limited time to complete the questionnaires due to time constraints. Based on the findings, future research should focus on how men apply the general knowledge they possess to maintain their health in good condition. Moreover, future research should focus on men’s understanding of their health and detailed views of their health status. The study used convenience sampling, which could limit the generalizability of the results. Future studies could employ random sampling techniques to enhance representativeness and reduce sampling bias. The study could have been improved by utilizing a mixed methods approach to explore the reasons influencing health awareness and knowledge gaps. Future research should employ mixed methods to allow a qualitative exploration of the factors affecting health awareness and knowledge gaps. The study could have been improved by utilizing a mixed methods approach to explore the reasons influencing health awareness and knowledge gaps. Future research should employ mixed methods to allow a qualitative exploration of the factors affecting health awareness and knowledge gaps.

CONCLUSION

The findings of this study revealed that while men are knowledgeable about their health, they lack awareness of the harmful effects of excessive alcohol consumption. Most men obtained health information from healthcare workers and reported perceiving their health status to be in good condition six months prior to the study. Alternative methods of disseminating information about men’s health should be explored to ensure that even those who do not visit health facilities or use social media platforms are informed about their health.

REFERENCES