Little research has investigated formal psychosocial support use among men with cancer living in rural areas. The current study investigated perceived barriers to support service use among such men, within the framework of the Behavioral Model of Health Service Use. In a mixed methodology study, 82 men with cancer living in rural Australia were surveyed, and nine of these men, plus three health professionals, participated in semi-structured interviews. Reasons for not participating in formal support were sufficient informal support and subjective judgements about perceived need. Service availability was rarely endorsed by the men as a reason for non-participation, but was emphasised by health professionals. Identifying factors that impede or facilitate service use might enable rural men experiencing cancer-related distress to seek the extra psychosocial support they need.
Keywords: cancer, psychosocial aspects, rural healthcare, masculinity, men's health, social support, Australia
A diagnosis of cancer carries with it a significant psychological impact. Men with cancer experience significantly higher levels of psychological distress than men in the general population (Hinz et al., 2010; Zenger et al., 2010). It has long been recognised that cancer-related distress can be addressed through attending to a cancer patient's psychosocial needs, that is, their emotional (psychological, social and spiritual), practical and informational needs (National Breast Cancer Centre and National Cancer Control Initiative, 2003). Psychosocial support available to people with cancer includes services provided by mental health professionals (e.g., psychiatrists, psychologists, social workers). Interventions can be one-on-one or group-based, professionally or peerled, and accessed either face-to face or remotely, via telephone or Internet. The structure and content of these interventions vary. For example, approaches for men with prostate cancer have included educational programs, cognitive behavioural therapy, relaxation training, and support groups (Bloch et al., 2007). Although there has been some recent debate about the efficacy of psychosocial interventions (e.g., Coyne, Lepore, & Palmer, 2006; Manne & Andrykowski, 2006), they have been shown to increase wellbeing, improve adjustment and coping, and reduce distress in people living with cancer (Carlson & Bultz, 2003; Edelman, Craig, & Kidman, 2000; Jefford et al., 2005; Meyer & Mark, 1995).
Despite these benefits the majority of people with cancer (75-98%) never utilise formal psychosocial support services (Carlson et al., 2004; Eakin & Stryker, 2001; Plass & Koch, 2001). Men in particular are reluctant to use support services (Grande, Myers, & Sutton, 2006; Plass & Koch, 2001) even when clinically distressed. For example, Merckaert et al. (2009) found that around 50% of male cancer patients in their study experienced significant levels of anxiety and/or depression, yet only 10% reported a desire to receive psychological support.
HEALTH SERVICES USE
Understanding the factors that influence help-seeking among men with cancer is an important step in increasing service use and improving outcomes for men experiencing cancer-related distress. Factors that facilitate or impede the use of health services have been examined in the health service utilisation literature using The Behavioral Model of Health Services Use (Anderson, 1995). In this model, one of the primary determinants of health behaviour is categorised as Population Characteristics. Under this category, use of health services is seen to be a function of three factors: predisposing characteristics, enabling factors and perceived need for care.
Predisposing characteristics. Predisposing characteristics are individual characteristics, such as age, sex, ethnicity, and attitudes about health and behaviour that influence health service use. …