Research and practice suggest that mental health care, and mental health care practices and practitioners along with mental health care systems, are confronted with obstacles when delivering mental health care to adult rural and remote males.
The objective of this systematic review is to appraise and synthesize primary research on obstacles which may influence the interaction between adult and rural/remote dwelling males and service providers. By reviewing and analyzing data from system, provider and recipient viewpoints in the research literature this review will bridge gaps in the focus of literature on this topic. Participants in the studies selected are male, over 18 years of age, of all cultural backgrounds, and residing in rural and remote areas of Australia.
This review included literature from quantitative and qualitative research designs. The quantitative component studies selected reviewed the nature and significance of obstacles, and the qualitative component explored the meaning and experience of these obstacles. The quantitative research focused on data search and surveys while the qualitative research was phenomenological in nature.
Outcomes were identified and descriptions made of a cluster of obstacles which impacted upon the take-up of mental health care by adult Australian rural and remote males. The search strategy in both qualitative and quantitative designs considered primary research in a three step search strategy involving searches of databases, keywords and index terms, and reference lists, in a complex research study. Medical Subject Headings (MeSH) terms and combinations of MeSH terms were utilized to uncover the most number of research papers.
Research papers which met the inclusion criteria were assessed by two independent reviewers for methodological quality prior to inclusion in the systematic review. Data was extracted from the research papers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for quantitative data, and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) for qualitative data, which revealed populations, interventions, phenomena of interest, comparators, study methods and outcomes as the fundamentals of the methodology of the study.
Data synthesis was presented in narrative form. Quantitative papers could not be subjected to meta-analysis due to the lack of heterogeneity of the respective studies. An aggregation and synthesis of findings from the qualitative research studies was conducted. Findings informed evidence-based practice in terms of the rurality of males themselves and the rurality of mental health care systems.
Results were analyzed using Anderson's Model of Health Care systems to reveal population, environment, health behaviors and health outcomes in four categories of findings. Outcomes were collapsed into supply and demand side factors. The outcomes of this systematic review led to the identification and description of four clusters of obstacles which impact upon adult males seeking medical health care in rural and remote communities of Australia. These clusters were in line with Anderson's Model. The model could not, however, readily be collapsed into supply and demand side factors which were more ubiquitous and equally distributed across the four categories.
Quantitative data indicated the existence of a constellation of everyday factors as obstacles and qualitative data which reflected the meaning and experience of recipients of rural and remote mental health care systems in terms of these types of obstacles.
Implications for clinical practice and research
The field of health promotion and prevention needs to consider more fully, as a psychological agenda, the mental health attitudes, beliefs and behaviors of both recipients and providers as well as suppliers and systems of mental health service provision to Adult Australian Rural and Remote Male (AARRMs). Obstacles to mental health service delivery to AARRMs carry significant meaning and significantly influence the experiences of this population.