Obstacles to the take-up of mental health-care provision by adult males in rural and remote areas of Australia: A systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective is to identify and synthesise the best available evidence on the obstacles to the take-up of health-care provision by adult rural and remote dwelling males in Australia seeking mental health services.

BACKGROUND: Men's health, in general health-care practice, is defined as the global management of mental, emotional, and physical health conditions, and related risk factors, that are specific to men in order to promote and generate optimal health.Research and practice tends to suggest that health-care and mental-health care practitioners seem to be confronted with obstacles such as distance clients need to travel and rurality in delivering care to adult rural males. Possible issues might be whether, or to what extent, care providers are conscious of these obstacles. Another issue might be how care providers work with these obstacles in practice, and whether or not they may, also to some extent, share some of the responsibility for the existence of these obstacles, on their own, or in conjunction with other factors which might be said to exist purely in the rural context. There is also a need to explore the contributions to obstacles from the adult rural male side as well. There may also be factors at work in the particular unique nature of rural and remote health-care and mental-health care as well, which could also be involved in the creation of obstacles.The structure and functioning of rural care available to adult males of all cultural backgrounds and the obstacles to the take-up of that care represents an area which warrants further exploration and understanding. A foundation paper in this field by Karoski suggests that obstacles exist in health-care provision, particularly in the field of mental-health care to adult males. Other research suggests that, while obstacles in service provision are common to all areas, some obstacles are more significant for rural and remote areas.The reasons for framing this review in terms of the adult rural and remote male (ARRM) context is as follows. Research suggests there is a consensus that Australian rural male health is a unique social problem, and there appears to be a possible perception that the state and national health systems may have failed ARRM's. This research also discusses that ARRM's respond differently and uniquely, compared to their international counterparts, and this might be especially true in the case of Australian Indigenous populations. There is a suggestion in the research that the Australian rural health-care environment is unique because of its mix of ARRM's among a population which includes culturally and linguistically diverse populations, local Indigenous people as well as people of Anglo-Saxon descent. Some research suggests that there are unique complexities confronting the ARRM population mix when access to health-care is considered. Research also suggests unique complexities might exist in the mix of care provision, delivery systems, and funding arrangements in the ARRM context. An interesting area of research in terms of social capital, and moral distress, suggests the Australian context might be unique in terms of its formal and informal care structures and arrangements.. Moral distress is believed to represent an issue in the professional delivery of quality health-care Other research considers the notion of structural disadvantage in the provision of, and access to, care services for ARRM's. Structural disadvantage refers to the dearth of asset-based community development opportunities that play a role in health-care provision.A screening search of Pubmed, Cinahl, the Cochrane Library and the JBI Systematic Review Library did not identify published systematic reviews, or active protocols in this topic of research. Therefore this systematic review will help address this gap.

DEFINITIONS: Obstacle: A barrier to the utilisation of health-care/mental-health care.Take-up: The accessing of health-care/mental-health care services.Health-care: Services which promote, maintain, and preserve health, life, and well-being.Mental-Health care: The assessment, diagnosis and treatment of people who are experiencing psychological and situational stressors which create mental-health conditions and disorders such as depression and anxiety.Provision: Professional services for health-care/mental-health care provided by Doctors, Nurses, Medical Specialists, Psychologists, Social Workers, Psychotherapists, and other care providers.Rural and Remote: This term can be conceptualised as a set of characteristics which can impact on the way a health-care service can be delivered and includes: geographical isolation from major population centres of Australia; greater distances; lower socioeconomic status; lower educational levels; higher proportion of Indigenous people; specific occupational health safety and welfare risks; a relatively close relationship with nature; specific cultural attitudes; poor access to services; and, smaller population centres where there is a distinctive occupational profile dominated by primary and resource production.