The Impact of Structural Barriers on Black Men’s Health-Seeking Behaviours in the Public Primary Healthcare Settings of Ga-Rankuwa Township, Pretoria, South Africa

Abstract

Over 1 600 public healthcare facilities have been constructed and upgraded in South Africa since 1994, making healthcare accessible to many communities. Despite these improvements, many Black men continue to underutilise these facilities. This qualitative study explored structural barriers that prevent many Black men in Ga-Rankuwa from seeking healthcare at their local public clinics. Such barriers are poor quality of care, congested waiting areas and provider demographics. The data were collected between November 2021 and March 2023 through in-depth semi-structured interviews with 15 purposively sampled participants. Data saturation determined the final sample size. To supplement interview data, an observation schedule was used to document clinic environments. Thematic analysis revealed that poor service quality, understaffing, overcrowded spaces, lack of privacy and the gender and age of healthcare providers discourage men from accessing care. Applying the theory of planned behaviour, the study suggests how these perceived barriers shape Black men’s attitudes, reinforce community norms and undermine Black men’s sense of control over accessing public healthcare – consequently extending the theory by contextualising it in structurally unequal healthcare environments. To address these challenges, healthcare facilities should improve registration and filing systems, ensure the availability of operational equipment and medical supplies by stocking pharmacies with essential drugs, recruit more male healthcare providers, and promote male-specific services. However, the small sample size and localised focus may limit the generalisability of the findings. Future studies with larger samples in other South African townships could further explore context-specific factors influencing these behaviours.