Meeting Multiple Needs in Familiar Spaces: Rural Men’s Engagement for Better Health

Highlights

Public health relevance—How does this work relate to a public health issue?

• Addressing the health disparities amongst rural men’s health requires a multiagency approach.
• Providing immersive work-integrated learning opportunities brings future healthcare providers together with rural men to learn together.

Public health significance—Why is this work of significance to public health?

• Accessing environments in which men feel connection and trust, enhances their likelihood to participate in activities that enhance their health.
• Providing ongoing opportunities for rural men to talk about their mental health is an ongoing health concern.

Public health implications—What are the key implications or messages for practitioners, policy-makers and/or researchers in public health?

• Rural men have multiple motivating factors to participate in student-led health promotion activities.
• Non-clinical and socially supportive rural environments encourage access to timely health checks, resulting in positive long-term health outcomes.

Abstract

Rural men in Australia experience poorer health outcomes compared to their urban counterparts, often due to barriers such as limited access to services, cultural norms around masculinity, and geographic isolation. This study explored the motivations underlying rural men’s participation in a student-led health promotion activity conducted by first-year paramedicine students at a large agricultural event. Using semi-structured verbal surveys with 60 participants, qualitative data were collected and analysed through an inductive content analysis approach. Three key themes were created to represent the reasons men engaged in the activity and the impact it had: factors that encouraged engagement and built trust, meeting multiple needs, and giving to student learning for the future. Participants were drawn to the activity by a welcoming environment, peer encouragement, and the consistent presence of health promotion at the event. Health promotion provided an opportunity for men to access basic health assessments, reflect on their wellbeing, and engage in conversations about physical and mental health in a supportive setting. Many participants also expressed a strong motivation to contribute to student learning, particularly through experiential interactions that allowed students to develop technical and interpersonal skills. The findings highlight the value of embedding health promotion activities in familiar, community-based settings and demonstrate the multitude of benefits for rural men. This research contributes to the growing evidence supporting innovative, community-engaged models of work-integrated learning that address health disparities while enhancing student education and rural workforce development.

1. Introduction

Health promotion is an important component of men’s health, and considerable research has explored effective strategies for engaging men in health-promoting activities [1,2]. In rural settings, however, socioeconomic and geographic barriers can limit access to health promotion programs and services [3]. As a result, effective health promotion for rural men requires place-based and contextually responsive approaches. Recent research suggests that health promotion initiatives delivered by undergraduate health students may provide an effective mechanism for addressing these challenges [4,5]. Such programs offer dual benefits as they provide students with work-integrated learning (WIL) experiences focused on rural health while simultaneously increasing access to community-based health promotion opportunities for rural men [3].

Rural health promotion initiatives have been shown to be valuable WIL experiences for paramedicine students. Studies by Green et al. [5] and Castelletto et al. [4] demonstrated that short-term placements within rural health promotion programs enhanced students’ technical skills, interpersonal capabilities, and understanding of community-based practice. Collectively, these studies found that the placements provided immersive and well-supported learning experiences while exposing students to the realities of rural healthcare delivery. Such opportunities are particularly important given that WIL is widely recognised as a critical component of undergraduate health education, supporting the development and integration of professional knowledge, skills, and practice [6]. The benefits of WIL also extend beyond student learning, with placements contributing to local organisations and communities and potentially supporting the future recruitment of rural health professionals [3]. Despite evidence supporting the educational value of rural health promotion activities, little is known about the factors motivating men’s participation in these programs or the impact participation may have on their health and wellbeing.

Across rural health literature, there is a notable absence of community member inclusion in evaluating placement activities [3,7]. Therefore, the current study examined the factors influencing men’s participation in student-led health promotion activities and the perceived impact of these activities. This research explores the community member experience, without examining the health promotion activities themselves (i.e., no information from the health promotion activities or measurements was collected as part of this study). This research provides insight into the factors that influence men’s decision to voluntarily participate in a health promotion activity and the impact this may have on them. The aims of this research were:

(1)

To explore why rural men participate in a student-led health promotion activity.

(2)

To explore the impact of participation in a student-led health promotion activity from the perspective of rural men.

2. Materials and Methods

2.1. Student-Led Health Promotion Activity

The student-led health promotion activity is annually undertaken for three days at a significant agricultural event and forms part of a five-day community-based WIL experience. While at the agricultural event, community members were asked as they walked past the health promotion tent if they would like to have a health chat and undergo some basic health measures with an undergraduate student. The students measure blood pressure, waist circumference, and body mass index and assist community members in completing a K-10 self-survey on mental wellness. Additionally, health screening needs for each age group are discussed, as outlined in the ‘Spanner in the Works?’ health promotion guideline (see https://malehealth.org.au (accessed on 23 September 2025) for program details). This health promotion activity is coordinated by lecturers in rural health at a local university (who are also registered health professionals), in partnership with the Australian Men’s Shed Association, and a representative from the Local Health District.

2.2. Participant Recruitment and Consent

For this research, men who voluntarily participated in the student-led health promotion activity were invited to participate in a verbal survey immediately afterwards. The process used by the interviewers to approach potential participants was guided by a recruitment proforma and included the following steps: introduction, brief context of this study, invitation to participate, information about the process, and invitation for questions. As men exited the health promotion activity area, they were approached by a member of the research team and asked if they would like to participate. If they agreed, they were able to choose to sit with an interviewer immediately or return for a verbal survey later during the event. The interviewers arranged a designated area for receiving consent and conducting verbal surveys. Participation consent for this research was written specifically for this activity only (i.e., participants could undergo a health check without opting into the verbal survey).

2.3. Data Collection

This research employed semi-structured verbal surveys to collect qualitative data, exploring participants’ experiences of completing a health check as part of the student-led health promotion activity. Verbal survey methods were chosen as the data collection method because they could be administered quickly to large numbers of participants. Verbal survey methods also offer flexibility, with some participants opting to provide longer answers while others provide short answers [8]. This allowed data to be collected in a format that provided direction and flexibility in the discussion [9].

Participants were recruited using purposive sampling, whereby men who had participated in the health promotion activity were intentionally selected because they could provide information relevant to the study aims [10]. All men aged over 18 years who had participated in the health promotion activity were eligible for inclusion in this study. Given the time-limited nature of the event, the final sample size was determined by the number of eligible participants who elected to participate during the three-day data collection period. As recruitment ceased when the event concluded, sample size was not guided by saturation but by the availability of participants and the richness of the data collected [11].

Two experienced qualitative researchers were responsible for data collection (EG, LK) and maintained a presence at the event for the duration of the field days. LK identifies as female and is an experienced occupational therapist with additional qualifications in psychology. EG identifies as female and is a registered nurse with a PhD. Some community members were known to the interviewers through personal connections, and in this instance, the other researcher conducted the verbal survey. If both researchers were occupied with data collection when an additional participant wished to complete the survey, a third member of the research team asked the participant to wait until a researcher became available. As the survey required less time to complete than the health promotion activity, researchers were generally available before participants had finished the activity, resulting in minimal waiting times. Each researcher explained to the participants that the purpose of the verbal survey was to collect feedback on the health check experience, which could be used to explore why people participate and to identify any quality improvements that could be undertaken. During the verbal surveys, only the interviewer and interviewee were present. All interviews were audio-recorded, and the researchers took notes. Interviews that were longer than 5 min were transcribed. The verbal surveys were based on the questions shown in Appendix A.

2.4. Data Analysis

An inductive approach to content analysis using the phases suggested by Erlingsson and Brysiewicz [12] was conducted by three members of the research team (LK, EG and BS). The researchers familiarised themselves with the data by reading the transcripts and listening to the recordings. During this process, phrases and words relating to two questions were identified: ‘Why did the participant attend the health check?’ and ‘What was the impact of the health check for this participant?’ These phrases and words were used by the researchers to create meaning units. The meaning units were then discussed by the researchers, condensed and used to create codes which were applied to the entire data set. Each of the codes was agreed upon by all three of the researchers after critical discussion and was given a description to ensure meaning was collectively agreed upon. Once the codes had been applied to all transcripts, the researchers had further discussions and arranged the codes into descriptive and meaningful categories. These were further discussed in relation to the research questions and were then used to create themes. The researchers have collectively spent several consecutive years conducting health checks at this event and drew on their experiences to aid in interpreting the data. The data analysis process was highly reflexive, with researchers coming together multiple times to discuss the latent meaning of the data.

To enhance trustworthiness, credibility was enhanced during the data analysis process using verbatim participant responses to exemplify the results, iterative development of the codes, repeated engagement with the data throughout the analytic process, and discussions among researchers regarding their interpretations. Dependability was maintained by using and reporting the systematic analytical process described by Erlingsson and Brysiewicz [12] to support methodological consistency. Consistent with Erlingsson and Brysiewicz’s approach to qualitative content analysis, differences in interpretation were explored through researcher reflection and discussion. Researchers also engaged in reflexive discussions to consider how their professional backgrounds and pre-understandings may have influenced interpretation. Coding decisions and theme development were continually checked against the original data to enhance confirmability. The transferability of the findings should be considered in relation to the unique context and design of the health promotion activity.

The authors confirm that generative artificial intelligence was not used in any part of the research phase, including in the writing for this publication.

3. Results

There were 60 verbal surveys conducted from a possible 784 participants at the health promotion activity in 2024 (response rate: 7.7%). The verbal surveys ranged in length from 1 min, 4 s to 24 min, 37 s (mean = 5 min, 58 s). The first question was optional and enabled participants to provide their age and location or postcode of residence. Of the 60 survey respondents, 40 provided their age. Participants had a mean age of 61.1 years (SD = 17.3), with ages ranging from 21 to 89 years. Participant location of residence was classified according to the Modified Monash Model [13]. Most participants resided in regional centres (29.2%) or small rural towns (33.3%). These results are shown in

Table 1. Remoteness classification of participants’ place of residence.

Remoteness Classification	n (%)
Metropolitan area	2 (4.2)
Regional centre	14 (29.2)
Large rural town	9 (18.8)
Medium rural town	6 (12.5)
Small rural town	16 (33.3)
Remote community	1 (2.1)

.

The remainder of verbal survey questions were answered by each participant (i.e., there was no missing data). Using the data collected through the surveys, three themes were created to represent the reasons men participated in the activity and its impact.

3.1. Factors That Encouraged Engagement and Built Trust

This theme highlights what initially attracted men to attend the health check: a sense of being welcomed and building legitimacy and trust. Regarding feeling welcomed, the men explained that having a relatable male presence at the front entrance who was welcoming passersby encouraged them to participate. Many men said this created some pressure to enter, but the decision was ultimately theirs.

“Old mate dragged us in…Yep, which is alright”.

Participant 14

“Well … a bloke stopped me and said–and he told me to come in”

Participant 18

Regarding building legitimacy, the consistent presence of health checks at the field days over several years helped strengthen the men’s trust in the program. Some participants mentioned that they had ‘been looking for you guys’. Consistency played an important role in establishing legitimacy and trust over time.

“So, I think this is important to be consistent. I always say about these sorts of events, you can’t come and do this one year and go, oh, it wasn’t a success… you can’t measure these things based on one year or two years, it, it’s really super important to be here year on year on year, offering the same thing if not more.”

Participant 4

Seeing the flurry of activity around the health promotion site and watching other men participate was also a motivating factor for engagement. The participants described this in relation to watching people come in and out of the health check site:

“Well, I’m sitting … right there, I’m watching everyone go in and I’m … what that is, I’ll go … and find out, and that’s what I did.”

Participant 15

Some entered as a group, which gave a sense of safety in numbers:

“Oh, someone said go in there and…oh it’s that easy, it is, get in here, righto…yeah so we all, there’s four, four of us, so we all did it, so yeah it’s good.”

Participant 12

Once engaged in the health check, several factors were identified that reinforced the feelings of legitimacy and trust in the program. Participants discussed how students created a happy, enthusiastic, and kind atmosphere, which promoted their feelings of comfort:

“Well, it was just, it was very friendly, it wasn’t invasive. She was obviously learning to do her craft which she did a really good job, and made you feel comfortable and you know it’s not an embarrassing thing to do. But I’m not the type of person that goes and puts myself out to go and get a medical appointment done.”

Participant 1

This theme demonstrates that the men’s participation was encouraged through personal invitations, social influence, and the visibility of the program. Positive interactions with students fostered trust, comfort, and ongoing engagement across the iterations of the program each year.

3.2. Meeting Multiple Needs

Participants identified four broad needs met by health promotion. Some believed health checks were important but did not regularly visit GPS. For them, health checks offered an unmet opportunity.

“I’m not a, I’m not a serial, you know a doctor or appointment maker, I’ve got to be nearly dying to go.”

Participant 2

The second category involved men who were engaged with health professionals but felt that the health check offered something additional in terms of empowering them to take an active role in their own health. One participant shared a compelling story about being previously told by health professionals that he needed to implement lifestyle changes, but not making those changes until they were reinforced by a conversation with a student during the health checks.

“…I was coming past here last year, I had the blood pressure, the weight and everything (checked)… I was on one of the highest blood pressure tablets and now I’m on one of the lowest. I feel so much better. I feel so happy… I can’t speak highly enough of the treatment here, I can’t praise it enough…it was because this [paramedic student] who spoke to me so nice, and I owe my life to this girl because she saved me.”

Participant 20

The reassurance provided by having a health check was identified as the third category of important needs met. It prompted the men to reflect on their health and whether they needed to make changes.

“But what you do is just gives–gives an indicator of where we might–might be situated in the–the health scale, and maybe go away, and I probably do need to have a look at that, or–or whatever, yeah.”

Participant 4

Finally, some participants discussed the impact of the health check on men’s comfort level in engaging in conversations about mental health.

“I think it’s a good thing, especially for the farmers, because I’m aware that they have a lot of loneliness and suicide, and a certain suicide rate, you know? Because they’ve been under the pump a lot … So I think this is a very good thing to have for them. And if you can help people like that, especially, that’s a bloody good thing to do”

Participant 13

These participants discussed the importance of health promotion activities for rural men and the notion that one conversation can have a wide-ranging impact on health.

“Even if it’s 1% of people, put them on the pathway to a more aware, or enlightened path of their health, that’s a win. You know any–any–any benefit–small benefit from here is magnified as you go forward”

Participant 7

Overall, this theme demonstrates how the health promotion activity effectively met the diverse needs of the participants, leading to physical, psychological, and societal benefits. The program provided accessible health assessment, reassurance, motivation for behaviour change, and opportunities to discuss important health concerns, including mental health.

3.3. Giving to Student Learning for the Future

In this theme, participants reflected on the importance of engaging in the health promotion activity to support student learning, driven by a desire to help others and, in some cases, motivated by personal connections to the healthcare industry.

“Yeah, nah, and then talking to the young lady, obviously starting to get her qualification as a paramedic, my mother’s a nurse, my wife’s a nurse… So I was like hey… here to help, stop, get a checkup.”

Participant 3

Reflecting on the health promotion activity, the participants felt that the volume of men who engaged in the activity was an important way for students to learn about having conversations about health.

“…I think in anything you do in life, you can read a book, and think you understand it, and all that, but how do I relate to different personalities, and different people in different health situations, so the only way to do that I would think–not being formally trained myself, would be to–to deal with … this is a great opportunity”

Participant 7

Participants also noted that experiential learning was seen as particularly important to allow students to develop skills related to mental health conversations.

“Yep, and–and they need to feel very capable, confident in asking those questions whether it’s where they get called out for anything, being able to recognise the mental health challenges that go behind some of the scenes that they arrive at yeah.”

Participant 5

In addition to learning technical and interpersonal skills, some participants emphasised the importance of gaining insight into rural life by directly interacting with people living in these areas.

“I think people need to get out in the country and see what’s out there. If they stay in the cities, they don’t–won’t experience or witness what’s happening in the country, and the country needs a lot more support”

Participant 6

This theme shows that men’s participation was also motivated by a desire to contribute to student learning, with participants recognising the value of authentic community interactions in developing students’ clinical, communication, and rural practice capabilities.

4. Discussion

Rural men experience higher rates of chronic disease and associated risk factors than their urban counterparts, contributing to poorer overall health outcomes [14]. Reduced engagement with health services has been linked to individual factors, such as stoicism and self-reliance, and structural barriers, including service availability, geographical distance, and limited transport options [15,16,17,18]. Previous research has demonstrated that health promotion initiatives can be effective when delivered in familiar, welcoming, and non-clinical environments. This study extends existing knowledge by exploring rural men’s perspectives on the motivations for participating in a student-led health promotion activity and the perceived impact of that participation.

The findings demonstrate that rural men were attracted to the health promotion activity through a combination of social, environmental, and relational factors. A welcoming and relatable male presence, visible activity around the site, and the participation of peers created a sense of comfort and social encouragement. Trust and legitimacy were reinforced through the program’s consistent annual presence, friendly interactions with students, and a respectful, non-threatening approach. Once engaged, participants described a range of benefits, including improved access to health information, reassurance about their health status, motivation for behaviour change, and opportunities to discuss mental health concerns. Participants also viewed their involvement as an opportunity to support the learning of future health professionals, demonstrating that engagement was underpinned not only by personal benefit but also by a desire to contribute to their community.

The importance of context was a key finding of this study. Participants consistently identified the agricultural field day setting as an environment that encouraged participation. The welcoming atmosphere, familiar surroundings, and opportunity to engage anonymously within large crowds reduced many of the barriers typically associated with seeking healthcare. Similar findings have been reported by Seaman et al. [3], who observed that men were often encouraged to participate in health checks by friends or family members. Our findings extend this work by highlighting the influence of group participation, with many men describing a “safety in numbers” effect that increased their willingness to engage. The consistent annual presence of the program further contributed to perceptions of legitimacy and trustworthiness described by the men. Over time, the activity has become a familiar and expected component of the field days, reinforcing its credibility and value. These findings are consistent with those of Bransgrove et al. [19], who demonstrated that male-focused health initiatives are most effective when they normalise health maintenance through social connection, familiarity, and non-judgmental engagement. Collectively, these findings reinforce the importance of embedding health promotion initiatives within existing community activities where participation feels natural, socially acceptable, and low-risk.

Our findings also highlight the broader impact of health promotion activities for rural men. Agricultural events provide a valuable opportunity to engage groups who may be less likely to access traditional healthcare services [3,20]. Participants in our study described how the health checks increased their awareness of health risks, improved their understanding of health issues, and prompted consideration of lifestyle changes or follow-up with health professionals. Importantly, the activity was viewed as a safe and trusted environment in which to discuss both physical and mental health concerns. Many valued the opportunity to seek reassurance about their health, reflect on their wellbeing, and practise health-related conversations in a supportive environment. This experience of connection, validation, and reassurance has been identified as an important outcome of community-based health promotion initiatives and may be particularly relevant for rural men who have limited opportunities to engage in conversations about health. The findings further support the notion that health promotion activities are most effective when they are “anchored” within broader community events, where the focus is not solely on health but on participation in a familiar and enjoyable activity [19,20].

The results of this study demonstrate that positioning the health promotion activity as part of a WIL program motivated engagement by providing the men with a safe and non-threatening environment. Students were perceived as approachable and less intimidating than qualified health professionals, which facilitated engagement with the men. This finding aligns with research suggesting that informal, person-centred environments are particularly effective for addressing health and wellbeing among rural men [21]. Previous research has shown that community members can feel psychologically safe, less judged, and more comfortable sharing personal experiences with students than with qualified health professionals [4,5]. This finding suggests that student-led health promotion activities may represent a unique model for engaging for rural men in health promotion.

Reciprocity is increasingly recognised as a critical factor in the sustainability of rural placements; however, community perspectives on this concept have received limited attention in the literature. The present findings demonstrate the reciprocity embedded in activities that have the dual focus of student education and rural men’s health promotion. Participation in the health promotion activity provided rural men with access to health information, opportunities for health monitoring, and a meaningful avenue through which they could contribute to the training of future health professionals. Men recognised the challenges associated with rural workforce shortages and were motivated to support students’ development through authentic community engagement. This motivation appeared to draw on a strong sense of community responsibility and giving back, qualities that are often associated with rural communities [22]. Such opportunities may be especially meaningful for older rural men, for whom contributing to their community can reinforce identity, purpose, and social connection during transitions such as retirement [23,24]. This reciprocal exchange, whereby students received rural health education and men received access to health promotion, and the ability to contribute to student learning created value for students and community members and contributed to positive perceptions of the program [24].

Limitations

This study provides preliminary evidence for the reasons men participate in a rural health promotion activity and the perceived benefits of engaging in a health promotion program run by undergraduate health students. Due to the unique nature of this health promotion program, the transferability of these findings should be considered in relation to the context of other similar programs and the local demography of participants. The findings of this study are representative of the men who participated in the verbal survey at this event and may have been impacted by selection bias due to voluntary participation. The results may also have been impacted by social desirability bias, whereby the men who engaged in the evaluation felt more inclined to reflect positively on the program. Although the verbal survey method enabled each survey to be completed quickly, it is possible some potential participants may have opted out of this research instead of waiting for a researcher to be available to talk to them. Considering the relatively small sample size and that this study was only able to recruit participants from one, time-limited agricultural event, future research is required to build on these results.

5. Conclusions

This study demonstrated the multifaceted motivations behind rural men’s participation in a student-led health promotion activity and the potential impact such engagement can have on their health. The findings highlight the importance of accessible, non-clinical, and socially supportive environments that foster trust and encourage meaningful health conversations, particularly those related to mental health. Participants valued the opportunity to contribute to student learning, often driven by a sense of community responsibility and personal connections to the healthcare field. These findings reinforce the potential value of embedding health promotion within familiar rural settings.