'You only care when it hurts' - men's engagement with their health: a qualitative interview study in Lower Austria

Compared with women, men have a lower life expectancy, engage more frequently in risky health behaviours, underuse preventive healthcare services, and are less likely to attend routine health checks or seek mental health support. Their low participation rates indicate they show less interest in health promotion. Existing literature on barriers and facilitators to men's participation in health promotion programmes focuses on older adults from English-speaking countries. The present study's aim was to identify the preferences, attitudes, and barriers related to participation in community-based health promotion among young and middle-aged men in Lower Austria.

We conducted a qualitative exploratory study using semi-structured interviews with 28 men aged from 15 to 29 or 45 to 65 years living or working in Lower Austria with a low to medium education level and little or no prior experience with health promotion programmes. Participants were recruited using a maximum-variation sampling strategy through conventional recruitment and opportunistic outreach in everyday settings. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.

Overall, men favoured health promotion offers that genuinely interested them, addressed a concrete need, offered a clear purpose and personal benefit, and used engaging formats and credible facilitators. When these conditions were unmet, participation was perceived as unnecessary or unappealing. In addition to lack of time, insufficient information about existing offers, and a low perceived need, traditional masculine gender norms emerged as a key barrier to health promotion programme participation, as participation, especially in mental health, was associated with weakness. Contrastingly, positive role models, gentle social pressure, and training alongside other men reduced hesitation and facilitated participation. Three groups of men emerged: self-organised, sceptical, and undecided but interested, the latter representing the greatest potential for engagement.

Men's health promotion offers should promote a clear purpose and personal benefit and use engaging formats with credible, relatable facilitators. Interventions and strategies must be co-designed to ensure men's genuine interest and address their concrete needs. Gender-responsive strategies should prioritise undecided men, embed programmes in familiar social contexts, emphasise well-being and quality of life rather than the triggering term health, and integrate mental health in a non-stigmatising way.