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SCHOOL OF NURSING AND MIDWIFERY 
COLLEGE OF HEALTH SCIENCES 
UNIVERSITY OF GHANA 
 
HEALTH - SEEKING BEHAVIOUR OF MEN LIVING WITH 
PROSTATE CANCER – A QUALITATIVE STUDY IN THE VOLTA 
REGION 
 
 
 
BY 
 
EMMANUEL KWAME DUMOR 
(10153341) 
 
 
 
 
THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, 
LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR 
THE AWARD OF MPHIL NURSING DEGREE 
 
 
 
 
OCTOBER, 2020
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DECLARATION 
 
 
  
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DEDICATION 
This thesis is dedicated to God, almighty for his grace, strength, and guidance. I also 
dedicate this work to my family without whom reaching this far will be a mirage and 
dream; especially my ever-loving mother Madam Akuworgah Ametor, my wife Cynthia 
Atiah, and my children for their support and strength. Finally, I dedicate this research 
work to all my friends especially all my childhood friends in Apekotuime in the Ketu 
South District in the Volta Region, Ghana for their motivation and encouragement. 
 
 
 
 
 
 
 
 
 
 
 
 
  
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ACKNOWLEDGEMENT 
My greatest gratitude goes to the omniscient and ever-living God, for his strength, 
protection, wisdom, and direction. I express my heartfelt gratitude to my supervisors Prof. 
Aziato Lydia, and Dr. Gideon Puplampu for your patience, guidance, assurance, direction, 
and readiness to get me refined. I say thank you very much. I will continue to be in-debted 
to you. My profound appreciation goes to the entire lecturers of the School of Nursing and 
Midwifery, University of Ghana for adequately equipping me with the necessary 
knowledge, skills, and confidence during the graduate study. Thank you to all my MPhil 
colleagues for sharing their love, thought, and encouragement during the period. I am 
grateful to the authorities of the Sogakope District Hospital and the entire staff especially 
the urology unit for permitting me to have the study conducted in their facility. My 
deepest appreciation goes to the men living with prostate cancer (PCa) for their acceptance 
to part take in the study, without their participation, this work would have not been 
successful. I say I am very grateful and may God, the everlasting father bless and showers 
his healing powers over you.  
 
 
 
 
 
  
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TABLE OF CONTENTS 
 
DECLARATION ................................................................................................................... i 
DEDICATION ...................................................................................................................... ii 
ACKNOWLEDGEMENT .................................................................................................. iii 
TABLE OF CONTENTS ..................................................................................................... iv 
LIST OF TABLE(S) ......................................................................................................... viii 
LIST OF FIGURES ............................................................................................................. ix 
ABSTRACTS ........................................................................................................................ x 
 
CHAPTER ONE ................................................................................................................... 1 
INTRODUCTION ................................................................................................................ 1 
1.1 Background ................................................................................................................. 1 
1.2 Problem Statement ...................................................................................................... 5 
1.3 Purpose of the Study .................................................................................................... 6 
1.4. Specific Objective ...................................................................................................... 6 
1.5 Research Questions ..................................................................................................... 7 
1.6 Significance of the Study ............................................................................................ 7 
1.7 Definition of Terms ..................................................................................................... 8 
 
CHAPTER TWO .................................................................................................................. 9 
LITERATURE REVIEW...................................................................................................... 9 
2.1 Justification of Models / Theoretical Frameworks of the Study ................................. 9 
2.2 Theoretical Framework:  Theory of Reasoned Action (TRA) .................................. 11 
2.2.1 The Overview of Health Seeking Behaviour of Men living with prostate cancer 
(PCa) ............................................................................................................................ 13 
2.2.2 Attitude of Men Living with PCa towards Health-Seeking Behaviour .............. 14 
2.2.2.1 Cognitive (Belief) Attitude of Men towards Health Seeking .......................... 24 
2.2.2.2 Affective (Emotion) Attitude of Men towards Health Seeking ....................... 26 
2.2.3 Subjective Norms that Influences the Health Seeking Behaviour of Men Living 
with PCA...................................................................................................................... 28 
2.2.4 Behavioural Intentions of men living with PCa toward Health Seeking 
Behaviour ..................................................................................................................... 32 
2.2.5 Behaviour of Men Living With PCa towards Health Seeking............................ 35 
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2.3 Summary of Literature Review ................................................................................. 41 
 
CHAPTER THREE ............................................................................................................. 43 
RESEARCH METHODOLOGY ........................................................................................ 43 
3.0 Introduction ............................................................................................................... 43 
3.1 Study Design ............................................................................................................. 43 
3.2 Research Setting ........................................................................................................ 44 
3.3 Target Population ...................................................................................................... 45 
3.3.1 Inclusion Criteria ................................................................................................ 46 
3.3.2 Exclusion Criteria ............................................................................................... 46 
3.4 Sample Size and Sampling Technique ...................................................................... 46 
3.5 Data Collection Tool ................................................................................................. 47 
3.6 Data Collection Procedure ......................................................................................... 47 
3.7 Piloting of the Interview Guide ................................................................................. 48 
3.8 Data Management ...................................................................................................... 48 
3.9 Data Analysis ............................................................................................................ 49 
3.10 Methodological Rigour (Trustworthiness) .............................................................. 50 
3.11 Ethical Considerations ............................................................................................. 53 
 
CHAPTER FOUR ............................................................................................................... 55 
FINDINGS OF THE STUDY ............................................................................................. 55 
4.0 Introduction ............................................................................................................... 55 
4.1 Description of the Study Population.......................................................................... 55 
4.2 Organization of the themes ........................................................................................ 56 
4.3 Attitude ...................................................................................................................... 57 
4.3.1 Cognitive Attitude (Beliefs)................................................................................ 58 
4.3.1.1 Ignorance of Early Signs and Symptoms ......................................................... 59 
4.3.1.2 Confusion ......................................................................................................... 60 
4.3.2 Affective Attitudes .............................................................................................. 61 
4.3.3 Behavioural Attitude ........................................................................................... 63 
4.4 Subjective Norms ...................................................................................................... 63 
4.4.1 Personal decision for treatment........................................................................... 64 
4.4.2 Financial Considerations..................................................................................... 65 
4.4.3 Counselling and Recommendations from others ................................................ 67 
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4.4.4 Motivation for Herbal Medication Usage ........................................................... 68 
4.5 Health-related factors influencing the intention to seek healthcare .......................... 71 
4.5.1 Healthcare Accessibility ..................................................................................... 72 
4.5.2 Effects of Clinical Manifestations ...................................................................... 73 
4.5.3 Professional Competencies ................................................................................. 74 
4.5.4 Maturity and Exposure........................................................................................ 75 
4.5.5 Cultural Factors................................................................................................... 76 
4.6 Behaviour Intentions ................................................................................................. 78 
4.6.1 Hope for Treatment ............................................................................................. 79 
4.6.2 Information Seeking ........................................................................................... 80 
4.7 Behaviour of men towards health seeking ................................................................ 81 
4.7.1 Personal Management ......................................................................................... 81 
4.7.2 Secrecy ................................................................................................................ 82 
4.7.3 Medication Adherence ........................................................................................ 84 
4.7.4 Combination of Treatment .................................................................................. 84 
4.8 Finding Summary ...................................................................................................... 86 
 
CHAPTER FIVE ................................................................................................................. 88 
DISCUSSION ..................................................................................................................... 88 
5.1 Demographic Characteristics of the participants ....................................................... 88 
5.2 Attitude of men Living PCa towards Health-Seeking Behaviour ............................. 90 
5.3 Subjective Norms Influencing the Health-Seeking Behaviour ................................. 95 
5.4 Health-related factors influencing the intention of men to seek healthcare .............. 99 
5.5 Behavioural intention of men living with PCa towards health seeking .................. 104 
5.6 Health Seeking Behaviour of Men living with PCa ................................................ 106 
5.7 Evaluation of the Theoretical Framework ............................................................... 108 
5.8 Conclusion ............................................................................................................... 111 
 
CHAPTER SIX ................................................................................................................. 112 
SUMMARY, IMPLICATIONS, LIMITATIONS, CONCLUSION AND 
RECOMMENDATIONS .................................................................................................. 112 
6.1 Summary of the Study ............................................................................................. 112 
6.2 Implications of the findings ..................................................................................... 113 
6.2.1 Nursing practice ................................................................................................ 113 
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6.2.2 Implication Nursing research ............................................................................ 114 
6.2.3 Implication on Nursing Policy .......................................................................... 114 
6.3 Limitations of the Study .......................................................................................... 115 
6.4 Conclusion ............................................................................................................... 115 
6.5 Recommendations ................................................................................................... 116 
6.5.1 Recommendation for Ministry of Health .......................................................... 116 
6.5.2 Recommendation for Ghana Health Service .................................................... 116 
6.5.3 Recommendation for Nursing & Midwifery Council of Ghana ....................... 117 
6.5.4 Recommendation for the Urology Departments ............................................... 117 
6.5.5 Recommendation for Complementary and Alternative Medicine Practitioners 
(CAM) ........................................................................................................................ 118 
6.5.6 Recommendation for the Multimedia Authority .............................................. 118 
 
REFERENCES .................................................................................................................. 119 
 
APPENDICES .................................................................................................................. 143 
Appendix A: Ethical Approval Letter ........................................................................... 143 
Appendix B: Introductory Letter ................................................................................... 144 
Appendix C:   Participant’s Information Sheet ............................................................. 145 
Appendix D: Consent Form .......................................................................................... 148 
Appendix E: Interview Guide ........................................................................................ 150 
 
  
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LIST OF TABLE(S) 
Table 4.1: Organization of Major Themes and Sub-themes ............................................... 57 
 
 
 
 
  
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LIST OF FIGURES 
Figure 2. 1:  Theory of Reasoned Action ............................................................................ 13 
Figure 3. 1: Map of Ghana showing South Tongu District ................................................. 45 
 
  
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ABSTRACTS 
Prostate cancer (PCa) is the most common male diagnosed cancer and the second leading 
cause of cancer death globally. The treatment involves huge financial commitments from 
patients and their families. In Ghana, there is a dearth of literature on the health-seeking 
behaviour of men living with PCa hence, the need for this study to explore the health-
seeking behaviour of men living with PCa in the Volta Region using the Theory of 
Reasoned Action as a guiding framework. An exploratory descriptive qualitative study 
design with a purposive sampling technique was employed to recruit ten (10) participants 
for the study. An in-depth interview was conducted using a semi-structured interview 
guide.  The interviews were audiotaped, transcribed, coded, and analyzed using thematic 
content analysis techniques.   Five major themes emerged: attitude, subjective norms, 
health-related factors, behavioural intention, and behaviour. The finding revealed that 
personal beliefs, emotions, and behaviour greatly influenced the participants' attitudes 
towards health-seeking. The participants sought interventions such as traditional, medical, 
and complementary therapies. Secrecy due to perceived negative judgment, ignorance, 
misinterpretation of the early clinical manifestation, and financial difficulties contributed 
to delayed health-seeking behaviour. Therefore, there is a need for more education on 
urological conditions especially PCa to promote early health-seeking behaviour.  
 
 
 
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CHAPTER ONE 
INTRODUCTION 
This chapter outlines the introduction, the problem statement of the research, the purpose 
of the study, the significance of the study, and research objectives.  It also contains 
research questions and an operational definition of some key terms. 
1.1 Background 
Cancer is one of the greatest public health challenges and has increased 
persistently over the years across the world (Vineis & Wild, 2014). Per the International 
Agency for Research on Cancer (IARC) estimation in 2018, over 18 million new cases of 
cancer are expected to be diagnosed with 9.5 million cancer deaths globally. This 
invariably accounted for nearly 1 out of every 8 deaths in the world (Bray et al., 2018). 
This global worrying concern of cancer is anticipated to surge with more than 27 million 
new cases, 75 million prevalent cases, and 17 million cancer death by 2030 (Adeloye et 
al., 2016). The burden of cancer imposes a lot of financial engagement and a drain on 
healthcare resources in the world. Approximately $88 to $124 billion is spent on cancer 
morbidity and premature mortality per year for medical costs only (Islami et al., 2018).  
Cancer affects all sexes but the most dominant among males is prostate cancer (PCa). 
Prostate cancer (PCa)  is the most common male diagnosed cancer and the second 
leading cause of cancer death in American men especially African Americans  (Badmus et 
al., 2010). It affects 1 in every 7 men in America (Sanda. et al., 2018) and mostly among 
the older population of 45 years and above (Bechis, 2011; Vickers, 2013). Globally, the 
rate of incidence varies widely with the developed nations leading the chart (Bray et al., 
2018). Prostate Cancer incidence is steadily on the rise and is estimated to triple by 2021 
(Quon, Loblaw, & Nam, 2011). It was also projected that 35% of men are more likely to 
be diagnosed with PCa than a woman is to be diagnosed with breast cancer globally (Amin 
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et al., 2014). Despite, this high incidence, there is also hope after treatment. The number of 
PCa survivors are equally steadily on the ascendency. There is almost 98.8% - 100%  5 
years to 10 years of survival rate after early diagnosis and treatment (Imm et al., 2017). 
This improvement can be ascribed to the advancement in the approaches to treatments as 
well as improvement in the healthcare system.  In 2015, almost 3 million PCa survivors 
were recorded in the united states alone and this number is anticipated to increase to 4 
million by 2024 (DeSantis et al., 2014; Imm et al., 2017).  
However, it is extremely cumbersome to accurately describe the burden of PCa in 
Africa as well as the sub-Sahara region. This difficulty stemmed from one main cause; 
issues of PCa is grossly underestimated and wrongly reported. This is because there is a 
lack of appropriate diagnosis, low quality of cancer data systems (Adeloye et al., 2016; 
Morhason-Bello et al., 2013), and a relatively low number of studies conducted on PCa in 
some parts of Africa (Adeloye et al., 2016). Despite the massive data inaccuracy, PCa is 
believed to be on the increase (Morhason-Bello et al., 2013; Ogunbiyi, 2011). In 2010, 
Sub-Sahara Africa alone has recorded about 69% increase in PCa rate representing a leap 
from 100,200 in 1990 to 219,700, and GLOBOCAN 2012 reports on the incidence of 
prostate cancer in Africa also indicated an increased rate of 23.2 (Adeloye et al., 2016).  
Prostate cancer and its treatment modalities expose men to several physical, 
psychological and psychosocial problems (De Sousa, Sonavane, & Mehta, 2012; 
Jayadevappa, Malkowicz, Chhatre, Johnson, & Gallo, 2012; Köhler et al., 2014; Levy & 
Cartwright, 2015a).  Men with advance prostate cancer are faced with increasing physical 
aberrations in their normal body functions such as pain, fatigue, decreased mobility, 
nausea, constipation, scrotal oedema, urinary frequency and urinary retention, osteoporosis 
with increased risks for fracture, anaemia, weight gain, muscle mass loss, loss of sexual 
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desire and erectile dysfunction (Ahmadzadehfar et al., 2016; De Sousa et al., 2012; Gavin 
et al., 2015; Levy & Cartwright, 2015a; Mohler et al., 2010) 
Again, depending on the treatment type or regimen, these males experience side 
effects of bodily deterioration challenges as hot flushes, loss of libido, erectile dysfunction, 
gynecomastia, weight gain, female distribution of fat, loss of body hair, decreased vitality, 
and mood disturbances (Gavin et al., 2015; Mohler et al., 2010). Studies have indicated 
that these side effects contribute significantly to impotency or sexual dysfunction in men 
which adversely disrupt interpersonal relationships between the patients and their spouses. 
These males consequently fear and doubt their chances of regaining their abilities to fulfil 
their roles as husbands again (Chung & Brock, 2013; Ervik & Asplund, 2012)  
Aside from the physical manifestations, men with PCa or on PCa treatment 
experiences various types of emotional distress such as depression, anxiety, unmet needs, 
and poor quality of life along the course of their cancer journey (Jayadevappa et al., 2012; 
Köhler et al., 2014; Watts et al., 2014). They experience an increased level of depression 
and anxiety due to erectile dysfunction (ED), high treatment cost, increased use of health 
care services, and mortality among men with PCa in the follow-up periods (Ettridge et al., 
2018; Fish, Prichard, Ettridge, Grunfeld, & Wilson, 2015; Medina-Perucha, Yousaf, 
Hunter, & Grunfeld, 2017).  
 Other studies confirmed that they failed to maintain intimacy because of the mood 
disturbances, low self-esteem, or fear of rejection that originated from cancer experiences 
(Bamidele, Lagan, McGarvey, Wittmann, & McCaughan, 2019; Chambers, Chung, 
Wittert, & Hyde, 2017). Even women whose partners are faced with new (or renewed) 
threat from PCa or treatment side effects are vulnerable to emotional stress and sexual 
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dissatisfaction (Galbraith, Fink, & Wilkins, 2011). To mitigate these frustrating effects of 
PCa, men and their partners seek treatment.  
It is believed that the most effective solution to PCa and its associated challenges is 
early detection and treatment (Nakandi et al., 2013a). There are many disease treatment 
outlets in Africa. In Ghana, there are different prostate cancer treatment modalities such as 
medical treatment including surgical intervention, radiotherapy, hormone therapy, 
chemotherapy (Keavey & Thompson, 2018; Yeboah et al., 2016). The non – medical 
treatment includes herbal treatment and watchful waiting (Kyei, Klufio, Ayamba, & 
Mohammed, 2017). Yet, literature carries it that in Sub-Sahara Africa and particularly 
Ghana, most of the men living with PCa report to the hospitals lately for treatment, and at 
the state where the disease advanced and metastasized to other surrounding vital organs 
rendering treatment extremely difficult (Asamoah et al., 2018). The reason for the delay in 
the treatment-seeking or hospital attendance is attributed to varied opinions.  
Per my candid understanding, these people resorted to allopathic means of 
treatment after the complementary and alternative treatment failed to provide the desired 
results or therapeutic effects. Again, studies have confirmed that most of these men deny 
the diagnosis of prostate cancer due to the hidden nature of the prostate gland and or due 
to a complete lack of knowledge and proper appreciation of early obvious physical and 
noticeable clinical manifestations (Ettridge et al., 2018). In the local parlance, there is an 
adage that “he who cries for help that is helped” but this is a scarce commodity in the 
domain of men. Men are generally unwilling to seek help when experiencing problems in 
life especially with issues bordering on masculinity as PCa. Men are always confronted 
with many healthcare-seeking challenges such as cultural beliefs, ignorance of clinical 
manifestation, and over-reliance on complementary and alternative treatment (Chawatama, 
2017; Gyamenah, 2015),  
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Finally, as perceptions and knowledge of PCa in Africa and Ghana especially are 
unclear and limited, men are largely handicapped in their quest in healthcare information 
seeking. As a result, men exhibit poor attitudes towards help‐seeking for both health and 
psychological problems. Furthermore, men consider healthcare seeking in prostate cancer 
as unnecessary exposure of their sexual weakness, privacy as well as a reduction in the 
masculinity (Torres, Thorn, Kapoor, & DeMonte, 2017; Zanchetta et al., 2017). Many men 
rely heavily on their spouses for practical, emotional, and medical support, and prefer to 
have their health decisions made with their urologists (Aning, Wassersug, & Goldenberg, 
2012; Bamidele et al., 2019; Barbara Joyce Davison & Breckon, 2012). Hence, the study 
to explore the health-seeking behaviour of men with prostate cancer. 
This study will adopt a psychological behaviour change model (Theory of Reasoned 
Action) developed by Ajzen, & Fishbein (1980) to predict and explain health-related 
behaviour as the theoretical framework to guide the study.   
1.2 Problem Statement 
Prostate cancer (PCa) is hidden cancer in men (Ettridge et al., 2018), and the 
second leading cause of death among men globally. Although the incidence rates of 
prostate cancer in Africa are on the increase, the data is unclear, limited, and 
disproportionate among the Africa countries compared to the advanced countries (Adeloye 
et al., 2016; Chu et al., 2011). Among the West African countries, prostate cancer is rare 
in Togo while the second leading cancer death among Ghana men (Badmus et al., 2010). 
According to the Ministry of Health, National Strategy for Cancer Control, (2012 – 2016), 
prostate cancer is placed second in Ghana with an incidence rate of more than 200 cases 
per 100,000 of the population per year after liver cancer (MoH, 2016).  
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Despite the high morbidity, literature indicated that most of the men with PCa 
delay in reporting to the hospital for treatment (Asamoah et al., 2018). The decision 
regarding early healthcare-seeking is preceded and influenced by several factors such as 
availability of alternative means of treatment (Mbonu, 2014), individual expectations, 
professional characteristics, community/family norms (Oberoi, Chaudhary, Patnaik, & 
Singh, 2016), and cost of treatment (Ajayi & Arigbede, 2012; Liew, 2018) 
Several studies were done on PCa but most of these studies focus on the disease 
progression, effects on the patient and the partners (Dowrick, Wootten, & Botti, 2018; 
Keen, 2016), early detection and treatment (Davison & Breckon, 2012), and quality of life 
after surgical treatment (Asante, 2012). Very little work was done in the area of the health-
seeking behaviour of patients. Moreover, most of these studies were done using a 
quantitative approach without paying much attention to the individual sentiment attach to 
this crucial decision-making process that precedes and influences the choice of treatment 
option. This study, therefore, seeks to determine the health-seeking behaviour of men 
living with prostate cancer using a qualitative approach. 
1.3 Purpose of the Study 
The purpose of this study is to explore the health-seeking behaviour of men living with 
PCa in the Volta region in Ghana.  
1.4. Specific Objective 
The following are the objectives of the study: 
a. To describe the attitude of men living with PCa toward health-seeking in the Volta 
region 
b. To identify the subjective norms that influence the health-seeking behaviour of men 
living with PCa in the Volta region 
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c. To describe the behavioural intentions of men living with PCa toward health-
seeking in the Volta region 
d. To describe the behaviour of men living with PCa toward health-seeking in the 
Volta region. 
1.5 Research Questions 
Qualitative analysis of the study in chapter 3 will address the following questions:  
• What are the attitudes of men living with PCa toward health-seeking? 
• What are the subjective norms influencing the health-seeking behaviour of men 
living with PCa? 
• What are the behavioural intentions of men living with PCa toward health-seeking? 
• How is the behaviour of men living with PCa towards health seeking? 
1.6 Significance of the Study 
The findings of this study describes the health-seeking behaviour of men living 
with prostate cancer. Also, it helps the policymakers and stakeholders to appreciate the 
contributive factors to the men’s delayed health-seeking behaviour in Pca treatment. 
Again, it adds to the existing literature on the health-seeking behaviour of men living with 
prostate cancer and stimulates further studies in this area.  It makes a significant 
contribution to the body of knowledge in nursing and midwifery education, research, and 
practice. Furthermore, it provides a source of reference for health care practitioners on 
PCa issues.  Finally, it provides information for policy formulation to involve the patient’s 
social networks in the management process. 
  
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1.7 Definition of Terms   
Prostate Cancer: Cancer that occurs in the prostate. 
Health: It is a state of complete physical, mental, and social well-being and not merely the 
absence of disease or infirmity. 
Health Seeking Behaviour: Any action undertaken by individuals who perceive 
themselves to have a health problem or to be ill to find an appropriate remedy 
Attitude: It is the way people or an individual feel towards performing a particular 
behaviour. 
Subjective Norms: These are perceptions or views of what significant others think about 
the behaviour in question.  
Intention: A person's mental preparedness and readiness to perform a given behaviour. 
Behaviour: Any action undertaken by individuals who perceive themselves to have a 
health problem for finding an appropriate remedy. 
 
 
  
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CHAPTER TWO 
LITERATURE REVIEW 
This chapter was discussed under two sections; the literature review and the 
theoretical framework. The literature review section focused on the literature related to the 
research topic. It started with the search for the formation of relevant health-related and 
nursing information regarding the topic. The literature sources  included books, 
dissertations, and online databases, such as the Cumulative Index of Nursing and Allied 
Health Literature (CINAHL), Medical Literature On-Line (Medline), Academic Search 
Complete, and Science Direct. Other databases used for the review were EBSCOhost 
Discovery, the Web of Science database, and Google Scholar. Both offered scholarly 
literature from different fields, including Nursing and Health. The key terms used for the 
search were: “Attitude”, “Character” “Subjective Norms”, “Intention”, and “Health – 
Seeking Behaviour”, “Help-Seeking Behaviour”, “Care-Seeking Behaviour”, and 
Wellness Seeking Behaviour  
The literature review is organized under the following headings; (a) the overview 
of health-seeking behaviour of men (b) attitude of men with PCa toward health-seeking (c) 
subjective norms influencing health-seeking behaviour of men with PCa (d)  behavioural 
intention of men with PCa towards health-seeking and (e) health-seeking behaviour of 
men with PCa. 
2.1 Justification of Models / Theoretical Frameworks of the Study 
The use of psychological, social, and behavioural science theory/model provided 
the grounds for understanding human behaviour relevant to public health interventions. 
Several behavioural models or theories guide to explain and predict health behaviour. 
Some of these models are the Health Belief Model (HBM) by Janz and Becker (1984), the 
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Rational Choice Theory by Becker (1992), and the Transtheoretical Model/Stages of 
Change (TTM) by Norcross, Krebs, and Prochaska (2011).   
The first model reviewed was the Health Belief Model (HBM). It was developed 
by social scientists in the United States of America in the 1950s. The theory was derived 
from psychological and behavioural theory which has its root from the two components of 
health-related behaviour such as the desire to avoid illness, and the belief that a specific 
health action will prevent, or cure illness. The health belief model (HBM) was developed 
to assess the failure of people to adopt disease prevention strategies or screening tests for 
the early detection of disease. It was later used to explore the patient’s symptoms 
appraisal, responses to symptoms, and compliance with medical treatments. It has six (6) 
constructs namely perceived susceptibility, perceived severity, perceived benefits, 
perceived barriers, cue to action, and self-efficacy. 
Although the Health Belief Model holds the same assumptions as the Theory of 
Reason Action, it failed to account for the person's attitudes, beliefs, or other individual 
determinants that influence a person's health decision. It also did not take into 
consideration the behaviour that is displayed for non-health-related reasons such as social 
acceptability, and had low predictive abilities. Hence, the health belief model could not be 
used as the organizing framework to structure the study.  
The second theory/model considered was the Rational Choice Theory developed 
by Gary Stanley Becker (1992). The Rational Choice Theory states that an individual’s 
action or behaviour is based on a chosen course of action which is most in tandem with 
personal preferences. Rational Choice Theory is used to shape the individual decision-
making process especially in the context of microeconomics. It best helps to understand 
and explains societal choices based on their preferences. But patients’ decision to seek 
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healthcare is not solely dependent on their preferences. Patients were often locked up in a 
dilemma regarding treatment options unless sanctioned and supported by significant 
others.  Hence, the Rational Choice Theory could also not be used to explore and explain 
the health-seeking behaviour of men living with prostate cancer.  
The Transtheoretical Model (TTM) focuses on people’s motivations to change. It 
proposes that people are always at different stages of readiness to adopt healthy behaviour. 
The differences in the stages of people’s readiness to change explains and predicts the 
varieties in people’s behaviour. It has five (5) distinct but interrelated stages namely pre-
contemplation, contemplation, preparation, action; and maintenance. However, the stages 
lacked detailed description and consistencies of how complex situations such as physical 
behavioural health changes occur across health behaviour or spectrum. It again failed to 
outline the determinants of a behaviour change. The Transtheoretical Model did not also 
give credence to the effect of social context in determining and influencing behaviour. 
Therefore, the Transtheoretical Model could also not be use as the organizing framework 
for the study. 
After exploring all these models / theoretical frameworks, the researcher settled on 
the psychological, behavioural, and social science theoretical framework called the Theory 
of Reasoned Action. 
2.2 Theoretical Framework:  Theory of Reasoned Action (TRA) 
The Theory of Reasoned Action propounded by Ajzen and Fishbein, (1980) was used to 
structure the work. This theory resulted from the attempt to explain and estimate the 
discrepancy between attitude and behaviour. Ajzen and Fishbein, (1980) developed  and 
validated this theory from the previous researches using social psychology persuasion 
model and attitude model. This theory is rated among the effective models in predicting 
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human behaviour and  has been used globally to measure, estimate and explain human 
behaviour in many spheres of life. The Theory of Reasoned Action (TRA) has four 
constructs: attitude, subjective norms, intention, and behaviour (see figure 2.1). In this 
study, it explained the health seeking behaviour of men livng with prostate cancer. The 
theory presumed that the best predictor of a person’s behaviour in any situation is the 
intention to perform the behaviour. Ajzen and Fishbein, (1980) stated that a person's 
behaviour is determined by his intention to perform the behaviour and this intention is, in 
turn, a function of his attitude toward the behaviour and his subjective norm. According to 
the authors, intention is the cognitive representation of a person's readiness to perform a 
given behaviour. The Theory of Reasoned Action (TRA) further suggested that attitude 
and subjective norms are two major factors that influence human intention to engage in a 
behaviour. Attitude is an evaluation of an object of thought which can be anything a 
person may hold in mind, ranging from the mundane to the abstract, including things, 
people, groups, and ideas. Subjective norms on the other hand is defined as the perceived 
social pressure to perform or not to perform a particular behaviour. It is a combination of 
perceived expectations of important others and motivations to comply with those 
expectations.  As such, a person’s decision to engage in a particular behaviour is enforced 
and motivated by the persons’s  awareness of the potential outcome and /or the action will 
be sanctioned by others or is expected of him by friends and relatives. However, these 
attitudes and subjective norms varied greatly from one person to another and also exert a 
different level of influence on the intention to perform a behaviour at different times. 
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Figure 2. 1:  Theory of Reasoned Action 
 
2.2.1 The Overview of Health Seeking Behaviour of Men living with prostate cancer 
(PCa) 
Health-seeking behaviour is explained as how individuals monitor their bodies, 
define and interpret their symptoms, take remedial action, and utilize other sources of 
help, as well as engage with the more formal healthcare system (Anwar, Green, & Norris, 
2012). It also describes actions taken by an individual, group of people, or a community in 
a bid to prevent, minimize or cure a disease condition as well as maintain good health 
(Adongo & Asaarik, 2018). Many factors contributed to the health-seeking behaviour of 
men. According to the health belief model, men’s response to a health situation is 
determined by two factors; the degree to which the individual perceives the situation as 
threatening, and /or the extent an individual can effectively reduce the anticipated negative 
results of the situation based on the resources available (Glanz & Bishop, 2010).  
Several studies have confirmed the challenges and difficulties associated with 
men’s health-seeking behaviour (Odaman & Ibiezugbe, 2014; Tong, Low, & Ng, 2011). 
Most notable of these factors are the men’s attitudes (Samal, 2016; Uddin, Hossin, 
Mahbub, & Hossain, 2012; Xu, Dailey, Eggly, Neale, & Schwartz, 2011) and subjective 
norms that inform their intention to engage in a behaviour (Jung, 2014).   
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2.2.2 Attitude of Men Living with PCa towards Health-Seeking Behaviour 
The attitude of an individual towards a behaviour is a predisposition and an overall 
evaluation of the outcome of the behaviour which determines either to respond positively 
or negatively to the specific stimuli (Fabrigar & Wegener, 2010). According to Coban, 
Kiırca, and Yurttaş (2015), attitude is a positive or negative pre-tendency to a reaction 
that cannot be observed directly, related to an object, situation, or feelings toward 
individuals. It changes from a person to another and serves as a guide to a person. Attitude 
plays a defining role in men’s decision-making regarding health.  Attitude helps to define 
identity, how people perceive issues, processes complex information, guides actions and 
consequences, determine what people consider relevant, good, and appropriate as well as 
influences judgments of people or situations (Howe & Krosnick, 2017; McCormick & 
Meekan, 2010; Pareek, Batra, Kalia, & Sethi, 2015).  
A positive attitude demonstrates a mental outlook of optimism and expectation of 
good fortune (Frijters, Liu, & Meng, 2012). According to Tornikoski and Maalaoui 
(2019), a positive attitude increases the possibilities of behavioural intention. Yeboah-
Asiamah, Yirenya-Tawiah, Baafi, Ackumey (2017) noted that men with adequate 
knowledge of PCa are always zealous to undertake the PCa screening. Negative attitudes 
on the other hand influence negative thoughts, ignore the good, and focus on the worse 
circumstances as such vulnerability (Clement et al., 2015). 
The level of vulnerability results in negative consequences such as labeling and 
unwanted disclosure such as public stigma. The examples of public stigma are social 
judgment and rejection, employment discrimination, shame/embarrassment, and family 
stigma. Prevention of these public stigma caused men to mask their symptoms, and 
deferred health-seeking. Teo, Ng, Booth, and White (2016) and Seidler et al (2016) 
claimed that men exhibit these poor attitudes by avoiding and denying illness, seeking 
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health only when the disease is severe, not trusting the doctor or health system, and fear of 
getting the disease and/or its consequences.  The men also become sceptical of the benefits 
of treatment processes, and believing that illness can heal naturally. Furthermore, they 
display negative attitudes such as laziness, procrastination, or forgetfulness of the illness. 
Avoidance is adopted as a coping mechanism where men encounter situations that 
they have limited control to effectively change the outcome. Ayers et al (2014) defined 
avoidance as a deliberate turning away from unpleasant emotions, thoughts, sensations, 
and situations as a result of unbearable negative internal states.  A qualitative study by 
Spendelow, Joubert, Lee, and Fairhurst (2018) asserted that avoidance protects and assists 
men to escape psychologically stressful situations as PCa and its consequences. Men 
diagnosed with PCa battle with many psychologically challenging and stressful events. 
They experience unpleasant emotions such as shock, disbelief, anxiety, depression, fear, 
grief, feelings of uncertainty about the future, fear of cancer metastasizing and death or 
dying, and a loss of control (De Sousa et al., 2012; Hyde et al., 2017; Jayadevappa et al., 
2012; Watts et al., 2014).   
Consequently, men avoid and deny the existence of PCa on the grounds of no 
physical growth, and even in the face of obvious clinical manifestations, men deliberately 
and wrongly appreciate the clinical manifestations (Idris, Hassan, & Sofian, 2019; 
Nakandi et al., 2013a). Men deny these diagnoses of PCa to temporally escape and isolate 
themselves from the physical and psychological impact associated with the disease. 
Persoskie, Ferrer, and Klein (2014) most importantly noted male gender, low income, low 
education, younger age, and not having health insurance as the main indicators of 
healthcare-seeking avoidance among men aged 50 and above. The study further stated that 
cancer worries are much more problematic to men aged 50 and above and contributed 
significantly to avoidance of the perceived cancer risks. 
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In the literature, a bulk of studies were conducted on factors influencing the 
attitude of men towards healthcare seeking. These factors include cultural beliefs, patient's 
age, personal experiences, knowledge, educational level, economic (financial) conditions, 
media, physical factors, and disease pattern (Adongo & Asaarik, 2018; Ukwaja, Alobu, 
Nweke, & Onyenwe, 2013; Yeboah-Asiamah et al., 2017). According to Singer et al 
(2016), cultural values and beliefs are the significant determinants of most of human 
attitudes and characteristics.  Cultural beliefs constitute the fundamental elements that 
modelled a person’s attitude and influenced the person responses to the condition. Cultural 
beliefs and practices contributed to how an individual responds, views, and appraises an 
impending condition and determines the intervention preferences be it orthodox care or 
traditional medicine (Yew & Noor, 2013).  
Although, culture is most frequently operationalized to mean race/ethnicity or a 
particular type of belief system of people and social determinants of health, it influences 
the health behaviour and health outcomes of an individual or a society (Singer et al., 
2016). In a participant-observation and in-depth interviews study in Bangladesh, patients 
were ever determined to settle for any specialized care that respects and takes into 
consideration their cultural variations (Rahman, Kielmann, McPake, & Normand, 2012). 
Similarly, findings from a study in Ghana, indicated that people’s belief system drives 
their passions and minds towards a treatment modality which is in harmony with their 
culture, religion, and spirituality (Gyasi et al., 2016).  
Again, culture is considered as a presumed explanatory variable for differences and 
disparities in the human health outcomes hardly attributable to other factors such as 
attitudes of men in healthcare-seeking (Singer et al., 2016).  Studies committed to the 
attitudes of men with PCa in healthcare-seeking indicated that men generally exhibit poor 
attitude towards healthcare seeking for both physical health and psychological problems 
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(Nakandi et al., 2013b; Quillin et al., 2018; Seidler et al., 2016; Teo et al., 2016; 
Thompson et al., 2016). A retrospective and matched case-control study in Jamaica 
affirmed that men refused treatment because their culture opposed the treatment process of 
digital examination (Dotson, Howard, Aung, Keenan, & Jolly, 2015). 
Another area of great impact on men’s attitude toward healthcare-seeking 
behaviour is their mentality and perception of masculinity. The male gender is 
traditionally perceived as superior and dominant in all contexts (Harvey & Alston, 2011; 
Olanrewaju et al., 2019). A qualitative study conducted among two groups of working-
class men opined that males considered themselves to be physically and emotionally 
stronger (Dolan, 2011; McAteer & Gillanders, 2019). Socio culturally, men are strictly 
forbidden to complain and outcry their pain as well as seeking health care. The men are 
appreciated and cherished for the endurance of pain, anguish, and frustration (Moore, 
Grime, Campbell, & Richardson, 2013). Men conformed to the belief of masculinity of 
being stronger and resilient to defer, delay, or refuse treatment-seeking (McAteer & 
Gillanders, 2019; Olanrewaju et al., 2019).  
Furthermore, health-seeking behaviour poses a great challenge to men especially 
when the situation affects masculinity as PCa (Zanchetta et al., 2017). Men perceive 
health-seeking in issues involving the reproductive system as means of unnecessary 
exposure of their sexual weakness or reduction in their masculinity (Marcos, Avilés, Del 
Río Lozano, Cuadros, & Del Mar García Calvente, 2015; Torres et al., 2017; Zanchetta et 
al., 2017).  Coupled with this, men harboured some ill-feeling against being treated by 
female health professionals whom they considered the “weaker sex” when they are sick 
and require medical attention (Moore et al., 2013; Olanrewaju et al., 2019). Moreover, 
some cultural norms prevent men from discussing certain pertinent issues with women. 
Therefore, men’s frequent visits to the hospital are impeded by these cultural norms in 
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circumstances where all the health professionals are women (Olanrewaju et al., 2019). 
However, in Kenya, a study was done to explore the patients and family’s perception 
towards PCa diagnosis. The finding noted that patients and families believed that PCa is 
caused by genetic factors. Therefore, it must be treated by medical professionals 
(Kirungia, 2019) 
Another factor of concern that influences the attitude of men is age. Age indicates 
the state and the reasoning capacity of an individual (Ukwaja et al., 2013). It also 
communicates the extent and level of autonomy, and significantly influences the decision-
making process regarding treatment choices (Chima, 2015; Barbara Joyce Davison & 
Breckon, 2012). However, the attitudes of men differ according to their ages because of 
healthcare-seeking behaviour (Kamate et al., 2010). Men of 60 years and below play an 
active role in the decisions regarding their treatment while men of 70 years and above 
engage in passive roles (Davison & Breckon, 2012). Meanwhile, a study in eThekwini 
Metropolitan Municipality and KwaZulu -Natal Province in South Africa indicated that 
older patients correctly respond to inform consents. They sought further information from 
reliable sources to inform their treatment decision making while young patients rely on the 
decisions of the surrogates (Chima, 2015). 
 Several studies identified patient’s age as one of the influential factors of attitude 
towards healthcare-seeking (Chima, 2015; Omotoso, 2010; Samal, 2016; Xu et al., 2011). 
The age of men affords them the autonomy, right and power to decide on when, where to 
obtain healthcare, and choose the age-related appropriate treatment options (Zhang et al., 
2015). A qualitative study in metropolitan Detroit, Michigan, verified the young men’s 
decision for rejecting watchful waiting PCa treatment options for surgical intervention. 
The finding concluded that watchful waiting intervention is best for the elderly (Xu et al., 
2011). Similarly, a study on attitude regarding advanced care planning and healthcare 
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autonomy among older Chinese men asserted that older men prefer to plan their health 
with health professionals and/or have total control over decisions on their healthcare 
(Zhang et al., 2015). 
Again, the factor of crucial influence on the attitude of men towards healthcare-
seeking worth considering is the patient’s educational level. The patient’s educational 
level explains the highest grade attained in academia (Zhao & Glewwe, 2010) and how 
enlightened a person had become in the event of a situation.  Education is widely accepted 
as a fundamental resource for individuals (Gutmann & Ben-Porath, 2014). According to 
McCoy et al (2011), education prepares individuals adequately to decide on intervention 
seeking and health promotion. It again improves an individual’s ability in appraising 
health situations and influences the healthcare utilization or choice of treatment modalities 
(Sørensen et al., 2012; Zhao & Glewwe, 2010).  
The effects of education on attitude towards healthcare seeking among men have 
been captured among studies (Leventhal Howard, Halm, Horowitz, Leventhal, & 
Ozakinci, 2015; Omotoso, 2010; N. Zhang et al., 2015). Education influences the 
decision-making process regarding health service utilization (Joseph-Williams, Elwyn, & 
Edwards, 2014). A systematic review by Joseph-Williams, Elwyn, & Edwards,(2014) 
asserted that patients who are well informed of both the therapeutic and side effects of the 
treatment options make quick decisions regarding health care service utilization, get 
prepared and well-conditioned to undergo a treatment type. However, well-educated 
individuals with strong financial stands perceive themselves as too busy (Hvidberg, Wulff, 
Pedersen, & Vedsted, 2015), and therefore, perceive visitation to the healthcare 
professionals for treatment as time-wasting (Williamson, Ramirez, & Wingfield, 2015).    
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According to Zhang et al (2015), men with higher educational levels and have 
much knowledge of their conditions preferred to enroll for early treatment than those 
counterparts of less educational level. Also in a cross-sectional survey in the Lower and 
Upper Myanmar posited that men with lower educational level skip treatment as against 
their counterparts of middle and higher educational status (Moe Dr., Tha, Naing, & Htike, 
2012). Meanwhile, less educated people than the educated elites believed that most cancer 
treatments are worse than cancer disease itself (Hvidberg et al., 2015). Some men rely 
heavily on the instructions and suggestions of the health care professionals because they 
have inadequate knowledge of the condition (Joseph-Williams et al., 2014). Again, a 
qualitative systematic review indicated that inadequate education and information 
regarding prognosis, treatment options, and severity of side effects generate uncertainty, 
fear, and panic among patients. This demotivates men toward healthcare-seeking (King et 
al., 2015) 
Another factor that enhances men’s health-seeking behaviour is their knowledge of 
the condition. In Zimbabwe, a study was done on men’s knowledge about PCa in 
Mhondoro Ngezi, Kadoma District. The finding indicated that the knowledge level of PCa 
was low. Only 21% of the participants who had some level of education or higher 
education heard of the condition (Moyo, 2017). Another study noted that men have faint 
or no knowledge of PCa because the prostate gland is notoriously hidden (Munatswa, 
2014). However, those men with little knowledge heard the information from different 
sources. These sources include friends, family, teachers, and newspapers/magazines, 
healthcare providers, radio, and television (Moyo, 2017; Olapade-Olaopa et al., 2014a). 
According to Chataut, Pandey, and Rao (2015), ignorance or inadequate knowledge of the 
clinical manifestation of PCa result in delayed healthcare-seeking behaviour. 
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Furthermore, the socioeconomic status of an individual contributes immensely to 
influencing the attitude of men in decisions regarding healthcare utilization. According to 
Pampel et al (2010), socioeconomic status explains the social position and the financial 
standing of the individual. Chan et al (2018) found that due to the high cost of treatment, 
most patients avoid health screening, and ignore the clinical manifestations of conditions. 
According to Sato (2012), people with higher income access healthcare services at the 
modern healthcare facilities while their counterparts with low-income access healthcare at 
the traditional care centres or postponed healthcare seeking.  
Also, many studies on the attitude of men in healthcare-seeking resort to the 
influence of men’s economic status (Musoke, Boynton, Butler, & Musoke, 2014; Van Der 
Hoeven, Kruger, & Greeff, 2012). The patients who are financially sound report for 
treatment with every ailment while patients who have financial constraints always skip 
treatment for some ailments. The poor only seek treatment when the condition is 
considered serious (Idris et al., 2019). Griffith et al (2011) stated that the cost of healthcare 
and lack of health insurance served as barriers to healthcare seeking among black men. A 
study among Bhutanese Refugees revealed that participants with less financial strength 
sought financial assistance from their family members, neighbours, nonprofit or 
governmental organizations in and outside their community (Yun et al., 2016)  
The role of media is another factor worth considering in this discussion. It is a tool 
used to convey information to the public (Jung, 2014), and it provides timely and credible 
health information to the public (Picazo-Vela, Gutiérrez-Martínez, & Luna-Reyes, 2012). 
Media influences the attitudes of men and contributes massively to the decision-making 
process of men relative to healthcare seeking behaviour. There are different forms of 
media namely print media; newspapers, magazines, and other types of publications 
(Wikström & Ellonen, 2012), broadcast media such as radio and television (Clayman, 
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Manganello, Viswanath, Hesse, & Arora, 2010), and digital media including Internet blogs 
and websites (Howard & Hussain, 2011). 
The media programmes, and the manner of presentations shape viewers 
understanding of reality (Livingstone, 2013). Media especially radio and television, 
account for the spread of the majority of all health-related issues on men and hence, 
positively influenced healthcare service utilization (Acharya, Khanal, Singh, Adhikari, & 
Gautam, 2015; Jung, 2014; Zanchetta et al., 2017). A study on the determinants of health 
information-seeking behaviour indicated that media advocacy leads to improvement in 
people healthcare management skills and medical compliance (Jung, 2014). Also, it 
increases the awareness, knowledge, and belief in the effectiveness of the get healthy 
service (O’Hara, Bauman, & Phongsavan, 2012). However, some perceived information 
by mass media as misleading as it misconstrues the real-world experiences (Keogh, 2015). 
A media content analysis to explore the newspaper reportage on men’s health noted that 
some media advocacy deprive men of knowledge that would improve their health 
decisions and practice (Cooke, 2017; Zanchetta et al., 2017) 
Another factor that inluences the attitude of men towards healthcare-seeking 
behaviour is the severity of symptoms. Several studies have been directed to the influence 
of symptoms on men’s healthcare-seeking behaviour (Emery et al., 2013; Jones et al., 
2014; Salmon, Clark, McGrath, & Fisher, 2015). The symptoms of cancer experienced by 
men include pain, dyspnoea, haematuria, bowel difficulty, urinary difficulty, erection 
difficulty, urinary incontinence, hot flushes, lack of energy, weight loss, and blood in the 
stool (Emery et al., 2013; McAteer & Gillanders, 2019; Watson et al., 2016). Men 
described their symptoms as intermittent, mild, and severe.  Participants who considered 
their symptoms as severe and perceived themselves at risk report promptly for treatment or 
sought help (Emery et al., 2013). Lammers, van Wijnhoven, Teunissen, Harmsen, and 
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Lagro-Janssen (2015) noted the persistent nuisance of the associated signs and symptoms 
as the main reason for the men’s healthcare-seeking behaviour.  
However, participants who are confident in their abilities to manage the symptoms 
and rated their symptoms as moderate felt less stressed and delayed treatment or help-
seeking (McAteer & Gillanders, 2019). They subsequently, sought care when the sickness 
becomes very painful (Nyalela, Dlungwane, Taylor, & Nkwanyana, 2018; Nzama, 2013). 
Therefore, a study by McAteer & Gillanders (2019) avowed that men who stand by the 
stoic ideology will be at a greater risk of emotional and mental distress. 
Studies on healthcare facility accessibility indicated the relevance of healthcare 
accessibility in determining the health-seeking behaviour of men (Haggerty, Roberge, 
Lévesque, Gauthier, & Loignon, 2014; Liew, 2018; Shahid et al., 2016; Uddin et al., 
2012). Haggerty, Roberge, Lévesque, Gauthier, & Loignon (2014) defined the 
geographical accessibility of healthcare facilities as the Spatio-temporal distance between 
the location of the patient and location of care. It is also expressed in the time used in 
reaching the facility. The distance of the nearest facility serves as a barrier or facilitator to 
healthcare seekers. The same study indicated that the distance of the healthcare facility is a 
barrier to healthcare seeking for the elderly and the poor. They have to travel a long 
distance to access healthcare which involves a lot of investment (Haggerty et al., 2014). 
Again, in Bangladesh, a study was conducted on health-seeking behaviour among 
basic school adolescents. The finding revealed that the distance of the healthcare facility 
from the participants served as a major barrier to their health-seeking behaviour. The 
distance needed to be covered to access healthcare demotivates participants from 
accessing healthcare (SEIDU, 2015).  In this view, a study on the health-seeking 
behaviour among African male asylum seekers in South Africa indicated that traditional 
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healers and herbal medical practitioners are the first point of contact due to their 
accessibility (Ntakobajira, 2012). 
An attitude of men towards health seeking can be seen in three perspectives such 
as cognitive (belief) attitude, affective (emotions) attitude, and behavioural attitude 
(Conner et al., 2013). 
2.2.2.1 Cognitive (Belief) Attitude of Men towards Health Seeking  
Beliefs are certain assumptions, ideas, or convictions that people ascribed to as 
being true (Usó-Doménech & Nescolarde-Selva, 2016). Beliefs can be of three main 
sources; personal experiences or experiments, acceptance of cultural or societal norms, 
and others perceptions or environments (Day & Lynch, 2013). Men’s beliefs or 
perceptions about their disease conditions or the clinical manifestations of disease 
massively influenced their quest for treatment or direction of management as well as the 
coping responses to the condition (Baines & Wittkowski, 2013). It is a common belief 
among Malaysian Chinese that mentioning the name of cancer increases the intensity and 
severity of the sickness as well as an invitation to cancer disease (Vivien, Er, & Noor, 
2013). Also, a qualitative study conducted among the black males in a college and 
university in the United States of America (USA) noted that black males refused health-
seeking because they have not considered themselves susceptible to PCa disease (Mincey 
et al., 2017).  
Several authors have also indicated that men’s beliefs in the health system 
motivate their health-seeking behaviour (Jones et al., 2015; Nyalela et al., 2018). A 
qualitative study conducted in Durban, South Africa identified that the participants’ 
relationship with their healthcare provider serves as a motivation and demotivation for 
their healthcare-seeking behaviour(Nyalela et al., 2018). In the study, whiles some 
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participants described their relationship with their healthcare provider as non-existent and 
distant, some considered it cordial. As a result, despite some nurses’ bad attitudes, the 
majority of the participants report early for treatment.  
 In another study, men are motivated to seek healthcare at a designated facility 
because of the professional characteristics. They described the professionals as intelligent, 
experienced, honesty, a listener, approachable, caring, and a specialist who base decisions 
on the most current research and evidence (Nolting, 2020). Another study noted that the 
participants have a very good relationship with their healthcare providers. They could 
discuss any issues related to their health and behaviour with them (Griffith et al., 2011). 
However, a qualitative study among African Americans conducted to explore the 
determinants of their medical help-seeking noted that the participants refused healthcare-
seeking because they were uncomfortable about the hash toned used by the doctors when 
communicating with them (Griffith et al., 2011). But another study opined that the 
participants' self-belief in medication demotivated and distanced them from health-seeking 
(Nyalela et al., 2018). Some claimed that doctors are not the only intelligent and smart 
people on earth as such do not trust their judgments. They conceived that their 
explanations are misleading (Griffith et al., 2011)  
The religious belief of men is another booster in their healthcare decision making. 
Religion and its practice provide major alternatives in the choice of methods of cure. 
Ntakobajira (2012) argued that the manner a person interprets his problem, illness, and any 
misfortune has an extensive impact on his method of treatment. Some participants 
conjugated the faith healing with the use of alternative medicine. It is opined by 
Olanrewaju et al (2019) in the study among the male staff of Covenant University that 
some participants engaged and committed their faith and trust in God, as the only source 
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of remedy to their sickness. The participants held the view that certain problems cannot be 
handled and dealt with alone. It is solacing, refreshing, and relieving to know that 
someone perceived to have possessed the power is praying for them (Ntakobajira, 2012).  
Another dimension of the factors influencing the belief of men with PCa toward 
healthcare-seeking behaviour is the age-related cause of the condition. Many studies noted 
that men believed that PCa affects only the elderly (Fish et al., 2015; Forbat, Place, 
Hubbard, Leung, & Kelly, 2014; Medina-Perucha et al., 2017). Fish et al (2015) found that 
although men are aware of PCa, they hold the belief that the condition affects only the 
older adults. They hence, deny its occurrence among the younger age groups. Some 
participants were also ignorant about the early signs and symptoms of PCa. Therefore, 
they misinterpreted or wrongly appreciated the early clinical manifestation as normal 
aging changes (Forbat et al., 2014; Medina-Perucha et al., 2017).  
2.2.2.2 Affective (Emotion) Attitude of Men towards Health Seeking  
Literature postulated that the attitude of men is significantly influenced by their 
emotions about the likely outcome of a phenomenon (Mincey et al., 2017). The emotion of 
men living with PCa plays a major role in the health decision-making process (Davison & 
Breckon, 2012). It provides propelling powers towards the determination and acceptance 
of a treatment option. These treatment options may be either allopathic or non-allopathic 
forms of treatment (Xu et al., 2011). A qualitative study in Malaysia to explore the reason 
for their delay in health-seeking indicated that the participants reported for treatment 
because they were worried about the symptoms although not painful (Azhar & Doss, 
2018). 
Several other studies have also identified fear as a major factor influencing men’s 
health-seeking behaviour (Fish et al., 2015; Medina-Perucha et al., 2017). Griffith et al 
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(2011) noted that black men avoid health-seeking because they are afraid of the diagnosis, 
and some medical instructions. They do not want to be informed that they have cancer or 
are instructed to modify their lifestyles. Also, men refrain from health-seeking because of 
fear of been associated with a medical condition and its treatment procedure (Medina-
Perucha et al., 2017; Persoskie et al., 2014). But having witnessed the death of a relative of 
PCa due to fear of health-seeking, induced tremendous fear into some participants to 
timely attend regular PCa checkup (Griffith et al., 2011).  
Another study on masculinity revealed that men are motivated to adopt preventive 
measures when they observed the death of a close relative or friends from a similar 
condition. (Harvey & Alston, 2011). After diagnosis and treatment, men turn to encourage 
others to be vigilant by being proactive in PCa screening (Forbat et al., 2014). Meanwhile, 
men diagnosed with erectile dysfunction feel ashamed, stigmatized, and find it difficult 
communicating with colleagues and even healthcare professional about their condition due 
to lack of confidentiality (Adams, Collins, Dunne, de Kretser, & Holden, 2013)  
Other studies have also identified embarrassment as a negative attitude that affects 
men’s health-seeking behaviour (Adams et al., 2013; Connolly et al., 2011; Ettridge et al., 
2018; Forbat et al., 2014). Embarrassment and a sense of stigma prevented men from 
discussing their disease condition with friends as well as health professionals (Adams et 
al., 2013; Ettridge et al., 2018; Forbat et al., 2014). The sources of their embarrassment 
include sexually related symptoms such as erectile dysfunction, the treatment and 
screening procedures e.g. DRE, and communication with the healthcare providers (Adams 
et al., 2013; Harvey & Alston, 2011; Medina-Perucha et al., 2017).  In Australia, another 
study was conducted on perceptions of stigma, social isolation, and help-seeking among 
men with PCa. The result opined that there was no stigma attached to being diagnosed 
with PCa since it is a condition associated with old age. But some men experience a 
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certain degree of stigma and embarrassment in areas of social norms such as sexual 
involvement with their partners (Ettridge et al., 2018). 
Again, Harvey and Alston, (2011) indicated that participants expressed aversion 
towards the PCa screening procedure of DRE and claimed it violates manhood perception. 
The men likened the procedure to homosexuality hence, felt uncomfortable and 
embarrassed permitting doctors inserting their fingers into their rectums. Therefore, men 
managed their embarrassment by keeping to themselves or delayed opening up to people 
about their condition (Forbat et al., 2014). In China, the result of a case study among 
Malaysian Chinese cancer survivors stated that the participants prefer to keep mute over 
their illness from friends, and outsiders even from their families to control and minimize 
their embarrassment. Because the term cancer is forbidden in Chinese communities. It is 
considered a bad omen. The participants hid their illnesses and delayed professional 
healthcare-seeking (Yew & Noor, 2013).  
2.2.3 Subjective Norms that Influences the Health Seeking Behaviour of Men Living 
with PCA 
Another factor that influences the intention of men toward health-seeking is the 
subjective norm. Subjective norms are perceived social pressure to engage or not to 
engage in a behaviour (St John, Edwards-Jones, & Jones, 2011). They serve as motivation 
that drives individuals to succumb to societal pressures and expectations (Sacconi & 
Faillo, 2010).  According to Bobek et al (2013), it forms the total sets of accessible 
normative beliefs concerning an expectation of important issues of concern. It is also the 
perceptions of anticipated behaviour from significant others (Ahn & Kahlor, 2019). 
Literature carried it that norms amplify conformity, and establish the bond between 
people's normative beliefs and behaviour (McKelley & Rochlen, 2010; Olanrewaju et al., 
2019; Tayler & Bloomfield, 2011).  
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These normative beliefs could be of an individual, significance others (relatives 
/friends), or societal expectations prescribing an accepted behaviour in a given context 
with an expectation of compliance (Bobek et al., 2013). Spouses, relatives, friends, and 
healthcare professionals play significant roles and have great influence in the healthcare 
decision-making process of men. The spouses and relatives seek, gather, process 
information, arrange for healthcare services, and other supports for the men (Buckley & Ó 
Tuama, 2010; Fish et al., 2015; Forbat et al., 2014; Tong et al., 2011). A qualitative study 
in Glasgow confirmed that the spouses played a significant role in interpreting symptoms.  
They also motivated men a lot to take immediate action by regularly visiting the 
healthcare professionals (Forbat et al., 2014). Also, spouses and relatives motivate men in 
various health conditions in timely healthcare utilization, and normal functioning (Fish et 
al., 2015).  
Norms shape human actions by clarifying expectations and bring about conformity 
in behaviour (Bicchieri & Muldoon, 2011). Studies on subjective norms identified 
information sourcing, treatment options, places of healthcare-seeking, and professional 
preferences as areas of impact (Ahn & Kahlor, 2019; Fish et al., 2015; Smith et al., 2019). 
Drawing on the place of healthcare, Griffith et al (2011) opined that it is a commonly 
accepted, and stereotype perception among black men that men do not frequently visit the 
doctor. They visit only with serious medical problems. Also, a systematic synthesis of 
mixed-method research indicated that notions of masculine gender of being strong and not 
weak prevented men from seeking early healthcare (Fish et al., 2015)   
Health information is crucial in health decision making (Zhang, Wen, Liang, & 
Lei, 2017). In the literature, men acquired information from many sources. These sources 
include the internet, general brochures, pamphlets, medical journals, talking to other 
patients who have been treated for the condition, and healthcare professionals (Davison & 
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Breckon, 2012; O’Callaghan et al., 2014; Smith et al., 2019). Again, behaviour endorsed 
by people in authority, increases its probability of enforcing the decision. Men required 
more shreds of evidence, and better understanding to make informed health decisions 
(Hirvonen & Ek, 2015).  As a result, men relied heavily on health professionals to have 
better understanding of situations of uncertain nature to respond appropriately and 
effectively (Davison & Breckon, 2012).  
Few studies confirmed that men preferred consultation and treatment 
recommendations with their healthcare providers (Davison & Breckon, 2012; Griffith et 
al., 2011; Xu et al., 2011). This assertion, however, was in sharp contrast with Dotson et al 
(2016) that men are defiant and reticent in discussing their sexual and reproductive health 
issues with their doctors. Also, some men considered information, suggestions, and 
decisions from their doctors and internets as misleading, confusing, and/or limited 
(Griffith et al., 2011; O’Callaghan et al., 2014)  
However, most men stood by their relatives' positions regarding a particular 
healthcare utilization and/or adopted a suggested healthy lifestyle. For instance, a cross-
sectional study by Zhang et al (2015) revealed that healthcare decision-making regarding a 
disease condition in Chinese societies resides in the hands of the family. Nevertheless, in 
most cases, only men take this crucial decision with the support of their spouses. In some 
extreme situations such as partner’s age, the decision is collectively made by the couple. 
But in critical situations such as longevity expectation or distressful memories of cancer-
related complications, healthcare professionals are involved in the decision making 
(Griffith et al., 2011; Hoffman et al., 2018; O’Callaghan et al., 2014). 
The next area of perceived societal pressure is the decision regarding the preferred 
treatment options. There are various treatment options such as active surveillance (AS), 
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surgery, and radiotherapy (Hoffman et al., 2018; Smith et al., 2019). Men’s decision on 
their treatment options is influenced by the perception of the healthcare professionals, 
family, wife, colleagues, and significant others from the society (Davison & Breckon, 
2012; Forbat et al., 2014). For instance, a qualitative study was done in Liverpool and 
Australia to explore the decision support needs of men with localized PCa choosing 
between robotic prostatectomy and radiotherapy treatment. The finding indicated that 
primary healthcare professionals became the source of treatment-related information, and 
their suggestions shaped men’s treatment decisions (Smith et al., 2019).      
Another study conducted in Australia has shown that men’s decision on treatment 
choice is informed by emotions, memories of cancer-related conditions, current and future 
lifestyles hope to live and information available (O’Callaghan et al., 2014). Young men 
are triggered to undergo medical screening as a preventive measure when they get married 
because they wish to stay healthy (Teo, Ng, & White, 2017). Again, in Australia, a 
qualitative study on the choice of localized PCa treatment between robotic prostatectomy 
and radiotherapy treatment stated that participants preferred radiotherapy because they 
believed it has lesser effect on the body and everyday life activities (Smith et al., 2019). 
The roles of the men’s social network greatly influenced the health-seeking 
behaviour of men. The social network encouraged men to regularly visit the healthcare 
provider, and helped them cope with the stresses of their condition (Forbat et al., 2014). 
Additionally, spouses adopted strategic measures to assist men to adhere to treatment and 
suggested lifestyle modification strategies. Some studies found that the men’s belief in the 
importance of their family health, and the effects of the clinical manifestations on the 
family motivated them to adhere to treatment recommendations to adopt a changed 
behaviour (Fish et al., 2015; Griffith et al., 2011). 
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Cost of health care, lack of insurance, and transportation to the healthcare facility 
are most often, the challenges to men’s health (Bourne, 2010; Griffith et al., 2011; Teo et 
al., 2016). When men do not want to distress their families and others with their illness or 
show themselves as weak and vulnerable, they kept their illness to themselves and 
pretended to be well to avoid seeking healthcare (Cornally & McCarthy, 2011; Fish et al., 
2015). Chan, Lee, and Low (2018) found that due to the high cost of treatment, lack of 
time and interest, patients avoided health screening, and overlooked clinical 
manifestations of health conditions which invariably delayed treatment. However, a 
descriptive cross-sectional study in Goma, Democratic Republic of Congo noted that 
elderly men received financial supports from their families and non-formal sectors for 
their healthcare (Lutala, Kwalya, Kasagila, Watongoka, & Mupenda, 2010). Also, studies 
indicated that encouragement from the spouses and significant others boosted men’s 
healthcare-seeking behaviour and lessened symptoms severity (Fish et al., 2015; Pedersen, 
Olesen, Hansen, Zachariae, & Vedsted, 2011). Furthermore, men are motivated and 
inspired by their spouses to seek medical health care and adhered to the decisions and 
advice of the health care professional (Griffith et al., 2011). 
2.2.4 Behavioural Intentions of men living with PCa toward Health Seeking 
Behaviour 
Behavioural intentions are a cognitive or mental readiness, and self-instruction to 
perform a given action.  It describes deliberate activities directed at healthcare-seeking 
behaviour (Sheeran & Webb, 2016). Many studies outlined several positive activities men 
with PCa adopted and directed at healthcare-seeking behaviour (Fish et al., 2015; Griffith 
et al., 2011). Other studies noticed lifestyle modification of men with PCa as a major 
intentional drive to health (Bourne, 2010; Hackshaw-McGeagh et al., 2017; Skolarus et 
al., 2014; Yew & Noor, 2013). Lifestyle describes the way of life of an individual or a 
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group of people. It includes all regular activities of daily living; eating patterns, 
homemaking, sport, leisure, shopping, and working (Hackshaw-McGeagh et al., 2017; 
Yew & Noor, 2013). A guideline for primary care management of PCa survivors 
suggested regular examinations to determine the level of involvement of clinicians and 
spouses in the management and to prevent the disease from serving as a barrier to lifestyle 
modification and health promotion (Skolarus et al., 2014). 
 A case study among Malaysian Chinese cancer survivors at Lembah Kiara 
Recreational Park in Kuala Lumpur, Malaysia found that to recover and cope with cancer, 
participants must adopt a renewed and a changed lifestyle. For instance, follow a dieting 
schedule, regularly participate in physical exercise, and be completely dedicated to the 
work of God and the ancestral spirits (Yew & Noor, 2013). Similarly, in England, a 
qualitative study on the acceptability of dietary and physical activity lifestyle modification 
among men after radiotherapy and radical prostatectomy opined that men are motivated to 
alter their lifestyle if they know the scientific benefits they stand to enjoy (Hackshaw-
McGeagh et al., 2017).  On the other hand, Hackshaw-McGeagh et al (2017) noted that 
participants face several health challenges adapting to their changed lifestyle. These 
impediments include bad weather conditions, incontinence with participants that 
underwent intervention, time pressure, and overall participants’ health conditions. 
Further exploration in the participants' intention of cure is demonstrated in the 
participants' adherence to treatment. A qualitative study with a grounded theory approach 
was conducted on the experiences and coping strategies of oncology patients undergoing 
oral chemotherapy. The result demonstrated total responsibility and commitment of the 
participants in their treatment and followed all prescription orders. They exhibited this by 
taking their medications at the right time and in the right dosage backed with the 
knowledge of the possible effects of meal, belief in the efficacy, and awareness of how 
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life-threatening was the condition (Gassmann, Kolbe, & Brenner, 2016; Verbrugghe, 
Verhaeghe, Lauwaert, Beeckman, & Van Hecke, 2013). However, some participants did 
not adhere to the  prescription orders. Literature avowed that the medication adherence 
rate was high among men with high socioeconomic status and educational standards than 
men with lower education, income, and poverty (Brown & Bussell, 2011; Verbrugghe et 
al., 2013).  
Also, men with single conditions recorded a high medication adherence rate than 
men with comorbid disease conditions (Rolnick, Pawloski, Hedblom, Asche, & Bruzek, 
2013). The factors influencing medication adherence were classified as patient-related, 
therapy-related, disease-related, healthcare system, and social and economic factors 
(Brown & Bussell, 2011; Jimmy & Jose, 2011; Verbrugghe et al., 2013). Findings of a 
systematic review on factors influencing oral anticancer drug (OACD) therapy 
nonadherence and persistence to oral anticancer drugs further considered patient-related 
factors as intentional and unintentional. The study furthermore explained that participants 
intentionally did not adhere to the prescription orders due to lack of perceived necessity 
taking the medication, doubts about the effects of the drug on the quality of life, concerns 
about the severity of symptoms, and not knowing the consequences of missing a dose 
whiles unintentionally forget and accidental take overdose (Verbrugghe et al., 2013).   
 A lot of studies demonstrated PCa patient’s intentions towards healthcare (Bass, 
Muñiz, Gordon, Maurer, & Patterson, 2016; Fish et al., 2015). The men sought healthcare 
from the formal healthcare facilities (hospitals, clinics, and health centres) or the non-
formal facilities such as herbal or traditional healing centres or both (Carter, Bryant-
Lukosius, DiCenso, Blythe, & Neville, 2011; Musoke et al., 2014; Sato, 2012; Uddin et 
al., 2012). Fan et al. (2017) examined the rationale for men with prostate disorders 
medical consultation. The result showed that men sought healthcare with an expectation to 
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have treatment for their troubling clinical manifestations and prevent complications of 
prostate condition. Again, a qualitative study examining the unmet psychological needs of 
PCa patients after treatment identified that the main concern of men irrespective of their 
ages is the need for survival (Hyde et al., 2017; Watson et al., 2016). Therefore, the young 
participants are provided with counseling services before treatment to prepare them for 
probable treatment consequences such as psychological concerns of loss of sexual function 
(O’Brien et al., 2011). 
In addition, Cornally and McCarthy (2011) noticed that participants delayed or 
refused healthcare-seeking if they anticipated negative outcome of their encounter with the 
healthcare professionals. For instance, Teo et al. (2016) noted that men misinterpreted 
information about cancer screening procedures and perceived them as painful. This 
misinformation discourages men from seeking early healthcare.  However, in another 
study on race, healthcare access, and physician trust among the black and Caucasian 
patients in the United States of America avowed that most patients sought healthcare 
because they have trust in their physicians. The same study further, noticed great 
differences in the participant’s levels of trust. The black patients exhibited lower trust 
(average score of 86.73) in their physicians' decisions compare with their Caucasian 
counterparts (average score of 89.65) (Do et al., 2010). 
2.2.5 Behaviour of Men Living With PCa towards Health Seeking  
Behaviour is an observable and measurable actions displayed by an individual in 
response to a particular situation. According to Bergner (2011) behaviour is an attempt of 
an individual to make a change from one state of affairs to another or to maintain a current 
state of affairs. To change the current state of affairs, men living with PCa employ a lot of 
interventions to relieve themselves of the burdens and predicament of the clinical 
manifestations of PCa.  Studies on PCa opined that the initial action of men towards health 
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care was information sourcing (Fish et al., 2015; Jung, 2014; Nelissen, Beullens, Lemal, & 
Van den Bulck, 2015).  
The men sought information about the disease condition, place of care, treatment 
modalities, medications, medication side effects, and competencies of the healthcare 
providers as well as new advancement in treatment (Carter et al., 2011; Uddin et al., 
2012).  According to Uddin et al (2012) and Zhang et al (2015), almost all patients 
preferred seeking health information regarding their condition and treatment from their 
physicians. Some participants sought this information from various sources including 
family, friends, know people who have experienced the condition, and the healthcare 
providers. They also sought this information from books, brochures, posters, and internets 
(Ettridge et al., 2018; Hyde et al., 2017; McClymont, Gow, & Perry, 2014; M. L. Smith et 
al., 2017; Yun et al., 2016).  
In Belgium, a cross-sectional study among cancer diagnosed and non-cancer 
diagnosed people avowed that people with cancer diagnosis actively search for more 
information on cancer than non-cancer diagnosed people (Nelissen et al., 2015). Another 
study on men diagnosed with localized PCa noted that about 94% of the participants 
accessed resources and supports of varied forms from health professionals, family, or 
friends (Hyde et al., 2017). This confirms the assertion that men are highly motivated to 
acquire healthcare navigation competencies to steer their affair (Ettridge et al., 2018; Yun 
et al., 2016).  In Ghana, a study conducted on the dynamic of health information-seeking 
behaviour among lower-income older adults noted that adequate health information from 
trusted sources promotes health (Agyemang-Duah, Arthur-Holmes, Peprah, Adei, & 
Peprah, 2020).     
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 However, factors such as inadequate knowledge of the relevance of health 
information, communication barrier, and professional’s bad attitudes prevented low-
income adults from health information seeking (Agyemang-Duah, Arthur-Holmes, Peprah, 
Adei, & Peprah, 2020).  Additionally, other scholars indicated that fear of being diagnosed 
with cancer and lack of insurance motivated men to avoid information searching on cancer 
(Nelissen et al., 2015; Persoskie et al., 2014). The disparities in these assertions may be 
due to the differences in the participants' ages. Chima (2015) avowed that older patients 
sought further information regarding treatment options from other sources while younger 
patients especially minors sought information or assistance from their parents or 
guardians.  
In the quest to recover from the challenges associated with PCa, men applied their 
personal known methods of treatment, sought medical treatment, consulted herbalists, and 
engaged in spiritual and religious treatments (Carter et al., 2011; Nelissen et al., 2015; 
Uddin et al., 2012; Verbrugghe et al., 2013). The medical treatments include surgery, 
radiation therapy, and systemic treatment such as chemotherapy, targeted therapy, 
hormonal therapy, and immunotherapy (Chen & Zhao, 2013; Miller et al., 2019). 
According to Hamdy et al (2016), 1643 men opted for medical treatment. Out of this 
number, 482 had undergone active monitoring, 391 men had surgical operation and 405 
men had radiotherapy. Another study was conducted in California, South Carolina, and 
Texas among men newly diagnosed with PCa to determine their preliminary treatment 
consideration. The finding showed that out of 198 participants that consider medical 
treatment, 59 % of the participants consider surgery while 41% opted for nonsurgical 
procedures such as radiotherapy or chemotherapy (Zeliadt et al., 2010).  
Studies have identified multiple health care utilization as the trending form of 
health-seeking behaviour among patients of PCa (Chan et al., 2018; Fouladbakhsh & 
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Stommel, 2010; Kristoffersen, Norheim, & Fønnebø, 2013; Sato, 2012). Some cancer 
patients, out of desperation and frustration sought treatment from many centres at the same 
time. They mixed both allopathic treatment with the non-allopathic treatment (Chan et al., 
2018; Kristoffersen et al., 2013). For instance, a qualitative study on Chinese culture and 
cancer among Malaysian Chinese cancer survivors opined that the majority of the 
participants sought treatment and other assistance from both allopathic facilities and herbal 
or alternative treatment centres (Vivien et al., 2013). Also, Sato (2012) examined whether 
socioeconomic status explains the usage of modern or traditional healthcare services in 
Ghana. The finding showed that out of the 741 participants, 411 participants used modern 
medicine, 53 participants used traditional medicine and 150 participants used both modern 
and traditional medicine.  
 Sato’s study further indicated that the differences in the participant’s preferences 
were due to their economic status: those with sound economic grounds access modern 
healthcare while those with less and unstable economic status access traditional 
healthcare. Similarly, in Singapore, a systematic review was conducted among rental and 
owned housing communities to assess the socio-economic impact on their health status, 
health-seeking behaviour, and healthcare utilization. The finding showed that more 
participants in the rented apartment preferred traditional or alternative medicine 
practitioners to medically trained doctors while the owned housing population had great 
preference for medically trained doctors (Chan et al., 2018). A result of another study 
revealed a significant association between men with lower income and complementary and 
alternative medicine usage (Kristoffersen et al., 2013) 
Again, a cross-sectional study in Ghana among cancer patients on chemotherapy 
and radiotherapy indicated that 75% of the participants used complementary and 
alternative medicine. And more than half of the participants that used complementary and 
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alternative medicine used more than one form at a time (Yarney et al., 2013). Kristoffersen 
(2013) stated that 33.8% of all cancer patients used complementary and alternative 
medicine. The common forms of complementary and alternative medicine used were 
prayers, herbal, Massages, Megavitamins, and Chinese Medicine (Yarney et al., 2013). 
The finding again indicated that the participants heard of these medicines from their 
friends, family members, health personnel, mass media, CAM practitioners, church, and 
religious groups (Yarney et al., 2013).  
The participants have various reasons for the usage of complementary and 
alternative medicine. These reasons include the desire to try anything and religious faith 
and beliefs. They believed that their sickness is spiritual, conventional treatment is too 
mechanical, disappointed in conventional treatment, and conventional treatment is too 
toxic (Gyasi et al., 2016; Yarney et al., 2013). Another study conducted in the Ashanti 
Region of Ghana to determine the motivation for alternative therapy usage indicated that 
traditional medicine is compatible with their cultural practices and beliefs. The 
participants also trusted the competencies and experiences of the traditional medicine 
practitioners (Gyasi et al., 2016).  
Also, a qualitative study in Kumasi Metropolis and Sekyere South District, Ghana, 
opined that people opted for traditional medicine because it is natural, has no or little 
chemical, and has minimal or no side effects, and easily accessible and less expensive 
(Gyasi et al., 2016). However, literature showed that some participants declined the use of 
complementary and alternative medicine because they had no faith in its effectiveness 
(Chan et al., 2018; Sato, 2012). They were discouraged by those who had used 
complementary and alternative medicine. They have trust in the allopathic treatment and 
believed that alternative medicine is unnecessary (Yarney et al., 2013). However, the same 
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study indicated that men’s distrust of medical treatment stems from the view that medical 
treatments are too mechanical, disappointing, and too toxic (Yarney et al., 2013). 
Furthermore, Vivien et al (2013) indicated that when men are faced with life-
threatening conditions as cancer, they initially call on their interventions; over counter- 
drugs and other herbal medications to alleviate the worries associated with the signs and 
symptoms of the illness. Blomberg et al (2016) also showed that participants managed 
their physical signs and symptoms such as frequency micturition by reducing their fluid 
intake and avoidance of some beverages like beer and coffee before bedtime. They 
managed their fatigue by enduring and keeping themselves active irrespective of the 
overwhelming nature of it. Another study was conducted on exploring and examining PCa 
survivor’s management behaviour, coping, and social support to health-related quality of 
life, anxiety, and depression. The finding revealed that men adopted behaviour such as 
avoidance of constipation, heavy lifting, use of an incontinence pad, and avoid drinking 
plenty of fluids as a measure to frequent urination. The participants also used medications 
for erectile dysfunction, share worries and concerns freely, get involved in emotional and 
social support activities, and ensure adequate rest (Paterson, Robertson, & Nabi, 2015).   
An exploration of the literature showed an extensive work of many authors on the 
roles of religion in the PCa management (Bowie et al., 2017; Moore et al., 2013; Vivien et 
al., 2013). In a comparative study between the African American and white men, it was 
opined that African American men believed that PCa diagnosis is a faith trial and 
punishment from God. The trial strengthens their faith more to cope with the condition. 
They believed that God is the healer and will heal them of the cancer through prayers. 
However, the diagnosis of cancer dampens the faith of some participants in God (Bowie et 
al., 2017). Also, a qualitative study on the faith of low income Africa America men treated 
for PCa indicated that the belief and faith of some participants in God enhance renewed 
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perceptions of PCa and subsequently helped them cope with the diagnosis, treatment, 
treatment adverse effects, and its associated death (Maliski, Connor, Williams, & Litwin, 
2010).  
Also, Vivien et al (2013) stated that as part of treatment modalities, the participant 
visits their religious leader to understand the cause of their illness because medical 
treatment could not provide the necessary explanations to the cause of cancer. They 
believed that cancer might be due to a divine punishment or possession of an evil spirit 
(Bowie et al., 2017). They prayed and performed rituals to their ancestor with the belief 
that by so doing, the ancestors would provide them with spiritual strength and protection 
against the pain and mishaps during the medical treatment (Vivien et al., 2013). 
The literature discussed a lot on men’s self-reliance in health-seeking (Yun et al., 
2016).  A study on how perceived stigma, self-stigma, and self-reliance related to 
treatment behaviour noted that men with high perceived or self - stigma toward healthcare-
seeking relied heavily on self-treatment (Jennings et al., 2015). Some participants did not 
see the need to seek attention at a hospital or consult with a doctor. They were confident of 
self-prescribed medications and self - appreciation of clinical signs and symptoms whether 
it demands external assistance or not. Some of the participants claimed that their 
medications were more effective than medication prescribed by the trained healthcare 
professionals (Buckley & Ó Tuama, 2010) 
2.3 Summary of Literature Review 
In summary, a detailed literature search was done on factors influencing the health-
seeking behaviour of men with PCa. The literature search was under the themes; attitudes, 
perceived subjective norms, behaviour intention, and the behaviour of men toward health-
seeking.  Several current studies including both qualitative and quantitative studies that 
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were related to the study were given much consideration in the review. Although this 
study is centred on the health-seeking behaviour of men with PCa, due to the dearth of 
literature in this area, the search was extended more to the health-seeking behaviour of 
men.  
From the literature, men generally have a negative attitude towards health-seeking. 
Men considered health-seeking in reproductive conditions such as PCa as unnecessary 
exposure to sexual weakness and masculinity. Many factors influenced the health-seeking 
behaviour of men. These factors include cultural beliefs, the patient's age, educational 
level, economic conditions, physical and financial accessibility, and disease pattern. 
Family and societal relation which constitute an integral part of men significantly 
influence men’s healthcare-seeking behaviour. Men with PCa sought healthcare to regain 
the normal state, enhance and promote the health of their family, and lessen the physical 
and psychological burden of their sickness on their family. Men enjoyed both emotional 
and financial supports from their spouses, relatives, and significant others. They preferred 
health decisions and suggestions from their healthcare professionals. 
Men with PCa demonstrated their commitment to regain a normal state of function 
by seeking information about the condition, available treatment modalities, medication, 
and treatment side effects. Some men in their quest to recover early, adhered strictly to 
their healthcare professional directives; kept to hospital prescribed medication. However, 
some men mixed these treatments with alternative treatments such as herbal medicine. 
They viewed issues regarding their condition confidential and private and as a resulted to 
self-medication. Although, indicative that men living with PCa sought health from several 
healthcare outlets, some of these men also kept information to themselves as a means of 
hiding their weakness as well as coping with the challenges associated with the conditions.  
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CHAPTER THREE 
RESEARCH METHODOLOGY 
3.0 Introduction  
The methodology describes the process by which the research is conducted (Polit 
& Beck, 2012). This chapter presents the study design, research setting, target population, 
sample size, and sampling techniques. It describes the data collection tool, data collection 
procedure, piloting of the interview guide, data management, and data analysis. The 
methodological rigour and ethical consideration are discussed. 
3.1 Study Design 
Research designs are strategies for research that bridge gap between decisions of 
broad assumptions to detailed approaches to data collection and analysis. It is a plan, 
which specifies who, where and when data are to be collected and analysed (Parahoo, 
2014). Research design can either be quantitative, qualitative or mixed (Creswell & 
Creswell, 2017). According to Grove, Burns, and Gray (2012), a study design must be 
chosen based on its  appropriateness and relevance to the topic being investigated. 
Qualitative research is an inductive approach used to gain in-depth information about the 
phenomenon under study. It also explores and describes all dimensions of a phenomenon 
or experience for a better understanding (Kornhaber, de Jong, and McLean, 2015). This 
study therefore, employed an exploratory descriptive qualitative approach to understand 
the health-seeking behaviour of men living with PCa in the Volta Region of Ghana. Polit 
& Beck, (2012) posited that an exploratory research, enables the  researcher to investigate 
the full nature of phenomena and provides an insight into the comprehension of an issue or 
situation, rather than simply observing and explaining the phenomena. This design ensures 
an adequate discourse and interaction between the researchers and the participants on their 
health-seeking behaviour. 
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3.2 Research Setting 
This study was conducted in the Volta region of Ghana. Volta region is one of 
Ghana's sixteen administrative regions. It is located in between Lake Volta on the West 
and the Republic of Togo on the East. It is bounded on the north by the Oti Region of 
Ghana and by the Gulf of Guinea in the south. It has Ho Municipal as its capital town. 
Hohoe, Kpando, and Aflao are the major commercial towns. The region covers an area of 
20,570 square kilometres representing 8.6% of Ghana. The population of the Volta region 
according to the 2010 population and housing census is 2,118,252 with 1, 019,398 males 
representing 48.1 % and 1,098,854 females representing 51.9 % (GSS, 2011). Volta region 
can boast of a total of 326 health institutions out of which 242 are Ghana Health Service 
(GHS) administered. 18 are Mission owned. One facility is quasi-government (that is the 
military hospital – MRS) at the medium mortar regiment in Ho, and 65are privately 
owned. Sogakope District Hospital was the outlet for the participants' recruitment. 
Sogakope district hospital is a 63-bed capacity hospital located along Accra to Aflao main 
road. It has a staff strength of 301 and has two specialty departments such as Urology and 
Obstetrics & Gynaecology. Due to the urology department, it draws its clientele from 
within the Volta Region, parts of the Eastern Region, and Oti Region. 
 
 
 
 
 
 
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Figure 3. 1: Map of Ghana showing South Tongu District 
Source:  Duedu (2016) 
3.3 Target Population 
The target population of the study were males who have been living with PCa in 
the Volta Region. 
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3.3.1 Inclusion Criteria 
The inclusion criteria included adult males who are aged 18 and above, who gave 
consent to participate in the study, who were living with PCa between six (6) months or 
more at the time of the study, and can speak English, Twi, or Ewe. 
 3.3.2 Exclusion Criteria 
The exclusion criteria excluded mentally impaired adults, speech impaired, and 
seriously ill adults.  
3.4 Sample Size and Sampling Technique 
A purposive sampling technique was used to recruit participants for the study. 
Purposive sampling technique is a non-probability sampling method to recruit the 
participants who have the specific knowledge and experience in the phenomenon under 
study (Marshall & Rossman, 2014). The researcher obtained verbal permission from the 
management of the hospital to collect data in the facility. The facility have two clinic days 
(Tuesdays and Thursdays) in a week for urological conditions. On these clinic days, the 
researcher met with the consultants (specialist) and got located a place around the 
consulting room. Before participants were recruited, they were first seen by the urologist. 
After their consultations, the consultant introduced the researcher to the participants living 
with the condition. The researcher then explained the purpose of the study to the 
participants and assured them of confidentiality and privacy. The participants who met the 
inclusion criteria and were willing to share their experiences were recruited for the study. 
The researcher then took their details and subsequently visited them for the interview on 
the agreed day, time and at locations convenient to the participants. 10 participants were 
used for the study because information saturation was attained at the time the researcher 
finished interviewing the 10th participant. The 10th participant provided the last point to 
end the interview because data saturation is crucial in qualitative research for the study to 
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be credible. Polit and Beck (2012), explains data saturation as the state where there is no 
new information emerging at a stage of interviewing such that the participants keeps 
repeating same information. 
3.5 Data Collection Tool  
A face-to-face in-depth interview guide (Semi-Structured Interview Guide) design 
based on the objectives and research questions of the study was used as the data collection 
instrument evidenced by Appendix E. The interview guide was developed from the 
literature review and the objectives of the study. The semi-structured interview guide had 
given the researcher the flexibility, enhanced dialogue in the interview, and provided the 
opportunity to reshuffle the mode of questioning. Also, the interview guide containing 
research questions of the study covered all relevant areas of the study. This facilitated 
deeper interrogation with the participants to elicit more information relevant to the study 
and kept the researcher focused on the objectives of the study. The interview guide was 
put into two sections: section A and section B. Section A focused on the demographic data 
of the participants, while section B involved subsections with several open-ended 
questions and probing questions. Also, the researcher kept field notes during each 
interview section to document other events such as participant reactions to some of the 
questions on the field. 
3.6 Data Collection Procedure  
The Interviews were conducted at various locations convenient to the participants. 
The researcher discussed with the participants the purpose of the study and provided them 
with the information sheet which contained detailed information about the entire study. 
The researcher further explained procedures to the participants and cleared any 
misconceptions they were having about the study. The researcher scheduled an 
appointment with the participants who expressed interest and willingness to participate in 
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the study. These participants were followed to their homes and offices after scheduling a 
convenient day and time for the interview. 
With permission from the participants, the interviews were recorded for word 
transcription into word files and analysis. Averagely, each interview lasted for 
approximately 30 – 60 minutes, and in the language most convenient for the patient.  The 
researcher commenced the interview with major and probing questions. This afforded the 
participants sufficient ground to provide detailed and convincing responses. Other 
supporting questions followed to probe deeper into the participants' experiences. When the 
participants lose track of the question, other probing questions were asked to bring them 
back to course. 
3.7 Piloting of the Interview Guide 
A pilot study was conducted to pretest the research instrument for data collection. 
Pretesting a research instrument permitted the researcher the opportunity to assess, 
identify the weakness of the research questions, and subsequently refined them. This 
helped determine the cost and time required for the study.  The semi-structured interview 
guide for the study was pretested at the Sogakope District Hospital to explore the health-
seeking behaviour of at least two men that had been living with PCa. By piloting the 
instrument, the ambiguous questions were subsequently reframed. The finding and 
participants of the pilot study were not included in the main study. 
3.8 Data Management  
Data management started with decisions about how to preserve and share data after 
the project is completed. To prevent lost data, errors, increase the quality of data analyses, 
allow others to validate and replicate findings. Participants were allocated and identified 
with codes (PRT1- PRT10). Each interview was transcribed verbatim after several replays 
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to minimize the errors and omissions. The electronic data were kept in a folder on a 
computer with a security password while a file designed with special identification marks 
were allocated for each interview transcription. Hard copies of the interview or transcribed 
copies of the interview were stored in a safe place with lock and key. 
3.9 Data Analysis 
The section A which captured the participants’ demographic data was analysed 
using descriptive analysis, putting the items in the range and finding the average age. Both 
manual and Computer based data management software (NVivo) was used to manage and 
assist in data analysis. It was first done manually with my supervisor for adequate 
understanding before the use of the NVivo. Interviews conducted in English were 
transcribed verbatim while those conducted in Ewe were translated into English based on 
the understanding of the researcher and crosschecked by an expert in the Ewe language for 
accuracy.  
The data was anlysed using thematic content analysis as stated by Braun and 
Clarke, 2006. The data analysis was done concurrently with data collection. As indicated 
by Vaismoradi, Turunen, and Bondas (2013), this will help improve upon the depth and 
quality of the interview as the initial analysis will provide some direction in the 
subsequent interviews. The researcher was actively involved in the transcription of the 
recorded interview into a word file to get familiar with the data. The researcher read the 
transcripts again one after the other carefully paying particular attention to each sentence 
as well as listening to the tape-recorded version to identify any trace and familiarity.  
After listening and carefully reading through the transcripts, the researcher began 
to label or code the relevant words, phrases, sentences, or sections. The researcher went 
through all the codes created, read them carefully, and generated new codes from them by 
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combining two or more existing codes based on the common trends, similarities, and 
contrasts. Codes that appeared less important were dropped. The researcher kept the codes 
that were of importance and group them to form categories or themes. At this point, the 
researcher became open-minded, unbiased, and focused on the objectives of the study to 
provide a guide or a framework for the analysis and categorization of the various sub-
themes. The researcher labeled the categories, identified more relevant codes, and 
established a connection between these categories that form the main results of the study. 
This formed the new knowledge of the world (health-seeking behaviour of men living with 
PCa) from the perspectives of the participants of the study.  The researcher then wrote the 
results of the study by describing the categories and how they were connected using a 
neutral voice devoid of the researcher’s interpretation of the result. 
3.10 Methodological Rigour (Trustworthiness) 
Rigour is about how a researcher persuaded the audience that the findings of an 
inquiry are worth paying attention to and worth taking account of (Sandelowski, 2015). To 
meet this standard, Polit & Beck. (2012), outlined five main strategies namely credibility, 
dependability, confirmability, transferability, and authenticity. 
Credibility   
Credibility is concerned about the truthiness of the data or the participant’s 
perceptions, interpretation, and genuine representation of the information gathered from 
the participants by the researcher (Polit & Beck, 2012). It assesses whether the findings 
make sense, and are they the accurate representations of the participants' perceptions. 
Credibility involves strategies that suggest that findings are trusted, convincing, or 
believed. To ensure the credibility of the study, a good relationship was established with 
the participants.  The researcher established rapport and explained every step and 
procedure involved in the study with all the participants to help build trust in them. Again, 
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the researcher ensured that participants’ recruitment met all the inclusion criteria. During 
the data collection period, the researcher ensured adequate time to engage the participants 
fully to elicit all the necessary information required, and adequate time (an average of four 
days) was allocated to transcribing and analyzing each interview before the next interview. 
After the data collection, the researcher and the supervisors coded the data separately and 
compare it to straighten out the differences to ensure that the position of the participants is 
well demonstrated. Also, the researcher kept a field note of the behaviour and emotional 
responses of the participants as well as the researcher perceptions of some of the reactions 
of the participants. Also, the researcher assessed and extracted his knowledge and position 
on the topic so that the finding depicts exactly the stance of the participants. Furthermore, 
a pilot study was conducted to assess the extent to which the instrument can cover all the 
objectives of the study. 
Dependability 
Dependability refers to stability or constancy (reliability) of data over time and 
conditions (Polit & Beck, 2012). It is achieved when the credibility of a study is fully 
measured. To ensure dependability, the researcher kept an audit trail of the events and 
procedures by tracing and recording any decisions that may influence the research 
findings.  
Again, the data was coded at two different times with at least a week separating the 
first coding and the second coding. The codes were then compared to assess any variation 
in the coding. Also, the researcher described in detail the research design, procedures, and 
analysis of the data collected for easy replication. Lastly, the audit examination was 
conducted by the supervisor to scrutinize the data from the participants and the importance 
of the study. 
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Confirmability 
Confirmability refers to the extent to which the findings of a study are congruence 
with another or verified by other researchers under the same conditions and circumstances. 
To ensure confirmability, the researcher kept a reflective journal (field note) of the events 
(the behaviour and emotional responses of the participants) that transpired during data 
collection. The researcher assessed and excluded his reflections such as motivations, 
biases, and perspectives about the study from distorting the data from the participants. 
Also, open-ended questions were asked to limit or avoid asking leading questions. The 
researcher ensured that participants were not enticed with unnecessary gifts. Finally, 
detailed audit trails were kept as evidence that the study is truly conducted.  
Transferability 
Transferability refers to the degree to which the result of a study in a certain area 
can be easily applicable in another setting (Polit & Beck, 2012). To achieve transferability 
of the study, the researcher provided detailed descriptions of the strategies such as the 
description of sampling techniques used, the data collection procedures, analysis, and 
vivid descriptions of other processes or steps employed in the study to ensure that the 
study can be easily replicated by another person under the same environment and 
conditions. Again, an audit trail is kept of all events that took place during the process as 
well as a detailed explanation of all the procedures involved in the study. 
Authenticity 
Authenticity is the degree to which the researcher fairly and faithfully presents and 
demonstrates the range of reality or truth of the participants in a study (Polit & Beck, 
2012). To ensure authenticity, the researcher bracketed himself or his knowledge of the 
study from influencing the data. The researcher analyzed and interpreted only the data 
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gathered from the participants. Finally, the researcher presented the findings of the study 
to depict the truth stances and perceptions of the participants. 
3.11 Ethical Considerations 
Ethical approval (Appendix A) was obtained from the Institutional Review Board 
of Ghana Health Service Ethics Review Committee (GHS-ERC030/10/19), verbal 
approval from the management of Sogakope District Hospital, and an introductory letter 
from the School of Nursing, University of Ghana (Appendix B).  Potential participants 
were issued a document containing information stating clearly the purposes and objectives 
of the study. They were adequately informed of the possible benefits, risks, and 
inconveniences associated with the study. The participants were assured of anonymity and 
confidentiality. They were also reminded that participation was voluntary and they have 
the reserved right to refuse the interview at any time or decline to respond to certain 
questions.   
A follow up was made to confirm their agreement and participation in the study. 
The potential participants that agreed to participate in the study were given consent forms 
to complete (Appendix C). Participants who are illiterates, the consent form were 
translated into their native languages in the presence of a witness. Both the participants 
and the witness signed and thumb printed the consent form for authenticity. Also, 
participants were made aware of the fact that, after appending signatures on the consent 
form, they still have the reserved right to withdraw from the study without any 
consequences. They were assured of the utmost confidentiality of all the information 
provided. Codes (PRT1 - PRT10) to represent the participants were used to ensure 
anonymity.  
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The participants were notified that the consent form, the information provided, and 
the audio recordings would be in the researcher’s possession for at least three years after 
the dissertation. Soft copies of the transcriptions are kept in electronic folders with a 
unique password on the researcher’s hard drive to ensure data security. Finally, the 
researcher had arrangements with a counselor or a clinical psychologist to attend to 
participants that may be become emotional in narrating his unpleasant life experiences 
during the study. Fortunately, such an incident has not occurred during the data collection.  
 
 
  
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CHAPTER FOUR 
FINDINGS OF THE STUDY 
4.0 Introduction  
This chapter presents and clarifies the findings of the study. The findings have 
been categorized into themes per the constructs of the theoretical framework, Theory of 
Reasoned Action propounded by Ajzen & Fishbein (1980), and the objectives of the study. 
The finding demonstrates the outcome of the in-depth interview had with men living with 
PCa in the Volta Region on their health-seeking behaviour. With the use of thematic 
content analysis, five major themes emerged namely attitude, subjective norms, health-
related factors, behavioural intention, and behaviour. These themes and corresponding 
sub-themes are captured in the study with verbatim quotations from the participants using 
participant’s codes as the symbols of identification. The participants' demographic 
characteristics are also captured in the chapter.  
4.1 Description of the Study Population  
A total of ten (10) participants comprising six (6) retirees made up of 3 
educationists, a police officer, a civil servant and a pastor, and four (4) in active service 
including an electrical engineer, a farmer, a kente weaver and a fisherman were 
interviewed. The ages of the participants range from 60 – 86 years. One of the participants 
was an Africa traditional believer and the remaining nine (9) were all Christians. Nine (9) 
participants were married and a widower. All the participants have children and the 
number of children ranges from 2 – 24. One of the participants is an Akan while the 
remaining nine (9) were Ewes. Their period of living with the condition ranges from 1 
year to 6 years.  
The following themes and sub-themes emanated from the data; Attitudes 
(cognitive, affective, behavioural), Subjective Norms (personal decision for treatment, 
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financial considerations, counseling and recommendations from others, motivation for 
herbal treatment), Health-Related Factors (healthcare accessibility, effects of clinical 
manifestations, professional competence, maturity and exposure, cultural factors) 
Behavioural Intention (hope for treatment, information seeking) and Behaviour (personal 
management, secrecy, medication adherence, a combination of treatment) 
4.2 Organization of the themes 
Thematic content analysis was employed for the analysis of the data from the 
participants and five (5) major themes emerged. These themes are attitude, subjective 
norms, health-related factors, behavioural intention, and behaviour. Out of these five (5) 
themes, four (4) namely attitude, subjective norms, behavioural intention, and behaviour 
were in line with the constructs of the model, theory of reasoned action which was used to 
structure the study. The other theme (health-related factor) was the additional finding to 
the model and it emerged from the content analysis of the data gathered from the 
participant. This indicated that aside from attitude and subjective norms, health-related 
factors such as healthcare accessibility, effects of clinical manifestations, professional 
competence, maturity and exposure, and cultural factors also influenced and contributed to 
the participants' behaviour intention to undertake a particular action. From the analysis of 
the data, twenty (20) sub-themes emerged and subsequently grouped under the various 
themes. 
  
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Table 4.1: Organization of Major Themes and Sub-themes 
Major themes Subthemes 
1. Attitudes  Cognitive attitude (Beliefs) 
 Ignorance of early signs and symptoms 
 Confusion 
 Affective attitude  
 Behavioural attitude 
 
2. Subjective norms  Personal decision for treatment 
 Financial Considerations 
 Counseling and Recommendations from 
others 
 Motivation for herbal treatment 
 
3. Health-related factors  Healthcare accessibility 
 Effects of clinical manifestations 
 Professional competence 
 Maturity and exposure 
 Cultural factors 
 
4. Behavioural intention  Hope for treatment 
 Information seeking  
 
5. Behaviour  Personal management 
 Secrecy  
 Medication adherence 
 Combination of treatment 
 
4.3 Attitude  
In response to the research question “What are the attitudes of men living with 
PCa toward health-seeking?” Attitude became a major theme that sought to describe the 
feelings of men living with PCa towards seeking healthcare. Participants narrated and 
demonstrated varied attitudes in their condition toward healthcare seeking.  
These attitudes were informed by several reasons such as degree of belief, 
emotions, and the passion to achieve and expedite recovery to offset the likely adverse 
outcomes of the condition. Out of the data, 3 sub-themes emerged namely; cognitive 
attitude, affective attitude, behavioural attitude.  
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4.3.1 Cognitive Attitude (Beliefs) 
Cognitive attitude (belief) is one of the concepts under attitude. It described how 
the belief of men influences their health-seeking behaviour. From the study, few of the 
participants chose to seek and obtain healthcare in a given facility because they believed in 
the health system. Few of the participants believed that the healthcare facilities are 
endowed with trained healthcare professionals who are capable to provide high-quality 
care to promote their recovery.  
… Because I have belief in medical science …. Personally, I have trusted and believed 
in the medical treatment so whatever affects me, the first point of call is the hospital… 
I know whatever afflictions it may be that may affect you, when you go to the health 
facility you will get the cure … They have the men there… PRT2 
 
Few of the participants believed and trusted allopathic medicine. They subsequently 
sought care at these healthcare facilities because of the disappointment they had with their 
previous encounters with the non-allopathic therapy. They were once promised and 
assured by the non-allopathic practitioners’ heaven and earth of certain encouraging signs 
and symptoms of recovery of their conditions but grossly failed after a period of 
religiously relying on their medicine.  
… As I stated earlier, as I took the herbal medication, if the catheter (rubber) were to 
come out, I wouldn’t have believed the hospital medication. Because the rubber hasn’t 
come out, I have to go back to for the hospital treatment…PRT3 
 
Again, some participants relied completely on the medical directives because they have 
absolute belief in their diagnosis of the condition. They believed the diagnosis because 
they had detailed education of the condition from their friends and other sources such as 
radio sets in the past before the onset of their condition.  
… I don’t doubt it, because I heard of it through friends and read a little about it so he 
said it I believed it… PRT 1 
… I did not doubt at all. I believed that it is that sickness that was about starting…This 
is because I have been listening to the educations on the prostate on the radio… I have 
been listening to these sorts of education on the radio all the time. Also, they 
mentioned that it is very common among men …PRT 6 
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4.3.1.1 Ignorance of Early Signs and Symptoms 
Ignorance of the early signs and symptoms was one of the commonest causes of 
delayed healthcare seeking among the participants. Most of the participants had no prior 
knowledge and education on the prostate gland and its associate problems. 
… I had no idea about the disease so… No, no. I have never had the chance of been 
educated on this condition before… PRT2 
… I have not heard anything about this condition…PRT3 
No, no, no. I have not heard it before… Not at all. Because my mind is never on this 
condition, so I don’t know anything called prostate let alone knows that there is a 
prostate that disturbs a man. I have not heard it before…PRT4 
… No, no, no. I have not heard of it before…. no. I had not heard of any education of 
any kind on radio regarding the prostate conditions…. PRT7 
Almost all the participants were ignorant of the early signs and symptoms of their 
condition. The early clinical manifestations were usually grossed over and considered as 
part of the aging process that merits no critical considerations until they become worse or 
get out of hand.  
… within these periods, anytime I wanted to urinate I have been experiencing some 
slight pains in the penis but I never knew that this was happening to me… I will agree 
with you perfectly in terms of ignorance… PRT 3 
… You see. Ignorance is the first cause of delay… Before the onset of this condition, 
when I am driving, every small time I have to stop and urinate. When I continue 
driving, after one hour, I have to stop and urinate. But it does not come and happens 
consistently. For some time, I will not feel it and I will forget. Until one day it has 
happened again. These are all signs of this but I didn’t know…. PRT 7 
 
Furthermore, some of the participants reported misinterpretation of the early clinical 
manifestations of the condition to a disease called “bilharzia” or the issues of bilharzia 
experienced in the past. 
…. I had what we called bilharzia. I suffered it for some time before it stopped. As it 
stopped, anytime I wanted to urinate, I experience pain…. PRT7 
 
… You have to be very careful especially when one suffered from bilharzia…. we drink 
from the creeks here. Even the Volta river…. those who live along the Volta river, at 
times they have this bilharzia system… I do drink direct water from the Volta River. 
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So, these things are there … So, while it happened ahaa, I quickly understand that this 
is probably the problem (bilharzia)… PRT8 
 
4.3.1.2 Confusion 
In the study, few of the participants at a point became confused knowing the 
consequences of delayed treatment. Yet the blurred and unclear pathway of the 
intervention process, misconceptions coupled with their ages and recuperation abilities 
after surgical operation caused them became much more confused and worried. They 
wondered about their chances of survival after undergoing the available surgical 
intervention for long.  
…I have become confused a little. Because it may cause more damage perhaps. If they 
have not removed it early and it gets worse, it may cost me. Therefore, I have become 
confused… Perhaps during the surgery, I wonder whether they were going to remove 
the whole scrotum with the testis or not…. I am now old. So, if at this stage of life, I 
should undergo a surgical operation, if God has not intervened, I may only survive for 
just a year…. PRT 10 
 
Again, a participant was equally confused since he could not attribute his recovery to a 
specific type of intervention adopted, being it medical or herbal intervention. Since he has 
used both interventions together and at the same time. 
…. So, for now, I cannot tell you whether my relief I am getting is the result of I mean 
the herbal preparation or whatever. But I am getting better…PRT 2 
 
Another participant indicated that he usually became confused considering his position 
and its associated responsibilities in his community. As nobody can perfectly represent 
him at certain functions. There are a lot of places and meetings that required his presence 
but due to his current condition, he could not attend and function as expected. He 
continuously gave excuses to absent himself, and even those that he attended, he usually 
leave midway through the section. 
 
 
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… I am the chief now…. Sometimes I usually become confused. Because there are 
some places that required my presence but I cannot go… when they summon meetings 
for the chiefs and insisted that I must be present… when I analyzed the situation and 
knowing very well that no representative can either speak or behave like me, it usually 
gives me headache… Sometimes, I managed to be there… but I always use the 
opportunity to excuse them that they are aware that I am not so healthy so I cannot be 
with them for the full length of the meeting before I proceed with my 
submissions…PRT 5 
 
Another participant was rather empathetic and pitiful for the limitations placed on him by 
the condition rather than been confused. He could not function freely and perform 
activities that he cherishes. 
… I will say at times I pity myself because things I used to do; I cannot do them 
anymore … I like fishing and farming. Where I usually go. But I have no more been 
going… probably those things may occupy me to be thinking otherwise… I wouldn’t 
say it is confusion… PRT 8 
 
4.3.2 Affective Attitudes  
This sub-theme focused on the emotional sentiment of men. It demonstrated the 
impacts of men’s emotions on their desire and passion for healthcare seeking. The study 
revealed that some participants claimed to have sought early treatment due to their 
emotions associated with the likely outcome of delay in seeking healthcare. They sought 
early healthcare for the fear that the condition may degenerate into cancer if it is not 
treated early by a healthcare professional.   
…I heard if it is not cured probably you will die. It will develop into cancer. So 
actually, it is fear that pushed me to start now … PRT 1  
…. the level of pain I experienced was too much for me. So, I became scared that I may 
die that is where I rushed to the hospital… PRT 7 
 
One of the participants believed that one may die of the condition if it is not properly 
treated at the right place and by a professional.  
…They said, PCa is a kind of disease that is very dangerous and if you don’t take good 
care of yourself, you may die… PRT 4  
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Also, some participants refused to seek care from the hospitals and relied on their 
interventions due to fear. The fear of the adverse effects of the medical intervention caused 
some participants to perceive some medical interventions as an issue of life and death. The 
survival is dependent on prayer, luck, and God’s mercies, protection, and intervention. 
…. the mention of an operation put some level of fear in me… I entertained some level 
of fear. Had it not the fear, when the surgeons have come to the St Anthony Hospital, 
Dzodze, they have sent for me but I refused to go with the excuse that even if these 
surgeons have gone, another group of surgeons may come again... I am now old. So, if 
at this stage of life, I should undergo a surgical operation, if God has not intervened, I 
may only survive for just a year…. PRT 10 
… They said they told them that when they perform surgery on them, their penis will 
not erect again… sometimes, when they have performed surgery on you and you are 
not fortunate, you will only die… Because of this, they remained and lived with this 
condition until they die … PRT 4 
 
However, few of the participants expressed no fear at all for any of the medical 
management especially surgical intervention because they had had experiences of some 
successful surgical operation in the past. 
… I had no fear at all. This is because I have undergone surgical operations before… 
With all these experiences, I don’t entertain any fear when mentioned surgical 
operation…. PRT 5 
… You see. Something had happened before so I don’t fear an operation. My wife was 
suddenly diagnosed with fibroid in 2002…. Finally, we went and they did the 
operation. It has not been long she has recovered… Therefore, I don’t fear an 
operation at all…PRT 7 
 
One participant reported that he was interested and preferred to have the cause of the 
predicament or problem removed at once through surgical intervention to been treated 
with chemotherapy. 
… There was no fear in me … I did not agree with been put on medication. Because of 
the problem they mentioned to me earlier, and he also stressed on it when I came to 
him. That problem must be removed so that I can be free. That is why I didn’t agree to 
be on the medication. If I had agreed on the medication, I believe by now I would have 
been tired or dead… PRT 3 
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4.3.3 Behavioural Attitude 
This sub-theme described the behaviour and commitment of men towards 
achieving early recovery from their ailment. The study showed that some participants put 
up desperate attitudes toward achieving early recovery. They started searching for a cure 
once noticed the changes in their health. They focused more on the activities and events 
that will facilitate and speed up their recovery. They tried every available intervention to 
achieve their normal stable condition.  
… I was like desperate to do whatever I can do to get relief … I tried several things 
eventually, I had to rash myself to a nearby clinic… that time I was suffering 
(Suffering). Severe pain so where I could pass to get relief is what I did… PRT 2 
… I am only sick. Whatever I can do to recover from this sickness is what I am 
doing…PRT 3 
 
However, few of the participants considered themselves very strong and resilient to some 
conditions hence developed a lackadaisical attitude and paid less attention towards 
immediate healthcare-seeking until the condition gets out of control.  
… Men are the type that when they fall sick, they don’t pay much attention to it … that 
sort of ego that they are strong and all these things that it makes people don’t care 
about it till it gets to place that they found out that they have to go… PRT 1 
 
Also, few men considered themselves busy to the extent that they considered waiting time 
at the hospitals for their turn of treatment as time-wasting. Hence, resort to self-medication 
by relying on the over the counter medicines.  
… Woooo. men you see men are always busy. Moving up and down. So, for a man to 
come and sit down for one hour waiting for a doctor to see him. No, no, no. So, he 
goes over the counter buys something to take and he keeps on moving… PRT 1 
 
4.4 Subjective Norms 
In response to the question “What are the subjective norms influencing the health-
seeking behaviour of men living with PCa?” Subjective norm was the main theme to 
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describe the perceived power of influence on the participants to engage in a behaviour.  
This influence emanated from the wife, children, friends, relatives, professionals, and 
significant others in the society at large intending to enforce compliance to perceive 
expectations or standards. Out of this theme, four (4) sub-themes emerged namely 
personal decision for treatment, financial considerations, counseling and recommendations 
from others, and motivation for herbal treatment. 
4.4.1 Personal decision for treatment 
Personal decision for treatment is one of the concepts of subjective norms. It 
described the personal determination and decisions towards health-seeking behaviour. 
From the data, most of the participants had no external coercion deciding for them when 
and where to seek treatment when they were sick. They solely decided on when and where 
to obtain their treatments.  
… There is no external pressure. Just that I decided to seek medical care… PRT 1. 
… It was purely my own decision… So that one there, let me say it was due to my own 
personal experience…PRT2. 
…. It was solely my decision to go to the hospital…. PRT 5. 
… Since I felt I could not urinate well, the urine was not flowing well, I decided to go 
to the hospital… I feel like I shouldn’t stay in the house for anything… I have to go to 
the hospital… it is not that I should wait for somebody to tell me… PRT 9. 
…. I have not sought anybody’s information before left for the hospital. Because I 
know that is where I can obtain treatment and attain healing. Therefore, I have to go 
to the hospital … PRT10. 
 
One of the participants confirmed that the nature of the condition did not permit him the 
luxury of time to be waiting on someone to instruct them regarding when, where to seek, 
and obtain healthcare.  
… The way and manner the disease came about … once you are in pain, every normal 
being once in pain, nobody will advise you before you go to wherever you can get 
help.… PRT 2 
 
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Additionally, some of the participants had taken most of the critical decisions regarding 
where, when, and what type of healthcare they wished to attain due to their positions and 
authorities they stamped in their families. Their wives continued to be submissive and 
follow their decisions to the latter. 
… I told my wife that I have to go to the hospital. She didn’t say anything but she 
agreed … PRT 6 
… I am the head. I am the head… I don’t fall sick and sought anybody’s decision 
before going to the hospital…. therefore, when any of my family member has fallen 
sick, I send him/her to the hospital… PRT10 
…. I live with only my wife…. she can’t say anything…. the reason why she cannot say 
anything is that the way I was suffering …. She also knows that that is the only way I 
can get a solution…. PRT 7 
 
One of the participants took this crucial decision on his own because he promised his 
children of living with them for long, never wanted to look up to anybody, and 
subsequently die young. He saw himself too young to die.  
… Huuuu. I am too young to die of this so I have to seek medical attention. I have to 
take the initiative… Because I promised my children that I will be a hundred plus 
(100+) before I will die ... PRT 8 
 
4.4.2 Financial Considerations 
This sub-theme described the role of the financial status of men in their health-
seeking behaviour. The study demonstrated that most of the participants were not 
financially sound to determine where to obtain desired care as well as who should provide 
the care. They did not have adequate funds to respond swiftly as they started experiencing 
the signs and symptoms of the condition.  
… I will say financial difficulties … Especially, financial difficulties. Because had it 
not for financial difficulties, just as you started noticing the changes and difficulties, 
you would have gone to the hospital for a checkup. But because you don’t have the 
money to go, you will continue to endure it that it will be fine. Therefore, it is financial 
difficulties… PRT 3 
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… The main thing that I will say probably delayed my coming here is finance, finance 
… it’s the finance… personally I am a pensioner, till the allowance comes, I can’t do 
anything… PRT 1 
… I cannot go any further where expenditure may be too much for me. Financial 
constraints. Yes, financial constraints… PRT 8  
 
One participant did not have money to pay for the initial cost of investigations to 
commence with his treatment. Even contributions from his children were not enough to 
meet the initial cost of treatment.  
… Finance was a problem. The first time the doctor told me to come with an amount of 
Four Million Old Cedis (₡ 4,000, 000). That a sample will be taken from there to 
Korle - Bu, I told my children. It was only one of them…They are not able to help. It is 
only W who gave me One Million Old Cedis (1, 000, 000) … PRT 8 
 
Another participant requested to know the cost of treatment. When the bill of treatment 
was served, he could not afford even half of the stated amount at the time. He, therefore, 
pleaded to have the least on him deposited whiles he goes to solicit for more funds to settle 
the rest later. But his suggestion was turned down by the healthcare facility authorities.  
… When I enquired about the operation cost, he said Seven Thousand Ghana Cedis 
(GHC 7,000.00). At this time, I was only having Five Hundred Ghana Cedis (GHC 
500.00). I pleaded to leave it with him and go home to solicit for some supports... 
Moreover, where will I get the remaining to add to it? And I was not having it… PRT 3 
 
Nevertheless, the participants with financial difficulties sought financial assistance from 
others. In the study, almost all the participants secured financial assistance of any kind 
from various sources to seek and obtain care. Most of the participants solicited and relied 
on financial assistance from their wives and children.  
… So yes. My wife supported me. Some of my children also supported me… PRT 2 
… Before we got there, my son has sent the money… PRT 3 
… In terms of finance, I have only been managing myself with some support from my 
children. They have been supporting me in the hospital until now…. PRT10 
 
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Also, some participants sought healthcare at certain designated facilities because they had 
total financial support from their employers. The company settled all the hospital bills 
incurred by the employees. Also, once they registered with the national health insurance 
scheme, most of the bills were covered and settled by national and private health insurance 
schemes.  
… for money wise there is no difficulty…I may say that in the company I work, anything as 
far as your health is concerned, the company will pay you … the health insurance always 
covers up for most of the costs or bills… most of the areas have been covered by health 
insurance… PRT 4  
… Once I registered with the national health insurance scheme, I know I will pay 
something when I get there but it will not be too much…PRT 6 
 
4.4.3 Counselling and Recommendations from others 
Counseling and recommendations from others is one of the concepts of subjective 
norms. It described the suggestions from people that matter on the participant’s position in 
their healthcare-seeking behaviour. The study has shown that participants had advice from 
many sources regarding the management of the condition. They had advice from their 
children, friends, health professionals, and some insurance companies.  
… She encouraged me to visit him [doctor] for a checkup to see whether there is an 
issue with the prostate…PRT4 
…. Then when I went to pension, I joined the Liberty Medical Scheme (private 
Insurance) so they told us that we could go for the treatment of the eyes and this 
prostate problem without any charge... PRT 1 
 
Again, few participants had been encouraged and admonished to seek early medical care 
or visit the specialist for a checkup to be aware of their health status whenever they are 
sick.  
… In our church, there is always teaching about taking care of ourselves… We should 
pray and seek medical attention whenever we are sick quickly to avoid anything worse 
from happening…PRT 8. 
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Also, one participant had been advised against the options of choosing herbal means of 
treatment, and he was motivated not to hesitate the option of surgical operation, should the 
need be, to have the problem solve once and for all. 
… If the doctor wanted to perform surgery on you, agree and endeavour to have the 
surgery done once. If the surgery is done, then you are free but if rely on the herbal 
medication, some will only solve the problem for a short period. Later, the condition may 
come back … PRT 4 
 
Furthermore, most of the participants were referred from their earlier facility of treatment 
to Sogakope District Hospital to obtain specialized care. Some participants have been 
referred with a referral letter from their earlier facility of care to receive specialized or 
advanced care.   
…When I went to him, he gave me a referrer to Sogakope District Hospital and that is 
where I start seeing the doctor, the specialist who has been seeing us here … PRT 2 
…When I got there, the doctor said, my condition can only be managed at the 
Sogakope District Hospital…So, he referred me to Sogakope District Hospital…PRT5 
 
Meanwhile, some participants walked in upon verbal information or recommendation from 
health professionals or through public education or lecture where they heard of the 
specialist. These people came to the facility requiring specialized care without a referral 
letter or authorization from a healthcare facility.  
… Yes. I heard of one Dr. A.H that he is a specialist… Because of him that he is a 
specialist that he can help me…. It was upon this that I was convinced that if I come to 
him, he will be able to treat me. Upon this that I decide to come… PRT 1   
… She said there is this doctor at their hospital called Dr (AH). He is a specialist 
urologist… PRT 4  
 
4.4.4 Motivation for Herbal Medication Usage 
This sub-theme considered the interest, the zeal, and the energy that drove the 
participants toward alternative medicine. The study revealed that almost all the 
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participants have first sought treatment at the herbal or alternative medicine centres in one 
form or another and later switched their course of healthcare-seeking to the hospitals. 
They sought these means for various purposes. Few of the participants first sought herbal 
treatment because of the persistent advertisement of the effectiveness of the herbal 
medicine on the radios by the herbal practitioners.  
… I was there first before I later went to the Sogakope District Hospital in the first 
instance…. I have been there for about 2 – 3 months before I went to the Sogakope 
District Hospital…. When the issue of frequency urination started, I listened to an 
advertisement of this herbal medicine on the radio inviting all those experiencing the 
signs and symptoms of the condition…. PRT 6 
 
Again, few participants asserted that men are naturally more inclined to and fascinated by 
the usage of herbal medication or alternative medicine than medical treatment. 
… Actually, the men or we the men, we are so much interested in those things than 
coming to the right place for the right treatment … PRT 1  
 
Although some participants had earlier been to the hospital and were kept on 
chemotherapy, when they later heard of or had the herbal medicine, they abandoned the 
medically prescribed medications and concentrated on the herbal medicine until it was 
finished. 
… I started with medically prescribed medications first. But when I started with the 
herbal medication, I stopped using the hospital prescribed medication… PRT 3 
… When I went to Medi Moses in the first instance, I have stopped taking the hospital 
prescribed medications… PRT 7 
… I sideline the hospital medication and concentrated on that one, till I finished it then 
I resume with the hospital medication… PRT 2 
 
Few of the participants reported that the underpinning circumstance that necessitated the 
decision and interest to sourcing other forms of treatment (herbal or alternative medicine) 
with medical treatment is to enhance the recovery process. 
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… In fact, the way I have suffered with the condition, I have looked for other drugs 
with the mind that once I take them the urethral should open…p7  
 
Also, some participants were not comfortable with the physical discomfort, worries, and 
embarrassment associated with some of the medical interventions especially indwelling 
catheterization. 
… I thought of it (catheter). I wonder how I will be walking. Is it that I will be carrying 
the urine bag along? I thought of it. I have also realized that when you come to sit with 
people who have a catheter (rubber) insitu, you will be smelling some odour. I wonder 
if I will not suffer the same …. PRT 5 
… I want relief because at that the catheter was in me. Because me, I wasn’t 
comfortable with it… PRT 2 
 
Besides, few of the participants perceived healthcare-seeking at the healthcare facilities 
such as hospitals as excessive time-wasting. Men considered themselves so busy and 
ascribed much knowledge or consciousness of the value of time. They had no time to 
either travel to healthcare facilities to obtain care or wait for their turn of service at the 
hospitals. Therefore, resort to herbal medications / alternative medicines or over the 
counter medications for the treatment of their condition. 
 
… Woooo. men you see men are always busy. Moving up and down. So, for a man to 
come and sit down for one hour waiting for a doctor to see him. No, no, no…. Many 
people just go there, buy those drugs and they take…. they buy those things there that 
they wouldn’t travel. They will not come and stay here for a long time before they get 
treatment and then they take those things…. So, he goes over the counter, buys 
something to take…. PRT 1 
 
In addition, some participants used herbal medication because it was suggested and 
sanctioned by their relatives. 
… I have a sister who told me that the husband knows some herbal treatment … I was 
actually undergoing treatment before my sister also came out with herbal medicine … 
That one is the only one bottle my sister recommended …PRT 2 
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… One man from the town came to me that he is a herbalist… He is preparing herbal 
medication for people… he had used his prepared medication to treat a lot of people at 
various places.  One of my grandson’s had led him to me… My grandson also insisted 
that the herbalist must prepare his medication for me… I said all I had but he 
[grandson] insisted … PRT 3 
 
However, few of the participants detested the herbal medication usage and threw his 
preference for an allopathic form of therapy. They claimed that herbal medication lacks 
prescription precision, is absurd, and incongruent with the standard system of 
measurement.   
… With the herbal medication, I am out … some people even opted to prepare for me 
some herbal medications and I refused… I don’t personally believe in those herbal 
medications… Because they have no standard of measurements. They will only say 
drink one cup meanwhile what’s happening you are not supposed to drink one cup. But 
once you are instructed, you will be forced to drink… PRT 4 
 
Another participant added that herbal medicine lacks prior standard investigations 
suggestive of the decisive prescriptions. The prescribers conducted no such necessary 
investigations that require a given medication or dosage. 
… The herbal medications I bought from here, not that they have conducted any 
examinations on me before sold them to me. They only said it stops the frequency of 
urination. They have not done any examination…. PRT 6  
 
4.5 Health-related factors influencing the intention to seek healthcare 
“Health-related factors” is the added theme that has emerged from the finding. It 
sought to answer the question “What are the health-related factors influencing the 
behavioural intention of men towards healthcare-seeking?” The health-related factor was 
identified as a major theme because it was revealed from the study that health-related 
factors have also contributed massively to the participants' decision making leading to the 
intention to seek healthcare other than the attitude and subjective norms ascribed to in the 
model. However, patient’s exposure /maturity, and cultural beliefs come under this 
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heading. Five (5) sub-themes emerged from the data namely healthcare accessibility, 
effects of clinical manifestations, professional competence, maturity and exposure, and 
cultural factors.  
4.5.1 Healthcare Accessibility 
Availability and accessibility to healthcare facility provides a boost to men’s 
healthcare-seeking behaviour. The data indicated that few of the participants chose to 
obtain healthcare at a certain healthcare facility because it was closer to their environment.  
… When I was registering for a national health insurance scheme, they asked about 
the hospital I will attend when I am sick and I mentioned that hospital… because it is 
closer to me… PRT5 
…. Because this place (IHDN Hospital, Adzadokpo) is closer to my hometown, if I am 
at home and keep visiting them for treatment, it will be better. That is why I have 
stayed back and keep going to the hospital…PRT10 
 
However, some of the participants claimed that they accessed healthcare at the healthcare 
facilities not because they were close by and easily accessible. They rather heard of the 
competencies of healthcare professionals and trusted that their competencies will facilitate 
their recovery. 
… I’m closer to Comboni Hospital than the Sogakope District Hospital…. Because of 
him that he is a specialist that he can help me…. It was upon this that I was convinced 
that if I come to him, he will be able to treat me. Upon this that I decide to come… 
PRT 1 
…. From here to Sogakope is a distance. We have a health centre here. But since I 
know that the Sogakope district hospital, I will be treated well I decided to go… PRT 9 
 
Again, few of the participants accessed healthcare only because they were sick and needed 
to recover. They neither accessed these healthcare facilities due to its closeness to their 
environment nor had any advanced information about the professional competencies. 
… I am only sick. Whatever I can do to recover from this sickness is what I am doing. 
Not because the hospital is close by…PRT 3 
… Even if you were somewhere else, you see, what had happened to you any part of 
the body can drive anywhere you want to go to…PRT7 
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4.5.2 Effects of Clinical Manifestations 
This sub-theme demonstrated the effects of symptoms on men’s decision-making 
process toward healthcare-seeking behaviour. The study revealed that participants 
experienced several and varied clinical signs and symptoms of their conditions such as 
“pain”, “feeling uneasy”, “sperm or gel-like urine”, “frequent urination (4 - 6 at night)”, 
“retention of urine”, “delayed urine flow” and “distention”.  
… I started feeling some uneasiness in my genitals and also in my groin … Sometimes, 
the urine comes with some sort of I don’t know whether it is sperms or gel-like that 
and then it will stop… PRT1 
… The urine delays for sometimes before begin to flow. It even begins flowing small, 
small before finally begins to flow…PRT5 
… In the night when I wanted to urinate, the urine refuses to come out …. PRT3 
 
The most dominant of these clinical manifestations was the pain. Some participants 
described the intensity as “severe”, “unbearable”, “burning” and “Indescribable”.  
… On the night of this day, I was in this severe pain until the following day… the pain 
was becoming unbearable… it become extremely difficult … PRT 3 
…. When the condition started, the pain associated was very unbearable … PRT 7 
…. Burning pain in the lower abdomen…. Burning pain, burning pain and at a certain 
point a whole day, a whole night. No, no, no…. PRT 8  
 
From the data, most of the participants sought healthcare at the various health care centres 
due to the intensity of the pain.  
… But in my case, the way and manner the disease came about, you have no other 
alternative than to rush to the expects [healthcare professionals]… Pain. Pain. Pain. 
What I am saying now I don’t know how to describe it… PRT 2 
… Due to the severity of the pain, during these periods, I never knew how I got to the 
hospital… PRT3 
… Certainly, I went to the hospital because of the pain associated with the 
sickness…PRT 5 
…. The level of pain I experienced was too much for me. So, I became scared that I 
may die that is where I rushed to the hospital… PRT 7 
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One participant claimed that the degree and the intensity of pain experienced caused him 
to lost hope of survival and thought his time of death was at hand. It took the timely 
interventions of the health team to still have him alive. He would have been died and gone 
long ago, had it not for health professional’s timely interventions.  
… Had help not come the next 20 to 30 minutes. I don’t think I will be here talking to 
you. The pains cannot be described… I was sweating all over and I knew my time was 
due. Had help no come that material time, it could have been a different story… PRT 2 
 
4.5.3 Professional Competencies 
Professional qualities and attributes encouraged men in their health-seeking 
behaviour. The study revealed that some participants sought and obtained healthcare at 
certain designated healthcare facilities due to the professional characteristics, qualities, 
and competencies exhibited by the professionals towards them. The manner the 
professionals approached and addressed their concerns motivated them to continue 
seeking healthcare at these facilities or insisted on been attended to by those particular 
specialists. 
… He is very free… He is free to extent that when you get to him, he will give you a 
listening ear… He is not the type that is harsh on his clients… He is the type of person, 
that is free and the way the situation is with you he will allow you to express it…. With 
this, you are always happy…. PRT 4 
… Wooo. In fact, the specialist, he has got time for me. Well, I don’t know whether it 
happens to me alone. Whenever I go to him, he has got time for me and ask me 
questions. Then give me advice as to how I should hold myself. So, I don’t have any 
fears…. PRT 9 
 
Meanwhile, some participants had neither special preference based on previous encounters 
with the healthcare professional nor information referenced to the healthcare professionals. 
They just have to seek care at these facilities for professional attention because their 
interventions have failed them. 
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… I tried several things eventually, I had to rash myself to a nearby clinic… PRT 2 
… I have tried all that I could do to urinate but they all failed. I bathed and drunk 
some water but the urine has not come. I entered my car and drove to Sogakope 
District Hospital to inform them of what was happening to me…PRT 7 
 
Again, one participant even though went to the hospital for treatment, but did not wholly 
trust the competencies of the medical team. He was only counting and trusting God for the 
manifestation of his healing powers. He believed that God is the overall healer. He created 
the heaven and the earth. He bargained with God to take his soul if he knows that it’s his 
time to leave the world.  
… At this particular time, I was only hoping for God. Because he is the maker of 
heaven and the earth. If he is aware, I worship him solely and wholly and believe in 
him, then he should heal me… but if he knows that the time is due for me then I can 
die… PRT 5  
 
4.5.4 Maturity and Exposure   
This sub-theme focused on the influence of participants’ maturity and exposure in 
their healthcare-seeking behaviour. From the data, some of the participants assumed total 
responsibilities for their health by deciding on when, and where to assess healthcare due to 
their maturity and exposure in life. They claimed that they were matured enough to be 
responsible for their health, and contributed significantly to the major decisions regarding 
where to obtain care, and who should provide the care.  
… Yes. I am old enough to know that this is wrong with me so I should seek medical 
attention … Yes, so my age also … PRT 1 
… Eeeeee… I am old enough that is why they cannot decide for me … because I am 
well educated and exposed …PRT 8  
 
However, one participant believed that a participant’s age as in numbers cannot play any 
significant role in determining and choosing a place to seek healthcare. An elderly person 
who had no exposure and advanced knowledge in the strength and competencies of the 
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healthcare facility and level of expertise of the professionals cannot make this all-
important decision.  
… I can only say exposure. You can be old. You can be hundred years meanwhile you 
have not had any experience with medical or health professionals, I don’t think your 
age can maybe direct you to such thing… PRT 2 
 
Again, a participant claimed that he sought healthcare not because he was matured enough 
to assume responsibility for his health or experience in life. He was not also scared of 
death. He was motivated to live long to ensure that the children are gainfully employed 
and financially independent in the future. 
… The only thing I keep on praying for is that God should help and provide my 
children with a job. Once that is achieved, it is fine. If I die today is good. I believe the 
best I can do I have done it. God is aware that I have done my best…PRT4 
 
4.5.5 Cultural Factors 
Cultural belief is one of the concepts under health-related factors influencing the 
health-seeking behaviour of men. In the study, some participants had declined to the 
consideration and the influence of cultural practices in their determination of issues 
concerning healthcare.  
… No, I don’t consider any cultural issues. I don’t deal with issues of culture … PRT6 
… In fact, I don’t really believe in superstitions… going to this African culture, going 
to the soothsayers to find out what might be the cause of this or that no, no, no… I 
don’t indulge in all that…. PRT 8 
 
One participant reported that some relatives suggested the performance of some cultural 
practices to ascertain the right of treatment, seek blessing and favour from their gods but 
he declined. This enraged the relatives and brought a misunderstanding between them.   
… No, no, no. however, my nieces, sisters, brothers, and cousins suggested the 
performance of certain cultural rites but I declined. I don’t live with those things hence 
my refusal to succumb to their suggestions. Their suggestion was to an extent that it 
generated misunderstanding between us… PRT 5 
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Few participants held the view that issues of cultural practice in health-seeking provide 
misleading information, and involve wasting of funds and resources. There is no 
consultation with the gods without the request of sacrifices and rituals which invariably 
demand money. Meanwhile, the main constraint in the condition was funding.  
 …. there is no way they will perform their rites and there will be no message from the 
gods and no ritual activities to be performed…. [Laughter]. They will be saying a 
whole lot meanwhile you don’t have the money to go to the hospital for treatment. 
They will ask you to buy fowls, goats, and others for some rituals to some gods. You 
will have all these perform yet the problem will persist… PRT 5  
 
Again, some participants believed that although health professionals die, with their 
professional advice and knowledge of treatment, the life of a sick person can be 
prolonged. They deemed health professionals as gods on earth. Therefore, assumed it is 
better to seek for health directives from the health professionals. This is because health 
professionals’ directives with God’s grace, will enforce recovery than to rely on 
superstitions. Reliance on superstition may only lead to death. 
… “Though a doctor dies of a disease yet by medicine life can be prolonged” …. Go to 
the people who know or who are trained with our human problem. Go to them to 
advise you…. going to the soothsayers to find out what might be the cause of this or 
that no, no, no…. In fact, I don’t really believe in superstitions…. these superstition 
and other things may not help you go anywhere. You will only die…. PRT 8 
… I convinced myself that whatever that happens is the wish of God, yet some are 
temptations. Any of them that happens to you, you have to hope on God. Doctors are 
the earthly gods. When you are sick, you will go to them [hospital]. When you go to 
them and they diagnosed the condition and start with their treatment, and when God 
agrees and permits, you will recover…. PRT 10 
 
However, one participant accepted and demonstrated the roles of cultural practice in his 
healthcare-seeking behaviour. He consulted with the gods, performed some rituals and 
sacrifices to seek the right course of treatment in the condition, and asked for favour and 
protection in the scheduled surgical operation.  
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… I went to enquire to find out the right courses that I have to take to undergo successful 
operations… I have performed some rituals and sacrifices to the gods for successful 
operations… PRT 3 
 
The study further revealed that participants adopted various approaches to seek 
involvement and blessings of God in their healthcare. Most of the participants attempted to 
manage their condition through continuous prayers to God through Jesus Christ. They 
believed that God has created heaven and earth as well as man and living things. 
Therefore, he has the power to change everything. They prayed to command the enlarged 
prostate to reduce or decrease to normal size because Jesus Christ has given them power 
over all sicknesses.  
… So, I prayed for some time. Pray, pray… I pray in the name of Jesus… Praying with 
the idea that the Lord himself has given me power over all sickness. So, I pray to cast 
it out… I command the prostate to reduce to normalcy for some time…PRT 1 
… The day the incident started, I was at the bathroom, I have prayed…. I have not 
ceased praying. I have been praying…PRT 7 
… You see, I am the Catechist of the local church here. Many people were coming, 
coming, coming and coming. Preaching, prayers upon prayers, prayers upon 
prayers…. PRT 8   
 
4.6 Behaviour Intentions 
This section sought to address the question “What are the behavioural intentions 
of men living with PCa toward health-seeking?” Behaviour intention was also considered 
as a major theme to describe the mental readiness of a person to engage in a behaviour. 
The mental readiness of the participants was informed by their awareness of the likelihood 
of positive outcomes, prior educations or exposure, past experiences, and desire for precise 
treatment decisions.  The sub-themes that were emerged from the behavioural intention 
were hoping for treatment, and information seeking. 
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4.6.1 Hope for Treatment 
This is one of the concepts of behavioural intention. It described men’s motivation 
to seek and obtain healthcare at a given healthcare facility. In this study, participants 
rushed themselves to the healthcare facilities after their interventions failed. They went 
with an expectation of professional expertise that would relieve them of their 
predicaments. 
… I tried several things eventually, I had to rash myself to a nearby clinic… PRT 2 
… I only intended going to the hospital for medicine for the sickness to stop… PRT 4 
 
Few of the participants reported immediately to the hospital for treatment as they observed 
the clinical manifestations of the condition.  
… I have not delayed healthcare seeking. Because just as it started, then we started 
attending hospital for treatment. We went to the hospital…  As we have heard of the 
surgeons here, that was why we have come … PRT10 
 
Few of the participants also visited several hospitals because they had not realized the 
desired and expected improvement in their condition after undergoing the prescribed 
treatments. 
…. At first, when I started urinating often and often, I realized that the rate is 
becoming too much. So, I went to the Sogakope District Hospital… at the hospital, I 
told them the rate at which I have been urinating but they have not confirmed to me 
that it was due to prostate problems but they have just given me some medications. 
After taking the medication, the rate of urinating was not changing so I went to 
Kpando Margaret Marquart Hospital…. PRT 6 
 
A participant reported that he had visited several hospitals with the hope of accessing the 
desired specialized treatment. But due to a lack of right information regarding the 
designated facility to access the desired specialized and advanced treatment led him to 
several hospitals.  
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… I was rushed to the hospital in Tema … they referred me to Ashaiman Hospital… 
they picked me to Battor Catholic Hospital… they directed us to the Sogakope District 
Hospital…PRT 3 
 
However, one of the participants delayed treatment to later days by dodging the specialist 
who suggested further investigations for the confirmation of the diagnosis. 
…. It started when I feel that there are certain things wrong with me. I used to urinate 
regularly which is abnormal… So, I went to seek medical advice at the Sogakope 
District Hospital with the specialist, and he told me to bring an amount so that a 
sample will be taken from somewhere and send to Korle - Bu for analysis to see if 
there is something developing there as cancer. So, in fact, I started dodging that 
hospital. I have no more been going there. Eventhough, this thing persists. I have not 
been going there. I always go to Comboni Hospital. When I complained, they also 
advised me to see the specialist at Sogakope district hospital but I don’t normally 
go…. PRT 8 
 
4.6.2 Information Seeking 
This sub-theme illustrated men’s knowledge sources regarding healthcare. In this 
study, participants sought information from various sources about their condition. This 
information ranges from the place of care to the intervention option. Some participants 
sought information from friends, relatives, and health professionals.  
… I have sought information from people about what was troubling me and they 
advised me to go to the hospital … fortunately, there was this nurse that came 
around… I informed her of my problem…then she said there is this doctor at their 
hospital. He is a specialist urologist… PRT 4 
… The doctor told me that they can remove it through surgical operation but they 
don’t perform such surgeries here. But at the Sogakope District Hospital, there is a 
specialist urologist and when you go and it is necessary, they can remove it…. PRT 10 
 
Two participants sought information from known patients who were experiencing the 
problem or have experienced the problem and have successfully recovered. 
… These people that were suffering from prostate conditions and I enquired from them 
…. They mentioned to me that the doctor at the Sogakope District Hospital is a 
specialist in prostate conditions (urologist) …. Yes. I sought information from people 
especially those that have suffered the condition… PRT 6 
… I heard from people who had the problem… PRT9 
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Furthermore, some participants claimed to have read about their condition. 
… I read a little about it … whenever I go to the hospitals and I see the posters, I go closer 
to them and read to add to it…PRT1 
… I have been reading pamphlets and posters along the hospital walls… PRT2  
 
While some participants learned about their condition from radio and television sets. 
… I have been hearing all this on the radio… I have been listening to these sorts of 
education on the radio all the time…PRT 6 
… I heard people talking about it on Tongu FM…PRT 1 
… I have viewed it on television for some time…PRT 9 
 
4.7 Behaviour of men towards health seeking  
This theme is directed at answering the question “How is the behaviour of men 
living with PCa towards healthcare-seeking?”  The study revealed that the participants 
demonstrated several actions towards healthcare seeking. These actions assumed diverse 
forms. Some of these actions were openly or closely exhibited. As a result, four 4 sub-
themes emerged from the theme namely personal management, secrecy, medication 
adherence, and combination of treatments. 
4.7.1 Personal Management 
This sub-theme described the various interventions employed by men with PCa in 
alleviating symptoms of their condition. The data indicated that during the onset of the 
condition, almost all the participants had undertaken various interventions to relieve 
themselves of the unexpected and unbearable clinical manifestations of the condition. Few 
of the participants applied Robb ointment to the areas to relieve the associated pain. 
… I applied Robb (ointment) on it for some time and then it goes off …PRT 1 
Few of them also applied warm compresses to some areas of the body where their pains 
were allocated. 
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… I performed warm compresses around the lower abdomen and waist… PRT 5 
One of the participants reported that he bathed several times thinking that it was due to the 
insufficiency of the water, and drank more fluids for instance water to apply more pressure 
on the area to open or to enhance the flow of urine. 
… Honestly, I bathed and bathed… for bathing, it was not only once. I have bathed 
thinking that the water was not sufficient that is where I was not able to urinate… I 
drank water too, on several occasions…PRT 7 
 
Most of the participants have taken some herbal concoctions either self-prepared or 
prepared by the relatives to relieve them of the pain accompanying the urine retention or to 
open up the urethral for the urine to flow out. 
… As I started having frequency in urination, all the herbs that I know that treat 
frequency of urination, I prepared them and used them…. PRT10  
… He told me to go and get penicillin and palm wine. When I use it, I will be fine… I 
mixed one bottle with the palm wine and took… PRT 3 
… I started shouting for help… Various people came with their herbal medications for 
me to take and I took…PRT 5 
However, one participant did nothing at home but rushed to the hospital for intervention. 
… I have not done anything. I just went to the hospital at once…PRT 4  
4.7.2 Secrecy  
Secrecy is one of the concepts under behaviour. The study indicated that few of the 
participants considered their sickness as an issue of privacy and secrecy. They viewed 
discussions centred on and surrounding their condition as a gross exposure of man’s 
masculinity and issues of private content to the society.  
… This sickness is something like you are exposing your sexual ability or inability to 
the public. So, I didn’t tell friends that this is worrying me. Sometimes at church, they 
talked about it but I didn’t come out boldly that this is my problem… It is privacy … I 
will find it very much unusual to go and be telling people what is happening to me. I 
cannot urine, probably my wife’s refusal for sex, and all those things might have 
caused this thing. I don’t feel easy telling people so I didn’t tell anybody…PRT 1 
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Moreover, one of the participants felt ashamed of discussing or mentioning their condition 
to people. Due to his positions in the society coupled with his job, he was afraid of societal 
negative interpretations. He presumed that people may wrongly judge him contracting 
sexually transmitted infections (STIs) especially gonorrhea through his amorous sexual 
activities with his secret numerous sexual partners. Hence, he preferred total silence over 
his condition to avoid public ridicule.  
… Not for me alone. Among males’ sicknesses, the most common one is gonorrhea. 
That is what people know so if you go mentioning some conditions, once people do 
know of it, they will take it for granted and once I am a pastor, they will associate their 
interpretations to it [gonorrhea]. They might say that he is not holy. He keeps on 
sleeping with women and contracted gonorrhea… For the type of sickness, anytime I 
go to give testimony for people to know the particular condition I suffered, I don’t say 
it...PRT 7 
 
However, the majority of the participants did not feel ashamed or stigmatized speaking 
about their condition. They believed that sickness is natural, inevitable, and can affect 
anybody at any time as well as families.  
… Wooo no. as for sickness, it can come at any time. So, I don’t feel anything. I feel it 
is a normal issue… when it happened? Ah! Yes. Whoever comes to me I told him what 
actually happened to me… PRT 9 
…  It didn’t induce any feeling of shyness or stigma. Those that are familiar I told 
them especially, my wives… this sickness does not make me shy in any way. The 
education about it made me to understand that it is natural… PRT 6 
… In my case, there is no shyness because sickness can affect any part of your body. If 
you have not committed any sin or offended anybody and you have fallen sick, there is 
no need for you to be ashamed of it... PRT 10 
 
Some participants wonder why they should be ashamed of sickness. They easily share 
their condition with people especially those that are familiar with them. 
… Oh. How can I be ashamed of sickness? Not at all …p3 
… Nothing, nothing, nothing. Nothing at all. Nothing at all. I don’t feel shy or 
stigmatized when talking about it… PRT 8 
… Woooo. No. the way I have gotten healing, so I wish for everybody…Wooo. I have 
been telling my colleagues… PRT 4 
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4.7.3 Medication Adherence 
          This sub-theme describes the commitment and reliance of men on the medical 
directives. In the study, most of the participants adhered to the treatment regimen by 
keeping to medical treatment directives and review dates.  
… I am only on the hospital prescribed medications… PRT10. 
… Presently yes. Now, I am solely on the hospital medications… PRT2 
… I have been regular.  The doctor will give me an appointment to see him at the 
clinic which I have been doing to date… PRT2  
 
However, the participants expressed various reasons for their medication adherence.  
Some participants followed strictly the treatment regimen directed by the medical 
healthcare professional because they had no other means of treatment, and had seen it as 
the only means of survival and good health hence, struggle to achieve it. 
 … I didn’t have any personal treatment for this. No. I didn’t… PRT 1 
… I believed that it is only the doctor who can treat men … PRT2 
… Because I am also struggling to be healthy…. because of that any appointment date 
that is given… I don’t skip or miss it. I am always there, and regular… PRT 4 
 
But due to the challenges associated with the condition, few of the participants did not 
adhere strictly to the medically prescribed medications. They explored other forms of 
medications as well. 
… Honestly, the way I have suffered with the condition, I have looked for other drugs 
with the mind that once I take them the urethral should open… PRT7 
 
4.7.4 Combination of Treatment 
In the interview, most of the participants out of desperation for cure and quest for 
early relief from the difficulties associated with the condition, mixed medically prescribed 
medication with the herbal medications. They used the two forms of medication 
concurrently.  
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… I tried a couple of that herbal medication alongside the medical treatment… PRT 2 
… I combined all the medicines given to me at the hospital and that of the Medi Moses 
herbal medicinal centre …. PRT 7 
… I may say, I relied only on the hospital prescribed medication. But since I know 
some herbals, I do prepare those herbs to take…PRT10  
 
Some participants abandon the medically prescribed medications completely for herbal 
medication. They then resumed the administration of the medically prescribed medications 
when they had finished with the herbal medication. 
… I started with medically prescribed medications first. But when I started with the 
herbal medication, I stopped using the hospital prescribed medication. Because I 
cannot mix the two medications… PRT 3 
… I was having the hospital prescribed medications. So, as I was using it [herbal 
medicine], I stopped using the hospital medications. It was when I have finished using 
it [herbal medicine] and I went home, was when I went back to the hospital… PRT 6  
… I have stopped taking the hospital prescribed medications…. PRT7 
 
However, one participant also used some forms of herbal medications concurrently with 
medical medication. The intention was not to treat the underlining condition but to rather 
promote good living and health. 
… These medicines are not directed to treating the particular condition but they are 
herbal medications for good life… to enhance healthy living I use these herbal 
medicines… PRT 6  
 
Furthermore, some participants never break the administration regimen of the medically 
prescribed medications. They were committed and religiously followed the administration 
regimen until the dosage has finished. As they waited for the date of review for the new 
set of medications, that they switched over to the locally prepared or herbal medication. 
They used the herbal medication as a stop-gap measure to wait for their review date. 
… Let’s say they give me 2 months to come for review when I finished with the 
medicine, I then go to concentrate on this herbal one… PRT 8 
… For hospital medication, they have given me some periods and directives regarding 
how I should administer it so for my self-prepared herbal medicines, I have been using 
them on different days before the days of the hospital prescribed medications… I drink 
it before I continue with the hospital medication….  PRT 10 
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4.8 Finding Summary  
A total of 10 participants living with PCa with ages of 60 – 68 took part in the 
study. With the guide of thematic content analysis, five (5) themes emerged from the 
health-seeking behaviour of men living with PCa. From the study, the participants 
demonstrated both positive and negative attitudes toward health-seeking behaviour. The 
study revealed that the participants exhibited these positive attitudes because they believed 
in the health system, they were afraid of delayed adverse effects of the condition, and 
desire to regain their normal state of health. However, the negative attitudes were due to 
the high treatment cost and the ignorance of the early signs and symptoms. 
Socially, the participants experienced no external pressure determining their 
directions of treatment. The final decisions regarding directions of treatment and treatment 
choices were made solely by the participants. They had absolute control of this decision 
because they were mature and more exposed. Moreover, the participants enjoyed massive 
financial and emotional supports as well as recommendations from their social network. 
These supports encouraged and facilitated a lot in their pursuit of a cure. Nonetheless, 
some participants were sceptical and feared for societal perceptions and misinterpretation 
of the condition of their condition as such kept it secret, and resort to self-medication.      
Also, health-related factors such as healthcare accessibility, effects of clinical 
manifestations, professional competence greatly influenced the health-seeking behaviour 
of men. From the study, most of the participants sought health care because the facilities 
were close by, or due to the worrisome effects of the clinical manifestation of the 
condition, or they were inspired by the professional competencies. Interestingly, however, 
cultural perceptions and views did not play any role in influencing the health decisions of 
the participants. The participants did not consider any views of culture in their health 
decision making relative to their healthcare-seeking. 
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Furthermore, all men living with PCa intended to secure treatment to enhance their 
survival. But lack of knowledge about the condition and where to access the desired 
treatment had forced participants to seek information. Most of the participants sought 
information from their social networks, health care professionals, and known people 
suffering from the condition. Moreover, the study indicated that some participants also 
reported at the hospital for medical assistance because their known interventions failed 
them or had no knowledge of managing the condition.  
Finally, the study showed that all participants accessed conventional treatment. But 
the struggle for survival has compelled some participants to seek other forms of treatment. 
While some participants however abandoned the conventional treatment for the non-
orthodox treatment, some participants used both forms of treatment concurrently. Even so, 
some participants used non-orthodox treatment because it was sanctioned by the 
significant others. 
 
 
 
 
 
 
 
  
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CHAPTER FIVE 
DISCUSSION 
The study explored the healthcare-seeking behaviour of men living with PCa in the 
Volta Region of Ghana. The Theory of Reasoned Action by Fishbein and Ajzan (1980) 
was employed as a theoretical framework to structure the work. Considering both the 
objectives of the study and the constructs of the theoretical framework, the discussion of 
this study is structured under the themes that emanated from the study such as attitude, 
subjective norms, health-related factors, behavioural intentions, and behaviour. 
To set the ball rolling, a brief discussion of the demographics of the participants 
was done followed by the discussion of the major themes as well as the sub-themes. 
5.1 Demographic Characteristics of the participants  
The ages of the participant in the study ranged from 60 – 86. This age range is 
consistent with other studies in the literature (Harvey & Alston, 2011; Hoffman et al., 
2018; Medina-Perucha et al., 2017). This indicates that this condition is mostly found 
among the older population (Fish et al., 2015; Forbat et al., 2014; Medina-Perucha et al., 
2017), and the chance of an individual developing the condition increases significantly as 
the individual aged 45 years and above (Bechis, Carroll, & Cooperberg, 2011; Vickers et 
al., 2013). This implies that men between the ages of 45 and above should be encouraged 
to be regularly screened for prostate disorders especially PCa.  
In terms of religion, almost all the participants 9 are Christian and only a 
participant is a traditional religious believer. This showed that majority of the population 
in the Volta Region for that matter Ghana practice Christianity. This was confirmed by the 
Ghana Statistical Service in the last population and housing census conducted in 2010. 
About 71.2% of the population are Christians (Nortey, 2013). Irrespective of religious 
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affiliation, most of the participants have a religious interpretation of the condition. This 
suggests that spirituality influences the interpretation of health conditions as reported by 
other studies (Taylor, 2019; Visser, Garssen, & Vingerhoets, 2010). People engaged in 
various forms of prayers to seek God’s healing, interventions, favour, and direction in 
their healthcare-seeking. This suggests that religion prepares men to accept, and 
strengthens their faith to cope with their conditions better (Bowie et al., 2017).  
Regarding education, most of the participants of this study had a formal education 
of different levels with 3 of them obtaining a university degree. Only a participant had no 
form of formal education similar to other studies (Abubakar et al., 2013; S. Dotson et al., 
2015). This is perhaps because most of the participants are from urban areas of the region 
where education is highly appreciated and cherished. This, however, has not been 
manifested in their desire and interest in early health-seeking to be abreast of their health 
status. This opposed the finding that education prepares individuals adequately to function 
on their health decision making towards healthcare intervention seeking as well as health 
promotion (McCoy et al., 2011). Most of these educated participants demonstrated a 
complete lack of prior knowledge of the condition. This is in contrast with the assertion 
that men with higher educational levels have much knowledge of their conditions and 
prefer early treatment than counterparts of less educational level (Zhang et al., 2015).  
Given the period of living with the condition, few of the participants lived with the 
condition for the period between 3 - 6 years while most of them lived with it for just one 
year. In this, half of these participants were kept on chemotherapy while the remaining 5 
participants had undergone surgical operations. This agrees with the previous study by 
Zeliadt et al. (2010) that out of 198 newly diagnosed men with PCa, 59 % of them chose 
surgery while 41% opted for chemotherapy. This means that newly diagnosed patients 
with a first stage or second stage cancer are managed on chemotherapy to suppress the 
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growth of the cancer cells. And those diagnosed with advanced-stage cancer can only be 
managed with surgical intervention. Therefore, the need for men within the risk age 
groups to regularly go for checkup for early detection and treatment to avert 
complications. 
All the participants are married with many children similar to the literature 
(Ettridge et al., 2018; Medina-Perucha et al., 2017). Most of these participants have 
children ranging from 5 to 24. Only a few of these participants were having 2 and 3 
children respectively similar to the literature (Abubakar et al., 2013; Moe Dr. et al., 2012). 
Most of these participants with larger family sizes reported to the hospital with an 
abnormal frequency of micturition while those with little or smaller family size came to 
the hospital with retention of urine with abnormal pain intensity. This invariably implies 
that men with larger family sizes engaged in more sexual activities which reduced their 
risk of the condition than men with less family size. Because high sexual activities per 
month protect men against PCa (Foley, 2015). 
5.2 Attitude of men Living PCa towards Health-Seeking Behaviour 
The study showed that men displayed both positive and negative attitudes toward 
health-seeking behaviour. The attitudes exhibited are consistent with other studies in the 
literature (Frijters et al., 2012; Seidler et al., 2016; Teo et al., 2016). This implies that 
although the attitude of men towards health issues is subjective, it is dependent on the 
participants’ evaluation of the situation based on their knowledge. For instance, men with 
adequate knowledge of PCa and its delayed treatment effects are always zealous to 
undertake early screening or treatment than counterparts with less knowledge (Yeboah-
Asiamah et al., 2017; N. Zhang et al., 2015). This means that the government and health 
institutions should regularly embark on educational campaigns to broaden the knowledge 
base of men on male-related conditions especially PCa. 
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The study again tried to gain a better understanding of the health-seeking 
behaviour of men with PCa, and noticed that the belief system influences the health-
seeking behaviour of men (Singer et al., 2016). The finding revealed that most of the 
participants sought orthodox healthcare because they believed in the health system. The 
participants believed that orthodox facilities have the professionals trained and equipped 
with the necessary skills to treat them. This finding is contrary to the previous study that 
views orthodox treatment as mechanical, disappointing, and too toxic. It concludes that 
doctors are not the only intelligent people on earth as such do not trust their judgments 
(Griffith et al., 2011). This disparity may be due to cultural variations of the participants. 
Gyasi et al (2016) stated that peoples’ belief system drives them towards treatment 
modalities that are in harmony with their belief system. Therefore, healthcare 
professionals should consider the role of the peoples’ belief system in the planning and 
formulation of health policies. The implementation of these policies should conform to the 
dictates of the belief systems. 
Again, the study revealed that some participants only saw orthodox treatment as 
the last resort after been disappointed with non-orthodox treatment. This finding is 
consistent with the other findings in the literature (Ng et al., 2013a; Yarney et al., 2013). 
This confirms the men’s vulnerability that results in negative attitudes such as masking of 
symptoms, and deferment of healthcare-seeking (Clement et al., 2015). This is due to an 
inherent fear and misconceptions of the medical procedures and perceived treatment side 
effects (De Sousa et al., 2012; King et al., 2015). Men become sceptical about the 
treatment process (Seidler et al., 2016; Teo et al., 2016) and wish to visit the hospital with 
only serious medical problems (Griffith et al., 2011; Ng et al., 2013b). To effectively 
alternate these negative perceptions among men, the healthcare professional should 
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encourage open discussions where men’s misconceptions can be addressed to demystify 
their fears.  
Furthermore, the behavioural attitudes demonstrated by the participants to ensure 
recovery from their condition contradicts the earlier findings that men exhibit poor attitude 
towards healthcare-seeking (Nakandi et al., 2013b; Quillin et al., 2018; Thompson et al., 
2016). The disagreement in these findings may be attributed to the inaccessibility of 
healthcare and lack of knowledge of where to access the desired healthcare. Indeed, the 
instinct of self-preservation actuates men to traverse every length to access health should 
the place of desired health service is known (Frey, Savage, & Torgler, 2010).  
Again, Nolting (2020) noted that men are motivated to seek healthcare at a 
designated facility because of the available information about the facility or professional 
characteristics. Lack of accurate information about a place of care and or on professional 
competences greatly affects men’s health-seeking behaviour. Agyemang-Duah, Arthur-
Holmes, Peprah, Adei, and Peprah, (2020) emphasized that adequate health information 
especially from trusted sources promotes health. Therefore, there is a need for a health 
information centre in the public domain for easy accessibility of information about the 
location of the specialized services to enhance men’s health-seeking behaviour. 
  Besides, the finding indicated that some participants entertained some degree of 
fear relative to their condition. The consequences of this fear indicated in this study 
contradicts the findings in the literature that men avoid health-seeking because they are 
afraid of the diagnosis (Griffith et al., 2011; Medina-Perucha et al., 2017; Persoskie et al., 
2014).  The inconsistencies in these outcomes may be due to the differences in the 
participants' educational levels. King et al (2015) noted that lack of education and 
information about prognosis, treatment, and side effects generates uncertainty, fear, and 
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panic and discourages healthcare seeking. Participants that are well informed of their 
condition and treatment options are well-conditioned to seek healthcare service without 
fears (Joseph-Williams et al., 2014). This means that mass media must outline health 
educational programmes on their airwaves to keep the people abreast with the much-
needed health information to disperse their fears. This is because the fear associated with 
the condition, and the extent to which a condition is perceived as life-threatening influence 
the health-seeking behaviour (Davison & Breckon, 2012; Jones et al., 2015). 
Another finding of the study indicated men’s desperation for immediate remedy 
instigated them to exploring all activities and interventions available. The results of men’s 
desperation in this study concurs with other finding that out of desperation and frustration, 
men seek various forms of treatment and other assistance (Vivien et al., 2013). The 
consistencies in the findings can be attributed to the man’s natural desire to be free from 
pain. Men who experience severe pain seek early treatment (Emery et al., 2013; Nyalela et 
al., 2018). This finding, however, contradicts another study which avowed that men 
express aversion towards some PCa screening and treatment procedures, for instance, 
digital rectal examination (DRE). They claimed that this treatment procedure violates 
manhood perception and likened the procedure to the act of homosexuality (Harvey & 
Alston, 2011). The disparity may be due to their cultural differences and their perceptions 
of masculinity ideology. This implies that healthcare professionals should be more 
circumspect in their recommendations because men might not comply with them if the 
recommendations contravene their personal or cultural views. Patients are determined to 
settle for any specialized care that respects their cultural variations (Rahman et al., 2012). 
Also, the effects of men’s stoic mentality demonstrated in the current finding is 
similar to the earlier studies that men perceived themselves stronger and resilient as such 
refuse health-seeking (Harvey & Alston, 2011; McAteer & Gillanders, 2019; Olanrewaju 
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et al., 2019). The male gender is traditionally perceived as superior and resilient in all 
contexts (Harvey & Alston, 2011). Therefore, health-seeking in issues involving the 
reproductive system signifies weakness (Marcos et al., 2015; Torres et al., 2017; Zanchetta 
et al., 2017). Most especially, when the healthcare provider is a female whom they 
consider “the weaker sex” (Moore et al., 2013; Olanrewaju et al., 2019).  Literature 
indicates that for this purpose men are continuously searching for an opportunity to 
acquire healthcare competencies to steer their health affairs (Ettridge et al., 2018; Yun et 
al., 2016).  
As a result, some participants of the current study treated their condition as a 
matter of privacy and secrecy. This perception may stem from the cultural norms that 
overrated and elevated male status and prevent men from even discussing certain issues 
with women (Olanrewaju et al., 2019). Therefore, the counseling services for men living 
with PCa should be more focused on the views of masculinity ideology. Effective 
discussion with men on the issues of masculinity will help reshape their perceptions and 
hence enhance their attitude towards health-seeking behaviour.   
Furthermore, timing in its essence is crucial in health, and it plays a significant role 
in influencing the health-seeking behaviour of men. The concerns and value of time 
expressed in the study are consistent with the previous findings reported by Hvidberg, 
Wulff, Pedersen, and Vedsted (2015) and Williamson, Ramirez, and Wingfield (2015). 
Williamson, Ramirez, and Wingfield (2015) reported that some men avoid professional 
healthcare-seeking because of the long waiting time for treatment. They therefore perceive 
visitation to healthcare professionals for treatment as time-wasting. This suggests that it is 
necessary for the authorities of the various cancer healthcare facilities to adopt new 
strategies and modern technologies to speed up health service delivery. Timing should be 
the hallmark of their service delivery. Chan, Lee, and Low (2018) reported that lack of 
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time is one of the major reasons for deferring health screening among men. Therefore, the 
employers must introduce weekly health screening exercises into their work schedule 
where health professionals can visit them at their workplaces for screening and treatment.  
5.3 Subjective Norms Influencing the Health-Seeking Behaviour  
This study showed that participants decided to seek healthcare on their own 
without coercion and authorization from anyone. This finding is contrary to the previous 
literature that suggested that spouses and relatives encourage men on healthcare utilization 
(Buckley & Ó Tuama, 2010; Fish et al., 2015; Forbat et al., 2014; Tong et al., 2011). It is 
believed that although health is subjective, it affects society. As such societies have certain 
perceived expectations as the right pathway of dealing with issues of health and healthcare 
(Bobek et al., 2013; Metheekul & Namanee, 2012). This outcome disparity may be 
attributed to men’s authority in their families. Men assume this status because they are 
always the oldest. This gives men the right and power to decide when and where to access 
healthcare. This confirms a finding of a study among older Chinese men that older men 
prefer total control over decisions on their healthcare (Zhang et al., 2015). 
Furthermore, the study demonstrated that the high cost of treatment was one of the 
major causes of delayed health-seeking behaviour. This finding is consistent with other 
studies (Griffith et al., 2011; Teo et al., 2016). Again, the study found that due to the high 
cost of treatment, patients avoided health screening, and overlooked clinical 
manifestations of conditions. This finding is similar to the study among rural male health 
workers in western Jamaica (Bourne, 2010) and the result of a systematic review 
conducted among the low socioeconomic status population in Singapore (Chan et al., 
2018). This shows that the impact of the high cost of treatment on health-seeking 
behaviour is not limited to the developing worlds but it affects also the people of the 
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developed world. The government must intervene with workable financial policies to 
assist and facilitate the health-seeking behaviour of men especially in the area of PCa. 
Moreover, the study identified that participants solicited and relied on financial 
assistance from various sources. This finding is consistent with the literature (Pedersen et 
al., 2011; Yun et al., 2016). A study conducted in Goma, Democratic Republic of Congo 
noted that elderly men receive financial supports from the family and non-formal sectors 
for their healthcare (Lutala, Kwalya, Kasagila, Watongoka, & Mupenda, 2010). The 
financial commitments of family and organizations to facilitate healthcare-seeking 
behaviour implies that the management of men with PCa must involve the family and the 
financial organizations. Financial assistance and encouragement from social networks 
boost men’s health-seeking behaviour (Pedersen et al., 2011). Patients with financial 
supports report for treatment with every ailment while patients with financial constraints 
skip treatment (Idris et al., 2019) 
When men are confronted with a disease like cancer, they seek information and 
support in various forms. The finding of the current study that the participant had advice 
and encouragement from many sources is consistent with the literature (Buckley & Ó 
Tuama, 2010; Carter et al., 2011; Forbat et al., 2014). Men seek information about the 
condition, place of care, treatment modalities, treatment side effects, and competencies of 
the healthcare providers (Carter et al., 2011; Uddin et al., 2012). The study further 
indicated that the participants sought information from their children, friends, health 
professional, and some organization. This finding also conforms to other studies that men 
seek information and support from the family, friends, known people who have 
experienced the condition, and the healthcare providers (Ettridge et al., 2018; Hyde et al., 
2017).  
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Also, the spouse and relatives seek and gather information (Buckley & Ó Tuama, 
2010; Fish et al., 2015; Forbat et al., 2014; Tong et al., 2011). The consistencies in these 
pieces of evidence are due to the gregarious nature of mankind. Man lives in association 
with society such that there is both an equal and opposed influence on the other that 
cannot be avoided and separated (May, 2011). The roles of the men’s social network in the 
healthcare-seeking indicated that healthcare institutions should involve them in the 
management. However, upon second thought, the spouse’s assumption of absolute 
responsibility of  men’s healthcare may contradict men’s positions on masculinity.  This is 
because some communities forbade men from discussing certain information with women 
(Olanrewaju et al., 2019). 
The study identified that participants sought healthcare assistance from multiples 
sources for instance allopathic and non-allopathic sources. This finding is consistent with a 
previous study conducted among cancer survivors in the USA that indicated that patients 
made use of both forms of treatment (Fouladbakhsh & Stommel, 2010). These pieces of 
evidence are similar to another study done among cancer survivors in Norway. The study 
reported that patients used orthodox medicine with complementary and alternative 
medicine (Kristoffersen et al., 2013). This implies that the adoption of a pluralistic manner 
of healthcare-seeking is unlimited to low economic states but can also be found in the 
more economically endowed states where health services delivery is par excellence.  
Another finding of the current study identified various reasons for participants’ 
usage of multiple treatments. These reasons are largely consistent with the existing 
literature (Kristoffersen et al., 2013; Sato, 2012; Yarney et al., 2013). Vivien et al. (2013), 
stated that some participants mixed treatment out of desperation, frustration, and out of 
curiosity to try anything that can solve their problem. Another study in Ghana opined that 
men opt for alternative medicine because it is natural, has no or little chemical, has 
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minimal or no side effects, easily accessible, and less expensive (Gyasi et al., 2016). The 
participants also believe alternative medicine is compatible with their cultural beliefs and 
practices, trust in the competencies of the practitioners (Gyasi et al., 2016; Yarney et al., 
2013). Moreover, the form of alternative medicine used by the participants in the current 
study conforms with those in the literature, such as herbal, massage herbal, megavitamins, 
and Chinese medicine (Gyasi et al., 2016; Sato, 2012; Vivien et al., 2013; Yarney et al., 
2013).  
Also, the study found that the participants heard of the alternatives medicine from 
several sources. The sources are similar to the finding in the literature (Kristoffersen et al., 
2013; Yarney et al., 2013). The participants heard of these medicines through spouses, 
relatives, friends, mass media, health personnel, complementary and alternative medicine 
(CAM) practitioners, church, and religious groups (Olbara et al., 2018; Yarney et al., 
2013). Media advertisements spread the majority of all health-related issues of men and 
influence their healthcare service utilization (Acharya et al., 2015; Zanchetta et al., 2017). 
To get to the larger population of men with PCa, alternative medicine practitioners 
advertise their products on several media channels such as the internet, radio, television 
sets, and newspapers. The alternative medicine practitioners throw an open invitation to 
men to their facilities (Kyei et al., 2017; Muriuki, Midiwo, Mbugua, & Gikunju, 2010). As 
such, orthodox facilities should develop a strategy to inform and attract men to access their 
services.   
However, the finding revealed that some participants declined the usage of 
alternative medicine in the management of their condition. The reasons for the refusal 
agrees with existing literature (Sitaresmi, Mostert, Schook, Sutaryo, & Veerman, 2010). 
Some participants declined the use of alternative medicine because they had no faith in its 
effectiveness, and had been discouraged by those who had used alternative medicine 
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(Yarney et al., 2013). Nevertheless, this indicates the need for more researches into 
complementary and alternative medicine to ascertain its efficacy in the treatment of PCa. 
The government should adopt means to integrate complementary and alternative treatment 
with the orthodox treatment.  
5.4 Health-related factors influencing the intention of men to seek healthcare 
Health seeking behaviour of men with PCa is influenced by many factors (Fish et 
al., 2015). The underpinning theoretical framework of the study suggested that the attitude 
of men coupled with perceived subjective norm accounts for the behavioural intention of 
men to undertake activity towards healthcare. However, from the data, other factors 
besides the aforementioned constructs of the theoretical framework had contributed to the 
health-seeking behaviour of men living with PCa. These factors include healthcare 
accessibility, effects of clinical manifestations, professional competence, participants’ 
maturity and exposure, and cultural factors.  
These factors of the current study are similar to factors identified in the previous 
study among rural dwellers in the Bongo district by Adongo and Asaarik, (2018). These 
findings are similar to another study that measures male teacher’s perceptions, knowledge, 
and attitude about PCa screening in the Sunyani Municipality (Yeboah-Asiamah et al., 
2017). The consistency in these findings may be expected since these studies were 
conducted in the same country where men largely share almost similar perceptions with 
cultural interpretation to issues of male significance. This means that factors of influence 
in men’s health-seeking behaviour are of no difference among men in Ghana irrespective 
of their geographical location. 
This study again noted that access to healthcare facilities is one of the major 
factors influencing the health-seeking behaviour of men. The study found that most of the 
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participants patronized health facilities accessible to them. This finding conforms to the 
study by Odaman and Ibiezugbe, (2014) that elderly men utilize health services because it 
was accessible to them. These patients perhaps patronized these nearest facilities due to a 
lack of information about where to access the specialized treatment needed. Every patient 
expects receiving the best treatment that will expedite recovery (Van Der Hoeven et al., 
2012). This desire supersedes the high transportation cost and even distance to cover to 
access good healthcare. This buttressed the result of a study conducted between closely 
and sparsely settlements in wales. The study opined that patients were ever determined to 
travel any distance to access good healthcare irrespective of time and cost (McGrail, 
Humphreys, & Ward, 2015). 
Nonetheless, the lack of knowledge regarding the right facility to access the 
specialized care identified shows that there is complete silence on information regarding 
specialized service delivery facilities that could ease men’s location of these designated 
facilities. Many of these men located these specialized facilities through scattered 
information from their social networks. As stated that spouses and relatives seek, gather, 
and process information for their men (Fish et al., 2015; Forbat et al., 2014; Tong et al., 
2011). This contributes to time-wasting and delayed health-seeking behaviour (Haggerty 
et al., 2014). Therefore, Ministry of Health and the various healthcare institutions should 
establish a telecommunication platform where potential patients can access information 
necessary about their conditions and designated places of specialized treatments. 
Clinical manifestations associated with PCa is one of the burdensome and scaring 
effects of the condition (Emery et al., 2013). The study found that participants living with 
PCa manifested many signs and symptoms with pain as the most dominant symptom. The 
severity of these signs and symptoms especially pain contributed to the participants’ 
patronage of healthcare facilities. This finding conforms to the literature that suggested 
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that men who experience severe symptoms report for early treatment (Emery et al., 2013). 
This confirms to the earlier assertion by Nyalela et al (2018) that men access healthcare 
when their condition is very painful. This is because pain when not properly controlled, 
has detrimental and negative effects on quality of life (Green, Hart-Johnson, & Loeffler, 
2011). 
Pain is subjective, and it is what the sufferer says it is (Wettstein, Eich, Bieber, & 
Tesarz, 2018). These participants might have been enduring these pains for a long, and 
perhaps reported for healthcare only as they realized that the condition has become 
persistent and overwhelming. As such healthcare professionals require training to provide 
optimal and timely intervention necessary. Again, this demonstrates men’s 
underestimation and inadequate knowledge of pain. There is therefore the need for mass 
media education on pain and its implication to increase the knowledge base of men. 
Because knowledge they said is power (Fogg-Rogers, Bay, Burgess, & Purdy, 2015).  
According to O’Hara et al (2012) and Jung (2014), media education increases the 
awareness and knowledge of men and positively influences their health-seeking behaviour.  
Professional competence is another discovery in this study. Some participants 
mentioned that the manner they were approached, and had their concerns addressed 
motivated them to continue seeking healthcare at these facilities. This finding is consistent 
with the previous studies that describe the cordial relationships between the participants 
and healthcare providers as the motivation for their healthcare-seeking behaviour (Nolting, 
2020; Nyalela et al., 2018). Literature indicates that some men have a very good and 
cordial relationship with their healthcare providers to the extent that they discuss any 
issues related to their health (Griffith et al., 2011). As a result, about (82.9%) of the 
participants report early for treatment (Nyalela et al., 2018). However, this finding of the 
current study is inconsistent with other previous studies (Nyalela et al., 2018; Rahman et 
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al., 2012). They described their relationship as non-existent, and distant. The professional 
qualities demotivated them from seeking healthcare (Nyalela et al., 2018). Another study 
in Bangladesh among tribal groups Bengali described the healthcare professionals as 
disrespectful, ignorant of emergency, and phlegmatic (Rahman et al., 2012).   
Again, Griffith et al. (2011), suggested that some men refused seeking healthcare 
because of the harsh tone used by the healthcare providers on them.  This disparity may be 
attributable to the cultural variation of men. Singer et al. (2016) opined that human 
attitudes and characteristics are determined by their cultural values and beliefs. These 
values and beliefs influence men’s perceptions and responses to situations. Therefore, the 
need for the government and health training institutions to introduce into the health 
professional training curricular cultural competency training module. A module that will 
afford trainees, and practitioners the opportunity to appreciate the impacts of cultural 
values and beliefs on the health-seeking behaviour and healthcare delivery of older men 
(Agness-Whittaker & Livia, 2016). 
The study revealed that participants assumed absolute control and took decisions 
regarding their healthcare because they were of age, matured, and more exposed in life. 
Maturity shows the reasoning capacity and level of autonomy of a participant (Chima, 
2015). The impacts of the participant’s maturity and exposure in the current study 
conforms to other findings in the literature that explained that maturity communicates the 
rights, and impacts of men regarding health service utilization. (Davison & Breckon, 
2012).  Literature reported that matured and experienced patients seek further clarification 
from other sources such as professionals and the internet to inform their decisions (Chima, 
2015). This shows that the participant’s age, maturity, and exposure affords them the 
autonomy, and power to decide and choose the appropriate treatment options (Zhang et al., 
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2015). As such healthcare providers must listen and consent with the elderly patients 
before their final decisions. 
Men’s inclination to the cultural belief determines their health-seeking behaviour 
(Singer et al., 2016). The finding of the current study indicates that most of the 
participants denounced the influence of cultural beliefs in their health-seeking. This 
finding is incongruent with the previous study by Yew and Noor (2013), that noted that 
cultural beliefs of men contributed to how they view, appraise and respond to an 
impending condition. It determines the intervention preferences, be it orthodox or 
traditional medicine. This finding disagrees with the earlier study that suggested that men 
are unwilling to seek health when experiencing problems because they are stronger and 
tough (Olanrewaju et al., 2019).  
Additionally, the finding indicated that cultural beliefs and practices were 
misleading, time-wasting, and involves wastage of limited resources. The participants 
perceived health professionals as representatives of God on earth. Therefore, they 
preferred professional treatment to submitting to the superstitions of cultural practice. 
These disparities in the findings may be due to the educational level of the participants of 
the current study. Most of the participants 9 (9%) were educated, of which some obtained 
university degrees. This buttressed the earlier evidence that education prepares individuals 
adequately, and improve their abilities to appraise health situations (Sørensen et al., 2012). 
Although there was an appreciable increase in awareness of the detrimental effects of 
cultural beliefs on health-seeking behaviour, it exists in literature even in the advanced 
worlds. This implies that more need to be done to encourage men to keep to the trending 
course of health-seeking behaviour exhibited in the current study. 
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Interestingly, the study further identified that some participants adopted religious 
approaches to the management of their condition. This finding concurs with the existing 
study among Malaysian Chinese that some cancer patients pray, perform rituals and 
sacrifices to their ancestors (Vivien et al., 2013). The finding by another study among 
African Americans and whites men demonstrated that some PCa patients pray to God 
(Bowie et al., 2017). The participants of the current study’s reasons for praying is 
consistent with the study by Bowie et al. (2017), that God is the healer and will heal them. 
Some men visit their religious leaders to seek to understand the cause of the illness and 
find a solution. Because, they believe that cancer is a divine punishment or a sign of 
possessing an evil spirit (Vivien et al., 2013). The consistencies in these findings echo the 
view that religious interpretations of health-related issues are not limited to third world 
countries. But it is also found in the advanced health and endowed economic states where 
health service delivery is second to none.  
Again, this shows the impacts of spirituality on health and how men assign 
religious interpretations to life events. Literature indicates that religious faith changes 
participants’ perception of life-threatening events such as cancer, and prepares them to 
accept and cope with the condition or get ready for death (Lee & Carvallo, 2014). 
Unfortunately, most of the health professionals are deficient in spiritual management and 
or hardly pay attention to the spiritual needs of these patients (Taylor, 2019). Therefore, 
the need for assessment of our health delivery system and development of spiritual care 
training programmes for trainees and practitioners to boost their knowledge, 
competencies, and confidence in assisting patients with their spiritual health issues.  
5.5 Behavioural intention of men living with PCa towards health seeking 
The intention of men with PCa was demonstrated in their mental readiness to seek 
healthcare.  From the study, information-sourcing was the foremost step taken by men 
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living with PCa towards treatment. The study revealed that all the participants realized the 
need for treatment and therefore, sourced information from various sources. This finding 
agrees with the existing literature that men with PCa seek information from their friends, 
relatives, other patients experiencing the condition, and healthcare professionals (Carter et 
al., 2011; Hyde et al., 2017; Olapade-Olaopa et al., 2014a). Some literature showed that 
men also source information from the internet, general brochures, pamphlets, medical 
journals and listen to the radio (Carter et al., 2011; Hyde et al., 2017; Olapade-Olaopa et 
al., 2014b; Uddin et al., 2012; Zhang et al., 2015). This is because health information is 
crucial in health decision making (Zhang et al., 2017). O’Callaghan et al (2014) stated that 
men’s decisions are made based on the available health information.  
Furthermore, the study revealed that most of the participants preferred this 
information from the healthcare professional. This finding is consistent with the existing 
literature (Uddin et al., 2012; Zhang et al., 2015). According to Joseph-Williams, Elwyn, 
& Edwards (2014), men do not have adequate knowledge of the condition on their own, as 
such healthcare professionals become a source of treatment-related information (Smith et 
al., 2019). It is convincing and enterprising to note that the participants sourced this 
necessary information perhaps due to the physical and psychological distress associated 
with the condition. Some of the physical and psychological distresses include hot flushes 
and sweats, loss of libido, erectile dysfunction, weight gain, loss of body hair, mood 
disturbances, depression, and anxiety (Gavin et al., 2015; Jayadevappa et al., 2012; Köhler 
et al., 2014; Mohler et al., 2010; Watts et al., 2014). This assertion conforms to the 
previous findings that men seek healthcare with an expectation to have treatment for their 
troubling clinical manifestations and to prevent complications (Fan, Lin, Huang, & Chen, 
2017). 
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In this current study, participants rushed themselves to the hospitals with an 
expectation and hope for experts’ assistance. At this moment hope becomes their strongest 
strength of survival. This confirms the assertion that to survive and live with a mind-
boggling condition as PCa, hope is the key element to hold up to (Levy & Cartwright, 
2015b). Hope for treatment as well as survival has become the driving force for the 
participants of this study to seek healthcare. As expected, this finding corroborates with 
the earlier evidences that men seek healthcare to have treatment for their conditions rated 
from moderate to severe (Chong et al., 2012; Fan et al., 2017). O’Brien et al (2011) 
established that the main concern of all PCa patients irrespective of their ages is the need 
for survival. This finding, however, contradicts an earlier study by Cornally and McCarthy 
(2011) that men delay or refuse healthcare-seeking when anticipating negative outcomes. 
The men’s negative health-seeking behaviour might have been due to their past 
experiences and poor education. Hence, the need for further studies and public 
surveillance to explore the impacts of memories and education on the health-seeking 
behaviour of men with PCa.  
5.6 Health Seeking Behaviour of Men living with PCa 
The findings of the currents study revealed that most of the participants adopted 
some physical and personally known measures to ameliorate the early clinical 
manifestations of their condition. The measures participants adopted concords with an 
earlier study that cancer patients initially apply known interventions; over counter- drugs 
and herbal medications to alleviate the signs and symptoms of the condition (Paterson et 
al., 2015; Vivien et al., 2013). The consistencies in these findings are not surprising 
because men always wish to have control and manage their health. Ettridge et al (2018) 
noted that men are highly motivated to acquire healthcare navigation competencies to steer 
their personal affairs. 
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Again, the study revealed that some participants sought medical attention since 
they knew no intervention of their own. This finding confirms the previous findings 
(Zeliadt et al., 2010). According to Chan et al. (2018) and Miller et al. (2019), some men 
with PCa opted for medical treatment. The consistency may be attributable to the trust 
these men have in the health system. A study among Black Americans and Caucasians 
patients in the USA indicated that 88.60% of the patients sought healthcare because they 
trusted the physicians (Do et al., 2010). This invariably tasks the health training 
institutions to equip trainees with modern techniques, professional codes, and etiquettes to 
maintain the standards to sustain the patient’s trust in the health system. For, trust is the 
cornerstone and the bedrock of the relationship between the patients and healthcare 
professionals (Tan & Goonawardene, 2017)  
Although, the study revealed that most of the participants did not feel ashamed of 
their conditions, few of them complained of shyness and stigmatization.  The negative 
consequences revealed by the participants agrees with earlier studies that embarrassment 
and stigma affects men’s health-seeking behaviour and prevent men from discussing their 
condition with friends and health professionals (Adams et al., 2013; Ettridge et al., 2018). 
Literature showed that some participants preferred to keep mute over their illness to 
control and minimize their embarrassment (Yew & Noor, 2013). The areas of 
embarrassment include erectile dysfunction, treatment and screening procedures such as 
DRE, and communication with friends and healthcare providers (Adams et al., 2013; 
Harvey & Alston, 2011; Medina-Perucha et al., 2017). However, participants that had no 
issue of embarrassment freely discuss their conditions with friends, family, and healthcare 
professionals (Forbat et al., 2014). 
The finding of treatment adherence revealed by this study is consistent with the 
previous studies that all participants take total responsibility for their treatment and follow 
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prescription orders religiously. They take their medications at the right time and in the 
right dosage (Gassmann et al., 2016; Verbrugghe et al., 2013). The study further revealed 
that participants adhered to medication because they are effective. This also confirmed an 
earlier study that men adhere to medication because they believe in the efficacy of the 
medication (Gassmann et al., 2016). The study finding of the participants' reasons for 
adherence disagrees with the literature. Literature indicates that men refused to adhere to 
medication order because of inadequate knowledge of its necessity, and doubts about their 
effectiveness on the quality of life (Verbrugghe et al., 2013). This indicates that more 
works need to be done because medication adherence is not the sole responsibility of the 
patients. Health services providers must institute measures to ensure that patients 
understand the need and adhere to their medications.  
The finding that participants combine alternative treatment with medical treatment 
is consistent with the other studies that identified multiple healthcare utilization as the 
trending form of health-seeking behaviour among PCa patients (Chan et al., 2018; 
Fouladbakhsh & Stommel, 2010; Kristoffersen et al., 2013; Sato, 2012). They mixed both 
allopathic treatment with the non-allopathic treatment (Vivien et al., 2013). This is 
certainly so because the non-orthodox healthcare facilities are available and accessible in 
almost every community (Gyasi et al., 2016; Ntakobajira, 2012). According to 
Kristoffersen (2013) and Yarney et al. (2013), 33.8% - 75.3% of all cancer patients use 
complementary and alternative medicine, and more than half of this population use more 
than one form at a time. This calls for an extensive study into the efficacy of herbal 
medicine in the treatment of cancer especially PCa. 
5.7 Evaluation of the Theoretical Framework 
The theory of reasoned action developed by Fishbein and Ajzan (1980), was used 
as the theoretical framework to structure the study. The objectives and research questions 
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were formulated from the constructs of the framework. The Theory of Reasoned Action 
framework has four (4) constructs namely attitude, subjective norms, behavioural 
intention, and behaviour. This theoretical framework was chosen because it measures 
exactly the reasons that influence men’s decision-making regarding healthcare seeking 
which was not clearly explained in the other models explored.  
The attitude component of the framework was explored under the beliefs, 
emotions, and behaviour characteristics of men living with PCa towards health-seeking. 
The study revealed that men’s trust in the health system, fear of death, and desire to 
recover influenced their health-seeking behaviour. The outcome of this study did not 
completely agree with the assumption of the construct. According to the authors, attitude 
explains how peoples’ belief in a behaviour determines their behaviour response after 
critically assessing the attributes. However, the fear of death and the desire to recover that 
emanated from the study were not captured in the description of the construct. As a result, 
the attitude of men living with PCa in this study did not completely conform to the 
framework. 
Subjective norms according to the framework, is the perceived social pressure to 
engage or not to engage in a behaviour. It is determined by normative belief or it is an 
expectation of acceptance from a significant referent. The findings of the study were 
consistent with the framework. Although, there was no direct coercion on the participants 
to seek healthcare, some participants sought healthcare to live long to fulfil the promise 
made to the families. However, the counseling and financial supports from the social 
network exerted an indirect force and boosted their effects to seek healthcare to satisfy the 
desires of the members of their social network. Again although the construct was not 
explained by the proponents in this direction, the financial challenges encountered and 
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lack of information regarding the place of healthcare could be accountable for its inclusion 
in the present study. Therefore, it could be added to the framework. 
 The behavioural intention describes the mental preparedness or the convictions of 
men living with PCa to undertake an activity directed to solving their problem. The current 
study supports the model as the participants hope for treatment and information sourced 
gingered their interests and directed them to the designated places of healthcare. 
Furthermore, the behaviour of the framework describes activities taken by individuals in 
response to or to effect changes in their health conditions. The findings of the current 
study support the explanation of this construct as the participants have undertaken several 
activities such as applications of their known interventions, seeking religious interpretation 
and assistance, seeking medical treatment, herbal treatment, and or both. Some 
participants treated issues about their condition as a matter of secrecy due to perceived 
stigma, embarrassment, and fear of societal negative interpretations. 
However, the additional theme that is emerged from the data is inconsistent with 
the constructs of the theoretical framework. The study identified health-related factors that 
influence men’s intention to seek healthcare. These factors include healthcare 
accessibility, effects of clinical manifestations, professional competencies, 
maturity/exposure, and cultural beliefs. Therefore, the need for modification and 
integration of health-related factors as a main construct in the framework. The integration 
will inspire further researches into finding the significant impacts of health-related factors 
on men with PCa’s health-seeking behaviour. Furthermore, the financial challenges 
encountered by men living with PCa in their treatment, couple with roles of the patient’s 
maturity/exposure and culture factors in the decision-making process regarding healthcare 
seeking should be a construct on their own.   
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5.8 Conclusion 
Prostate cancer is life-threatening and poses many challenges to men. From the 
study, men generally exhibited positive and negative attitudes towards health-seeking. 
Men living with PCa employed several activities within their means to ameliorate the 
challenges of the condition. They sought healthcare from medical, herbal, and 
spiritual/religious treatment and even combined some of these treatments.  
 The participants were motivated to employing medical treatment because of the 
trust in the health system, fear of death, and the desire to regain a normal state. However, 
the persistent advertisement and praises of the effectiveness of herbal medicine on the 
media motivated them to trace their pathway to visiting the herbal medicine practitioners 
against other treatment choices. 
The high cost of treatment, ignorance of early clinical manifestation, and secrecy 
due to fear of stigmatization have generated negative attitudes towards health seeking as 
reported by earlier studies. Fortunately, most of the participants solicited and had financial 
assistance from their close relatives, insurance companies, and employers as reported by 
other studies.   
Finally, cultural factors and perception of masculinity had no influence on health-
seeking behaviour in this study as reported in other studies. The men relegated the 
perception of masculinity to the background as they desired and forged forward to have 
the cause of their condition eliminated for good.  
 
  
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CHAPTER SIX 
SUMMARY, IMPLICATIONS, LIMITATIONS, CONCLUSION AND 
RECOMMENDATIONS 
This chapter discusses the summary of the study, implications of the findings, and 
limitations of the study. It presents also the conclusion and recommendations. 
6.1 Summary of the Study 
Health-seeking behaviour describes the activities of men living with PCa employed 
in the management of their condition. The name cancer triggers attention and puts shivers 
into the spins of men. As such, men diagnosed with PCa put in all resources available to 
recover. But much is not known about the health-seeking behaviour of men living with 
PCa in the Volta Region. The Theory of Reasoned Action was adopted as a guiding 
framework to structure the work on the health-seeking behaviour of men with PCa.  
Thematic content analysis technique was used for the analysis of the data. Five 
main themes emerged namely attitude toward health-seeking, subjective norms 
influencing health-seeking, health-related factors influencing health-seeking, behavioural 
intentions towards health-seeking, and health-seeking behaviour of men.   
The attitude of the participants in the study was both positive and negative. The 
positive attitudes were motivated by professional competencies, financial supports, and 
desire for wellness. The quest to regain a normal state of function has led the participants 
to adhere to the treatment regimen, sourced for information about the condition, available 
treatment options, and places of care. The participants sourced this information from their 
social networks. However, the negative attitudes were due to ignorance of the early signs 
and symptoms, high cost of treatment, and secrecy due to perceived wrongful 
interpretation of the condition. The financial supports from close family members, 
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insurance companies, and employers were overwhelming in this study. Most of the 
participants solicited for financial and other supports from their social networks. This 
served as a booster for them to explore and go the extra mile to seek treatment. 
The participants sought healthcare from various healthcare facilities such as 
hospitals, herbal medicine centres, spiritual/religious centres, and or a combination of 
these facilities. Participants patronized these services due to their trust in the health 
system, fear of death, and the desire to regain a normal state of function.  
6.2 Implications of the findings 
The findings of the study have been categorized under the following headings: 
nursing practice, nursing research, and policy formulation. 
6.2.1 Nursing practice 
This study indicated that men living with PCa sought medical treatment because 
they believed in the health system. Yet, the study emphasized that some either abandon the 
medical treatment for herbal medicine or mixed the two forms of treatment at once. This 
invariably means that these participants have not been educated well on their medication, 
and the adverse effects it may have on them mixing medical treatment with the herbal 
medicines. Also, some participants accessed the medical treatment because their 
intervention failed them. This might be due to some previous experiences with the 
healthcare professional. Therefore, it is necessary for the nurses in the medical team to 
educate them on the treatment regimen. They should advise them to adhere to their 
treatment and encourage them to report immediately at the facility if there is any shortage 
in the medication before their next review date or there is any adverse effect after the 
administration of the medication. Nurses should listen to the concerns of these men since 
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the condition has to do with the male organ and provide the needed assistance they 
deserve. 
 6.2.2 Implication Nursing research 
The most practicable and basic sources of nursing knowledge for evidence-based 
nursing practice is through nursing research. Therefore, nurses should be more focused on 
nursing research to understand the concerns raised by men with prostate problems 
especially PCa.  
6.2.3 Implication on Nursing Policy 
The findings of this study have a massive implication on nursing policy 
formulation and implementation in the area of PCa with much regard to the health-seeking 
behaviour of men. Reference to the mammoth concerns raised by the participants about 
the high cost of treatment, it is necessary that health policymakers and stakeholders in the 
facilities outline some policies to assist men with PCa financially in their healthcare -
seeking. The specialized service facilities should seek assistance or collaboration from 
some companies to take up part of the treatment cost of PCa. This should represent and 
form part of their social responsibilities to facilitate easy treatment costs for these men. 
Finally, there is the need for policy change to include cancer investigations and treatment 
costs in the national health insurance scheme (NHIS) benefit package to alleviate from 
men living with PCa the pressure of treatment cost. There should be a policy on 
continuous awareness creation on PCa through mass media to increase the knowledge base 
of men on this condition to promote early treatment-seeking behaviour. 
Lastly, since PCa affects largely the older population, it calls on the government, 
researchers, and practitioners to develop capacity-building programmes in communication 
strategies to assist these vulnerable groups. 
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6.3 Limitations of the Study  
Irrespective of study designed and methodology, every study is bound to have 
some limitations.  The first limitation of the current study comes from the geographical 
location of the study. This study was conducted in the Volta Region where the cultural 
influence of the findings might not be the same elsewhere. However, the findings may be 
transferable. Also, the participants were recruited from just a hospital in the region. The 
finding may not be generalized to other hospitals in the region and the country as a whole. 
Therefore, the need for similar and further studies in the other facilities. Another major 
limitation faced was the invasion of the coronavirus (covid19) pandemic. The data 
collection period has coincided with the covid19 pandemic in that it was scary and 
difficult to travel from one place to another to meet participants for the scheduled 
interviews.  
6.4 Conclusion  
This study explored the health-seeking behaviour of men living with PCa in the 
Volta Region of Ghana. From the study, participants demonstrated both positive and 
negative attitudes toward health-seeking behaviour. The positive attitude displayed include 
their continuous treatment-seeking and strict adherence to the treatment regime. They 
sought healthcare from three major facilities namely hospitals, herbal and religious 
centres. The men’s belief in the health system, persistent advertisement of herbal 
medicine, fear of death and financial support from their social network motivated them to 
seek treatment at these outlets. 
Nevertheless, the negative attitude involve their delayed heath seeking behaviour 
due to ignorance of the early sigh and symptoms, high treatment cost, and secrecy for fear 
of societal wrongful judgment. Finally, issues of culture played no role in the decision-
making reference to the healthcare-seeking behaviour of men in this study. Therefore, 
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healthcare professionals should develop a very good communication strategy to address 
these concerns and encourage this elderly and vulnerable population. 
6.5 Recommendations  
According to the findings of this study, the undermentioned recommendations are 
made to the Ministry of Health (MOH), Ghana Health Service (GHS), Nursing & 
Midwifery Council of Ghana, Urology Departments, Complementary and Alternative 
Medicine Practitioners (CAM), and Multimedia for possible implementation. 
6.5.1 Recommendation for Ministry of Health 
The Ministry of Health should: 
• Work with government and other health agencies to enact laws binding on the major 
companies to partly absorb the treatment cost of PCa patients as part of their social 
responsibilities. 
• Work with government and other health agencies to make the cost of PCa diagnostic 
tests and treatments part of the national health insurance benefit package. 
• Collaborate with the government to establish oncology specialist training institutions. 
To enhance the training of the professionals in this area. 
• Work with the government and agencies to set funds aside to support institutions and 
researchers to conduct more researches into herbal medicine to ascertain its efficacy in 
cancer management especially PCa.  
6.5.2 Recommendation for Ghana Health Service 
The Ghana Health Service should:  
• Create cancer management units in all the districts, municipals, regional hospitals 
across the country. This will make these units accessible to the patients. 
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• Work with healthcare institutions to establish a telecommunication platform to ease 
information-sourcing reference to the location of specialized facilities. 
• Formulate policies on continuous education of men on prostate conditions especially 
PCa to enhance health-seeking behaviour. 
6.5.3 Recommendation for Nursing & Midwifery Council of Ghana 
The Nursing and Midwifery Council should: 
• Consider the establishment of oncological nursing as a specialty in some training 
institutions to train professionals in this area. This would enable these professionals to 
provide the best of care to cancer patients especially PCa. 
• Introduce in the current nursing curriculum some basic principles and topics of 
oncology (urology) to assist students from other specialty areas to be able to provide the 
basic oncological care.  
• Introduce into the curriculum spiritual management programmes to equip the trainees 
with the necessary skills to meet the spiritual needs of the patients.  
6.5.4 Recommendation for the Urology Departments 
Urology department should: 
• Continuously upgrade the knowledge and competencies of the staff in the assessment 
of PCa patients through regular organization of in-service training. 
• Develop a standardized and structured protocol for the assessment and management 
of PCa patients.   
• Collaborate with other organizations and agencies to regularly organize PCa 
awareness creation programmes to educate men on prostate problems especially PCa. 
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6.5.5 Recommendation for Complementary and Alternative Medicine Practitioners 
(CAM)  
CAM practitioners should: 
• Present their (products) medicines to the Center for Scientific Research into Plant 
Medicine for examination before making them available in the markets. 
• Read more on the conditions before going on the media to educate the public to avoid 
misinformation. 
6.5.6 Recommendation for the Multimedia Authority 
The multimedia group should: 
• Collaborate with the healthcare institutions to outline educational programmes on 
oncological conditions especially PCa 
• Collaborate with the healthcare institution to keep informing the public on the 
location of specialized healthcare facilities especially PCa. This would assist the public to 
seek healthcare at facilities where their care needs can be timely met. 
 
 
 
 
 
  
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APPENDICES 
Appendix A: Ethical Approval Letter 
 
  
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Appendix B: Introductory Letter 
 
  
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Appendix C:   Participant’s Information Sheet 
Title: Health Seeking Behaviour of men living with Prostate Cancer: A Qualitative 
Study in the Volta Region 
Principal Investigator: EMMANUEL KWAME DUMOR  
Address: School of Nursing and Midwifery, Adult Health Department, College of Health 
Sciences, University of Ghana. P o box 43, Legon  
General Information about Research: 
The purpose of this study is to explore the lived experiences of men living with prostate 
cancer towards health care seeking. This become necessary because despite the high 
morbidity and mortality rate, men living with prostate cancer, report for screening and 
treatment at the hospital late. They report at the stage when the condition goes beyond 
control and management thus, where the cancer cells metastasize to other surrounding 
structures. Secondly, the findings will help the policy makers in drafting measures to assist 
patients in their decision-making processes toward health seeking.  
Your agreement and involvement in this study will not interfere with your daily activities 
because the interview will be conducted at the most convenience time and place of your 
choice.  You will be engaged in a face to face interview with only the researcher. The 
interview will last for not more than 60 minutes. 
Your responses will be recorded using audiotape recorder. Some open-ended questions 
about your perceptions and experiences on health seeking behaviour of men living with 
prostate cancer will be sought.  
Possible Risk and Discomfort  
It is anticipated that the study will not expose you to any harm, risk or discomfort. It is 
however possible that some questions may elicit some emotional responses when narrating 
your story. In situation as this, the researcher will refer you to Dr. Eric Kugbey Nuworza 
(0249377659), a clinical psychologist to attend to you psychologically to relief you of 
your emotional stress without any financial commitment from you.  Therefore, you also 
have the reserved right to refuse responses to questions that will be sensitive and 
provocative.  
 
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Possible Benefits  
Your involvement in this study will contribute greatly to knowledge generation in the area 
of prostate cancer. These knowledges will afford the policy makers to formulate policies 
to direct the decision-making processes of individuals that will fall sick in this area. Again, 
the knowledge will be made available to public through media educations and television 
programmes. 
Confidentiality  
Your real name will not be used for in the study to ensure that you are not associated to 
any of the information collected from you. Codes will be generated and used to protect 
your identity so that information provided cannot be traced to you ensure confidentiality. 
In order to ensure privacy, no identifiable information will be collected during this 
interview. Your phone number will be taken when you agree to part take in the study for 
the reasons of further clarifications.  Information provided will be protected electronically 
and on a hard print. The information provided will be accessible to only the researcher and 
supervisor.  In cases of publications of the finding of the study, the information will be 
processed and all personal identifiers will be excluded. During data collection, privacy 
will be ensured. The demographic data and audiotape will be destroyed after ten (10) 
years, after analyzing and erasing the information from time to time.   
Compensations 
There will not be any compensation package for participating in this study. The participant 
may however be given some Snacks of Malta Guinness and Sandwich during the interview 
section. 
Voluntary Participation and Right to leave the research 
Participating in this study is purely voluntary. You may choose not to participate and leave 
at any point in time. If you feel uncomfortable or for whatever reason best known to you, 
you are absolutely free to withdraw your participation from the study. 
Contacts for additional information: For any further information about the study, 
contact  
 
 
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THE RESEARCHER:   
 Emmanuel Kwame Dumor M.Phil. Nursing (Student)  
Address: Department of Adult Health, School of Nursing and Midwifery, College of Health 
Sciences, University of Ghana, P. O. Box LG 43 
Legon, Accra Ghana.  Tel. 0249886484 Email: emmanueldumor4@gmail.com  
SUPERVISOR:  
Prof. Lydia Aziato,  
The Dean, School of Nursing and Midwifery, 
College of Health Sciences,   
University of Ghana, P. O. Box LG 43, Legon, Accra Ghana.   
Tel - 0244719686. Email: aziatol@yahoo.com  
COUNSELOR:  
Dr. Eric Kugbey Nuworza,  
Lecturer & Clinical Psychologist,  
University of Health and Allied Sciences 
Hohoe, Volta Region   
Tel. 0249377659 
For further clarification on ethical issues and right to participation.  
Contact: 
 The administrator  
Ethics Review Committee 
Nana Abena Kwaa Ansah Apatu  
0503539896, ethics.research@ ghsmail.org 
  
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Appendix D: Consent Form 
 
STUDY TITLE: HEALTH SEEKING BEHAVIOUR OF MEN LIVING WITH 
PROSTATE CANCER: A QUALITATIVES STUDY IN THE VOLTA REGION 
 
PARTICIPANTS’ STATEMENT 
 
I acknowledge that I have read or have had the purpose and contents of the Participants’ 
Information Sheet read and all questions satisfactorily explained to me in a language I 
understand (English / Ewe / Twi). I fully understand the contents and any potential 
implications as well as my right to change my mind (i.e. withdraw from the research) even 
after I have signed this form. 
 
I voluntarily agree to be part of this research. 
 
Name or Initials of Participant…………………………..   ID Code 
…………………………….. 
 
Participants’ Signature ……………………...OR Thumb Print…………………………… 
 
Date: ………………………………. 
 
 
INTERPRETERS’ STATEMENT 
 
I interpreted the purpose and contents of the Participants’ Information Sheet to the afore 
named participant to the best of my ability in the (………name of language) language to 
his proper understanding. 
 
All questions, appropriate clarifications sort by the participant and answers were also duly 
interpreted to his/her satisfaction. 
 
Name of Interpreter…………………………… 
 
Signature of Interpreter………………………..            Date: …………………… 
 
Contact Details 
 
 
 
 
  
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STATEMENT OF WITNESS 
 
I was present when the purpose and contents of the Participant Information Sheet was read 
and explained satisfactorily to the participant in the language, he/she understood (….name 
of language)  
 
I confirm that he/she was given the opportunity to ask questions/seek clarifications and 
same were duly answered to his/her satisfaction before voluntarily agreeing to be part of 
the research. 
 
Name: ………………………… 
 
Signature…………………………... OR Thumb Print ………............................  
 
Date: …………………………… 
 
 
 
INVESTIGATOR STATEMENT AND SIGNATURE 
Brief statement or declaration that investigator has given enough information to 
participants to make informed decisions. 
 
I certify that the participant has been given ample time to read and learn about the study. 
All questions and clarifications raised by the participant have been addressed.  
 
Researcher’s name………………………………………. 
 
Signature …………………………………………………. 
 
Date…………………………………………………………. 
 
 
 
 
 
 
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Appendix E: Interview Guide 
UNIVERSITY OF GHANA 
MPHIL THESIS RESEARCH: Health Seeking Behaviour of Men Living with 
Prostate Cancer: A Qualitative Study in the Volta Region 
SEMI STRUCTURED INTERVIEW GUIDE 
The purpose of this interview is to explore the health seeking behaviour of men living with 
prostate cancer from six (6) months and above. The interview is only about your 
experiences within these periods regarding your health seeking when living with prostate 
cancer. I therefore humbly request you to share with me your experiences in this 
condition.     
Code Number …………………                  Date of Interview …………………… 
Interview Number ………………………     
      Section A: Background Information Form / Demographic Data    
1. Age (year) 
……………………………………………………………………………… 
2. Place of Residence 
………………………………………………………………………… 
3. Nationality 
………………………………………………………………………………… 
4. Tribe 
……………………………………………………………………………………… 
5. Marital status 
……………………………………………………………………………… 
6. Number of children 
……………………………………………………………………… 
7. Profession / Occupation 
…………………………………………………………………… 
8. Level of Education 
………………………………………………………………………… 
9. Language (s) spoken 
……………………………………………………………………… 
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10. Religion 
…………………………………………………………………………………… 
11. Date of PSA Investigation 
………………………………………………………………… 
12. How long have you been living with the condition? 
……………………………………… 
 
Section B: Interview Guide 
1. Please share with me what you know about your condition (prostate cancer) 
Probe: 
 Causes 
 Signs and symptoms  
 Treatment option to your condition 
2. What is the attitude of men living with prostate cancer towards health seeking? 
Probe 
 Actively seeking information about mode of treatment 
 Active in seeking health care 
 Refusal to seek health care 
 Prefer medical treatment  
 Prefer local and herbal or traditional treatment 
3. What are the personal factors you consider before seeking for health care? 
Probe: 
 Cultural beliefs 
 Financial  
 Severity of signs and symptoms 
 Physical accessibility  
 Disease pattern 
  
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4. Share with me the external forces/ pressures that influence your decision making 
towards seeking health care? 
Probe  
 Family  
 Spouse  
 Friends 
 Members of the community 
5. What factors inform your decision to seeking a particular health care? 
Probe 
 Level of education 
 Culture and religiosity  
 Age  
 Media 
 Friends and family information 
6. What do you think are the behaviour of men living with prostate cancer toward 
seeking healthcare? 
Probe: 
 Acting Ignorantly 
 Fear 
 Confusion 
 Feeling stigmatized 
 Seek for information every where 
 Reliance on mixed form of treatment 
 Count on health professionals 
 
 
 
 
 
 
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