Abstract
Background:
Men’s health has been subjected to diverse approaches to research over the past two decades. Much of the literature has focused on specific medical and health issues. Other contributions have focused more broadly on masculinities and its relationship to health. It is arguable that there has not been a lot of attention paid to Australian rural men’s health and even less on their understanding of health as it relates to physical activity and dietary behavior.
Objectives:
To gain a better understanding of these issues this paper provides rich, descriptive qualitative data from men living on Kangaroo Island, which is 13.5 kilometres off the South Australian mainland and is regarded as a rural and remote area.
Methods:
Qualitative data is used to develop greater understanding of the men’s attitudes and behaviours as they relate to physical activity and dietary behaviours. The semistructured interviews and focus groups were conducted with 40 men aged between 23–64.
Conclusions:
The results indicated that the locality in which the men lived provided them with an excellent opportunity to be physically active and eat fresh, locally produced, foods. However, it was identified that many of the men did not have a comprehensive understanding of health and seemingly displayed low levels of health knowledge. As a result for many of these men, their physical health was left to chance. There was little evidence of any planned health promotion to assist them with making improvements to their nutrition and physical activity levels as they aged. Recommendations and population-based strategies are provided to assist men living in remote rural settings to enhance not only their health ultimately their health knowledge. This will positively impact community health.
Introduction
There have been assertions that men’s health, globally, is in crisis. Academic literature (e.g. Courtenay, 2000; Harris and McKenzie, 2006; Sabo and Gordon, 1995; Williams, 2003), professional health organisations (Australian Medical Association [AMA], 2005; White and Cash, 2003) and government analyses (e.g. New South Wales Health, 2009; South Australia Department of Human Services [SA DHS], 2000) have all described the inequity in health that exists between men and women. In a report published by the South Australian government (SA DHS, 2000), it was identified that men are at an increased risk of a range of health issues that includes accidents and injury (including suicide), substance abuse, mental health concerns, and sexually transmitted illnesses. Men are comparatively susceptible to obesity and other hypokinetic diseases (which are diseases and conditions that are related to a lack of movement) largely based on poor physical activity (PA) and dietary behaviours. Importantly, some academics have argued that masculinity, and what it means to be a man, may explain in part the general poor health of men along with their attitudes towards PA and nutrition (e.g. Courtenay, 2000; White and Johnson, 2000). These authors claim that current definitions of masculinity in Western culture may negatively impact the health of men in several ways. For example, it may influence men to adopt risky behaviours, which may lead to injury and death. However, it is the conceptualisation around health as being something that the antithesis of masculinity, that is feminised, that is an interesting notion (Drummond and Drummond, 2012). This pervading notion surrounding men’s health can influence some men into believing it is feminine to be concerned about their health, or to take care of their health through means such as proper diet and exercise (Filiault and Drummond, 2009). Men may also be less motivated to seek help when it is needed, because doing so may be viewed as being feminine (Drummond and Drummond, 2012). It is not surprising that many studies report that men utilise health services less than women (Courtenay, 2000; Smith et al., 2006), which ultimately has the capacity to impact negatively on their long-term health. There is a range of reasons to explain this phenomenon and those more frequently mentioned suggest lack of time, lack of access, reluctance to openly discuss their health, and lack of male providers as reasons for not seeking help when it is needed (Smith et al., 2006). Poverty and deprivation also play a significant part of health outcomes both generally (Australian Bureau of Statistics [ABS], 2013; Fone et al., 2013; Scollo and Winstanley, 2012) and in men (Robertson et al., 2010; Roy et al., 2014). While this information may help explain men’s health seeking behaviours, it is important to better understand their responses to health education and promotion messages to minimise the need to seek health provision.
Given that increasing health problems for men are related to being overweight or obesity leading to the development of ‘lifestyle’ diseases, this paper will explore knowledge, attitudes and behaviour of men and their association with PA and dietary behaviours. The context of the research is the location of Kangaroo Island. Due to Kangaroo Island being both rural and isolated, there is potential for men’s health concerns to escalate considerably. Kangaroo Island is Australia’s third largest island 13 km off the mainland of South Australia (SA) and only accessible by ferry or aeroplane. It is in excess of 110 km from the centre of Adelaide and has a population of around 4,500 people. It is possible to attain a sense of the vastness of the island and relative remoteness of people from one another living on the island when you consider that Kangaroo Island is seven times larger than Singapore, which has a population of around 4.7 million people. In terms of health services, the island has a main health service that is run and operated by the State Government of SA. Known as the Kangaroo Island Health Service, it is located in the central area of Kingscote, which is the largest of the towns on Kangaroo Island with a population in excess of 2,000 and is seen as the administrative hub of the island. Significantly, the health service is accessible to most. Ambulances are also provided to those who require assistance. The health service provides a range of services ranging from in-hospital care for adults and children by local general practitioners (GPs) to specialist surgical, obstetrics and outpatients. It also has specialist mental health services available (Government of SA and SA Health, 2016). Kangaroo Island with its unique ‘separate’ locality from the Australian mainland can exacerbate poor health outcomes for men, which can be related back to a lack to PA and poor diet.
Methods
The research reported here is based on in-depth (Patton, 2002), phenomenological interviews with men across a range of ages and demographics living on Kangaroo Island. The researchers (M.D. and S.E.) made contact with a number of different community groups and organisations prior to the commencement of the data collection phase. Establishments such as the local government health services and health promotion centre were contacted to assist in distributing research flyers and information sheets to the local men. Sports clubs and community groups such as football and cricket clubs as well as Lions and Rotary clubs were also contacted in order to allow us to access a range of men. The men that were interested in being involved provided their name and contact details for the researcher to follow up and make contact with them. Once a time and location was established to be involved in either an individual interview or focus group, men were invited to sign a consent form as per institutional ethical requirements. Indeed, each of the participants was provided an information sheet outlining the scope of the research as well as a consent form they were each required to sign as stipulated by the Flinders University Human Behavioural Research Ethics Committee. The men understood that despite being interviewed in depth and the data being transcribed verbatim, their identities would remain anonymous. Furthermore, they understood that they could withdraw from the study at any time without prejudice and their data would be destroyed and ineligible to use. All of the men in this research willingly accepted to be a part of the research and tell their ‘stories’.
In-depth phenomenological interviews were the most appropriate means of data collection for this study as they could provide the richest source of data in relation to the phenomenon being researched (Patton, 2002). This is true of the data that were collected in both the individual and focus group interviews with the 40 men. It should be recognised that focus groups can elicit phenomenological data despite the traditional ideology that only individual interviews have the capacity to do so (Bradbury-Jones et al., 2009). The area of research in this instance is that of men and their PA and dietary behaviours that live on Kangaroo Island. While the study focused heavily on PA, nutrition and health, there were also questions relating to meanings, perceptions, and expectations of masculinity within each man’s total life experiences. This technique provided flexibility and enabled the interviewer to probe particular issues recognised as being crucial to the study, and in turn the depth, clarity and ‘richness’ of the data are enhanced. Another important benefit of the interview technique is that respondents can express their feelings, opinions and understandings of a phenomenon in their own terms (Patton, 2002).
The study used a digital audio-recorder to capture interviews with participants. In-depth and focus groups interviews utilised a general interview guide approach. The guide served as a basic checklist during the interview to ensure that all relevant topics were covered. No standardised questions were prepared in advance and therefore the interviewer was required to be adept at wording and sequencing the questions appropriately to specific respondents in the context of the interview. According to Patton (2002),
An interview guide is a list of questions or issues that are to be explored in the course of an interview. An interview guide is prepared in order to make sure that basically the same information is obtained from a number of people by covering the same material. (p. 283)
Rural living men’s understanding, knowledge and experiences of PA and dietary behaviour were the subject of this study and questions were directed at the respondents in a manner that would best draw on their individual perspectives and experiences.
Data collection
In total, 40 men were involved in the research. A total of 16 individual interviews and six focus groups with 24 men were carried out. The interviews and focus groups were conducted at a location convenient to the men, which was generally in the men’s homes, in a pub (hotel) or at the Kangaroo Island Health Service where a dedicated room was assigned to undertake the research. Each audio-recorded interview or focus group was approximately 1 to 2 hours in duration with shorter follow-up interviews, designed to gather any additional information and as means of validity checks. These were conducted over the telephone in order to clarify specific aspects of the text. The interview guide was also devised to ensure issues pertaining to men PA and dietary behaviours were discussed. Respondents’ interviews were transcribed verbatim with their permission.
Data analysis
Data were thematically analysed using an inductive approach to theorisation. Such an approach complements a phenomenological methodology very well. Maximal variation sampling, inter-coder reliability and individual member checking (Creswell and Miller, 2000; Patton, 2002) were employed to enhance methodological rigour. During the analyses of the data, similarities and differences were noted drawing on personal understanding, professional knowledge and the literature (Strauss, 1987). However, as Goetz and Le Compte (1984) suggest, a ‘studied naivete’ was adopted that allowed each aspect of the phenomena to be viewed ‘as if it were new and unfamiliar and, hence, potentially significant’ (p. 168).
The following themes emerged from the men in this study. These themes are primarily based around PA and nutrition, although we have presented a theme relating to broader conceptions of health for men given that health knowledge is critical to understanding men and their health (Peerson and Saunders, 2011), including PA and dietary behaviours.
Themes
Basic men’s health
Men involved in this study came from a variety of educational and demographic backgrounds. The data indicated that those men involved in health-related professional services on the island had a more comprehensive understanding of health promotion practices. Conversely, it was also clear that for most of the non-professional men, their health knowledge was lacking. While this was not problematic in terms of current health status, neglecting health in the years prior to ageing is fraught with complications later in life. Despite these men currently displaying little concern, there is a good chance health issues will arise during ageing. One man provided a statement that was indicative of other men by claiming,
I’ve got to be really crook (sick) or they put me in an ambulance sort of thing. Or if I cut a finger off or something or you’ve got to get stiches. Other than that, I’ve had major back surgery as well and I just don’t like doctors or hospitals. Don’t get me wrong, the hospital and the doctors here are wonderful but I don’t like all the fuss. (Pete, 54)
The same man, Pete, in the following conversation provided an example of the type of ideology that was prevalent within this cohort of men on Kangaroo Island:
So when do you take the risk and say, ‘No, it’ll be fine’ when in fact there is a legitimate concern for your health and wellbeing?
Last time I went and saw the doctor he said to me, ‘You know you’re 54 now, you need to be coming in at least once every 12 months for a check-up’. And I said, ‘Yeah right-o’.
How did you respond to that?
Yeah, I thought probably I should.
And, you’re smiling now because?
I thought probably I should but I probably won’t.
Why not?
Because a lot of these things entail taking time off work as well. I don’t know, just can’t be bothered with it sometimes, can you?
He then went on to discuss a recent event with what he perceived were just stomach cramps, but ended up being far worse:
I had a lot of pain, so much so that I had appendicitis and I left it and it eventually burst and I got peritonitis. I was lucky to survive that, apparently. I just thought I had a crook guts. I suppose I don’t want to be seen as a hypochondriac. And I think our medical system’s overrun with hypochondriacs. I mean, we’re a population here of 4,500 people on the island and we’ve got five doctors. You’ve only got to drive past that medical clinic and the bloody place is full every day. It just beggars belief that we could be that sick. Are we that sick or have people just become hypochondriacs?
For another 49-year-old man (Dave) who required surgery on his ankle, the prospect of surgery was more associated with cost rather than health outcomes. He simply could not afford to have his ankle reconstructed to eliminate the pain due to financial constraints, and the possibility of losing money as a diesel mechanic when he was ‘out of action’. Dave stated,
At the moment I’ve been on the waiting list now for 12 months. Privately it costs $25,000, and that’s if everything went to plan. Otherwise it’s another $800, plus expenses. So we can’t afford that. So I’m still working and trying to the through the pain by using painkillers. There’s not much you can do.
While men claimed to hear of health promotion messages on the radio or from their GP and other health services, the majority did not act on them due to a number of underpinning reasons such as work, or that they ‘just can’t be bothered’.
Incidental PA
The majority of the men interviewed had a very basic understanding of PA guidelines for optimum health benefits. Most identified 30 minutes of PA a day as being the optimal amount of PA required to maintain the basis of good health. However, the problem for the majority of the men is that they are employed for long hours in jobs as carpenters and mechanics or they work long hours on the farm and cannot commit to regular PA outside their work hours. Therefore, many of the men have disengaged from formal forms of sport of PA beyond their work life. Certainly, there is evidence to suggest that when individuals drop out of sports and physical activities re-engagement is more difficult in later life (Drummond et al., 2008). The following two comments are typical of participants who were tradesmen and farmers:
We own an 11 hectare property, so I get a fair bit of physical activity on the weekend. Just maintenance, repairs, digging, shifting rocks, pruning, all that kind of stuff. (Angus, 47)
Another man stated,
I probably don’t do the physical work that I used to do. Like, as a shearer, when I was younger, you’re pretty full on. But I would still walk a fair way. … But the farming does take it out of you. You are on your feet a fair bit. The work has to get done and it takes time. (Jed, 52)
A number of men had no idea about the National PA guidelines and identified their long hours and work as a means through which they could attain their PA. When asked whether he was aware of the national guidelines, one man (Graham, 45) claimed,
No. But I figure I work hard enough so I don’t have to worry about that stuff.
And you don’t want to look into it?
No. I’m not interested anymore, really, generally because you’re knackered at the end of the day and come Friday, sometimes you’re working on the weekends as well. So you do 80 hours a week, you haven’t got too much time to be contemplating about doing too much else other than eating and sleeping.
In terms of employment, some men were undertaking ‘incidental PA’ within their occupations. The following comment is typical of such a notion:
I kind of know the PA guideline but I have never really taken notice of it. I mean, I’m walking and lifting and doing stuff all day at work, so I’ve never really taken much notice of it. (Ian, 52)
This comment was common among the men and suggests that they are aware of receiving regular PA through their work. Problematically, however, they do not have a comprehensive understanding of the need to undertake PA for their health beyond their employment.
Sport as PA
Many of the men in this study had played sport during their childhood, adolescence and early adulthood years. Similar to other rural areas, sport is a positive aspect of their rural community. What happens then when men stop playing sport in these communities? It is clear that sport has been, and continues to be, an important part of most of the men’s lives on Kangaroo Island. It is also evident that the men generally perceive sport on the island as a means of socialisation and is ‘just what you do’. The primary sport in which younger men are engaged on Kangaroo Island is Australian football and is played during the spring and winter months of April–August. Football is a dynamic sport, and there is concern that it may place the body under particular physical pressures such as rapid twisting and turning, high leaping and strong tackling. It is also arduous in terms of heavy physical collisions. In both of these situations, injuries can occur, and as men move towards their 30s, these injuries become prevalent. Typically, Australian football is a sport where men generally only play into their early 30s. In the country areas such as Kangaroo Island, footballers playing in the lower grades can play into their mid-late 40s, though this is not commonplace. Cricket is also played over autumn and summer (October–March), although the men claim it is less popular than football and therefore harder to gather teams together. Typical of the comments made by men in this research, this man stated,
Yeah, I played football most of my younger life. But I had a few health and injury issues that have sort of put an end to that. I mean with the property we’ve got here, it sort of eats up all my spare time. (Jamie, 50)
The same individual went to on to claim,
Well now I have to a play an old man’s sport, bowls. But I do go fishing on the weekends with my son. Though we don’t do a lot now since we got this property. I also try and stay involved with the football club and go down there when I can. (Jamie, 50)
This comment is important, not only because it highlights the restricted options for sports involvement as men age, but also that men consistently raised fishing as a sport they were involved in. By their definition, fishing was viewed as a sport and therefore commonly seen as providing opportunities to be physically active. However, given that fishing generally involves a good deal of sitting and waiting, it is hard to claim this is a form of moderate to vigorous PA. It is also not uncommon for alcohol to be consumed in the process of sitting and waiting for the fish to bite, making this activity more of a leisure pursuit.
For a number of the men, fishing was ingrained in what they do on a regular basis as this man claimed,
I like to fish. My father had a fishing license as well as a farm, so I grew up fishing.
Fishing ranked highly on the island for many of these men in terms of it being a sport, leisure or recreation pursuit. Indeed, one of the men claimed the ‘sport’ had specific links to masculinity. This is interesting given that much of the literature links traditional masculine sports such as football, rugby, cricket and basketball as being the popular sports that Australian men gravitate towards (Drummond, 2011):
Yeah hard, physical work in the country I think is associated with masculinity, hard, physical activity so surfing, even fishing if you’re the kind of guy who goes out fishing every day in your boat and you’re a good fisherman well you must be a real bloke it’s a kind of symbol of being a man.
The following comment encapsulates the type of ideology espoused by a number of the men in this research. There is a certain underpinning sentiment that suggests once in retirement, the men on Kangaroo Island are destined for a life of ‘slow decay’. Problematically, there appears to be a strong perception that there is very little beyond retirement:
Well I don’t know if you give up on them. It’s hard to say isn’t it? But I think if you’re going to look for bang for buck, like your farmers aren’t going to change I don’t think, to any great degree. They’re going to focus on their work and on their farm and when they retire they’ll go fishing and some of them do the bush walking and stuff. You know, some of them might go to the gym and things like that but by and large that lifestyle is, you know, they kind of expect to cruise off to the grave, you know, hopefully over a long steady decline. (Brian, 56)
While ‘cruising off to the grave’ is not the optimal ideology that health educators promote, being happy and content are important aspects of quality of life. Engaging in leisure and recreation pursuits that do not necessarily promote high levels of PA and yet positively influence health through socialisation is an important part of the men’s existence. Ultimately, it makes their lives meaningful to them. As one of the men said, ‘you’ve got have a reason to get out bed in the morning’ (Bill, 68).
Daily diet and the junk food debate
The men on Kangaroo Island appear to have a very good understanding of the essential requirements for a healthy diet. The majority claimed to have a diet that consisted largely of ‘good wholesome foods’. Indeed, the island is rich in produce and the men claimed to like eating the foods grown there. The following comments underpin the types of claims made by many of the men:
Well, because we’ve got our own sheep on this property, we eat quite a lot of lamb, our own lamb. We’d have probably a minimum of two lamb meals a week and like last night, we had sausages and vegetables. But we probably have steak once a week, fish once or twice a week, that sort of thing. (John, 52)
Another man said,
I have a good diet. Actually we don’t eat a lot of takeaway at all. So quite a varied diet. I have juice and cereal in the morning. ‘Smoko’ time, we just had smoko, so maybe a bit of cheese and some crackers and maybe a sandwich and a piece of fruit and a cup of coffee. Lunch similar, homemade sandwich or a salad and meat or and again a bit of fruit and that sort of thing. And tea (dinner) we cook meals and there pretty much your standard Aussie fare type of thing, meat and 3 veg and that – and we eat a lot of fish, because we catch a lot of fish so good home cooked meals. (Andy, 56)
1
For many men, there seemed a disconnect between notions of junk food and convenience food. For example, while claiming that they did not eat junk food, men reported having little hesitation in buying items from the local bakery, and hamburgers from the local fish and chip shop. This was not seen as eating ‘junk’. Many of the men claimed that the foods consumed were made from wholesome local produce and therefore were good for them. They felt comfortable eating locally produced convenience foods despite the fact that they contained high levels of fat, sugar and salt:
No, I don’t consider the bakery to be a junk food shop. I love pastry foods, they’re great. They’re very, very tasty. Wrap anything in pastry and I’ll eat it. So I don’t have a pie every day for lunch, everything in moderation, that’s my theory. If you’re going to have a pie, have a pie Monday, and have a pie Friday, but in between, vary your diet, it’s all about moderation. (Tom, 41)
I’m the same. I think if you talk about the cakes and all the other stuff, it’s good food. I think there’s nothing wrong with having a good meat pie, but I wouldn’t consider it to be junk food. (Jake, 32)
OK, what are your thoughts guys?
Same answer, and I know what goes into their products and it’s good fresh products, cooked freshly, it’s made there. So you have a choice, I mean a good salad sandwich or a well-made pie, or I can get the coffee scroll or some of the sugar buns and stuff. (Josh, 30)
Similarly, another man stated,
With junk food, probably the first thing that springs to my mind is it’s full of saturated fat and it’s fair to say that there’s going to be fat in pies but generally bakery food is fairly wholesome in what it contains and to some extent it probably fulfils some of the food groups. (Mike, 40)
This comment by Mike provides a fundamental overview of the way in which most men perceived nutrition and their daily dietary behaviours. However, the motto of ‘everything in moderation’ also appeared as a mantra that has permeated these men’s vernacular when it comes to daily dietary habits:
Yeah, I still probably suggest that I don’t meet the consumption of the required fruits and vegetables in my opinion. But if you average it out over the year, you know, what is it two serves of fruit and five serves of veg? I probably suggest I don’t make it, I still probably don’t intake that much. I mean my lunch probably consists of a toasted ham, cheese, and tomato sandwich or maybe a meat pie from the bakery. That doesn’t contribute to the two fruit and five veg on a daily basis. I concentrate mainly on that main meal at night, and I probably should eat something else throughout the day, but I don’t. I don’t tend to eat a lot during the day. I basically wait until that main meal of the day. It’s just small meals for breakfast and lunch. But, yeah, I’m well aware of it. Again, I probably don’t eat the recommended dose, but I wouldn’t eat a load of crap instead of. That’s the thing, everything in moderation.
An interesting observation was the association between junk food and the mainland. Given the paucity of convenience food service by international multinational corporations such as McDonalds, KFC (Kentucky Fried Chicken) and Pizza Hut on the island, some said that when they visited the mainland they would take the opportunity to eat this sort of convenience food as a form of ‘treat’. As one man said,
Yeah I don’t often go and get a hamburger from the local shop here or anything like that, it’s just when you’re over in town I suppose it’s just, it’s a bit of a treat and something quick and easy. (Andy, 56)
Discussion
Men’s health in Australia is comparatively poor in comparison with that of women (AMA, 2005). With respect to most key indicators associated with lifestyle disease, men appear to be doing poorly. In analysing and interpreting these statistics at a deeper level particularly where rural men’s health is concerned, it is clear that the geographical and social demographic characteristics of Kangaroo Island present their own set of challenges for the men living on the island.
During their working years, most of the men involved in this study were receiving enough ‘incidental PA’ to satisfy the daily PA recommendations established within Australia’s PA and Sedentary Behaviour Guidelines (Department of Health [DoH], 2014). A number of those who were farmers were spending time walking the paddocks, tending animals, mending fences, shifting water pipes and so forth. Therefore, their occupations enable them to fulfil levels of PA that may have been in-line with National Guidelines. This is also true for those involved in trades that required them to be on their feet from early morning to evening. While such men may incidentally have satisfied the desired PA requirement, the key issue of concern is that they do not necessarily have a good understanding of the PA requirements for good health. Problems may arise in retirement when their work no longer provides them with the opportunity to exercise.
Many men identified as having been engaged in sport, mainly Australian rules football, up until their mid-40s. This meant training several times a week and playing the game on the weekend, thereby increasing levels of PA. However, once they ceased playing the game either through age or injury, they became spectators and tended not to take on another sport. The limited number of organised sports opportunities available on Kangaroo Island for these men compounds this. While attending a football match and socialising with friends is an excellent way to promote positive mental health and wellbeing, it does not adequately promote physical health.
Lack of understanding about what constitutes being physically active means led many of the men to believe that participating in the recreational pursuit of fishing was a form of PA that would enable them to experience the health benefits of being physically active. While some men did stand on the beach or on rock ledges and cast a line, most of the men ‘fished’ in boats where they would be sitting down for the majority of time.
With respect to diet, men in this study adopted the mantra ‘everything in moderation’. Many believed they had adequate dietary behaviours as a consequence of living on an island that has boundless opportunities for fresh produce, minimal numbers of fast food outlets, a bakery that provides wholesome food, and the men’s liking for catching and eating fish on a regular basis.
It is fortuitous that the men involved in this study live in a setting that may unintentionally promote PA and health-oriented dietary behaviours. The need to promote PA and health-oriented nutrition in a more systematic manner, however, is clear. Leaving health up to chance is not a good example of contemporary health promotion because as Pete (54) said, left to their own devices in terms of understanding health messages, it is like ‘sorting out the fly shit from the pepper, the fact from the fiction’. What this comment highlights is the enormous amount of information available to individuals with respect to health. However, the men found difficulty in accessing, interpreting and understanding what was ‘useful’ to their needs. In consequence, they continued on with the attitudes and behaviours they currently held, unless a major life event intervened such as a ‘health scare’.
Conclusion
Health services available on Kangaroo Island are attempting to engage the community in health promotion initiatives. However, engaging men in health promotion initiatives requires a specific set of skills. Working in a rural and isolated setting where traditional masculine ideologies exist is difficult and provides a greater challenge than in other settings (Macdonald, 2011). This paper points to the need to engage men more in thinking about their health by identifying areas that require attention. Interventions in localities like Kangaroo Island need to adopt a ‘model of best fit’ and work with the local men to sustain long-term health without having to rely on unintentional PA and good nutrition, as is the case now. Building on the resources of the location in which the men live (Robertson et al., 2013), and working with men rather than on men will be the key to future success.
Footnotes
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded through a Flinders University Collaborative Grant and Rural Health South Australia - Government of South Australia.