Selective Disclosure, Barriers to Care, and Masculinity Norms Among Male First Responders: A MANifest Health Theory-Informed Cross-Sectional Study.

Abstract

Male first responders face high occupational stress and health risks, influenced by structural barriers and masculine norms. This cross-sectional study examined men's health knowledge, perceived barriers to care, traditional masculinity norms, and health behaviors among 102 male first responders. Descriptive statistics were computed, and nonparametric tests and Spearman correlations evaluated associations with key outcomes, including omission of pertinent health information during clinical encounters. Scale reliability was strong (men's health knowledge α = 0.92; barriers α = 0.77; masculinity norms α = 0.78). Mean age was 44.9 years (SD 13.5); mean BMI was 30.8 (SD 5.6, n = 84), with 53.6% classified as obese/severely obese. A total of 22.0% (n = 91) endorsed Yes/Maybe to having omitted pertinent health information from a provider. Men endorsing omission reported higher overall barriers (Mann-Whitney, p = .0268, r = .325), driven by lack of time (pFDR = .0055, r = .453) and limited awareness of services (pFDR = .0467, r = .332). Traditional masculinity norms differed by occupation (Kruskal-Wallis, p = .00211, ε² = .117), with police scoring higher than firefighters and EMS. Provider satisfaction was inversely associated with barriers (ρ = -.273, pFDR = .0206) and masculinity norms (ρ = -.295, pFDR = .0142). Diet and exercise correlated positively with self-rated health and body image, whereas BMI correlated negatively. Findings support MANifest Health Theory: selective disclosure is shaped by "maintenance friction" (time/awareness barriers) interacting with masculinity-aligned identity needs. Interventions reducing access friction and framing care as readiness maintenance may improve disclosure.