Offering healthcare services at livestock marts will help to remove stigma about seeking help among agricultural community, study shows

The study shows how farmers, particularly men, can frequently be resistant to seeking support, but putting doctors and nurses in a place where they meet and work with others regularly can help break down barriers.

Those who took part in the research said masculine traits, including pride, fear of being judged, or stoicism linked to their farming identity also prevented them seeking support.

Removing barriers such as time constraints, the need to change out of work clothes, the need to book and travel to an appointment, and thus take time off work, and other more subtle barriers such as mistrust of practitioners can help encourage farmers to get healthcare.

Researchers from the University of Exeter interviewed 90 people at 17 livestock marts in England, Northern Ireland, Scotland and Wales - 42 farmers, 27 auction operators, 15 individuals from support initiatives (including nurses) and 6 other mart stakeholders (such as chairpersons or trading standards officers). The age of farmers ranged in age from 25 to 83, and six were women.

Of the 17 auction mart sites, two hosted permanent clinics, three hosted mobile clinics and four hosted ad hoc services.

Most interviewees said an illness or injury must be extremely bad before they looked for help.

Nurses, auction operators and farmer support organisation representatives interviewed said they believed that by aiding farmers to bypass the more structural issues, such as inconvenience, time constraints, work commitments, flexibility issues, appointment availability, and developing confidence in the service, stoicism as a determinant was weakened, and no longer acted as a barrier to help-seeking.

The majority of farmers interviewed viewed the placing of health hubs at auction marts positively.

Several farmers spoke proudly of the fact that farmers are known for not seeking help. Some farmers said they had continued to work for several hours with injuries later diagnosed as broken bones or torn ligaments. Some were reported to have continued to work for days before seeking help.
Many interviewees said farmers often went to the doctor because of pressure from a female relative. Those who were older (over 55) were considered more likely to delay help-seeking.

Several farmers across a range of age groups, as well as auction operators, admitted to having experienced challenges with their mental health. Many stated a preference to talk to a rural chaplain, friends or family members before a professional.

Many of the farmers interviewed lived in rural or semi-rural locations and had to travel to local towns or villages to see a health professional.

Because of the long hours they worked they were unable to take time out from animals or land. Some said the time and effort of having to change out of dirty work clothes was also off-putting, and doctors surgery opening hours did not match with the erratic nature of farming. They were more likely to put the welfare of their animals before their own.

Several commented on the lack of availability of appointments, particularly in the case of mental health services.

Dr Caroline Nye said: “Livestock auction marts continue to be entrenched in tradition but can also be spaces where outdated and potentially harmful behaviour can be challenged. We need to stop those in the agricultural community feeling reluctant to seek help and remove any shame or stigma they associate with seeing a doctor or nurse.

“Putting services in livestock marts can help to create positive attitudes towards health services. They can be used to show masculine behaviour not to see a doctor is not healthy through peer to peer persuasion in the places where farmers feel at home and part of their community.

“Often farmers will not go to the doctor for a multitude of reasons, but if the healthcare professional is brought to them then fewer barriers remain to their seeking help.”

Professor Matt Lobley said: “Much research on mental health in the farming community focuses on the extent and cause of problems. This is one of few pieces of work that considered how mental health support can be delivered to members of the farming community in a manner that is meaningful and accessible to them and which moves away from urban-centred models of health care support.”

One farmer support organization said 54 people passed through a clinic each market day. Other sites also reported a consistent flow, with between 2 and 17 attendees per day, depending on the type of service offered. The services are always staffed by nurses, although some might also employ other practitioners such as physiotherapists or podiatrists.