you gotta avoid that place like the plague!: a phenomenological, qualitative study on men’s views...
TRANSCRIPT
1
You gotta avoid that place like the plague!: A Phenomenological, Qualitative Study on Men’s Views Towards Healthcare
James E. Leone, PhD, MPH, MS, ATC, CSCS, *D, CHES, FMHI
Associate Professor
Health Sciences
Bridgewater State University
Bridgewater, MA
Adjunct Lecturer
Northeastern University
Master of Public Health Program
Boston, MA
October 2, 2015
INTEGRIS Men’s Health Symposium
Oklahoma City, OK
2
Note
• These data are part of a larger multiphase project [Men Accessing and Learning to Engage in Health Education and Learning Programs]
• Part of this research was funded by a Center for the Advancement of Research and Scholarship [CARS] Faculty and Librarian Research Grant [FLRG] at Bridgewater State University.
3
Activity
• Write down your top three (3) reasons why men/males are less likely to seek healthcare when needed or preventatively
• Pair and share
• Group process
4
Results?
•Gender Norms
•Masculinity
•Resources
•Time, convenience, utility, etc.
5
Introduction: Review of the Literature
• Men are far less likely than women to access and receive healthcare, particularly preventative healthcare [Evans, Frank, Oliffe, & Gregory, 2011]
• Highest mortality rates in 9 out of the top 10 leading causes of death [CDC, 2007; Courtenay, 2000; NCHS, 2010; White et al., 2011; Wilkins, 2010]
• Consistently higher morbidity rates
• Racial & ethnic disparities [Fortuna et al., 2009; Gordon, Hawes, Reid, et al., 2013; Hooker, Wilcox, Burroughs, et al., 2012; KFF, 2012]
• Masculinity or something else? Often goes “under the radar” Downstream vs. upstream
• “Normative Content” – health inequity enculturation [Leone & Rovito, 2013]
Kaiser Family Foundation, 2012
8
Purpose/Aim
• Three phase approach to the problem
• Phase I
• Theoretical Model Development
• Key Informant Interviews
• Content Analysis
• Phase II
• Qualitative Methods
• Individual Interviews (N=15)
• Phase III
• Quantitative Survey (N = 479)
• MHQ (Leone, 2014)
• Model confirmation
• Regression
• Beyond…
• Decisional modeling
Beyond…
Phase III
Phase II
Phase I
1. To refine the original conceptual model as to why men are less likely to access
healthcare.
2. To understand what precludes men from accessing healthcare using a qualitative,
phenomenological perspective.
9
Theoretical Frameworks
• Hegemonic Masculinity Theory [Connell, 2005]
• Theory of Normative Contentment [Leone & Rovito, 2013]
• Health Belief Model [Glanz, Rimer & Viswanath, 2008]
10
Study Design/Approach
•Exploratory, question-generating
•Phenomenological, qualitative design [Creswell, 1998 & 2013; Patton, 1990]
• Individual Interviews [IDIs]
11
12
Core
Core
Programming
13
Procedures
• IRB Approval from Bridgewater State University and Northeastern University
• Recruitment via convenience, word-of-mouth, snowball, online health forums, personal referrals
• Scheduling/timing w/ participants
• Informed consent
• Trained interviewer w/ guiding script
14
Procedures [cont.]
• Audio recorded
• Interviews average 30-45 minutes each
• Transcribed verbatim & sent to participants for member checks (accuracy)
15
Data Approach
• Interviews were conducted until data saturation was achieved
• Open coded, then axially coded [noting emerging themes] & root hermeneuristics
• Themes matched to illustrative/supporting quotes
• New themes added and used to refine original conceptual model
16
Findings
• Preliminary conceptual model (N = 39 factors) as to why males do not access healthcare was constructed
• The preliminary model was expanded to include 58 factors.
Interview Data
• Fear, control, time/convenience, unaware/lack of health education, trust, medical cultural competence, reactivity
[REACTIVE] Sean (37): Let’s say because there’s something wrong. Usually it’s… you seek out…like not a cure but, you know, relief from symptoms or pain.
[INCONVENIENCE] Frank (47): “Work, being too busy in a cement company…so I’m working long hours and again maybe [I] want to spend time with my family, not time at the doctor’s office. So, if I feel fine, I just don’t like to go to…to see the doctor….so it’s more or less convenience.”
[LACK OF HEALTH EDUCATION/AWARENESS] Cindy (64): “I also think that men may not really know options or really where to turn with the medical problems if they’re having them.”
Roger (26): “…if they’re sick, they feel like it will go away on its own…”
Findings…
Sean…I think maybe twofold. It’s one that, you know, lack of a better word, macho? You
know…and then the other is really just, you know, inconvenience. ….you know, try to
schedule appointments, when you know, kind of work and family and there’s, you know, I
know it’s an excuse but I don’t see any other time especially with the workload that I have
and my travel schedule. Doctor’s appointments just get cancelled or forgotten
about.
Nick: Some put it off, I believe. If something
happens to them, they will go.
Dave: Cuz they don’t want to know that something is wrong with them…like scared or they fear the unknown. Some guys tend to shake it off or they were brought up that
way…to think that way that is.
I: Any other reasons?
Dave: Well, yeah, it is like a macho thing too…do as I say but not as I do. A lot of guys I know stick their head in the sand and don’t wanna see when something is
wrong with them.
19
Discussion• Themes were consistent with Addis & Mahalik’s (2003) research concerning gender norms in addition to other themes such as, embarrassment, reactivity, lack of education, and concerns about cultural competency of healthcare providers among others.
• Masculinity appears to be the overarching strongest theme versus resources
• Going beyond anecdotal “stereotypes” of men & healthcare can help public health dissect elements of masculinity so they are useful in the field [Addis & Mahalik, 2003]
• “Prominent among the reasons cited by the researchers for the persistent gender disparity are male gender norms, which include reluctance among men in many areas of the world to seek medical care or follow medical advice” [Kurtzman, 2014, np]
20
Limitations
• Convenient sample
• Regionally-based sample/recruitment
• IDIs response bias (i.e. socially acceptable responses)
• Ethnic differences (respondent-interviewer bias)
• Lack of diversity in SES
21
Conclusions
• Participants in this study suggest health education and public health efforts need to leverage gender norms and masculinity in outreach programs and strategies to engage men in healthcare.
22
Translation to Practice
• Maximize on “masculine capital” [Gough, 2013]
• We need to “unpack” masculine norms and use them versus just accounting for them
• Programs that work based on men’s “lived experiences”
24
Select References• Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking.
American Psychologist, 58(1), 5-14.
• Courtenay, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Social Science and Medicine, 50, 1385-1401.
• Dobson, R. (2006). Men are more likely than women to die early. British Medical Journal, 333, (7561), 220.
• Galea, S., & Vlahov, D. (Eds.). (2005). Handbook of Urban Health: Populations, Methods, and Practice. Springer: New York.
• James, S. (2009). Epidemiologic research on health disparities: some thoughts on history and current developments . Epidemiologic Reviews, 31 , 1-6.
• Keppel, K., Garcia, T., Hallquist, S., Ryskulova, A., & Agress, L. (2008). Comparing racial and ethnic populations based on Healthy People 2010 objectives. Healthy People Statistical Notes, 26, 1-15.
• Porche, D. J. (2010). Healthly Men 2020. American Journal of Men’s Health, 18(3), 18.
• Turnock, B. J. (2009). Public Health: What it is and how it works. Jones & Bartlett: Boston, p.11.
• Wilkins, D. (2010). Men’s health. Perspectives in Public Health, 130(5), 201.
• Xanthos, C. (2008). The secret epidemic: Exploring the mental health crisis affecting adolescent African-American males. Community Voices: Healthcare for the Underserved, 1–16.
25
Acknowledgements• Shan Mohammed, MD, MPH [Northeastern University]
• Irina Torodova, PhD [Northeastern University]
• Christina Lee, PhD [Northeastern University]
• Michael J. Rovito, PhD [University of Central Florida; Men’s Health Initiative]
• Elizabeth M. Mullin, PhD [Springfield College]
• Scott T. Williams, MPA [American Cancer Society]
• Ana Fadich, MPH [Men’s Health Network]
• Ian Banks, MD [International Society of Men’s Health; European Men’s Health Forum]
• Justin Tindall, MPH [Brigham Young University; Men’s Health Network]
• Alan White, PhD [Leeds Metropolitan University]
