Masculinity lost: a systematic review of qualitative research on men with spinal cord injury

Factors affecting sexual health in individuals with spinal cord injury: A systematic scoping review

PURPOSE

This study aims to review the literature to explore some factors affecting sexual and partnership adjustment in individuals with spinal cord injury (SCI).

METHODS

This study was based on the methodological framework of scoping reviews, including 3 methodological steps: (1) identifying relevant studies (searching for related studies); (2) selecting related studies; (3) collecting key findings, summarizing, and reporting the results. The electronic databases were searched including Medline (PubMed), Scopus, Web of Science, Embase, and Cochrane Library. Studies were included if they reported data about the related factors of sexual and partnership adjustment in individuals with SCI. No limitations were considered in terms of time or methodology of the search.

RESULTS

After the full-text screening, 52 studies were included from the year of 1978 - 2019 with various methodologies. The present review demonstrated that proper sexual health among individuals with SCI is related to several factors including the anatomical factor, level of the injury, completeness of the injury, psycho-social factor, socio-economic status, and type of relationship.

CONCLUSION

With consideration of factors affecting sexual and partnership adjustment in individuals with SCI, a better estimation of sexual health can be achieved in clinical to improve the relationship and quality of life.

The Life-Course Perspectives of Mexican American Men With Mobility Limitation

The life-history narratives of 10 Mexican American men with mobility limitations, age 55-77 years (mean = 63.8, SD = 5.8), were explored using a qualitatively driven, life-history mixed-methods study to understand perceptions of mobility limitations over the life course. Within that methodological and paradigmatic framework, conceptualizations of alterity and masculinity guided interpretation of data. Through an iterative, thematic analysis, we detail the way the men's lives were influenced by growing familial responsibility with age. Quantitative data were integrated into themes of narrative inheritance, family, and masculinity. It was posited that masculinity with mobility limitations shaped and was shaped by ethnic identity and responsibility. This has implications for understanding the experience of Mexican American men over the life course.

(Loss of) the super soldier: combat-injuries, body image and veterans' romantic relationships

PURPOSE

Some military personnel sustain physical injuries that alter their appearance, such as limb-loss and scarring. Veterans injured this way may experience body image distress and mental and physical wellbeing difficulties. While research with civilians indicates those with appearance-altering conditions may experience relationship difficulties, this issue remained unexplored among combat-injured veterans. This study aimed to understand how veterans who sustained appearance-altering combat injuries experienced and understood their changed appearance within the context of their romantic relationships.

MATERIALS AND METHOD

Semi-structured interviews with four male UK combat-injured veterans were conducted and analysed using Interpretative Phenomenological Analysis.

RESULTS

Three superordinate themes were generated: (loss of) the super solider; new states of vulnerability; and injury tests relationships.

CONCLUSIONS

Masculinity was central to participants' military identity and represented by their military bodies. Following injury and the loss of their military body, some experienced relationship challenges including a test to the foundations and commitment of their relationships. In contrast, some veterans' relationships grew stronger, especially among participants who described dyadic coping. Additional challenges were related to decreased self-confidence, appearance concerns, and sex and intimacy. Implications for the provision of relationship support for combat-injured veterans and their partners through the long-term trajectory of rehabilitation are discussed.Implications for RehabilitationChanges to veterans' body and physique following appearance-altering combat-injuries may affect identity, self-esteem, confidence, perceived attractiveness, sexual activity, and romantic relationships.Appearance-altering combat injuries may test the stability and strength of existing romantic relationships and introduce new challenges in initiating new romantic relationships.Peer support is helpful for combat-injured veterans adjusting to appearance-altering injuries and the impact on their romantic and intimate relationships.Combat-injured veterans may benefit from specific relationship support provided during their rehabilitation and recovery, to help alleviate relationship difficulties, minimise relationship breakdown, and support those whose relationships end post-injury.

'You Lose Confidence in Being a Human Being, Never Mind Being a Parent': The Lived Experience of Mothers With Spinal Cord Injury

Little research to date has explored the experiences of parenting among mothers with Spinal Cord Injury (SCI). The aim of the study was to explore the lived experiences of mothers with SCI. Semi-structured interviews were conducted with eight mothers and an interpretive phenomenological analysis was carried out. Two super-ordinate themes were identified. The first theme, entitled: 'A sit-down mummy: The visibility of differences as a mother with SCI' highlighted how mothers faced challenges when undertaking practical parenting tasks, thus making them feel less than their non-injured peers, and how they navigated the visible and physical intrusion of the wheelchairs in their relationships with their children. The second theme, entitled: 'What kind of mother? Being a good enough parent' reflected mothers' heightened sense of guilt with respect to unmet expectations of the self as mother, and the contrasting positive experiences of availing of support and finding new ways to connect with their children. Clinical implications, methodological considerations and future directions are discussed.

Intersections between disability, masculinities, and violence: experiences and insights from men with physical disabilities from three African countries

Background

Gender-transformative work in the Global South often focuses on transforming ‘toxic masculinities’ to prevent intimate partner violence (IPV), but there has been little research on whether and how constructions of masculinities by men with disabilities shape their experiences and perpetration of violence.

Methods

We used repeated in-depth interviews and content analysis to understand whether and how physical disability intersects with the construction of masculinities and experience/perpetration of violence among 15 adult men with physical disabilities participating in interventions to prevent IPV in Ghana, Rwanda, and South Africa.

Results

Societal expectations and participants’ aspirations around masculinity impacted their vulnerability to violence mainly by men without disabilities. Participants reported experiences of disrespect and social exclusion in their communities and felt incapable of protecting themselves when being violated. Most participants felt they were not providing for their families and perceived themselves as having lost decision-making and positions of power in their homes. They expressed their disappointment with having reduced stamina, virility, and sexual prowess in intimate partnerships as a result of their disability. While participants reported that they could not attain key markers of idealized masculinity, placed upon and often internalized by themselves, they longed to achieve these markers to facilitate their inclusion and acceptance in their communities.

Conclusions

Programmers addressing violence need to engage with men with physical disabilities and consider the intersectionality of masculinities and disability, how these reinforce patriarchal norms and how men with disabilities can be included and enabled to overcome their conflict between disability and masculinities.

Negotiating Multiple Identities of Brazilian Paralympians

In this article, I draw on the personal narratives of 41 Brazilian Paralympic athletes who competed in the 2016 Rio Paralympic Games to explore their multiple identities shaped within and outside sport and how they negotiated those self-representations. Parathletes’ narratives gave a sense of who they are, how they live their lives, and what their struggles, hopes, and aspirations are within and outside sport. The available studies in disability sport and the representation of disabled athletes have largely failed to examine the stories of these individuals and address their unique realities and perspectives. Five major themes emerged from the interview analysis regarding the parathletes’ self-representation: athletic identity, gender identity, disability identity, national identity, and activist identity. These accounts also revealed how these individuals negotiated their multiple identities in different settings and the tensions they experienced in their social interactions. The Rio Paralympics presented such a new interaction setting for the Brazilian parathletes who competed on such a grand scale at home for the first time and provided multiple examples in the athletes’ accounts of their identities.

"You have to fight to legitimize your existence all the time": The social context of depression in men with physical disabilities

Little is known about the common experience of depression in men with physical disabilities. To help address this gap, we present findings from a qualitative study situated in the social determinants of health (SDH). Findings describe the detrimental effects of marginalization, economic precarity, restrictive masculine norms, stigma, and the need to resist ableist messages on men's health and well-being. It is our intention to raise awareness of the impact of the SDH on depression in men with physical disabilities and encourage clinicians and policy makers to address the social domain as they seek to improve mental health in this population.

"I can't have it; I am a man. A young man!" - men, fibromyalgia and masculinity in a Nordic context

Purpose: Research shows that gender has a substantial impact on the health behaviour such as expression of physical symptoms like persistent pains and aches. However, there is yet little knowledge about the gendered aspect of pain by men who suffer from typical female diseases like fibromyalgia. The purpose of the study was to elucidate the interplay between illness and gender by exploring life-stories of men who suffer from fibromyalgia. Methods: The data were collected through life-story interviews of eight men suffering from fibromyalgia. A narrative methodology for analysis was applied to explore the storytelling and the linguistic and performative aspects of the life-stories. Results: The masculine identity of the participants was re-negotiated by comparisons to other men and life before symptom onset, and by discussing expectations and beliefs of how men should act in contemporary societies. The transition from experiencing a strong, active and reliable body to experiencing a painful, vulnerable and helpless body was perceived as fundamental. Conclusions: Self-management and rehabilitation of fibromyalgia it is not only about learning to manage the symptoms but also about the struggle to find coherence in life through re-constructing gender identity that is acceptable both for the individual and for the community.

Disrupting gender norms in health systems: making the case for change

Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. In this Series paper, we explore how to address all three through recognition and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case studies based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research. We found that health systems reinforce patients' traditional gender roles and neglect gender inequalities in health, health system models and clinic-based programmes are rarely gender responsive, and women have less authority as health workers than men and are often devalued and abused. With regard to potential for disruption, we found that gender equality policies are associated with greater representation of female physicians, which in turn is associated with better health outcomes, but that gender parity is insufficient to achieve gender equality. We found that institutional support and respect of nurses improves quality of care, and that women's empowerment collectives can increase health-care access and provider responsiveness. We see promise from social movements in supporting women's reproductive rights and policies. Our findings suggest we must view gender as a fundamental factor that predetermines and shapes health systems and outcomes. Without addressing the role of restrictive gender norms and gender inequalities within and outside health systems, we will not reach our collective ambitions of universal health coverage and the Sustainable Development Goals. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.

Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury: A case series analysis

CONTEXT/OBJECTIVE

Spinal Cord Injury (SCI) patients face unique identity challenges associated with physical limitations, higher comorbid depression, increased suicidality and reduced subjective well-being. Post-injury identity is often unaddressed in subacute rehabilitation environments where critical physical and functional rehabilitation goals are prioritized. Therapeutic songwriting has demonstrated prior efficacy in promoting healthy adjustment and as a means of expression for post-injury narratives. The current study sought to examine the identity narratives of therapeutic songwriting participants.

DESIGN

Case-series analysis of the individual identity trajectories of eight individuals.

SETTING

Subacute rehabilitation facility, Victoria, Australia.

PARTICIPANTS

Eight individuals with an SCI; 7 males and 1 female.

INTERVENTION

Six-week therapeutic songwriting intervention facilitated by a music therapist to promote identity rehabilitation.

OUTCOME MEASURES

Identity, subjective well-being and distress, emotional state.

RESULTS

Three participants demonstrated positive trajectories and a further three showed negative trajectories; remaining participants were ambiguous in their response. Injury severity differentiated those with positive trajectories from those with negative trajectories, with greater injury severity apparent for those showing negative trends. Self-concept also improved more in those with positive trajectories. Core demographic variables did not however meaningfully predict the direction of change in core identity or wellbeing indices.

CONCLUSION

Identity-focused songwriting holds promise as a means of promoting healthy identity reintegration. Further research on benefits for those with less severe spinal injuries is warranted.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section)

INTRODUCTION

Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions.

EVIDENCE ACQUISITION

A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section.

EVIDENCE SYNTHESIS

The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure.

CONCLUSIONS

The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.

Diferencias de sexo en el uso de estrategias de afrontamiento en personas con lesión medular

Objetivo: profundizar en la experiencia de afrontamiento en personas con lesión medular (LM), teniendo en cuenta tanto el afron- tamiento actual como el afrontamiento durante momentos iniciales tras sufrir la LM. Materiales y métodos: estudio transversal de encuesta. Participaron 127 personas con LM de larga evolución, 95 hombres y 32 mujeres. Los datos fueron recogidos por medio de un cuestionario online con información sociodemográfica y el Cuestionario de Afrontamiento del Estrés (CAE). Se han realizado análisis descriptivos, pruebas t de Student y análisis multivariados de la varianza (Manovas) Resultados: las comparaciones intrasujetos muestran que la estrategia de focalización en solución de problemas se usa más en el afrontamiento actual. La autofocalización negativa es más utilizada en el afrontamiento pasado, en los momentos iniciales tras sufrir la LM. Los resultados de los Manovas muestran que no existen diferencias en función del sexo en el afrontamiento rememorado ni en el actual. Los Anova de seguimiento para el afrontamiento actual evidencian que las mujeres utilizan más las estrategias de búsqueda de apoyo social y expresión emocional abierta. Conclusiones: no hay diferencias de sexo en el uso de las estrategias de afrontamiento en la LM. Se sugiere seguir investigando cómo el género puede actuar en este proceso.

The meaning of work after spinal cord injury: a scoping review

STUDY DESIGN

Scoping review.

OBJECTIVES

To explore the meaning of work after spinal cord injury (SCI) in existing literature.

METHODS

Arksey and O'Malley's widely used methodological framework for scoping reviews was used to guide this review. Studies involving adults with SCI, conducted using qualitative methods, and published in peer reviewed literature were identified based on key terms and searches in three databases (CINAHL, MEDLINE, PsycINFO). Further search steps included checking citations in identified articles and citation tracking for other relevant articles and reviews. Reported qualitative data were then thematically analysed to generate themes.

RESULTS

Twelve studies were included. Three themes were identified across these studies that describe the meanings of work after spinal cord injury: re-developing a sense of self, re-establishing place in the community and regaining economic self-sufficiency.

CONCLUSIONS

The varied meanings of work after SCI identified in this review may be used in rehabilitation programs to explore ideas about work, the types of work they wish to pursue, and the ways in which work may be meaningful for people with SCI, so as to identify individually and contextually relevant work. Taking account of meaning in ICF based models of work participation could enhance patient-centred approaches in SCI rehabilitation.