Healthy masculinities? How ostensibly healthy men talk about lifestyle, health and gender

How Do Men Who Post Publicly on Social Media Author Themselves and Their Experiences of Crohn's Disease? A Dialogical Analysis of Three Cases

Despite distinct sex- and gender-related differences in the presentation and manifestation of Crohn's disease (CD), little research to date has considered men's particular experiences. Whilst hegemonic masculine ideals have been reported to negatively impact men's mental and physical health, increasingly research has emphasized that men engage in a diverse range of practices, including those beneficial to health. One such practice is posting about their illness experiences on social media. The interactive nature of posting online means that a dialogical approach, based on a relational epistemology, is particularly useful. This study therefore asked: "How do men who post publicly on social media author themselves and their experiences of CD?" Three participants were recruited, all of whom had a diagnosis of CD, wrote a blog, and posted on other social networking sites (SNSs) about CD. Two resided in Canada and one in the United Kingdom. All were white. For each participant, 2 years of multimodal social media data was downloaded. After screening, in-depth analysis was conducted using a dialogical approach focusing on three key dialogical concepts: genre, chronotope, and forms of authorship. The key findings emphasized the participants' different responses to the lack of predictability caused by CD and the different ways they used social media to gain a greater sense of control over their illness stories and identities, providing important insights into the interaction between masculine identities and illness. Finally, the potential deployment of such methods in future research and within therapeutic contexts was considered.

Effectiveness of Telephysiotherapy in Improving Older Adults' Physical and Psychological Outcomes: A Systematic Review and Meta-Analysis

(1) Objective: to investigate the effectiveness of telephysiotherapy compared with traditional rehabilitation for elderly patients and determine the factors impacting its efficacy. (2) Method: Five online databases (PubMed, Google Scholar, Scopus, Web of Science, and Cochrane) were reviewed up to 31 July 2023. The search included the literature in English from 2014 to 2023, to capture the latest practices in telephysiotherapy for elderly patients. Data from all qualified studies were independently extracted by two authors, quantifying effect size to reflect treatment performance. (3) Results: 222 records from 19 articles were analyzed. The effect size for telephysiotherapy was 0.350 (95% C.I. = 0.283-0.416; p < 0.01). The standardized mean differences for physical and psychological outcomes were 0.406 (95% C.I. = 0.325-0.488; p < 0.01) and 0.223 (95% C.I. = 0.110-0.336; p < 0.01), respectively. (4) Conclusions: Telephysiotherapy was more effective than traditional rehabilitation, significantly improving the physical and psychological status of elderly patients. The factors influencing the effectiveness of telephysiotherapy were intervention type, intervention duration, outcome, and gender.

Masculinity, Meat, and Veg*nism: A Scoping Review

Men historically consume more meat than women, show fewer intentions to reduce meat consumption, and are underrepresented among vegans and vegetarians. Eating meat strongly aligns with normative masculinities, decisively affirming that "real men" eat meat and subordinating men who choose to be veg*n (vegan or vegetarian). The emergence of meat alternatives and increasing environmental concerns may contest these long-standing masculine norms and hierarchies. The current scoping review addresses the research question what are the connections between masculinities and men's attitudes and behaviors toward meat consumption and veg*nism? Using keywords derived from two key concepts, "men" and "meat," 39 articles were selected and analyzed to inductively derive three thematic findings; (a) Meat as Masculine, (b) Veg*n Men as Othered, and (c) Veg*nism as Contemporary Masculinity. Meat as Masculine included how men's gendered identities, defenses, and physicalities were entwined with meat consumption. Veg*n Men as Othered explored the social and cultural challenges faced by men who adopt meatless diets, including perceptions of emasculation. Veg*nism as Contemporary Masculinity was claimed by men who eschewed meat in their diets and advocated for veg*nism as legitimate masculine capital through linkages to physical strength, rationality, self-determination, courage, and discipline. In light of the growing concern about the ecological impact of meat production and the adverse health outcomes associated with its excessive consumption, this review summarizes empirical connections between masculinities and the consumption of meat to consider directions for future men's health promotion research, policy, and practice.

Interpretative repertoires of long-term weight management: negotiating accountability and explaining success

OBJECTIVE

Public health messages encourage maintaining a stable weight and are influential in shaping normative weight management discourses. We studied how individuals with different weight maintenance histories constructed relations to these discourses in their sense-making on weight management.

DESIGN

Our study used critical discursive psychology (CDP) as a theoretical and methodological framework for examining the accounts of 20 lifelong weight maintainers and 20 weight-loss maintainers (altogether 17 men and 23 women, aged 51-74).

RESULTS

We identified three interpretative repertoires the participants used for making sense of weight management. The lifelong weight maintainers and weight-loss maintainers differed in their ways of using three repertoires. The "everyday challenges" repertoire that emphasized external obstacles was most emphatic in weight-loss maintainers' accounts of unsuccessful weight management, and the "following instructions" repertoire that highlighted control and disciplined behavior in their accounts of success. The "lifestyle and personalized routines" repertoire that stressed customized needs and routinization of practices was most prominent in lifelong weight maintainers' accounts of successful weight management.

CONCLUSION

Our findings stress the importance of alternative ways of talking about and supporting weight management to prevent stigmatization. In conclusion, we suggest employing morally neutral language by focusing on lifestyle and wellbeing instead of weight.

Love and lifestyle: how 'relational healthism' structures couples' talk of engagement with lifestyle advice associated with a new diagnosis of coronary heart disease

OBJECTIVES

Healthy lifestyle change improves outcomes in coronary heart disease (CHD), but is rarely sustained. To better understand barriers to lifestyle change, we examined couples' talk of engaging with lifestyle advice after one partner receives a diagnosis of CHD.

DESIGN

A longitudinal qualitative design, in which a poststructuralist discourse analysis was performed on 35 interviews, conducted with 22 heterosexual British people in a long term relationship. The interviews occurred over three months after one partner was referred to a cardiac rehabilitation programme designed to support lifestyle change.

RESULTS

Couples understood their health as a shared practice underpinned by an ideological framework of healthism, creating a form of 'relational healthism'. Practicing relational healthism was not straightforward because the practices of surveillance, control, and discipline related to healthism often contravened relationship norms of support, acceptance and respect for the other's autonomy. Couples struggled to resolve this tension, dynamically adopting, resisting, and occasionally transforming discourses of health and love in ways that worked for and against engagement in lifestyle change.

CONCLUSION

In foregrounding the discursive and relational contexts of behavioural change engagement, we show the considerable complexity for couples, including costs related to engagement with lifestyle advice.

Very small effects of an imagery-based randomised trial to promote adherence to wearing face coverings during the COVID-19 pandemic and identification of future intervention targets

OBJECTIVE

Mental imagery interventions are a cost-effective way of promoting health behaviour change. We tested a mental imagery intervention designed to promote adherence to wearing face coverings during the COVID-19 pandemic.Design: A four-arm randomised controlled trial to explore potential mechanisms of action. Main outcome measures: Measures of behaviour (frequency of self-reported face covering adherence), theory of planned behaviour constructs (i.e. intention, attitudes, subjective norms, and perceived behavioural control), personality traits, imagery ability and barrier self-efficacy were measured at baseline (T1). Behaviour was also assessed at four-week follow-up (T2).Results: Of 297 participants, a majority always wore face coverings (N = 216, 73% overall sample). Logistic regression analyses revealed no intervention effects on changes in adherence to wearing face coverings, though T1 wearing of face coverings and being male predicted T2 behaviour. Subgroup analysis of participants self-reporting 'suboptimal T1 adherence, revealed that T2 non-adherence was predicted by being a non-student and by subjective norms and lower T1 intention to wear face coverings.Conclusion: Imagery-based interventions to increase face covering wearing adherence may exert significant public health effects but only when conducted on a very large scale. Our findings suggest that interventions should target men and disrupt habitual past behaviour.

A Qualitative Study on Young Men's Experiences of Intentional Weight-Gain

This qualitative study investigated how young men perceive their body image and experiences of purposively gaining weight, and what these reveal about broader sociocultural meanings around food, consumption and male body image. The participants in this study were a subsample of men participating in the 'GlasVEGAS' study which examined the effect of weight-gain and weight loss on metabolism, fitness and disease risk in young adult men. Twenty-three qualitative, semi-structured interviews were conducted with thirteen men (mean age 23 years) at GlasVEGAS baseline (n = 10) and weight-gain (6-week) follow-up assessment (n = 13). Data were analysed using the principles of framework analysis. The majority of men viewed the foods provided as part of the GlasVEGAS study as 'luxury' items despite their being of low nutritional value. The weight-gain process prompted men to reflect on how cultural norms and social environments may amplify overeating. Several described being surprised at how quickly they assimilated unhealthy eating habits and/or gained weight. Some valued changes in their appearance associated with weight-gain, including appearing larger or having increased muscle size. These factors are vital to consider when developing weight management initiatives targeting young men, including the valorisation of unhealthy foods, wider social influences on diet and male body image ideals.

Cultural Repertoires and Situated Selections as an Alternative Framework to Hegemonic Masculinities: Findings From Eswatini

Since the 1980s studies on men have frequently utilized Connell's framework of hegemonic masculinities. We critically appraise this framework in the context of a population-based HIV pre-exposure prophylaxis study in Eswatini. Our findings highlight that men confidently show variation in their behavior and choices, which manifest across different men and within the same men acting in particular situations and over the life course. This led us to interrogate the hegemonic masculinities framework on the following grounds: Men's choices and behavior do not seem to fit the model of aspiring to a hegemonic ideal; the delineation of masculine traits as hegemonic or subordinate remain vague in terms of "responsibility," "fidelity," and "consideration for others"; the binary gender concept underpinning hegemonic masculinities seems outdated. Building on the work of Hirsch and Kachtan, we propose cultural repertoires as an alternative framework which also bridges the gender divide.

Men's help-seeking and engagement with general practice: An integrative review

Aim

To critically synthesize the literature that describes men's help‐seeking and engagement with general practice.

Design

Integrative literature review.

Data sources

CINAHL plus, Medline and APA PsycInfo were searched for papers published between 1999 and March 2021.

Review methods

After screening titles and abstracts, full‐text papers were screened against inclusion / exclusion criteria. All included papers were assessed for methodological quality. Findings were extracted, critically examined and synthesized into themes.

Results

Twenty studies met the inclusion criteria. Thematic analysis revealed four themes related to; (1) structural barriers, (2) internal barriers, (3) men's understanding of the role of general practice, and (4) self‐care and help‐seeking. The findings indicate that men can find general practice unwelcoming and unaccommodating. Men can also experience psychological barriers that impact engagement and help‐seeking. Men predominantly view general practice as a source of acute health care and do not appreciate the role of general practice in preventive health care and advice.

Conclusion

This review has provided insight into the issues around the barriers to health care engagement, men's understanding of the role of general practice and their associated help‐seeking. Seeking to further understand these issues could assist in the development of strategies to promote engagement of men with general practice health care.

Impact

This review highlights research about men's engagement with general practice and the missed opportunities in receiving preventive health care and education.

Enhancing men's engagement with general practice has the potential to reduce the impact of their health on quality of life and improve health outcomes.

The Gendered Dimensions of Photovoice in Men's Health Promotion Research

The use of photovoice in men’s health promotion research has grown significantly over the past 15 years. Initially mobilized as an elixir for men’s talk about health practices and illness experiences, participant-produced photographs and accompanying narratives have grown significantly in reach, influence, and application. The current article highlights the gendered dimensions of photovoice in men’s health promotion research across three studies addressing (1) psychosocial prostate cancer care, (2) fathers’ tobacco reduction and smoking cessation, and (3) male suicidality. Insights drawn from the psychosocial prostate cancer care project emphasize the plurality of masculinities, and the implications for health promoters treating the common treatment side effect of erectile dysfunction. The relational nature of gender is central to the fathers’ tobacco reduction and smoking cessation work whereby the well-being of partners and children strongly influenced men’s behavior changes amid guiding adjustments to smoke-free policies. The male suicidality research highlights the unmuting powers of photovoice for making visible the interiority of men’s mental illness, and the destigmatizing potentials for sharing participants’ accompanying narratives. Evident across the three projects are the gendered dimensions of photovoice processes and products for advancing understandings of, and avenues toward, promoting the health of men and their families. After reflecting on these advances, we offer recommendations for future men’s health promotion photovoice work.

Sleep Health in Male-dominated Workplaces: A Qualitative Study Examining the Perspectives of Male Employees

OBJECTIVE

The purpose of this qualitative study was to explore working men's perspectives about sleep health and the intersecting influences of gender and work, describing participant's views on current and potential programming and organizational support to promote sleep health.

METHODS

Twenty men employed in male-dominated industries in the north-central region of Alberta, Canada, participated in 4 consultation group discussions addressing motivators, facilitators and barriers to sleep health.

RESULTS

Participants reported sleeping an average of 6.36 (SD ±1.1) hours per night, and the majority worked more than 40 hours per week. Data were analyzed using an inductive approach. The findings provided important insights. In normalizing sleep deprivation and prioritizing the need to "just keep going" on six or less hours of sleep, the men subscribed to masculine ideals related to workplace perseverance, stamina and resilience. Workplace cultures and practices were implicated including normative dimensions of overtime and high productivity and output, amid masculine cultures constraining emotions and conversations about sleep, the sum of which muted avenues for discussing, let alone promoting sleep. Challenges to good sleep were primarily constructed around time constraints, and worry about meeting work and home responsibilities. Men's preferences for workplace support included providing and incentivizing the use of sleep health resources, designing work for sleep health (e.g., shift schedules, overtime policies) and getting advice from experienced coworkers and experts external to the workplace organization.

CONCLUSION

These findings hold potential for informing future gender-sensitive programming and organizational practices to support sleep health among working men.

[From theory to practice: the discourse of healthy lifestyles and its application to the daily lives of low-income Chilean women]

The discourse on healthy lifestyles (HLS) states that a population will remain healthy by adopting such lifestyles, modifying unhealthy and thus morally incorrect individual behaviors. The HLS discourse has been hegemonic in Public Health since the late 20th century. It assumes freedom of choice by individuals, who purportedly make rational decisions, seeking the lowest cost and maximum individual benefit, the neoliberal model's basic premise. It thus overlooks the relevance of living conditions for health and health inequality. The current study focused on the perception of the HLS discourse and its repercussions on the behavior of low-income Chilean women. Semi-structured interviews were held with beneficiaries of a government program (Healthy Life Program), based on the HLS discourse. The study explored the women's discourse on health and its correspondence with the HLS discourse. It also analyzed the possibilities of implementing the discourse in practice, from the women's own perspective. The results showed that the women view health as the result of lifestyle, which can be freely chosen. However, they identify various barriers to implementing healthy lifestyle in practice at the economic, family, and sociocultural levels. The conclusion is that individuals should be considered within the family, social, and structural contexts in which health and disease are produced, while abandoning the moralist perspective that legitimizes the neoliberal definition of health.

Engendered Expressions of Anxiety: Men's Emotional Communications With Women and Other Men

While the contemporary therapeutic discourse inveigles us to talk about our personal problems, a countervailing neo-liberal healthist discourse, aligning with conventional masculinity norms, presumes that we will manage any issues independently. This discursive tension can be difficult to navigate, especially for men confronted with still powerful traditional expectations around masculinity (e.g., self-reliance; personal control; restricted emotionality). Although qualitative research has examined how men negotiate masculinities with respect to depression, to date there has been scant attention focused on men experiencing anxiety. This article reports on an interview study with men, some with anxiety diagnoses and some without (N = 17). Thematic analysis highlights that participants can and do talk about their anxieties, most readily with significant women in their lives (e.g., partners; mothers)-although this is not always straightforward. Talking to other men was more fraught, and while participants were wary of sharing problems with male friends, or signaled issues indirectly, they also highlighted situations where they would open up e.g., workspaces where they felt safe; with best friends. Those who had gone through a therapeutic process over many years tended to me more comfortable talking to others, male or female, about their mental health-and were also keen to other support to others where they could. Our analysis suggests that despite stereotypical notions of silent, self-contained men, there are many contexts where men may feel comfortable sharing their stories of pain and suffering. This chimes with wider cultural changes and the reported experiences of some mental health initiatives.

Men's Help-Seeking for Depression: Attitudinal and Structural Barriers in Symptomatic Men

Objective: Men with depression are known to have significant challenges with health service engagement. The current study sought to better understand attitudinal and structural mental health care barriers among those men identified as symptomatic for symptoms of major depression. Design: Cross-sectional study with data provided by Canadian men via a nationally representative online survey. Outcomes examined depression, suicide risk, and barriers to mental health services. Participants: A total of 117 men (mean age = 42.36 years) reporting symptoms of major depression consistent with moderate severity as identified by the Patient Health Questionnaire–Depression Module (PHQ-9). Results: In all, 51.3% of the sample reported previously receiving counselling or psychotherapy for mental health concerns. The majority (63.2%) reported past 2-week suicide or self-harm ideation; however, only a small proportion (8.5%) were currently engaged with professional mental health support. Logistic regression indicated that men’s attitudinal barriers to mental health help-seeking had a greater predictive effect than structural barriers (33% vs 0% of items, respectively). In particular, lower likelihood of help-seeking was associated with men’s reluctance to disclose mood-related symptoms to their physician/family doctor (adjusted odds ratio [AOR] = 0.37), a tendency for self-reliance and solving one’s own problems (AOR = 0.34), and uncertainly about the process of psychotherapy (AOR = 0.29). Conclusion: Gender-transformative approaches to primary health care may be key to improving men’s rates of disclosure and increasing detection for depression and suicide risk.

Participatory survey design of a workforce health needs assessment for correctional supervisors

INTRODUCTION

The correctional workforce experiences persistent health problems, and interventions designed with worker participation show favorable outcomes. However, participatory intervention research often leaves workers out of the health needs assessment, the basis of interventions subsequently developed. This omission risks failure to detect factors contributing to the health and is less likely to result in primary prevention interventions.

METHODS

Partnering with a correctional supervisors' union, we followed Schulz and colleagues' community-based participatory research (CBPR) methods for participatory survey design and used Healthy Workplace Participatory Program (HWPP) tools to develop a tailored survey to assess workforce health and contributing factors. Utilizing the HWPP Focus Group Guide, we generated key themes to adapt the HWPP All Employee Survey, a generic workforce health assessment, to become thorough and contextually-relevant for correctional supervisors.

RESULTS

Content analysis of focus group data revealed 12 priority health concerns and contributors, including organizational culture, masculinity, work-family conflict, family support, trauma, positive job aspects, health literacy and efficacy, health/risk behaviors, sleep, obesity, and prioritizing work and income over health. Twenty-six measures were added to the generic survey, mainly health-related antecedents including knowledge, attitudes, norms, and motivation.

CONCLUSION

Findings yielded new insights about supervisors' lived experiences of work and health, and resulted in a customized workforce survey. CBPR methods and HWPP tools allowed us to identify health issues that we would not have detected with conventional methods, and provide opportunities for interventions that address root causes of poor health. We share challenges faced and lessons learned using CBPR with the correctional workforce.

Gender and health literacy: men's health beliefs and behaviour in Trinidad

Gender variations in health literacy have implications for engagement in preventive behaviours and the uptake of health services, especially in areas such as the Caribbean where there are marked disparities in life expectancy and health service utilization. A self-reported questionnaire was used to examine men's concepts of health, their help-seeking behaviours and their functional and interactive health literacy. Two hundred and forty-eight men across the life course participated at three sites in Trinidad. Data were analysed using descriptive statistics, with free-text responses analysed thematically. Men were concerned about, and accepted responsibility for their own health but social norms concerning sickness and masculinity were barriers to accessing health services. Almost one-third (31.5%) sought advice from a healthcare service when they were last sick because they were prompted to do so by their wife/partner or family. Levels of functional and interactive health literacy were not high among older men, who were reliant on healthcare professionals to communicate health messages. There was an age divide in e-health literacy. There is little published evidence on men's health literacy, particularly from Caribbean countries such as Trinidad and Tobago. This study highlights the importance of the design and implementation of specific policies focusing on men's health. A major challenge is to engage with men who do not access health services.

A thematic analysis of men's help-seeking on an Australian health helpline

AIMS AND OBJECTIVES

The current study aimed to qualitatively explore men's help-seeking behaviours by analysing male callers' talk on an Australian health helpline. Analysis focused on identifying the ways in which men positioned themselves as help-seekers and the extent to which help-seeking behaviours deviated or conformed to the narrative commonly reported on in men's health literature which, generally speaking, positions men as reluctant help-seekers and health service users.

METHODS

The present study utilised naturally occurring instances of men's help-seeking during 196 calls to the helpline, Healthdirect Australia. Thematic analysis was used to explore recurrent themes in help-seeking interactions.

FINDINGS

The analysis yielded three broad themes, which were formulated as caller archetypes. These themes included the 'reluctant caller', the 'unwell patient' and the 'concerned carer', as well as a number of associated sub-themes within these broad categories.

CONCLUSIONS

The findings demonstrated that male callers sought help in a variety of different ways, rather than prescribing to a homogenous pattern of help-seeking. However, it was acknowledged that some data did align with help-seeking behaviour which indicated men's reluctance to engage with their own health. SO WHAT?: The present study contributes to men's health promotion by identifying the various social devices used by men to facilitate help-seeking. The findings highlight the changing and flexible landscape of contemporary masculinity and its impact on health engagement. Recognising the versatility in men's health behaviour is important for ensuring that men have positive experiences during healthcare encounters which, in turn, may facilitate future health service uptake and engagement.

Yoga not a (physical) culture for men? Understanding the barriers for yoga participation among men

Yoga offers an integrated approach to health and well-being that could potentially benefit men. This qualitative descriptive study examined men's perceptions of yoga, and identified barriers and possible facilitators for participation. Twenty-one non-yoga participant men, 18-60 years old, and living in Queensland, Australia, were interviewed. Two major barriers were identified using thematic analysis: (1) preference for other forms of physical activity, and (2) gender-related perceptions and pressures (i.e., perception of yoga as feminine, and presence of "bloke" culture and masculine ideals in society). Potential facilitators included: (1) acceptability of yoga among men, (2) providing brief information sessions, and (3) men-only classes. The non-competitive nature of yoga, in addition to being predominantly undertaken by women, makes it less appealing for men living in Australia. These barriers need to be considered if yoga is to be promoted as an option for men, particularly those not drawn to traditional sports or exercise.

Masculinity beliefs and willingness to seek help among young men in the United Kingdom and Pakistan

Health-related behaviors including help-seeking are related to men's felt and perceived masculinity. This study explored whether findings from studies of links between masculinity and health-related behavior in developed 'western' contexts applied in the more strongly patriarchal cultural context of Pakistan. Online questionnaires were completed by male university students aged 17-30: 307 in Pakistan and 105 in the United Kingdom. Analyses revealed that compared to British men, Pakistani respondents had less egalitarian beliefs about gender relations, gave more importance to their own masculinity, considered non-traditional behaviors to have greater negative implications for men's masculinity, and were less willing to seek help. Among Pakistani men, lower willingness to seek help for physical and mental health was predicted by having less egalitarian gender beliefs, giving greater importance to personal masculinity, and considering non-traditional behaviors to have greater negative implications for men's masculinity. Among British men, greater perceived masculinity of help seeking predicted help seeking for physical concerns, and less importance of personal masculinity predicted help seeking for mental health. The results highlight a need for sensitivity to men's gender identity concerns when providing and encouraging use of health care, and to be aware of how cultural norms shape individuals' beliefs and behavior.

An Examination of Gender Differences in the National Diabetes Prevention Program's Lifestyle Change Program

PURPOSE

The purpose of the study was to examine how gender was related to enrollment and number of sessions attended in the National Diabetes Prevention Program's Lifestyle Change Program (DPP LCP).

METHODS

To better understand program uptake, a population of those who would be eligible for the LCP was compared to those who enrolled. Estimates of those eligible were computed using data from the National Health and Nutrition Examination Survey, whereas enrollment and sessions attended were computed using data from the Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program.

RESULTS

Results revealed that although similar numbers of males and females were eligible for the program, only 39 321 males versus 121 007 females had enrolled in the National DPP LCP by the end of 2017 (odds ratio = 3.20; 95% CI, 3.17-3.24). The gender differences persisted even when stratifying by age or race/ethnicity. In contrast, no significant gender differences were found between the average number of sessions attended for males (14.0) and females (13.8).

DISCUSSION

Results of the study can help inform efforts to market and tailor programs to appeal more directly to men and other groups that are underrepresented in the National DPP LCP.

Positive Lifestyle Behavior Changes Among Canadian Men: Findings From the HAT TRICK Program

PURPOSE

To estimate program effectiveness regarding physical activity (PA), diet, and social connectedness as part of a feasibility study.

DESIGN

Pre-post quasi-experimental.

SETTING

HAT TRICK was delivered in collaboration with a Canadian semi-professional ice hockey team and offered at the arena where they trained and played games.

PARTICIPANTS

Participants (N = 62) at baseline were overweight (BMI >25kg/m²) and inactive (<150 minutes of MVPA/week) men age 35+ years.

INTERVENTION

Gender-sensitized 12-week intervention for men targeting PA, healthy eating and social connectedness.

METHOD

Baseline, post-intervention (12 weeks) and 9-month follow-up self-report and accelerometer data were collected. Multi-level modeling assessed growth trajectories of outcome measures across time.

RESULTS

Accelerometer measured weekly/min. of moderate PA showed significant linear trends (95%CI: 42.9 - 175.3) from baseline (147.0 ± 104.6), 12-week (237.7 ± 135.5) and 9-month follow-up (204.89 ± 137.7) qualified with a quadratic trend. Self-reported weekly/min of moderate and vigorous PA showed significant linear trends (95%CI: 94.1, 264.1; 95%CI: 35.1, 109.6) from baseline (52.6 ± 83.8, 22.42 ± 44.9), 12 week (160.1 ± 157.4, 66.6 ± 74.4) and 9-month follow-up (118.6 ± 104.6, 52.2 ± 59.2) qualified with quadratic trends. DINE measured fat score rating showed linear trends over time (95%CI -14.24, -6.8), qualified with a quadratic trend. DINE fibre score and social connectedness showed no trends.

CONCLUSION

Findings yield valuable information about the implementation of gender-sensitized lifestyle interventions for men and demonstrate the importance of male-specific strategies for reaching and engaging overweight, physically inactive men.

Is it an issue before it's a problem? Investigating men's talk about fertility

While fatherhood and male involvement in family life have been the focus of much research during the past few decades, we know less about men's involvement in the stage that precedes fatherhood and reproductive decision-making, their awareness of and sense of responsibility for reproductive health and fertility. This article draws attention to how men talk about fertility and reproductive intentions, focusing on how their perceptions and knowledge of fertility and procreation are structured around social norms and expectations. The study was based on interviews with 25 men in reproductive age with no prior history of infertility, including men with as well as without children and men of different sexual orientations and gender diversity. Our findings indicate a tension between, on the one hand, a general tendency among the men to take their fertility for granted and neither think nor talk about it, and, on the other hand, a latent concern about possible infertility which seemed to be activated in the interview situation. These findings raise questions of how conversations about fertility might impact men's thinking about their own fertility that call for further exploration and that are of significance in considerations of how to promote fertility awareness and reproductive health.

A cross-cultural examination of masculinity and health behaviour in Hong Kong: the mediating role of age and social support

Objectives: Examine masculinity as a predictor of engagement in health behaviour, and explore the mediating effect of age and social support on the relationship between conformity to masculine norms and health behaviour among a sample of Hong Kong Chinese, mainland Chinese, Caucasian, and South Asian men living in Hong Kong.Methods: A cross-cultural community sample of 495 men aged 18-81 years (M_age = 39.87 years) were recruited to the study. Participants completed self-report measures of conformity to masculine norms (CMNI), social support (MSPSS), and health behaviour (HBI).Results: Conformity to masculine norms was predictive of engagement with health behaviour, meanwhile age and social support mediated the relationship between conformity and health behaviour. Conformity was stronger among younger men, while higher levels of social support were predictive of poorer engagement in health behaviour for men in the present study. Findings from the multiple mediation revealed that social support better accounted for poorer engagement in health behaviour when compared to age.Conclusions: While much of the literature has focused on the toxic impact of masculinity on men's health, the present findings demonstrate that conformity to masculine norms does not necessarily equate with health risk behaviour. The association between lower levels of social support and health behaviour were interesting and demonstrate men's autonomy in health matters; this contradicts previous findings emphasising the importance of social support in influencing men's positive health behaviour. Findings are discussed in terms of their implications for and applications to men's health and health promotion.

Health-related masculine values, depression and suicide risk in men: associations among men with a history of childhood maltreatment

Background: Identification of masculine values associated with men's depression and suicide risk may generate new intervention targets for those with known static risk factors (e.g., exposure to childhood maltreatment).Aims: To validate the factor structure of a measure of health-related masculine values and examine correlates relative to childhood maltreatment exposure.Method: Self-report data was collected from 530 Canadian men, mean age 47.91 years (SD  =  14.51).Results: Confirmatory factor analysis validated an abbreviated eight-item, two-factor model of the Intensions Masculine Values Scale (IMVS-8; CFI = .984, TLI = .977, RMSEA = .054, SRMR = .032). Cluster groups of low (n = 57), moderate (n = 206) and high (n = 267) adherence to these health-related masculine values were identified, equivalent on exposure to childhood maltreatment and previous mental health treatment. A multivariate group × maltreatment interaction was observed (p = .017) whereby males in the low cluster with a maltreatment history endorsed higher mood-related symptomology. This same pattern was observed in a univariate group × maltreatment interaction for suicide risk (p = .006).Conclusions: Health-related masculine values were associated with lower depression and suicide risk in men who have a history of childhood maltreatment. Future intervention studies should investigate whether development of health-related masculine values can reduce depression and suicide risk among men with a history of childhood maltreatment.

The Influence of Social Relationships on Men's Weight

OBJECTIVE

To explore how men's social relationships influence their dietary, physical activity, and weight loss intentions and behaviors.

DESIGN

Qualitative study using semistructured interviews.

SETTING

One county in the southwest of England.

PARTICIPANTS

Men (n = 19) aged 18-60 years with a body mass index ≥24 kg/m² who were otherwise healthy.

PHENOMENON OF INTEREST

Men's perceptions of dieting, physical activity and weight loss, and how social relationships influence these behaviors.

ANALYSIS

Interviews were audiorecorded and transcribed verbatim. Transcripts were coded line by line using NVivo software. Themes and subthemes were inductively generated using thematic analysis.

RESULTS

Four themes were derived: (1) how experiences shape beliefs, (2) being a proper bloke, (3) adapting to family life, and (4) support from outside the home. Men discussed how partners were a greater influence on diet than physical activity. Attitudes toward diet and physical activity were influenced by life events such as becoming a father. It was framed as acceptable for men to talk to their friends about exercise and food intake in general, but they emphasized that this was not for "support."

CONCLUSIONS AND IMPLICATIONS

Family members were key influences on men's behaviors. Future qualitative research could include interviews with men's families. Findings may inform family weight loss interventions.

Community-based men’s health promotion programs: eight lessons learnt and their caveats

Long-standing commentaries about men’s reticence for accessing clinical medical services, along with the more recent recognition of men’s health inequities, has driven work in community-based men’s health promotion. Indeed, the 2000s have seen rapid growth in community-based programs targeting men, and across this expanse of innovative work, experiential and empirical insights afford some important lessons learnt, and caveats to guide existing and future efforts. The current article offers eight lessons learnt regarding the design, content, recruitment, delivery, evaluation and scaling of community-based men’s health promotion programs. Design lessons include the need to address social determinants of health and men’s health inequities, build activity-based programming, garner men’s permission and affirmation to shift masculine norms, and integrate content to advance men’s health literacy. Also detailed are lessons learnt about men-friendly spaces, recruitment and retention strategies, the need to incrementally execute program evaluations, and the limits for program sustainability and scaling. Drawing from diverse community-based programs to illustrate the lessons learnt, caveats are also detailed to contextualize and caution some aspects of the lessons that are shared. The express aim of discussing lessons learnt and their caveats, reflected in the purpose of the current article, is to guide existing and future work in the ever growing field of community-based men’s health promotion.

The impact of a workplace cardiovascular health screening programme 'Farmers Have Hearts' on health behaviour change among Irish farmers

BACKGROUND

Irish farmers are a high-risk group for cardiovascular disease (CVD) which imposes not only a risk to their health but has more far-reaching implications for occupational health and safety.

OBJECTIVE

This study assessed the impact of a workplace health screening and health behaviour change programme among a sub-group of male Irish farmers.

METHODS

Data were collected from male livestock farmers (n = 310) who attended health screenings at livestock marts. Participating farmers also received lifestyle advice to prompt health behaviour change. Health behaviour change was tracked by two phone questionnaires at Week 1 (n = 224) and Week 12 (n = 172). All data were entered into SPSS v22 and analysed using chi-square and regression techniques.

RESULTS

At Week 12, 48% reported having changed at least one health behaviour. The majority of farmers were referred to their GP and by Week 12, 32% had acted on this advice. Participants most in need of health behaviour change based on adverse health screening results were, paradoxically, the least likely to contemplate or engage in health behaviour change.

CONCLUSIONS

Findings demonstrate that whilst workplace health screenings can be a catalyst for behaviour change for some farmers, more follow-up supports are needed to encourage sustainable behaviour change.

"I don't mind being ugly but I don't wanna have skin cancer": A qualitative study of attitudes to UV exposure and a facial morphing intervention in men 35 years and older

Objectives: Skin cancer is a growing problem globally. Older men have been largely ignored in previous research, even though men may generally be prone to riskier exposure to the sun than women. Past research suggests that appearance-focused techniques such as facial morphing can increase motivations to use sun protection among women of all ages, and younger men.Design: was qualitative, consisting of individual interviews.Methods: were semi-structured interviews with 25 older men, to examine attitudes to UV exposure and reactions to a facial morphing intervention. Interviews were subjected to thematic analysis.Results: Three themes were constructed: masculine UV exposure; appearance that's accepted; personal responsibility. The men did not identify gaps in their sun protection behaviour and demonstrated a lack of concern about ageing and appearance. These attitudes translated into a lack of motivation for behaviour change due to ageing acceptance. However, motivation to change behaviour came from health concerns resulting from the intervention.Conclusions: The men experienced different motivations and barriers for sun protection use than women of similar ages. Facial morphing can be effective with older men but may need to be reframed to focus on health implications and personal choice.

"Take a Spoonful of Concrete and Harden the **** up!": How British Men in Hong Kong Talk About Health and Illness

The present study draws on semistructured focus group discussions conducted with British men living in Hong Kong to examine how men’s constructions of masculinity influence health behavior and attitudes. Twenty-eight men aged 21–51 years were divided into groups based on age (≤35 years and ≥36 years); length of residence ranged from 2 to 20 years. Discussions were analyzed using open-ended thematic analysis. Following intensive analysis of the transcripts, four subthemes were identified and analyzed in greater detail: (a) health talk; (b) help-seeking behavior; (c) health risk; and (d) health motivations. Findings suggest a widespread endorsement of a hegemonic view of masculinity among men in the present study. Men expressed reluctance in seeking help for illness, regardless of age, particularly when experiencing symptoms of ill-health that were deemed to be “minor.” However, help seeking was embraced when it was perceived to impact masculinity, for example, when potentially related to sexual performance or function. While men in the present study were sometimes dismissive of health advice provided by family, they were more open and responsive to seeking help upon the advice of male friends. Findings are further discussed with reference to the relationships between masculinities and health; implications for health are discussed.

Can Reproductive Life Plan-based counselling increase men's fertility awareness?

BACKGROUND

Many men have limited knowledge about reproductive health and fertility. The aim of the study was to evaluate if Reproductive Life Plan (RLP)-based counselling during a sexual health visit could increase men's fertility awareness.

MATERIAL AND METHODS

The study was a randomized controlled trial including 201 men aged 18-50 who visited either of two participating sexual health clinics in Sweden for sexually transmitted infection testing during 2014-2016. All men received standard care, and men in the intervention group (IG) also received oral and written RLP-based information about lifestyle and fertility. Awareness about fertility and lifestyle-related factors were the main outcomes, measured through a questionnaire before the intervention and through a telephone survey after three months. Impressions from the counselling were also assessed at follow-up.

RESULTS

A majority (71%) of men wanted children in the future. General fertility awareness increased from a mean score of 4.6 to 5.5 out of 12 (P = 0.004) in the IG. The mean number of accurate lifestyle factors (that could affect fertility) mentioned increased from 3.6 to 4.4 (P < 0.001) in the IG. There were no improvements in the control group. Among the men in the IG, 76% had a positive experience of the counselling, and 77% had received new information.

CONCLUSION

The intervention managed to increase different aspects of men's fertility awareness. In the future, the format for preconception care for men needs further development. Including men in preconception health policy guidelines and identifying suitable actors for care provision would be important first steps.

Men's Perspectives of a Gender-Sensitized Health Promotion Program Targeting Healthy Eating, Active Living, and Social Connectedness

Men in high income countries have poorer dietary habits and higher rates of overweight and obesity than women. A major challenge with engaging men in health promotion is the perception that attention to one's health runs counter to masculine identities. Contemporary health promotion programs are believed to hold little "manly" appeal and often fail to engage and retain men. The HAT TRICK program was designed to engage men with their health by delivering an intervention in collaboration with a semi-professional ice hockey team. The program included 12 weekly sessions promoting healthy eating, active living, and social connectedness among men. Gender-sensitized elements were reflected in the program design, setting, content, and delivery. Semistructured telephone interviews were conducted with 23 men to explore perspectives of their participation in the gender-sensitized intervention. Participants were white (100%) with a mean age of 53 years ( SD ± 9.9), Body Mass Index (BMI) of 37 kg/m2 ( SD ± 6.8), and waist circumference of 127 centimeters ( SD ± 14.5). Inductive thematic analysis revealed three overarching themes, including: (a) Harnessing nostalgia for past masculinities: "Closet athletes from 30 years ago," (2) Offsetting resistance to change with sensible health advice: "Don't give up drinking beer, just have less," and (3) Gendered social spaces for doing health: "A night out with the guys," The findings support the value of gender-sensitized approaches to men's health promotion. Further research is needed to identify which gender-sensitized elements are critical to engaging men in healthy lifestyle changes.

Cross-cultural differences in the relationship between conformity to masculine norms and health behaviour among men in Hong Kong

OBJECTIVE

Examine differences in the relationship between conformity to masculine norms and engagement in health behaviour among a cross-cultural sample of Hong Kong Chinese, mainland Chinese, Caucasian, and South Asian men living in Hong Kong.

DESIGN

Cross-sectional.

METHODS

A community sample of 495 Hong Kong Chinese (n = 161), mainland Chinese (n = 107), Caucasian (n = 122), and South Asian (n = 105) men enrolled in the study. Ages ranged from 18 to 81 years (M = 39.87). Participants completed self-report measures of conformity to masculine norms, health behaviour, social support, and job stress.

RESULTS

Younger age was predictive of greater engagement in health behaviour among all men. Stronger conformity to masculine norms was predictive of engagement with health behaviour among Hong Kong, mainland Chinese, and Caucasian men, but not South Asian men. Social support was negatively predictive of engagement in health behaviour among Hong Kong Chinese, mainland Chinese, and South Asian men, suggesting that greater levels of social support may hinder engagement in health behaviour in some men. Job stress had a negative impact on engagement with health behaviour among Hong Kong Chinese and South Asian men only.

CONCLUSIONS

Present findings demonstrate the need for a broader examination of the relationship between masculinity and health behaviour, focusing not only on the negative, but also the positive impact that masculinity can have on men's health behaviour. Findings are discussed in terms of their implication on men's health and health promotion. Statement of contribution What is already known about this subject? Men around the globe have higher mortality and morbidity across all leading diseases. Explanations have focused on men's poor health-seeking behaviour and how this impedes on health. The pursuit of masculinity is thought to contribute to poor health outcomes in men. What does this study add? Conformity to masculine norms was predictive of engagement in health behaviour. This is one of few studies cross-culturally examining masculinity and health in a Chinese context. Findings provide examples of how conformity can support engagement in health behaviour.

Engaging Men in Psychological Treatment: A Scoping Review

Tailoring psychological treatments to men's specific needs has been a topic of concern for decades given evidence that many men are reticent to seek professional health care. However, existing literature providing clinical recommendations for engaging men in psychological treatments is diffuse. The aim of this scoping review was to provide a comprehensive summary of recommendations for how to engage men in psychological treatment. Four electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO) were searched for articles published between 2000 and 2017. Titles and abstracts were reviewed; data extracted and synthesized thematically. Of 3,627 citations identified, 46 met the inclusion criteria. Thirty articles (65%) were reviews or commentaries; 23 (50%) provided broad recommendations for working with all men. Findings indicate providing male-appropriate psychological treatment requires clinicians to consider the impact of masculine socialization on their client and themselves, and how gender norms may impact clinical engagement and outcomes. Existing literature also emphasized specific process micro-skills (e.g., self-disclosure, normalizing), language adaption (e.g., male-oriented metaphors) and treatment styles most engaging for men (e.g., collaborative, transparent, action-oriented, goal-focused). Presented are clinical recommendations for how to engage men in psychological treatments including paying attention to tapping the strengths of multiple masculinities coexisting within and across men. Our review suggests more empirically informed tailored interventions are needed, along with formal program evaluations to advance the evidence base.

Is gender inequity a risk factor for men reporting poorer self-rated health in the United States?

Theoretical approaches suggest that gender inequity increases men's health risks. Previous findings from the United States support this contention, however only a small number of health outcomes have been explored. This study extends the range of health outcomes examined by using a cross-sectional, multilevel analysis to investigate whether measures of state-level gender inequity are predictors of men's self-rated health. Data were derived primarily from the Behavioral Risk Factor Surveillance System and the full-case data set included 116,594 individuals nested within 50 states. Gender inequity was measured with nine variables: higher education, women's reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and gross domestic product per capita. In fully adjusted models for all-age men the reproductive rights (OR 1.06 95% CI 1.01-1.11), abortion provider access (OR 1.11 95% CI 1.05-1.16) and earnings (OR 1.06 95% CI 1.02-1.12) measures all predicted an increased risk of men reporting poorer self-rated health for each 1 standard deviation increase in the gender inequity z-score. The most consistent effect was seen for the 65+ age group where the reproductive rights (OR 1.09 95% CI 1.03-1.16), abortion provider access (OR 1.15 95% CI 1.09-1.21), elected office (OR 1.06 95% CI 1.01-1.11) and earnings (OR 1.10 95% CI 1.04-1.16) measures all showed a significant effect. These findings provide evidence that some aspects of gender inequity increase the risk of poorer self-rated health in men. The study contributes to a growing body of literature implicating gender inequity in men's health patterns.

“Mas se o homem cuidar da saúde fica meio que paradoxal ao trabalho”: relação entre masculinidades e cuidado à saúde para homens jovens em formação profissional

Resumo Este estudo objetivou compreender como homens jovens em formação profissional relacionam masculinidades e cuidados à saúde no contexto do trabalho. Por meio de uma abordagem qualitativa, foram realizadas entrevistas individuais com 27 homens jovens, com idades entre 17 e 19 anos, matriculados em cursos técnicos vinculados ao Programa Jovem Aprendiz de uma escola técnica localizada em Recife/PE. As entrevistas foram gravadas, transcritas e submetidas à análise de conteúdo temática. O software Atlas.ti foi utilizado para auxiliar na organização do material produzido. O processo de análise resultou em duas categorias temáticas: “Dificuldades para promoção/prevenção à saúde” e “Possibilidades de promoção/prevenção à saúde”. Na primeira categoria, os jovens afirmaram que a rotina de atribuições, o fato de os homens priorizarem outras atividades e a forma como os serviços de saúde estão organizados dificultam para que homens jovens trabalhadores envolvam-se em ações de cuidado à saúde. Citaram também a concepção de que adolescentes têm dificuldades para buscar ações de promoção/prevenção da saúde. Na segunda categoria, os jovens apontaram que os cuidados à saúde acontecem por meio da manutenção de hábitos saudáveis ou no apoio fornecido pelos locais de trabalho. Os resultados apontaram diferentes maneiras de relacionar masculinidades e cuidados à saúde, com destaque para a reprodução de valores que reforçam essa relação baseada em modelos hegemônicos. Diante disso, observa-se a necessidade de práticas de educação em saúde, no intuito de desconstruir estereótipos e fortalecer a importância da prevenção e promoção da saúde entre homens jovens.

Physical activity and masculinity in rural men: a qualitative study of men recruited from churches

The majority of rural US men fail to meet physical activity (PA) guidelines and are at risk for chronic diseases. This study sought to understand rural men's perceptions about PA and PA engagement and the influence of masculinity and social norms. From 2011 to 2014, 12 focus groups were conducted with men prior to a church-based health promotion intervention. Men were recruited from Illinois' rural, southernmost seven counties, where 40% of men report no exercise in the past 30 days. We used inductive content analysis methods to identify PA-related themes, and subsequently used elements of the Health, Illness, Men, and Masculinities framework as a lens to explore subthemes. We identified four themes: (i) knowledge of the positive impact of PA on health, (ii) perceptions of appropriate types of PA for men, (iii) the importance of purposeful PA and (iv) the desire to remain strong and active, particularly during aging. These findings can inform strategies for messaging and interventions to promote PA among rural men. Health promotion efforts should consider the intersections between rurality and masculinity as it relates to rural men's perceptions of PA, include information about purposeful PA and encourage them to engage in PA with a support person.

No Man Left Behind: Effectively Engaging Male Military Veterans in Counseling

Ex-military men have emerged as a vulnerable subgroup for mental illness amid long-standing trends signaling men's reticence to seek professional help. Less explored is how men engage or disengage when they actually do enter helping programs. Contrasting decades of quantitative research pairing masculine ideology with low help seeking (i.e., describing the problem), this article draws on qualitative data to distill factors that help men become engaged and committed to counseling (i.e., identifying solutions). Shared is an evaluation of a treatment program with high success rates and virtually no dropouts-a unique occurrence in men's counseling. Enhanced Critical Incident Technique data suggest that helping men feel competent and free from judgment in the company of down-to-earth peers and genuine practitioners are instrumental in helping men draw benefit from counseling. While appealing to male gender roles may be critical in recruiting men to counseling, men can transition to embrace virtues (i.e., that might be shared by men and women alike) and universal human needs as counseling progresses.

"You've Gotta Be That Tough Crust Exterior Man": Depression and Suicide in Rural-Based Men

Suicide rates in Canada are highest among rural men. Drawing on photovoice interviews with 13 women and two men living in a small rural Canadian town who lost a man to suicide, we inductively derived three themes to describe how contextual factors influence rural men's experiences of depression and responses to suicidal thoughts: (a) hiding depression and its cause, (b) manly self-medicating, and (c) mobilizing prevention. Further discussed is how gender relations and ideals of masculinity within rural milieu can inhibit men's acknowledgment of and help seeking for mental illness issues. Participants strongly endorsed a multifaceted approach to the destabilization of dominant ideals of masculinity that likely contribute to depression and suicide in rural men.

The HAT TRICK programme for improving physical activity, healthy eating and connectedness among overweight, inactive men: study protocol of a pragmatic feasibility trial

INTRODUCTION

Physical activity, healthy eating and maintaining a healthy weight are associated with reduced risk of cardiovascular disease, type 2 diabetes and cancer and with improved mental health. Despite these benefits, many men do not meet recommended physical activity guidelines and have poor eating behaviours. Many health promotion programmes hold little appeal to men and consequently fail to influence men's health practices. HAT TRICK was designed as a 12-week face-to-face, gender-sensitised intervention for overweight and inactive men focusing on physical activity, healthy eating and social connectedness and was delivered in collaboration with a major junior Canadian ice hockey team (age range 16-20 years). The programme was implemented and evaluated to assess its feasibility. This article describes the intervention design and study protocol of HAT TRICK.

METHODS AND ANALYSIS

HAT TRICK participants (n=60) were men age 35 years, residing in the Okanagan Region of British Columbia, who accumulate 150 min of moderate to vigorous physical activity a week, with a body mass index of >25 kg/m² and a pant waist size of >38'. Each 90 min weekly session included targeted health education and theory-guided behavioural change techniques, as well as a progressive (ie, an increase in duration and intensity) group physical activity component. Outcome measures were collected at baseline, 12 weeks and 9 months and included the following: objectively measured anthropometrics, blood pressure, heart rate, physical activity and sedentary behaviour, as well as self-reported physical activity, sedentary behaviour, diet, smoking, alcohol consumption, sleep habits, risk of depression, health-related quality of life and social connectedness. Programme feasibility data (eg, recruitment, satisfaction, adherence, content delivery) were assessed at 12 weeks via interviews and self-report.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of British Columbia Okanagan Behavioural Research Ethics Board (reference no H1600736). Study findings will be disseminated through academic meetings, peer-reviewed publication, web-based podcasts, social media, plain language summaries and co-delivered community presentations.

TRIAL REGISTRATION NUMBER

ISRCTN43361357,Pre results.

Nurse Practitioners and Men's Primary Health Care

Though life expectancy sex differences are decreasing in many Western countries, men experience higher mortality rates at all ages. Men are often reluctant to seek medical care because health help-seeking is strongly linked to femininity, male weakness, and vulnerability. Many men are also more likely to access emergency care services in response to injury and/or severe pain instead of engaging primary health care (PHC) services. Nurse practitioners are well positioned to increase men's engagement with PHC to waylay the pressure on emergency services and advance the well-being of men. This article demonstrates how nurse practitioners can work with men in PHC settings to optimize men's self-health and illness prevention and management. Four recommendations are discussed: (1) leveling the hierarchies, (2) talking it through, (3) seeing diversity within patterns, and (4) augmenting face-to-face PHC services. In terms of leveling the hierarchies nurse practitioners can engage men in effectual health decision making. Within the interactions detailed in the talking it through section are strategies for connecting with male patients and mapping their progress. In terms of seeing diversity with in patterns and drawing on the plurality of masculinities, nurse practitioners are encouraged to adapt a variety of age sensitive assessment tools to better intervene and guide men's self-health efforts. Examples of community and web based men's health resources are shared in the augmenting face-to-face PHC services section to guide the work of nurse practitioners. Overall, the information and recommendations shared in this article can proactively direct the efforts of nurse practitioners working with men.

Peer Positive Social Control and Men's Health-Promoting Behaviors

Men are generally thought to be less inclined to take care of their health. To date, most studies about men’s health have focused on deficits in self-care and difficulties in dealing with this sphere of their life. The present study reframes this perspective, using a salutogenic strengths-based approach and seeking to identify variables that influence men to take care of their health, rather than neglect it. This study focuses on the association between peer positive social control and men’s health behaviors, while controlling for other important individual and social determinants (sociodemographic characteristics, health self-efficacy, home neighborhood, spousal positive social control, and the restrictive emotionality norm). In a mixed-method study, 669 men answered a self-reported questionnaire, and interviews were conducted with a maximum variation sample of 31 men. Quantitative results indicated that, even after controlling for sociodemographic variables and other important factors, peer positive social control was significantly associated with the six health behaviors measured in the study (health responsibility, nutrition, physical activity, interpersonal relations, stress management, and spirituality). Interview results revealed that peer positive social control influenced men’s health behaviors through three different mechanisms: shared activity, being inspired, and serving as a positive role model for others. In summary, friends and coworkers could play a significant role in promoting various health behaviors among adult men in their daily life. Encouraging men to socialize and discuss health, and capitalizing on healthy men as role models appear to be effective ways to influence health behavior adoption among this specific population.

Gender differences in beliefs about health: a comparative qualitative study with Ghanaian and Indian migrants living in the United Kingdom

BACKGROUND

There is a well-established association between migration to high income countries and health status, with some groups reporting poorer health outcomes than the host population. However, processes that influence health behaviours and health outcomes across minority ethnic groups are complex and in addition, culture ascribes specific gender roles for men and women, which can further influence perspectives of health. The aim of this study was to undertake a comparative exploration of beliefs of health among male and female Ghanaian and Indian migrants and White British participants residing in an urban area within the UK.

METHODS

Thirty-six participants (12 each Ghanaian, Indian and White British) were recruited through community settings and participated in a semi-structured interview focusing on participant's daily life in the UK, perceptions of their own health and how they maintained their health. Interviews were analyzed using a Framework approach.

RESULTS

Three super ordinate themes were identified and labelled (a) beliefs about health; (b) symptom interpretation and (c) self-management and help seeking. Gender differences in beliefs and health behaviour practices were apparent across participants.

CONCLUSIONS

This is the first study to undertake a comparative exploration of health beliefs among people who have migrated to the UK from Ghana and India and to compare with a local (White British) population. The results highlight a need to consider both cultural and gender-based diversity in guiding health behaviours, and such information will be useful in the development of interventions to support health outcomes among migrant populations.