'My Wife Ordered Me to Come!': A Discursive Analysis of Doctors' and Nurses' Accounts of Men's Use of General Practitioners

'Through a kaleidoscope': A Foucauldian discourse analysis of Belgian policy regarding patients with a migration background and depression in general practices

A higher prevalence of depression is found among patients with a migration background within the Belgian population. Nevertheless, this group is underrepresented in ambulant and residential mental health care services. Since general practitioners (GPs) have a crucial gatekeeping role, this led some researchers to investigate the possibility of a provider bias influencing GPs' assessment and referral of depressed patients with a migration background. However, GPs' accounts may be influenced by wider professional discourses present at the policy level, which are inevitably linked to institutions regulating the conduct of GPs. Therefore, this study applied a Foucauldian discourse analysis (a) to identify broader professional discourses in Belgian policy documents regarding patients with a migration background and depression in general practices, (b) to examine how patients with a migration background are discursively positioned and (c) to investigate which different balances of power in the relationship between GPs and patients with a migration background are demonstrated in the identified discourses. We identified three recurring discourses: (a) the othering discourse, (b) the health literacy discourse, and (c) the person-centred discourse. Our analysis demonstrated that the former two discourses illustrate the perpetuation of a biomedical discourse. While the last discourse is aligned with a counter-discourse associated with the person-centred care model in health care. Consequently, our analysis demonstrated the construction of a contradictory discursive framework throughout the various policy documents on which GPs might rely when speaking about patients with a migration background suffering from depression.

Nurses' Social Representations of Men's Sexual Health Care Access: Preliminary Results

Background

Men's access to sexual health care is influenced by the nurses' symbolic universes, translated into maps of signification and normative idealization that structure their practices.

Aim

The aim of the study was to analyze nurses' social representations of men's sexual health, considering the barriers and possibilities in accessing health care.

Methods

Descriptive study with qualitative approach. Data were collected through an online focus group with 9 Portuguese nurses. Data were subjected to lexicographic analysis with the support of the interface IRaMuTeQ-R.

Results

269 text segments were analyzed, retaining 84.86% of the total in 4 classes: interactions between professionals and men, therapeutic itineraries, "talking" about sexual health, and men's access to sexual health care. Similarity analysis led to 3 central cores: problem, saying, and patient.

Conclusions

The training of professionals in men's sexual health to demystify stereotypes about masculinity is fundamental. At the organizational level, it is necessary to analyze the possibilities of access and its visibility in electronic records and rethink the planning and provision of primary and differentiated care.

Healthcare professionals discourses on men and masculinities in sexual healthcare: a focus group study

Studies have reported that men's uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and "tailored for women". They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men's sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men's sexual health in SHC.

Men's and women's endorsement of hegemonic masculinity and responses to COVID-19

Using a gendered psychology of health approach, we examine the effects of the culturally idealized form of masculinity-hegemonic masculinity-for both men and women's health attitudes and behaviors. Using data collected across four studies (N = 805) during the COVID-19 pandemic, we found that stronger endorsement of hegemonic masculinity related to health attitudes antithetical to mitigation strategies (e.g. more engagement in risky behaviors, less support for federal mandates) and evaluations of how political leaders have responded to COVID-19. These effects did not differ by gender suggesting that hegemonic masculinity has implications for both men and women's health.

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.

Opt-in HIV testing in construction workplaces: an exploration of its suitability, using the socioecological framework

Background

Late diagnosis of HIV remains a challenge, despite improved testing and treatment. Testing is often targeted at high-risk groups; workplace events might normalise testing and allow access to a wider population. The construction workforce has a number of risk factors for HIV. In the Test@Work study, HIV tests were delivered within general health checks to construction employees, with high uptake and acceptability. This paper reports on the experiences of construction managers and health professionals involved in Test@Work and explores the suitability of construction worksites as a venue for opt-in HIV testing.

Methods

Qualitative interviews (n = 24) were conducted with construction managers who had facilitated health check/HIV testing (n = 13), and delivery partners (n = 11) including i) healthcare volunteers who had delivered general health checks (n = 7) and, ii) HIV professionals who had conducted HIV testing (n = 4) at 21 Test@Work events held on construction sites. Interviews explored their experiences of these events and views towards HIV testing in the workplace. Exit questionnaires (n = 107) were completed by delivery partners after every event, providing qualitative data identifying facilitators and barriers to effective delivery. Thematic analysis identified themes that were mapped against a socioecological framework.

Results

Delivery partners reported high engagement of construction workers with workplace HIV testing, peer-to-peer encouragement for uptake, and value for accessibility of onsite testing. HIV professionals valued the opportunity to reach an untested population, many of whom had a poor understanding of their exposure to HIV risk. Managers valued the opportunity to offer workplace health checks to employees but some identified challenges with event planning, or provision of private facilities.

Conclusions

The construction sector is complex with a largely male workforce. Providing worksite HIV testing and education to an untested population who have poor knowledge about HIV risk helped to normalise testing, encourage uptake and reduce HIV-related stigma. However, there are practical barriers to testing in the construction environment. Rapid testing may not be the most suitable approach given the challenges of maintaining confidentiality on construction worksites and alternatives should be explored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13787-5.

Knowing the entire story – a focus group study on patient experiences with chronic Lyme-associated symptoms (chronic Lyme disease)

Background

Healthcare providers frequently struggle to provide effective care to patients with chronic Lyme-associated symptoms (chronic Lyme disease, CLD), potentially causing these patients to feel misunderstood or neglected by the healthcare system. This study is the first to use a combined medical and communication science approach, and aims to assess patients’ experiences with CLD & CLD-related care, identify themes and repertories in these patients’ narrations, and provide potential ways to improve communication with them.

Methods

Informed by the principles of ‘clean language’, we conducted focus groups with self-identified CLD patients (N = 15). We asked participants about their experiences with CLD and CLD-related healthcare. We performed thematic analyses using a bottom-up approach based in discourse analysis. We also sought to identify specific types of verbalizations (repertoires) across themes.

Results

Participants thematised a heterogeneous set of CLD-associated symptoms, which they frequently labelled as ‘invisible’ to others. Their illness significantly affected their daily lives, impacting their work, social activities, relationships with loved ones, hobbies and other means of participating in society. Negative experiences with healthcare providers were near-universal, also in patients with short-lived CLD-associated symptoms. Verbalizations were notable for frequent use of communicative modes that implicitly create common ground between participants and that give a certain validity to personal experiences (impersonal ‘you’ and other forms of presupposition).

Conclusion

Central themes found in CLD patients’ communication are 1. the experience of significant symptoms, 2. for which adequate relief is only rarely found from conventional medical practitioners, and 3. that are largely invisible to the outside world. Verbalizing these themes, patients use various repertoires for their shared experiences, such as a feeling of abandonment or not being heard by the medical system, feelings of loss with respect to their previous health, and the idea that they might have been better off had they been diagnosed sooner. Working with these repertoires will enable healthcare providers to establish a shared perspective with their CLD patients, thus engaging in more fruitful doctor-patient communication. We hypothesize that these findings are not unique to CLD, but may also be applicable to other conditions with an uncertain aetiology, such as Long COVID.

Notions About Men and Masculinities Among Health Care Professionals Working With Men's Sexual Health: A Focus Group Study

Health care professionals’ (HCPs) notions about gender may influence the provision and quality of care. If care-seeking men are met by HCPs holding idealized and stereotypical notions of masculinity, this could reinforce barriers to adequate care. This study explored notions about men and masculinities among HCPs working with men’s sexual health in Sweden. Focus group interviews with 35 HCPs from primary health and sexual health clinics were analyzed using qualitative content analysis. The analysis resulted in three descriptive themes: (a) Contradictory masculinity—elusive but clear. Notions of masculinity as a phenomenon or concept were elusive, but masculine and un-masculine traits, behaviors, and qualities were clear. (b) Sexual health care is a social place where men and masculinities can be challenging. Male patients were associated with unwanted sexual tensions. Masculinity could challenge professionality. Seeking sexual health care was perceived as doing un-masculinity. (c) Regarding masculinity as irrelevant—a difficult ambition to achieve. Participants strived for gender-neutrality by regarding patients as humans, individuals, or patients rather than as men and masculine. The analysis also identified a theme of meaning: Notions of masculinity are situated relationally. HCPs situate masculinity in real and hypothetical relationships. Romantic and sexual preferences were used to define preferred masculinity. This study identified themes that showed how HCPs balanced professional and private notions of men and masculinity in their patient encounters. Increased gender awareness and training are needed to professionalize the management of gendered notions in encounters with men who seek care for sexual health problems.

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.

"I Have Since Repented": Discursive Analysis of the Role of Religion in Husband-to-Wife Abuse in Ghana

Religion has long been recognized as a powerful tool capable of shaping the lives of people in many societies. In this study, we draw insights from discursive psychology to explore the influence of religious beliefs and practices on the perpetration of husband-to-wife abuse and the entrapment of victims in Ghana. Semi-structured focus group discussions and in-depth individual interviews were conducted with 40 participants, comprising 16 (60%) perpetrators (men), 16 (60%) victims (women), and eight (20%) key informants from rural and urban Ghana. Participants' discursive accounts suggest that both perpetrators and victims invoke religious instructions on gender norms to legitimize male authority over women in marriage. While perpetrators construct husbands' conjugal authority over their wives in terms of prescriptive religious norms, victims construct their entrapment in abusive relationships in terms of proscriptive theology of divorce in the bible. The double-edged role of religion in providing both motivational and inhibitory support for wife abusers is also discussed.

"A country boy can survive:" Rural culture and male-targeted suicide prevention messaging

The low rate of help-seeking and high rate of suicide completion among men has prompted public health officials to create suicide prevention campaigns that specifically target men. Drawing from data collected as part of a larger study of fire recovery in a rural county in Northern California, this paper utilizes 68 interviews with fire survivors (24 men and 44 women) and 40 interviews with mental health service providers to examine how rural residents interpret this type of campaign. To track patterns of help-seeking over time, I also draw upon 26 follow-up interviews - 20 with fire survivors (7 men and 13 women) and 6 with service providers - conducted one year after the first wave of interviews. In total, 134 in-depth interviews were conducted. This paper also draws on a secondary data source; I conducted content analysis of an internal Health and Human Services Agency focus group report used in the development of a local male-targeted suicide prevention campaign, Captain Awesome. As I show, male-targeted suicide prevention efforts have little salience in rural communities in which treatment resources are limited and stigma abounds. Perceptions about material conditions - i.e., treatment resources being few and far between - contribute to residents establishing a norm of not seeking help. Rural culture which emphasizes self-sufficiency and independence contributes to a pattern of both men and women repeating a narrative that frames men who seek help as weak. While research has identified women as key drivers for men's physical health maintenance, my research suggests that the same pattern might not hold around mental health maintenance in rural settings. In sum, I argue that male-targeted campaigns have limited resonance and efficacy in rural communities where material conditions and cultural narratives create physical and psychological barriers to accessing to treatment.

Challenges working with men: Australian therapists' perspectives

OBJECTIVE

Emerging research highlights that therapists experience difficulty engaging and retaining male clients in talk therapy. Understanding therapists' challenges when working with men can inform gender-specific training efforts.

METHODS

Open-ended qualitative survey data were collected from a sample of 421 Australian-based therapists. Participants described that which they find most challenging about therapeutic work with men. Responses were analyzed using inductive thematic analysis.

RESULTS

Three themes were revealed: (1) men's wavering commitment and engagement; (2) males as ill-equipped for therapy; and (3) therapists' uncertainty. Contrasting state and trait constructs, much of the men's state-based wavering commitment and engagement was positioned as amenable to change whereas traits assigned men as ill-equipped for therapy and unreachable.

CONCLUSION

These findings underscore a clear need to better target training efforts to directly respond to the needs of therapists working with men, such that all therapists are well-equipped to meet men with gender-sensitive therapy.

A Qualitative Exploration of the Experiences of Veterans Who Are Serving Sentences in Custody

The focus on veterans in research is not a novel topic; however, the majority of studies are related to trauma, employment, mental health, suicide, and substance misuse. The criminal justice system involvement with veterans is a topic that has yet to be examined to a great extent. This study, conducted with adult male prisoners, elicited information from six veterans regarding their experiences of being in the armed forces, leaving the armed forces, and becoming involved in the criminal justice system. Responses were evaluated using interpretative phenomenological analysis (IPA) and three main themes were identified: "you're baptized into the army," "them and us," and "operational mind-set"; each of which comprised a number of superordinate themes. The research highlights that although it is important to acknowledge the heterogenic nature of this group, it is equally important to note that much of their thinking and behavior may be similar to those that have not had these experiences. As such, there is a need to reduce the notion that they are separate and different to other prisoners, requiring different treatment. The study highlights that many of the offending behavior programs and interventions already available to prisoners would be appropriate for this group. The current research supports the merit in creating a service in prisons that will allow ex-servicemen to meet together and access the support that is available to them. The implications of the research are discussed further.

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.

"It's hard for us men to go to the clinic. We naturally have a fear of hospitals." Men's risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

Few studies on HIV Pre-Exposure Prophylaxis (PrEP) have focused on men who have sex with women. We present findings from a mixed-methods study in Eswatini, the country with the highest HIV prevalence in the world (27%). Our findings are based on risk assessments, in-depth interviews and focus-group discussions which describe men’s motivations for taking up or declining PrEP. Quantitatively, men self-reported starting PrEP because they had multiple or sero-discordant partners or did not know the partner’s HIV-status. Men’s self-perception of risk was echoed in the qualitative data, which revealed that the hope of facilitated sexual performance or relations, a preference for pills over condoms and the desire to protect themselves and others also played a role for men to initiate PrEP. Trust and mistrust and being able or unable to speak about PrEP with partner(s) were further considerations for initiating or declining PrEP. Once on PrEP, men’s sexual behavior varied in terms of number of partners and condom use. Men viewed daily pill-taking as an obstacle to starting PrEP. Side-effects were a major reason for men to discontinue PrEP. Men also worried that taking anti-retroviral drugs daily might leave them mistaken for a person living with HIV, and viewed clinic-based PrEP education and initiation processes as a further obstacle. Given that men comprise only 29% of all PrEP users in Eswatini, barriers to men’s uptake of PrEP will need to be addressed, in terms of more male-friendly services as well as trialing community-based PrEP education and service delivery.

Applying critical discursive psychology to health psychology research: a practical guide

This paper outlines a qualitative methodological approach called Critical Discursive Psychology (CDP), considering its applicability to health psychology research. As applied to health psychology, the growth of discursive methodologies within the discipline tends to be located within a critical health psychology approach where CDP and others enable a consideration of how wider societal discourses shape understandings and experiences of health and illness. Despite the increasing usage of CDP as a methodology, little has been written on the practical application of the method to date, with papers instead focusing on the theoretical underpinnings of a CDP approach. This paper seeks to address that gap and offers a step by step guide to the key principles and analytic stages of CDP before giving a worked example of CDP applied to a health topic, in this case ‘baby-led weaning’ (BLW). As we discuss, a key strength of CDP, particularly in relation to health psychology, is in its attempts to understand both macro and micro levels of data analysis. By doing so it offers a nuanced and richer understanding of how particular health topics are working within context. Therefore, CDP is a readily applicable analytic approach to contested and complicated topic areas within health research.

Improving Mental Health Help-Seeking Behaviours for Male Students: A Framework for Developing a Complex Intervention

Men are less likely to seek help for mental health difficulties and this process is often used to help explain the disproportionally higher suicide rates compared to women. Furthermore, university students are often regarded as a vulnerable population group with a lower propensity to seek help. Thus, male students are a very high-risk group that is even more reluctant to seek help for mental health difficulties, placing them at high risk of suicide. Often, student mental health problems are highlighted in the media, but very few evidence-based solutions specifically designed for male students exist. The current paper seeks to provide a comprehensive framework about how to better design mental health interventions that seek to improve male students' willingness to access psychological support. The Medical Research Council's (MRC's) framework for developing a complex intervention was used to develop an intervention relevant to male students. In this paper, previous help-seeking interventions and their evaluation methods are first described, secondly, a theoretical framework outlining the important factors male students face when accessing support, and thirdly, how these factors can be mapped onto a model of behaviour change to inform the development of an evidence-based intervention are discussed. Finally, an example intervention with specific functions and behaviour change techniques is provided to demonstrate how this framework can be implemented and evaluated. It is hoped that this framework can be used to help reduce the disparity between male and female students seeking mental health support.

Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking

Compared to women, men are less likely to seek help for mental health difficulties. Despite considerable interest, a paucity in evidence-based solutions remains to solve this problem.

The current review sought to synthesize the specific techniques within male-specific interventions that may contribute to an improvement in psychological help-seeking (attitudes, intentions, or behaviors). A systematic review identified 6,598 potential articles from three databases (MEDLINE, EMBASE, and PsycINFO). Nine studies were eligible. A meta-analysis was problematic due to disparate interventions, outcomes, and populations. The decision to use an innovative approach that adopted the Behavior Change Technique (BCT) taxonomy to synthesize each intervention’s key features likely to be responsible for improving help-seeking was made. Of the nine studies, four were engagement strategies (i.e., brochures/documentaries), two randomized controlled trials (RCTs), two pilot RCTs, and one retrospective review. Regarding quality assessment, three were scored as “strong,” five as “moderate,” and one as “weak.” Key processes that improved help-seeking attitudes, intentions, or behaviors for men included using role models to convey information, psychoeducational material to improve mental health knowledge, assistance with recognizing and managing symptoms, active problem-solving tasks, motivating behavior change, signposting services, and, finally, content that built on positive male traits (e.g., responsibility and strength). This is the first review to use this novel approach of using BCTs to summarize and identify specific techniques that may contribute to an improvement in male help-seeking interventions, whether engagement with treatment or the intervention itself. Overall, this review summarizes previous male help-seeking interventions, informing future research/clinical developments.

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.

A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health belief model

Background

The high incidence (32.9, age-standardized per 100,000) and mortality (23.0, age-standardized per 100,000) of cervical cancer (CC) in Ghana have been largely attributed to low screening uptake (0.8%). Although the low cost (Visual inspection with acetic acid) screening services available at various local health facilities screening uptake is meager.

Objective

The purpose of the study is to determine the barriers influencing CC screening among women in the Ashanti Region of Ghana using the health belief model.

Methods

A analytical cross-sectional study design was conducted between January and March 2019 at Kenyase, the Ashanti Region of Ghana. The study employed self-administered questionnaires were used to collect data from 200 women. Descriptive statistics were used to examine the differences in interest and non-interest in participating in CC screening on barriers affecting CC screening. Multivariable logistic regression was used to determine factors affecting CC screening at a significance level of p<0.05.

Results

Unemployed women were less likely to have an interest in CC screening than those who were employed (adjustes odds ratio (aOR) = 0.005, 95%CI:0.001–0.041, p = 0.005). Women who were highly educated were 122 times very likely to be interested in CC screening than those with no or low formal education (aOR = 121.915 95%CI: 14.096–1054.469, p<0.001) and those who were unmarried were less likely to be interested in CC screening than those with those who were married (aOR = 0.124, 95%CI: 0.024–0.647, p = 0.013). Also, perceived threat, perceived benefits, perceived barriers and cues for action showed significant differences with interest in participating in screening with a P-values <0.003. The association was different for long waiting time, prioritizing early morning and late evening screening which showed no significant difference (P-value > 0.003).

Conclusions

Married women, unemployed and those with no formal education are less likely to participate in CC screening. The study details significant barriers to cervical cancer screening uptake in Ghana. It is recommended that the Ghana health services should develop appropriate, culturally tailored educational materials to inform individuals with no formal education through health campaigns in schools, churches and communities to enhance CC screening uptake.

Attitudes towards male partner HIV testing among low-income, minority pregnant women and their partners

OBJECTIVE

Primary prevention of maternal HIV seroconversion requires knowledge of the HIV status of sexual partners, but testing rates, particularly among urban minority heterosexual males, remain low. This study was initiated to understand the attitudes of pregnant women and their partners surrounding partner HIV testing.

METHODS

This was a qualitative study of pregnant women receiving publicly-funded prenatal care in a large urban hospital located in a high HIV prevalence area and their partners. Participants underwent in-depth individual interviews about HIV testing. Semi-structured interview guides were used to elicit participant attitudes. Transcripts were analyzed using the constant comparative method to determine themes and subthemes; analysis was organized by whether participants desired or declined partner testing.

RESULTS

Of 51 participants, 29 were pregnant women and 22 were male partners of female participants. Reasons for desiring or declining HIV testing aligned within three major themes: risk perception, logistical considerations, and testing history. An individual's perception of risk included evaluations of fetal safety as well as partner autonomy and fidelity. Logistical considerations included cost, test availability, and male partner geographic location. Individuals' recent testing histories also influenced testing preferences. One cross-cutting theme was of the pregnant woman taking responsibility for family health, which could serve as a motivator to test or reason to decline.

CONCLUSION

Pregnant women are often the linchpin of prevention of HIV transmission in the family unit. These data inform strategies to engage pregnant women and their partners to improve implementation of partner HIV testing in the prenatal setting.

How Children of Parents With Dementia Can Make Their Subject Positions Understandable and Meaningful

The families of people diagnosed with dementia are commonly first-in-line caregivers. This can have a considerable effect on their lives, health, and relationships. However, few studies have focused on the children in such families. Therefore, the aim of this study was to describe how children, in their own narratives, construct themselves as subjects growing up and caring for a parent with dementia. The study applies discourse analysis. The findings show three subject positions: parent to your parent(s), orphan with parents, and time traveler stuck in time. There is a need to support these children, both as children and as young adults. More knowledge is necessary regarding the kind of support they might want or need. For health care professionals, it is important to know that it might not always be easy to ask for information or support as a child caring for a sick parent.

Understanding decision-making in interprofessional team meetings through interpretative repertoires and discursive devices

Health practitioners of the geriatrics ward in a teaching hospital participate in interprofessional team meetings to agree on treatment and discharge care plans for their patients suffering from chronic illnesses and co-morbidities and in need of coordinated assessments and care. We turn to the ideas in critical discursive psychology to grow a much-needed research area of examining the language-in-use and its effects in team decision-making. Specifically we explore how healthcare team members use language to perform collaboration or disengagement, creating different subject positionings for themselves and others out of a backcloth of discursive resources and practices. We observed and transcribed 108 case discussions and analyzed them for interpretative repertoires and discursive devices. During the first half of the team discussions, the members of various health professions employed the empiricist and lifeworld interpretative repertoires and the discursive strategy of perspective-taking, articulating these through formulations and questions. We use the notion of argumentative texture to better understand why an administrative structural support like protected turn-taking in team meetings is not enough to promote interprofessional collaboration. We conclude that health practitioners can improve their contributions and subject positionings at team meetings and consequently patient-care, by identifying habitually deployed linguistic resources depicting professional knowledge, and augmenting these with Other-oriented perspectives in their repertoires. By expanding their range of discursive repertoires and recognizing that discursive practices are embedded in the bigger context or argumentative texture of institutional and societal discourses, norms, values, beliefs and practices, interprofessional teams can work to improve communication and knowledge-sharing.

Why it's time to focus on masculinity in mental health training and clinical practice

OBJECTIVE

Men present with complex, diverse and often contradictory expressions of masculinity that are relevant to their health status. This article argues for the inclusion of masculinity into mental health curricula in Australia. Masculinity mediates health outcomes by influencing help seeking and engagement with treatment.

CONCLUSION

An online curricula audit of publicly available information from Australian medical programs and their professional bodies reveals increasing awareness of the needs, but limited practical inclusion of masculinity models in training and practice. Described are the elements essential to training and subsequent clinical practice to curb the poor mental health outcomes of Australian men.

That mr. Alzheimer… you never know what he's up to, but what about me? A discourse analysis of how Swedish spouse caregivers can make their subject positions understandable and meaningful

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.

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.

"You Worry, 'cause You Want to Give a Reasonable Account of Yourself": Gender, Identity Management, and the Discursive Positioning of "Risk" in Men's and Women's Talk About Heterosexual Casual Sex

Heterosexual casual sex is routinely depicted as a physically, socially, and psychologically "risky" practice. This is the case in media accounts, psychological research, and other academic work. In this article, we examine 15 men's and 15 women's talk about casual sex from a discursive psychological stance to achieve two objectives. Firstly, we confirm the categories of risk typically associated with casual sex but expand these to include a domain of risks related to (gendered) identities and representation. Men's talk of risk centered on concerns about sexual performance, whereas women's talk centered on keeping safe from violence and sexual coercion. The notion of a sexual reputation was also identified as a risk and again manifested differently for men and women. While women were concerned about being deemed promiscuous, men displayed concern about the quality of their sexual performance. Secondly, within this talk about risks of casual sex, the participants' identities were identified as "at risk" and requiring careful management within the interview context. This was demonstrated by instances of: keeping masculinity intact in accounts of no erection, negotiating a responsible subject position, and crafting agency in accounts of sexual coercion-in the participants' talk. We argue that casual sex, as situated within dominant discourses of gendered heterosexuality, is a fraught practice for both men and women and subject to the demands of identity representation within co-present interactions.

"Correcting an Erring Wife Is Normal": Moral Discourses of Spousal Violence in Ghana

This study draws insights from discursive psychology to explore moral discourses of spousal violence in Ghana. In particular, it investigates how sociocultural norms and practices are invoked in talk of perpetrators and victims as moral warrants for husband-to-wife abuse in Ghana. Semi-structured focus group and personal interviews were conducted with a total of 40 participants: 16 victims, 16 perpetrators, and eight key informants from rural and urban Ghana. Participants' discursive accounts suggest that husbands have implicit moral right and obligation to punish their wives for disobedience and other infractions against male authority in marriage. Both perpetrators and victims build their talk around familiar normative discourses and practices that provide tacit support for spousal violence in Ghana. While perpetrators mobilize culturally resonant and normative repertoires to justify abuse, blame their victims, and manage their moral accountability; victims position husband-to-wife abuse as normal, legitimate, disciplinary, and corrective. These moral discourses of spousal violence apparently serve to relieve perpetrators of moral agency; prime battered women to accept abuse; and devastate their agency to leave abusive marital relationships. The findings contribute to our understanding of how cultural and social norms of spousal violence are morally constituted, reproduced, and sustained in talk of perpetrators, victims, and other key members of society.

'Do you know how to use a condom?' - UK nurse practitioners' conversation about men and family planning

INTRODUCTION

Health professionals have been identified as central to encouraging men to take an active part in family planning. The aim of this article is to understand nurse practitioners' conversations about men as family planning patients.

METHODS

One-to-one, semi-structured interviews were conducted with five nurse practitioners. Nurses interviewed worked in a northern UK student medical practice serving over 34,000 students with a diverse range of ages and demographic backgrounds (both home and overseas students). The research method was qualitative using discourse analysis.

RESULTS

After completing the analysis, two discourses emerged. Discourse one, family planning services are culturally female centric, and discourse two, condom use by male family planning patients is problematic.

DISCUSSION

Implications for how nurse practitioners can continue to play an important part when providing care to male family planning patients is discussed, specifically in relation to culture and condom efficacy.

The Men's Safer Sex project: intervention development and feasibility randomised controlled trial of an interactive digital intervention to increase condom use in men

BACKGROUND

This report details the development of the Men's Safer Sex website and the results of a feasibility randomised controlled trial (RCT), health economic assessment and qualitative evaluation.

OBJECTIVES

(1) Develop the Men's Safer Sex website to address barriers to condom use; (2) determine the best design for an online RCT; (3) inform the methods for collecting and analysing health economic data; (4) assess the Sexual Quality of Life (SQoL) questionnaire and European Quality of Life-5 Dimensions, three-level version (EQ-5D-3L) to calculate quality-adjusted life-years (QALYs); and (5) explore clinic staff and men's views of online research methodology.

METHODS

(1) Website development: we combined evidence from research literature and the views of experts (n = 18) and male clinic users (n = 43); (2) feasibility RCT: 159 heterosexually active men were recruited from three sexual health clinics and were randomised by computer to the Men's Safer Sex website plus usual care (n = 84) or usual clinic care only (n = 75). Men were invited to complete online questionnaires at 3, 6, 9 and 12 months, and sexually transmitted infection (STI) diagnoses were recorded from clinic notes at 12 months; (3) health economic evaluation: we investigated the impact of using different questionnaires to calculate utilities and QALYs (the EQ-5D-3L and SQoL questionnaire), and compared different methods to collect resource use; and (4) qualitative evaluation: thematic analysis of interviews with 11 male trial participants and nine clinic staff, as well as free-text comments from online outcome questionnaires.

RESULTS

(1) Software errors and clinic Wi-Fi access presented significant challenges. Response rates for online questionnaires were poor but improved with larger vouchers (from 36% with £10 to 50% with £30). Clinical records were located for 94% of participants for STI diagnoses. There were no group differences in condomless sex with female partners [incidence rate ratio (IRR) 1.01, 95% confidence interval (CI) 0.52 to 1.96]. New STI diagnoses were recorded for 8.8% (7/80) of the intervention group and 13.0% (9/69) of the control group (IRR 0.75, 95% CI 0.29 to 1.89). (2) Health-care resource data were more complete using patient files than questionnaires. The probability that the intervention is cost-effective is sensitive to the source of data used and whether or not data on intended pregnancies are included. (3) The pilot RCT fitted well around clinical activities but 37% of the intervention group did not see the Men's Safer Sex website and technical problems were frustrating. Men's views of the Men's Safer Sex website and research procedures were largely positive.

CONCLUSIONS

It would be feasible to conduct a large-scale RCT using clinic STI diagnoses as a primary outcome; however, technical errors and a poor response rate limited the collection of online self-reported outcomes. The next steps are (1) to optimise software for online trials, (2) to find the best ways to integrate digital health promotion with clinical services, (3) to develop more precise methods for collecting resource use data and (4) to work out how to overcome barriers to digital intervention testing and implementation in the NHS.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN18649610.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 91. See the NIHR Journals Library website for further project information.

From denial to awareness: a conceptual model for obtaining equity in healthcare

BACKGROUND

Although Swedish legislation prescribes equity in healthcare, studies have reported inequalities, both in face-to-face encounters and in telephone nursing. Research has suggested that telephone nursing has the capability to increase equity in healthcare, as it is open to all and not limited by long distances. However, this requires an increased awareness of equity in healthcare among telephone nurses. The aim of this study was to explore and describe perceptions of equity in healthcare among Swedish telephone nurses who had participated in an educational intervention on equity in health, including which of the power constructs gender, ethnicity and age they commented upon most frequently. Further, the aim was to develop a conceptual model for obtaining equity in healthcare, based on the results of the empirical investigation.

METHOD

A qualitative method was used. Free text comments from questionnaires filled out by 133 telephone nurses before and after an educational intervention on equity in health, as well as individual interviews with five participants, were analyzed qualitatively. The number of comments related to inequity based on gender, ethnicity or age in the free text comments was counted descriptively.

RESULTS

Gender was the factor commented upon the least and ethnicity the most. Four concepts were found through the qualitative analysis: Denial, Defense, Openness, and Awareness. Some informants denied inequity in healthcare in general, and in telephone nursing in particular. Others acknowledged it, but argued that they had workplace routines that protected against it. There were also examples of an openness to the fact that inequity existed and a willingness to learn and prevent it, as well as an already high awareness of inequity in healthcare.

CONCLUSION

A conceptual model was developed in which the four concepts were divided into two qualitatively different blocks, with Denial and Defense on one side of a continuum and Openness and Awareness on the other. In order to reach equity in healthcare, action is also needed, and that concept was therefore added to the model. The result can be used as a starting point when developing educational interventions for healthcare personnel.

Masculinity and preventing falls: insights from the fall experiences of men aged 70 years and over

PURPOSE

To explore men's fall experiences through the lens of masculine identities so as to assist health professionals better engage men in fall prevention programs.

METHODS

Twenty-five men, aged 70-93 years who had experienced a recent fall, participated in a qualitative semi-structured interview. Men's willingness to engage in fall prevention programs taking account of individual contexts and expressions of masculinity, were conceptualised using constant comparative methods.

RESULTS

Men's willingness to engage in fall prevention programs was related to their perceptions of the preventability of falls; personal relevance of falls; and age, health, and capability as well as problem-solving styles to prevent falls. Fall prevention advice was rarely given when men accessed the health system at the time of a fall.

CONCLUSIONS

Contrary to dominant expectations about masculine identity, many men acknowledged fall vulnerability indicating they would attend or consider attending, a fall prevention program. Health professionals can better engage men by providing consistent messages that falls can be prevented; tailoring advice, understanding men are at different stages in their awareness of fall risk and preferences for action; and by being aware of their own assumptions that can act as barriers to speaking with men about fall prevention. Implications for rehabilitation Men accessing the health system at the time of the fall, and during rehabilitation following a fall represent prime opportunities for health professionals to speak with men about preventing falls and make appropriate referrals to community programs. Tailored advice will take account of individual men's perceptions of preventability; personal relevance; perceptions of age, health and capability; and problem-solving styles.

Medicine, rhetoric and undermining: managing credibility in homeopathic practice

This article examines homeopathic practitioners ‘real life’ accounts, and illustrates the ways in which they negotiate their homeopathic practices as contingently formulated ongoing social events in research interview settings. Interview transcripts were analysed in a qualitative framework using discourse analysis. The findings show that practitioners construct homeopathy and defend their own individual practices either by ‘alignment-with-medicine’ or by ‘boosting-the-credibility-of-homeopathy’. Homeopathy is also negotiated and sustained as an ‘alternative’ to notions of conventional medicine, which is the accepted yardstick for practice or as a practice that is portrayed as problematic. Overall, managing personal credibility is accomplished through specific ways of accounting that tend to marginalise homeopathy. Developing and establishing homeopathic practice further as a discipline in its own right is offered as a ‘nucleus’ to reduce continuing marginalisation.

Gendered accounts of managing diabetes in same-sex relationships: A discursive analysis of partner support

The gendered dimensions of partner support in relationships where one partner has a chronic condition has been a recurring focus within the literature on gender and health. Such literature however typically focuses exclusively on heterosexual couples while same-sex relationships are rendered invisible, leading to the discourse around partner support being heteronormative. This article examines gendered dimensions within accounts of lesbian, gay and bisexual people with diabetes using a discursive psychological approach. The analysis identifies how participants drew upon a range of interpretative repertoires, including: (1) notions that women are more caring than men; (2) that men can take control in an emergency; (3) that gay men are caring; (4) that grown men can take care of themselves; and (5) that gay men are more independent than heterosexual men. It is argued that rather than simply dismissing heteronormative repertoires of gender and health, non-heterosexuals draw upon them in ways that display ideological tensions.

Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views

Objectives

The aim of the study was to gather the views of sexual health clinic staff and male clinic users regarding digital sexual health promotion and online trial procedures.

Methods

The Men’s Safer Sex website was offered on tablet computers to men in the waiting rooms of three sexual health clinics, in a feasibility online randomised controlled trial (RCT). Interviews were conducted with 11 men who had participated in the trial and with nine clinic staff, to explore their views of the website and views of the online trial. Interviews were audio-recorded and transcribed, and we conducted a thematic analysis of interviews and of 281 free text comments from the online RCT outcome questionnaires.

Results

Clinic users and staff felt that digital interventions such as the Men’s Safer Sex website are useful, especially if NHS endorsed. Pre-appointment waiting time presents a good opportunity for intervention but clinic users and staff felt that a website should supplement rather than replace face-to-face healthcare. The RCT procedures fitted well around clinical activities, but men did not self-direct to the tablet computers. Staff were more concerned about consent and confidentiality than clinic users, and staff and patients were frustrated by multiple technical problems. The trial outcome questionnaire was thought-provoking and could constitute an intervention in itself. Participants felt that clinics would need to promote a digital intervention and/or offer the site routinely to promote engagement.

Conclusion

Digital interventions could usefully supplement in-person sexual health care, but there are important obstacles in terms of IT access in NHS settings, and in promoting engagement.

The Men's Safer Sex Trial: A feasibility randomised controlled trial of an interactive digital intervention to increase condom use in men

Objectives

We aimed to determine the feasibility of an online randomised controlled trial (RCT) of the Men’s Safer Sex website, measuring condom use and sexually transmitted infection (STI).

Methods

For this study 159 men aged ≥16 with female sexual partners and recent condomless sex or suspected STI were recruited from three UK sexual health clinics. Participants were randomised to the intervention website plus usual clinic care (n = 84), or usual clinic care only (n = 75). Online outcome data were solicited at 3, 6, and 12 months.

Results

Men were enrolled via tablet computers in clinic waiting rooms. Software errors and clinic Wi-Fi access presented significant challenges, and online questionnaire response rates were poor (36% at 3 months with a £10 voucher; 50% at 12 months with £30). Clinical records (for STI diagnoses) were located for 94% of participants. Some 37% of the intervention group did not see the intervention website (n = 31/84), and (as expected) there was no detectable difference in condomless sex with female partners (IRR = 1.01, 95% CI 0.52 to 1.96). New acute STI diagnoses were recorded for 8.8% (7/80) of the intervention group, and 13.0% (9/69) of the control group over 12 months (IRR = 0.75, 95% CI 0.29 to 1.90).

Conclusion

It is likely to be feasible to conduct a future large-scale RCT to assess the impact of an online intervention using clinic STI diagnoses as a primary outcome. However, practical and technical challenges need to be addressed before the potential of digital media interventions can be realised in sexual health settings.

Trial registration number: ISRCTN18649610

Repertoires of responsibility for diabetes management by adults with intellectual disabilities and those who support them

The limited existing research on diabetes management and intellectual disabilities (ID) highlights the need for further exploration of the concept of responsibility. This study explored repertoires of responsibility in accounts of managing diabetes for adults with ID. Fourteen semi-structured interviews were conducted in the UK with seven adults with mild/moderate ID and type 1 or 2 diabetes and seven people who they nominated as supporting their diabetes management. A discursive psychological analysis found that interpretative repertoires relating to competence, independence and accountability were drawn on to construct multiple and sometimes conflicting versions of responsibility. Within these repertoires people with ID were positioned in conflicting ways; as competent, personally responsible, and entitled to independence and choice, but as also lacking competence, dependent on others and incapable of overall accountability. People with ID often took up empowering positions defending against an incompetent identity. Supporters built accounts which negotiated dilemmatic repertoires on the dual responsibilities of empowering adults with ID to self-manage and managing risk to support good and safe care. The implications of available discursive resources and the ways in which they are mobilised are considered.

Marriage and cancer prevention: Does marital status and inviting both spouses together influence colorectal cancer screening participation?

Objectives

This study examined the influence of marital status and inviting both partners together on participation in colorectal cancer screening.

Setting

Data were from a subset of participants from the UK Flexible Sigmoidoscopy Trial (1996–1999).

Methods

Marital status was self-reported, and co-invitation of partner was obtained from the trial database. Screening intentions were assessed in 16,527 adults aged 55–64 years. Attendance was recorded in the 4130 respondents who were subsequently invited.

Results

Multivariate analyses, controlling for age and educational level, indicate that married (or cohabiting) people have more positive intentions (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.14–1.38) and higher attendance rates at screening (OR = 1.23; 95% CI 1.04–1.45) than non-married people. After adjusting for the marriage effect, inviting partners together (co-invitation) significantly increased screening intentions among women (OR = 1.17; 95% CI 1.04–1.31) but not men (OR = 0.97; 95% CI 0.85–1.10). Co-invitation significantly increased attendance at screening in both genders (OR = 1.34; 95% CI 1.14–1.58).

Conclusions

In this age group, married adults are more likely to participate in colorectal cancer screening than the non-married, and inviting both members of a couple together further increases screening uptake. The positive effect of marriage was as strong for women as men.

"Our people has got to come to terms with that": changing perceptions of the digital rectal examination as a barrier to prostate cancer diagnosis in African-Caribbean men

OBJECTIVE

African-Caribbean men in the United Kingdom in comparison with other ethnicities have the highest incidence rate of prostate cancer. Psychosocial aspects related to screening and presentation impact on men's behavior, with previous studies indicating a range of barriers. This study explores one such barrier, the digital rectal examination (DRE), due to its prominence within UK African-Caribbean men's accounts.

METHODS

African-Caribbean men with prostate cancer (n = 10) and without cancer (n = 10) were interviewed about their perceptions of DRE. A synthetic discursive approach was employed to analyze the data.

RESULTS

Findings illustrate that an interpretative repertoire of homophobia in relation to the DRE is constructed as having an impact upon African-Caribbean men's uptake of prostate cancer screening. However, the discursive focus on footing and accountability highlight deviations from this repertoire that are built up as pragmatic and orient to changing perceptions within the community.

CONCLUSIONS

Health promotion interventions need to address the fear of homophobia and are best designed in collaboration with the community.

From the "Technician Thing" to the "Mental Game": Masculinity and U.S. Homebirth

Previous research on pregnancy and birth from the perspective of men has found that men approach them from the perspective of hegemonic masculinity, though many find that hospital birth is a time of potential failure at masculinity. In this qualitative study of 11 men who had children born at home, I find that, like their hospital-birth counterparts, they find roles in their partners' pregnancies and early labors that are congruent with hegemonic masculinity. In ways that converge and diverge with the experience of hospital-birth fathers, they find their masculinity disrupted as the birth approaches, becoming nurturers and servers rather than technicians and protectors. These acts shift them from the masculinity of a young man to that of a father. This is consonant with Connell's (1995) theory that masculinity is not singular, but shifts situationally and across the life course, and Butler's (2003) theory that gender is constructed through acts.

The influence of marital status on the use of breast, cervical, and colorectal cancer screening

PURPOSE

To examine the impact of marital status on the use of screening for breast, cervical, and colorectal cancer.

METHODS

We relied on 2012 Behavioral Risk Factor Surveillance System Survey age-appropriate screening cohorts. Appropriate screening for breast, cervical, and colorectal cancer was determined according to United States Preventive Services Task Force recommendations in effect at the time of the 2012 survey. Complex samples logistic regression models were performed to examine the effect of marital status on cancer screening.

RESULTS

Overall, 81.6, 83.9, and 68.9% of married participants underwent breast, cervical, and colorectal cancer, respectively, relative to 74.2, 75.1, and 60.9% for divorced/widowed/separated, individuals, and 74.7, 78.7, and 53.4% for never married individuals. Marital status (married vs. never married) was an independent predictor of screening for all cancers examined: breast cancer, odds ratio (OR): 1.42 (95% confidence interval [CI]: 1.25-1.61); cervical cancer, OR: 1.29 (95% CI: 1.16-1.43); colorectal cancer, OR: 1.63 (95% CI: 1.51-1.77). Gender-specific subgroup analyses for colorectal cancer suggests that marital status may exert a greater effect in men, relative to women (married men: OR 1.75, 95% CI: 1.56-1.96; married women: OR: 1.52, 95% CI: 1.35-1.70).

CONCLUSION

Being married is associated with increased utilization of breast, cervical, and colorectal cancer screening. The influence of marital status was greater in men relative to women eligible for colorectal cancer screening. Our results emphasize the importance of social determinants of health-seeking behaviors.

Constructing Agency in Treatment Decisions: Negotiating Responsibility in Cancer

People belonging to cancer patient support groups participated in focus groups concerning their experiences of orthodox and complementary medicine. Their accounts of treatment decisions for cancer were analysed through discourse analysis. Accounts of both complementary and orthodox medicine addressed an ideological dilemma concerning the positioning of individuals as active or passive. Active positions were congruent with the everyday value of autonomy and responsible individuality, but conflicted with the established expertise of the medical profession in cancer and entailed being accountable for one’s health. Passive positions reversed this situation. Complementary medicine provided an opportunity for people with cancer to negotiate active positions in a limited domain of health care. The responsibility for health associated with taking active treatment decisions was problematic in accounts of both orthodox and complementary medicine.

‘What he hasn’t told you...’: Investigating the Micro-Politics of Gendered Support in Heterosexual Couples’ Co-Constructed Accounts of Illness

Research has demonstrated that heterosexual men receive enhanced health benefits from their relationships with women. Explanations for this gendered pattern often focus on women’s role as the main caregivers and arrangers of health care. However, what remains unclear is how these benefits are mediated. In this article, we describe the micropolitics evident in negotiations between 12 heterosexual couples as they discuss the serious illness of one of the pair with an interviewer. The interviews were transcribed and subsequently analysed using a synthetic approach to discursive psychology. We argue that in these co-constructed stories, women potentially trouble men’s identity performances. For instance, by interjecting emotional assessments, women supporters allow men the opportunity to discuss aspects of the illness experience that might be otherwise viewed as at odds with hegemonic masculinity. We suggest that women’s positioning of men is a form of complicity with hegemonic masculinity and urge that further research should follow this line of enquiry.

Taking the Biscuit? A Discursive Approach to Managing Diet in Type 2 Diabetes

Adopting and maintaining a healthy diet is pivotal to diabetic regimens. Behavioural research has focused on strategies to modify/maintain healthy behaviours; thus ‘compliance’ and ‘ noncompliance’ are operationalized by researchers. In contrast, discursive psychology focuses on the actions different accounts accomplish—in this case regarding diets. Using thematic discourse analysis, we examine dietary management talk in repeat-interviews with 40 newly diagnosed type 2 diabetes patients. Women in our study tended to construct dietary practices as an individual concern, while men presented food consumption as a family matter. Participants accounted for ‘cheating’ in complex ways that aim to accomplish, for instance, a compliant identity. Discursive psychology may facilitate fluidity in our understandings of dietary management, and challenge fixed notions of ‘compliant’ and ‘non-compliant’ diabetes patients.