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Mokua SN, Ombogo L, Mathu D, Otambo P, Nyandieka L, Onteri SN, Mbuka SJ, Kariuki J, Ahmed I, Wanjihia V, Mutai J, Bukania Z. "For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002925. [PMID: 38713655 DOI: 10.1371/journal.pgph.0002925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/16/2024] [Indexed: 05/09/2024]
Abstract
The achievement of Universal Health Coverage (UHC) requires equitable access and utilization of healthcare services across all population groups, including men. However, men often face unique barriers that impede their engagement with health systems which are influenced by a myriad of socio-cultural, economic, and systemic factors. Therefore, understanding men's perspectives and experiences is crucial to identifying barriers and facilitators to their healthcare-seeking behaviour under UHC initiatives. This qualitative study sought to explore men's perceptions, experiences, healthcare needs and potential strategies to inform an impartial implementation of Universal Health Coverage (UHC) in Kenya. The study employed a qualitative research design to investigate men's healthcare experiences in 12 counties across Kenya. Thirty focus group discussions involving 296 male participants were conducted. Men were purposively selected and mobilized through the support of health facility-in-charges, public health officers, and community health extension workers. Data was coded according to emergent views and further categorized thematically into three main domains (1) Perspectives and experiences of healthcare access (2) Socio-cultural beliefs and societal expectations (3) Desires and expectations of health systems. Findings revealed complex sociocultural, economic, and health system factors that influenced men's healthcare experiences and needs which included: masculinity norms and gender roles, financial constraints and perceived unaffordability of services, lack of male-friendly and gender-responsive healthcare services, confidentiality concerns, and limited health literacy and awareness about available UHC services. Our study has revealed a disconnect between men's needs and the current healthcare system. The expectations concerning masculinity further exacerbate the problem and exclude men further hindering men's ability to receive appropriate care. This data provides important considerations for the development of comprehensive and gender-transformative approaches challenging harmful masculine norms, pushing for financial risk protection mechanisms and gender-responsive healthcare delivery attuned to the unique needs and preferences of men.
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Affiliation(s)
- Sharon N Mokua
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lorraine Ombogo
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - David Mathu
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Prisca Otambo
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lilian Nyandieka
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Stephen N Onteri
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Schiller J Mbuka
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - James Kariuki
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Ismail Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Violet Wanjihia
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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Metlock FE, Addison S, McKoy A, Yang Y, Hope A, Joseph JJ, Zhang J, Williams A, Gray DM, Gregory J, Nolan TS. More than Just a Number: Perspectives from Black Male Participants on Community-Based Interventions and Clinical Trials to Address Cardiovascular Health Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:449. [PMID: 38673360 PMCID: PMC11050149 DOI: 10.3390/ijerph21040449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Black Americans remain significantly underrepresented and understudied in research. Community-based interventions have been increasingly recognized as an effective model for reckoning with clinical trial participation challenges amongst underrepresented groups, yet a paucity of studies implement this approach. The present study sought to gain insight into Black male participants' perception of clinical trials before and after participating in a community-based team lifestyle intervention in the United States. METHODS Black Impact, a 24-week community-based lifestyle intervention, applied the American Heart Association's Life's Simple 7 (LS7) framework to assess changes in the cardiovascular health of seventy-four Black male participants partaking in weekly team-based physical activities and LS7-themed education and having their social needs addressed. A subset of twenty participants completed an exit survey via one of three semi-structured focus groups aimed at understanding the feasibility of interventions, including their perceptions of participating in clinical trials. Data were transcribed verbatim and analyzed using a content analysis, which involved systematically identifying, coding, categorizing, and interpreting the primary patterns of the data. RESULTS The participants reported a positive change in their perceptions of clinical trials based on their experience with a community-based lifestyle intervention. Three prominent themes regarding their perceptions of clinical trials prior to the intervention were as follows: (1) History of medical abuse; (2) Lack of diversity amongst research teams and participants; and (3) A positive experience with racially concordant research teams. Three themes noted to influence changes in their perception of clinical trials based on their participation in Black Impact were as follows: (1) Building trust with the research team; (2) Increasing awareness about clinical trials; and (3) Motivating participation through community engagement efforts. CONCLUSIONS Improved perceptions of participating in clinical trials were achieved after participation in a community-based intervention. This intervention may provide a framework by which to facilitate clinical trial participation among Black men, which must be made a priority so that Black men are "more than just a number" and no longer "receiving the short end of the stick".
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Affiliation(s)
- Faith E. Metlock
- Johns Hopkins School of Nursing (Formerly The Ohio State University College of Nursing), Baltimore, MD 21205, USA;
| | - Sarah Addison
- Washington University School of Medicine (Formerly The Ohio State University College of Medicine), St. Louis, MO 63110, USA;
| | - Alicia McKoy
- OhioHealth (Formerly The Ohio State University Center for Cancer Health Equity), Columbus, OH 43202, USA;
| | - Yesol Yang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.Y.); (J.Z.)
| | - Aarhea Hope
- Nell Hodgson Woodruff School of Nursing (Formerly The Ohio State University College of Nursing), Atlanta, GA 30322, USA;
| | - Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH 43210, USA; (J.J.J.); (A.W.)
| | - Jing Zhang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.Y.); (J.Z.)
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, OH 43210, USA; (J.J.J.); (A.W.)
| | - Darrell M. Gray
- Gray Area Strategies LLC (Formerly The Ohio State University College of Medicine), Columbus, OH 43210, USA;
| | - John Gregory
- The African American Male Wellness Agency, National Center for Urban Solutions, Columbus, OH 43205, USA;
| | - Timiya S. Nolan
- University of Alabama at Birmingham Heersink School of Medicine (Formerly The Ohio State University College of Nursing and The Ohio State University Comprehensive Cancer Center), Birmingham, AL 35233, USA
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Jordan H, Jeremiah R, Watson K, Corte C, Steffen A, Matthews AK. Exploring Preventive Health Care Utilization Among Black/African American Men. Am J Mens Health 2024; 18:15579883231225548. [PMID: 38243644 PMCID: PMC10799604 DOI: 10.1177/15579883231225548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/21/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024] Open
Abstract
Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.
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Affiliation(s)
- Harrell Jordan
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Rohan Jeremiah
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Karriem Watson
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Colleen Corte
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Alana Steffen
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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