Performing masculinity, influencing health: a qualitative mixed-methods study of young Spanish men

Constructing, Deconstructing or Abolishing? Discourses on Masculinities in Violence Against Women Prevention by Stakeholders in Spain

In the field of violence against women (VAW) prevention, one of the current questions at stake is how to address men's role and masculinities, but it is still an emerging field in Spain. The aim of this study was to analyze the up-to-date discourses on masculinity among stakeholders in the field of VAW prevention and gender equity in Spain. We used a qualitative methodology with semi-structured interviews, conducted between October 2019 and February 2020 in Madrid and Alicante (Spain), with 23 key stakeholders from different areas: in governmental (public health and VAW prevention/intervention, and institutional and policy positioning) and nongovernmental organizations (anti-violence masculinities workers, youth education workers, and feminist and LGBT associations). A discourse analysis was performed with the data collected. Our findings showed that discourses around masculinities among Spanish stakeholders in VAW prevention and gender equity were diverse and presented different layers of critique. Despite a general agreement on the importance of transforming sexist men's practices toward more gender equitable relations, three main interpretive repertoires were identified: "Constructing positive/new masculinities" discourse, focused on promoting men's engagement and egalitarian practices; "Deconstructing hegemonic masculinity" discourse, intended to critically identify and question harmful masculinities norms; and "Abolishing gender" discourse, which aims at dismantling masculinity, and gender in general, as a social structure that generates oppression in itself, advocating for its abolition. Those interpretive repertoires were not mutually exclusive and sometimes stakeholders incorporate in their work more than one approach. The study findings shed light on this current emerging and urgent debate and contributes more broadly to the critical assessment of the concepts used and their implications for VAW prevention.

"It is what we have been told to do": Masculinities and femininities crossing with sexual orientation and feminist activism in Spain

Masculinities and femininities are often characterized by social inequalities and mainly studied from the perspectives of adult, heterosexual and non-activist people. This study explores the discourses on masculinities and femininities of young cisgender men and women, involved or not in feminist activism and of different sexual orientations (heterosexual, bisexual and homosexual) in Spain. Between 2019 and 2020, we conducted a qualitative study with 20 semi-structured interviews and 8 discussion groups in which 73 people participated. A socially dominant gender discourse was identified, which establishes a dichotomous understanding of masculinity in constant confrontation with femininity, as well as of heterosexuality against homosexuality, in a heteronormative context. Young people discursively position themselves differently from said discourse according to their sexual orientation and involvement in feminist activism. We encounter discursive positions that reproduce the socially dominant gender discourse, especially detected among non-activist heterosexuals. We also observe others that try to transgress it, mainly among activists of all sexual orientations and non-activist homosexuals and bisexuals. This study empirically adds to the knowledge of the configuration of inequalities in gender relations and how interactions with sexuality take place. The results also provide guidance for future gender-transformative interventions to promote gender equality and social justice.

Onset of Weight Gain and Health Concerns for Men: Findings from the TAP Programme

With shown reticence by men to engage with dietary interventions for weight loss, investigations that provide detail on men’s perceptions for the causes of weight gain and subsequent concerns over health and image are important. Such discoveries have potential to make a valuable contribution to male gendered programme design aimed at tackling weight gain and promoting good health. Connecting to men to health using their hobbies and interests, this study deployed semi-structured interviews of eight male participants (age > 35 years) enrolled on The Alpha Programme (TAP). TAP is a 12-week football and weight management intervention delivered in local community venues. Results captured men’s lived experiences and feelings of being overweight, their attempts at dietary modification, health and causes of weight gain. Results signify externalized attribution for weight gain, entrenched habitual intake practices, despondency related to weight stigmatization, self-objectification and low self-worth. Moreover, this study outlines the processes for capturing this information using a male friendly approach and setting. Outcomes have potential for shaping bespoke men’s weight management and health improvement interventions in the future.

"If You Do Not Fit in With the Stereotype, They Eat You Alive": Discourses of Masculinities and Their Reflections in Young Spanish Men's Health

Hegemonic masculinity has been especially linked, among other aspects, to unhealthy behaviors and heterosexuality. This study aimed to explore the discourses of masculinities with young Spanish men with different sexual orientations (heterosexuals, bisexuals, and homosexuals), comparing them with the social representations that are put into practice on Instagram. Three qualitative approaches were triangulated to seek a richer comprehension and interpretational level: discussion groups, semi-structured interviews, and an online non-participant observation on Instagram with a total of 26 young men aged between 18 and 24. Results indicate that hegemonic masculinity discourse is still significant when understanding and experiencing young men's masculinities, promoting behaviors that put their health at risk and generating psychological discomfort, especially among non-heterosexual men. Our findings provide knowledge of the social framework that legitimizes and reproduces male domination in younger generations both online and offline and how this is reflected in men's health.

PositivMasc: masculinities and violence against women among young people. Identifying discourses and developing strategies for change, a mixed-method study protocol

INTRODUCTION

Despite public policies and legislative changes aiming to curtail men's violence against women (VAW) around the world, women continue to be exposed to VAW throughout their life. One in three women in Europe has reported physical or sexual abuse. Men who display unequitable masculinities are more likely to be perpetrators. VAW is increasingly appearing at younger ages. The aims of the project are fourfold: (1) to explore and position the discourses that young people (men and women, 18-24 years) in Sweden, Spain, Ireland and Israel use in their understanding of masculinities, (2) to explore how these discourses influence young people's attitudes, behaviours and responses to VAW, (3) to explore individual and societal factors supporting and promoting anti-VAW masculinities discourses and (4) to develop actions and guidelines to support and promote anti-VAW masculinities in these settings.

METHODS AND ANALYSIS

A participatory explorative mixed-method study will be used. In Phase 1, qualitative methods will be used to identify the discourses that young people and stakeholders use to conceptualise masculinities, VAW and the actions that are needed to support and promote antiviolence masculinities. In Phase 2, concept mapping will be used to quantify the coherence, relative importance and perceived relationship between the different actions to support and promote anti-VAW masculinities. Phase 3 is a knowledge creation and translation phase, based on findings from Phases 1 and 2, where actions and guidelines to promote and support anti-VAW masculinities will be developed.

ETHICS AND DISSEMINATION

Ethical clearance has been obtained from ethics review boards in each country. Results will be disseminated through peer-reviewed publications, presentations at international conferences, policy briefs, social media and through the project online hub. With its multicountry approach, our project results seek to inform policies and interventions aimed at promoting discourses which challenge hegemonic masculinities.

[The study of health in men from a gender perspective: where we come from, where are we going]

Comprehensive and in-depth analyses of differences and inequalities in health require a broad-based approach to the study of masculinities and men's health. Interest in this issue has grown in parallel to increased concern over specific risks and vulnerabilities faced by men, but also due to the need to involve them in programs capable of promoting progress towards gender-based health equity. This article attempts to reframe these issues from the perspective of public health, providing a wider viewpoint on men's health situated within debates on the social determinants of health and the analysis of health inequalities. Based on a relational gender approach, we formulate some recommendations regarding policy and research agendas, which we argue can contribute to advancing the study and development of programs from a gender-based perspective in health.

“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.

'Life under the tent is not safe, especially for young women': understanding intersectional violence among internally displaced youth in Leogane, Haiti

BACKGROUND

Haiti's 2010 earthquake devastated social, health, and economic infrastructure and left 2 million persons homeless. Over 6 years later 61,000 people remain displaced, most lacking protection, services, and durable solutions. Structural contexts elevate risks of gender-based violence (GBV) targeting internally displaced (ID) girls and women.

OBJECTIVE

We used an intersectionality framework to explore lived experiences and understanding of violence among ID young men and women in Leogane, Haiti.

METHODS

We conducted six focus groups, three with ID young women (n = 30) and three with ID young men (n = 30) aged 18-24 years, and 11 in-depth individual interviews with frontline workers in Leogane. Focus groups and interviews were conducted in Kreyol, transcribed verbatim, translated into English, and analyzed using narrative thematic techniques.

RESULTS

Findings revealed violence experienced by ID youth was (re)produced at the intersection of gender, poverty, displacement, and age. Multi-level forms of violence included structural (e.g. poverty), community (e.g. gender norms, and interpersonal (e.g. family expectations) dimensions. Coping strategies spanned intrapersonal (hope), community (social support), and structural (employment/education) dimensions.

CONCLUSIONS

Interventions to reduce violence should be tailored to address the social inequities that emerge at the intersection of youth, poverty, displacement, and hegemonic gender norms.

"The Heart Desires but the Body Refuses": Sexual Scripts, Older Men's Perceptions of Sexuality, and Implications for Their Mental and Sexual Health

We use sexual scripting theory in the present paper to gain a better understanding of older men's perceptions of their sexuality in relation to dominant Tanzanian cultural norms of masculinity. Qualitative in-depth interviews were conducted with 15 older men, and ten focus group discussions were conducted with 60 men aged 60-82. Participants' recruitment was guided by theoretical sampling strategies. Consistent with the principles of grounded theory, data collection and analysis occurred simultaneously. Our findings indicate that Jando (male initiation rites) serves as a script for male sexuality that outlines the expectations and rewards of male sexuality. Adhering to masculine sexual script affects older men's perceptions of their sexuality in later life and has detrimental effects on their well-being. Older men were concerned with changes in their sexual life, such as the decline in their sexual performance. The majority of the participants said they felt emotionally distressed about the age-related decline in their body and in their sexuality, and they reported that their inability to conform to male sexual scripts undermined their sense of masculinity. Several of the participants reported that in an effort to regain their previous sexual performance, they had turned to remedies and strategies of questionable appropriateness and effectiveness. Our study suggests that older men may benefit from age-related interventions tailored to their cultural background. These interventions may require trained health care providers on mental health issues to bridge the gap between the internalized scripts of ideal male sexuality and the reality of aging.

Assessing gender stereotypes and sexual risk practices in men who have sex with men

OBJECTIVE

To analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM).

METHODS

Cross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed.

RESULTS

Two main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partner's serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants.

CONCLUSION

The BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partner's serological status. The information obtained may be useful to define intervention and prevention programs.

Sport practice, physical structure, and body image among university students

BACKGROUND

The aim of this study was to estimate body image perception in undergraduate students, and to investigate its associations with weight status, abdominal obesity, muscularity, gender and sport.

METHODS

The sample consisted of 231 Italian students (174 males and 57 females); anthropometric measurements, taken by trained technicians, were: height, weight, arm-circumference, waist and hip circumferences. BMI, WHR and Δ arm-circumference were calculated. Body image was assessed using body silhouette charts. Information about sport (currently practiced sport, starting age, and weekly hours of sport) was acquired with questionnaires.

RESULTS

Females perceived themselves as slightly overweight, while males identified themselves as normal weight. Females had a tendency to desire to be thinner in all weight status categories; in males, normal weight subjects had a tendency to desire to be larger, while overweight wished to be thinner. Sport practice was significantly higher in males. Individuals who were overweight and did less sport were significantly more likely to have higher body dissatisfaction.

CONCLUSIONS

The present study highlights a positive relationship between sport practice, corpulence and body image perception.

Introducing gender equity to adolescent school children: A mixed methods' study

Background

Over the past decade, gender equality and women's empowerment have been explicitly recognized as key not only to the health of nations but also to social and economic development. The aim of the present study was to assess the effectiveness of a mixed methods' participatory group education approach to introduce gender equity to adolescent school children. It also assessed baseline and postintervention knowledge, attitudes, and practices regarding gender equity, sexual and reproductive health among adolescent students in government-aided schools, and finally, compare the pre- and post-intervention gender equitable (GE) attitudes among the study participants.

Methodology

A government-aided school was selected by nonprobalistic intentional sampling. On 5 predesignated days, willing students were included in the intervention which included a pretest, a group of educational-based participatory mixed methods' intervention followed by a posttest assessment. A total of 186 students participated in the study.

Results

Girls had better baseline GE scores as compared to boys and they also improvised more on the baseline scores following the intervention.

Conclusion

The present mixed method approach to introduce gender equity to adolescent school children through a group education-based interventional approach proved to be effective in initiating dialog and sensitizing adolescents on gender equity and violence within a school setting.

Social and Cultural Factors Affecting Maternal Health in Rural Gambia: An Exploratory Qualitative Study

BACKGROUND

The high rate of maternal mortality reported in The Gambia is influenced by many factors, such as difficulties in accessing quality healthcare and facilities. In addition, socio-cultural practices in rural areas may limit the resources available to pregnant women, resulting in adverse health consequences. The aim of this study is to depict the gender dynamics in a rural Gambian context by exploring the social and cultural factors affecting maternal health.

METHODS AND FINDINGS

Five focus group discussions that included 50 participants (aged 15-30 years, with at least one child) and six in-depth interviews with traditional birth attendants were conducted to explore perceptions of maternal health issues among rural women. The discussion was facilitated by guides focusing on issues such as how the women perceived their own physical health during pregnancy, difficulties in keeping themselves healthy, and health-related problems during pregnancy and delivery. The data resulting from the discussion was transcribed verbatim and investigated using a qualitative thematic analysis. In general, rural Gambian women did not enjoy privileges in their households when they were pregnant. The duties expected of them required pregnant women to endure heavy workloads, with limited opportunities for sick leave and almost nonexistent resources to access prenatal care. The division of labor between men and women in the household was such that women often engaged in non-remunerable field work with few economic resources, and their household duties during pregnancy were not alleviated by either their husbands or the other members of polygamous households. At the time of delivery, the decision to receive care by trained personnel was often beyond the women's control, resulting in birth-related complications.

CONCLUSIONS

Our findings suggest that despite women's multiple roles in the household, their positions are quite unfavorable. The high maternal morbidity and mortality rate in The Gambia is related to practices associated with gender inequality.

Gender differences in the prevalence and clustering of multiple health risk behaviours in young adults

AIMS

To estimate the sex-stratified prevalence and clustering of 14 behavioural and metabolic health risk factors in emerging adulthood.

BACKGROUND

The high prevalence and the clustering of risk factors multiply health consequences and increase the threat to the future health and quality of life of young adults.

DESIGN

Descriptive cross-sectional study.

METHODS

During November-December 2012, we assessed 14 lifestyle characteristics of 1058 1st year university students' that were classified as: healthy (score = 0), unhealthy (score = 1) and high-risk unhealthy (score = 2). We subsequently created a Multiple Health Risk Behaviours Index by summing the score of each behaviour adjusted to 0-100.

RESULTS

Only 0·3% of the students had one risk behaviour and 21·3% (male: 31·5%; female: 12·6%) had ≥10 of 14. Male students had higher risk index score. In adjusted regression analyses, female students had higher odds of reporting healthier behaviours in oral hygiene (tooth brushing), red meat and junk food consumption, binge drinking, cannabis/hashish/marijuana use and lower number of sexual partners and Body Mass Index. Male students reported higher physical activity. No statistically significant gender differences were noted for screen time/sedentary behaviours, condom use, smoking, sunburns, breakfast and fruit and vegetable consumption.

CONCLUSION

Although health-compromising behaviours are highly prevalent in both men and women, they are gender-related, with males engaging in more health risk behaviours than females. Preventive interventions may need to focus on gender-informed approaches when targeting multiple health risk behaviours.

[Explanation of risky sexual behaviors in men who have sex with men]

OBJECTIVE

To explore views about risky sexual behaviors and perceptions of HIV, and to propose interventions for preventing HIV infections in a group of men who have sex with men.

METHODS

We performed a qualitative study in a sample of 13 men who have sex with men, who were participating in an HIV-seronegative cohort, and who we contacted via saunas for the gay community in Barcelona (Spain). We performed in-depth semi-structured interviews, followed by content analysis.

RESULTS

Risky sexual behaviors were associated with masculinity related to strong sexual needs, certain sexual exchange venues (such as saunas, private parties and clubs), drug use, and a desire to experiment with risk and one's own sexuality. HIV infection was perceived as a normalized disease, although becoming infected was still associated with shame and guilt. Proposed interventions included raising awareness of what it is like to live with HIV, generating greater social alarm, incorporating new technologies in prevention, and intensifying activity at gay venues.

CONCLUSIONS

The concept of masculinity plays a fundamental role in sexual practices among men who have sex with men. We suggest renewed innovation in preventive programs and incorporating the perception of risk and HIV infection from a gender perspective.