Researching the real worlds of men's health
Leeds Metropolitan University
Men’s health is still a marginal issue in the disciplines of health and medicine that largely dominate the policy and provision of health services and the understanding of health and illness. In the UK, there is now an obligation to take account of the gendered dimensions of health and illness. The UK Equality Act 2006 is perhaps best known for replacing the Commission for Racial Equality, the Disability Rights Commission, and the Equal Opportunities Commission with the Commission for Equality and Human Rights (CEHR) as a single body for all equality issues. What has received relatively little attention is that the Equality Act 2006 established the Gender Duty, which places a statutory obligation upon public bodies to ensure they meet the different needs of men and women. In an attempt to grapple with the emergence of men’s health and the changing health policy context, the work in this symposium explores the dual concerns of a) seeking/using healthcare services, and
b) the construction and engagement with, or against, different aspects of health and illness. Branney et al. set the context for health policy in the UK with a particular focus on the obesity ‘epidemic’. In men’s health it is common to focus on men’s unhealthy practices, particularly the under use of health services, which can be seen in a study of how men use primary care services by Hale et al. In contract, Witty el al. find almost 500 men who frequently attend their GP practice in a large evaluation study of a self-care initiative. Rugby Union is perhaps indicative of masculinities enacting themselves even in the face of serious health threats. Smith considers male rugby union players who have been propelled into the world of disability through playing their sport. Male breasts are, however, a good example of how men can be feminised through health and Singleton considers cosmetic surgery for their removal, when they are colloquially known as ‘moobs’ and the procedure is medically referred to as gynecomastia.
Paper 1: Gendered access to primary care services for obesity: a multi-method scoping study to explore areas of action that may enable public health bodies to meet their obligations under the UK Equality Act 2006
P. Branney, Leeds Metropolitan University;
S. Payne, Bristol University; G. Granville, GillianGranville Associates & D. Wilkins, Men’s Health Forum
Where it is probable that inequitable use of services is resulting in unequal outcomes between men and women, the Equality Act 2006 requires all public bodies to examine their service and adjust it to ensure a better balance. The Department of Health has funded a research project to examine what is known about the use of primary care services (for six disease areas: alcohol abuse, cancer, cardiovascular disease, mental health, obesity, and sexual health) in the UK and to highlight areas of action that may enable public health bodies to meet their obligation. The objective of this paper is to consider these findings by focusing on one area that many consider to be an epidemic and where primary care services are being given a key role namely, obesity.
A multi-method design has been utilised to scope information on gendered access from three different sources; policy-makers, research literature, and service-use datasets. This information was subsequently taken back to potential research users to engage them in the issues covered, generate critical feedback, and identify priorities for action.
A) Eight interviews were conducted with policy leads at the Department of Health, which were transcribed by the interviewer and analysed by the research team. B) Literature databases were scoped for research on gender and primary care services for each disease group. C) Routine service use datasets were scoped for primary care morbidity and UK mortality data that could be disaggregated by sex and analysed using descriptive statistics. D) Academics with a special interest or expertise in gender and health, policy makers, and practitioners were invited to a one-day symposium to explore the initial results. The symposium was transcribed with suggestions included in the final report.Results: While there is a considerable body of research on gender and obesity and the policy context for obesity appears particularly open to examining gendered differences in service use, there is a dearth of information on the how men and women utilise primary care services for obesity.
Conclusions: If public health bodies are to meet their obligations under the Equality Act 2006 then they need information on the following: how specific diseases or symptoms and relevant services are understood by men and women; how services are used by men and women.
Paper 2: Men’s relationship with male GPs: An interpretative phenomenological analysis
S.C. Hale, S. Willott & S. Grogan, Staffordshire University
The primary objective of this study was to investigate findings from a previous study looking at the factors that influenced men in making the decision to seek medical help. This had suggested that some men found it difficult to seek help from male GPs. The current study sought to examine how widespread this difficulty was and whether this was influenced by men’s socioeconomic status.
A total of 64 street interviews were carried out divided between four different locations each populated by a different socioeconomic group. Interviews were audio taped, transcribed and subjected to interpretational phenomenological analysis.
Two major themes emerged. The first theme, ‘men don’t do healthcare’, related to men’s adherence to masculine stereotypes and rejections of healthcare behaviours even in the face of serious health threats. The second theme relates to men’s distrust of the healthcare system and their difficulty in relating to male GPs. Men from higher socioeconomic groups preferred a businesslike relationship with their GP whereas those from lower socioeconomic groups preferred a warmer relationship.Conclusion: These findings suggest that men’s problems relating to male GPs may be due to the different needs that different socioeconomic groups bring to the consultation and may also be confounded by what the GPs, who are generally healthy men of a high socioeconomic group, feel their patients want. A greater awareness of men’s differing needs within the consultation could improve the relationship between male patients and male GPs.
Paper 3: ‘Bruises heal but moobs last forever’: A discourse analytic and phenomenological exploration of cosmetic surgery for removing male breasts
P. Singleton, H. Fawkner & A. White, Leeds Metropolitan University
The primary objective of this paper is to examine the role of masculinity in cosmetic surgery to remove male breasts (‘moobs’), which occur in a condition termed gynecomastia. This is part of a larger three-year project aiming to examine British men’s experience of cosmetic surgery, and to examine the gender discourses in their accounts with particular reference to hegemonic masculinity theory.
The study examined the detailed accounts of men who have undergone surgery for gynecomastia, accounts given on a public facing support website for this condition (http://gynecomastia.org/). A planned photo-elicitation study could not recruit any participants. Fortunately, men are very happy to discuss such experiences in detail – with the protection of the anonymity of online interaction.
The study examined the online accounts of 25 men who had undergone surgery for gynecomastia, including their accounts of seeking help and advice in the initial stages of the process of seeking surgery. Interpretative phenomenological analysis (IPA) was used to describe their experiences. Foucauldian Discourse Analysis (FDA) was then used to examine the gender discourses in those accounts.
The accounts show that it is usually incredibly difficult for men to get surgery on the NHS for this condition and demonstrate often severe physical, emotional and psychological effects of gynecomastia.
The experiences of men who choose to undergo cosmetic surgery to remove male breasts have hitherto been little described in the psychological literature. The emotional and psychological effects of ‘gynecomastia’ need to be considered in light of the relatively recent medicalisation of male breasts as a pathological disorder.
Paper 4: Men, sport, spinal cord injury, and storytelling bodies
B. Smith, University of Exeter
Set against the turn to narrative, and in response to the call by Richardson (2000) for a methodology of creative analytic practices (CAP) within qualitative research, this paper presents a story of men’s experiences of becoming disabled through playing the masculine sport of Rugby Union football. It is based on life history and informal interviews, as well as participant observation, with a small group of men who were propelled across the border from the world of the able-bodied into the world of disability. The story is an attempt to move from a story analyst to a story teller in order to show and think with (dis)embodied struggles and joys, experiences of boredom, and the body performing masculinities. Methodological issues abound in the telling and showing are raised and conceptual matters regarding (dis)embodied masculinities discussed.
Paper 5: An Investigation into health service use amongst male frequent attenders
K. Witty, A. White, A.M. Bagnall & J. South, Leeds Metropolitan University
The appropriateness of the delivery of healthcare is a contentious issue in UK health policy with some arguing that, for example, so few men visit their GP because practices rarely open outside of working hours. The objective of this paper is to examine the preferred sources of health support in a sample of men who frequently attend their GP surgery.
The study used quantitative and qualitative data taken from a large scale evaluation of the impact of a multidisciplinary self care training package for primary health care professionals, a project funded by the Working in Partnership Programme (WiPP)
The evaluation recruited 963 female and 491 male frequent attenders (between eight and 11 visits in the previous 12 months) across control and intervention conditions. Pregnant women, people under 16 years of age, those attending because of severe mental illness or with a terminal illness and patients in a residential home were not eligible for inclusion. Quantitative data were collected using questionnaires mailed to participants at baseline, six months and 12 months. Data was inputted into SPSS where descriptive summaries were generated. A sample of 46 female and 34 male participants were interviewed at baseline with the intention of being surveyed at six and 12 month follow up. Interviews were summarised using critical listening and analysed in the qualitative data analysis tool Nvivo.
Early results derived from the quantitative analysis showed significantly higher current and intended future use of hospital services in male frequent attenders compared to female frequent attenders. Male frequent attenders were also significantly more likely to report intentions to visit their GP in the future than their female counterparts. This trend was not reflected in interviews. No men disclosed a preference for hospital attendance, and one male explicitly indicated strategies to avoid hospital attendance: ‘I’ve spent enough time in hospital to avoid it if I can.’Conclusions: Preliminary findings suggest that male frequent attenders at the GP surgery report differing patterns of healthcare support usage compared to their female counterparts. The disparity may be indicative of male frequent attenders’ preference for specific health care settings, but may also reflect male patients’ failure to engage with health care services for serious conditions until a time when hospitalisation is required.