Control, struggle, and emergent masculinities: a qualitative study of men’s care-seeking determinants for chronic cough and tuberculosis symptoms in Blantyre, Malawi

BMC Public Health

Liz Corbett⁴  Nicola Desmond²  Geoffrey A Chipungu¹  Moses Kumwenda⁵  Graham Hart³  Jeremiah Chikovore⁵ 

[1] Helse Nord TB Initiative, College of Medicine, Private Bag 360, Chichiri, Blantyre, Malawi;Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK;School of Life & Medical Sciences, University College London, Maple House 1A, First Floor, 149 Tottenham Court Road, London W1T 7JA, UK;London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;Malawi Liverpool Wellcome Research Programme, P.O Box 30096, Chichiri, Blantyre 3, Malawi

关键词: Emergent masculinities;    Qualitative;    Control;    Gender;    Healthcare-seeking;    Tuberculosis;    Masculinity;    Africa;    Malawi;   

Others  :  1126281
DOI  :  10.1186/1471-2458-14-1053

 received in 2014-05-29, accepted in 2014-09-09,  发布年份 2014

【 摘 要 】

Background

Men’s healthcare-seeking delay results in higher mortality while on HIV or tuberculosis (TB) treatment, and implies contribution to ongoing community-level TB transmission before initiating treatment. We investigated masculinity’s role in healthcare-seeking delay for men with TB-suggestive symptoms, with a view to developing potential interventions for men.

Methods

Data were collected during March 2011- March 2012 in three high-density suburbs in urban Blantyre. Ten focus group discussions were carried out of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers. Individual interviews were done with 20 TB patients (female =14) and 20 un-investigated chronic coughers (female = eight), and a three-day workshop was held with 27 health stakeholder representatives.

Results

An expectation to provide for and lead their families, and to control various aspects of their lives while facing limited employment opportunities and small incomes leaves men feeling inadequate, devoid of control, and anxious about being marginalised as men. Men were fearful about being looked at as less than men, and about their wives engaging in extramarital sex without ability to detect or monitor them. Control was a key defining feature of adequate manhood, and efforts to achieve it also led men into side-lining their health. Articulate and consistent concepts of men’s bodily strength or appropriate illness responses were absent from the accounts.

Conclusions

Facilitating men to seek care early is an urgent public health imperative, given the contexts of high HIV/AIDS prevalence but increasingly available treatment, and the role of care-seeking delay in TB transmission. Men’s struggles trying to achieve ideal images seem to influence their engagement with their health. Ambiguous views regarding some key masculinity representations and the embrace of less harmful masculinities raise questions about some common assumptions that guide work with men. Apparent ‘emergent masculinities’ might be a useful platform from which to support the transformation of harmful masculinity. Finally, the complex manifestations of masculinity indicate the need for interventions targeting men in health and TB control to assume supportive, multidimensional and long-term outlooks.

【 授权许可】

   
2014 Chikovore et al.; licensee BioMed Central Ltd.

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