Joseph Daniels1, Andrew Medina-Marino2, Katherine Glockner3, Emily Grew4, Nondumiso Ngcelwane5, Aaron Kipp6. 1. Department of Psychiatry and Human Behaviors, Charles R. Drew University of Medicine and Science, Los Angeles, USA. Electronic address: josephdaniels@cdrewu.edu. 2. Foundation for Professional Development, East London, South Africa; Division of Men's Health, Desmond Tutu HIV Centre, University of Cape Town, South Africa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. Electronic address: Andrew.Marino@hiv-research.org.za. 3. Foundation for Professional Development, East London, South Africa. 4. Northeastern University, Boston, USA. 5. Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, South Africa. 6. Department of Public Health, East Carolina University, USA.
Abstract
RATIONALE: Globally, the prevalence of tuberculosis (TB) disease is significantly higher among men compared to women. This is compounded by men's poorer uptake of TB testing and treatment, and worse outcomes for smear conversion and successful treatment completion compared to women; in South Africa specifically, TB accounts for a large portion of sex-specific life expectancy differences. OBJECTIVE: To understand men's unique barriers to accessing care and their needs while engaged in TB treatment, we conducted a qualitative study with men currently in or who recently completed TB treatment to understand how social norms for masculinity influence resource access and health behaviors, and in turn affect their engagement in care. METHODS: We interviewed 31 men using a semi-structured protocol, with domains including: social network composition and support; TB illness; and testing, treatment, and clinical care experiences. Interviews were analyzed using a constant comparison approach to identify resources and how these are exchanged within men's social networks for TB care. RESULTS: We found that men's prioritizing of work ensured food security and maintenance of masculinity norms, but delayed seeking and engagement in care. Once in treatment, men found it difficult both to negotiate clinic hours and work schedules and to navigate clinic environments without being labeled as weak. To mitigate individual resource gaps and losses, men typically accessed women family members who provided key resources (e.g., food, money, and emotional encouragement). Masculine identification with fatherhood was a key motivator to remain engaged in TB care and treatment. Loss from care was facilitated by isolation and limited access to social network resources. CONCLUSION: To improve men's engagement in care and successful treatment outcomes, interventions that leverage their social networks and build upon existing resources should be strongly considered.
RATIONALE: Globally, the prevalence of tuberculosis (TB) disease is significantly higher among men compared to women. This is compounded by men's poorer uptake of TB testing and treatment, and worse outcomes for smear conversion and successful treatment completion compared to women; in South Africa specifically, TB accounts for a large portion of sex-specific life expectancy differences. OBJECTIVE: To understand men's unique barriers to accessing care and their needs while engaged in TB treatment, we conducted a qualitative study with men currently in or who recently completed TB treatment to understand how social norms for masculinity influence resource access and health behaviors, and in turn affect their engagement in care. METHODS: We interviewed 31 men using a semi-structured protocol, with domains including: social network composition and support; TB illness; and testing, treatment, and clinical care experiences. Interviews were analyzed using a constant comparison approach to identify resources and how these are exchanged within men's social networks for TB care. RESULTS: We found that men's prioritizing of work ensured food security and maintenance of masculinity norms, but delayed seeking and engagement in care. Once in treatment, men found it difficult both to negotiate clinic hours and work schedules and to navigate clinic environments without being labeled as weak. To mitigate individual resource gaps and losses, men typically accessed women family members who provided key resources (e.g., food, money, and emotional encouragement). Masculine identification with fatherhood was a key motivator to remain engaged in TB care and treatment. Loss from care was facilitated by isolation and limited access to social network resources. CONCLUSION: To improve men's engagement in care and successful treatment outcomes, interventions that leverage their social networks and build upon existing resources should be strongly considered.
Authors: Juliet Addo; Dave Pearce; Marilyn Metcalf; Courtney Lundquist; Gillian Thomas; David Barros-Aguirre; Gavin C K W Koh; Mike Strange Journal: BMC Public Health Date: 2022-09-10 Impact factor: 4.135
Authors: Andrew Medina-Marino; Dana Bezuidenhout; Nondumiso Ngcelwane; Morna Cornell; Milton Wainberg; Chris Beyrer; Linda-Gail Bekker; Joseph Daniels Journal: Am J Mens Health Date: 2022 Sep-Oct