Paper: Men, masculine identities, and health care utilisation
Reference: Noone, J. H., & Stephens, C. (2008). Men, masculine identities, and health care utilisation. Sociology of health & illness, 30(5), 711-725.
https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-9566.2008.01095.x
Original Articles
Masculinity and health care use Jack H. Noone and Christine Stephens Men, masculine identities, and health care utilisation
Jack H. Noone and Christine Stephens Department of Psychology, Massey University, New Zealand
Abstract
Seeking medical help early is critical for recovery, yet evidence indicates that men do not utilise general practitioner services as often as women. This paper draws on Connell’s (1995) theory of hegemonic masculinity to critically examine how men’s under-utilisation of medical services may be influenced by the social construction of masculine identities. Interviews with seven older rural men about their help-seeking behaviour, used a movie extract and hypothetical scenarios to stimulate discussion. Transcribed data were analysed using discourse analysis, which showed that in this particular social context, the men faced a dilemma when identifying with two conflicting subject positions: the virtuous regular health care user, and the masculine infrequent user of health care services. They solved this dilemma by positioning women as frequent and trivial users of health care and themselves as legitimate users of health care. By using biomedical and morality discourses in this way the men could maintain a masculine identity whilst also identifying as virtuous users of health care services. These results support the utility of hegemonic masculinity as a theoretical basis for examining the construction and maintenance of gendered identities by highlighting the complexity of multiple masculine identities. Keywords: masculine identities, health care utilisation, discourse analysis, hegemonic masculinity, position
Aims
In summary, it has been argued that the assumption that ‘men’ and ‘women’ are two homogenous and mutually exclusive groups does not help to explain the complexities of health care utilisation (Addis and Mahalik 2003). Social constructionist theories of gender may explain variations in men and women’s help-seeking behaviours and Connell’s (1995) ‘hegemonic masculinity’ provides a relativist approach to studying gender. Thus, we aimed to examine the utility of hegemonic masculinity for understanding the ways men construct masculine identities within the context of health. To achieve this aim we conducted a study to identify and describe the discursive resources used by a group of late-mid-aged men to construct health and health care utilisation, and to examine how socially constructed masculine identities may impact on medical help-seeking. This understanding is important as older men are particularly at risk for illnesses such as prostate cancer and heart disease. We also aimed to examine the seldom-studied masculine identities available to rural men. Much of the masculinity research to date has focused on urban males, and as a result a great deal of theorising on help-seeking behaviour is based on masculinities constructed in urban contexts.
Conclusion
These findings demonstrate that hegemonic masculinity is alive and well. Our older rural men did not focus on any practical difficulties about their access to a doctor. Rather, they drew on widely available discursive resources that have been noted in other studies, to construct masculine identities. In doing so they encountered the same incongruence between virtue and masculinity as the younger urban men in Robertson’s (2003) study of health care utilisation. Robertson suggested that the men in his study had to legitimise their health behaviours in order to maintain their masculine identity, and we suggest that this negotiation takes place in the shadow of the ideals of hegemonic masculinity as described by Connell (1995). We further suggest that because gendered identities are constructed in opposition, our respondents were compelled to identify as ‘not feminine’. Hall (1996) points out that identities, including gender identities, are constructed through difference or the relation to the ‘other’. Our respondents demonstrated the discursive work involved in constructing and maintaining a masculine identity in opposition to feminine behaviours. Although many men rejected the masculine position of one who seldom uses health care, a non-immoral position in the interview context, they still orientated their accounts away from frequent consultations which they had constructed as feminine health behaviours. Thus, the ideals of hegemonic masculinity may be seen as ‘slippery’ (Donaldson 1993) in regard to shifting, context-dependent norms of masculinity, but as consistently demanding that a man is positioned as non-feminine
The talk of our respondents did support Wetherell and Edley’s (1999) contention that there are multiple strategies for doing hegemonic masculinity and that these strategies are context dependent (Jefferson 2002). O’Brien et al. (2005) found that, although many of their participants endorsed a masculine reluctance to seek medical attention, within the highly ‘masculinised’ context of fire fighting, men highlighted the importance of help-seeking to preserve more important aspects of masculinity. Similarly, in the current study, a number of respondents additionally positioned themselves as knowledgeable and legitimate health care users who understood the importance of seeking medical advice, while positioning other men, who do not seek help, as ignorant and weak. These findings illustrate the flexibility of doing masculinity in talk; masculine subject positions for regular health care
These findings will assist health care providers to be reflexive about the discursive resources that they make available to men who use their services. Previous research (SeymourSmith, Wetherell and Phoenix 2002) has shown how health care practitioners may construct male patients as stubborn and unwilling to seek help whilst constructing female patients as the over-users of health care services. The reinforcement of these positions in a medical setting serves only to further discourage men from seeking help. Following on from this, these findings do not support the provision of health promotion programmes that position men as ignorant about the functioning of bodies, about medical services, and about health care. Instead they support the continuing development of serious health care education for men (such as men’s health nights focusing on prevention and early detection information) which provides resources for men to be knowledgeable about health issues and active in making health care choices
In summary, we argue that hegemonic masculinity is a useful concept for exploring the imperatives and power relations inherent in construction of masculine identities. It is however only useful for understanding men’s reluctance to seek medical help if we take into account the social context. Suggestions that men delay seeking help simply because they do not want to appear effeminate fail to understand the resources available that enable men to negotiate health care as masculine behaviour, and the ways in which the context of interactions may enable or restrain the availability of certain subject positions.
https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-9566.2008.01095.x
Original Articles
Masculinity and health care use Jack H. Noone and Christine Stephens Men, masculine identities, and health care utilisation
Jack H. Noone and Christine Stephens Department of Psychology, Massey University, New Zealand
Abstract
Seeking medical help early is critical for recovery, yet evidence indicates that men do not utilise general practitioner services as often as women. This paper draws on Connell’s (1995) theory of hegemonic masculinity to critically examine how men’s under-utilisation of medical services may be influenced by the social construction of masculine identities. Interviews with seven older rural men about their help-seeking behaviour, used a movie extract and hypothetical scenarios to stimulate discussion. Transcribed data were analysed using discourse analysis, which showed that in this particular social context, the men faced a dilemma when identifying with two conflicting subject positions: the virtuous regular health care user, and the masculine infrequent user of health care services. They solved this dilemma by positioning women as frequent and trivial users of health care and themselves as legitimate users of health care. By using biomedical and morality discourses in this way the men could maintain a masculine identity whilst also identifying as virtuous users of health care services. These results support the utility of hegemonic masculinity as a theoretical basis for examining the construction and maintenance of gendered identities by highlighting the complexity of multiple masculine identities. Keywords: masculine identities, health care utilisation, discourse analysis, hegemonic masculinity, position
Aims
In summary, it has been argued that the assumption that ‘men’ and ‘women’ are two homogenous and mutually exclusive groups does not help to explain the complexities of health care utilisation (Addis and Mahalik 2003). Social constructionist theories of gender may explain variations in men and women’s help-seeking behaviours and Connell’s (1995) ‘hegemonic masculinity’ provides a relativist approach to studying gender. Thus, we aimed to examine the utility of hegemonic masculinity for understanding the ways men construct masculine identities within the context of health. To achieve this aim we conducted a study to identify and describe the discursive resources used by a group of late-mid-aged men to construct health and health care utilisation, and to examine how socially constructed masculine identities may impact on medical help-seeking. This understanding is important as older men are particularly at risk for illnesses such as prostate cancer and heart disease. We also aimed to examine the seldom-studied masculine identities available to rural men. Much of the masculinity research to date has focused on urban males, and as a result a great deal of theorising on help-seeking behaviour is based on masculinities constructed in urban contexts.
Conclusion
These findings demonstrate that hegemonic masculinity is alive and well. Our older rural men did not focus on any practical difficulties about their access to a doctor. Rather, they drew on widely available discursive resources that have been noted in other studies, to construct masculine identities. In doing so they encountered the same incongruence between virtue and masculinity as the younger urban men in Robertson’s (2003) study of health care utilisation. Robertson suggested that the men in his study had to legitimise their health behaviours in order to maintain their masculine identity, and we suggest that this negotiation takes place in the shadow of the ideals of hegemonic masculinity as described by Connell (1995). We further suggest that because gendered identities are constructed in opposition, our respondents were compelled to identify as ‘not feminine’. Hall (1996) points out that identities, including gender identities, are constructed through difference or the relation to the ‘other’. Our respondents demonstrated the discursive work involved in constructing and maintaining a masculine identity in opposition to feminine behaviours. Although many men rejected the masculine position of one who seldom uses health care, a non-immoral position in the interview context, they still orientated their accounts away from frequent consultations which they had constructed as feminine health behaviours. Thus, the ideals of hegemonic masculinity may be seen as ‘slippery’ (Donaldson 1993) in regard to shifting, context-dependent norms of masculinity, but as consistently demanding that a man is positioned as non-feminine
The talk of our respondents did support Wetherell and Edley’s (1999) contention that there are multiple strategies for doing hegemonic masculinity and that these strategies are context dependent (Jefferson 2002). O’Brien et al. (2005) found that, although many of their participants endorsed a masculine reluctance to seek medical attention, within the highly ‘masculinised’ context of fire fighting, men highlighted the importance of help-seeking to preserve more important aspects of masculinity. Similarly, in the current study, a number of respondents additionally positioned themselves as knowledgeable and legitimate health care users who understood the importance of seeking medical advice, while positioning other men, who do not seek help, as ignorant and weak. These findings illustrate the flexibility of doing masculinity in talk; masculine subject positions for regular health care
These findings will assist health care providers to be reflexive about the discursive resources that they make available to men who use their services. Previous research (SeymourSmith, Wetherell and Phoenix 2002) has shown how health care practitioners may construct male patients as stubborn and unwilling to seek help whilst constructing female patients as the over-users of health care services. The reinforcement of these positions in a medical setting serves only to further discourage men from seeking help. Following on from this, these findings do not support the provision of health promotion programmes that position men as ignorant about the functioning of bodies, about medical services, and about health care. Instead they support the continuing development of serious health care education for men (such as men’s health nights focusing on prevention and early detection information) which provides resources for men to be knowledgeable about health issues and active in making health care choices
In summary, we argue that hegemonic masculinity is a useful concept for exploring the imperatives and power relations inherent in construction of masculine identities. It is however only useful for understanding men’s reluctance to seek medical help if we take into account the social context. Suggestions that men delay seeking help simply because they do not want to appear effeminate fail to understand the resources available that enable men to negotiate health care as masculine behaviour, and the ways in which the context of interactions may enable or restrain the availability of certain subject positions.
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