Date Published: February 15, 2019
Publisher: SAGE Publications
Author(s): Natalie T. Eley, Emily Namey, Kevin McKenna, Annette Carrington Johnson, Greg Guest.
Morbidity and mortality rates are alarmingly high among African American men and are influenced by the health-seeking behaviors of this population. This study examined data from 40 focus groups with African American men in Durham, North Carolina, to better understand social and cultural influences on health-seeking behaviors. Data were analyzed using inductive thematic analysis. Three broad types of social/cultural influence on motivation to seek health care services were identified: family, culture and upbringing, and peers. Study findings confirm the importance of social relationships in influencing African American men’s health-seeking behaviors and offer characterization of the nature of influence across different types of relationships, according to the direct support or indirect messages they provide. Future programs can draw on these data to inform efforts to include family and peers as well as utilize existing cultural gender norms to the advantage of health promotion for African American men.
This study recruited a total of 310 African American men from Durham, North Carolina, to participate in the 40 study focus groups. The focus groups included 6 to 8 individuals and averaged 7.75 individuals each. The sample ranged substantially in age, with a mean of 47 years (Table 1). The majority of men had completed high school (205; 67%), were unemployed (234; 78%), and had an annual household income of less than $20,000 (235; 78%). Although most of the men had seen a physician within the past year (217; 70%), many of them did not currently have health insurance (151; 61%).
Findings from this analysis confirm that social relationships are important influences on the health and health care–seeking behaviors of African American men and go further to delineate the nature of the influences across relationship types, both in direct provision of information and support and in the indirect messages they send. With family, female partners (i.e., spouses, girlfriends) provide encouragement and instruction for men (e.g., telling them to go) to seek medical care. The presence of a partner intensified men’s sense of responsibility to take care of themselves so as to be around for their partners. A similar motivation was derived from children; men reported taking care of their health in order to provide for and watch the development of their children (and grandchildren). Parents and other relatives positively influenced men’s beliefs and behavior through their own health problems, which inspired in participants the desire to maintain their health in order to avoid similar medical issues. Family—along with peers and culture—also provided negative influences on men’s health-seeking behavior, in the form of socialization around gender norms. Cultural gender norms often included emphasis on toughness in boys and men, which manifested for some into a perception of invincibility and/or an avoidance of medical care to avoid the appearance of weakness. Of note, African American men have the twofold burden of contending with male gender norms of machismo and stoicism and cultural norms of bias against using health care, both of which influence their health-seeking behaviors. Additionally, entangled with culture and gender norms was the crosscurrent of financial strain and limited ability to afford health care, the intersectionality (Griffith, 2012) of structural factors, which are not directly discussed here, but, which can be seen in several of the participants’ quotes within this article.