'We are doing our best': African and African-Caribbean fatherhood, health and preventive primary care services, in England

Recent policy pronouncements emphasise the importance of engaging fathers with preventive primary care services. However, in England, there is a paucity of literature which examines African and African-Caribbean fathers' experiences of service provision. This paper reports a study that investigated African and African-Caribbean fathers' beliefs about fatherhood, health and preventive primary care services, with the aim of addressing the deficit in the literature. Nine focus groups involving 46 African and African-Caribbean fathers, recruited using purposive sampling, were undertaken between October 2008-January 2009. Fatherhood was seen as a core aspect of the participants' identities. The fathers enacted these identities in a number of ways, such as caring for and protecting children, which were influenced by spirituality, relationships with women, paid work and racism. The fathers had concerns about their bodies, medical conditions, physical activity and forms of consumption. However, their primary focus was on maintaining and improving the well-being of their children. This resulted in them neglecting their own health needs as they had to meet the obligations of family life and paid work. The fathers reported limited contact with preventive primary care services and were unaware of their purpose, function and availability. They identified ethnicity as a positive asset, and felt their families and communities had particular strengths. However they acknowledged that structural constraints, including racism, influenced their perceptions of and access to local health services. The engagement of African and African-Caribbean fathers needs to be addressed more specifically in policy as part of a broader programme of action to tackle health inequalities. In addition, child health services could build on fathers' commitment to children's well-being through practice that addresses fathers' as well as mothers' needs in families.     

Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making: a qualitative study from rural Vietnam

Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.     

Male callers to NHS Direct: the assertive carer, the new dad and the reluctant patient

It has been suggested in the light of mortality and morbidity rates, and men's reluctance to seek medical help and advice, that there is a crisis in men's health. Little is known about men's experiences of using health care services, despite an emergent UK men's health movement. NHS Direct, the new telephone advice line, was designed to be more accessible, convenient and responsive to the public's needs for health care. In-depth interviews with male callers to the service, aged between 29 and 59, reveal that they sought help in their roles as fathers, partners and on their own behalf. Having used it once, they anticipated doing so again. Their learning about health matters, from both the formal structure and the informal agenda of the telephone consultation, suggests the potential of men's use of this service for 'normalizing' help seeking by men, and thereby for longer-term improvements in men's health.     

'That's just the cesspool where they dump all the trash': exploring working class men's perceptions and experiences of social capital and health

This article explores issues relating to the concept of social capital which has been become an important explanation for inequalities in health. It is based on an analysis of in-depth interviews with working class men living in two contrasting socio-economic areas--one relatively disadvantaged and one advantaged. It highlights the role of different community contexts in the nature and extent of local social capital. In particular, it demonstrates how de-industrialization and economic change as well as material deprivation and a perceived dis-investment in local communities impacted on the men's levels of social capital. Analysis also shows the ways in which gender mediates the processes through which social capital is developed and accessed as a personal and social resource, and how the norms and values associated with working class masculinities appeared to preclude the men from building supportive health-enhancing relationships with others in their community. The prominence of social capital has focused attention on the subjective dimensions of community life as potential determinants of health. This article has, therefore, sought to contribute to this field by widening our understanding about the relationship between social capital, gender and health.     

Gender and Disadvantage in Health: Men's Health for a Change

Women, typically, have been the focus for discussions of health inequalities in relation to gender. Now research on prostate illhealth turns attention to the neglected area of men's health and to men's disadvantage in health. Drawing on evidence of men's experiences and perspectives of their health, the complexities of the workings of gender in relation to health are explored, using current theorising around masculinities, hegemonic masculinity, negotiated gender and the disaggregation of gender from sex. Touching also on a range of other related issues including methodological ones, the discussion offers ideas towards better understanding of gender in relation to health disadvantage. In the context of the continuing concern about health inequalities, there is scope not only for documenting 'hidden' health disadvantage among men, but also for reviewing how health disadvantage by gender is framed and analysed; both are useful to inform health policy and practice.     

'You can't ask for a Dubonnet and lemonade!': working class masculinity and men's health practices

In recent years, much research concerning men's health has focused on men's health-related practices. While this body of research has often sought to contextualise men's health practice it has done so primarily in terms of gender not social class. The need remains therefore to link theories of masculinity and health to broader theories regarding social class and health which highlight the social and economic context of people's lives, in order to develop more complex understandings regarding the interactions between social class, gender and men's health practices. The aim of this article is to explore these interactions via a qualitative examination of the ways in which two groups of working class men living in two contrasting socio-economic areas construct masculinity and how this intertwines with their class position to impact on their health practices. This study highlights how men's conceptualisations of masculinity coupled with their class position informed their understanding of male roles and the expectations that flow from this. It shows how certain risky practices are firmly rooted in the material reality of men's lives, not simply in their gender, and how aspects of masculinity and class position intimately entwine to structure men's health seeking behaviour.     

Fathers' beliefs about parenting and fathers' clubs to promote child health in rural Haiti

Health care providers are challenged to use culturally appropriate, low-technology approaches to improve child health in resource-poor countries. Village fathers' clubs is one approach used in rural Haiti since 1994. Fathers meet regularly for health education and community-building activities. Our aim was to investigate parenting practices and beliefs among Haitian fathers of young children and to explore their views on fathers' clubs. We conducted semistructured interviews with 18 fathers. Themes identified were fathers' involvement in routine care of their children, the close partnerships of fathers and mothers in child care, fathers' responsibilities to their communities, and fathers' clubs as an important supportive institution for the Haitian fathers and their families. Rural Haitian fathers reported taking a very active role in the lives of their families and children. Increased involvement of fathers should be explored as a strategy to improve child health and survival in other parts of Haiti and throughout the world.     

Men, masculine identities and childbirth

In recent years, fathers' experiences during childbirth have attracted much research and policy interest. However, little of this work has been grounded in the first-hand accounts of men and there is a lack of theory-based research to help understand men's thoughts and practices around childbirth. This paper is based on qualitative research undertaken with first-time fathers and healthcare professionals. It draws on Connell's (1995) conceptualisation of hegemonic masculinity to explore how men construct masculine identities within the context of pregnancy and childbirth and also how healthcare professionals construct masculinity. The paper demonstrates the ways in which men can find themselves marginalised within the context of pregnancy and childbirth, but are still able to draw on identifiable markers of masculine practice which enable them to enact a masculine form congruent with dominant masculinity. It also illustrates how healthcare professionals' constructions of masculinity enable them to predict how men will behave and allow them to position men in ways that involve minimum disruption to their own practice. The paper also highlights how men's marginal status is embedded in the dynamics of the social structure, which produce and reproduce dominant masculine identities within the context of childbirth.     

Experiences of fathering a baby admitted to neonatal intensive care: a critical gender analysis

More fathers than ever before attend at the birth of their child and, internationally, there is a palpable pressure on maternity and neonatal services to include and engage with fathers. It is, thus, more important than ever to understand how fathers experience reproductive and neonatal health services and to understand how fathers can be successfully accommodated in these environments alongside their partners. In this paper we advance a theoretical framework for re-thinking fatherhood and health services approaches to fatherhood based on Critical Studies on Men (CSM). We illustrate the importance of this feminist informed theoretical approach to understanding the gendered experiences of fathers in a Neonatal Intensive Care Unit (NICU) setting in Northern Ireland. Using a longitudinal follow-up research design, with two data collection points, a total of 39 in-depth semi-structured interviews was conducted with 21 fathers of infants admitted to the NICU between August 2008 and December 2009. The findings demonstrate: (i) how men are forging new gendered identities around the birth of their baby but, over time, acknowledge women as the primary caregivers; (ii) how social class is a key determinant of men's ability to enact hegemonic forms of 'involved fatherhood' in the NICU, and; (iii) how men also encounter resistance from their partners and health professionals in challenging a gender order which associates women with the competent care of infants. An understanding of these gendered experiences operating at both individual and structural levels is critical to leading change for the inclusion of fathers as equal parents in healthcare settings.     

Barriers to healthy eating amongst men: a qualitative analysis

Currently, little is known about the meanings men attach to food or to the links between food and health. The burgeoning literature on men's health highlights forms of masculinity (e.g. risk-taking, invulnerability) as a factor (negatively) influencing men's health practices. The aim of this study was to provide an analysis of men's accounts of food and health using concepts pertaining to masculinity. We report on a qualitative analysis of a dataset comprising 24 interviews with UK men from a range of age and social class groups. Our findings suggest two principal barriers to healthy eating in men: cynicism about government health messages and a rejection of healthy food on grounds of poor taste and inability to satisfy. These findings are discussed in relation to masculine ideals such as rationality, autonomy and strength. The implications of our analysis for future research and men's health promotion policy are discussed.     

Time to father

This paper reports the qualitative findings from 40 couples involved in a study exploring men's post-natal mental health. Interviews were conducted with individuals soon after the birth of their first child. Findings suggest that new fathers want to be more involved in the direct care and nurturing of their children than their fathers were with them. Discourses which construct fathers and inform social structures have not kept pace with men's changed attitudes and role expectations limiting the options available to men as fathers. In particular men's employment circumstances figure in their experience of adjusting to life as a father. Those fathers having least flexibility and autonomy in their work report experiencing, since the birth of their child, more unhappiness, anxiety, and generally higher levels of stress. These findings suggest increasing workplace flexibility and provisions such as parental leave are important for men's post-natal mental health.     

Heading into fatherhood--nervously: support for fathering from online dads

Men are becoming increasingly aware of and keen about the promises of involved fathering, and there is growing recognition of the need to support fathers, especially in the postnatal period. However, there is limited evidence of how best to offer this support. In this article, we investigate a new avenue of support that is gaining popularity in the public health sector: the Internet. Using qualitative methods, we examine messages in an asynchronous online chat room for new fathers to reveal how fathers themselves requested, offered, and received social support. Features of their communication style included humor and self-disclosure. An emergent, overarching purpose of their communications was to make fathering more "visible," and to encourage each other to engage confidently and wholeheartedly in fathering.     

Fathers' experience of parenting a child with juvenile rheumatoid arthritis

The author examined the experience of fathers who have a child with juvenile rheumatoid arthritis (JRA). He used grounded theory methodology, in which 22 fathers participated in semistructured interviews, and developed a substantive theory of fathers' experience that addresses the impact of their child's JRA, their adaptational responses, and the meanings they associated with their experiences. Fathers were profoundly affected, perceived their child's condition as a catalyst for meaningful involvement, experienced many emotions, and sought to adopt a positive approach to making sense of their child's condition. Fathers' efforts to be strong for others resulted in an overreliance on self-support strategies, particularly during periods of high stress. Given the nature of fathers' experience and the extent of their involvement, greater attention by health care practitioners to fathers' adaptation is indicated.     

Smoking behaviour change among fathers of new infants

Protecting infants from exposure to parental tobacco smoke is key to positive health outcomes in childhood and later life. While mothers' smoking has been well researched, fathers' smoking has received little attention. This paper reports data from a cross-sectional survey of 286 smoking fathers in the English Midlands, interviewed when their infants were 8-14 weeks old. It examines whether fathers attempt and successfully achieve two smoking behaviours positively associated with infant health: quitting and not smoking in the home. The birth of a new baby was not associated with attempting or successfully quitting smoking for the majority of fathers. Less than 20% had tried to quit and only 4% had successfully quit smoking since the birth of their baby. Half of the participants reported that they had not changed their cigarette consumption since their baby's birth. Not smoking in the home appeared to be a more achievable behaviour for many fathers; 78.0% had attempted and 60% had successfully achieved not smoking in home. Independent predictors of attempting to quit were fathers' own cigarette consumption and level of knowledge about infant exposure to tobacco smoke. Attempting to abstain from smoking in the home and being successful in the attempt were both independently associated with partner's smoking status, number of financially dependent children and father's social class. Findings suggest that promoting reductions in cigarette consumption and improving knowledge levels among fathers about passive smoking in infants may encourage more quit attempts. Not smoking in the home is a more achievable behaviour and is linked to fathers' caring and economic circumstances and their partner's smoking status. Influences on fathers' smoking behaviour appear to be multi-factorial. Understanding father's smoking and developing health promotion strategies to protect infants from passive smoking is likely to depend on research which can bridge the caring and economic spheres of their lives.     

Gender roles and/or styles in crisis: an integrative analysis of the experiences of fathers of children with cancer

Despite a proliferation of research with families of children with cancer and gender differences in parental coping, few studies have explicitly explored the experiences of fathers of children with cancer. Using several different data collection efforts, including semistructured in-depth interviews and open workshops, this integrative analysis views fathers' experiences through the lens of gender. Findings suggest that fathers' experiences can be understood as influenced by gender identities, gender roles, and the gendered organization of support systems, employment, and health care institutions. The results suggest the need for interventions that provide fathers and entire families with the opportunity to develop new skills and coping strategies for dealing with the stresses and challenges of childhood cancer.     

A qualitative exploration of first-time fathers' experiences of becoming a father

This study aimed to explore first-time fathers' experiences of becoming a father, focusing on their expectations, experiences, and how they are coping with this transition. An interpretative phenomenological analysis (IPA) epistemology and methodology were adopted as the study was focused on understanding the meaning and experiences of this transition for fathers. Nine participants were recruited from seven NCT antenatal classes. The mean age of participants was 38 years (range=30 to 46 years). Participants completed a semi-structured interview between four and eleven weeks post birth. One overarching superordinate theme was derived: 'searching for a place'. This theme consisted of three sub-themes--'the separation connection struggle', 'a sense of utility, agency and control' and 'changing focus of affection'. The findings expand on our understanding of new fathers' experiences, and suggest that first-time fathers experienced an array of psychological responses during each stage of their transition as they searched for their place as father in relation to their partner, child and work. Professionals working in antenatal and postnatal services should discuss with men the possible emotional and psychological changes they may go through to enable more realistic expectations to be considered.     

Young men in 'crisis': attending to the language of teenage boys' distress

The last two decades have seen a changing profile of young male mental health in Britain, including increased suicidal and parasuicidal behaviours. For mental health professionals to respond effectively and appropriately to meet these changing needs there needs to be further theorising and development of knowledge of young men's psychological processes and, in particular, how they make sense of their experiences within the cultural context of their lives. By drawing upon contemporary theories of subjectivities, this paper attempts to begin to address some of these issues. It looks in detail at two young men's accounts of their experiences of mental health problems. By using narrative, thematic and discourse analyses, the authors consider the cultural concepts the young men draw upon, and the language they use to voice their distress. The paper focuses on how gender and traditional masculinities constrain and influence the young men's narratives within the context of their individual life-histories and how these may become problematic for their mental health. The analyses provide a contemporary language-sensitive and culturally-sensitive reading of the young men's accounts of mental distress. It highlights how young men may talk about their distress in ways that are not immediately recognisable and extends the knowledge of the contemporary discourses used by young men in British society today. The implications for male subjectivities and mental health and therapeutic engagement are discussed.     

Men's health promotion: a new frontier in Australia and the UK?

The field of men's health has grown markedly over the past few decades. Increased activity specifically relating to men's health promotion in both Australia and the UK has been noted during this period. There has, however, been a reticence to critically examine men's health promotion work within a broader discourse relating to gender and gender relations. Indeed, the vast majority of health-related gender discussion to date has been focused on women's health experiences and their health practices. In this paper, we argue that grounding men's health within this broad gender discourse is important for building an evidence base in, and advancing, men's health promotion work at a range of levels. We specifically explore the research, practice and policy contexts relating to men's health in Australia and the UK, and describe the facilitators for, and barriers to, promoting men's health. We conclude by suggesting that a critical gender lens ought to be applied to current men's health promotion work and provide strategies for researchers, practitioners and policy makers to move towards this new frontier.     

Constructions of masculinity and their influence on men's well-being: a theory of gender and health

Men in the United States suffer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these differences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these differences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signifiers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context influence the kind of masculinity that men construct and contribute to differential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.