An article has been published in the BMC Public Health Journal exploring whether current self-management support interventions are acceptable and accessible to men with long term conditions, and what may act as barriers, or pull-factors, to men’s to participation in support activities.
Men, as a group, are frequently under represented at many self-management support services and are believed to be poorer self-managers than women despite having an increased incidence of many long term conditions such as chronic pulmonary disease, diabetes and cardiovascular diseases.
Recognition of this trend and the increased incidence of serious long term conditions in men have led to widespread calls and action for interventions to be specifically targeted at men. In response the authors of this study conducted a systematic review and meta-synthesis of the qualitative research literature to examine the experiences of, and perceptions towards, self-management support among men with long term conditions.
The most common type of self-management support identified and included in the study were face-to-face support groups (12 studies), followed by ‘lifestyle’ interventions (11 studies) and internet information and/or online support (5 studies).
The study found that in order to access and continue to engage with self-management support, the support activity needs to have a clear purpose and address an unmet need. Support that is structured, involves some element of physical activity, offers opportunities to garner new information on self-management, or that is ‘action-orientated’, can provide a clear purpose that is appealing to men. The authors also highlight that men may distance themselves from self-management support activities that are perceived as ‘feminine’, such as ‘touchy-feely discussions’.
The article also found though that emotional support is a valued component of self-management support activity, although men may feel less comfortable than women with reporting this as a motivation for using the support service. Men can be more comfortable when emotional support arises as a ‘by-product’ of other shared activities as opposed to it being an explicit component of a self-management support intervention.
Feeling comfortable to participate was shown to be critical for accessibility and acceptability of self-management support, especially where participation has the potential to make men feel vulnerable or lacking in confidence. The clearest example of this is when interventions or group-based activities involve the discussion of ‘taboo’ topics – such as mental health, sexual function, and/or emotional expression.
The study identified that interaction with peers is widely valued by men across a range of self-management support activities. Peers are generally seen as those who are “roughly in the same boat”. Differences in some social characteristics (such as age, ethnicity, class/economic background) are often transcended by a shared experience of a particular health issue and by gender. For many men with long-term conditions, the peers they encounter through self-management support activities provide a welcome opportunity to experience a sense of belonging and normality.
A strong peer-group identity was also found to encourage health behaviour change. Learning from peers by sharing self-management tips and strategies or reading accounts of ‘survivor stories’ may be more acceptable than learning from health professionals because relationships are more equal and there is less of a feeling of being “preached at”.
The studies showed that many men place a high value on receiving health information and education in order to develop their capacity to manage and ‘become an expert’ in their condition. Opportunities to build confidence and expertise in communicating with care providers can be an attractive component of self-management support.
However, where the information provided is overly complex or technical information this can act as a barrier to learning, provoke anxiety, and overwhelm. Complex content, style, or language can reduce the accessibility of information. Information that is presented in ‘everyday language’, can be integrated with daily life, and that is tailored to demographic characteristics that men can relate to is particularly appealing for some.
In conclusion the authors find that self-management support is most likely to be successful in engaging men when it is congruent with key aspects of their masculine identity. In order to overcome barriers to access and fully engage with interventions, some men may need self-management support interventions to be delivered in an environment that offers a sense of shared understanding, connectedness, and normality, and involves and/or is facilitated by men with a shared illness experience.
The accessibility and acceptability of self-management support interventions for men with long term conditions: a systematic review and meta-synthesis of qualitative studies
Paul Galdas, Zoe Darwin, Lisa Kidd, Christian Blickem, Kerri McPherson, Kate Hunt, Peter Bower, Simon Gilbody and Gerry Richardson
BMC Public Health 2014, 14:1230 doi:10.1186/1471-2458-14-1230