'For a mere cough, men must just chew Conjex, gain strength, and continue working': the provider construction and tuberculosis care-seeking implications in Blantyre, Malawi.
'For a mere cough, men must just chew Conjex, gain strength, and continue working': the provider construction and tuberculosis care-seeking implications in Blantyre, Malawi.
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DOI：
10.3402/gha.v8.26292
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发表时间：
2015
影响因子：
2.6
通讯作者：
Corbett L
中科院分区：
文献类型：
--
作者：
Chikovore J;Hart G;Kumwenda M;Chipungu GA;Corbett L
男性在接受艾滋病毒或结核病 (TB) 治疗期间延迟寻求医疗保健会导致更高的死亡率，并导致在接受治疗之前社区一级疾病的持续传播。了解男性气质在男性寻求医疗保健的延迟中所扮演的角色，重点关注结核病提示症状。数据收集于 2011 年 3 月至 2012 年 3 月期间在布兰太尔市区的低收入郊区，通过与社区成员 (n=8) 和卫生工作者 (n=2) 进行焦点小组讨论、对 20 名结核病患者（女性 = 14）和 20 名未经调查的慢性咳嗽者（女性 = 8）进行深入访谈，以及与 27 名健康利益相关者代表一起参加为期 3 天的参与式研讨会。研究过程在很大程度上借鉴了 Strauss 和 Corbin (1998) 以及 Charmaz (1995) 的扎根理论原则。研究中对男性和女性的角色描述普遍将男性视为其直系家庭的主要物质提供者，即那些赚取收入、维持生计和额外物质需求的人。在集体主义受到重视的背景下，男性也被期望带头为更广泛的亲属提供支持。成功的角色扮演被认为是获得认可的一个合格男人的关键；与此同时，工作机会稀缺和不安全以及收入低严重阻碍了男性的发展。创造持续收入的压力意味着不断寻找工作，或不断工作以保留不稳定的工作或通过自营职业筹集资金。所有这些导致男性放弃了对健康的考虑。尽早参与正规医疗保健对于应对结核病和艾滋病毒至关重要。然而，本研究中为男性描绘的角色构建，以及承认疾病的机会成本，在脆弱的情况下似乎是寻求护理的重要障碍。有必要解决隐藏的就医费用，并考虑采取更复杂的干预措施，包括减少不稳定，以努力改善男性对健康的参与。
Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB) treatment and contributes to ongoing community-level disease transmission before going on treatment. To understand masculinity's role in delay in healthcare seeking for men, with a focus on TB-suggestive symptoms. Data were collected between March 2011 and March 2012 in low-income suburbs in urban Blantyre using focus group discussions with community members (n=8) and health workers (n=2), in-depth interviews with 20 TB patients (female=14) and 20 uninvestigated chronic coughers (female=8), and a 3-day participatory workshop with 27 health stakeholder representatives. The research process drew to a large extent on grounded theory principles in the manner of Strauss and Corbin (1998) and also Charmaz (1995). Role descriptions by both men and women in the study universally assigned men as primary material providers for their immediate family, that is, the ones earning and bringing livelihood and additional material needs. In a context where collectivism was valued, men were also expected to lead the provision of support to wider kin. Successful role enactment was considered key to achieving recognition as an adequate man; at the same time, job scarcity and insecurity, and low earnings gravely impeded men. Pressures to generate continuing income then meant constantly looking for jobs, or working continuously to retain insecure jobs or to raise money through self-employment. All this led men to relegate their health considerations. Early engagement with formal healthcare is critical to dealing with TB and HIV. However, role constructions as portrayed for men in this study, along with the opportunity costs of acknowledging illness seem, in conditions of vulnerability, important barriers to care-seeking. There is a need to address hidden care-seeking costs and to consider more complex interventions, including reducing precarity, in efforts to improve men's engagement with their health.