Academic journal article International Journal of Men's Health

Identifying Work as a Barrier to Men's Access to Chronic Illness (Arthritis) Self-Management Programs

Academic journal article International Journal of Men's Health

Identifying Work as a Barrier to Men's Access to Chronic Illness (Arthritis) Self-Management Programs

Article excerpt

Why are men under-represented as users of arthritis self-management programs? What are the main barriers to service access? This paper explores the interaction between work, gender, and self-management of a chronic illness from a socio-constructive perspective. A qualitative study was conducted involving in-depth interviews with 17 men with arthritis. This paper discusses the role of work as one of the factors affecting men's access to arthritis self- management services. Work was found to be a significant conceptual, structural, and social barrier due to: its role in relation to men's concepts of health and fitness; practical difficulties in accessing services during business hours; and sociocultural influences resulting in prioritising of work commitments over health concerns. The structural, conceptual, and sociocultural work influences were more of a constraint for men in the middle stages of life when work and family obligations were greatest. Further research extending this understanding would inform the development of gender-sensitive delivery of self-management services.

Keywords: masculinity, work, gender, arthritis, qualitative research, self- management services

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There are well established gender differences in the utilization of primary health care services and in health management behaviours. For instance, women are more likely to use general health services than men (Australian Bureau of Statistics, 1996; Baum, 1998; Courtenay, 2000a), men and women access health services in different ways and for different reasons (Broom, 1991; Hegelson, 1995), and women can influence the health management behaviour of men more so than vice versa (Norcross, Ramirez, & Palinkas, 1996). These gender differences in the extent and patterns of primary health services use also occur in relation to chronic illness self-management services. For example, male participation rates in the Arthritis Victoria Telephone Information Service were reported as 23% (Gibbs & Reidpath, 2005). The rates were remarkably similar for the Cancer Helpline (22%) (Metcalfe, Akkermann, & Cohen, 1997), the Asthma Telephone Information Service (23%) (G. Irving, personal communication, 2002), the Epilepsy Foundation Telephone Information Service (26%) (E. Adamson, personal communication, 2002), the Arthritis Self-Help Courses (17%- 21%) (Goeppinger & Lorig, 1997; Lorig, Lubeck, Kraines, Seleznick, & Holman, 1985) and slightly higher for the Living with Cancer course (33%) (K. Todd, personal communication, 2001).

Self-management programs in the context of this study included all programs which complement medical services by assisting people to manage their condition on a day-to-day basis. Programs providing disease or symptom specific information, education, exercise or peer support, all represent a service designed to assist people to self-manage. Examples of such programs include arthritis water exercise classes, telephone information services, self-help groups and self-management courses. Chronic illness self-management courses usually involve a weekly 2 hour workshop over a period of approximately 6 weeks. They incorporate all of the elements of self-management, as well as meeting the criteria for true self-management education which includes:

   (a) content presentation focused on patients' perceived needs, (b)
   practice and feedback in new skills, including decision making and
   problem solving, (c) attention to emotional and role management in
   addition to medical management, (d) use of techniques to increase
   patients' confidence in their ability to manage their conditions,
   and (e) emphasis on the patients' active role in the
   physician/patient relationship. (Lorig, 1996, p. 680)

Chronic illness self-management programs may be offered as a disease-specific course, for example, the Arthritis Self-Help Course (Lorig & Fries, 1995). Alternatively, courses such as the Stanford Model (Lorig et al. …

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