A Theoretical Approach to Understanding Black Men's Health-Seeking Behavior
Plowden, Keith O., Journal of Theory Construction and Testing
Abstract: Black men are suffering disproportionately from most illnesses. Action is needed to decrease the current health disparity. An important step in decreasing this disparity is to understand social factors that act as motivators and barriers to seeking care. This article examines how social factors influence health-seeking behaviors of Black men using two theoretical frameworks: Leininger's Culture Care Diversity and Universality Theory and the Health Belief Models. By understanding the impact of social factors on health seeking behaviors, nurses can develop appropriate behavioral interventions for Black men.
Key Words: Black Men, Fatalism, Health behavior, Culture, Health Beliefs, Social factors
"If the misery of our poor be caused not by the laws of nature, but by our institutions, great are our sins. "-Darwin
Black men are disproportionately affected by most chronic illnesses. According to the United States Census (2000), Black men make up approximately 6% of the general population. Black men, however, make up a significantly higher percentage of the groups suffering from chronic diseases, such as acquired immune deficiency syndrome (AIDS), coronary heart disease (CHD), cancer, and diabetes (Department of Health and Human Services [DHHS], 1998). Black men die at an earlier age than other demographic groups. From 1996 to 1998, age-adjusted Years of Potential Life Lost (YPLL) for Blacks was 13,338 compared to 6,708 years for Whites (U.S. Census Bureau, 2001). The YPLL is a measure of lost productive years of life due to premature death before age 75 (Gordis, 2000). Blacks are less likely to have adequate health insurance in order to seek care (U.S. Census, 2001). More work in primary and secondary prevention that specifically targets Black men, is needed to decrease current disparities. Development of appropriate interventions is dependent upon understanding critical social factors that influence health-seeking behaviors. This article explores health-seeking behaviors of Black men using Leininger's Culture Care Diversity and Universality Theory and the Health Belief Model.
Health and well being are functions of biological and social factors (Airhihenbuwa, 1995; Morris, 1998; Cohen, Scribner, & Parley, 2000). Genetics and social structure are not mutually exclusive; instead, they work together to create health and illness. The National Cancer Institute reports only 30% of cancers are caused by genetics. Approximately 85% of chronic illnesses are related to behavior (Roderick, 1992). It can be assumed, therefore, that social factors contribute significantly to health. The World Health Organization (WHO) (Facion, 1999) has defined health outcome based on accessing health care services, being able to afford those services, having needed services available, and receiving culturally appropriate services. Four factors influence health outcomes (Facion, 1999). These factors are accessibility, affordability, availability, and adaptability. When these factors are missing or neglected, health is affected. Access, affordability, availability, and adaptability of health services are influenced by social structure and must be addressed to decrease health disparity.
Leininger's Culture Care Diversity and Universality Theory
Many things motivate health-seeking behaviors among Black men. Education, economics, religion, philosophy, family/kinship, and politics interact to influence now an individual behaves (Leininger, 1991a). These dimensions influence the perceived ability of Black men to seek care, which impacts health behavior. Leininger's theory of Culture Care Diversity and Universality (Leininger, 1988, 1991a, 1991b, 1995, 1998) can be used to explain, interpret, and predict culture care knowledge and lifeways. Motivators of health seeking behavior in urban Black men are influenced by societal factors. These motivators are known to Black men and those who interact with them, such as significant others. …