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The purpose of this study was to better understand the barriers to health promotion among African American older men living in the rural Mississippi Delta. Data included one key informant interview and two focus group interviews with 14 men, with the majority between the ages of 41 and 55 years. The life expectancy at birth, at African American men also ificantly underutilize health care services National Center for Health Statistics, ; Sandman et al.
The Delta region of Mississippi is most affected by these limitations. The Mississippi Delta is traditionally recognized to include 18 counties in the northwestern part of the state, along or near the Mississippi River. Department of Agriculture, Economic Research Service, as well as the lowest health rankings University of Wisconsin Population Health Institute, in the state. These counties also are home to the highest percentage of African Americans, ranging in most counties from Community members in these counties suffer from low educational attainment, high unemployment Delta Regional Authority,and a pervasive history of racism and segregation Harvey, The rural nature of the Mississippi Delta further creates additional barriers to access to many health services Delta Regional Authority, As a result, grassroots efforts have been developed to empower community members for health promotion, as a means to improve the health of Mississippi Delta citizens.
Health promotion and prevention efforts specific to cancer have been one priority, given that this disease is the second largest contributor to the deaths of African Americans, second to heart disease Kochanek et al. The purpose of this CHA network is to focus on cancer awareness, education, research, advocacy, and on increasing utilization of empirically based, life-saving early detection screenings. The CHA network comprises volunteer men in the community who provide educational materials and speak individually and in groups to community members about health care.
A key emphasis of this network is the role of African American men to provide education, solidarity, and support to one another to promote health care utilization. The male-specific nature of the CHA contributes to the extant literature on masculinity and health seeking.
However, the intersection between masculinity and health-related attitudes and behaviors are unknown for African American men given that much of what is known is compared with White American experiences and constructions of masculinity cf.
Thus, little is known about the experiences of older African American men although benefits have been reported to emerge from having trusted fellow community members provide health information with each other e. Additionally, the current study draws from the conceptual framework of Metzl to direct attention to the importance of attending to the structural health and politics of older African American masculinity. Thus, an inherent assumption of this study was recognizing the existence of cultural, economic, and political influences of health for African American men.
The research team for this study was composed of individuals from the disciplines of nutrition and psychology at a university located in the southeast region of the United States. For nine months, the research team met for 90 minutes weekly and deed, collected, analyzed, and wrote the findings of this study as part of a pilot study for a future grant-funded project.
The racial composition of the group included individuals who identified as White non-Hispanic, Asian American, and African American. The research de for this study was a qualitative, intrinsic, case study. This de was selected for a of reasons. To begin, qualitative research has been identified to contribute to research by providing marginalized groups with an opportunity to have their voices heard Creswell, Even more specifically, Lyons et al.
In deciding on a specific qualitative approach, case study de was chosen for its emphasis on understanding a central phenomenon within a particular context.
“we need help in the delta”
Finally, case study des are unique for their characteristics of being bound by space and time Creswell, and the current study was conducted over a 3-month time period and bound to Public Health District 3 in the Mississippi Delta. This individual invited participants who represented formal and informal community outreach organizations.
Additionally, given her important role in the community, she was interviewed as a key informant, providing the researchers with contextual, background information about the history of the CHA network.
With regard to the focus group recruitment procedure, recruitment letters were sent to members of one of the county chapters of the CHA network, and to organizations in the community which provided outreach services such as churches, fraternities, and public health organizations, asking them to participate in a minute focus group session. Participants had to fit the following two criteria which were to reside in the two Delta counties in which there were active Men in Black and Blue Fighting Prostate Cancer groups, and self-identify as African American.
It was preferable but not required for participants to be within 35 to 60 years of age and for them to have had some formal or informal experience with community outreach, leadership, or programming. A total of 14 men were recruited with 8 men attending the first focus group session, and 6 attending the second session.
The individual interview and the two focus groups were conducted by the first and second authors, both of whom identified as ethnic minorities i. The moderator of African American descent grew up in the Mississippi Delta and visited family there frequently. Her family resided in a different county from where the study was conducted.
The moderator of Asian American descent was not originally from Mississippi but was a resident of the state at the time of the study.
The individual interview was scheduled at a time and place convenient for the key informant. Focus group participants were scheduled to attend one of two focus group meetings and greeted with a sandwich buffet and drink station prior to beginning the interviews. Informed consent was obtained using an oral presentation and written consent. Cultural mistrust was anticipated throughout the research process. Data analysis for a case study consists of capturing a rich, descriptive understanding of the context and content of the case, followed by identifying the most salient themes that emerged throughout the interview process.
The thematic analysis procedures of Braun and Clarke were followed so that the process consisted of gaining familiarity with the data by reviewing the transcripts repeatedly, generating codes, and continuing to reread the transcripts.
Throughout the process, memos were also written in the margins of the documents to maintain a record of any ideas, phrases, or concepts that emerged when reviewing the materials Creswell, As codes emerged from the data, they were then grouped into themes, which were the broader overarching umbrellas to capture the smaller codes. These larger themes were then defined, named, and reviewed.
Whenever possible, the direct wording of the participants was used, via in vivo coding in order to stay as close as possible to the participant wording King, In following this process, members of the research team first independently read and coded each of the transcripts to identify codes and themes.
Next, they met to discuss areas of similarities and differences in the codes and themes that emerged. Last, members decided on a final list of themes and rereviewed the transcripts as a group to ensure that the themes best captured the data.
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The strategies used were prolonged engagement in the field, triangulation, researcher reflexivity, and using quotes of evidence. Members of the research team had spent extensive time working with communities in the Delta region, including the gatekeeper interviewed for this study, to learn the culture and build trust. In this way, rapport could be more easily established so that study participants were willing to disclose information.
With regard to triangulation, researchers used different methods and sources of information i. Thus, findings were based on multiple, overlapping data. In terms of researcher reflexivity, the first author maintained a detailed record of her experiences, prior knowledge, and subjectivity throughout the research process through journal entries as well as field notes.
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The most salient theme across all of the interviews was the message that men do not talk about health because there are no opportunities to do so. This is the most I think, any of us in this room. Just from this group today. The notion of sharing to help one another was a motivating factor for individuals to talk about themselves: to disclose their own health in an effort to assist others.
Having health problems therefore ified personal flaws in ways that led to feelings of shame. We were brought up in an era where a man was considered a gladiator. You know he had to get out there and go get it. Ignoring or denying physical ailments was considered a of strength and even described as a type of indestructibility. In turn, seeking health services was considered to be a form of weakness and one rendered acceptable only at critical junctures.
We were brought up to think that a man is a person that is invincible. Unless you sick, cold, flu, or something.
Furthermore, to highlight the ways in which masculinity encompassed hiding their experiences, the men contrasted their lack of disclosure with their perception of women openly discussing their health issues with one another. Now on the other hand, you know, Black women [ sic ] is different. You can hear them on the phone talking about stuff all day. They referred to the psychological pressures they put on themselves to be seen as invulnerable and unsusceptible to weakness. They further described physical sickness as a physical toll and psychological consequence from feeling defeated:.
One participant jokingly admitted that men would not even tell each other if they were overweight, whereas women might look out for each other to address issues related to body image. The contrast between masculinity and femininity was salient and also reflected in diet and nutrition. One participant sarcastically joked about the futility of using diet to address health when there were larger concerns for safety and the stress of staying alive in the Mississippi Delta:.
Similarly, another participant talked about challenges beyond individual-level factors, such as problems confronting the community from the rates of incarceration to the rates of unemployment, to parenting problems, and, subsequently, teachers being overwhelmed by their responsibilities to socialize the children.