Applications of masculinity theories in a chronic illness context.

The objective of this qualitative study was to explore men's experience of arthritis and to identify influences on men's decision to access arthritis self-management programs. One of the overriding themes that emerged was the influence of hegemonic masculinity on men's perceptions of services and themselves following the onset and progression of chronic arthritis. Men's sense of their own masculinity appeared to shift in response to the impact of arthritis and to reposition itself in relation to hegemonic masculinity. This study showed that men's experience of severe arthritis reflected the influence of hegemonic masculinity in a manner consistent with Connell's theory of multiple masculinities and a gender-relational approach to health. It also demonstrated that the reliance, reformulation, and rejection of masculinity evident in men with disabilities as described by Gerschick and Miller was equally applicable to the experiences of men with severe arthritis.

Keywords: masculinity, gender, chronic illness, arthritis, qualitative study

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There are various sociocultural influences on men's health behaviour, and the role of masculine identity in particular has been identified as a significant influence (Broom, 1998; Connell, 1999). This is not represented by a single model of masculinity but rather by a range of possible masculinities that shift over time and place and operate in a hierarchy (Connell, 1999). The dominant social construction of masculinity in the hierarchy, hegemonic masculinity, is the most honoured or desired, not the most common. Conversely, there tends to be a marginalisation of subordinate masculinities. Hegemonic masculinity, like other masculinity constructs, may vary for different social groupings and shift over time and place (Connell, 1999). However, it is generally expected that men not show pain, be self-sufficient, and not appear weak (Baum & Cooke, 1986; Nathanson, 1975; Verbrugge, 1985). Hegemonic masculinity cannot be ignored; however, men will position themselves differently in relation to it, depending on the form of masculinity they have adopted (Connell, 1999). In this sense, gender is a dynamic social structure residing in gendered social transactions rather than in the individual (Courtenay, 2000). Relational theories on gender and health highlight the complexity of human interactions with other individuals, with organisations, and with social structures, each of which impacts on health opportunities and constraints (Sabo, 2005; Schofield, Connell, Walker, Wood, & Butland, 2000). The dynamic nature of gender practices, gender relations, and sociocultural practices is likely to result in changes in gendered experiences of health over time (Sabo, 2005; Schofield et al., 2000).

Gerschick and Miller (1995), in their classic paper on men and disabilities, refer to the marginalisation and stigmatisation of men with physical disabilities in their development of the "Three 'R' Framework," a description of a combination of strategies employed by men to come to terms with masculinity and physical disability. These strategies are characterised by reformulation, which entails men's redefinition of hegemonic characteristics of masculinity on their own terms; reliance, reflected by sensitive or hypersensitive adoptions of particular attributes of hegemonic masculinity; and rejection, characterized by the renunciation of hegemonic standards and either the creation of one's own principles and practices or the denial of hegemonic masculinity's importance in one's life. The terms reformulation, reliance, and rejection were developed by Gerschick and Miller to describe men's primary response to physical disability while acknowledging that these strategies can often be enacted in complex combinations. This theory has not been explored in relation to chronic illness.

Chronic illness can involve pain, fatigue, and reduced strength and flexibility, thus undermining the image of strength and independence that is associated with hegemonic masculinity and the factors that have previously sustained a man's place in the gender order. Some chronic conditions such as arthritis can affect the individual's ability to perform daily living tasks independently such as dressing, washing, or gardening, placing them in a role that involves dependence on others. These changed situations of dependence can undermine the man's role within the family and as a result impact significantly upon family relationships (Commonwealth Department of Human Services and Health, 1996; Martin, 1995). The unpredictability and uncertainty of chronic illness can also undermine the traditional male role of "being in charge"(Cameron & Bernardes, 1998). Therefore, following the development of a chronic condition, men can find they are being perceived differently by others and have been relegated to a position of marginalised masculinity (Charmaz, 1995; Connell, 1987; Gerschick & Miller, 1995; Messner & Sabo, 1990; Morris, 1993; Sabo & Gordon, 1992). This may explain men's apparent reluctance to acknowledge chronic illness and access health services (Gibbs & Reidpath, 2005).

The particular type of chronic illness being profiled in this paper is arthritis. The word "arthritis" simply means inflammation of the joint. However, the term is generally used to refer to more than 150 different musculoskeletal conditions. "Musculoskeletal conditions are the most common cause of severe long-term pain and physical disability affecting 25% of Australians" (Arthritis Foundation of Victoria Inc., 2000, p. 24). It may develop gradually or have a sudden onset. The symptoms may be intermittent or ongoing and may be variable or progressive in nature. The severe and unpredictable nature of the symptoms can undermine the person's capacity to engage in work, relationships, recreation, and planning for the future (de Ridder et al., 1997).

Men with a chronic illness may be experiencing a crisis, not only in terms of their health status, but also their sense of their own masculinity and their place in the gender order and in gender relations (Cameron & Bernardes, 1998; Schofield et al., 2000; Watson, 2000). This paper explores men's experience of arthritis and factors influencing their utilisation of self-management services.

METHODOLOGY

This was a qualitative study conducted using a grounded theory (Glaser & Strauss, 1967; Strauss & Corbin, 1990) and a participatory research approach (Petras & Porpora, 1993). Semi-structured interviews were held with 17 men and four female partners. Maximum variation sampling was conducted initially to allow identification of common patterns emerging from the variation between the male participants (Patton, 1990, 2002). Further theoretical sampling was conducted throughout the research process to explore emerging themes relating to age and sexuality. Recruitment was restricted to men with arthritis and related conditions, and some partners. Time since diagnosis ranged from four months to 25 years. Three main sources of variation were sought in the initial purposive sampling.

EXTENT OF PARTICIPATION IN SELF-MANAGEMENT PROGRAMS

Self-management programs support the efforts of the individual with arthritis to manage their condition on a day-to-day basis in partnership with health professionals who take responsibility for the medical management of the condition. Participation levels ranged from zero involvement to involvement in four different self-management programs.

SOCIAL DEMOGRAPHICS 

Variation in a range of social demographic factors was represented in the sample. Twelve of the men identified as Anglo/Celtic. One of" the men identified as Anglo/Celtic but also as a member of the Aboriginal community. The remainder identified as UK/European, Greek, Chilean, Italian, and Filipino/Asian. Two of the partners identified themselves as Anglo/Celtic, one as Polynesian/New Zealander, and the other as Italian.

Identification of sexuality was not included in the initial demographic questionnaire. However, as the research proceeded in line with a grounded-theory approach, it emerged as an important element because of its potential influence on the interaction between gender and health. Of the 17 men, one identified as homosexual and one as bisexual. The rest of the men interviewed referred to female partners, and so it was assumed that these men identified as heterosexual, although it is acknowledged that due to the complexity of human sexuality, a heterosexual relationship does not necessarily equate to heterosexual identity (Smith, Rissel, Richters, Grulich, & Visser, 2003).

The majority of the interviewees were either retired (35%) for medical or age-related reasons or were working lull time (41%). The health status of the men was self-rated as poor (3), fair (8), or good (6).

SELF-LABELLED MASCULINITY

The questionnaires also gave participants an opportunity to indicate whether they would use any of the masculinity terms commonly used in the media (e.g., sensitive new age guy, macho, sports mad, yuppie) to describe themselves (Lambevski, 2000). Some of the men selected "other" and defined their own masculinity rather than using the stereotyped labels provided. Table 3 indicates that a range of masculinities were represented in this study, although it became apparent over the interview period that the self-labelling question was problematic when used cross-culturally because of men's unfamiliarity with terms that are strongly linked with the Anglo-Australian culture. Labels also appeared to have different meanings for different age groups.

The sampling across social groupings and masculinity stereotypes shows that opinions were sought across a wide variety of men. This contributes to the transferability of the results (Strauss & Corbin, 1990).

The interviews were semi-structured to allow them to be flexible and free flowing. They were guided by an interview protocol of possible questions. The interview questions were designed to explore men's experience of arthritis, their awareness of existing arthritis self-management services, their level of use of self-management services to date, and factors influencing their use of services. These questions continued to evolve throughout the research process in response to the theories emerging in the concurrent data analysis.

In addition, three examples of advertising slogans for arthritis self-management services were presented to the interview participants to gain some insight into the power of language as either a motivator or barrier to access. The same message was delivered in three different ways:

* Slogan 1

Arthritis--We can help you to manage. Call Arthritis Victoria now on 9530 0255.

* Slogan 2

Arthritis--Real Men Take Charge. Get your toolkit here! Arthritis Victoria 9530 0255.

* Slogan 3

Arthritis--Something Can Be Done. For more details contact Arthritis Victoria on 9530 0255.

The different versions were designed to demonstrate reliance on (slogan 2) or rejection (slogan 1) of hegemonic masculinity or a gender-neutral message (slogan 3) to allow reformulation of hegemonic masculinity (Gerschick & Miller, 1995).

All but one of the interviews were tape-recorded with the permission of the interviewee and then fully transcribed. The remaining interview was conducted via e-mail at the participant's request because of time constraints. The transcripts were entered into N-Vivo 1.1 qualitative software. This was used as a tool to assist with the in-depth coding and analysis of data in a manner consistent with a grounded theory approach. Pseudonyms were assigned by the researcher to each participant to protect the anonymity of the responses. The results were circulated to participants and stakeholders at two stages in the concurrent data collection and analysis as part of the participatory research approach to establish the confirmability of the results (Lincoln & Guba, 1985).

RESULTS

It was found that there were a number of structural, conceptual, and sociocultural issues influencing men's access to arthritis self management services. However, the dominant theme in the study was the influence of dominant social constructions of masculinity operating in opposition to positive health behaviours (Courtenay, 2000). In fact, hegemonic masculinity impacted almost all aspects of men's discussion about the experience of arthritis and their decision making in relation to service access including, but not limited to, response to advertising language, perceptions of services, and perceptions of self.

RESPONSE TO ADVERTISING LANGUAGE

It was anticipated that using "male-friendly" language, i.e., language that was consistent with hegemonic masculinity, to promote self-management services would make services more accessible to men. This did not appear to be the case. Instead, the men were more likely to be responsive to the gender-neutral language (slogan 3) and were generally ambivalent about the language that was in opposition to hegemonic masculinity (slogan 1). The strongest reaction, a negative reaction, was demonstrated by almost all of the men in response to slogan 2, which used language that was consistent with hegernonic masculinity. The men described it as offensive and/or something that did not relate to them.

   I'm not too sure about that. I don't like the inference that you've
   got real men and men who are not real. (John, part-time or casual
   work, aged over 75)

   It seems like they're trying to attract a certain, particular type
   of person who likes to think they're in a certain category or
   they're stronger than some people for whatever particular reason.
   I'm just more interested in information. (Phillip, student and
   casual work, age group 18-25)

These responses show a rejection of hegemonic masculinity (Gerschick & Miller, 1995) and a recognition and respect for the multiple masculinities available to men in our society (Connell, 1998).

Significantly, even men who demonstrated reliance on dominant masculinity traits (Gerschick & Miller, 1995) did not respond to the advertisement, rejecting it as "advertising" and "hype." Bruce found it amusing but seemed to think it was trying to trick him into seeking help:

   That's more or less saying, "Come here, chicken," ... and so it
   hits you on the ego side. What do you mean a real man? I'm a real
   man. A real man takes pain. That's a different sort of sense ... it
   wouldn't change my mind. (Bruce, employed full-time, age group
   26-40)

Bruce seemed to recognise that the slogan was encouraging reformulation of hegemonic masculinity norms (Gerschick & Miller, 1995) to encourage service use but was not going to fall for it because he "knew" that "A real man takes pain." This shows the extent to which he relied on hegemonic masculinity. He was not prepared to reconsider his position when it was challenged, even when this slogan promoted service use in terms that complied with hegemonic masculinity traits.

For Kevin, the language used in slogan 2 undermined his efforts to reconcile the impact of his condition with his sense of his own masculinity and his reliance on hegemonic masculinity:

   "Real men" immediately reminds me of the fact that I'm a failure
   in terms of masculinity. (Kevin, casual/part-time work, age group
   41-60)

The impact of Kevin's condition had threatened his own sense of masculinity, so he felt the term "real men" excluded him. This sense of exclusion from a desired masculinity status reinforced his sense of personal failure. Others were not offended by the wording of slogan 2 but preferred slogan 3.

PERCEPTION OF SERVICES

One of the clear barriers to accessing self-management services was the perception among the men that they consisted solely of support groups that involved sharing of experiences. There was little awareness of the exercise, pain management, and educational options available. The idea of sharing emotional experiences in a public context is in direct opposition to characteristics of hegemonic masculinity (Huggins, 1995). Consciousness of this conflict was evident in each of the men's responses. Adam described in detail the concerns about being involved in a men's support group. His first comment was that he would advise against men's programs because of "not wanting to feel that you're any different to anyone else." This showed that he was more comfortable operating within dominant social expectations of men.

   I've got all sorts of thoughts about the men's group that you don't
   want to feel that you're stepping over the boundary.... By stepping
   over the boundary, I guess I'm talking about the issue of
   masculinity, probably a fear of being seen by someone as less than
   masculine for needing to be part of that support group. (Adam,
   retired, age group 41-60)

Adam seemed to be seeing the need for a support group as a sign of weakness. His use of the word "fear" shows how signs of weakness can be critical in undermining a man's position in society's hierarchy of masculinities. He also expressed a belief that men's groups are perceived by others to be linked to homosexuality:

   I do think there is a perception out there that a men's group may
   have an element of homosexuality. I don't believe that, but I have
   heard that perspective pontificated at the bar and the local footy
   clubrooms and in comedy routines. I heard the other day something
   like "the bikies would bash it, the footy club would take it
   away on an end-of-season trip, the homos would form a self-help
   group, and the lesbians would workshop a support network."

Adam related this in a "jokey" manner but presented it as a widely held view of a men's support group. Each of the options and the language used to describe the different groups fit squarely within hegemonic characteristics of masculinity. It is pertinent that Adam had heard these views in the pub and the football clubrooms, sites and sociocultural spaces that also fit within the parameters of hegemonic masculinity. It is also consistent with the findings of Kehily (1997) and Lyman (1987) that show that men use sexist and sexual references in humour to demonstrate their belonging to male bonding groups and to distance themselves from homosexuality.

Adam stated that he did not share this perception of support groups and was quite definite that it would not influence his decision to join a support group. Adam's views were consistent with, if more detailed than, many of the men interviewed. However, for Kevin, the severity of his condition and its impact on lifestyle meant that he sought the opportunity to share his experiences with others who understood. Kevin had practiced avoidance in managing his condition until he got to such a difficult point in his experiences with arthritis that he had to talk to someone about it. At this stage he found support groups helpful, where talking to others had not been. This suggests that the emotional needs that develop as a result of living with severe arthritis may override the constraints on support group involvement imposed by hegemonic masculinity. Others were not interested in accessing services because they were experiencing only moderate effects from their condition.

PERCEPTIONS OF SELF

There was evidence that men who had adhered to hegemonic masculinity were forced to reassess its inherent expectations in order to make sense of what they were experiencing and to reconsider how they would respond to it. This readjustment was articulated by Harry. When asked why he had not sought treatment for his feet at an earlier stage, he said with a smile and then a laugh:

   Why didn't I? Because I'm a real guy--and there's nothing wrong
   with me! (Harry, unemployed, age group 41-60)

Harry was very conscious that his delay in seeking help for his feet had been driven by his need to match the ideals of hegemonic masculinity and deny any physical weakness. However, the loss of work and the pain and emotion he experienced as a result of his condition challenged Harry's view of himself:

   It's funny all that emotional stuff ... it is entirely
   debilitating, even more than the pain. I'm really fortunate, I just
   have a huge support system around me of family and friends, and
   there's a lot of positivity existing in my life, but I recognise
   the debilitation that occurs with all that emotional stuff and
   psychological, loss of self-esteem, you know this whole bloke thing
   that sort of crumbles when you've been told that you've got this
   pain and physical limitations which may not go away for the rest of
   your life.... And when you go out, and you have friends of the same
   age who don't have that pain or they're sort of kicking the footy
   around, it's really hard to control and manage that loss of
   confidence in their company. It's just so, ohhh, you know, with
   pain comes unemployment and that whole financial thing as a
   background.... I've been really in darkness these last few month
   for various reasons, and a lot of it is attributable to the new
   information--"You've got arthritis."

Harry's explanation of the emotional and social adjustments that accompany a diagnosis of arthritis mirrored those expressed by others with severe arthritis but not those with more moderate arthritis. The gender relations that contribute to this experience were clearly evident in Kevin's description of his rejection of the notion of hegemonic masculinity as reinforced by the women in his life:

   I have been profoundly affected by normal social expectations of
   men. We should be self reliant.... It took me years, it took
   decades, well for one decade at least, where I never told anyone I
   was affected by arthritis. I covered it up totally. Friends of mine,
   closest friends, didn't know that I was profoundly affected. I
   would scarcely speak to my doctor about it, but it was when I got
   to the point where I couldn't walk up a flight of stairs, I
   couldn't continue working in the work that I love, I was broke, I
   couldn't go out for dinner with friends, I couldn't go on holidays,
   my life was just closing in on me, that I had to look carefully at
   the social expectations on me. I had to look carefully and think,
   well, what does our society expect of men ... We're expected to
   find the answers ourselves, we're expected not to need support from
   others, we're expected to be a kind of rock of strength for others.
   And I've had women friends and women partners, basically been very
   clear with me that my role is to be supportive to them while somehow
   I'm meant to magically find these resources within myself.
   And I don't have them. They're not there. (Kevin, casual work,
   age group 41-60)

Even those who already had a chronic illness had to go through the same adjustment process when they were diagnosed with arthritis. Peter has HIV and a heart condition and yet was reluctant to access Arthritis Victoria services because it meant identifying as a person with arthritis.

   I think in the back of my mind would be--I had this with HIV,
   too the idea that the clientele of a place called Arthritis Victoria
   would be a different kind of clientele to one that I fit into....
   There is a labelling thing that happens, I think. I do not want to
   accept myself as a person with arthritis, and going along there would
   be taking a step down that road. I want to resist that, I guess.
   (Peter, employed full time, age group 26-40)

As a man who identifies as gay and has two other chronic illnesses, it might be expected that he would have reformulated or rejected these expectations at some previous stage in his life. Instead it appears that these issues had to be renegotiated with each successive illness scenario. Peter may have been avoiding further marginalisation on top of what he had already experienced as a result of his homosexuality and his existing chronic illnesses (Vernon, 1998).

Whereas some of the men demonstrated a rejection of hegemonic masculinity in their need to access self-management services, Peter had managed to reformulate his masculinity constructs to work in a positive way to achieve health management goals and regain a sense of control over his HIV status.

   ... with HIV, for example, I've taken on a role as a health consumer
   in that, and it took a while to work out how it was going to
   work for me, but in a way it's been through intellectualising the
   problem and then becoming more competent at managing it than
   my doctor is, and that's worked for me, and I'm sure I could get
   around arthritis in the same way. (Peter, employed full-time, age
   group 26-40)

Peter's way of dealing with a chronic condition by "intellectualising the problem" and treating it as a "technical problem to be resolved" is an example of how the hegemonic notion that health services and health behaviours have feminine associations (Courtenay, 2000) can be overcome by positioning the behaviour within a hegemonic context (Cameron & Bernardes, 1998). Significantly, for Peter this reformulation of masculinity constructs to allow a self-management approach to be adopted appeared to be a process that had to be activated for each new situation as it arose, or more particularly for each new chronic health condition.

Men who had moderate arthritis did not refer to any adjustments in terms of their gender role or status.

DISCUSSION

The use of "male friendly" language is a technique being used more commonly by health services as a means of increasing the accessibility of health promotion services to men. However, the findings of this study indicate that this technique may not be appropriate and may in fact be alienating for men with a severe chronic condition if they are already feeling distanced from the hegemonic pattern (Schofield et al., 2000).

It was found that men conformed to hegemonic notions of strength by avoiding self-management programs, which may involve sharing of feelings. These constraints were reinforced in men's interactions with others (Sabo, 2005; Schofield et al., 2000), particularly in sociocultural settings aligned with hegemonic masculinity. Exceptions to this pattern of behaviour occurred when the severe pain and restrictions of arthritis made it impossible to sustain and the demands of the condition overrode those of hegemonic masculinity. This resulted in a rejection or reformulation of hegemonic masculinity to accommodate the need to access self-management services.

The greater the impact of arthritis on the men's lives in terms of pain, fatigue, and ability to maintain employment and to participate socially, the greater the impact on sense of self and masculinity. Moderate arthritis was less likely to affect the factors sustaining men's place in the gender order. Increasing severity of pain and physical limitations affected men's capacity to work, socialise, and maintain their role in relation to partners and friends. Men subsequently experienced gender marginalisation and either rejected or reformulated their understanding of hegemonic masculinity in order to make sense of their own circumstances.

CONCLUSION

The constraints imposed by hegemonic masculinity were clearly evident in men's discussion about their experience of arthritis, their responses to advertising language, and their perceptions of self and self-management services.

This study contributes to existing theories of multiple masculinities, hierarchical masculinities, and gender relations by demonstrating their application to men experiencing severe chronic arthritis. It was found that the impact of severe chronic illness can undermine a man's sense of his own masculinity in reference to dominant social constructions of masculinity, resulting in an adjustment of men's sense of their own self and their own masculinity, their place in the gender order, and their experience of gender relations. This indicates that self-management programs need to use language and services that are sensitive to the interaction between gender and chronic illness.

The findings of this study also demonstrate that the theory of reliance on, reformulation of, and rejection of masculinity that was outlined in Gerschick and Miller's classic paper on men and disability is equally applicable to men with moderate to severe chronic illness. It was found in this study that the impact of severe arthritis forced men to reassess their reliance on hegemonic masculinity and either reformulate or reject that masculinity in order to make sense of their experience and to rationalise their need to access self-management services.

The fact that there was less evidence of this readjustment or gendered shift for men with moderate arthritis reflects the fact that the milder symptoms did not have the same impact on men's lifestyles and functional ability and subsequently did not undermine their existing place in the gender order.

The dynamic nature of gender constructions and gender relations suggest that there may be scope for health services to adopt and encourage a gendered approach to health that reshapes/reformulates hegemonic ideals to minimise the impact of chronic illness and to support positive health.

REFERENCES

Arthritis Foundation of Victoria, Inc. (2000). Strategic plan 2000-2005. Victoria: Arthritis Foundation of Victoria Inc.

Baum, F., & Cooke, R. (1986). Community health services for men in the southern area of Adelaide: Rationale, development and evaluation (Research). Morphett Vale: Southern Community Health Services Research Unit (Part of S.A. Health Commission).

Broom, D. (1998). Gender and health. In J. Germov (Ed.), Second opinion. An introduction to health sociology (pp. 39-55). Melbourne: Oxford University Press.

Cameron, E., & Bernardes, J. (1998). Gender and disadvantage in health: Men's health for a change. Sociology o/Health and Illness, 20, 673-693.

Charmaz, K. (1995). Identity dilemmas of chronically ill men. In D. Sabo & D. F. Gordon (Eds.), Men's health and illness. Gender, power, and the body (Vol. 8, pp. 266-291). Thousand Oaks: Sage Publications.

Commonwealth Department of Human Services and Health. (1996). Draft national men's health polio': Primary Health Care Group.

Connell, R.W. (1987). Gender and power: Society, the person, and sexual politics. Stanford, CA: Stanford University Press.

Connell, R.W. (1998). Introduction: Studying Australian masculinities. jigs, 3(2), 1-8.

Connell, R.W. (1999). Men's health: A research agenda and background report. Canberra: Commonwealth Department of Health and Aged Care.

Courtenay, W.H. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science and Medicine, 50, 1385-1401.

de Ridder, D., Depla, M., Severens, P., & Malsch, M. (1997). Beliefs on coping with illness: A consumer's perspective. Social Science and Medicine, 44, 553-559.

Gerschick, T.J., & Miller, A.S. (1995). Coming to terms. Masculinity and physical disability. In D. Sabo & D.F. Gordon (Eds.), Men's health and illness. Gender, power, and the body (Vol. 8, pp. 183-204). Thousand Oaks: Sage.

Gibbs, L., & Reidpath, D. (2005). What about the men'? Gender differences in utilisation of chronic illness self management services. Australian Journal of Primary Health, 11(1), 63-71.

Glaser, B.G., & Strauss, A.L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine De Gruyter.

Huggins, A.K. (1995). Men's health is a serious issue not being taken seriously enough: The need for a cultural change in the way we view masculinity and health. Paper presented at the National Men's Health Conference, Melbourne.

Kehily, M.J. (1997). "Lads and laughter": Humour and the production of heterosexual hierarchies. Gender and Education, 9(1), 69-86.

Lambevski, S. (2000). Living as men. Sydney, Australia: National Centre in HIV Social Research, University of New South Wales, and the Australian Research Centre in Sex, Health and Society, La Trobe University.

Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.

Lyman, P. (1987). The fraternal bond as a joking relationship: A case study of the role of sexist jokes in male group bonding. In M.S. Kimmel (Ed.), Changing men: New directions in research on men and masculinity (pp. 148-163). Thousand Oaks, CA: Sage.

Martin, C.L. (1995). Stereotypes about children with traditional and nontraditional gender roles. Sex Roles, 33, 727-751.

Messner, M.A., & Sabo, D.F. (1990). Toward a critical feminist reappraisal of sport, men and the gender order. In M. Messner & D. Sabo (Eds.), Sport, men and the gender order (pp. 1-15). Champaign, IL: Human Kinetics.

Morris, J. (1993). Gender and disability. In J. Swain, V. Finkelstein, S. French, & M. Oliver (Eds.), Disabling barriers--Enabling environments (pp. 85-92). London: Sage.

Nathanson, C.A. (1975). Illness and the feminine role: A theoretical review. Social Science and Medicine, 9, 57-62.

Patton, M.Q. (1990). Qualitative evaluation and research methods. Newbury Park, CA: Sage.

Patton, M.Q. (2002). Qualitative research and evaluation methods (3rd ed.). London: Sage.

Petras, E.M., & Porpora, D.V. (1993). Participatory research: Three models and an analysis. American Sociologist, 24, 107-126.

Sabo, D. (2005). The study of masculinities and men's health. In M.S. Kimmel, J. Hearn, & R.W. Connell (Eds.), Handbook of studies on men and masculinities (pp. 326-352). Thousand Oaks, CA: Sage.

Sabo, D.F., & Gordon, D. (1992, August). Rethinking men's health and illness: The relevance of gender studies. Paper presented at the Society for the Study of Social Problems, Pittsburgh, PA.

Schofield, T., Connell, R.A., Walker, L., Wood, J.F., & Butland, D.L. (2000). Understanding men's health and illness: A gender relations approach to policy, research and practice. Journal of American College Health, 48(6), 247-256.

Smith, A.M.A., Rissel, C.E., Richters, J., Grulich, A.E., & Visser, R. (2003). Sexual identity, sexual attraction and sexual experience among a representative sample of adults. Australian and New Zealand Journal of Public Health, 27(2), 138-145.

Strauss, A., & Corbin, J. (1990). Basics of qualitative research. Grounded theory procedures and techniques. London: Sage.

Verbrugge, LM. (1985). Gender and health: An update on hypotheses and evidence. Journal of Health and Social Behavior, 26, 156-182.

Vernon, A. (1998). Multiple oppression and the disabled people's movement. In T. Shakespeare (Ed.), The disability reader (pp. 201-210). London and New York: Cassell.

Watson, J. (2000). Mule bodies: Health, culture and identity. Buckingham: Open University Press.

Correspondence concerning this article should be sent to: Lisa Gibbs, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood 3125, Victoria, Australia. Electronic mail: [e-mail].

LISA GIBBS

School of Health and Social Development, Deakin University

Victoria, Australia

Table 1

Age Groups of Participants

Age groups   18-25   26-40   41-60   61-75   Over 75

Men            2      3        7       3        2
Partners       0      1        3       0        0

Table 2

Education Level of Participants

Education                                         Men    Partners

Primary school only (ages five-12 years)           1        0
Completed secondary school (ages 13-18 years)      5        0
Passed final year of secondary school              1        1
Tertiary diploma/trade                             7        2
University                                         3        1
Unknown                                            3        0

Table 3

Self-Labelled Masculinities of Participants

Label selected          % of participants

Macho                          11.8
Nerd                            0
Ocker                           5.9
Regular guy                    52.9
Sensitive new age guy          23.5
Sports mad                     35.3
Surfie                          0
Traditional                    29.4
Yuppie                          5.9