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Health seeking in men: a concept analysis.

This article describes the analysis of the concept of health seeking in men. Men have shorter life expectancies and utilize health services less often than women, leading to poor health outcomes, but a gendered basis for health seeking remains poorly defined. Walker and Avant's framework was used to guide this concept analysis. Literature published in English from 1990-2015 was reviewed. Thematic analysis identified attributes, antecedents, and consequences of the concept. Based on the analysis, a contemporary definition for health seeking in men was constructed, rooted in the concept of health. The definition is based on the concept analysis and the defining attributes that were identified. This analysis provides a definition specifically for health seeking in American men, making it more specific and gender-based than the parent concept of "health." This concept analysis provides conceptual clarity that can guide development of a conceptual framework that may be uniquely relevant to providers in urology. Further exploration will uncover specific cultural, social, sexual, and geographic perspectives.

Key Words: Men's health, urology nursing, masculinity, gender norms, health seeking.

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Shorter lifespans, poorer health outcomes, and the lack of health seeking exhibited by men has become a growing concern for healthcare entities in the United States (U.S.) and around the world. The consistent difference in health between the genders is a frequent theme in the literature, but causes for this remain poorly categorized. Despite research over the past 30 years primarily in sociology and psychology, the concept of what health-seeking behavior is for men remains undefined.

Decreased support systems are a potential influence on health seeking in men; the influence of embarrassment, anxiety about their perception as "masculine" (Keough, 2015), and issues with communication (Yousaf, Grunfield, & Hunter, 2015) are also factors. This manifests as a lack of understanding as to why men engage in riskier behaviors and why targeted health promotion messages seem ineffective (Fleming, Lee, & Dworkin, 2014; Keough, 2015).

Research on men's health was rare until the year 2000 (Baker, 2002, Courtenay, 2000a, b; Courtenay & Keeling, 2000; Gough, 2006; Meryn & Jadad, 2001) and presented an either/or approach grounded in the sociological literature (Wenger, 2011). Men's health became an area of public health concern in 2001 with the First World Congress on Men's Health. Since that time, Healthy People 2010 has included gender among the many specific health disparities in need of examination (U.S. Department of Health and Human Services [DHHS], 2010). Only recently has the World Health Organization (WHO) recognized gender differences and the need for a better understanding of men's health behaviors (Baker et al., 2014).

Nurses promote the health and well-being of all individuals, yet a lack of understanding of how men pursue their health limits the ability to identify barriers to men's health seeking. Walker and Avant's (2011) method for concept analysis was used to examine the concept of health-seeking behavior in men, and was approached as a blending of the established concepts of health and health seeking through the lens of male gender and U.S. concepts of masculinity. Examining the elements of this concept using the Walker and Avant (2011) method will help to clarify the concept and operationalize a definition for future research that influences practice and health care for men.

Background

Health seeking is not a universal concept. Health has a widely adopted WHO (1946) conceptual definition: "health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." But the WHO definition is not the only way to conceptualize health; it is a concept that is constantly evolving because definitions of health are based in the perspective of the agency offering the definition. The word health can be used as a noun, and denotes a condition of being sound in body, mind, or spirit; freedom from physical disease or pain; the general condition or state of the body; and a toast to someone's health or prosperity (Merriam-Webster, n.d.).

Florence Nightingale, in her Notes on Nursing: What It Is and What It Is Not (1859), defined health as the most important aspect of the human body. The American Nurses Association (ANA) (n.d.) defines nursing as an agent in the protection, promotion, and optimization of health. Several key factors influence whether people are healthy or unhealthy, including income and social status, social support networks, education and literacy, employment and working conditions, physical and social environments, personal health practices, coping skills, healthy child development, biology, genetics, health care services, gender, and culture (Baker et ah, 2014). Synonyms for the word health include wellness, healthiness, and wholeness. The WHO definition grounds the current concept analysis toward a new definition for health seeking in U.S. men.

Health Seeking

Taking the definition a step further, the concept of "health seeking" represents social, cultural, and intellectual influences that impact the individual as he or she avoids illness and pursues treatment if unwell. Because health seeking is subject to multiple influences, no universal definition applies to both genders in all cultural circumstances. Seek is the root word for the term seeking; the word "seek" is used as a verb and a noun. When used as a verb, it means to go in search of, look for, discover, ask for, try to acquire or gain, or to make an attempt. When used a noun, it denotes a series of notes upon a horn calling out to hounds to begin a chase. Uses of the term seek as a verb is congruent with the concept of health seeking, but use of the term as a noun is not.

The North American Nurses Diagnosis Association International (NANDA-I) (2012) definition guides use of "health seeking" in nursing literature and under the nursing diagnosis of "ineffective health maintenance." The NANDA-I definition includes an inability to identify, manage, or seek out help to maintain health--a definition built around negative consequences. This definition includes expressed interest in improving health behaviors, demonstrated lack of knowledge regarding basic health practices, demonstrated lack of adaptive behaviors to internal and external environmental changes, and reported or observed inability to take responsibility for meeting basic health practices. Defining characteristics include a history of lack of health-seeking behavior; reported or observed lack of equipment, financial, and/or other resources; and reported or observed impairment of personal support systems.

Related factors to health seeking include disabled family coping, perceptual-cognitive impairment due to complete, or partial lack of gross or fine motor skills; lack of or significant alteration in communication skills (written, verbal, or gestural); unachieved developmental tasks; lack of material resources; dysfunctional grieving; disabling spiritual distress; inability to make deliberate and thoughtful judgments; and ineffective coping. These individual factors are congruent with nursing practice and avoid a strict biomedical interpretation of "health seeking" while acknowledging the subjective perceptions of an individual. Synonyms for the word seek include pursue, inquire, and investigate. For the purpose of this analysis, a synthesis of the NANDA-I components guided the use of "health seeking" as it was incorporated into developing a new conceptual definition for "health seeking in men."

Male Gender

The word male is both a noun and an adjective, and has considerable historical significance. It has meaning in biology, geography, geology, medicine, and law. As an adjective, the word male has five distinct meanings. These include characteristics or behaviors, such as a deep masculine, virile voice; or attributes or conduct deemed by a culture or society appropriate to or ideally associated with men or boys. In botany, male implies being capable of producing fertilization but not bearing fruit.

When used as a noun, the word male means 1) an animal that produces gametes (spermatozoa) that can fertilize a gamete (ova); 2) a person who belongs to the sex that cannot have babies; 3) the capital of the country Maldives; 4) the sex of a person, animal, or plant. Synonyms for male, masculine and virile, are adjectives that describe men and boys or culturally ascribed attributes and conduct. In American and Western European culture, these behaviors have traditionally included impatience at indecision and self-efficacy. Gender is conceptualized as the mental analog of sex (one's maleness or femaleness) as seen from one's own perspective. Gender includes status as a man or a woman, but is also a matter of personal recognition, social assignment, or legal determination; it is based on one's genitalia, but also on physical and behavioral criteria that go beyond genital differences.

[FIGURE 1 OMITTED]

The WHO defines gender as socially constructed roles, behaviors, activities, relationships, and attributes that a given society considers appropriate for men and women. This perspective guides the underlying conceptualization of gender in this analysis. Conceptualization of maleness and masculinity in the U.S. implies fearlessness, toughness, independence, and avoidance of emotional expression from early childhood (Garfield, Isacco, & Rogers, 2008), and this perspective focused the concept analysis.

Walker and Avant (2011) promote a concept analysis to examine the structure and function with the goal of clarification of the concept of interest. This clarification allows the development of a useful and meaningful concept, and avoids interchangeable labels, enhancing the utility of a concept within interdisciplinary healthcare settings and among patients and their families.

Purpose of the Analysis

The goal of this concept analysis is to clarify the meaning of "health seeking in men" as a concept in U.S. men in order to identify key attributes and antecedents, and develop an operational definition for use in guiding policy, promoting research, and informing healthcare practice.

Method

The initial search using Google Scholar, CINAHL, PubMed, and MEDLINE yielded 1,354,399 initial sources (see Figure 1). For example, a search of the term health-seeking behavior using PubMed listed 9,051 results for "health-seeking behavior in men" and 28,501 results for the similar terms "health locus of control," "treatment-seeking behavior," and "information-seeking behavior." "Health care-seeking behavior" returned 18,949 results. Search results were screened for relevance by scanning titles and abstracts. Selected full-text articles from 1990-2015 were retrieved and reviewed in full; the analysis was limited to full-text articles published in English. Published abstracts, commentaries, letters to the editor, and papers that included males under age 18 were excluded. Application of the exclusion criteria and elimination of duplicate articles reduced this number to 349 sources.

Results

Based on review of the 349 articles, several other terms were associated with the term health seeking. These terms included help seeking, care seeking, health care seeking, health locus of control, treatment-seeking behavior, ineffective coping, and information seeking. Review of the articles demonstrated that "health seeking" and "help seeking" are often used interchangeably, even within articles that purport to focus on one concept. Only three articles were authored by nurses. Seminal works of Courtenay provided a deep exploration into the concept of health-seeking behavior in males; Courtenay was the most published author on men's health behaviors. Five factors related to health seeking in men emerged.

Gender Norms

Males in North America strongly endorse cultural--and health-related beliefs that they are independent, self-reliant, strong, robust, and tough, and can provide for their family (Courtenay, 2000a; Mahalik, Lagan, & Morrison, 2003; McCreary, 1994). Men feel pressure to adopt these beliefs. Gender role socialization theories hold that men acquire gendered behaviors and attitudes from the cultures in which they live. O'Neil, Good, and Holmes (1995) identified four categories of gender-role conflict: 1) orientation to success, power, and competition; 2) restricting emotions and expression of emotions; 3) restricting of affectionate behavior between men; 4) and conflicts between work and family.

Health seeking can provoke significant gender role conflict for some men (Addis & Mahalik, 2003). This reflects a lack of consensus regarding gender as a trait that is malleable or one solely based on prevailing cultural and societal norms. In healthcare environments, this manifests as a reluctance to relate or difficulty when relating personal and private information. The literature reflects that not all prevailing norms apply to all individuals in a group at the same time; individual characteristics can and do influence behavior.

Masculinity

Men's view of masculinity is greatly affected by illness or disability (Charmaz, 1995) and is a socially constructed concept. This concept is dynamic; in any situation, the individual adapts his "norms" to fit the context. The cultural beliefs and stereotypes men hold about masculinity and manhood play an important role in shaping patterns of behavior that can negatively impact their health. Courtenay (2000a) lists denial of weakness or vulnerability, emotional and physical control, the appearance of strength and robustness, dismissal of any need of help, a ceaseless interest in sex, and display of aggressive behavior and physical dominance as the prevalent masculine characteristic of males. Men are less likely to express fear or emotional distress (Courtenay, 2001) except for anger (Brody, 1999; Courtenay, 2001).

Vogel, Heimerdinger-Edwards, and Hubbard (2011) associated asking for help and caring for one's health a feminine characteristic, acknowledging that the most powerful men were those for whom safety and health were irrelevant. This validates the perspective that males value independence and emotional control, and supports the traditional U.S. male self-schema that offers resistance to help seeking and focuses on self-monitoring one's own health. Individual health seeking is shaped by societal norms, values, beliefs, gender stereotypes, and religious influences that create the "typical male." This varies among groups, and is subject to the prevailing attitudes in the culture (e.g., U.S. white heterosexual males) and to the fear stigmatization.

Social Attitudes Affecting Health Care Practices

Stanton and Courtney (2003) found that men have limited social networks and respond to stress in less healthy ways than women; they use avoidant coping strategies, such as denial and distraction. Men tend to view their partners and friends as primary resources for health information and assistance with health matters (Denner, 2000). Men received the most support for health concerns from their female partners and little from their male friends (Tudiver & Talbot 1999). The prevalent themes regarding men's attitudes included a lack of willingness to seek help when needed (Courtenay, 1998, 2000a, 2001), presenting better health to their friends or peers, and neglecting signs and symptoms of illness when ill. Studies on men and distress found men deny their physical or emotional distress, and attempt to conceal their illnesses or disabilities (Courtenay, 2001; Robertson & Fitzgerald 1992).

Men were also found to be less likely to rely on themselves, more likely to withdraw socially, and less likely to try to talk themselves out of feeling depressed (Courtenay, 2000b); however, if a concern can be "normalized," that is, constructed as something many/most men would experience, men are more likely to seek help (Addis & Mahalik, 2003). Health behaviors in men become an expression of masculinity in a given context, one that includes the anticipated expectations of other men and weighted against the risks of not seeking help. These risks are weighed against health as a female focus and responsibility; health seeking is not a worthy pursuit if one needs to maintain a masculine appearance.

Tudiver and Talbot (1999) found that perceived vulnerability, fear, and denial were important influences as to whether men sought help, and men initially sought indirect methods to seek help. Men focus on physical problems and are less likely to disclose mental and emotional problems (Schofield, Connell, Walker, Wood, & Butland, 2000), and men are significantly influenced by previous experiences. Courtenay and Keeling (2000) found men were less likely to seek help for or report medical and psychological illnesses; less likely to get regular check ups and conduct self-examinations; use fewer medications, vitamins, and dietary supplements; sleep less and less well; and stay in bed to recover from illness less time than women. Saltonstall (1995) demonstrated that work activities often take precedence over positive health-related activities. While corporations expect men to work 12to 14-hour days (limiting access to health care), men themselves accept this corporate climate but expect to be rewarded with money, power, position, and prestige--all of which society endorses, accepts, and encourages (Courtenay, 2000a). Men define illness through the lens of how they anticipate others would define the issue and may resist seeking care due to a perceived lack of competency of credibility in a provider.

Men feel they have less control over personal health and that their personal actions contribute less to good health (Furnham & Kirkcaldy 1997). Fear of the unknown and anxiety deter men from seeking advice about health issues (Hale, Grogan, & Willott, 2007).

Health Risks

Risk of disease and lifestyle are closely correlated in men (Courtenay, 2003), and represent a potential threat to their autonomy. Men are less likely to wear seat belts (Allen, Shankhuan, Sauter, Layde, & Hargarten, 2006; Preusser, Williams, & Lund 1991), perceive themselves as being at risk for illness and injury (Boehm et al., 1993; Dejoy, 1992: Gustafson, 1998; Savage 1993; Weissfield, Kirscht, & Brock, 1990), and perceive less risk associated with using cigarettes, alcohol, and other drugs than women. (Flynn, Slovic, & Mertz 1994; Kauffman, Silver, & Poulin, 1997). Men are less likely to discuss experiences of pain or physical distress, report less pain, have a greater tolerance of pain, and have higher pain thresholds with shorter pain duration than women (Unrnh. Ritchie, & Merskey, 1999).

Zuckerman (1994) found men underestimated the risks associated with engaging in physically dangerous activities, such as dangerous driving (Dejoy, 1992; Flynn et al., 1994; Savage, 1993). This is consistent with the Western concept of illness or dysfunction as a challenge and not a problem (Wenger, 2011), and it is further subject to context of health seeking, which directly impacts their pursuit of care. Men are prone to minimizing symptoms to the point of insignificance to maintain a masculine self-schema in part because interest in health or their bodies can be interpreted as a "feminizing" trait. This manifests as a lack of knowledge about how issues can become chronic (e.g., hypertension, diabetes) and have a pervasive impact on other aspects of health and quality of life.

System Barriers Affecting Men's Health

White (2008), in a scoping study of men and problems with their health, identified four key areas influencing men and their health: 1) access to health services, 2) lack of awareness of health needs, 3) inability to express emotions, and 4) lack of social networks. Men in this study exposed two primary themes for men and health seeking: access to health care and the threat of submitting to a personal failure and loss of control/fear related to health.

According to Courtenay and Keeling (2000), men may be reluctant to wait for appointments to see a healthcare provider. They theorized that identifying with social norms might make men feel that health services are primarily for women and children, and men may lack understanding of such simple tasks as the process of making appointments and negotiating those appointments with a female receptionist. Courtenay and Keeling (2000) found that men spend less time with physicians than women and receive less advice from physicians about disease risk factors. Tudiver and Talbot (1999) found that having time, access to care, having to state the reason for a visit, and the lack of a male care provider was a system barrier for men.

A lack of gender-specific education for providers regarding how to address chronic disease in men represents a separate barrier. Men also lack knowledge about resources, and may find cost and other socioeconomic issues a significant barrier to care. Cost is a prevalent theme that relates back to the masculinity factor; men feel it is less expensive to self-monitor, even if they have insurance.

Defining Attributes

The defining attributes of a concept are those characteristics consistently associated with the concepts that act to differentiate the concept from other similar or related ones (Walker & Avant, 2011). From the literature review, five critical attributes of men's health-seeking behavior are evident: gender norms, masculinity, social attitudes and health care practices, health risks, and system barriers affecting men's health. The defining attributes of health-seeking behavior in men are reliance on female support, rejection of feminine characteristics, increase in health risks, knowledge deficits, and underutilization of health services.

Related Concepts

As critical attributes for health seeking in men began to emerge from an examination of the literature, closely related concepts emerged as well. These concepts may interfere with an accurate interpretation of health seeking in men because they share some defining attributes. However, these related concepts are distinct and different from the concept of health seeking in men and include help seeking, care seeking, health locus of control, treatment-seeking behavior, ineffective coping, and information seeking.

Cornally and McCarthy (2011) defined the concept help-seeking behavior as a "problem-focused, planned and intentional interaction with a healthcare professional" (p. 286). Although similar to health seeking, help seeking does not incorporate health promotion and prevention. Health seeking occurs for both perceived and/or real health problems, whereas help seeking does not.

There are three dimensions of health locus of control that embrace health-seeking behavior: beliefs that health outcomes are related to one's own ability and effort (internal dimension), beliefs that health outcomes are associated with the power of health providers, and the belief that health is due to chance or fate (external dimension) (Wallston & Wallston, 1982; Wallston, Wallston, & deVellis, 1978). Studies on health locus of control and health behavior have shown they are closely connected, yet only one aspect of health behavior.

Model and Constructed Cases

Walker and Avant (2011) call for cases or models to help clarify the concept. Three categories of case studies are provided to further expand on the concept of health-seeking behavior in men.

Model Case

The model case is an exemplar of a concept that has been investigated and includes all of its defining attributes (Walker & Avant, 2011). This case demonstrates a male who takes risks, neglects safety, ignores serious health threat, and is unable and unwilling to negotiate the healthcare system.
   Sam, a 49-year-old male,
   lives alone in an isolated
   rural area. Like other men in
   his family, Sam has smoked
   since age 15 years. He drinks
   two cases of beer weekly. On
   Saturday nights, Sam drives
   his three-wheeler to the local
   bar, where he has been
   arrested for disorderly conduct
   and intoxication on several
   occasions. Sam was
   recently diagnosed with
   throat cancer found on an X-ray
   taken after having an
   accident on his three-wheeler.
   Sam was referred to an
   oncologist but refused to go
   to the appointment until persuaded
   by his girlfriend. Sam
   arrived at his appointment,
   but instead of signing in at
   the registration desk, he sat
   down in the crowded waiting
   room. After waiting for an
   hour, Sam became angry and
   left without being seen. Sam
   later told his girlfriend his
   cancer had never bothered
   him before and the cancer
   would go away on its own.


Borderline Case

According to Walker and Avant (2011), a borderline case contains many of the defining attributes of the model case but not all of them. This borderline case demonstrates a male who delays treatment due to fear, while taking risks with his health, but is willing to visit a provider.
   Mike is a 54-year-old businessman
   whose goal is to
   make it to the top in his company.
   Mike puts in 10 to 12
   hours each work day. Mike
   has a cocktail with dinner
   every night, walks two miles
   a day on the treadmill, and
   has never smoked. Mike has
   recently developed rectal
   bleeding but has decided to
   put off seeing his primary
   care provider until his scheduled
   yearly physical in six
   months. Mike has not shared
   his current health problem
   with his wife. Mike is afraid
   and worried he has cancer.


Related Case

The related case demonstrates fidelity with the concepts of interest but lacks attributes of the concept analyzed (Walker & Avant 2011). Related cases can help clarify the phenomenon study by demonstrating how it is distinct from other similar phenomena.
   Matthew is 34 and has spina
   bifida. He has spent all of his
   life in and out of hospitals or
   waiting for hours in clinic
   waiting rooms. He is well
   known by the clinic staff who
   always greet him warmly and
   bring him juice and crackers
   while he waits. Matt loves the
   special attention he receives
   from the staff and never misses
   his appointments. Matt has
   been instructed to catheterize
   four times daily using a new
   catheter each time to prevent
   urinary tract infections. He
   finds catheterization inconvenient,
   especially at work,
   and will sometimes only
   catheterize twice daily using a
   catheter he keeps in his desk
   drawer. Matt does the best he
   can to stay healthy but has to
   be careful of skin breakdown
   due to immobility.


Contrary Case

The contrary case offers a clear example of what the phenomenon is not (Walker & Avant, 2011), and in this case, acknowledgement of the health seeking in men concept in a unique clinical environment.
   Adam has just turned 50
   years old. He does not drink
   alcohol and has never smoked.
   Adam jogs five miles each
   day. Adam is aware that to
   prevent illness and remain in
   good health, he should undergo
   a yearly physical examination.
   Adam's primary care
   provider's office is easily
   accessible, convenient to his
   office, and built with men
   in mind. Office hours are
   extended to accommodate
   men's long work hours. To
   reduce anxiety glazed doors
   are used between the patient
   waiting area and the clinical
   corridors. Adam's female
   physician takes time to answer
   his questions and provides
   preventive health education.


Antecedents and Consequences

The antecedents of heath seeking in men are the dynamism of masculinity and its adaptation to context to preserve one's internal "masculine" self-schema in relation to one's perceptions of a "feminine" presentation. This masculine socialization can make adoption of health seeking a challenge because pursuing help may be seen as a conflict with one's masculine role. It can imply a vulnerability that is inconsistent with an individual's self-schema as a male. This contributes to men's confusion about when to seek help (Garfield et al., 2008).

Walker and Avant (2011) characterized consequences as defining outcomes as a result of the concept. The consequences of a poor understanding of health seeking in men are those conditions that are costs of the current poor health-seeking behavior in men: reliance on female support; rejection of feminine characteristics; poor mental, social, and physical health; suffers from preventable illnesses; decreased quality of life; early morbidity; increase in health risks; knowledge deficits; and underutilization of health services. Men have an increased risk for anxiety, depression, psychological stress, and maladaptive coping (Courtenay, 2003); unhealthy lifestyles and poor health behaviors were found across racial and ethnic groups (Courtenay, McCreary, & Merighi 2002).

Empirical Referents

The final step in Walker and Avant's (2011) method of concept analysis is developing empirical referents to measure or observe the phenomenon in reality. Because few instruments are available to fully assess the multidimensional concept of health-seeking behavior in males, assessment can be indirectly measured with instruments that assess gender, psychological, social, and health-seeking behaviors, and long-term outcomes for chronic disease. Additional measures of health as defined in a given population of men (e.g., community-based, ethnicity-based, citywide, or countrywide) also have a role in the measurement of men's health-seeking behaviors.

Mansfield, Addis, and Courtenay (2005) designed a measure to assess and identify reasons men do not seek professional help for mental and physical health problems. The Barriers to Help Seeking Scale (BHSS) consists of seven subscales, including need for control, self-reliance, minimizing problem and resignation, concrete barriers, distrust of caregivers, privacy, and emotional control. The Gender Role Conflict Scale (GRCS) (O'Neil et al., 1995) assesses male gender role conflict, which is defined as a "psychological state in which socialized gender roles have negative consequences on the person and others" (p. 380). The GRCS consists of 37 statements and is composed of four subscales: success, power, and competition; restrictive emotionality; restrictive affectionate behavior between men; and conflict between work and family. It is the only scale available to assess help for physical and mental health problems. The Attitudes Toward Seeking Professional Psychological Help Scale (ASPPH) (Fischer & Turner, 1970) is the most widely used measure of attitudes toward seeking professional help, which targets the importance of advancing in one's professional life, keeping emotions in check, wielding power over people and situations, and showing discomfort with homosexual behavior between men.

Definition

Many factors affect health-seeking behaviors of men: it is complex and multidimensional, and based on biological, social, and psychological differences. Men approach healthcare using indirect methods, and there is a need in our present healthcare system to recognize and address differences in health-seeking behaviors of men to influence, modify, and effectively prevent illness (one's subjective sense of unwell) in men.

The following synthesis of findings from the concept analysis (see Figure 2) led to this definition:
   Health seeking in men is a
   dynamic, multidimensional,
   interactive process driven
   by a man defining a
   concern as a problem;
   directed by individual biological,
   psychological, and
   social components that
   allow him to maintain
   fidelity with his masculine
   self-schema while seeking
   care; and influenced by the
   healthcare system.


Discussion and Implications

This concept analysis clarified the concept of health seeking in men while demonstrating this concept is both the result of masculine beliefs and behaviors, as well as influenced by them. The new definition can be operationalized for research and health promotion, crafting future mid-range theories, and developing a contemporary definition for health seeking in men that can be used in building the evidence base to guide nursing interventions. Moving forward with this concept requires acknowledgement and acceptance of the role of gender, rather than attempting to create a gender-neutral view of the "health-seeking" concept. The new definition allows this perspective to be conceptualized for research. Gender is commonly seen as a construct that cannot be disconnected from socioeconomic status, sexual orientation, geography, or job (Wenger, 2011), to the disservice of male patients. Much of the previously published data minimizes the diversity of men's experiences to create a dichotomous scenario in which men do or do not choose to pursue health.

[FIGURE 2 OMITTED]

Masculinity as a concept is subject to the prevailing local culture and national perspective; this concept analysis offers a focused perspective through the lens of U.S. society. Placed within a "masculine" framework, health-seeking behavior becomes subject to external influences, such as diet, community, alcohol use, and decreased use of primary care and screening services. Men have strongly endorsed cultural and health-related beliefs, have limited social networks, are less likely to seek medical attention or express emotions, and perceive themselves to be less at risk for injury and illness. Healthcare systems can be difficult for men to navigate, and studies show men may receive less advice and less time from providers.

Health seeking is a learned behavior and can be positively influenced; men can be educated to know that care does not need to result in a cure, such as in the case of health screening and vaccinations. This may be particularly relevant to genitourinary issues, and men may choose to bypass primary care and self-refer to a urology provider. Social networks for men, in respect to illness, tend to be small, but are an important influence on health-seeking behaviors. There can be a failure to include the perspective and the role or influence of others in the social networks of unpartnered men (e.g., coworkers, family).

Nurses can be leaders in understanding and investigating the future of men's health, and urology nurses are in a unique position to improve the health and well-being of men. Nursing is based on incorporating the person and his social context into care, an approach that may be especially advantageous to health promotion for men (Addis & Mahalik, 2003). The review of literature uncovered articles noting that men find it easier to show emotion and self-disclose to women than to other men. Henderson and Weisman (2001) found that having a female physician is associated with a greater likelihood of receiving both preventive counseling and increased likelihood of receiving more gender-specific screenings for both male and female patients. Urology nurses, the majority of whom are female (Society of Urologic Nurses and Associates, 2016), are an untapped resource and potential leaders in the investigation of men and their health care issues. They can strive to present information in a manner that "normalizes" a given concern as a way to decrease its stigma.

The limitations of this analysis include that only literary works in English were examined, limiting other insights and perspectives, but allowing a definition to be crafted specific to U.S. men. Qualitative studies were lacking, which could provide a clearer picture of this concept.

Conclusion

The developed definition offers the opportunity for better understanding and better rapport with male patients, which can encourage future use of healthcare resources, and perhaps most importantly, preventative screening services and promotion of treatment compliance. This new definition promotes a dynamic approach that encourages flexibility within the acknowledgement of men's individual experiences with health seeking and navigation of the healthcare system.

Instructions for Continuing Nursing Education Contact Hours

Health Seeking in Men: A Concept Analysis

Deadline for submission: August 31, 2018

UNJ 1694

To Obtain CNE Contact Hours

1. For those wishing to obtain CNE contact hours, you must read the article And complete the evaluation through SUNA's Online Library. Complete Your evaluation online and print your CNE certificate immediately, or later. Simply go to www.prolibraries.com/suna

2. Evaluations must be completed online by August 31, 2018. Upon completion of the evaluation, a certificate for 1.1 contact hour(s) may be printEd.

Learning Outcome

After completing this learning activity, the learner will be able provide a Dynamic approach to health care for men that encourages flexibility within The acknowledgement of men's individual experiences with health seeking and navigation of the healthcare system.

Articles in the SUNA Online Library are FREE for SUNA Members.

CNE Evaluation Fee--$15

The author(s), editor, editorial board, content Reviewers, and education director reported no Actual or potential conflict of interest in relation to This continuing nursing education article.

This educational activity is provided by the Society of Urologic Nurses and Associates (SUNA).

SUNA is accredited as a provider of continuing Nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

SUNA is a provider approved by the California Board of Registered Nursing, provider number CEP 5556. Licensees in the state of California Must retain this certificate for four years after the CNE activity is completed.

This article was reviewed and formatted for Contact hour credit by Rosemarie Marmion, MSN, RN-BC, NE-BC, SUNA Education Director.

doi: 10.7257/1053-816X.2016.36.4.163

References

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Gwendolyn L. Hooper, PhD, RN, APRNBC, CUNP, is an Assistant Professor, The University of Alabama, Capstone College of Nursing, Tuscaloosa, AL.

Susanne A. Quallich, MSN, ANP-BC, NPC, CUNP, FAANP, is an Andrology NP, University of Michigan Health System, Ann Arbor, MI. She is a member of the Urologic Nursing Editorial Board.
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Title Annotation:SERIES
Author:Hooper, Gwendolyn L.; Quallich, Susanne A.
Publication:Urologic Nursing
Article Type:Report
Date:Jul 1, 2016
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