Social Support from Peers and Spouses
Focus group feedback improved our consideration of the potential role of peer support to address dietary and physical activity behaviors among African American men. Initially, we expected male peer support to be of primary importance for addressing both eating behavior and physical activity among African American men, and spousal support to be an important, yet secondary, source of support. We are finding that these sources of social support vary by health behavior, however. Preliminary focus group data analysis suggests that peer support from other men may be a critical part of changing physical activity behaviors, but may be less influential for addressing changes in dietary behaviors. Women, particularly spouses, seem to be key, if not the most important, sources of influencing married men’s dietary behaviors, but are far less influential in engaging men in physical activity behavior changes. Our preliminary qualitative data suggest that women are central figures who may have the capacity to support the behaviors of African American men, particularly as they relate to diet.
Our focus group data suggest that spouses play considerable roles in influencing the health of older African American men (Griffith, Johnson, Allen, & Hill, 2009; Johnson et al., 2009). Men in this study articulated less on the role of supportive female family members as facilitating linkage to care, but did describe the role of their spouses in helping them to make healthy lifestyle changes related to physical activity and eating. While men received medical advice or instruction from physicians about behavior changes that they needed to make, spouses provided support to attempt the first steps toward healthy diet or physical activity. One of the biggest barriers voiced by men in the focus groups concerned men simply not knowing how to make behavioral and lifestyle changes prescribed by physicians. Another critical barrier was if the prescribed changes conflicted with deep-seated norms and behaviors that seemed to have positive outcomes for men over their lives.
Faith-Based Organizations Versus Other Organizational Settings
African American faith-based organizations have historically figured prominently in serving as a setting for social activities, a tool for organizing in the community, a vehicle for sharing information, and a means of providing social services (Billingsley, 1999). However, faith-based, worksite, and other community-based studies of diet and physical activity have consistently enrolled more women in their studies and reported more robust findings for women than men (Resnicow et al., 2002, 2004, 2005; Sorensen et al., 1998, 1999, 2002, 2003). In prior studies it has been noted that African American women attend religious services more frequently, are more likely to be church members, and express higher levels of religiosity than African American men (Taylor, 1988; Victor et al., 2004). While the role of spirituality and religion among African American men remains important, we decided to explore and consider other organizations that men may frequent more than faith-based organizations.
Initially, we attempted to reach African American men through men’s civic, social, and fraternal organizations. Whether founded to support African Americans in urban areas or to provide social and educational support to aspiring college and graduate students on college campuses, fraternal organizations have been an important institution within African American communities, and particularly among African American men. The African American Greek letter organizations, which were originally founded for college students, quickly grew to also support African American men who have graduated and moved on to a new phase of life. Many of these fraternal and civic organizations have national and international graduate topics, connecting men of African descent around the world beyond their college years. These organizations serve as spaces to help convene and support African American men, and they are potential settings to intervene to improve the eating and physical activity of African American men. In these settings, we aimed to build on the values, support, and camaraderie of organizations influential in the lives of African American men.
In addition to civic and fraternal organizations, we also considered barbershops. Barbershops are important institutions for African American men. In addition to grooming services, barbershops often provide a safe space for men to connect and communicate about issues most salient to them. While some have utilized these spaces to provide health information, we sought to indentify alternative sites for reaching men and for influencing their health behavior, in an attempt to explore a variety of organizations that are central to the lives and relationships of Black men.
In our experience, fraternities and lodges present some challenges for intervention activities and may not be the ideal organizational contexts for interventions to improve the health of African American men. However, these settings may pose fewer challenges in other communities, populations, or economic contexts. In our experience, in an economically challenged community or among an economically challenged population, less time and money is allocated for recreational activities that may be associated with social or fraternal organizations, and an economically struggling community undermines the viability of these institutions and organizations. In an economically challenged setting, fraternities, lodges, and social organizations may not be as financially stable, strong, or supported; and if men are not regularly participating in these organizations, then these settings do not have significant influence in men’s lives. Additionally, the confidential nature of membership to these organizations poses barriers for intervention activities or community presentations and does not allow for an open setting for intervention.
TOWARD MEN 4 HEALTH: A CULTURALLY AND GENDER-SENSITIVE HEALTH PROMOTION INTERVENTION
The process that we outline in this topic is a model that others may use to adapt existing interventions to new populations and health issues or use to develop new interventions that consider both race/ethnicity and gender. Through the process we are using to develop M4H, we are examining the factors that influence African American men’s eating and physical activity, and the contextual factors that help and hinder their ability to maintain healthy behaviors over time. Our approach suggests that future interventions with African American men should expand notions of cultural sensitivity to include gender sensitivity and the myriad factors that affect health behavior.
The intersectional approach we propose is, admittedly, complex and may yield more immediate questions than specific directions for where and how to intervene to improve health behavior. On the other hand, an intersectional approach considers a broader array of factors from the perspective of the population of interest. It also provides a lens that helps intervention researchers consider how people in the populations of interest view the multilevel factors that influence health behavior—elements of the social ecology of people’s lived experiences that rarely can be factored into health behavior interventions. These contextual and environmental factors may be the key to understanding not only how to change behavior but also to maintain behavior change, since often it is the intersection of health with other nonhealth aspects of people’s lives that impedes their ability to maintain recommended levels of health behavior. If viewed through the lens of how members of the population view their challenges, we believe that interventions can give people the needed information, tap into the necessary motivation, and train them to have the essential behavioral skills to adapt to unhealthy environments and life stressors, and sustain healthy behavior change. As technology continues to progress, individually tailored materials, not just print materials, seem to be a promising vehicle through which highly efficacious, high-reach, low-cost interventions can be delivered in a way that is most relevant to the aspects of people’s identity that influence their health behavior.
