Navigating the cultural adaptation of a US-based online mental health and social support program for use with young Aboriginal and Torres Strait Islander males in the Northern Territory, Australia: Processes, outcomes, and lessons.

BACKGROUND: Despite disproportionate rates of mental ill-health compared with non-Indigenous populations, few programs have been tailored to the unique health, social, and cultural needs and preferences of young Aboriginal and Torres Strait Islander males. This paper describes the process of culturally adapting the US-based Young Black Men, Masculinities, and Mental Health (YBMen) Project to suit the needs, preferences, culture, and circumstances of Aboriginal and Torres Strait Islander males aged 16-25 years in the Northern Territory, Australia. YBMen is an evidence-based social media-based education and support program designed to promote mental health, expand understandings of gender and cultural identities, and enhance social support in college-aged Black men. METHODS: Our adaptation followed an Extended Stages of Cultural Adaptation model. First, we established a rationale for adaptation that included assessing the appropriateness of YBMen's core components for the target population. We then investigated important and appropriate models to underpin the adapted program and conducted a non-linear, iterative process of gathering information from key sources, including young Aboriginal and Torres Strait Islander males, to inform program curriculum and delivery. RESULTS: To maintain program fidelity, we retained the core curriculum components of mental health, healthy masculinities, and social connection and kept the small cohort, private social media group delivery but developed two models: 'online only' (the original online delivery format) and 'hybrid in-person/online' (combining online delivery with weekly in-person group sessions). Adaptations made included using an overarching Aboriginal and Torres Strait Islander social and emotional wellbeing framework and socio-cultural strengths-based approach; inclusion of modules on health and wellbeing, positive Indigenous masculinities, and respectful relationships; use of Indigenous designs and colours; and prominent placement of images of Aboriginal and Torres Strait Islander male sportspeople, musicians, activists, and local role models. CONCLUSIONS: This process resulted in a culturally responsive mental health, masculinities, and social support health promotion program for young Aboriginal and Torres Strait Islander males. Next steps will involve pilot testing to investigate the adapted program's acceptability and feasibility and inform further refinement.

"Put your personality into the call": A qualitative interview study illuminating strategies for improving men's engagement on crisis helplines.

BACKGROUND: Crisis telephone helplines are an integral part of community suicide prevention. Despite high male suicide rates, men's experiences of these services are poorly understood. The current study explored men's perspectives of their interactions with helpline counsellors to understand how their engagement on helplines can be enhanced. METHOD: Sixteen men (19-71 years) who had previously used a mental health or crisis helpline in Australia completed individual semi-structured interviews about their experiences. Data were analysed using interpretive descriptive methodologies. RESULTS: Two themes derived from the data related to how men engaged with counsellors on helpline services. First, men emphasized the importance of helpline counsellors creating and maintaining an authentic connection across the call, providing suggestions for strategies to secure connection. Second, men discussed how counsellors can facilitate outcomes through offering space for their narratives and aiding in referrals to other support services when required. CONCLUSIONS: Findings highlight the value of crisis helplines for men's suicide prevention services while identifying target areas to improve engagement. We discuss implications for the findings including suggestions for gender-sensitive care within crisis helplines.

'That Sounds to Me Like You Are Making This Too Complicated ': Reflections on a Social Media Recruitment Effort for a Study on Masculinities and Contraception.

This reflection focuses on the methodological and ethical challenges encountered during the recruitment stage in a focus group and interview study that sought to investigate how men (co-)construct (their) masculinity in the context of contraception and family planning. We critically engage with the comments sections of our social media recruitment announcements and draw lessons in regard to (i) the 'correct' and socially acceptable terminology when trying to recruit men in an inclusive manner and (ii) the feasibility of our method more generally. We asked what we may learn about ourselves, our specific research project, and the conduct of research more generally when we view the ethical challenges arising during the recruitment stage as an integral part of reflexive research ethics.

Operationalising masculinities in theories and practices of gender-transformative health interventions: a scoping review.

Gender-transformative health interventions that involve men and boys are gaining global reach, adaptability to specific geographical, population and epidemiological contexts, public endorsement, and conceptual sophistication. However, the ways in which masculinities are conceptualised and operationalised in theory and practice across these interventions remains unclear. The purpose of this scoping review is to map intervention studies that conceptually grapple with masculinities and analyse: a) how the concept of masculinities is adapted and operationalised in gender-transformative interventions, with respect to intervention population and context, b) what the relationship between the concept of masculinities and its wider theoretical embedding is, and c) on which levels transformation can be observed when working with 'masculinities'.We conducted a search in APA Psych Articles, APA PsycINFO, and CINAHL via EBSCO, MedLine, PubMed, and Web of Sciences (December 2021) looking for peer-reviewed studies on gender-transformative health interventions which engaged with masculinities conceptually. There were no restrictions regarding language, publication date, or geography. Forty-two articles were included in this review. Our abductive analysis finds that 'hegemonic masculinities' is a central concept in almost all included studies. This shows how the concept is adaptable to a range of different intervention contexts. The review further identifies five theoretical approaches, that help operationalise masculinities on an analytical level: feminist framework, affect theory, critical pedagogy, theories of social change, and ecological approaches. Lastly, this review draws out six levels on which transformation can be observed in the intervention outcomes: relational level, symbolic level, material level, affective level, cognitive-behavioural level, and community-structural level. The discussion underlines that processes and practices of (gender) transformation also require engagement with theories of transformation more widely and advocates for theoretical pluralism. Lastly, implications for practice, including preventative, ecological and community-based care models, are drawn out.

Listening to stakeholders in the prevention of gender-based violence among young people in Spain: a qualitative study from the positivMasc project.

OBJECTIVE: This study seeks to deepen current knowledge of the phenomenon of gender-based violence (GVB) among young people in Spain, identifying the main challenges in terms of prevention from the perspective of key stakeholders in the field. METHODS: 23 semi-structured qualitative interviews were performed with professionals whose work involves youth and comes from different areas: social work, policy making, youth education, feminist and LGBTQ activism and anti-violence masculinities engagement (13 women and 10 men). RESULTS: Among the main challenges identified by stakeholders in relation to GBV preventive strategies in young populations there is a need to focus on transformative programmes within educational settings. The findings indicate that specific programs and interventions in this area may not be yielding the expected effectiveness. This outcome could be attributed less to a lack of resources and more to a failure to address the core issues and challenges adequately. Thus, the results underline that intervention programmes should emphasise equitable gender norms and gender relations and incorporate content on anti-violence masculinities. Finally, a pivotal aspect seen by professionals to facilitate GBV prevention is the design and development of interventions based on participatory and active approaches, close to young people's everyday situations. The results also draw attention to the need to analyse the impact of new forms of violence in greater depth, especially those that occur through information and communication technologies. CONCLUSION: Among other implications for policy and practice, the study points to the need to articulate interventions designed to work simultaneously at different levels of influence acting on people.

South African male university students' perspectives on gender norms concerning alcohol and related harmful behaviours towards female drinkers.

High rates of gender violence in South Africa, including those in higher education institutions, have prompted considerable research into understanding its causes. Studies focusing on gender and sexual risk at universities have found alcohol to be a significant contributor to gender violence. In this study, I analyse alcohol-related gender violence against female drinkers from the perspectives of male students. In-depth individual interviews were conducted with ten undergraduate male students at a university residence. Findings reveal that alcohol is seen as a masculine privilege. Male students explain that men use alcohol to give them the courage to enact hegemonic heterosexual masculinities. While they see alcohol as a tool to enhance men's capacity to control women, they simultaneously attribute blame to alcohol for men's loss of control over their behaviour. Alcohol is also exploited as currency to coerce women into submission to sexual favours. When male students blame alcohol for any deviant behaviour, men's culpability in the violation of female students remains hidden. Violence prevention efforts in educational contexts must address the ways in which alcohol shapes students' experience of gender, sexuality and violence.

"Guys with Big Muscles Have Misplaced Priorities": Masculinities and Muscularities in Young South Korean Men's Body Image.

Men's body image is an issue of increasing importance as related illnesses continue to grow in prevalence around the world. However, cross-cultural attention to men's body image experiences has been relatively understudied. Based on data derived from cognitive anthropological methods of cultural domain analysis, I develop the concept of "muscularities" to more effectively examine the expectations inherent in multifarious models of body image men continuously navigate. Related to but distinct from "masculinities"-the recognition of culture-bound hierarchies of ways of doing-being a man-"muscularities" attends to the culturally particular ways in which muscles are conceived and evaluated as indices of socioeconomic status, intelligence, social skills, and professionalism, to name a few. Young South Korean men's experiences of chan'gunyuk ("small muscle") and manun kunyuk ("large muscle") challenge universalist assumptions about the kinds of muscles people value in global perspective, demonstrate the necessity of recognizing multiple muscularities in research, and encourage new directions of inquiry that attend to the consequences of variable embodiments of muscularities.

Incarcerated Young Men, Masculinity, and Trauma.

The current article is part of a unique comparative study of the experiences and adjustment of 190 incarcerated young men in both Scotland and Canada. In collecting data on the participants' lives, the authors learned of the multiple traumas and losses many of them had suffered. Many participants however seemed to adhere to a prison masculinity that may constrain help-seeking behavior. Ultimately, this article analyses the levels of trauma that exists in a population of incarcerated young men within the context and alongside of the masculine ideals they appeared to adhere to. This article advocates for gender-responsive trauma-informed care for incarcerated young men that incorporates an exploration and understanding of masculine identity and how it interacts with help-seeking and trauma recovery.

Intersections between disability, masculinities, and violence: experiences and insights from men with physical disabilities from three African countries.

BACKGROUND: Gender-transformative work in the Global South often focuses on transforming 'toxic masculinities' to prevent intimate partner violence (IPV), but there has been little research on whether and how constructions of masculinities by men with disabilities shape their experiences and perpetration of violence. METHODS: We used repeated in-depth interviews and content analysis to understand whether and how physical disability intersects with the construction of masculinities and experience/perpetration of violence among 15 adult men with physical disabilities participating in interventions to prevent IPV in Ghana, Rwanda, and South Africa. RESULTS: Societal expectations and participants' aspirations around masculinity impacted their vulnerability to violence mainly by men without disabilities. Participants reported experiences of disrespect and social exclusion in their communities and felt incapable of protecting themselves when being violated. Most participants felt they were not providing for their families and perceived themselves as having lost decision-making and positions of power in their homes. They expressed their disappointment with having reduced stamina, virility, and sexual prowess in intimate partnerships as a result of their disability. While participants reported that they could not attain key markers of idealized masculinity, placed upon and often internalized by themselves, they longed to achieve these markers to facilitate their inclusion and acceptance in their communities. CONCLUSIONS: Programmers addressing violence need to engage with men with physical disabilities and consider the intersectionality of masculinities and disability, how these reinforce patriarchal norms and how men with disabilities can be included and enabled to overcome their conflict between disability and masculinities.

'We're welcomed into people's homes every day' versus 'we're the people that come and arrest you': The relational production of masculinities and vulnerabilities among male first responders.

Encouraging men to open-up about their feelings is a new cultural directive, yet little is known about how this works in practice, including to promote mental health. Ideals of hegemonic masculinity may be increasingly tolerating expressions of vulnerability in some areas of social life. However, the expression of vulnerability in paid work and/or career situations is regulated by organisational ideals and circumstances that may also produce distress. To address uncertainty in the literature, we investigated the experiences of men in traditionally male dominated professions, namely first responders (police, paramedics, and firefighters/rescue). Twenty-one UK based men of diverse ranks and experience currently working within first responder services participated in semi-structured telephone interviews. Distress was positioned as an inevitable part of the work. Yet, striking differences in institutionalised ways of expressing vulnerabilities differentiated the experiences of frontline workers, contributing to a wide spectrum of men's silence right through to relative openness about vulnerability, both in the workplace and domestic spheres. The findings provide importanat insights into how vulnerability is institutionally regulated, illuminating and contrasting how the possibilities for male vulnerabilities are socially produced.

"If You Do Not Fit in With the Stereotype, They Eat You Alive": Discourses of Masculinities and Their Reflections in Young Spanish Men's Health.

Hegemonic masculinity has been especially linked, among other aspects, to unhealthy behaviors and heterosexuality. This study aimed to explore the discourses of masculinities with young Spanish men with different sexual orientations (heterosexuals, bisexuals, and homosexuals), comparing them with the social representations that are put into practice on Instagram. Three qualitative approaches were triangulated to seek a richer comprehension and interpretational level: discussion groups, semi-structured interviews, and an online non-participant observation on Instagram with a total of 26 young men aged between 18 and 24. Results indicate that hegemonic masculinity discourse is still significant when understanding and experiencing young men's masculinities, promoting behaviors that put their health at risk and generating psychological discomfort, especially among non-heterosexual men. Our findings provide knowledge of the social framework that legitimizes and reproduces male domination in younger generations both online and offline and how this is reflected in men's health.

"Deadly", "fierce", "shameful": notions of antiretroviral therapy, stigma and masculinities intersecting men's life-course in Blantyre, Malawi.

BACKGROUND: Stigma and masculinity represent persistent barriers in delivering successful HIV interventions to men. Our study examined community perceptions of HIV and anti-retroviral therapy (ART) and their implications for men on ART across the life course in Blantyre, Malawi. METHODS: Our qualitative study is based on 72 face-to-face semi-structured interviews. Participants were selected purposively and included men on ART (with suppressed and unsuppressed viral loads), adult male community members irrespective of HIV status and other HIV stakeholders such as health personnel and program implementers. Interviews were conducted in Chichewa and English, transcribed verbatim and analyzed thematically in NVivo 12. We applied the socio-ecological model as our theoretical framework as well as a "life-course" perspective. RESULTS: Our findings highlight lingering negative perceptions towards ART in general and towards PLHIV irrespective of viral load suppression. With intersecting notions of masculinity and stigma, men's descriptions of anticipated stigma in their relationships and when visiting health facilities dominated. Stigma was experienced at the personal, interpersonal, facility and community level. Yet, men living with HIV were perceived differently throughout the life-course, with young sexually active men seen as the most stigmatized group and older men seen as drawing resilience from a greater range of masculine norms. Some men of all ages displayed "transformative" masculinities independent of stigma and community expectations. CONCLUSIONS: We propose the "life-course" as a useful concept for studies on masculinity, HIV and stigma. Considering gendered constructions of "respectable" midlife-older age vis-à-vis younger age, and how they influence stigma as well as uptake and adherence to ART might lead to more targeted services for men that build on "transformative masculinities".

Subordinated agency: Negotiating the biomedicalisation of masculinity among gay men living with HIV.

Health practices are shaped by gender relations and constructs. Utilising qualitative data, this study explores a shift in medication practices among gay men living with HIV (GMLH) in light of changing HIV/AIDS responses in Taiwan. In the 1980s and 1990s, the mobilisation of moralising discourses forged a gender hierarchy that subordinated HIV-positive gay males. In the 2000s, new state programmes on HIV/AIDS were implemented to enhance patients' adherence to treatment, but GMLH often expressed ambivalence towards medication, which could lead to HIV disclosure and, consequently, social exclusions under the gender hierarchy. Starting in the 2010s, the knowledge of HIV 'treatment as prevention' and a policy on early treatment have offered a new path for GMLH to navigate gender power dynamics and to strive towards an inclusive social life by taking medicine and optimising health, which facilitates a biomedicalisation of subordinated masculinity. This study contributes to the scholarship on HIV/AIDS by underscoring the significance of biomedicine for configuring masculine identities and practices among a subordinated group of men, as well as by highlighting the gender power relations and everyday 'nonbiomedical' negotiating practices that legitimise biomedicalisation.

How men step back - and recover - from suicide attempts: A relational and gendered account.

Men account for three-quarters of suicide deaths in the UK, yet we know little about how at-risk men construct their experiences of moving towards - and then subsequently stepping back from - suicide, nor the part played by relational factors therein. An inductive thematic analysis was used to examine narrative interviews with eleven UK men who self-reported serious thoughts, plans and up-to and including suicide attempts in progress, but who consciously decided against carrying out an attempt. Their accounts suggest a highly social process of movements towards and away from suicide (e.g. frustrated help-seeking). Stepping back from suicide represents not a discrete issue, but a linked process in suicidality and wider recovery. Here, the use of military metaphors in particular (e.g. waging war, fighting back) highlights the gendered nature of the issue. Additionally, our article illuminates a range of social relations and forces that circulate in and around suicidality, which itself is embedded in varying forms of relationality, normativity and gendered practices.

A human diversity analysis of culture and gender in Asian American men's intimate partner violence perpetration.

This integrative literature review aims to fill the gap in our understanding of the cultural and gendered predictors of intimate partner violence (IPV) perpetration by Asian American men. A comprehensive search using PsycINFO returned N = 24 peer-reviewed journal articles that examine Asian American men's IPV perpetration and patriarchal gender role norms and that met inclusion criteria. Patriarchal gender role norms consistently predicted IPV perpetration. However, the associations between acculturation/enculturation and IPV perpetration were less clear. Greater enculturation (Asian cultural identification) was associated with more patriarchal gender role norms while greater acculturation (mainstream US cultural identification) was associated with more masculine gender role strain. Additionally, violence in the family of origin consistently predicted later IPV perpetration as an adult. Results suggest that integrating multiple dimensions of human diversity (e.g., culture, gender, and power) in intersectional models may best explain Asian American men's IPV perpetration.

The role of masculinities in psychological and emotional help seeking by men with prostate cancer.

OBJECTIVE: To assess the impact of demographic characteristics and masculinities on seeking support for psychosocial care needs in men with prostate cancer. METHODS: Prostate cancer survivors (n = 225) completed mail-out surveys measuring psychological care needs, masculinities, and psychological and emotional help-seeking intention and behaviour at 6- and 12-month follow-ups. RESULTS: Older age was associated with seeking help from a general practitioner (GP), χ2 (1,225) = 4.72, P = .03, and being born overseas was associated with seeking peer support (1,225) = 7.13, P = .01. Men with higher levels of optimistic action who reported moderate to high unmet psychological need were less likely to seek help for psychological and emotional concerns at 6- (odds ratio [OR] = 0.06, confidence interval [CI], 0.01-0.46) and 12-month (OR = 0.13, CI, 0.26-0.65) follow-ups. CONCLUSIONS: Optimistic action may explain why some men with prostate cancer fail to seek help for their psychological care needs. Clinicians should be aware that men with chronic illness who appear to approach challenges with optimistic action may in fact be less likely to seek psychological help when needed.

Harmful masculinities among younger men in three countries: Psychometric study of the Man Box Scale.

In response to growing evidence of associations between harmful masculinities and adverse health outcomes, researchers developed the Man Box Scale to provide a standardized measure to assess these inequitable gender attitudes. In 2019, we evaluated the psychometric properties of the 17-item Man Box Scale and derived a 5-item short form. Using previously collected data (in 2016) from men aged 18-30 years across the United States (n = 1328), the United Kingdom (n = 1225), and Mexico (n = 1120), we conducted exploratory (EFA) and confirmatory factor analyses (CFA), assessed convergent validity by examining associations of the standardized mean Man Box Scale score with violence perpetration, depression, and suicidal ideation, and assessed internal consistency reliability of the full scale. We used item response theory (IRT) to derive a 5-item short form, and conducted CFA and additional assessments for reliability and convergent validity. We identified a single underlying factor with 15 items across all three countries. CFA resulted in good model fit. We demonstrated significant associations of standardized mean Man Box Scale score with violence perpetration (OR range = 1.57-5.49), depression (OR range = 1.19-1.73), and suicidal ideation (OR range = 1.56-2.59). IRT resulted in a 5-item short form with good fit through CFA and convergent validity, and good internal consistency. The Man Box Scale assesses harmful masculinities and demonstrates strong validity and reliability across three diverse countries. This scale, either short or long forms, can be used in future prevention research, clinical assessment and decision-making, and intervention evaluations.

Patriarchy and gender-inequitable attitudes as drivers of intimate partner violence against women in the central region of Ghana.

BACKGROUND: In order to reduce women's exposure to violence and develop culturally appropriate interventions, it is important to gain an understanding of how men who use violence rationalize it. The present study sought to explore the perspectives of men who had used violence on their female partners, specifically their views on intimate partner violence (IPV), gender norms, manhood, their gender attitudes and to understand how these may drive male perpetrated IPV against women in the Central Region of Ghana. METHODS: This was a qualitative study involving purposively sampled adult men who had participated in a household-based survey in selected districts in the Central Region of Ghana and who had self-reported perpetration of IPV in the past 12 months. In-depth interviews were conducted with 17 men. RESULTS: Data revealed how a range of social, cultural, and religious factors ̶ stemming from patriarchy ̶ combined to inform the construction of a traditional masculinity. These factors included the notion that decision-making in the home is a man's prerogative, there should be rigid and distinct gender roles, men's perceptions of owning female partners and having the right to have sex with them whenever they desire, and the notion that wife beating is legitimate discipline. Findings suggest that it was through performing, or aspiring to achieve, this form of masculinity that men used varying forms of violence against their female partners. Moreover, data show that the men's use of violence was a tactic for controlling women and emphasizing their authority and power over them. CONCLUSIONS: Developers of interventions to prevent IPV need to recognize that there is a coherent configuration of aspirations, social norms and behaviours that is drawn on by some men to justify their use of IPV. Understanding the perspectives of men who have perpetrated IPV against women and their motivations for perpetration is essential for interventions to prevent IPV. This is discussed as drawing authority from 'tradition' and so engaging traditional and religious leaders, as well as men and women throughout the community, in activities to challenge this is likely to be particularly fruitful.

Enacting alcohol realities: gendering practices in Australian studies on 'alcohol-related presentations' to emergency departments.

'Alcohol-fuelled violence' and its prevention has been the subject of recent intense policy debate in Australia, with the content of this debate informed by a surprisingly narrow range of research resources. In particular, given the well-established relationship between masculinities and violence, the meagre attention paid to the role of gender in alcohol research and policy recommendations stands out as a critical issue. In this article, which draws on recent work in feminist science studies and science and technology studies, we focus on the treatment of gender, alcohol and violence in Australian research on 'alcohol-related presentations' to emergency departments (EDs), analysing this type of research because of its prominence in policy debates. We focus on four types of 'gendering practice' through which research genders 'alcohol-related presentations' to EDs: omitting gender from consideration, ignoring clearly gendered data when making gender-neutral policy recommendations, methodologically designing out gender and addressing gender in terms of risk and vulnerability. We argue that ED research practices and their policy recommendations reproduce normative understandings of alcohol's effects and of the operations of gender in social arrangements, thereby contributing to the 'evidence base' supporting unfair policy responses.

Men, masculinities and diabetes: 'doing gender' in Italian men's narratives of chronic illness.

There has been a growing interest in the study of masculinity and its intersection with health. However, and despite epidemiological data showing men's general disadvantage in health, there are only a few empirical studies that explore men's experiences of chronic illness. Drawing on empirical data collected in qualitative research on masculinity and autoimmune diabetes, this article investigates the multiple ways in which gender may intersect with health, in an attempt to go beyond the widespread thesis that 'masculinity is bad for men's health'. In line with more recent critical perspectives on the study of men's health that have challenged this oversimplistic assumption, this work further problematises masculinity in relation to health and illness. In-depth interviews have been conducted with 40 young/adult diabetic men from working/middle-class backgrounds. The findings show that gender might intersect health in complex ways and diabetic men can embody and re-signify health practices in order to fulfil or redefine dominant ideals of masculinity. From the analysis, three different 'diabetic masculinities' have been identified and will be discussed: the Diabetic Quantified Self, the Athlete and the Free Spirit.