Abstract
As a population, adult males in the United States are measurably less connected to the health care system than adult females. In general, men are less likely than women to make use of preventive health care, less likely to carry health insurance, and less likely to have seen a physician in the previous year. The Centers for Disease Control and Prevention studied ambulatory care use by the genders, finding that even when pregnancy-related visits are omitted, “the rate of doctor visits for such reasons as annual examinations and preventive services was 100 percent higher for women than for men.” 1 One third of men (as opposed to less than one fifth of women) reported having no regular physician. Twenty-four percent of men as opposed to only 8% of women reported not having seen a physician in the past year, and these disparities are greatest in young adulthood. 2 One of the most striking findings has been that men tend not to seek medical care in response to subjective pain or signs of illness, with less than 20% of males stating that they would seek help promptly if faced with these circumstances. 2 Men of minority groups (African American and Latino) in all income brackets (poor, near-poor, middle, and high income) are only half as likely to have seen a physician in the past year 3 and are also less likely to have health insurance than their respective female counterparts. 4
To be effective, any process of getting and keeping a specific target population in health care must be tailored to that population’s specific cultural nuances, socialization, manner of language, and interpersonal interaction styles. While it is true that the genders often have real and sometimes very subtle biological differences that affect health outcomes, it is also clear that they are typically socialized very differently. For instance, men often display stoic attitudes toward pain and fear by virtue of gender role training, which may lead them to delay in, or avoid, seeking health care when ill or in pain. The principles of cultural sensitivity and linguistic appropriateness that are deemed essential in approaching research and treatment aimed at racial and ethnic minorities is being called for in dealing with the genders as well.
In general, men are less likely than women to make use of preventive health care, less likely to carry health insurance, and less likely to have seen a physician in the previous year.
At the present time, in-depth information about the attitudes and beliefs that keep adult males out of health care have not been adequately examined. This oversight has contributed to a critical lack of knowledge about men’s attitudes concerning health and barriers to men’s adoption of healthier behaviors. For this reason, the work of Garfield, Isacco, and Sahker represents a novel and important contribution to our scientific knowledge on two key factors that may facilitate or inhibit the participation of males in health care, religion and spirituality.
Different schools of thought exist among health care practitioners as to whether religious and spiritual belief systems can be helpful to patients or whether they may be actually harmful. The authors do not shy away from existing controversies about the role of religion and spirituality in men’s health behaviors, instead presenting a well-balanced discussion on the issues. The names and viewpoints of proponents on both sides of the subject are discussed in considerable detail. The article is quite generously referenced, with many up-to-date citations supporting each of the authors’ contentions over a wide range of areas. This expansive referencing is called for, because interrelationships between the issues of religion/spirituality and gender, race, sexual orientation, and ethnicity may be quite complex, often affecting different demographic groups in unexpectedly different ways.
An important factor cited by the authors affecting health involvement for men is that the general public tends to be considerably more likely to hold deeply felt religious or spiritual beliefs than health care practitioners as a group. This disparity often results in a gulf between the belief systems of practitioners and those of patients, leading to mutual difficulties in communication and understanding, which may in turn undermine men’s health care participation and patient compliance. This underscores the need for practitioners to make concerted efforts to understand, respect, and work in concert with the beliefs of their clients in order to be maximally effective in their role as providers.
The authors also make important distinctions between religion and spirituality, religion being defined as participation in an organized community as opposed to spirituality as a set of individually held subjective beliefs. This distinction is important as the two factors may not affect participation in health care in the same ways in several respects. Different health care issues may interrelate in different or even opposite ways to various religious and spiritual beliefs, and variation among subsets of the male population (race, ethnicity, and sexual orientation) may further compound the interaction. Important differences between the genders in religious and spiritual beliefs are discussed, as well as their potential impact on support networks, ability to cope, and disease prevention behaviors associated with religion and spirituality.
Four major areas of health care and their respective subsets are explored in detail, each demonstrating unique interactions with religion and spirituality. These include prostate cancer screening and coping with the diagnosis of prostate cancer; HIV/AIDS prevention and living with HIV; addictions to substances, sex, and gambling; and palliative care. In the area of prostate cancer, detailed relationships were demonstrated between religion/spirituality and informed decision making, screenings, patient knowledge of treatment options and consequences, trust in health practitioners, characteristics of specific ethnic groups, coping with prostate cancer, and finding meaning and peace within a diagnosis.
Concerning HIV, the impact of religion/spirituality on prevention of transmission, medical costs, and varying reactions among specific demographic groups is discussed. Gender differences in rates of addiction to substances, sexual behaviors and pornography, and gambling are presented, with interrelations between men’s addictive behaviors and spirituality/religion often yielding unexpected findings. Race/ethnicity, level of religious belief, type of addiction all may affect treatment outcome in complex ways, with spirituality sometimes serving as an actual risk factor for certain addictions.
Regarding palliative care, many significant interactions of gender, sexual orientation, specific religious affiliation, and ethnicity were demonstrated. The role of the practitioner in uncovering, understanding, and respecting a patient’s religiously based beliefs and concerns to address end-of-life considerations is stressed. Valuable interview techniques for exploring a patient’s religious/spiritual beliefs are provided, as well as the importance of provider self-awareness in accepting and working with those beliefs. Vital resources are offered for improving outcomes in accordance with patient beliefs, including referral sources.
Finally, Garfield, Isacco, and Sahker suggest specific strategies concerning the issue of religion and spirituality that would likely increase the health care participation rates among men. The authors conclude with a series of recommendations for clinicians to incorporate an understanding of religion and spirituality into their patient encounters. Depending on patient needs, some suggested interventions include group therapy, 12-step support groups, referring patients to a spiritual/religious leader, behavioral therapy, and “spiritual strengthening,” which refers to a therapeutic approach aimed at improving the patient’s acceptance of meaning, values, and beliefs in order to promote more sensitive treatment and prevention. The work of these authors addresses a previously unrecognized health care barrier for men as a population relatively disconnected from medical services. Persons concerned with improving men’s participation in health care will find this article novel, uniquely illuminating, and informative.