Ideals on Masculinity May Guide Health Behaviors in Men With MS

Study: Men concerned about 'weakness' may not seek medical help

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Men with multiple sclerosis (MS) show differences in health-related behaviors based on how much they value certain masculine ideals, according to a new study that suggests possible negative effects of masculinity in terms of seeking medical care.

Results from the study — which specifically focused on white males in the U.S. with relatively advanced MS — indicated that men who are very concerned with controlling their emotions tend to report poorer self-care tendencies. Meanwhile, those who are more concerned with appearing heterosexual tend to report a greater tendency toward self-care.

“Masculinity adherence to traditional gender norms was a significant predictor of how men engaged in health behaviors,” the researchers wrote.

“Such information is novel and important to providers serving male patients with MS. The results … can improve provider awareness/conceptualization of male patient needs and elicit needed resources for men to better manage MS symptoms and outcomes,” they wrote.

The study, “Effects of Conformity to Masculine Norms and Coping on Health Behaviors in Men With Multiple Sclerosis,” was published in the International Journal of MS Care.

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MS is nearly three times more common in women than men, but male patients tend to have more severe disease and worse outcomes. For example, men are more likely to have motor symptoms, including loss of coordination, and cognitive difficulties. They also experience specific challenges, such as sexual dysfunction, related to the disease.

An emerging area of study is examining how the way men are socialized impacts their relationship with healthcare.

Masculinity and self-care

“Male socialized gender norms, such as Western culture gender roles … are established at a young age and guide young men in how to be masculine, which is socially reinforced by peers, caregivers, and society at large,” the researchers wrote. “Although such gender norms do not seem to be inherently detrimental and can also teach helpful behaviors (eg, independence, toughness, provision), some behaviors may contribute to differences in health behaviors and disease management.”

For example, some men may not seek medical help due to beliefs that vulnerability, weakness, and dependence are not masculine behaviors. Others also seem to seek healthcare services less frequently because they perceive medical care as more “feminine.”

To better understand how male gender norms affect men with MS, scientists at the Cleveland Clinic, in Ohio, conducted a survey of 81 men with MS. The men had an average age of about 51, and the mean time since diagnosis was more than 12 years. More than 90% of the participants were white males, around half were college-educated, and about 1 in 5 was married.

The men completed three standardized questionnaires, including the Health Behavior Inventory-20 (HBI-20), which measures health-related behaviors. Another was the Ways of Coping Questionnaire (WCQ), which, as its name suggests, assesses coping strategies.

Masculine ideals were assessed with the CMNI-46, which measures a person’s adherence to nine ideas about masculinity that are prevalent in Western cultures. The assessment covered an emphasis on winning, a need for emotional control, power over women, a penchant for violence, and self-reliance.

The scientists conducted a battery of statistical analyses to look for relationships between the various measurements.

Among the notable results, men who reported a greater need to appear heterosexual — one of the nine ideals on the CMNI-46 — tended to report a greater tendency to engage in self-care, as measured by the HBI-20. By contrast, men with a greater need for emotional control tended to report poorer self-care.

Men who reported coping with positive reappraisal, which involves re-assessing oneself in a positive light, tended to also report better self-care.

“Men who endorsed the gender norm of Heterosexual Self-presentation (importance of presenting oneself as heterosexual) reported greater efforts in self-care. In contrast, men with MS who endorsed the gender norm of Emotional Control (emotional restriction and suppression) reported poorer Preventive Self-care,” the researchers concluded. “Specific to coping, men with MS who used the strategy of positive appraisal (create positive meaning by focusing on personal growth) also reported greater effort in self-care.”

Analyses also indicated that men with more substantial perceived physical disability tended to take greater efforts to control their anger and stress, as measured by HBI-20. Men who reported a greater need to appear heterosexual or a penchant for violence tended to score lower for controlling anger and stress.

The researchers noted several limitations of this analysis, including the relatively homogenous sample of mainly older patients who had already been living with MS for some time, and the fact that measures were taken only at one point in time.

The team also noted that they did not assess the men’s sexual orientation in this analysis. Further research into how gender identity affects healthcare for people with MS is needed, they stressed.

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