Revisiting Bias in Qualitative Research : Reflections on Its Relationship With Funding and Impact

Recognizing and understanding research bias is crucial for determining the utility of study results and an essential aspect of evidence-based decision-making in the health professions. Research proposals and manuscripts that do not provide satisfactory detail on the mechanisms employed to minimize bias are unlikely to be viewed favorably. But what are the rules for qualitative research studies? Whenever I am reviewing a thesis, manuscript, or research proposal involving qualitative research and I come across attempts to manage “bias,” it always gives me cause for concern. Here, I outline the reasons for my concern and reflect on whether the growing tendency of qualitative researchers trying to manage “bias” in their work is due to the increasing pressure to demonstrate research outputs lead to quantifiable impact

Older men and loneliness : a cross-sectional study of sex differences in the English Longitudinal Study of Ageing

Background Research into men and masculinities suggests men may be more reluctant than women to state they are lonely, more reliant on partners/spouses and/or alcohol to tackle it, and that this may be a result of poorer social relationships. Ageing is often associated with loneliness, and research has indicated gendered results in older people, but existing evidence lacks generalisability and cultural context. This study tests hypotheses on sex differences in loneliness in older England-based men and women. Methods We conducted a cross-sectional study using a sample of 6936 respondents aged 50 + from the English Longitudinal Study of Ageing (wave 8). Multiple imputation with chained equations was conducted to handle missing data. Multivariate regression was used to investigate the impact of sex on a direct question on loneliness whilst controlling for the University of California loneliness (UCLA) scale. Multivariate regression with interaction terms were used to examine sex differences in loneliness and alcohol consumption, partner status, and social relationships. Results Older men were less likely than older women to state they are lonely even when controlling for UCLA score. Older men showed a greater association between loneliness and alcohol consumption, but only when measuring the number of units consumed in the last week, and not using a less precise measure of the past year. Older men who cohabited with a partner were less lonely than cohabiting older women, whereas previously married but not cohabiting older men were lonelier than their female counterparts. However, never married older men were less lonely than never married older women. Evidence was found to suggests older men’s worse friendships mediated this association, but social isolation and number of close relationships did not. Severe isolation predicted greater loneliness in older women, but not older men. Conclusions Cultural ideals of masculinity and older men’s poorer quality friendships may explain their reluctance to directly state loneliness, greater dependency on partners/spouses, and use of alcohol. Severely isolated older men may under-report loneliness on the UCLA scale as well as a direct question

Reconceptualising men's loneliness: An interpretivist interview study of UK-based men

Loneliness has been extensively linked to negative physical and mental health outcomes. Often defined as a subjective emotion, the influence of sex and gender has regularly been cited as vital to understanding individuals' experiences. Despite this, little research has explored men's perspectives of loneliness using interpretivist approaches. This study addresses this by exploring how gender influences men's constructions and experiences of loneliness in an interview study with a diverse sample of 20 UK-based men. Theoretical thematic analysis led to the generation of a novel conceptualisation of loneliness comprising four interconnected themes: socially negotiated self-worth (an intersubjectively defined mental state); being positively occupied (a mental state of meaningful focus/action); social connections (vital for consistently achieving these mental states); and capacity to form social connections. A second ‘layer’ in the findings describes how cultural norms of masculinity impacted loneliness defined in this way. Notions of invulnerability and social comparison could render it more difficult for men to form intimate and supportive connections or seek help for loneliness. However, as they were normative, they could also promote self-worth, and facilitate social connections, despite these negative effects. Similarly, masculine roles, in particular family roles, represented a normative framework for preventing loneliness, and could be both beneficial or problematic depending on other aspects of life, identity, or needs. The study offers insight into how men negotiate loneliness within a habitus incorporating multiple and varied gendered norms, values, and structures. Policy and practice interventions could usefully consider and mitigate the risks posed by non-conformity, aim to promote mental states of self-worth and positive occupation, and work to deconstruct masculine norms and values where appropriate

A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)

Review methods: In the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis. Results: Forty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men. Conclusions: Health professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities

Services just for men? Insights from a national study of the well men services pilots.

Men continue to have a lower life expectancy in most countries compared to women. Explanations of this gendered health inequality tend to focus on male risk taking, unhealthy lifestyle choices and resistance to seeking help from health services. In the period 2005-2008 the Scottish Government funded a nationwide community health promotion programme aimed at improving men's health, called Well Men Service Pilots (henceforth WMS)

Men and suicide prevention : a scoping review

Background: Male suicide rates are higher than their female counterparts in almost every country around the world. Several developed countries have attempted to implement suicide prevention programmes, but few have specifically targeted men. Aims: To identify what is currently known about suicide prevention strategies, programmes, and interventions of relevance to men. Method: A scoping review guided by Arksey and O'Malley’s five-stage framework. Results: 22 studies were included. Thematic analysis identified three categories: (i) male suicide prevention interventions; (ii) factors or coping strategies that interrupt the suicidal process in men; (iii) men’s perspectives on service provision. Interventions included awareness campaigns; training of community ‘gatekeepers’; psychological support; and educational initiatives targeted to either GPs or depressed or suicidal men. Men emphasised the need to receive support from a trusted and respected individual, preferably in an informal setting. Connecting with others, reframing help-seeking as masculine, and the use of emotional regulation techniques were all identified as factors with potential to interrupt the suicidal process. Conclusions: This review demonstrates the need for further research examining the perspectives of suicidal middle-aged men and their close family and friends

Intersecting identities, diverse masculinities, and collaborative development : Considerations in creating online mental health interventions that work for men

Online mental health interventions have received attention for their potential to bypass barriers that stop men from seeking mental health help from a health professional. However, emerging data suggest that men's use of online mental health interventions is low, and when used, early attrition is common. In this commentary, we hypothesise that men's common lack of engagement with online mental health interventions may reflect limited attention being paid to the needs and preferences of potential users during their development. We outline a series of considerations that we believe are important to advance the development of acceptable, effective online mental health interventions for men: (1) men's diverse and intersecting characteristics, circumstances, and needs; (2) centring positive, progressive masculinities; and (3) listening to, learning from, and working in partnership with men to develop interventions. We also examine how existing online mental health interventions targeting men have engaged with these considerations

Coping Strategies, Psychological Impact, and Support Preferences of Men With Rheumatoid Arthritis: A Multicenter Survey.

OBJECTIVE: To investigate the existence and distribution of 2 typologies (termed "factors") of men with rheumatoid arthritis (RA) identified through our previous Q-methodology study (n = 30) in a larger sample of men with RA, and whether differences in psychosocial impact or support preferences exist between the 2 factors, and between men and women with RA. METHODS: A postal survey was sent to 620 men with RA from 6 rheumatology units across England, and the support preferences section of the survey was given to 232 women with RA. RESULTS: A total of 295 male patients (47.6%) and 103 female patients (44.4%) responded; 15 male participants had missing data, and thus 280 were included in the analysis. Of these, 61 (22%) were assigned to factor A ("accept and adapt"), 120 (35%) were assigned to factor B ("struggling to match up"), and 99 (35%) were unassigned. The two factors differed significantly, with factor B reporting more severe disease, less effective coping strategies, and poorer psychological status. For support, men favored a question and answer session with a consultant (54%) or specialist nurse (50%), a website for information (69%), a talk by researchers (54%), or a symptom management session (54%). Overall, women reported more interest in support sessions than men, with ≥50% of women reporting interest in nearly every option provided. CONCLUSION: Some men accept and adapt to their RA, but others (43%) report severe disease, less effective coping, and poor psychological status. Men's preferences for support are practical, with a focus on expanding their knowledge