Developing Resilience: Gay Men’s Response to Systemic Discrimination

Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men’s resilience in actively resisting discrimination

An exploration of middle-aged and older gay men's health and illness practices

Background: Despite a wealth of knowledge that demonstrates middle-aged and older gay men experience substantial health inequities when compared to heterosexual men, little information is available pertaining to the health and illness practices of gay men. Methods: This dissertation includes three qualitative manuscripts with the overarching aim of exploring middle-aged and older gay men’s health and illness practices. Data were collected via conversational interviews with 25 men who self-identified as gay. The first qualitative descriptive manuscript examined how middle-aged and older gay men developed resilience over time to promote health and wellness. Next, a grounded theory was conducted to describe the processes by which middle-aged and older gay men managed their health. The third manuscript involved a qualitative description of how men experienced their mental health and the strategies they used to mitigate the deleterious effects of mental health challenges. Results: The findings from the first manuscript demonstrated that resilience was developed over time by: (1) building and sustaining networks, (2) addressing mental health, and (3) advocating for self. The grounded theory indicated that the core process of health management is overcoming adversity, which is achieved by three overarching and interrelated processes: (1) advocating for health needs, (2) knowing about health issues and treatments, and 3) engaging in health promoting practices. The third manuscript findings yielded three categories as to how mental health was experienced, and how the deleterious effects of mental health challenges were mitigated: (1) gaining new perspectives of mental health over time, (2) reaching out to formal health services for support with mental health challenges, and (3) engaging in practices to maintain and improve psychological well-being. Conclusion: These findings highlight the influence of age and experience, historical and ongoing discrimination, as well as capacity, to middle-aged and older gay men’s health and illness practices. Consequently, meaningful and effective health services must be developed with recognition of men’s strengths and capacities amidst discrimination. Potential approaches to health service development and delivery to improve health outcomes include equity-oriented primary health care, trauma-informed care, social public health approaches and peer-based services and resources.Applied Science, Faculty ofNursing, School ofGraduat

The process of safer crack use amongst women in Vancouver's downtown eastside

Crack cocaine is prevalent in Vancouver’s Downtown Eastside, with evidence suggesting women use more than men. Crack cocaine poses many harms to the body, and women face unique harms due to the gendered use of crack. However, there has been little investigation into how women go about minimizing some of the harms associated with crack. Informed by harm reduction and women’s-centred philosophies, a grounded theory approach was employed to explore the process that women engage in to limit the physical, psychological and interpersonal harms associated with crack use, as well as identify the social, economic and political factors that influence the process of safer use. Data were collected via seven group interviews (n=27) that took place over a three month period with women who were actively using crack cocaine. Data illustrated women’s crack use patterns shifted over time from heavier to more intermittent use, and four central processes that enabled women to practice safer crack use were identified. At the root of these processes was a dedication to care for the self and others. The processes were identified as: establishing a safe physical space, building trusting relationships, learning about safer crack use, and accessing safer use equipment. These strategies were in turn influenced by larger contextual factors including the spatial environment (violence and police activity), economics (living with extreme financial limitations) and politics (the instability of supportive housing and lack of safe places for women). Women demonstrated proficiency to care for themselves and others in the context of crack use, but many changes within the political and health care systems are necessary to facilitate safer practices to improve health outcomes. Firstly, a political agenda that is dedicated to the development of supportive housing is essential for safer use, as is greater access to income assistance. Furthermore, harm reduction programming that focuses on women’s contributions and expertise in the realm of safer use is essential to ongoing development of a supportive community of women. Moreover, the availability of safer use equipment is quintessential for women to apply knowledge regarding safer crack use to minimize some of the harms associated with crack.Applied Science, Faculty ofNursing, School ofGraduat

Resilience among older adults during the COVID-19 pandemic: A photovoice study

Older adults faced significant challenges during the COVID-19 pandemic but also demonstrated great resilience. Investigating these strengths may enhance and inform strategies to mitigate the impacts of the pandemic. To gain insight into the resilience processes of older adults during the first year of the pandemic, we conducted a photovoice study with 26 older adults (aged over 60) in the province of Quebec, Canada. Participants met online weekly for three weeks in small groups to discuss their photographs and share their resilience strategies. The thematic analysis revealed three interrelated themes. First, participants distanced themselves from the pandemic by engaging in activities that took their focus away from COVID-19 and that afforded much-needed respite. Second, participants regained their bearings by reorganizing their schedules and establishing new routines that bolstered occupation rather than rumination. Third, participants used the pandemic to self-reflect and revise their priorities, leveraging the pandemic as an opportunity for growth. Together, these themes demonstrate the strengths, coping strategies and resilience of older adults and contrast the stereotypes of older adults as vulnerable and resourceless. These findings have the potential to inform the implementation of strength-based health promotion initiatives to mitigate the harms of the pandemic

The process of safer crack use among women in Vancouver’s Downtown Eastside

In this article we discuss the findings from a grounded theory study in which we explored how women residing in Vancouver’s Downtown Eastside (DTES) minimized some of the physical, psychological, and interpersonal harms associated with crack cocaine use, and identify the social, economic, and political factors that influence safer use. Data were collected over a 3-month period and involved group interviews with 27 women at an agency run by drug users in the DTES. A preliminary theory of safer crack use is discussed, consisting of the central phenomenon of caring for self and others. In addition, four thematic processes are described: (a) establishing a safe physical space, (b) building trusting relationships, (c) learning about safer crack use, and (d) accessing safer equipment. Implications of the findings are discussed in relation to supporting women’s efforts and improving health outcomes.Applied Science, Faculty ofNursing, School ofReviewedFacultyGraduat