Masculinity and Race-Related Factors as Barriers to Health Help-Seeking Among African American Men

Abstract

Men's tendency to delay health help-seeking is largely attributed to masculinity, but findings scarcely focus on African American men who face additional race-related, help-seeking barriers. Building principally on reactance theory, we test a hypothesized model situating racial discrimination, masculinity norms salience (MNS), everyday racism (ERD), racial identity, sense of control (SOC), and depressive symptomatology as key barriers to African American men's health help-seeking. A total of 458 African American men were recruited primarily from US barbershops in the Western and Southern regions. The primary outcome was Barriers to Help-Seeking Scale (BHSS) scores. The hypothesized model was investigated with confirmatory factor and path analysis with tests for measurement invariance. Our model fit was excellent CFI = 0.99; TLI = 1.00; RMSEA = 0.00, and 90% CI [0.00, 0.07] and operated equivalently across different age, income, and education strata. Frequent ERD and higher MNS contributed to higher BHHS scores. The relationship between ERD exposure and BHHS scores was partially mediated by diminished SOC and greater depressive symptomatology. Interventions aimed at addressing African American men's health help-seeking should not only address masculinity norms but also threats to sense of control, and negative psychological sequelae induced by everyday racism.

Keywords:

• masculinity
• men's health
• health disparities
• help-seeking
• African Americans

ACKNOWLEDGMENTS

The first author wishes to thank current and past members of the UNC Men's Health Research Lab: Derrick Matthews, Travis Melvin, Justin Smith, Allison Mathews, Dr. Keon Gilbert, Melvin R. Muhammad, and Donald Parker for their assistance with data collection for the African American Men's Health & Social Life Study. The first author also thanks Dr. Amani Nuru-Jeter, Keith Hermanstyne, and Adebiyi Adesina for their assistance with data collection.

Funding

Data collection for this research was supported by the Robert Wood Johnson Foundation Health & Society Scholars Program and The University of North Carolina Cancer Research Fund. Additional research and salary support during the preparation of this manuscript was provided to the first author from the National Institute for Minority Health and Health Disparities (Award #1L60MD002605-01), National Cancer Institute (Grant #3U01CA114629-04S2), and CFAR (Grant #P30 AI50410).The first author is currently supported by the National Institutes of Drug Abuse (Grant #1K01 DA032611-01A1).

Notes

¹ Measurement invariance or measurement equivalence is defined as the “degree to which measurements conducted under different conditions yield equal measures of the same attributes.”¹¹⁷ Tests for ME/I are generally used to answer questions concerning whether individuals from different groups interpret a measure in a conceptually similar manner. Put another way, measurement invariance pertains to whether there is consistency of measurement across subgroups of a given population, and if the operationalization of a construct has the same meaning under different conditions.