The influence of masculinity on white and south Asian men's help seeking behaviour for chest pain

Coronary heart disease is the leading cause of premature death for men in the UK. The mortality rate is almost twice as high for South Asian men living in the UK compared to the rest of the population. There is established evidence that prompt diagnosis and treatment of heart disease significantly reduces morbidity and mortality. However, there is a growing body of literature to suggest that `masculinity' may lead men to be reluctant to seek medical help when experiencing symptoms of ill health. It is not known whether there are differences or similarities between white and South Asian men relating to the influence of masculinity on their help-seeking behaviour for chest pain. This thesis aims to address this gap in the literature by exploring how masculinities influence white and South Asian men's decision to seek or delay-seeking medical help for acute chest pain. A modified grounded theory methodology employing in-depth interviews was used in two studies that investigated the help-seeking experiences of white and South Asian men who had been admitted with acute cardiac chest pain to two hospitals in the North East of England. Thirty-six men were interviewed for the first study; twenty men were interviewed for the second study. The two studies revealed that both white and South Asian men of Indian and Pakistani origin engaged in a complex process of help-seeking decision-making when experiencing acute chest pain symptoms. The main findings of the thesis highlight white and South Asian men's differing perceptions and behaviours associated with the core concept of this process defined as `acting like a man'. The core concept illustrated that the salient feature of men's help seeking decision-making process related to how they perceived they should `act as a man' whilst experiencing chest pain. For the majority of South Asian men of Indian and Pakistani origin, the concept corresponded to culturally distinct representations of masculinity that were principally signified by a belief that chest pain was a symptom worthy of concern, and a willingness to discuss their symptoms with others and seek help from their GP. By contrast, for the majority of white men, the core concept corresponded to hegemonic representations of masculinity that were principally signified by a belief that chest pain alone was a symptom unworthy of concern, a perceived need to display a high tolerance for pain, and a fear of being seen to be acting `soft' by others if they sought medical help. The thesis argues that a `gender-sensitive' approach to healthcare practice and policy should recognise the way ethnicity shapes how men represent their masculinity in the context of seeking help, and that current prevailing theories of masculinity that consider first generation Indian and Pakistani men's representations of masculinity as `marginalised' in this context are overly simplistic and ethnocentric.