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改变男性还是改变卫生系统?针对撒哈拉以南非洲地区男性健康的干预措施、服务和方案的范围综述。

Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men's health in sub-Saharan Africa.

机构信息

Health Services Department, Copperbelt University, Jambo Drive, Riverside, Kitwe, Zambia.

Institute for Global Health and Development, Queen Margaret University, Edinburgh, Musselburgh, EH21 6UU, Scotland, UK.

出版信息

Int J Equity Health. 2021 Mar 31;20(1):87. doi: 10.1186/s12939-021-01428-z.


DOI:10.1186/s12939-021-01428-z
PMID:33789688
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8011198/
Abstract

BACKGROUND: Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women's health, which is a long-standing global health priority. We examine literature focused on the 'missing men' in global health research, in particular empirical studies that document interventions, programmes, and services targeting men's health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men's health and how these have influenced the design of men's health interventions and services. METHODS: This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categorise services, interventions, or programs according to their gender-responsiveness was adapted and used for the latter analysis. RESULTS: From the included studies, we distinguished four principal ways in which men were conceptualized in programs and interventions: men are variously depicted as 'gatekeepers'; 'masculine' men, 'marginal' men and as 'clients. Additionally, we classified the gender-responsiveness of interventions, services or programmes described in the studies within the following categories: gender-neutral, -partnering, -sensitive and -transformative. Interventions described are predominantly gender-neutral or gender-partnering, with limited data available on transformative interventions. Health systems design features - focused mainly on achieving women's access to, and uptake of services - may contribute to the latter gap leading to poor access and engagement of men with health services. CONCLUSION: This review highlights the need for transformation in sub-Saharan African health systems towards greater consideration of men's health issues and health-seeking patterns.

摘要

背景:性别已被证明会影响健康素养、寻求健康行为和健康结果。然而,研究性别与健康之间关系的主要集中在女性健康上,这是一个长期的全球健康重点。我们研究了专注于全球健康研究中“缺失的男性”的文献,特别是记录针对撒哈拉以南非洲男性健康问题的干预措施、方案和服务的实证研究。在这些研究中,我们确定了男性和男性健康的主要概念化方式,以及这些概念如何影响男性健康干预措施和服务的设计。

方法:这是对已发表和灰色文献的范围审查。在全面搜索后,我们将 56 项研究纳入审查。我们对所有研究进行了书目分析,并使用归纳方法分析了提到男性概念化和服务设计的文本摘录。我们对现有框架进行了调整,用于根据其对性别响应的程度对服务、干预措施或方案进行分类,并将其用于后者的分析。

结果:从纳入的研究中,我们区分了男性在方案和干预措施中被概念化的四种主要方式:男性被描绘为“守门人”;“阳刚”的男性、“边缘化”的男性和“客户”。此外,我们将研究中描述的干预措施、服务或方案的性别响应性分为以下几类:性别中立、性别合作、性别敏感和性别变革。描述的干预措施主要是性别中立或性别合作,关于变革性干预措施的数据有限。健康系统设计特征——主要侧重于实现妇女获得和接受服务的机会——可能导致后者的差距,导致男性对卫生服务的获取和参与不佳。

结论:本综述强调了撒哈拉以南非洲卫生系统需要向更全面地考虑男性健康问题和寻求健康模式转变。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c934/8011198/9ee6653c8404/12939_2021_1428_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c934/8011198/d5e6a5b61f59/12939_2021_1428_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c934/8011198/892047b07c70/12939_2021_1428_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c934/8011198/9ee6653c8404/12939_2021_1428_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c934/8011198/d5e6a5b61f59/12939_2021_1428_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c934/8011198/892047b07c70/12939_2021_1428_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c934/8011198/9ee6653c8404/12939_2021_1428_Fig3_HTML.jpg

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