As the main aim of the thesis is to investigate how ethnicity and culture connect, and influence health help seeking behaviours of men in Brunei, I will first share briefly some of the key ideas emerging from research on men’s health help seeking behaviour across different cultural and ethnic groups. I will enter into a fuller discussion and consideration of this literature in the next chapter of
this thesis. The primary objective here is to sketch the context of our current understanding and demonstrate the gap in the knowledge base that the review, which follows in chapter 2, addresses.
It is first, however, incumbent on me to explain the relationship between ethnicity and culture having until now referred explicitly to culture but not introduced the idea of ethnicity. In this thesis it is apparent that these concepts are somewhat distinctive but also overlap. For example, men in Brunei share aspects of their cultural life and identity as Bruneian but may also come from different ethnic groups (Malay, Chinese, and Iban, for example). In many studies this distinction or indeed the relationship conceptualised between ethnicity and cultural identities is not explicitly articulated.
That said, whilst little research has been conducted on health help- seeking amongst non-western men, much has been written on non- Western masculinities and particularly relating this to the concept of hegemonic masculinities. This is critical to this thesis in that taking the findings of this research into consideration helps to enable me to make more accurate claims about how my work fits with the existing body of research addressing men’s health help seeking behaviour.
Overall, it can be demonstrated that male behaviours and attitudes that affect men’s health are strongly influenced by culture. As
mentioned earlier, a traditional masculine ideal common in the West emphasises healthy, strong and self-sufficient men (Steve. Robertson & Williams, 1998). At the same time, however, studies have also shown that what men consider “manly” varies by culture.
For example, a study from 2005 (Hjelm, Bard, Nyberg, & Apelqvist, 2005) explored the health and illness beliefs of Arab men, men from Sweden, and men from the former Yugoslavia, all with diabetes. This study revealed the disparities in belief about health and health practices amongst the various cultural and ethnic groups. This study found that Arab men showed more active information-seeking behaviour than men in other groups and regarded this as more gender-appropriate in comparison to their white counterparts.
The work of Galdas, Cheater & Marshall (2007) further confirmed Hjelm et al’s claim. Galdas et al showed that the Caucasian male conforms to the traditional idea of masculinity in which they perceived health seeking as weak. In this study, conducted in the UK, researchers interviewed white patients who had survived a heart attack and they concluded that their fears of being seen to be weak contributed to delays in seeking medical care and led to reluctance to disclose symptoms to others. Yet the same study found that South Asian men tended to regard seeking help as more appropriate (P. Galdas et al., 2007). These South Asian men emphasised wisdom,
education and responsibility for their family and their own health as highly valued masculine attributes, and this contributed to a greater willingness to seek medical help. Similar findings were also seen in studies conducted in the global south. Following on from the observation about the importance of family responsibilities made by Galdas et al, Cleaver (2002) found that there are strong links between ‘masculinity’, employment and family issues in Latin America. This study suggests that men’s idea of what it is to ‘be a man’ are strongly oriented by concerns to be the main financial provider to the family. Men from Latin America see the importance of their role as a man in relation to employment and ability to provide for families. What may be discernable in these studies is that similar environmental conditions bear on men’s ideas about masculinity and health but that cultural factors may enable them to be mobilized and play out differently. For example, the importance of ‘bread-winning’ and leadership of the household is important to male identities in the Global North, Latin America and amongst Asian men in the UK but the requirement on men from these groups to rethink this relationship and its implications may differ according to their cultural traditions and the resources that these provide. Meanwhile, for instance, there has been a great deal of change in the social and economic environment in which men (particularly these Western men, living in the developed Global north countries) are growing up today and that experienced by their grandfathers who had a clearly defined role as
the authority in the family (Cleaver, 2002). It may be that these changes may not have taken place yet in the South Asian community and consequently they have attached a different priority to what they consider to be important masculine attributes from their Western counterparts. They may, in short, be part of or living within a north- western culture but able to draw on and mobilise other cultural traditions to make sense of their masculinity within it.
As I will show, in the literature review that follows in chapter 2, whilst the pool of research relating to men outside the global northwest is somewhat limited in terms of the number of studies, findings show clear differences but also continuities in health help seeking behaviour between men of different ethnicities and in different cultural contexts. It is also critical to note that the study by Galdas, Cheater & Marshall (2007) only involved studying the perceptions of men resident in a north-western hemisphere country, similar to other studies as aforementioned (Courtenay, 2003; O’Brien, Hunt and Hart, 2005; García-Calvente et al., 2012; Hennessy and Mannix-Mc Namara, 2014) It can be argued that Asian men who live in their country of origin may have different views in comparison to those who were born and live abroad. This would be plausible given that social environment may influence and shape their lifestyles and attitudes. Indeed, one valid criticism of much of the research literature would be that the studies to which it relates were conducted
in the Western Europe. There are no studies that specifically look into health help seeking behaviour of men in South East Asia, apart from those which are mainly on urological problems (Li, Garcia, & Rosen, 2005; Low, Khoo, Tan, Hew, & Teoh, 2006; Low, Ng, Choo, & Tan, 2006; Low, Tong, & Tan, 2008; Ping, Meng, Yun, & Jenn, 2013; H. M. Tan et al., 2007; W. S. Tan, Ng, Khoo, Low, & Tan, 2011), physician’s view on men’s’ health (Seng Fah Tong, Low, Ismail, Travena, & Willcock, 2011; Yates, Low, & Rosenberg, 2008) and Malaysian men’s and women’s general perception of men’s heath (Yun et al., 2008). The latter study (Yun et al., 2008) published in a book entitled “About Men’s health: views from Mars and Venus”, provides a general overview of men’s and women’s perceptions of men’s health and illness in Malaysia but did not explore this from the lens of masculinity and its relation to health. There has never been a study focusing on men’s health in Brunei Darussalam.