"Some They Need Male, Some They Need Female": A Gendered Approach for Breast Cancer Detection in Uganda.

Introduction: There are several challenges associated with breast cancer detection in Uganda and other low-and-middle-income countries. One of the identified challenges is attributed to the health workers' gender, which facilitates gender disparities in access to breast cancer detection services. Although this challenge is well acknowledged in existing literature, there are hardly any studies on how it can be addressed. Therefore, drawing on an intersectionality lens, our study examined how to address gender disparities facilitated by health workers' gender in accessing breast cancer detection services in Uganda. Materials and Methods: We collected qualitative data through semi-structured interviews with twenty participants comprising community health workers, primary health care practitioners, non-governmental organizations, district health team, and the Ministry of Health. For the data analysis, thematic analysis was conducted on NVivo using Braun and Clarke's non-linear 6-step process to identify the themes presented in the results section. Results: Four themes emerged from the data analysis: understanding a woman's gender constructions; health workers' approachability; focus on professionalism, not sex; and change in organizational culture. These themes revealed participants' perceptions regarding how to address gender disparities relating to the role health workers' gender play in breast cancer detection. Through the intersectionality lens, our findings showed how gender intersects with other social stratifiers such as religious beliefs, familial control, health worker's approachability, and professionalism within the health workforce. Conclusion: Our findings show that the solutions to address gender disparities in breast cancer detection are individually and socially constructed. As such, we recommend a gendered approach to understand and redress the underlying power relations perpetuating such constructions. We conclude that taking a gendered approach will ensure that breast cancer detection programs are context-appropriate, cognizant of the prevailing cultural norms, and do not restrict women's access to breast cancer detection services.

A discursive analysis of compliance, resistance and escalation to threats in sexually exploitative interactions between offenders and male children.

There is a notable scarcity of empirical studies focusing on online sexual grooming using real world, naturally occurring data. Limited research with real victims (as opposed to decoys) has indicated that more overt forceful threats are employed by offenders in such interaction; however, they tell us little about how these threats are built up and managed by both parties. Furthermore, the majority of research focuses on female victims, with limited attention paid to male victims. The current study presents a discursive psychology analysis of chat logs between one offender (posing as a teenage girl) and five male victims under the age of 16 years, in order to explore how victims attempt to resist such manoeuvres in situ, and how offenders manage such resistance. The sexualized nature evidenced in our data contrasts with other findings which suggest that boys are not sexually solicited and that interactions with boys are less aggressive and forceful. Our findings demonstrate for the first time how an offender escalated his issuing of threats following victims' resistance and non-compliance to requests. Turning points that appeared odd in the online interactions suggest that they may be used to encourage children to be more reflective about any further engagement.

Food assessment: a discursive analysis of diet talk in interviews with older men who are obese.

Objective: Obesity rates are increasing faster in men than in women, with particular concerns raised regarding older men. However, men are less likely than women to engage in weight-loss activities such as dieting, typically constructed as a feminine practice. Previous research has argued that men's food consumption is notably different and unhealthier than women's. The novel contribution of this article is an analysis of food assessments in order to explore how older men (mostly) undergoing weight management programmes make sense of changes in their nutritional intake. Design: Semi-structured interviews were conducted with 30 men who were obese, 27 of whom were engaged in weight loss programmes. Discursive psychology was employed to analyse the data. Results: In contrast to other research, participants constructed nutritional advice as enlightening. Participants worked up 'ownership' and pleasure assessments to certain food choices which they contrasted with new, less calorific, eating practices. Moreover, new diets were constructed as acceptable. Conclusion: Our study contributes new insights about how nutritional advice impacts upon preconceived (mis)understandings of healthy eating practices. During the interviews, men positioned themselves as educators - health promoters might usefully develop nutritional advice in collaboration with men who have successfully changed their diets for optimum effect.

A Qualitative Analysis of Offenders' Modus Operandi in Sexually Exploitative Interactions With Children Online.

Transcripts of chat logs of naturally occurring, sexually exploitative interactions between offenders and victims that took place via Internet communication platforms were analyzed. The aim of the study was to examine the modus operandi of offenders in such interactions, with particular focus on the specific strategies they use to engage victims, including discursive tactics. We also aimed to ascertain offenders' underlying motivation and function of engagement in online interactions with children. Five cases, comprising 29 transcripts, were analyzed using qualitative thematic analysis with a discursive focus. In addition to this, police reports were reviewed for descriptive and case-specific information. Offenders were men aged between 27 and 52 years ( M = 33.6, SD = 5.6), and the number of children they communicated with ranged from one to 12 ( M = 4.6, SD = 4.5). Victims were aged between 11 and 15 ( M = 13.00, SD = 1.2), and were both female and male. Three offenders committed online sexual offenses, and two offenders committed contact sexual offenses in addition to online sexual offenses. The analysis of transcripts revealed that interactions between offenders and victims were of a highly sexual nature, and that offenders used a range of manipulative strategies to engage victims and achieve their compliance. It appeared that offenders engaged in such interactions for the purpose of sexual arousal and gratification, as well as fantasy fulfillment.

"Our people has got to come to terms with that": changing perceptions of the digital rectal examination as a barrier to prostate cancer diagnosis in African-Caribbean men.

OBJECTIVE: African-Caribbean men in the United Kingdom in comparison with other ethnicities have the highest incidence rate of prostate cancer. Psychosocial aspects related to screening and presentation impact on men's behavior, with previous studies indicating a range of barriers. This study explores one such barrier, the digital rectal examination (DRE), due to its prominence within UK African-Caribbean men's accounts. METHODS: African-Caribbean men with prostate cancer (n = 10) and without cancer (n = 10) were interviewed about their perceptions of DRE. A synthetic discursive approach was employed to analyze the data. RESULTS: Findings illustrate that an interpretative repertoire of homophobia in relation to the DRE is constructed as having an impact upon African-Caribbean men's uptake of prostate cancer screening. However, the discursive focus on footing and accountability highlight deviations from this repertoire that are built up as pragmatic and orient to changing perceptions within the community. CONCLUSIONS: Health promotion interventions need to address the fear of homophobia and are best designed in collaboration with the community.

Applying discursive approaches to health psychology.

OBJECTIVE: The aim of this paper is to outline the contribution of two strands of discursive research, glossed as 'macro' and 'micro,' to the field of health psychology. A further goal is to highlight some contemporary debates in methodology associated with the use of interview data versus more naturalistic data in qualitative health research. METHOD: Discursive approaches provide a way of analyzing talk as a social practice that considers how descriptions are put together and what actions they achieve. RESULTS: A selection of recent examples of discursive research from one applied area of health psychology, studies of diet and obesity, are drawn upon in order to illustrate the specifics of both strands. 'Macro' discourse work in psychology incorporates a Foucauldian focus on the way that discourses regulate subjectivities, whereas the concept of interpretative repertoires affords more agency to the individual: both are useful for identifying the cultural context of talk. Both 'macro' and 'micro' strands focus on accountability to varying degrees. 'Micro' Discursive Psychology, however, pays closer attention to the sequential organization of constructions and focuses on naturalistic settings that allow for the inclusion of an analysis of the health professional. CONCLUSION: Diets are typically depicted as an individual responsibility in mainstream health psychology, but discursive research highlights how discourses are collectively produced and bound up with social practices.

Stumbling into sexual crime: the passive perpetrator in accounts by male internet sex offenders.

Public reactions to internet child offending remain ambivalent in that, while there is vocal condemnation of contact child sex offending, there is less indignation about internet child abuse. This is potentially due to a lack of recognition of this type of offence as sexual offending per se. This ambiguity is reflected by internet sex offenders themselves in their verbalizations of their offending. This article presents a qualitative analysis of the accounts offered by seven individuals convicted of internet-based sexual offences involving the downloading and viewing of images of children. In particular, this article presents an analysis of the explanations of offenders for the commencement of internet activity and the progression to more illicit online materials. The data were collected through semi-structured interviews and analyzed using discursive methods, paying close attention to language use and function. The analysis documented the practices that internet child abusers employed in order to manage their identities, distance themselves from the label of sex offender, and/or reduce their personal agency and accountability. Implications of this analysis are discussed with reference to the current minimization of the downloading of sexually explicit images of children as a sexual crime per se by the public and offenders alike and the risk assessment and treatment of individuals convicted of these offences.

'It's not a disease, it's a nuisance': controlling diabetes and achieving goals in the context of men with Type 1 diabetes.

Despite a steady growth in research into men's health, little is known about how men experience life with a chronic illness like Type 1 diabetes. To address this knowledge gap, we conducted an interview study with 15 men who have Type 1 diabetes. Following grounded theory analysis of the interview transcripts, we generated a number of inter-related themes which were then formulated as a theory of adjustment to life with Type 1 diabetes. This theory indicates that men reduce the seriousness of diabetes by defining it in ways other than a serious illness. By viewing diabetes in this way, men are then able to prioritise the pursuit of their personal goals over adherence to the diabetes regimen. Finally, men reassess their relationship with diabetes in light of diabetes-related complications. The goal of this process is to find the 'best fit' for diabetes in their lives - a place which will allow them to pursue and satisfy their personal goals. As men progress through life, personal goals may change and so too will their relationship with diabetes.

A reconsideration of the gendered mechanisms of support in online interactions about testicular implants: a discursive approach.

OBJECTIVE: Researchers have observed gender differences in the frequency of emotion language used in cancer forums, with men more likely to seek medical information and women more likely to seek social and emotional support (Blank, Schmidt, Vangsness, Monteiro, & Santagata, 2010; Seale, Ziebland, & Charteris-Black, 2006). The aim of this article was to investigate Internet support groups to examine the support mechanisms that men employed when deciding whether or not to have a testicular implant. METHOD: The four longest threads about prostheses were taken from four separate testicular cancer online support forums (totaling a number of 129 posts). A discursive approach (Edwards & Potter, 2001) was employed in order to consider what support mechanisms were employed by men. RESULTS: Findings illustrate that men employed a number of discursive strategies in "doing" support, including assessments, attending to issues of accountability, humor, providing alternative information, constructing decisions as personal choices, reconstituting normality, and sanctioning "emotional" talk. CONCLUSIONS: The psychological benefits of online homosocial support are discussed, and it is suggested that clinicians recommend Internet support groups to men with testicular cancer in order to start the psychological healing process.

Monitoring and normalising a lack of appetite and weight loss. A discursive analysis of an online support group for bariatric surgery.

A significant adjustment in eating practices is required before and after bariatric surgery, yet we know relatively little about how patients manage these changes. In this paper, we explored how members of an online bariatric support group constructed their appetite and weight loss. Two hundred and eighty four online posts were collected, covering a period of just over a year, and analysed using discursive psychology. We found that a lack of appetite post-surgery was oriented to as something that was positively evaluated yet a cause for concern. Indeed, members monitored their food intake and marked out food consumption as a necessary activity in line with notions of healthy eating. Through monitoring members also normalised periods of weight stabilisation and were inducted into a group philosophy which encouraged a more holistic approach to post-surgery 'success'. Our analysis also highlights how monitoring and policing work as social support mechanisms which help to maintain weight management. Thus we argue, in line with others, that weight management, typically depicted as an individual responsibility, is bound up with the social practices of the online support group. We suggest that clinical advice about a loss of appetite and periods of weight stabilisation post-surgery perhaps need further explanation to patients.

'Blokes don't like that sort of thing': men's negotiation of a 'troubled' self-help group identity.

Research has demonstrated that gender is a barrier to men's participation in self-help groups. In this article I analyse how four men and seven women negotiate their identities as members of cancer self-help groups. Their accounts were transcribed and analysed using a synthetic approach to discursive psychology. Women's accounts were organized around the notion of receiving help whereas men appeared to resist this type of identity. I explore how men attended to the presentation of a masculine identity and focus on how men negotiated 'legitimately masculine' reasons to be engaged in self-help groups.

'My Wife Ordered Me to Come!': A Discursive Analysis of Doctors' and Nurses' Accounts of Men's Use of General Practitioners.

This study used a discursive approach to analysing doctors' and nurses' accounts of men's health in the context of general practice. The analysis worked intensively with interview material from a small sample of general practitioners and their nursing colleagues. We examine the contradictory discursive framework through which this sample made sense of their male patients. The 'interpretative repertoires' through which doctors and nurses constructed their representations of male patients and the 'subject positions' these afforded men are outlined in detail. We describe how hegemonic masculinity is both critiqued for its detrimental consequences for health and paradoxically also indulged and protected. These constructions reflect a series of ideological dilemmas for men and health professionals between the maintenance of hegemonic masculine identities and negotiating adequate health care. Men who step outside 'typical' gender constructions tended to be marked as deviant or rendered invisible as a consequence.