abstract: 'Background: Delay by men in seeking healthcare results in their higher

  mortality while on HIV or tuberculosis (TB) treatment and contributes to

  ongoing community-level disease transmission before going on treatment.

  Objective: To understand masculinity''s role in delay in healthcare

  seeking for men, with a focus on TB-suggestive symptoms.

  Design: Data were collected between March 2011 and March 2012 in

  low-income suburbs in urban Blantyre using focus group discussions with

  community members (n = 8) and health workers (n = 2), in-depth

  interviews with 20 TB patients (female = 14) and 20 uninvestigated

  chronic coughers (female = 8), and a 3-day participatory workshop with

  27 health stakeholder representatives. The research process drew to a

  large extent on grounded theory principles in the manner of Strauss and

  Corbin (1998) and also Charmaz (1995).

  Results: Role descriptions by both men and women in the study

  universally assigned men as primary material providers for their

  immediate family, that is, the ones earning and bringing livelihood and

  additional material needs. In a context where collectivism was valued,

  men were also expected to lead the provision of support to wider kin.

  Successful role enactment was considered key to achieving recognition as

  an adequate man; at the same time, job scarcity and insecurity, and low

  earnings gravely impeded men. Pressures to generate continuing income

  then meant constantly looking for jobs, or working continuously to

  retain insecure jobs or to raise money through self-employment. All this

  led men to relegate their health considerations.

  Conclusions: Early engagement with formal healthcare is critical to

  dealing with TB and HIV. However, role constructions as portrayed for

  men in this study, along with the opportunity costs of acknowledging

  illness seem, in conditions of vulnerability, important barriers to

  care-seeking. There is a need to address hidden care-seeking costs and

  to consider more complex interventions, including reducing precarity, in

  efforts to improve men''s engagement with their health.'
affiliation: 'Chikovore, J (Corresponding Author), Human Sci Res Council, Sexually
  Transmitted Infect \& TB, HIV AIDS, 750 Mary Thipe Rd, ZA-4001 Durban, South Africa.

  Chikovore, Jeremiah, Human Sci Res Council, Sexually Transmitted Infect \& TB, HIV
  AIDS, ZA-4001 Durban, South Africa.

  Hart, Graham, UCL, Sch Life \& Med Sci, London, England.

  Kumwenda, Moses; Chipungu, Geoffrey A., Helse Nord TB Initiat, Coll Med, Blantyre,
  Malawi.

  Kumwenda, Moses; Corbett, Liz, Malawi Liverpool Wellcome Res Programme, Blantyre,
  Malawi.

  Corbett, Liz, London Sch Hyg \& Trop Med, London WC1, England.'
article-number: '26292'
author: Chikovore, Jeremiah and Hart, Graham and Kumwenda, Moses and Chipungu, Geoffrey
  A. and Corbett, Liz
author-email: jchikovore@hsrc.ac.za
author_list:
- family: Chikovore
  given: Jeremiah
- family: Hart
  given: Graham
- family: Kumwenda
  given: Moses
- family: Chipungu
  given: Geoffrey A.
- family: Corbett
  given: Liz
da: '2023-09-28'
doi: 10.3402/gha.v8.26292
eissn: 1654-9880
files: []
journal: GLOBAL HEALTH ACTION
keywords: 'Malawi; masculinity; tuberculosis; healthcare seeking; gender; provider;

  qualitative; low income'
keywords-plus: 'ANTIRETROVIRAL THERAPY; HELP-SEEKING; GENDER; HIV; HEALTH; MASCULINITY;

  SYMPTOMS; BEHAVIOR; PREVENTION; PREVALENCE'
language: English
number-of-cited-references: '60'
orcid-numbers: 'Hart, Graham/0000-0001-9676-6577

  Chikovore, Jeremiah/0000-0002-4910-6952

  Corbett, Elizabeth/0000-0002-3552-3181

  Kumwenda, Moses Kelly/0000-0003-3091-7330'
pages: 1-9
papis_id: 3b8d84f1d8a85fc39f15ab33e2917c5a
ref: Chikovore2015merecough
researcherid-numbers: 'Hart, Graham J/C-1591-2008

  '
times-cited: '32'
title: '`For a mere cough, men must just chew Conjex, gain strength, and continue
  working'': the provider construction and tuberculosis care-seeking implications
  in Blantyre, Malawi'
type: Article
unique-id: WOS:000352006200001
usage-count-last-180-days: '0'
usage-count-since-2013: '9'
volume: '8'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2015'