Abstract
Background
Aotearoa New Zealand is experiencing a rapidly expanding older population. Ageing males are experiencing a gradual reduction in health, social and economic aspects and this situation is under-researched and under-recognised in service provision. There have been calls for the public health agenda to take a more proactive approach to specifically address the needs of ageing males, but little is known about how New Zealand men understand their health and wellbeing as they age and what their latent ageing well issues are. This thesis aims to explore the beliefs, opinions, and experiences of men 45 years old and over, resident in Otago and Southland regarding their health and wellbeing and to determine what factors influence their ability to age well.
Methods
A scoping review was first and foremost carried out to systematically map the men’s health-relevant research conducted in Aotearoa New Zealand. Then a mixed-methods approach was adopted to address the research aims and objectives. Contiguous and sequential qualitative and cross-sectional quantitative studies were conducted with men 45 years old and over resident in the Otago and Southland regions of Aotearoa New Zealand. Focus groups were developed, piloted and conducted in the qualitative phase using an abductive principle, with narrative data analysed using a reflexive thematic approach. The quantitative phase employed a random cross-sectional survey (employing both online and postal survey) designed according to the findings from the qualitative phase and the scoping review. Participants of the survey were identified from the electoral roll using a stratified random sample strategy. The survey results were analysed using a combination of descriptive and inferential statistics.
Results
The scoping review draws a comprehensive picture of men's health in NZ. It also provides practical applications of incorporating intersectionality to enhance rigour in designing, conducting and interpreting mixed methods research. In the qualitative phase, six group focus groups (five face-to-face and one online) were undertaken with men (n=28) from February to June 2020 at three different locations in Aotearoa New Zealand. Participants ranged in age (45-92 years old) and varied in socioeconomic status. Three core themes were identified: men’s perspectives towards ageing well, challenges for male gender identities, and health risks during an identified social transition. These themes and their included subthemes informed the development of the subsequent survey questionnaires. In the quantitative phase, 434 out of 1,500 eligible survey responses were included in the final analysis. The multivariate regression models revealed that for respondents the most significant positive and negative factors influencing their ability to age well were, life engagement and purpose in life (positive effect), substance misuse (negative effect), and masculinity norms (dual effects).
Conclusion
This thesis can be seen as the basis for the men’s health and ageing well research in Aotearoa New Zealand. The integrated findings of the mixed-methods study describe the perspectives of men from Southern New Zealand regarding their health and wellbeing as they age, and contribute to the literature regarding the significant determinants of ageing well in men. The identification of the most influential men’s health-related indicators of ageing well is instructive for informing the development of gender-tailored interventional research programmes. Further studies are recommended to focus on these identified areas in a broader range of intersectional factors. This important piece of research can be further used to guide the future direction of Aotearoa New Zealand-specific evidence-based public health practices (Men’s Health Policy and Positive Ageing Strategy) to support men to age well.