Background There is limited research on the health experiences of fathers in the UK, nor has this issue been fully recognised within policy or healthcare practice.
Aim This empirical research study looked at the health beliefs and practices of African-Caribbean and white working-class fathers in order to identify implications for policy and nursing practice.
Method Empirical data was taken from a qualitative parent study carried out in a city in the Midlands. The parent study explored the links between masculinities, fathering, health and social connectedness. This article focuses on three themes around fathers’ health beliefs and practices.
Results and discussion The first theme, ‘fathers’ fragmented bodies’ indicated that all fathers were aware of how their bodies were changing over time in ways that may affect their health. The second theme, ‘fathers’ paternal love, and health’ indicated that love for their children, demonstrated through involvement with them, could ameliorate life stressors, but fathers also experienced tensions between paid work and family life. The third theme, ‘fathers’ pleasurable risk-taking’ indicated that fathers undertook activities they perceived to be unhealthy. Implications for public health and health promotion activity by nurses are discussed.
Conclusion Changes in men’s beliefs about their gender identities, their beliefs and practices about being a father, their limited autonomy, and their experience of family and paid work tensions and stressors all influenced their health beliefs and practices.
For nurses to promote health within families effectively, it is often assumed that they should work with the woman as the key gatekeeper to family health and welfare. However, social changes in the UK mean that increasing numbers of fathers are actively involved in childcare (O’Brien, 2005). Changes in care leave, paternity leave and the balance between work and family life (Department of Trade and Industry, 2005) indicate that policy development is responding, to some extent, to the changing welfare needs of families and fathers in the UK.
However, fathers’ health experiences, specifically within families, have not been fully recognised within policy, practice or research. For example, Acheson’s report (1998) on health inequalities and the more recent Choosing Health strategy (DH, 2004) both emphasise the importance of public health and health promotion but, where families are discussed, it is the importance of mothers that is recognised.
The research literature indicates a growing interest in men’s health experiences and how these are linked with their gender identities (Williams, 2007). Findings indicate that some aspects of masculinity can be either helpful or damaging when dealing with health and illness. For example, research on men with chronic conditions (Chapple and Ziebland, 2002), and those with disabilities (Gershick and Miller, 1995) indicates that it is important to understand gender if we are to minimise the more negative effects of men’s health beliefs and practices. However, in their analysis of men’s accounts about depression, Emslie et al (2006) reported that some were able to resist the constraints of stereotypical notions of masculinity, such as dominance, control and power.
Watson (2000) also indicated that experiences of parenthood, specifically, for fathers was linked to notions of paying less attention to their bodies, where their obligations towards families and paid work became most important.
This article reports on an empirical piece of research with African-Caribbean and white working-class fathers looking at their health beliefs and practices. The aim was to identify implications for policy and nursing practice.
Empirical data is drawn from an unpublished qualitative parent study carried out in a city in the Midlands in the UK, which explored the links between masculinities, fathering, health and social connectedness. This article focuses on key themes regarding fathers’ health beliefs and practices.
Individual semi-structured interviews were conducted on two occasions with six African-Caribbean and seven white working-class fathers, who were all accessed through community contacts. The subjects were aged 27-48 years, were in good health (not service users, patients or clients), in paid work, living with a female partner and with some (or all) of their children, and all lived in the same neighbourhood, which was segmented by areas of deprivation and affluence.
The study used abductive reasoning (Blaikie, 1993). Abductive reasoning means that we use the evidence and ideas we acquire from literature to influence how we do the empirical work, and in turn that empirical work may help us challenge or confirm evidence or ideas. So the empirical and the theoretical are interdependent rather than crudely separated.
Three interdependent themes from the qualitative data analysis are discussed:
• Fathers’ fragmented bodies;
• Fathers’ paternal love, and health;
• Fathers’ pleasurable risk-taking.
Fathers’ fragmented bodies
Watson (2000) found that men, particularly during parenthood, may experience their bodies as ‘fragmenting’ over time – that is changing in ways they did not anticipate nor enjoy. Fathers within this study indicated that they may have gained weight, or their shape had altered, or they may have felt less agile, strong or ‘fit’ than before:
Well it is different now. It’s inevitable. You can see the flab appearing. Just look at this… [points at waist]. All that fat. Urrrrgh! It wasn’t always like this. No, don’t get me wrong, I’m not a geek, a fitness type. Nothing like that, never have. And I like my food, and a drink at the weekend. But when you are doing a job like mine, and you have the kids and stuff round the house, things change. Well, this belly changed! (Ron, white, production line worker)
Fathers linked this perceived ‘fragmentation’ to the combined effects of their domestic and paid work obligations. Indeed, these bodily changes were also bound up with a more limited sense of personal freedom. Hence, freedom to change jobs, seek promotion, retrain, or to continue with friendships or with their previous social life had been eroded.
The fathers in this study took part in a range of activities that they enjoyed and perceived to improve their health and their bodies. These included gardening, playing music, walking, jogging, running, boxing and ‘working out’. Such activities were seen as healthy, in that they helped with relaxation or ‘fitness’ or overall well-being, or were indicators of personal achievement. Nevertheless, such experiences were often constrained by work and family obligations:
I do go jogging, and Amelia, my daughter, might follow me along on her bike. That’s if the weather is good. I like it a lot. I feel tired at the end, but I feel fitter. I get a buzz out of it. (Paul, African-Caribbean, fitness instructor).
Fathers’ paternal love, and health
While the fathers associated a sense of fragmentation with the responsibilities of paid work and family life, they also indicated that being a father was a positive experience. Indeed, one of the surprising findings was ways in which fathers repeatedly talked about their love for their children, even though they were never prompted to do this. While it was sometimes stressful, all the fathers enjoyed being with their children. Their involvement included play, learning and caring for the children, which allowed fathers to establish emotional reciprocity and allowed them to show the love they felt for their children.
Yes, yes, I mean they are so important. They are well loved. By me, and the wife. Always… always. That is important isn’t it? And I know, well I think, they do know it too. They must do. Like… I try to show them this every day. It’s there all the time…. (Paul, African-Caribbean, fitness instructor)
Paternal love and involvement with children were interdependent for all the fathers. Such experiences had many benefits including the way that time with children ameliorated work stressors, or was entertaining or stimulating.
On the other hand, involvement with children could in itself be difficult or stressful. Fathers’ experiences in this respect were diverse, in that concerns about security, children’s health, their behaviour, or conflicts with female partners about children’s needs and behaviour may create difficulties for them. Such experiences were complicated further by work stressors, such as income, debt, shift work, exhaustion, fear of unemployment or insecurity.
When you are tired it is hard. You come home knackered. And you end up doing the wrong thing… you regret it. Big time, especially when it’s the kids who get it in the neck. I don’t like to talk to them about work, see. They don’t need to know about it. So I make up for it by doing things with them. You know, football in the garden, helping Terry with his homework or going out on the bikes. When that happens it’s better. (Don, white, firefighter)
As Don’s story indicates, fathers lived with tensions and contradictions between paid work and caring for their children. Some had decided to take different jobs, work fewer hours, stop doing shift work or even, in one case, to leave paid work to help care for his disabled daughter.
Fathers’ pleasurable risk-taking
All the fathers were involved in pleasurable forms of risk-taking, through which they broke medical or moral ‘rules’, which they perceived they ‘ought’ or ‘should’ not do. They all enjoyed smoking cigarettes, or ‘binge drinking’ or ‘going on the beer’, or eating ‘junk’ food. For example:
You see, you’ve got to have the occasional binge, haven’t you? Everybody does it, don’t they? You know, relaxing with your mates. Going on the lash relaxes me no end. The next day I regret it… [laughs] … but you’ve gotta, haven’t you? I know I shouldn’t, but you can’t spend your whole time doing the right thing. That time is for me, just once in a while. (John, white, production line worker)
However, the fathers’ stories linked these forms of risk-taking to the constraints over their autonomy, which they experienced while meeting the obligations of paid work and family life. Breaking rules in this sense was enjoyable or very enjoyable, and such practices were understood as being distinct from their home and work lives and helped to alleviate family or work stressors.
There is no evidence to suggest the fathers fully accepted health promotion about food, exercise, alcohol consumption or cigarette smoking. Indeed, two expressed deep cynicism about official health promotion messages. Nevertheless, all the men talked about the ways that that their risk-taking may negatively affect their bodies, or cause future illnesses.
As Robertson (2006) also found in research with heterogeneous groups of men, there was ambivalence and contradictions within fathers’ stories. The fathers within this study sometimes denied themselves enjoyable products and, at other times, enjoyed them.
Furthermore, their reflexivity about risk-taking was reinforced when they compared their ongoing experience of being a father with the times, in the past, when they were younger men without children.
In addition, the form, volume and location of consumption of alcohol, food and cigarettes, in particular, was something that most fathers were keen to manage around their children. Such reflexivity was partly influenced by their participation in preparing or cooking for children, for example. There was a lot of talk about eating ‘healthy’ rather than unhealthy food.
How about chicken nuggets and chips, then, eh? No, no, we are careful about it. So, on a Wednesday, like tonight, I’ll be getting the tea… we have like a proper meal. That junk food is not good for ’em. So we have some veg, and maybe some fruit too….
You see, it is different for me now. I have to try and think, all the time, about what I’m dishing up. When you’re a dad, it is different. It was never like this before, before the kids, that is. I ate and did what I fancied. Those were the days…[laughs]. (Don, white, firefighter)
As Don’s story also demonstrates, there is evidence within fathers’ stories that their beliefs about masculinities and their identities as men were in a state of flux. Throughout the data, it was clear that being a father was associated with dynamic, changing forms of masculinity. However, it is also important to emphasise that findings indicated that fathering was also associated with changing beliefs about risk-taking or, as Don put it simply above: ‘When you are a dad, it is different.’ Furthermore, the fathers had changed, or intended to change, their activities related to cigarette smoking, drinking alcohol, food consumption, unsafe car driving or the limited amount of physical activity they did, because of their obligations to children. As John said:
As I told you about the smoking before, I feel good about this. It was hard to stop smoking. I started again, then stopped and then started again. I do want to stick with it. It’s about the kids. I have changed. Being a dad is different from being a man on his own, young, free and single. It’s about different priorities. (John, white, production line worker)
The findings presented here indicate that the experience of fathering is associated with reflexivity about the body and risk-taking, which, in turn, is linked to fathers’ beliefs about being a man. The findings indicate that masculinities are dynamic and open to change.
This small qualitative study enabled fathers to talk about the complexity and contradictions within their life experiences. A larger multi-method study is planned to further examine fathers’ health beliefs and practices within a larger and more socioeconomically and ethnically diverse sample.
The fathers’ paternal love for their children was demonstrated through their involvement with children, which is a key finding. This love is linked to changes about health that fathers have made to improve their own health and that of their children.
For nurses, health visitors and midwives, building on men’s desire to care for others has potential benefits not only for boys and girls but also for women and other men. However, the findings also indicate that fathers’ health experiences are mediated by gender, specifically by masculinity. Watson (2000) indicated that men’s gendered experiences of masculinity may encourage and constrain their health practices. This article builds on this developing work to indicate that fathers’ health experiences are influenced by gender, in the sense that reflexivity about gender is evident within their stories about risk-taking. Such changes provide public health and health promotion opportunities for nurses.
The findings also indicate that fathers experience tensions between paid work and fathering, which had implications for their sense of autonomy. In turn, this tension influences their forms of risk-taking. Such tensions between paid work and family life have implications for policy and practice.
UK government policies to support a work-family balance, to support parents’ care for children and to enable increased care leave, paternity or parental leave (Department of Trade and Industry, 2005) are to be welcomed.
It may be that security in work and levels of pay may be more important to working-class families than flexibility, as O’Brien (2005) and La Valle et al (2002) argued. Within this study, findings indicate that fathers’ health experiences are bound up with their work experiences, and fears about income, security and unemployment are key factors in this respect.
The original study from which this paper’s findings were drawn aimed to compare the experiences of working class African-Caribbean fathers with those of working class white fathers. However the findings presented here regarding paternal love, fragmented bodies and risk-taking indicate that not only was there diversity within individual fathers’ stories but also, interestingly, an absence of any pattern indicating substantive differences between these two groups of men. However, it is important not to ignore the importance of insight into how social divisions like racism and ethnicity affect fathers’ experiences, especially if policies and services are to successfully engage fathers, as has been earlier noted elsewhere (Williams, 2007a; 2007b).
Another issue to note on gender is that, in a society divided by unequal gender relations (Connell, 2005), nurses should be sensitive in working with fathers within families. Specifically, they should ensure that health promotion or public health interventions do not reinforce nor condone gender inequalities or traditional forms of power for men in families and wider society that can potentially undermine women and children (see also Williams and Robertson, 2006).
There is evidence within this study to support Crawford’s (2000) work, which suggests individuals may experience ongoing ambivalence between attempting to control the pleasure of consumption and experiencing that pleasure. Indeed, Robertson (2006) indicated that men in the UK may be influenced by a ‘don’t care, should care’ dichotomy around their health.
The fathers in this study were reflexive about the fragmentation of their bodies and their risk-taking. They also demonstrates ambivalence between enjoying alcohol, food and smoking on the one hand and avoiding such pleasures on the other. At the same time, being a father was associated with changes in beliefs and practices regarding the volume, form and location of consumption with or around children. Such findings provide opportunities for nurses when working with families around health promotion and public health issues.
The findings also indicate an interest and participation in sport and physical activity in some fathers, which is welcome. However, we must be careful about drawing too many conclusions from the findings, as some research on using sport for health promotion work suggests it can exclude certain groups of men (such as gay men) as well as potentially promoting the male stereotypes represented through particular sports (Robertson, 2007).
Government health policy has moved in the past 10 years from an interest in the social determinants of health (Acheson, 1998) to a narrower focus on individual ‘behaviour’, ‘lifestyle’ and ‘choice’ (see Department of Health, 2004, for example).
This study’s findings demonstrate an awareness among the fathers of the changes in their bodies, the fragmentation of their bodies, and awareness of how such processes are associated with being a father, being a worker and with forms of consumption. Indeed, the fathers’ more constrained sense of their own autonomy was linked to the competing obligations of caring for children and doing paid work.
To compound the complexity of these processes, the fathers’ accounts also linked constraints on autonomy with risk-taking, which helped them to enjoy some pleasure in living with the obligations of fathering and paid work. Hence, breaking perceived rules about what they may consume, limited autonomy, family and work stressors, and changing forms of masculinity are interdependent factors and cannot be simply reduced to ‘behaviour’ or ‘choice’. This issue again has implications for public health and health promotion activity with fathers. For example, educating about parenting, diet, smoking or alcohol consumption does little to ensure that a father has the skills, resources or assets needed to cope with the stresses and strains within the family or within the workplace.
In conclusion, this study’s findings indicate that fathers are aware of changes in their bodies and the implications for their health. Indeed, changes in their beliefs about gender and in their beliefs and practices about risk-taking provide important opportunities for health promotion and public health work with fathers.
There is no quick fix to working effectively with fathers around their health – although it is clear that a reductionist approach focusing on individual ‘behaviour’ does not sufficiently grasp the ways that gender, paid work and family life influence individual fathers’ ‘behaviour’ or ‘choice’. It is therefore essential that public health and health promotion approaches are based on fundamental, public health principles of collaboration, equity and participation (Beaglehole, 2003). These allow us to address how fathers’ health experiences are shaped by wider social and economic factors. Indeed, such a public health approach must not ignore issues like risk-taking, but recognise that improving the health of men, including fathers, involves reorienting health services, tackling discrimination and inequalities, creating healthy supportive environments within communities, developing personal skills and building healthy public policies (Wilkins and Baker, 2004).
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Author Robert Alan Williams, PhD, RGN, HV, is lecturer, School of Health Sciences, University of Birmingham, Birmingham.