On the Edge of the Bench: An Ethnographic Study on Health among Socially Marginalised Men in a Large Danish Municipality

Unmet healthcare needs among marginalised populations have increased globally in recent years. This particularly concerns socially marginalised men who may find it difficult to understand and navigate the complex and fragmented healthcare system in different sectors. This is worrying from a public health perspective because these men often have complex care needs that also require the integration of healthcare and social services. Even though research points to different reasons for the inequality in health – such as strong association between health and social position – it still doesn’t capture the individuals’ perspectives. Consequently, this results in lack of insight into how socially marginalised men perceive health and how their perceptions influence their health behaviours and health-related help-seeking. It is therefore important to explore how to support socially marginalised men’s health needs in a municipal context. The overall aim of this PhD research was to explore the socially marginalised men’s experiences and perceptions of health in the context of their everyday lives. The aim was also to explore municipal employees’ experiences and perceptions of how to support socially marginalised men’s healthcare needs and contribute with perspectives and clarification of possible challenges. The thesis is based on two substudies (1 & 2), allowing varying interpretations of how it is possible to support health based on contextual, social processes taking place in everyday life among the men. The two substudies are represented in three papers (I, II & III), each guided by specific objectives (A, B & C). Substudy 1, objectives: A: To explore health perceptions and health behaviours influencing overall health among socially marginalized men who seem to not benefit from existing healthcare in a large Danish municipality (Paper I) B: To explore the factors that influence health-related help-seeking behaviour among socially marginalised men between 45 and 65 years of age in a large Danish municipality (Paper II) Substudy 2, objective: C: To explore municipal employees’ experiences and perceptions of how to support healthcare needs among socially marginalised men between 45 and 65 years of age who currently seem not to benefit from municipal healthcare services in a large Danish municipality (Paper III) This research used an ethnographic study design. Substudy 1 involved five months of fieldwork at two public bench sites in a large Danish municipality and interviews with 25 socially marginalised men between 45 and 65 years of age. Substudy 2 involved interviews with 21 managers and employees from two municipal policy sectors. To answer the overall aim of the thesis, the findings from the two substudies were synthesised. The findings show that the men’s health perceptions are tied up in their everyday lives and that they conceptualise health as what makes life worth living. Thereby, it seems significant that health professionals build respectful trust-based relationships with the men in order to obtain insight into the men’s everyday lives and support their health needs. However, forming relationships may be a challenge, as the men have had poor previous experiences with different health services, such as not receiving the support they needed. At the same time, municipal employees have experienced challenges in supporting socially marginalised men because they often have complex health needs. These complex needs require integration of social care and healthcare. Consequently, supporting the men’s health needs has proven challenging and is dependent on relationships between the men and the professionals as well as the professionals’ competencies and abilities to work across policy sectors and professional boundaries. In sum, this research explored the socially marginalised men’s experiences and perceptions of health in the context of their everyday lives as well as municipal employees’ experiences and perceptions of how to support these men’s healthcare needs and contribute to furthering research and clarification of possible challenges. This research highlights several issues of importance surrounding healthcare for socially marginalised men in order to construct targeted interventions to support the men’s health needs. Nevertheless, it is important to acknowledge that this research’s findings are simply the first step in order to support health needs among the men. The next step should be research on how to implement knowledge from this research in the municipality.