Men, Health, and Lifestyle: Insights from Thematic Analysis

Full Methodology and Write Up:

Method

Many qualitative analytic methods are capable of thematising meanings from interview data (Holloway & Todres, 2003). Although the present task of analysing a single data item (as apposed to a data set) would have typically been suited to a biographical/case-study method such as narrative analysis (e.g., Brooks & Dallos, 2009), the limited level of detail of the supplied transcription prevented such analytic methods from being considered. Furthermore, such methods are commonly tied to theoretical frameworks and therefore lack flexibility (Braun & Clarke, 2006).

I chose to use thematic analysis (TA) due to its compatibility with a range of theoretical approaches and because of its capacity to facilitate the rich identification and analysis of themes. I used a realist/essentialist approach which was derived from my goal of reporting the interviewee’s experience, meaning and reality. I used an inductive, data-driven approach for identifying patterns as I did not approach the analysis with preconceptions about the patterns/meanings I hoped (or expected) to find. There was not a research question attached to this project and I purposefully avoided examining the published literature on the subject to increase the validity of the inductive approach chosen. This, coupled with the analysis being confined to a single data item, made it inappropriate for me to venture beyond the semantic content of the data.

I used Braun and Clarke’s (2006) six phase method of conducting TA as outlined below:

• The transcript was read several times prior to coding. I immersed myself in the data and searched for meanings in an active way (as apposed to believing that themes would emerge on their own). I made initial notes to inform subsequent coding.
• After familiarisation, initial codes were generated using an inductive approach based on semantic content. All data extracts were then coded manually and collated by code. Care was taken to include some of the surrounding data to maintain the context of the extracts. Inconsistencies and contradictions were not ignored.
• The collated, coded data extracts were then sorted into broader themes. The prevalence of the coded extracts was used to guide initial themes. Prevalence was primarily determined by counting the number of instances of collated extracts occurring under each code. However, word count was also taken into consideration. Initial thematic maps were constructed to try and gain a sense of how the themes fitted the data and of the relationships and hierarchy that could be seen between them.
• The concepts of internal homogeneity and external heterogeneity (Patton, 1990) were used to refine themes. Themes were either maintained, disbanded, combined or reworked depending on how accurately they encapsulated the meaning of their parent coded data extracts. This phase culminated in a working thematic map.
• The coded data extracts were then reread multiple times acknowledging the perceptual colouring conferred by identifying the themes in phase 4. The stories the themes told were considered and the central organising concepts they surrounded were articulated in order to facilitate the distinction between themes and sub-themes and the subsequent naming and defining process. This resulted in the final thematic map (see figure 1).
• The report was written in line with the epistemological position previously defined. An effort was made to tell the story of data within and across the (sub) themes in a simple and concise way, using data extracts to help paint a picture and to support my subjective, thematic presentation. For the reasons outline above, I did not search for meanings other than those explicitly voiced by the interviewee, nor did I attempt to interpret the significance and implications of the themes I identified.      

Figure 1: Final thematic map

Analysis

The most prevalent theme I have identified in the transcript is John’s desire to lead a healthy lifestyle. I use the word desire in the title of the main theme to reflect John’s view that, in terms of living healthily, he “could do a lot better but [he] could do a lot worse”. John frequently discusses the various aspects of his lifestyle and explains why he generally considers them to be healthy. There is a validation component to this which is explicit in his reference to the “body MOT” he receives from his doctor.

There are three extremely prevalent sub-themes organised around the central, overarching theme of wanting to lead a healthy lifestyle: the motivations for it, the effect of masculinity and the compromises it often entails (which John makes reference to as “a bit of give and take”). Because of their prevalence, these sub-themes were initially identified as main themes. However, they were later classified as sub-themes because they intertwine with the main theme and with each other.

Desire to Pass the “Body MOT”

John expresses a keen desire to lead a healthy lifestyle. He appears to define such a lifestyle primarily in terms of diet, exercise, alcohol and smoking:

I try to lead a healthy lifestyle as much as I can in that I don’t smoke, I rarely drink erm ….read the food labels a lot so I am fairly conscious of what I consume. I am aware of the different types of food groups and the balance that you need. And try and eat accordingly to try and lead a healthy life. Exercise, yer I have been quite passionate about exercise since turning 30.

This perspective, he claims, is informed by his scientific, logical outlook and the published statistics concerning health: “there is such an overwhelming amount of evidence to show that you would be stupid to go against it”.

Motivations

In fact, concern for his health is one of the primary factors that John says motivates his desire to live a healthy lifestyle. For example, he describes how his previous employment in the chemical industry involved him seeing several of his colleagues “die younger than they should have done” and that this is a major reason why he tries to stay healthy and features “quite prominently in [his] list of priorities”.

Furthermore, John says the primary goal of his exercise routine is to increase his lifespan, although he acknowledges some uncertainty about the benefit it confers: “the ultimate thing I get is just to put a few more quality years on your life, but who knows if you can be sure about that”. Therefore, unsurprisingly, John expresses satisfaction at the validation he gets from his doctor that his lifestyle is a healthy one:

I know that I am fitter. I know because the doctor says so. I go for a body MOT if you like, now on a regular basis, and I always get good numbers, so that’s very satisfying.

However, as well as expressing concern for his health, John frequently mentions vanity as being a motivating factor in his desire to lead a healthy lifestyle. For example, discussing the reasons why he tries to stays fit, John says “there is a big part of vanity and how I am perceived by other people”. These two motivating factors (health concern and vanity) appear closely intertwined for John. This is especially evident when he talks about weight-loss:

Well I put a bit of weight on around the middle. And I did not like the way I looked and I thought that well this is only going to start getting worse. You start looking at people ten years older than yourself and think is this the way I am going. That really kick [started] me to try and shed some weight. Then we are going back some twenty or thirty years now, obesity was getting into the news and getting some press.  Both my parents were obese, erm… neither of them died of that . erm … I think I started to think ‘oh no I don’t want to be another statistic’. That’s what started it but what has kept me going as well as that is the vanity aspect. Er, yes I am quite a vain person.

Therefore, for John, the metaphor of the “body MOT” appears to extend to the bodywork as well as the engine!

The Effect of Masculinity

Being masculine is important to John but his concepts of being masculine and looking masculine appear to be intertwined in a similar way as his concepts of being healthy and looking healthy are. Furthermore, the two sets of concepts are themselves intertwined. For example, John testifies to the health benefits of exercise but claims the reason men to go to the gym is vanity: to achieve a “v shaped masculine shape”. In fact, John admits that he personally does body building “to put on a more masculine shape”.

John claims the reason many men want to look masculine is “born out of wanting to impress the opposite sex”; and that it is a “me Tarzan you Jane type thing”. But John believes that, in today’s society, being/looking masculine also requires “being in charge and controlling and creating an impression” in order to impress women and that “you just don’t want women to perceive you as a weak person”. John believes that such old-fashioned perceptions of masculinity can, in fact, be very damaging to men’s health:

I think it’s born out of a rather old fashioned attitude that, if you are manly you just go out there and get on with things. And erm, you certainly don’t worry about your health and being ill. . . . So many men now never go to the doctors, when they should, until it’s too late.

According to John, women go to the doctors when they are ill which gives them an advantage over men. He also says women are happy talking about their problems with friends which is a further benefit to health: “you [women] get things off your chest so you don’t get as stressed as we do. You don’t carry stuff about. Like we do”.

John suspects it might be different for the younger generation of men, but those of his age he says still “feel uncomfortable talking about emotional issues” which he describes as a “big shame”.

However, John also describes another side of masculinity:

It’s a man who has got his life organised he has got his stuff together he has strength of courage and strength of conviction, he knows where he is going and he knows how to get there. Erm , but equally welll he has humility  to others to, he does not stand on others to get there. He accepts and appreciates that everyone else has a right to be, as well. Its not all about being hard and ruthless to get on. Masculinity equally well has a softer side, and the ability to show consideration to other people.

This conceptualisation of masculinity is apparent when John discusses the influence of masculinity on his own health:

I think it [masculinity] is tied in very intricately with my health . . . knowing where you [want] to go and how to get there, being purposeful. Being, having strength of character having commitment and determination, all those qualities are healthy, by being fit and having a healthy body and mind.

So where does John stand overall on the subject of masculinity and health? John sums it up by saying: “For me personally, masculinity is good for my health . . . its good. It’s definitely good.  But for a lot of men in this country I think it’s bad”.

“A Bit of Give and Take”

Despite admitting that masculinity is important to him, John does not conform to certain masculine stereotypes that he believes would compromise his health:

Despite what I said about how important it is about how other people perceive me . . . it’s not that important that I have to be typical and fit in with the crowd no matter what the crowd is doing. I am quite happy to be accepted as not rejected, but this ‘what’s wrong [name] why are you not going to have this vindaloo or whatever?’  I am happy to stand my ground and say because it’s not healthy and it’s not something that I would choose to eat.

Therefore, John appears more willing to compromise his vanity and his desire to appear masculine than to compromise his healthy lifestyle. However, John is prepared make compromises to his healthy lifestyle for other reasons. For example, he admits he will occasionally treat himself to a “bit of chocolate or tub of ice cream” which he says is because “you have to enjoy life as well”. In fact, making compromises to one’s healthy lifestyle, especially the compromises associated with relationships, is a prevalent sub-theme that runs throughout the transcript.

According to John, drinking alcohol was not something he compromised on during his relationship(s):

It was a bit of a bone of contention when I was married, my ex wife liked to have a drink, and it was her way of unwinding, and she took it too excess sometimes she got silly, and a bit stupid, and she criticised me for not having a few drinks more and erm but I resisted. That’s part of my personality as well I think I, I tend not to follow the herd.

However, he does report that a relationship has caused him to compromise his diet in the past:

I did not do it [eating healthily] as much as I would have liked to when I was married, my wife had not had the same upbringing as I had. Certainly in terms of the wholesome food. So she would tend to go for the cheaper stuff, cos [that’s] how they had been brought up, I was always encouraging her to go for the healthy food, so we could eat better, but sometimes there is a bit of give and take, she wanted to buy the cheap stuff so that we could save some money.

Furthermore, John reports that: “the women I know including my partner…erm  are not particularly keen on exercise” which John believes is because of the compromises they make for their families:

The women in my circle of friends virtually all of them are married [or] have a partner at home.  And that seems to come first or that’s how it seems to me. If you are going to keep fit and go to the gym you have to make a conscious effort to go and do it, that’s how it seems to me, so [things] have to be given up and compromises made. Some things have to take a back seat. Erm I think probably the women that I know have chosen to put their husbands or partner or their families first.

Although John does not mention any compromises to health that the men in his circle of friends make because of relationships, he reports that his own exercise routine is influenced by his relationships: 

I might want to go [to the gym] on a Saturday or a Sunday but I know that we have got family coming. But you have to make choices and compromises . . . . but it can impinge on [some things] that you want to do.

However, John believes he is fortunate with his current living situation as he can go to the gym when his partner is at work, although he admits that “sometimes it can be a bit of a conflict” and that sometimes he feels “obliged to stay at home”.

John reports that his previous marriage ended in divorce, although he states this was not due to his desire to eat more healthily than his partner or spend longer at the gym. However, he says he became really conscious about what he ate and that he really looked after himself after the divorce. He also says this has now “reverted back a little bit” due to his new relationship.

In summary, John generally believes he leads a healthy lifestyle. The primary motivations for this lifestyle are health concerns and vanity which are intertwining concepts for John. John appears willing to make compromises to healthy lifestyle for his relationships and this appears to be compatible with his concept of masculinity as he mentions that masculinity includes “the ability to show consideration to other people”. Although he generally considers masculinity to be a positive influence on his own health, he believes it can be a very negative influence on men’s health in general, particularly due to the fear of showing any “sign of weakness”.

The thematic structure used in this analysis has shed some light on what living healthily means to John and on the meanings he attaches to masculinity, motivation and compromise. Further interviews on the topic should be conducted and themes analysed across data items in order to examine other men’s experiences and meanings and how these relate to Johns’. 

Reflections

Transcription

Because the transcription was provided for me, I missed what Braun and Clarke (2006) consider to be an important part of the analytic process in that transcribing allows the researcher to gain a more detailed understanding of the data. I attempted to offset this disadvantage by devoting more time to the familiarisation stage.  

However, according to Bird (2005), transcription is an interpretive act because it cannot possibly capture all the information contained within a recording and Green, Franquiz, and Dixon (1997) argue that it is also a situational act, influenced by the researcher’s assumptions about language, discourse and culture.

Therefore, transcription is “always and necessarily selective” (Have, 2007, p. 96). This calls the validity of my analysis into question and it is therefore important to acknowledge that my analysis may have been biased by the researcher’s linguistic and cultural assumptions, his or her knowledge, the goal of carrying out the research project and what he or she expected to find. Furthermore, an interview is a social interaction and the experiences and meanings that John communicated were likely influenced by the interviewer.

It could be argued that asking another researcher to analyse the text (triangulation) could shed light on the reliability/dependability of my analysis. However, the second researcher would face the same problem of validity; the analysis may be reliable without it necessarily being valid.        

Analysis

Had I used TA to identify and analyse themes across a data set I might have adopted a contextualist approach at a latent level; acknowledging the social factors that influence individual processes of meaning-making and examining underlying meanings. However, the epistemological position I adopted was largely dictated by the scope of the project; to explore meanings, experiences and motivations at the semantic level only. This limited the influence of my own biases, experience and knowledge on the analysis. However, I acknowledge these personal factors may still have influenced the analysis, even at the semantic level, as my own conceptualisations (especially about masculinity and health) likely guided the identification and interpretation of perceived patterns within the data item and their relative significance. For example, there were certain themes I identified upon initially reading the transcript and, although I spent a great deal of time non-discriminately coding the data in an effort to prevent my biases from colouring my judgement, two of these initial themes (the effect of masculinity and the compromises required to maintain relationships) made it into the final analysis (as sub-themes). I determined prevalence of patterns using the frequency of occurrences and the word count of coded extracts to guide me, which I believed would give a more “objective” classification of prevalence. However, this is verging on quantitative methodology; Pyett (2003) even argues that “counting responses misses the point of qualitative research” (p. 1174). In terms of coding and identifying themes, I believe a balance must be found between defined, objective measures and subjective ones, as long as the researcher makes his/her chosen method as transparent and consistent as possible.

Despite the discussed limitations of using TA on a pre-transcribed, single data item, the analysis gravitates towards some interesting themes that should be explored in future research.

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References

Bird, C. M. (2005). How I stopped dreading and learned to love transcription. Qualitative Inquiry, 11(2), 226-248.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.

Brooks, E., & Dallos, R. (2009). Exploring young women’s understandings of the development of difficulties: A narrative biographical analysis. Clinical Child Psychology and Psychiatry, 14(1), 101-115. doi: 10.1177/1359104508100139

Green, J., Franquiz, M., & Dixon, C. (1997). The myth of the objective transcript: Transcribing as a situated act. Tesol Quarterly, 31(1), 172-176.

Have, P. (2007). Doing Conversation Analysis: SAGE Publications.

Holloway, I., & Todres, L. (2003). The status of method: flexibility, consistency and coherence. Qualitative research, 3(3), 345-357.

Patton, M. Q. (1990). Qualitative evaluation and research methods: SAGE Publications, inc.

Pyett, P. M. (2003). Validation of qualitative research in the “real world”. Qualitative Health Research, 13(8), 1170-1179.