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There is growing awareness about issues of sexual consent, especially in autonomy-compromising or "non-ideal" contexts, including sex involving alcohol. Understanding the conditions needed for consensual sex to occur in this emergent milieu is critically important, especially for young men (ages 18–30 years) who normatively combine drinking alcohol with sex and are most often perpetrators of sexual violence. This study offers a discourse analysis of young men's alcohol use and sexual consent. Data are drawn from qualitative interviews with 76 young men (including gay, bisexual, queer, and straight men) in Vancouver, Canada, from 2018 to 2021. Informed by Kukla's non-ideal theory of sexual consent and critical and inclusive masculinities, this analysis identified three discursive frames: careful connections, watering it down, and blurred lines. In careful connections young men discussed their efforts to actively promote sexual and decisional autonomy for themselves and their sexual partners when drinking. Yet, in watering it down young men invoked discourses of disinhibition, deflection, and denial to normalize alcohol use as being somewhat excusatory for sexual violence, downplaying the role and responsibility of men. Lastly, men operationalized blurred lines through a continuum of consent and of "meeting (masculine) expectations" when discussing sexual violence and victimization while intoxicated. Together, these discursive frames provide insights into the gendered nature of sexual violence and the extent to which idealized notions of sexual consent play out in the everyday lives of young men who use alcohol with sex. Findings hold philosophical and pragmatic implications for contemporary efforts to scaffold sexual consent. [ABSTRACT FROM AUTHOR]

The issue of "men's health", and how best to promote it, has been gaining increasing attention in both academic and media arenas across the globe. Whilst commentaries on the state of health promotion for men have been provided in countries including Australia and the United Kingdom, no corresponding Canadian-specific insights have yet been published. This article provides such an overview, focusing on research, policy and practice and suggesting what future direction men's health promotion in Canada might take.

Suicidal ideation (SI) is a known precursor to suicide among men. While loneliness and thwarted belongingness (TB) have been identified as key factors influencing SI, no study has reported on all three constructs to investigate whether loneliness is associated with SI by way of TB. Furthermore, it is not clear whether personality impairment has a moderating role on this process. The present study examined the impact of loneliness on SI among men and whether TB mediated this relationship. Additionally, the study investigated whether personality impairment (i.e., self‐functioning, interpersonal functioning) moderated the relationship between loneliness and TB. Canadian men (N = 434) completed an online survey that included self‐report assessments of the study constructs. Conditional process modeling was used to test the indirect effect of loneliness on SI via the mediating effect of TB. Findings indicated a significant association between loneliness and SI that was mediated by TB. Further, impairment in self‐functioning moderated the relationship between loneliness and TB, indicating that the relationship was stronger among men with greater difficulties in self‐functioning. The findings are important to consider within the COVID‐19 context, as they point to the need to reduce the detrimental impacts of loneliness, thereby potentially mitigating male SI. [ABSTRACT FROM AUTHOR]

Men's intimate partner relationship services have focused on correcting the behaviors of male perpetrators of intimate partner (IPV) and/or domestic violence (DV). There is a need to advance IPV and DV prevention efforts by better equipping men with relationship skills. This study explores service providers' and stakeholders' perspectives about the challenges and strategies for assisting men to build better intimate partner relationships. Interviews were conducted with participants (n = 30) from Canada and Australia who worked in the men's intimate partner relationships sector. Three themes were inductively derived: (a) crisis management (barriers to engagement), (b) owning deficits and leveraging strengths (engaging though accountability and action), and (c) me then we (self-work as requisite for relationship success). Using a gender relations lens, we examined the influence of masculinities on men's intimate partner relationships and engagement with services. Participants described crisis management challenges for men accessing services including shame, threats to masculine identity, and mental health challenges. Owning deficits and leveraging strengths hinged on men's accountability and action, rather than assigning blame for problematic behaviors in accessing services. Related to this, the me then we theme highlighted men's strength-based approaches in focussing on self-work to develop tangible skills and awareness needed to build healthy relationships. Overall, the findings indicate men's healthy relationships hinged on working with masculine identities to inform their perspectives and behaviors. Men's intimate partner relationship work likely requires labor at multiple levels (e.g., individual, partners, and systems) to secure the strong potential for reframing masculine identities as asset-building for men's relationships. [ABSTRACT FROM AUTHOR]

Men's emotions in intimate partner relationships have received little research attention. The current interpretive descriptive study included 30 Canadian‐based men to address the research question: What are the connections between masculinities and men's emotions in and after intimate partner relationships? Three inductively derived themes included emergent distressing emotions wherein participants' predominance for holding in abeyance their concerns about the relationship manifested varying levels of emotional stoicism. Within this context most men denied or downplayed and did not express their emotions. When the relationship broke, men were overwhelmed by mixed and weighty break‐up emotions comprising diverse and often‐times discordant emotions, including sadness, shame, anger, regret and guilt, calling into question men's rationality for deciphering and expressing what was concurrently but inexplicably felt. Shame and anger were prominent emotions demanding the participant's attention to all that happened in and at the end of the relationship. In the third theme, understanding and transitioning after‐burn emotions, participant's grief levered their efforts, including soliciting professional help for deconstructing, reframing and expressing their emotions in the aftermath of the partnership ending. The findings contextualise and in some instances counter claims about the utility of men's emotional stoicism by mapping participants' feelings in and after intimate partner relationships. [ABSTRACT FROM AUTHOR]

Physical activity can be a conduit for improving men's social connectedness as well as physical gains for well-being. However, marginalised men, and fathers in particular, can be challenged to engage in leisure time physical activity. This qualitative study reports how fathers, who experience complex and significant social and health inequities, conceptualise and experience barriers to physical activity. Drawing from focus groups with 17 fathers, and semi-structured interviews with seven service providers about their perspectives on men's physical activity in Vancouver's Downtown Eastside (DTES), a highly marginalised neighbourhood. A masculinities framework was used to describe and contextualise physical activity in fathers' lives. Three themes were inductively derived through the analyses: (1) 'they're busy surviving' a finding referencing the work and limits invoked by poverty wherein survival was triaged ahead of leisure time physical activity; (2) 'there is no activity centre' chronicling the lack of physical activity spaces, programmes and resources available to fathers; and (3) 'lifestyle affects our capability to exercise' a theme detailing how social isolation amplified by factors including housing and opioid crises, and being a father in a resource poor setting imposed significant barriers to physical activity. The findings support reconceptualising physical activity programmes with men who are living in marginalising conditions to address behavioural and structural health inequities in tailoring father-centred programmes and resources. [ABSTRACT FROM AUTHOR]

Identification of masculine values associated with men's depression and suicide risk may generate new intervention targets for those with known static risk factors (e.g., exposure to childhood maltreatment). To validate the factor structure of a measure of health-related masculine values and examine correlates relative to childhood maltreatment exposure. Self-report data was collected from 530 Canadian men, mean age 47.91 years (SD = 14.51). Confirmatory factor analysis validated an abbreviated eight-item, two-factor model of the Intensions Masculine Values Scale (IMVS-8; CFI =.984, TLI =.977, RMSEA =.054, SRMR =.032). Cluster groups of low (n = 57), moderate (n = 206) and high (n = 267) adherence to these health-related masculine values were identified, equivalent on exposure to childhood maltreatment and previous mental health treatment. A multivariate group × maltreatment interaction was observed (p =.017) whereby males in the low cluster with a maltreatment history endorsed higher mood-related symptomology. This same pattern was observed in a univariate group × maltreatment interaction for suicide risk (p =.006). Health-related masculine values were associated with lower depression and suicide risk in men who have a history of childhood maltreatment. Future intervention studies should investigate whether development of health-related masculine values can reduce depression and suicide risk among men with a history of childhood maltreatment. [ABSTRACT FROM AUTHOR]

The prevalence of depression in men is significantly lower than women despite male suicide being higher. Therefore, improving the understanding and detection of depression in men is an important research and clinical aim. To examine the prevalence of prototypic, externalising and mixed depressive symptoms and their relation to mental illness and suicide risk Quantitative data were obtained through a survey of N = 1000 Canadian males (median age = 49.63 years, SD = 14.60). A range of validated scales were incorporated including the PHQ-9, K6, SBQ-R and MDRS. Using established cut-off scores, the proportions classified into distinct symptom groups were: not depressed (69%), prototypical (8%), mixed (12%) and externalising (11%). Risk of mental illness and suicidal risk was significantly elevated in all depressed groups. Compared to the not-depressed group, those experiencing only externalising symptoms and those with mixed symptomology were at significantly increased risk of mental illness as well current suicide risk. These results highlight the clinical importance of considering a broad range of potential presentations of depression in men, all of which are associated with increased suicide risk. [ABSTRACT FROM AUTHOR]

Engaging men in mental health promotion can be difficult because of reticence about help-seeking, especially for gender neutral programmes. Developments in men's health research has pointed to the success of gender-sensitized programmes to increase men's engagement in healthy lifestyle interventions targeting physical activity and healthy eating; however, less is known about the impact of these interventions on men's mental health. This study explored changes to men's depression risk and health-related quality of life at post-intervention (12 weeks) and 9-month follow-up, after participating in HAT TRICK, a gender-sensitized lifestyle intervention for overweight men. Participants completed validated self-report measures of mental health at baseline, post-intervention (12 weeks) and 9-month follow-up. Men's scores on the Male Depression Risk Scale (MDRS) and the SF-12 questionnaire, including physical health (PH12) and mental health (MH12) composite scores, were analyzed using mixed linear models to assess linear trends. At baseline, men (N  = 62) had a mean age of 50.98 (SD = 10.09) years and BMI of 35.87 (SD = 5.51) kg/m2. Results show that both the MDRS and the MH12 showed improvements in participants' mental health, with significant linear trends (p = 0.003; p = 0.003) qualified with significant quadratic trends over time (p = 0.02; p = 0.03). There were no significant changes in the PH12 over time. Gender-sensitized programmes for overweight men, such as HAT TRICK, are a promising approach to positively influence components of men's mental health, with the potential for sustained improvements over the long term. [ABSTRACT FROM AUTHOR]

Though men's health promotion has attracted increased research attention, conspicuously absent have been empirical insights to health literacy levels within and across male subgroups. Recent advancements in the measurement of health literacy have made available avenues for evaluating individual and social determinants of health literacy. Important insights can be drawn to detail patterns and diversity among men as a means to informing the design, implementation, and evaluation of tailored health promotion programs. Drawing on 2000 Canada-based men's responses to the Health Literacy Questionnaire, correlations between demographic variables and six health literacy scales are described. Low income, low education, and living alone were associated with men's low health literacy, with the strongest effect sizes for the "Social support for health" and "Actively engaged with health care professionals" scales. Multiple linear regressions confirmed low income as the strongest predictor of men's low health literacy in all the scales except "Appraisal of health information." Low income, self-identifying as gay, bisexual, or other, and living alone were strongly predictive of low scores on the "Social support for health" scale. The findings affirm the importance of considering men's health literacy and inequities to advance effective men's health promotion programs. [ABSTRACT FROM AUTHOR]

The objective was to describe the health literacy of a sample of Canadian men with prostate cancer and explore whether sociodemographic and health factors were related to men's health literacy scores. A sample of 213 Canadian men (M age = 68.71 years, SD = 7.44) diagnosed with prostate cancer were recruited from an online prostate cancer support website. The men completed the Health Literacy Questionnaire along with demographic, comorbidity, and prostate cancer treatment–related questions online. Of the 5-point scales, men's health literacy scores were highest for "Understanding health information enough to know what to do" (M = 4.04, SD = 0.48) and lowest for "Navigating the health care system" (M = 3.80, SD = 0.58). Of the 4-point scales, men's scores were highest for "Feeling understood and supported by health care professionals" (M = 3.20, SD = 0.52) and lowest for "Having sufficient information to manage my health" (M = 2.97, SD = 0.46). Regression analyses indicated that level of education was positively associated with health literacy scores, and men without comorbidities had higher health literacy scores. Age and years since diagnosis were unrelated to health literacy. Support in health system navigation and self-management of health may be important targets for intervention. [ABSTRACT FROM AUTHOR]

Background: Substantial evidence has demonstrated that sexual minorities (gay, lesbian, and bisexual people) and gender minorities (transgender and gender non-binary people) (SGM) experience poorer mental health than heterosexual and cisgender individuals. Meanwhile, less attention has been given to inequities within SGM populations. Aims: This study investigated depression within a sample of Canadian SGM who took part in an online survey (n = 2778). Methods: Multivariable regression was used to identify social characteristics associated with depression, as measured by the Patient Health Questionnaire (PHQ-9) (p < 0.05). The sample was then stratified by gender and sexual identity and the multivariable analysis was repeated for each stratum. Results: PHQ-9 scores were associated with every social position investigated, with the largest coefficients observed for non-binary and transgender individuals and those with a lower level of educational attainment. In stratified analysis, statistically significant associations were observed for cisgender respondents identifying as bisexual, queer, or pansexual (relative to gay/lesbian) and for transgender women from ethnic minority groups or with lower income. Conclusions: These results provide evidence of depression inequities within SGM along multiple social positions. Interventions to reduce depression should be prioritized for these sub-groups of SGM who experience the highest rates of depression. [ABSTRACT FROM AUTHOR]

The number of men in the Canadian workforce who have prostate cancer is increasing. The purpose of the study was to explore the processes involved in men's return to work post radical prostatectomy and understand how these events are connected to masculinities. Drawing on data collected through individual interviews with 24 participants, constructivist grounded theory method was used to develop the substantive theory of Reformulating the Worker Identity which comprises two processes, recovering after radical prostatectomy and renegotiating work expectations. Recovering after radical prostatectomy revealed how men overcame side effects at home and evaluated their potential for returning to work. Renegotiating work expectations included participant's strategies for securing graduated return to work accommodations. Study findings revealed that the challenges for fully returning to work post prostatectomy are often underestimated by clinicians and patients. In this context, preempting return to work challenges preoperatively might allay significant anxieties for many men. [ABSTRACT FROM AUTHOR]

Objective: Men can be reluctant to disclose distress and many men have ambivalence toward seeking help for depression, leading to poor uptake of and engagement in psychotherapy. The present study sought to explore whether a previously dissatisfying therapy experience leads to greater doubts about the effectiveness of treatment, in turn impacting on a man's willingness to disclose their distress in future. Method: An online survey of 133 Canadian men was conducted to investigate their current depressive symptoms, previous experience of, and belief in, the effectiveness of psychotherapy and likelihood of disclosing distress to their physician. A regression model with mediation was employed to analyze the relationship between these responses. Results: The regression model highlighted a significant negative association between satisfaction with previous therapy and doubt about the effectiveness of therapy (t = −7.299, 99% confidence interval [−.537, −.254], p <.001). There was also a significant indirect effect, such that doubt about the effectiveness of therapy mediated the association between previous satisfaction and willingness to disclose distress to a physician (t = 3.748, 99% confidence interval [.123,.690], p <.001). Conclusions: Providing treatment for depression that men find engaging and satisfying may improve their confidence that psychotherapy can help, make them more likely to reach out for assistance in the future and in turn, benefit their long-term mental health outcomes. [ABSTRACT FROM AUTHOR]

Men are at high risk for both morbidity and premature mortality from several of the most common serious diseases. Although numerous factors have been identified to explain men's risk, this study focused on the relationship between lifestyle behaviors, health-related self-stigma and masculine role norms. An age and location stratified sample of 2000 Canadian men completed measures assessing five lifestyle behaviors (smoking, alcohol use, sleep, diet and exercise), a screen for depression, and measures of self-stigma and masculine role norms. The results showed that elements of both health-related self-stigma and masculine role norms were associated with increased risk for being above the clinical threshold for four of the lifestyle behaviors and depression. The most frequent and largest relationships were associated with exercise and depression. The total number of lifestyle behaviors for which participants were above the clinical cut-points was also associated with self-stigma and masculine role norms. These findings demonstrate the importance of health-related self-stigma and masculine role norms as potential barriers to men's health and well-being. [ABSTRACT FROM AUTHOR]

Alexithymia has been hypothesised to elevate risk of negative mental health outcomes for men. The growing literature related to the role of men's experience of self-conscious emotions (i.e., shame and guilt) suggests that these aversive affective experiences may be important in the relationship between alexithymia and negative mental health outcomes. The present study used parallel mediation models to determine the mediating roles of shame and guilt in the relationships between alexithymia and psychological distress and suicide-related behaviours. Online self-report data was collected from a sample of Canadian men (N = 1,000; M age = 49.63, SD = 14.59). Participants completed measures of alexithymia, guilt, shame and depression. Adjusting for current depression symptoms, bias corrected bootstrapping (95% CIs) indicated that both shame and guilt were mediators between identification of feelings and distress (R2 =.67), and description of feelings and distress (R2 =.64). In contrast, guilt, but not shame, mediated the relationship between both identification of feelings and suicide-related behaviours (R2 =.38), and description of feelings and suicide-related behaviours (R2 =.39). Results indicate that men's difficulties identifying and describing their feelings and corresponding distress are particularly explained by shame – an aversive maladaptive emotion that promotes concealment of a perceived defective self. Conversely, guilt was more salient for men's suicide-related behaviours. [ABSTRACT FROM AUTHOR]

While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities. [ABSTRACT FROM AUTHOR]

Distress among young immigrant and refugee men has drawn increasing research attention in recent years. Nuanced understandings of distress are needed to inform mental health and public health programming. The purpose of this research was to examine distress from the perspectives of young immigrant and refugee men living in Greater Vancouver, British Columbia, Canada. Thirty-three young men (aged 15–22 years) from diverse immigrant and refugee backgrounds participated in interviews, which were conducted between 2014 and 2015. Data were examined using narrative analysis and theories of masculinities. Three narratives were identified—norming distress, acknowledging distress as ongoing, and situating distress. The findings reveal that the narratives offer different frames through which distress was rendered a norm, or acknowledged and situated in relation to the participants' relationships and to masculine discourses that shaped their expressions of distress. The findings can inform initiatives aimed at providing spaces for diverse young men to acknowledge their distress and to receive support for mental health challenges. [ABSTRACT FROM AUTHOR]

This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% screened for being at risk of suicide. The most frequently cited barriers to mental health services access were inability to pay (62.3%), insufficient insurance (52.2%), a preference for 'waiting' for the problems to go away (51.5%), discomfort discussing emotions (45.7%), and feeling embarrassed and ashamed about mental health challenges (42.5%). Policy and practices implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

The workplace provides an important setting to promote men's mental health, yet few studies have explored the gendered views of men and workplace representatives in male-dominated industries about workplace mental health promotion. Consultations with working men (N = 23) and interviews with seven representatives from male-dominated industries in northern British Columbia, Canada were conducted. Findings highlight the impact of masculine workplace cultures on men's mental health and practices that limit men's disclosures about vulnerabilities, as well as discussions about promoting mental health. Within such milieus a healthy mind was viewed as vital for workplace safety. Participant recommendations focused on reducing stigma, promoting enjoyable activities, and creating sustainable efforts toward building social cohesion. Overall, efforts to promote mental health in male-dominated industries should be tailored for the unique needs of men and should include paid time to engage in wellness activities and positive strategies that facilitate group comradery. Given male-dominated workplaces in particular constitute unique contexts where adherence to masculine ideals is normed, the findings hold potential for advancing mental health promotion programs designed to reach men. [ABSTRACT FROM AUTHOR]

Introduction: In Canada, patients with haemophilia can receive health care through a limited number of specialized haemophilia treatment centres. Treatment of this X‐linked bleeding disorder through self‐infusion of factor replacement is common; however, some individuals with haemophilia require additional infusion support from medical professionals. While provincially funded outreach clinics and telehealth are available, pharmaceutical companies that supply factor have developed novel home infusion programs wherein registered nurses assist/manage factor administration in the patients' homes. Aim: The current qualitative evaluation explored the real‐world effectiveness and impact of the Be Involved (Pfizer Canada) home infusion service, from provider, program end‐user and needs analysis perspectives. Methods: Qualitative interviews with patients and caregivers who had used Be Involved (n = 7) and Be Involved Staff (n = 8) provided important insights and recommendations for program improvement initiatives. Also included were needs assessments of potential end‐users (n = 11) as a means to making program adjustments. Results: The inductively derived findings revealed Be Involved as a highly valued, though key specialized service providing significant assistance to a small number of haemophilia patients. Augmenting traditional services, the program was endorsed as easing the burden of haemophilia care, while the Be Involved nurses were affirmed as highly effective and critical to the program's success. A lack of program promotion and awareness was evident – limiting uptake, amid communication and systems delivery challenges. Conclusions: The current evaluation findings inform our recommendations for, and brief discussion of, the need for stronger promotional strategies and improved communication lines to increase the reach and efficiencies of the Be Involved program. [ABSTRACT FROM AUTHOR]

Masculinity frameworks in men's health research have focused on masculine ideals and norms to describe men's health practices. However, little attention has been paid to inductively deriving insights about what constitutes health-related masculine values among young men. A sequential exploratory mixed-methods design, comprising a qualitative lead to derive health-related masculine values with a follow-up quantitative arm to test the items, was used. Drawing on a sample of 15-29-year-old Canadian male interview participants (n = 30) and survey respondents (n = 600), 5 health-related masculine values were highlighted: (a) selflessness, (b) openness, (c) well-being, (d) strength, and (e) autonomy. Selflessness was characterized by caring for and helping others. Openness included the willingness to gain exposure from new experiences, ideas, and people. Well-being was linked to fitness and masculine body ideals and aesthetics. In terms of strength, men endorsed intellectual, emotional, and physical strength. Regarding autonomy, there was consensus men should be self-sufficient and decisive, whereas being independent drew less endorsement. Highlighting the interdependency of these domains, exploratory factor analysis yielded 2 overarching reliable quantitative dimensions characterized by domains of being inclusive (openness and selflessness; α = .88) and empowered (well-being and autonomy; α = .85). Some inductively derived and pilot-tested values ran counter to long-standing claims that young men are typically hedonistic, hypercompetitive, and estranged from self-health. Study findings are discussed detailing how the evaluation of specific health-related masculine values in subgroups of men might advance masculinities-focused men's health research and inform the next generation of targeted gendersensitized services. [ABSTRACT FROM AUTHOR]

Although gay, bisexual, and two-spirit men (GBTSM) experience high rates of suicidality, there have been few empirical studies of prevention initiatives and policies that could address or reverse this major social problem. This article reports on a photovoice study of 29 GBTSM who had a history of suicidality or lost a fellow GBTSM to suicide. We focused our analysis on participants' perspectives on suicide prevention. Participants described four key considerations for GBTSM suicide prevention: (a) recognizing and addressing enduring homophobia, biphobia, and mental illness stigma; (b) provision of low-barrier, long-term, and GBTSM-affirming counseling; (c) de-isolation through peer support and community connection; and (d) fostering creativity and cultural resilience. By engaging GBTSM affected by suicide through photographs that depict their experiences and points of view, in this study, we offer concrete recommendations to reduce suicidality among GBTSM. [ABSTRACT FROM AUTHOR]

Background: Clinical practice and literature has supported the existence of a phenotypic sub-type of depression in men. While a number of self-report rating scales have been developed in order to empirically test the male depression construct, psychometric validation of these scales is limited. Aim: To confirm the psychometric properties of the multidimensional Male Depression Risk Scale (MDRS-22) and to develop clinical cut-off scores for the MDRS-22. Method: Data were obtained from an online sample of 1000 Canadian men (median age (M) = 49.63, standard deviation (SD) = 14.60). Confirmatory factor analysis (CFA) was used to replicate the established six-factor model of the MDRS-22. Results: Psychometric values of the MDRS subscales were comparable to the widely used Patient Health Questionnaire-9. CFA model fit indices indicated adequate model fit for the six-factor MDRS-22 model. ROC curve analysis indicated the MDRS-22 was effective for identifying those with a recent (previous four-weeks) suicide attempt (area under curve (AUC) values = 0.837). The MDRS-22 cut-off identified proportionally more (84.62%) cases of recent suicide attempt relative to the PHQ-9 moderate range (53.85%). Conclusion: The MDRS-22 is the first male-sensitive depression scale to be psychometrically validated using CFA techniques in independent and cross-nation samples. Additional studies should identify differential item functioning and evaluate cross-cultural effects. [ABSTRACT FROM AUTHOR]

Social isolation has featured as a significant and oftentimes all-encompassing risk factor for male suicide, yet, as an explanatory mechanism, it has not been unpacked in terms of what it constitutes in everyday life. The current photovoice study explores the various dimensions of the lived experience of social isolation, as embedded in accounts of suicidality drawn from 35 Canadian men. Study participants narrated the following factors as underpinning their social isolation: (a) family dysfunction and estrangement, (b) marginality and feeling like misfits at school and work, (c) alienation and provisional acceptance of health care, (d) ineffectual and self-harming management, (e) intrusive dislocating thoughts, and (f) society's burdensome and immoral subjects. These interwoven but discrete spheres provide a means for understanding the phenomenology of social isolation and a basis for melding ideas about connectedness, relationality, personal history, and care, along with strategies to support and reduce men's suicidality. [ABSTRACT FROM AUTHOR]

As part of a participatory health research project seeking to support men in achieving their health goals during the transition from prison to community, a workshop program was developed and piloted in a Community Residential Facility in British Columbia, Canada. The pilot program was evaluated through feedback surveys at each of the 16 workshops and a focus group interview at the end of the program. Workshops were highly valued by participants and seen as a means for (1) building skills relevant to their health and wellness, (2) working toward changing attitudes and behaviors adopted in prison, and (3) helping others and accepting help from others. Similar programs may be an effective support for men working to achieve their health goals during other transitions (e.g., bereavement, cancer patients, returning soldiers, and veterans). [ABSTRACT FROM AUTHOR]

Syndemics (socially produced intertwined epidemics) of psychosocial issues have been shown empirically to increase the risk of HIV infection among gay, bisexual and other men who have sex with men (GBM). However, to intervene effectively identifying those who are most vulnerable is critically important. Using an intersectionality framework, this study analyzed data drawn from 8490 Canadian GBM respondents to an online survey to evaluate demographic factors associated with experiencing a syndemic. A multivariable regression model was used to identify demographic characteristics among those experiencing a syndemic of two or more issues. Then, applying an intersectionality framework, the sample was stratified by gay and bisexual men, and by men partnered with woman (whether they were gay, bisexual or other), and the multivariate analyses for demographic variables were repeated for each strata. Multivariate regression models found that men were more at risk of syndemics if they identified as gay, were single, young (< 30-years-old), did not have a university degree and were low-income earners (< $60,000 per year). On stratified analysis, variations were found between gay, bisexual and female-partnered men where gay men were at greater odds of reporting a syndemic. These results provide further evidence that syndemics of psychosocial issues increase the risk of HIV infection among GBM. More so, the occurrence of syndemics was dependent on every single variable investigated including ethnicity and income. As such, interventions to reduce the effects of syndemics should be targeted to those most at risk and address social and structural inequities. [ABSTRACT FROM AUTHOR]

Although male suicide has received research attention, the gendered experiences of men bereaved by male suicide are poorly understood. Addressing this knowledge gap, we share findings drawn from a photovoice study of Canadian-based men who had lost a male friend, partner, or family member to suicide. Two categories depicting the men’s overall account of the suicide were inductively derived: (a) unforeseen suicide and (b) rationalized suicide. The “unforeseen suicides” referred to deaths that occurred without warning wherein participants spoke to tensions between having no idea that the deceased was at risk while reflecting on what they might have done to prevent the suicide. In contrast, “rationalized suicides” detailed an array of preexisting risk factors including mental illness and/or substance overuse to discuss cause–effect scenarios. Commonalities in unforeseen and rationalized suicides are discussed in the overarching theme, “managing emotions” whereby participants distanced themselves, but also drew meaning from the suicide. [ABSTRACT FROM AUTHOR]

As photovoice continues to grow as a method for researching health and illness, there is a need for rigorous discussions about ethical considerations. In this article, we discuss three key ethical issues arising from a recent photovoice study investigating men’s depression and suicide. The first issue, indelible images, details the complexity of consent and copyright when participant-produced photographs are shown at exhibitions and online where they can be copied and disseminated beyond the original scope of the research. The second issue, representation, explores the ethical implications that can arise when participants and others have discordant views about the deceased. The third, vicarious trauma, offers insights into the potenial for triggering mental health issues among researchers and viewers of the participant-produced photographs. Through a discussion of these ethical issues, we offer suggestions to guide the work of health researchers who use, or are considering the use of, photovoice. [ABSTRACT FROM AUTHOR]

HIV positive gay and bisexual men (GBM) continue to struggle with the pervasiveness of HIV stigma, but little is known about the health effects of stigma. In this article, suicidal ideation and attempts are measured among GBM living with HIV, evaluating the extent to which these experiences are associated with stigma and suicide. Drawing from an online national survey of Canadian GBM completed by 7995 respondents, a sub-set of data provided by respondents self-reporting HIV-positive status was used for the current study. The associations between suicidal ideation (SI) and attempts (SA) and four measures of HIV stigma were measured: social exclusion, sexual rejection, verbal abuse and physical abuse. A total of 673 HIV-positive men completed the survey (8% of total sample). Among this group, 22% (n = 150) reported SI and 5% (n = 33) SA in the last 12 months. After adjusting for sociodemographic factors, SI and SA were associated with each of the four measures of HIV stigma: being excluded socially for being HIV positive (SI adjusted odds ratio, AOR 2.0 95% CI 1.4-3.1; SA AOR 3.8 95% CI 1.9-7.9), rejected as a sexual partner (SI AOR 1.6 95% CI 1.1-2.4; SA AOR 2.6 95% CI 1.1-6.0), verbally abused (SI AOR 2.9 95% CI 1.9-4.5; SA AOR 2.4 95% CI 1.1-5.1), and physically abused (SI AOR 4.5 95% CI 1.8-11.7; SA AOR 6.4 95% CI 2.0-20.1). Furthermore, experiencing multiple forms of stigma was associated with significantly increased risk of SI and SA. The authors conclude that HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide. The findings affirm the need for targeted interventions to prevent suicide amid public health efforts to de-stigmatize HIV and mental illness. [ABSTRACT FROM AUTHOR]

Background: Immigrants often experience economic hardship in their host country and tend to belong to economically disadvantaged groups. Individuals of lower socioeconomic status tend to be more sensitive to cigarette price changes. This study explores the cigarette purchasing patterns among Chinese Canadian male immigrants. Methods: Semi-structured in-depth interviews were conducted with 22 Chinese Canadian immigrants who were smoking or had quit smoking in the last five years. Results: Because of financial pressures experienced by participants, the high price of Canadian cigarettes posed a significant challenge to their continued smoking. While some immigrants bought fully-taxed cigarettes from licensed retailers, more often they sought low-cost cigarettes from a variety of sources. The two most important sources were cigarettes imported during travels to China and online purchases of Chinese cigarettes. The cigarettes obtained through online transactions were imported by smoking or non-smoking Chinese immigrants and visitors, suggesting the Chinese community were involved or complicit in sustaining this form of purchasing behavior. Other less common sources included Canada-USA cross border purchasing, roll your-own pouch tobacco, and buying cigarettes available on First Nations reserves. Conclusions: Chinese Canadian immigrant men used various means to obtain cheap cigarettes. Future research studies could explore more detailed features of access to expose gaps in policy and improve tobacco regulatory frameworks. [ABSTRACT FROM AUTHOR]

Background: Male suicide prevention strategies include diagnosis and effective management of men's depression. Fundamental to suicide prevention efforts is public awareness, which in turn, is influenced by literacy levels about men's depression and suicide. Aim: The aim of this study is to examine sex differences in mental health literacy with respect to men's depression and suicide among a cohort of Canadian respondents. Methods: About 901 English-speaking Canadian men and women completed online survey questionnaires to evaluate mental health literacy levels using 10-item D-Lit and 8-item LOSS questionnaires, which assess factual knowledge concerning men's depression and suicide. Statistical tests (Chi-square, z-test) were used to identify significant differences between sex sub-groups at 95% confidence. Results: Overall, respondents correctly identified 67% of questions measuring literacy levels about male depression. Respondents' male suicide literacy was significantly poorer at 53.7%. Misperceptions were especially evident in terms of differentiating men's depressive symptoms from other mental illnesses, estimating prevalence and identifying factors linked to male suicide. Significant sex differences highlighted that females had higher literacy levels than men in regard to male depression. Conclusions: Implementing gender sensitive and specific programs to target and advance literacy levels about men's depression may be key to ultimately reducing depression and suicide among men in Canada. [ABSTRACT FROM AUTHOR]

Objective:Restricted emotional abilities may present significant implications for men’s health. The purpose of this study was to examine the relationship between alexithymia and several health-risk behaviours: substance misuse, aggressive and risky behaviours and suicidal ideation. Methods:A nationally representative sample of 1000 Canadian men responded to a survey containing measures of alexithymia, maladaptive coping behaviours, suicidal ideation and depressive symptoms. A series of hierarchical regressions were conducted using alexithymia as the predictor variable and each health-risk behaviour as the criterion variable, controlling for depressive symptom severity. Results:Alexithymia was found to be significantly associated with drug use, alcohol use, angry/aggressive behaviour and risk-taking behaviour – as well as suicidal ideation – beyond the effects of depressive symptoms. Conclusions:The findings provide evidence for the link between alexithymia and several problematic behaviours that pose risks to men’s health. [ABSTRACT FROM PUBLISHER]

Background: Young people's mental health is a public health priority. Given the influences of migration and resettlement on mental health, synthesis of current research with young people from migrant backgrounds can help inform mental health promotion initiatives that account for and are responsive to their needs. Aims: This article distils the results of a review of published literature on the mental health of adolescent immigrants (ages 10–19) living in Canada. Method: Scoping review methods were used to define inclusion and exclusion criteria; inform the search strategies; and extract and synthesize key findings. Results: Fourteen articles met criteria for inclusion. Analysis of the studies indicate diversity in mental health indicators, e.g., mental distress, emotional problems and behavioral problems, as well as a wide range of influences on mental health from age at migration and length of stay to place of residence, income and discrimination. Conclusions: Findings support the need to account for the array of influences on young people's mental health in relation to migration and to augment initiatives beyond the level of individual intervention. [ABSTRACT FROM AUTHOR]

The purpose of this research was to explore the role of masculinity and heterosexual gender relations in new and expectant fathers' explanations of their continued smoking. We conducted a secondary analysis of in-depth interviews with 20 fathers. Two themes were identified: (1) reconciling with partners to maintain a smoke-free family home; and (2) smoking to self-regulate emotions and maintain relationships. Fathers' decisions to smoke and changes in smoking behavior were shaped by ideals of masculinity and by partner relationships and family and social contexts, including division of domestic duties and childcare. Recognizing the influence of both masculinity and gender relations could provide new directions for supporting men's smoking cessation efforts during early parenthood. © 2014 The Authors. Research in Nursing & Health Published by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: The assumption that men dislike psychotherapy has been espoused by clinicians, health care administrators, and those in the popular media. Whether this assumption holds true among help-seeking men has not been tested. Aims: Treatment preferences of men attending outpatient psychiatric clinics were investigated to assess their willingness to engage in psychotherapy. Methods: In three different studies (total N = 407; 170 men), male and female outpatients completed various self-report measures that assessed their treatment preferences, as well as psychiatric symptoms. Results: Across all three studies, men indicated a preference for psychotherapy over medication or no treatment/wait and see; a preference pattern that did not differ significantly from that of women. The only between-sex difference to emerge regarding preferences was in study 2; a greater proportion of men preferred individual therapy over group therapy compared to women. There were no between-sex differences with regard to symptoms. Conclusions: Contrary to assumptions that portray men, generally, as unwilling or uninterested to engage in psychotherapy, men that have sought mental health services appear to prefer psychotherapy as their intervention of choice to address their mental health problems. [ABSTRACT FROM AUTHOR]

Background: In Canada, prostate cancer (PCa) is the most common male cancer, and prostate cancer support groups (PCSGs) have prevailed for more than 20 years providing support to men with PCa and their families. While the format, focus and benefits of attending PCSGs have been reported little is known about primary physicians' (PPs) perceptions of these groups. This article describes Canadian primary physicians' views about face-to-face and web-based PCSGs. Methods: Canadian based primary physicians (n = 140) attending a 2012 Continuing Medical Education Conference participated in a pilot survey questionnaire study. The 56-item questionnaire used in this study included six sets of attitudinal items to measure primary physicians' beliefs about positive and negative influences of PCSGs, reasons for attending PCSGs, the attributes of effective PCSGs, and the value of face-to-face and web-based PCSGs. Results: Results showed that PCSGs were positively valued, particularly for information sharing, education and psychosocial support. Poor inclusivity, privacy, and accessibility were identified as potential barriers, and recommendations were made for better marketing and web-based PCSGs to increase engagement with potential attendees. Conclusions: Findings suggest PPs highly valued the role and potential benefits of PCSGs. Information provision and an educational role were perceived as key benefits amid the need to improve local and provincial marketing of PCSGs. The potential for web-based PCSGs to help in the support of PCa patients was also recognized. [ABSTRACT FROM AUTHOR]

Abstract: In this article we consider young adults' photo-narratives about smoking and quitting and their linkages to themes of healthy lifestyles and the culture of place in Vancouver, Canada. Drawing from a pilot study using participant-driven photography with a group of twelve young women and men ages nineteen to twenty-six, participants' visual and narrative representations of being a smoker and the process of quitting smoking were analyzed. Findings suggest “healthy lifestyle” imperatives within the Vancouver context may be productive for facilitating cessation, but may also have exclusionary effects. [Copyright &y& Elsevier]

Purpose – The purpose of this paper is to describe culture- and context-specific suicidal behaviours among Korean-Canadian immigrants as a means to guiding the development of targeted culturally sensitive suicide prevention programmes. Design/methodology/approach – Fifteen Korean-Canadian immigrants who had experiences with suicidal behaviours (e.g. suicidal ideation, suicide attempts) participated in this qualitative research study. Semi-structured interviews were conducted for 30-90 minutes individually and constant comparison analysis methods were used to inductively derive recurrent prevailing themes from the interview data. Findings – The study findings reveal that causes and triggers for suicidal behaviours among Korean-Canadians most often emerged from academic and work pressures, estranged family and altered identities. Permeating these themes were deeply embedded cultural values, which according to the participants, could afford protection or heighten the risk for suicide. Research limitations/implications – By focussing only on first-generation Korean-Canadian immigrants, the results are limited in what they can reasonably say about other Canadian immigrant sub-groups. Practical implications – In light of the current research findings, mental health care providers should be cognizant of immigrant patients’ cultural backgrounds and life circumstances as a means to further understanding what underpins their risk for suicide. Originality/value – Notwithstanding the aforementioned limitation, this study contributes important empirical insights about Korean-Canadian immigrants’ suicidal ideation and risk/protective factors. This not only adds to the wider literature connecting culture and suicidality, it affirms the need for culture-specific research as a means to developing culturally sensitive mental health services. [ABSTRACT FROM AUTHOR]

Abstract: Severe depression is a known risk factor for suicide, yet worldwide men’s suicide rates continue to outnumber reported rates of men’s depression. While acknowledging that the pathways to suicide are diverse, and being mindful of the complex challenges inherent to studying suicide, we interviewed men who experienced depression as a means to better understanding the processes they used to counter and contemplate suicide. This novel qualitative study provides insights on how masculine roles, identities and relations mediate depression-related suicidal ideation in a cohort of 38 men in Canada, ranging in age from 24 to 50 years-old. Constant comparative analyses yielded the core category of reconciling despair in which men responded to severe depression and suicidal ideation by following two pathways. To counter suicide actions, connecting with family, peers and health care professionals and/or drawing on religious and moral beliefs were important interim steps for quelling thoughts about suicide and eventually dislocating depression from self-harm. This pathway revealed how connecting with family through masculine protector and father roles enabled men to avoid suicide while positioning help-seeking as a wise, rational action in re-establishing self-control. The other pathway, contemplating escape, rendered men socially isolated and the overuse of alcohol and other drugs were often employed to relieve emotional, mental and physical pain. Rather than providing respite, these risky practices were the gateway to men’s heightened vulnerability for nonfatal suicidal behaviour. Men on this pathway embodied solitary and/or risk taker identities synonymous with masculine ideals but juxtaposed nonfatal suicidal behaviours as feminine terrain. [Copyright &y& Elsevier]

Abstract: Depression, a disorder often thought of as a women’s health issue, is underreported in men, and little is known about how heterosexual couples respond when the male partner is depressed. Within the context of men’s depression, couples may be challenged to make life adjustments that impact their gender relations. The findings detailed in this article are drawn from an innovative qualitative study of 26 Canadian heterosexual couples (26 men and their 26 women partners) in which the man had a formal diagnosis and/or self-identified as depressed. Participants completed individual, semi structured interviews that focused on exploring how masculinities and femininities intersect to forge particular heterosexual gender relations in the context of men’s depression. A social constructionist gender analysis revealed three couple patterns: trading places, business as usual, and edgy tensions. Trading places refers to couples who embodied some atypical masculine and feminine roles to compensate for the men’s depression-induced losses (e.g., men as homemakers and women as breadwinners). Women partners in these dyads broke with feminine ideals in how they provided partner support by employing tough love strategies for self-protection and a means of prompting the men’s self-management of their depression. Couples involved in business as usual co-constructed men’s alignment with masculine workman ideals and women’s support of their partner to counter and conceal men’s depression induced-deficits. Also described were edgy tensions, where a mismatch of gender expectations fueled resentment and dysfunction that threatened the viability of some relationships. Overall, the limits of women’s resilience and care-giving were evident, yet the findings also reveal how men’s management of their depression was directly influenced by their partner. Opportunities for couples to assess their relationship dynamics within a broad range of gender relations might support couples’ connectedness and life quality amid the challenges that accompany men’s depression. [Copyright &y& Elsevier]

International university students can experience isolation amid academic pressures. Such circumstances can manifest as or exacerbate depression. This qualitative study involved 15 international male students at a Canadian university who were diagnosed or self-identified as having depression. Individual interviews revealed men's perspectives about causes, implications, and management of depression. Participants intertwined sex- and gender-based factors in detailing causes, and emphasized the potential for parents to impact depression. Implications of depression for embodying traditional masculine roles of breadwinner and career man influenced many men to filter details about their illness within "home" cultures. This practice often prevailed within Canada despite the men's perceptions that greater societal acceptance existed. Masculine ideals underpinned self-management strategies to fight depression and regain control. Counter to men's reluctance to disclose illness details were participants' self-management preference for peer-based support. Study findings highlight how masculine ideals and cultural constructs can influence depression experiences and expressions. [ABSTRACT FROM AUTHOR]

The experiences of elderly South Asian (SA) men who have immigrated to Canada provide unique insights to men's health and illness behaviors and beliefs. In this article, we describe the connections between masculinity, culture, and health among a cohort of 14 SA immigrant men. The findings indicated that participants' health behaviors were closely aligned to those of western men. However, a fine-grained analysis revealed how complex cultural connections informed and influenced many men's health behaviors and beliefs. Based on the study findings, recommendations for the future design of healthcare services targeted to SA men are made. [ABSTRACT FROM AUTHOR]

Background: Although evaluation studies confirm the strong potential of men's electronic health (eHealth) programs, there have been calls to more fully understand acceptability, engagement, and behavior change to guide future work. Relatedly, mapping of behavior changes using health promotion theories including the transtheoretical model (or stages of change) has been recommended to build a translatable empirical base to advance design and evaluation considerations for men's eHealth programs.Objective: This study aimed to use a benchmark sample as a reference group to map the recent and intended health behavior changes in Canadian men who use the Don't Change Much (DCM) eHealth program. The hypothesis being tested was that increased exposure to DCM would be positively associated with men's recent and intended health behavior changes.Methods: DCM users (n=863) were sampled for demographic data and self-reported recent and intended health behavior changes. Respondents also reported their usage (frequency and duration) for each of the 3 DCM components (web, newsletter, and social media) and were allocated to limited exposure (257/863, 29.8%), low exposure (431/863, 49.9%), and high exposure (175/863, 20.3%) subgroups. A benchmark sample (n=2000), comprising respondents who had not accessed DCM provided a reference group. Bivariate analysis of recent and intended health behavior changes and DCM exposure levels were used to compute the strength of association between the independent variables (exposure levels) and the 10 categorical dependent variables (recent and intended health behavior changes). Binary logistic regression models were computed for each of the 10 recent and intended health behavior changes. Linear regression was used to model the association between the number of recent and intended changes and the level of exposure to DCM.Results: Compared with the benchmark reference group, DCM high-exposure respondents had significantly increased odds for 9 of the 10 health behavior changes, with the largest effect size observed for Changed diet or Improved eating habits (odds ratio [OR] 5.628, 95% CI 3.932-8.055). High-exposure respondents also had significantly increased odds for 9 intended health changes, with the largest effect sizes observed for Reduce stress level (OR 4.282, 95% CI 3.086-5.941). Moderate effect size (goodness of fit) was observed for increased total number of recent (F12,2850=25.52; P.001; adjusted R2=.093) and intended health behavior changes (F12,2850=36.30; P.001; adjusted R2=.129) among high-exposure respondents.Conclusions: DCM respondents contrasted the predominately precontemplative benchmark sample mapping across the contemplative, preparation, and action stages of the transtheoretical health behavior change model. Almost 10% of variation in the recent and 13% of variation in the intended health behavior changes can be explained by DCM exposure and demographic factors, indicating the acceptability of this men's eHealth resource. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to understand the exercise levels, preferences and interests of prostate cancer survivors in Canada. Methods: An electronic survey was administered via a prostate cancer‐specific website and assessed self‐reported exercise levels, exercise preferences and interests, exercise barriers and facilitators to exercise. Results: Based on 103 participants, the majority (75.7%) of prostate cancer survivors did not meet both aerobic and resistance exercise guidelines, despite an interest in exercise. Strongest exercise preferences were shown for resistance exercise, walking, flexibility and bicycling and for performing exercise from a community‐based gym or from home. Significant differences in exercise interests and facilitators were found between individuals who were meeting exercise guidelines compared to those who were not. Conclusion: The majority of Canadian prostate cancer survivors are insufficiently active. Exercise preferences and facilitators appear to be influenced by current exercise levels. Resistance and aerobic exercise should be considered when programming exercise for prostate cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men's health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation. Objective: Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men's health. Methods: We present experiences of KT across two case studies of men's health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men's depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men's depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled "If I Were Jack". Results: For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men's health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset. Conclusions: The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work. [ABSTRACT FROM AUTHOR]