Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: empirical evidence from secondary analysis of multi-national, online cross-sectional surveys

McDaid, L. , Flowers, P. , Ferlatte, O. , McAloney-Kocaman, K. , Gilbert, M. and Frankis, J. (2020) Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: empirical evidence from secondary analysis of multi-national, online cross-sectional surveys. SSM Population Health, 10, 100519. (doi: 10.1016/j.ssmph.2019.100519) (PMID:31853476) (PMCID:PMC6911981)

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Abstract

Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level.

Item Type:Articles
Additional Information:LMcD and PF are funded by the United Kingdom Medical Research Council (MRC) and Scottish Government Chief Scientist Office (CSO) at the MRC/CSO Social & Public Health Sciences Unit, University of Glasgow fund LMcD and PF (MC_UU_12017/11, SPHSU11; MC_UU_12017/12, SPHSU12). JF and KMK are funded by Glasgow Caledonian University. The SMMASH2 study was partly funded from a grant from NHS Greater Glasgow and Clyde and NHS Lothian, United Kingdom. Postdoctoral funding for OF was provided by Movember Canada (Grant # 11R18296), the Canadian Institutes for Health Research (Grant # 11R06913) and the Michael Smith Foundation for Health Research in Canada (Grant # 17945). MG is funded by the Provincial Health Services Authority, British Columbia, Canada. The Sex Now 2014-15 survey was partly funded by a grant from the Vancouver Foundation and the Public Health Agency of Canada.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McDaid, Professor Lisa and Flowers, Professor Paul
Authors: McDaid, L., Flowers, P., Ferlatte, O., McAloney-Kocaman, K., Gilbert, M., and Frankis, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:SSM Population Health
Publisher:Elsevier
ISSN:2352-8273
ISSN (Online):2352-8273
Published Online:27 November 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in SSM Population Health 10:100519
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727631SPHSU Core Renewal: Relationships & Health Improvement Research ProgrammeLisa McDaidMedical Research Council (MRC)MC_UU_12017/11IHW - MRC/CSO SPHU
SPHSU11
727641SPHSU Core Renewal: Setting and Health Improvement Research ProgrammeKathryn HuntMedical Research Council (MRC)MC_UU_12017/12IHW - MRC/CSO SPHU
SPHSU12