Abstract
The purpose of this study was to evaluate men’s perceptions of self-dynamics and partner dynamics during common everyday sickness. Five focus group interviews (N = 44) were conducted, each lasting approximately 120 minutes. The data were analyzed using a generic qualitative approach which identified two larger themes and several sub-themes: sickness appraisals and appraisal communication (gender differences in symptom appraisal and minimization of own and partner’s sickness) and coping and support strategies (individual coping, one-way provision of support, and coping together). It seems acute sickness creates shared stressors for both partners but differentially impacts each based on gender and family roles.
Introduction
Common everyday sickness affects nearly every member and family in society. For example, the Centers for Disease Control and Prevention (CDC) estimated that between October 2018 and March 2019, approximately 32.8 million people were diagnosed with the influenza virus (CDC, 2019). Considering that adults on average have 2–3 cold or flu episodes a year, lasting anywhere from 7–10 days, families could have multiple rounds of sickness every year (CDC, 2016). This can have spillover effects that burden family relationships and affect other aspects of day-to-day life including work, childcare, housework, and extracurricular activities (Northouse et al., 2007), which can then strain the caregiver and couple relationship and compound normal life stress.
Does the acute, yet reoccurring nature of these everyday sicknesses, operate differently in relationships than chronic illnesses? Research, literature, and theoretical frameworks are established for couples coping with chronic illnesses (e.g. Berg and Upchurch, 2007; Lyons et al., 1995; O’Brien and DeLongis, 1997; Revenson, 2003), yet no research has identified couple dynamics during acute health conditions and everyday illnesses. Furthermore, gender has been shown to play a large role in how either partner makes sense of experiencing an illness (accurate vs inaccurate appraisals) and how they cope (interdependent vs independent coping) (Cross and Madson, 1997; Revenson et al., 2005), yet again, this has not been studied in acute sicknesses—possibly because men might minimize their own symptoms or experience, refuse help from their partner (which could undermine the relationship), or delay healthcare utilization (Gast and Peak, 2011; Novak et al., 2019). These research gaps are important to address so that health educators and interventionists can better tailor prevention, education, and intervention efforts to improve the physical and relational health of the family. Consequently, utilizing data from focus groups and a general qualitative inquiry approach, the purpose of this study was to investigate men’s perceptions of the individual and partner experiences and the collective relationship dynamics during common, everyday sickness.
Literature review
Theoretical orientation: systemic transactional model and sickness
The present study utilizes the systemic-transactional model (STM) of Dyadic Coping (Bodenmann, 1995, 2005; Bodenmann et al., 2016), which was built upon Lazarus and Folkman’s (1984) transactional theory of stress and coping, to identify and understand the processes occurring in the experience of everyday sickness in the relationship. This theoretical framework will be applied and woven in with the literature in the sections below.
Stress
According to the STM of dyadic coping, there are three separate types of stress: (1) individual stress, in which the individual can cope and manage the stress without the partner; (2) dyadic stress, in which individual stress is not resolved by the individual alone and the partner is pulled into the stress; and (3) genuine dyadic stress, in which the stress directly affects the couple as a unit (such as a relocation or birth of a child) (Bodenmann, 1995, 2005; Rentscher, 2019). Shared stressors arise from concerns about the sickness interfering with the couple’s life, both relationally and for other domains of day-to-day activity (CDC, 2016)—including the possible redistribution of household responsibilities (Oliver and Cronan, 2005). In couples where husbands are ill, women take on even more responsibilities, while men tend to reduce their work activities and responsibilities and are nurtured by their wives (Revenson et al., 2005). In contrast, for couples in which wives are ill, the division of household labor was only slightly narrowed; women resume household responsibilities more quickly, including taking care of other family members, and report receiving a greater amount of help from adult daughters and neighbors than from their healthy husbands (Revenson et al., 2005). As such, it seems that experience of an acute sickness, such as the cold or flu, presents stress that not only disrupts the sick individual’s day-to-day routines and activities but also that of their partner and family.
Appraisals
The STM delineates three appraisal processes that both partners engage in: (1) assess their partner’s appraisal of the situation, (2) evaluate whether the partner realizes and understands his or her own appraisal, and (3) reevaluate and synthesize their partner’s appraisal with their own. According to the model, if both partners agree, then a “common” or dyadic appraisal results. In that case, a stress communication process occurs where one partner shares his or her appraisal with the other, the partner then interprets the message and can respond on a continuum from taking action to doing nothing or ignoring the message (Bodenmann, 2005; Rentscher, 2019).
Specifically related to sickness and illness, appraisals and illness representations include the couple’s perceptions of severity, controllability, and the consequences of the illness (Goldsmith, 2009). In addition, each individual defines the ownership of the illness, whether they ascribe it as an individual problem (“mine” or “his/hers”) or whether the problem belongs to the couple in unison (“we”). Gender plays a large role in the couples’ experience of coping with illness (Revenson et al., 2005)—especially related to appraisals. Much of the literature suggests that these differences are because of self-representations on the independent-interdependent continuum—men lean more toward independence in appraisals and coping and women are more interdependent (Acitelli and Antonucci, 1994; Cross and Madson, 1997). Regarding illness appraisals, women perceive more collective appraisals of illness (“we”) (Kuijer et al., 2000), are more attuned to physical symptoms, and report higher sensitivity to changes in physical sensations than men do (Van Wijk et al., 1999; Verbrugge, 1980, 1989) These appraisals, both individually (the patient and spouse separately) and relationally (how they both make sense of it together), set the stage for the type of coping—either individual or dyadic (Johnson et al., 2013).
Coping
Finally, the STM describes the three types of dyadic coping: (1) common coping, in which both partners work together to manage the stressful situation, (2) supportive coping, in which one partner provides aid to the other, and (3) delegated coping, in which one partner requests that the other manage the stressful situation because of his or her own preferences, competencies, experiences, or resources (Rentscher, 2019). Studies have shown how collaborative or concordant coping strategies are often associated with positive psychosocial adjustment for the patient and may promote better health outcomes (Franks et al., 2004), while discordant coping strategies such as overprotection and protective buffering (Berg and Upchurch, 2007) are often associated with poorer adjustment and health outcomes for both the patient and partner (Johnson et al., 2013). Concerning gender differences, women prefer more supportive and collaborative types of coping, including expression of feelings and emotions, whereas men are more self-focused and oftentimes prefer to cope alone or in less relational ways (Tamres et al., 2002). The question remains then, what types of coping strategies do couples engage in during everyday sickness?
The present study
As previously mentioned, the experience of acute, but reoccurring sickness, has not been previously investigated, so it is unknown what couples experience and how it might be similar or different to chronic illness. Yet, research shows that individuals within families experience multiple waves of common sicknesses every year that invariably can impact day-to-day activities (CDC, 2016). Furthermore, men and women experience illness in different ways, both in their perception of the symptoms and how they cope (Revenson et al., 2005). Because men might downplay or ignore their symptoms and delay healthcare because of socially acceptable ways of behaving as a man (masculine gender scripts; Helgeson and Lepore, 1997), research needs to investigate how men view the experience of everyday sickness and the differences they perceive in their female partners. The present study seeks to identify men’s perceptions of the individual, partner, and relationship dynamics during common, everyday sickness.
Methods
Procedure
In the current study, data were collected from five focus groups that ranged from eight to ten men each. All participants were married and heterosexual as the groups were part of a larger study concerning the impact of wives on health decision-making of their male spouses. To obtain the volunteer sample, participants were recruited through printed flyers and digital displays posted in various buildings on a university campus in the state of Utah in the United States. Recruitment flyers were also posted at multiple businesses, at employment centers, on social media, and at a senior center. Potential participants contacted the researcher via phone, text message, or email, were made aware of the overall goal of the study and what they could expect to take place during the focus group discussion, and if they agreed to participate, were given days/times that they could participate in the focus groups. Participants were then contacted, informed them of their assigned date and time, and received reminder text messages, phone calls, or emails sent a few days prior to the focus group. After participants arrived and were seated, the moderator passed out a letter of informed consent and a demographic questionnaire. After given consent to participate, the moderator read an opening statement, introduced himself, and asked participants to introduce themselves.
A semi-structured discussion guide to ascertain how participants viewed health, illness, healthcare seeking, spousal influence on health behaviors, and strategies to preserve masculine capital was developed and pilot tested (N = six). The purpose of the pilot test was to determine the effectiveness of the proposed discussion guide. The pilot test also allowed the moderator (a male graduate student) to refine his interviewing skills prior to conducting the focus groups. Data collected during the pilot test were not used for final data analysis. The pilot participants were asked to provide feedback concerning the clarity of the questions used in the discussion guide. The research team also met to discuss if the questions were effective related to the research aims. For the purpose of this study, participants were asked about how they and their wives perceive being ill differently to see what differences might exist. Participants were allowed to discuss the topic while the moderator guided the conversation. Focus groups were audio-taped and video-taped and ranged between 1.5 and 2.5 hours. All focus groups were held in a conference room on the university campus. Participants were paid $20 and provided parking validation. University institutional review board (IRB) approval was obtained prior to data collection.
Sample
A total of 44 heterosexual married men participated in the five focus groups. Participant ages ranged from 21 to 82 (M = 32). The majority of the sample were Caucasian/white/non-Hispanic (90%, n = 40), reported attending some college or finished college (78%, n = 30), were employed full-time or part-time (86%, n = 38), were married between less than one year and five years (60%, n = 26), reported marriage between one and five years, and were highly active in their religion (82% reported affiliation with The Church of Jesus Christ of Latter-day Saints). See Table 1 for full demographic information.
Demographic information (N = 44).
Note: Owing to rounding, totals may not equal to 100.
Data analysis
The present study used a generic qualitative approach to identify themes from the data about the experience of couple processes during common everyday sickness from the perspective of the husband. In generic qualitative inquiry, the goal is to stimulate participants’ ideas and responses around a specific topic (Percy et al., 2015). This approach is used when none of the typical qualitative methodological approaches (case study, ethnography, or phenomenological grounded theory) are appropriate and when the researcher wants a broader understanding of individual interpretation (participant reflections and subjective thoughts, beliefs, and attitudes) of a phenomenon (Marshall and Rossman, 2016). This approach to data collection can vary from semi-structured or fully structured interviews, questionnaires, or content-specific participant observation—rather than using more traditional approaches to attempt to acquire deeper meaning or insight (Kahlke, 2014; Marshall and Rossman, 2016; Percy et al., 2015). This allows for larger samples sizes in which the researchers can glean multiple viewpoints and differing opinions, which help to understand the breadth and scope of a certain topic (Percy et al., 2015).
Both an inductive and deductive approach was taken in the interpretation of the data (Azungah, 2018), with first an inductive approach to identify themes as they unfolded (Saldana and Omasta, 2018) and then a deductive approach with existing theory (STM) and literature. Both approaches have been used together in qualitative articles and often both are used with different dominancy during analysis (Armat et al., 2018). After the transcription of each focus group (Charmaz, 2014; Corbin and Strauss, 2008), each transcript was read line-by-line by each member of the research team to find recurring themes and identify similarities and differences among the men’s responses in other focus groups. In this way, the researchers ensure accurate data analysis, limit potential researcher bias, and confirm that the overall results reflect participant opinions representative of the whole (Marshall and Rossman, 2016).
In any qualitative study, there is concern about the trustworthiness of the data. To combat this, several components of trustworthiness should be included: credibility, dependability, confirmability, and transferability (Tolley et al., 2016). Credibility was established by comparing thematic results to the existing literature on couples coping with illness—unexpected results were noted and included as part of the analysis. Dependability was established by reflexivity of and diversity of the research team, which included two marriage and family therapists, a public health specialist, and a social worker, and helped the team view the data from multiple perspectives and offset discipline bias. In addition, the research team included both men and women, which also helped offset gender bias, especially around issues of power and privilege. Confirmability was bolstered by an audit trail that included raw data and use of memos at each step of the coding process. All of the notes, memos, and protocols were secured in a cloud server. Finally, transferability of the model is in the context of highly religious, heterosexual men in traditional gender roles (e.g. men were the primary breadwinners and women were primarily stay-at-home partners or worked some hours outside of the home).
Results
Defining themes
The inductive analysis conducted on the five focus groups helped identify themes related to how men perceived their own and their partners’ experience of sickness. These were the subthemes that resulted below. Deductively, the subthemes were grouped according to how they fit together conceptually, and higher order themes were labeled according to the STM’s conceptualization of appraisals and coping. As such, both the inductive and deductive approaches worked in a complementary fashion (Azungah, 2018). The first higher order theme, sickness appraisals and appraisal communication, reflected participant’s experience of how they viewed the differences in their own symptoms versus how they viewed their wife’s symptoms. Other themes included minimizing their own and their partners’ sickness. The second higher order theme, coping and support strategies, reflected how participants saw both their own and their partner’s strategies to work through the sickness and included how either coped alone or with their partner. Each larger theme and subthemes will be discussed in depth below with corresponding quotes from the participants (Table 2).
Description of themes and subthemes.
Sickness appraisals and appraisal communication
The higher-order theme of sickness appraisals and appraisal communication was generated as most appropriate to the participants’ descriptions of how men specifically viewed their symptoms compared to their partner’s symptoms with important gender distinctions emerging. This theme reflects a dyadic appraisal process in which a partner minimized his or her own sickness experience, as well as how this appraisal was perceived and communicated to their partner.
Gender differences in symptom appraisals
The male participants reflected on how their appraisals of their symptoms differed from their wives specifically because of gender. Several participants discussed how men and women see symptoms differently, with men viewing them as basic yes/no symptoms and women seeing them along a gradient or continuum. A participant (FG 4, age 26, married 1.5 years) stated,
I really don’t need an excuse to be sick. If I’m sick or I’m tired, I’m just like, “I’m sick, or I’m tired, I don’t want to do stuff today, and that’s all I have to say about it.” She’s like, “Oh, but I’ve got to do this, I’ve got to do that,” it’s like we’re filling out two different forms for “I’m sick!” Mine is, check yes or no for sick, hers is do you have these symptoms, do you feel this way, can you plausibly give yourself a reason to do this, and I’m just like, Nah, I’m good.
Another participant (FG 4, age 28, married 9 months) said,
I think this is kind of ubiquitous among men and women, respectively. I think guys see sickness as more of a . . . we see a little bit more into the root of it, or we see the basics of it . . . and women like to work on the symptoms. But that kind of goes for everything in marriage, am I right? They like to focus on the nitpicky details and the symptoms, and the outside vision of things, and we like, we like the basics, the meat and potatoes, if you will, of everything, and so if we can get down to that in sickness, too.
Minimizing one’s own sickness
The sickness appraisal that occurred most often was men minimizing their own sickness. Participants reflected on how they tended to downplay being sick and how they did not want their partner to know. A participant (FG 5, age 26, married 3 years) stated,
I’m not sure if it’s so much how we react differently to us being sick, or how we react differently to each other being sick, like I force her to lay down and I take care of her. But if I’m sick, I usually don’t want to let on. I’m kind of like (other participant) in that; I just do my normal stuff and so I try not to like let her know because I’d probably be the same way. So I guess I react differently to who is sick. Like, I make her like lay down I really want to take care of her. But, when I’m sick I want to tough it out and do what I have to do.
Another participant (FG 1, age 23, married 6 months) described his experience compared to his wife’s experience, which seemed related to gendered positions on symptoms:
I rarely get sick, and when I do, I kind of ignore it, so it’s not very bad, ever, and it usually goes away, eventually but, my wife, when she gets sick, like, she’s SICK. It really hits her hard. She, I think she’s feels mentally sick when she’s physically sick, as well . . . and she worries about it. And it hits her a lot harder than it usually hits me, when I get sick.
One participant (FG1, age 25, married a little over a year) discussed how his wife minimized her own sickness because she has things to take care of but how he wanted her to rest and take it easy:
Then anytime she is sick, which is all the time, because she is a nanny, then she is like, “No, no I’m fine . . .” I’m like, “you just coughed up a piece of your lung. Will you just please go and sit down for a couple of minutes,” And she’s just acts like, she’s just very driven, I just have to get everything in order.
Minimizing partner’s sickness
The subtheme of minimizing a partner’s sickness arose as participants discussed how their partners downplayed their (the men’s) sickness (or they minimized their partners’ sickness). A crucial component of this theme seemed to be that they or their partner knew about the others’ appraisal and it was communicated. A participant (FG 4, age 36, married 13 years) stated: “My wife thinks that I’m a baby when I’m sick. I don’t.” Similarly, another participant (FG 2, age 26, married 9 months) described how his partner perceived him being sick, “She always thinks I’m being a little ridiculous when I complain of being a little sick. She thinks that I overreact.”
Another participant (FG 1, age 24, married 2 years) referred to how his partner minimized his sickness experience that turned out to be serious:
I know my wife reacts to me being sick as if it’s not almost not real. When I’m sick, she’s like, “You’re not sick!” And I actually developed pneumonia and I’m lying in bed, and I’d breathe, and my lungs, and I can hear it, and I’m like, “There’s something wrong.” . . . and she’s just like, “You’re just being a baby . . . you need to get up and go do things.” And I’m like, “I feel like I’m dying.” It’s not okay.
In addition, participants discussed how they minimized their partner’s (the wife’s) sickness or suggested that she was overreacting to her symptoms. A participant (FG 4, age 28, married 9 months) stated,
But I think our wives will take those coughs and sniffles and those little things and take those and make them feel like meat and potato sicknesses for themselves. I mean, that’s . . . it sounds exactly the same . . . I haven’t felt sick enough to need to miss, you know, school or work for probably 10 years now. And my wife likes to take a sick day, or even if it’s a couple of hours of, “Oh, I’m too sick to go to work,” for a runny nose or a cough.
Another participant (FG 5, age 39, married 16 years) also minimized his partner’s sickness but seemed to have more awareness for his lack of sympathy toward his wife:
I don’t know, I get kind of disappointed, I guess, because I don’t expect for her to get sick just because, you always want to be healthy, but when something happens then I have a hard time being, I guess, what’s the word . . . being sympathetic? Maybe it’s because I’ve never gone through having a kidney stone but I understand they are very painful. I would just think, you know, you continue going, you go to work, you try to do those things, but, yeah, she had to lay down, she had to rest and those types of things. Sometimes I maybe expect too much when you do get sick. So that’s not good.
Coping and support strategies
The higher-order theme of coping and support strategies was generated as participants discussed what they did to manage sickness versus what their partners did. These ranged from independent to interdependent coping strategies but were reflective of roles in the family and household duties. Important distinctions emerged related to how they did or did not bring a partner in with or during their management of the sickness, how the wives tried to support their husbands, and how coping together was salient particularly for older couples.
Individual coping strategies
Participants reflected on how they and their partners differed in their use of individual coping strategies, with specific mechanisms on how they cope, such as medication usage (or not), trying to force it out or rest, or seeking healthcare. Participants also reflected on how both they and their partners coped based on their roles and responsibilities in the family. A participant (FG 2, age 26, married 9 months) said: “I think for myself I try to take care of myself more whereas with her she keeps going on.” Another participant (FG 4, age 23, married 4 months) indicated how he saw himself and his wife as using different strategies:
It’s just rest, drink water, just let your body take care of itself. If you’ve got a runny nose, just drink water; that’s the best thing to flush it out, get rest. You know, her thing, she’ll get Mucinex. And then she keeps asking, “Why isn’t this working? Why won’t this congestion go away?” “Well, you’ve got to do more than just take medicine.” You’ve got to do everything else, you’ve got to prevent it as well as treat the symptoms and the cause. So that’s the big difference between me and my wife.
Another participant (FG3, age 23, married 3 months) described the differences between his and his wife’s strategies, specifically with how they viewed using medication:
This is one of the funniest things in my marriage. I’ve always been the kind . . . I won’t take medicine unless, like, I’ll die otherwise, and my wife’s got, like, 10 pills she takes for every symptom. Um.., whereas, I mean, if I get sick, I got sick a couple of weeks ago, just kind of let it happen and let my body get over it, whereas she gets sick and she’s kind of, like, bedridden, and thinks she’s about to go pass to the other side, kind of thing. She needs all kinds of medicine and what not, to fix her problems.
Conversely, there were exceptions to women being more prone to take medication and men avoidant. It seemed that in his relationship, he was the one to take medication, whereas his wife was medication avoidant. He reflected (FG 3, age 21, married 1 month):
My wife reacts really strangely to being sick, because her mom’s had cancer for 13 years that she’s been fighting, so whenever she starts to get sick she kind of goes into denial and won’t admit that she’s sick, or she won’t go see a doctor because she doesn’t want to be told that she has this, like something wrong with her. And so, I’m on the other hand, I go to a doctor straight away if I feel like I have a strep throat or anything, you know, that might need any kind of medication, I’m like, “Oh, let’s go see the doctor.” But she’s afraid to go get any help for anybody, which is . . . I think is weird . . .
Participants reflected on how they were able to cope or manage the sickness on their own without having to worry about their responsibilities in the home but that their wives did not have that luxury. This seemed to reflect traditional and stereotypical gender roles in heterosexual couples, where the man is the breadwinner and works outside the home (so taking off from work leads to no reduction in perceived responsibilities) and the woman stays at home and but still has to manage children and household duties (cannot take or has a harder time taking a break even when she is sick). One participant (FG 4, age 37, married 7 years) stated this difference:
I think that’s common with wives. They think men are wimps when they’re sick, and I probably am, so I think I agree with her (laughter), but my wife is a lot tougher when it comes to being sick. I get sick, and I’m just in bed, and she’s taking care of the kids still.
Another participant (FG 1, age 36, married 14 years) stated,
I don’t get sick very often, but when I do, I feel like my whole life needs to stop. I need to just take a day or so in bed, and she’s never been like that. She’s one that just, she’s very driven from within and needs to, or feels like she needs to keep the household running and keep all her appointments.
A participant (FG4, age 36, married 13 years) stated that he could just rest while his wife had more demands in the house:
I think that I just like to take the time out for however many hours, 12 hours, just to sleep, get the fluids, mostly water, into my system, and just sleep it out. She’ll do something similar, but I guess she feels like there’s more demands put on her when she’s sick and I guess, I don’t see those demands, because when she’s sick try to just take over whatever roles and responsibilities that she has in the home (kids and pets, whatever else is going on). But I guess she has that experience where I don’t. I don’t know.
Finally, another participant (FG4, age 33, married 9 years) reflected on the discourse between him and his wife, how he wanted her to rest, but that she still did things around the house and for him:
My wife just contracted a cold, and of course, I left her home with 5 kids to do this, but (laughter) I, in nine years . . . (laughter) and I came home from work yesterday, and before work, I said, “You just make sure you take it easy; chuck the kids in front of a movie, do whatever,” and I came home for lunch an she’s like, “I made 3 pizzas, and I made you this,” and I said, “Why did you do that,” and she, “well, I cleaned the bathroom, and I” [interrupting] “What are you doing! . . . lay down . . . do you want me to teach you how to do this? It’s great. Let the kids veg for a while.” For her, it’s like, a responsibility to keep the kids engaged and active and it’s just like, yeah, you got to take lessons from me, boy am I smart, I just (laughter) . . . completely useless to you, you know, I’ll take the afternoon off work, so you can rest. “Oh, no, no, no . . . don’t do that.” Then I come home and she’s done a bunch of other stuff, and I go, “Man, you’re not very good at this.”
One-way provision of support
One-way provision of support emerged as an important theme where participants reflected on how their partners took care of them, which seemed to take the form of giving pills or soup. However, the participants reflected on how they tried to turn down or reject that aid or at least made it a point to not accept it at first. Perhaps this could be in part, because of masculine ideals and a mentality of downplaying their sickness or symptoms but also might be a function of a shorter length of marriage. A participant (FG 2, age 25, married 3 years) considered how his wife likes to take care of him, “I’ll get a cold or something like that and my wife will be like, ‘here let me get you some soup.’” Another participant (FG1, age 25, married 2 years) reflected how his wife tried to be supportive by giving him vitamin C pills but how she tries to give them to him in a way he can receive:
When I get sick my wife’s always throwing Vitamin C pills at me, which, if they taste good, I’m okay with. Usually, they’re like the ones that dissolve in water and are really gross which she tries to mask by putting it in, like, ice cream or something (laughter). So, I sort of told her, you know, if it’s the good stuff, I’ll take it.
Another participant (FG3, age 35, married 3 years) described his experience of how involved his wife wants to be and how he tries to refuse her care:
If I get sick and she wants to be the one who’s right there: “I want to help you get better. Here’s noodle soup, here’s all the . . . no, stay in bed.” And I’ve got to get up and go, I’ve got to keep moving, the more I move the more I’m healthy, the more I can get rid of the sickness. I can make my body burn through it. She kind of just like, “No, lay in bed.”
Coping together
Coping together was generated as some participants stated that they and their partners did a good job of taking care of each other. This theme appeared different from one-way provision of support because one partner reflected on the reciprocal nature of care in which both took care of the other. This also seemed to be related to older age or longer duration of marriage. One participant (FG 5, age 42, married 13 years) said: “My wife and I take care of each other when we’re ill. If she’s ill I help take care of her, and if I’m ill, she takes care of me.”
Another participant (FG 3, age 30, married 4.5 years) described how being sick is a bid for connection and care from their partner:
But then when I get quite sick then I almost want to be like babied, and I’ll definitely be in bed for it, whereas for my wife, whether it’s minor or major, she’s usually pretty vocal about it, and wants to be taken care of . . . no matter what it is.
Another participant (FG 2, age 25, married 3 years) reflected on how everyday sickness brings them together and becomes a bonding experience with quality time:
My wife is so funny because she loves spending time with me I’m the type of person where I kind of need my space sometimes, but especially when I get sick. She says,” Just stay home, I’ll take care of you and it gives you an excuse to be with me” When she gets sick she says, “oh, be here with me. I want you to stay here with me” and then if I get sick, she’s like “Oh just stay home from work, you know. We’ll save the money up elsewhere if you don’t have to go to work.” I think it’s kind of humorous when she’s like “don’t go” and I’m like, “Okay. If you’re going to take care of me you know, it is fine with me.”
Finally, a participant (FG2, age 35, married 11 years) described how sickness had brought them closer together and that they learned to compromise and see each other’s point of view:
Over time, you know, we’ve kind of, again, we grow together and we’ve kind of countered each other’s strengths and weaknesses, and find a niche where it works for us and we understand. I think we see a little bit better, eye to eye on the sickness. She’s kind of a little bit more this way, and I’ve come a little bit more this way, and we compromise in the middle.
Discussion
This study sought to identify the themes related to men’s perceptions of how they and their partners experienced common everyday sickness. Two overarching themes were generated—sickness appraisals and appraisal communication, which included gender differences in symptom experience, minimizing one’s own sickness, and minimizing a partner’s sickness, and coping and support strategies, which included individual coping, one-way provision of support, and coping together. These themes have important implications for physical and relational health in couples and families navigating acute but reoccurring illnesses.
Sickness appraisals and appraisal communication
Sickness appraisals and appraisal communication developed as an important theme for men’s perceptions of how they and their partners differed in the experience of symptoms, how they downplayed their own sickness experience, as well as how their partner communicated their appraisals about the men’s sickness experience to them. First, men described the differences between themselves and their partners in the experience of sickness—their partners focused on the range of symptoms and they themselves focused on the basics. This finding could implicate the gendered research on women being able to better identify physical symptoms and report higher sensitivity to physical symptoms than men (Van Wijk et al., 1999; Verbrugge, 1980, 1989) In addition, this finding could also be related to men minimizing their own sickness, which in the current study, the men reported downplaying, ignoring and “not letting on” how they were feeling to their wives. This phenomenon seemed tied to masculine gender norms (Helgeson and Lepore, 1997) where men might perceive it as weak to disclose an illness or condition, and in this case, an acute cold or flu might be perceived as “no big deal.” This, in part, could be a strategy used by men to be able to cope alone and not draw unwanted attention to themselves. Conversely, this might be a strategy whereby men are trying to elicit compassion, care, or empathy from their partner. This fits with other research suggesting that when patients minimize the illness, their partners may maximize the illness (or see it more accurately) (Heijmans et al., 1999), thereby activating support from their partner. Interestingly, these men mostly do not ask for help, so appearing to minimize their physical symptoms and sickness experience during a cold or flu might be an acceptable way to elicit concrete support from their partners without losing their masculine capital by directly asking for care and comfort. Regardless, these findings support previous research on gender differences in illness appraisals (Berg and Upchurch, 2007; Coyne and Fiske, 1992; Hagedoorn et al., 2000; Lyons et al., 1995).
In addition to minimizing their own symptoms, both partners minimized the other’s sickness. Men reported that their partners told them they were “being a baby.” In addition, they reported that their wives were making too big of a deal out of her symptoms—as if to say that she should not be feeling that way. This finding could reflect the comparisons that each partner is making about the other in light of their own illness experiences. This supports the STM’s description whereby partners are trying to synthesize their own appraisals with their partner’s appraisals, in this case, sickness symptoms yet do reach an agreement and communicate that to their partners. Men in this study seemed to reflect on both directions occurring—where their partners communicate that their appraisals of the man’s symptoms do not match what he is experiencing as well as the men’s appraisals of their partner’s symptoms do not match what she is experiencing.
The findings of minimization of their own and each partners’ sickness is important for two reasons. First, although some research suggests that minimization of the illness (by the patient) might benefit coping (Heijmans et al., 1999), downplaying their own symptoms or illness might diminish social support opportunities for their partner, which could affect illness adjustment and coping. In addition, minimization could prevent or delay seeking healthcare, which supports the literature on men and healthcare utilization—they do not seek services, and if they do, it is not until symptoms have progressed considerably (Gast and Peak, 2011; Novak et al., 2019). Second, each partner minimizing the other’s sickness and symptoms could harm the overall couple relationship as well as support-seeking behavior. For example, when feeling like a partner is downplaying one’s symptoms, that person may be less likely to seek support, assistance, and care in the future. This could have important implications for chronic illness coping and management in the future, should that occur (Berg and Upchurch, 2007).
Coping and support strategies
Related to individual coping strategies, men perceived distinct differences between how they coped with sickness as compared with their wives, at least related to individual strategies. Some men reflected on how they would let things “run their course” or do something to facilitate the symptoms to move out of the body quicker (e.g. “sweat it out”). In contrast, although with one exception, they reported that their wives were more apt to use medications/remedies or seek healthcare. In addition, important gender differences emerged related to individual coping strategies used. Most notably, men reported that their wives did not have the luxury of taking care of themselves or taking it easy—they had to manage household responsibilities, chores, and childrearing. In contrast, men felt they could rest and take a break from their work duties. These findings support previous research on illness and division of labor—women resume household duties quicker because their partners are not helping or picking up the slack (Revenson et al., 2005).
Related to one-way provision of support, some men reported how they rejected or brushed off concern and care from the other, while other times they accepted care from their partner. This could be, at least in part, connected to the partner appraisals—if a partner minimized their sickness, he or she could reject care; if they felt their partner validated their sickness, then they would be more apt to accept care. This finding could also reflect individuals’ self-representations on whether they prefer independent coping or interdependent coping (Acitelli and Antonucci, 1994; Cross and Madson, 1997). Similar to men minimizing their sickness symptoms, men might also be hesitant to accept care from their partners again because of masculine gender scripts and help seeking. Finally, it could be a function of younger couples and less time to adapt to and understand each other’s way of coping or managing sickness.
Related to coping together, men reported that a reciprocal relationship existed between them and their partners, whereby both took care of the other. This experience seemed to bond and unite them as a couple, learn to rely on each other, and strengthen the couple relationship by spending time together. Again, this could be connected to the individual appraisal and coping strategies that emerged and the partner observed, although from our results, it was difficult to ascertain the interconnectedness of the themes. It could also be a function of older age or longer length of marriage, where over time, couples adjust to the experience of sickness and learn to better rely on each other. Regardless, this finding highlights that illness has the potential to bring couples together, resulting in better psychosocial adjustment (Berg and Upchurch, 2007).
Implications for theory
The findings from this study support aspects of the STM of dyadic coping (Bodenmann, 1995, 2005; Bodenmann et al., 2016). First, the experience of an acute sickness seems to fit under the STM’s conceptualization of dyadic stress, regardless if the individual conceptualizes it as an experience only impacting him or herself. There are spillover effects related to work, housework and childcare, and relationship communication and support from the partner. Second, and related to appraisals, there does seem to be a process, whereby partners are communicating their appraisals or the perception of their partner’s appraisals to the other (perhaps a co-construction of illness appraisals; Radcliffe et al., 2013), although “common” dyadic appraisals may occur less frequently in acute illness. Either partner might disagree with the severity of their partner’s sickness symptoms (men being perceived as “babies” by their partners or men seeing their partners’ symptoms as being sensitive or focusing on the “nitpicky” details). The findings from this study suggest that acute sickness qualitatively impacts the couple relationship differently, with differing relationship dynamics emerging than during a chronic illness (Helgeson et al., 2018). Regardless, the lack of common dyadic appraisals could impact the couple negatively, both in physical health management as well as in the couple relationship in provision and reception of support. Finally, although individual coping strategies were used, the present study identified examples of both common coping and supportive coping (one-way provision of support).
Implications for prevention, education, and intervention
The findings from this study have important implications for prevention, education, and intervention. First, minimization of one’s own and a partner’s sickness and symptoms should be addressed by health educators and clinicians. As discussed above, these dynamics could impact either member of the couple seeking or giving less social support during sickness. It could prove fruitful to address these appraisals and help each member of the dyad learn to appreciate and value the other’s appraisals, which might help increase expression and discussion of symptoms and thereby increase support opportunities. Second, related to gender differences in sickness appraisals and coping strategies, health educators and practitioners would do well to address the different coping strategies used by the couple and help each member identify his or her roles in household and childcare responsibilities. Perhaps helping each couple discuss where they could take on more household tasks (specifically husbands) or reducing their workload (wives) during sickness would help the family unit better adjust to acute sickness disruptions in the household. Related to receiving support and individual coping strategies (particularly by the men), to some degree a strategy seemed to be deception where some individuals would not tell their partners they were sick to avoid being asked to seek medical care, not take time off of work, and dodge unwanted spousal attention and care. Healthcare providers could reframe men’s perceptions of both receiving care and taking time to rest and recuperate from acute sicknesses as doing what they need to do to better able provide for their family, as this reframe still fits within masculine gender ideals about their role as provider (Novak et al., 2019).
Limitations and directions for future research
Although this study adds to the literature base, it should be considered in light of its limitations. First, the majority of the sample were Caucasian, heterosexual, married, younger, and members of a traditional religious faith, so the results cannot be generalized to all men’s experiences and backgrounds. However, the beliefs and practices of members of The Church of Jesus Christ of Latter Day Saints is similar in many regards to other religious groups (Pew Research Center, 2012), so some of these dynamics and experiences may fit the experiences of other religious men. It may also be a function of traditional gender roles, which although could be tied to religious groups, may function independently outside of religious contexts. Regardless, future research should include a more diverse sample to see how and if these processes differ. Second, the participants reflected on their own experiences and gave their perceptions of what their wives did, which might not accurately reflect the wives’ experiences. Future research should assess the wives’ experiences and consider interviewing couples together. Third, we did not collect information on which illness/sickness the participants were referring to (e.g. cold, flu, etc.), and these processes might differ depending on type and duration of acute sickness.
Fourth, the focus group format may have influenced participant willingness to disclose their opinions. Participants may join in with what others are saying in a “group think” mentality, while ideas that are less popular or perceived as different may not be given as strong a voice which might sway the direction and nature of the group conversation. The interview protocol may have addressed this to some degree, and in our study, the interviewer made sure to highlight less popular responses and ask for contradicting views or opinions. Also, men self-selected to participate, so their reported experiences could be different from potential participants who were unwilling to take part in a focus group interview. Finally, related to the experience of sickness over time, responses could differ depending on the age of participants or relationship length, so future research should investigate these differences.
Conclusion
This study is among the first to identify men’s perceptions of couple-related dynamics during acute sickness. It seems that the experience of acute sickness creates shared stressors for both partners but differentially impacts their perception of sickness, the symptoms experienced, and the type of coping and support strategies used based on gender and role in the family. This study suggests that relationship dynamics during acute sickness play out differently than in chronic illnesses—partners might be more critical or more apt to voice their opinion and take different coping or support strategies with their partners than during serious illness.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
