This study seeks to identify the factors that shape the communication networks of men on a prostate biopsy waiting list and find out how these factors relate to their disclosure about their changing health status. Men facing a potential diagnosis of prostate cancer are in a challenging situation; the benefits of disclosing their changing health status to others in their communication networks to receive support is set against the backdrop of the uncertainty of the diagnosis and a potential stigma of prostate cancer.
Often it is the first time for men to manage new personal health information and consider whether they should disclose it to others. For many reasons disclosure could be challenging. Prostate cancer challenges the self-belief associated with masculinity, as men are forced to seek advice and support from others and also prostate cancer is perceived as a stigmatizing disease. Communication networks are a potential avenue for men facing prostate cancer to address some of these challenges.
Communication networks differ from social networks in that communication and not individual attributes (such as in social networks) constructs relationships. Communication networks encompass all people with whom communication occurs; for example, health professionals, such as nurses, and neighbours. Networks are comprised of both structure and content, in which the structure is the physical composition of networks, the nodes (individuals) and ties (relationships between them), and the content is the provision of social support and access to resources and material goods. Networks also bear a large part of the burden of healthcare, for example, network members such as siblings, adult children and friends suffered similar levels of psychological distress to spouses/significant others of cancer survivors. However, in order to access their networks for support, men on a prostate biopsy waiting list need to disclose their health status. These factors guide the research question which is: what is the relationship between the structural features of communication networks and men’s perceptions about disclosing their health status when faced with the diagnosis of prostate cancer?
After gaining ethics approval, 40 men were interviewed about their network structures and the disclosure of health information. I analysed the interviews to find themes and found that four network factors shaped men’s perspectives about disclosing their health status. First tie strength in which men demonstrated strong ties with both family and friends. Strong ties made the other a safe person with whom to disclose; they were known with a sense of trust. Most men were selective in their disclosure to weak ties. Some disclosed to weak ties if they felt they could ‘put their experience to good use’ by promoting openness, discussion and action about prostate issues. Weak ties in this category were those who were nearby and generally work colleagues.
Second, disclosure was to knowledgeable others. Ties could be strong or weak when people had medical knowledge. A medical professional in the family had an important role in networks regardless of the strength of tie. Several men in this study had a sibling, child, brother/sister-in-law, or other family member who was a medical professional, usually a doctor or nurse. These family members became important in networks for their health knowledge and as a result men disclosed to them.
Third, homophily was found to be important. Homophily is the principle that contact between similar people occurs at a higher rate than among dissimilar people. Others known to have a similar medical condition, could provide helpful information and emotional support. Finally, geographical proximity was an important factor in disclosure, with men showing a preference for face-to-face communication.
If any one of the factors-tie strength, knowledgeable others, homophily or geographical proximity-is present in one person in a network, the man is likely to consider disclosing to them. For example, men are more likely to talk with someone who lives nearby than someone else who lives further away. If two factors are present, then he is more likely to share than with individuals demonstrating only one factor. Combinations of two factors in this study were shown in (i) partners who were in close proximity and were also their strongest tie but may not have had previous experience of cancer; (ii) siblings who were a strong tie and a medical professional but who lived elsewhere in New Zealand or overseas; (iii) work colleagues who were in close proximity and had prostate cancer themselves but were only a weak tie. If three factors are present, the man will almost certainly disclose his prostate issues
In conclusion, communication networks influence men’s disclosure of their health status and in particular weak ties with medical knowledge have an important role. Men who use the potential for support in their networks may experience improved health outcomes.
The author is grateful for the support of the Prostate Cancer Foundation of New Zealand to conduct this research. The article was published in the Journal of Clinical Nursing in 2016.