Exploring puberty experiences of young males (18-21 years) living in urban Pakistan : a qualitative inquiry

• Main Author: Shivji, Noureen Asif
• Published: University of Nottingham 2018
• Subjects: WS Pediatrics
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.765520

Background: Adolescence is a time of dynamic change during which puberty transition occurs, which is characterised as bringing profound psychological transformation to adolescents' identity, mental health and to impact on their overall behaviour. Literature has identified male adolescents to be less engaged in health promotion activities, and considered them a high risk population, particularly during puberty influencing their physical and psychological health outcomes, which may last longer. It is therefore essential that these young boys have good puberty experiences, as that will help to ensure better psychosocial adjustment in later life. However, socio-cultural factors play a significant role in Pakistan and other similar countries to create several barriers to puberty awareness and understanding of adolescent males, where only limited support is available for them in terms of enhancing their puberty experiences. It is because of these cultural factors that puberty and related topics have not been adequately researched in Pakistan, despite having enormous significance of puberty transition in male adolescents' life. Instead, studies that are more general have been conducted to assess the sexual and reproductive health (SRH) knowledge, attitudes and behaviours of adolescents of both sexes. In case where reproductive health (RH) needs of adolescent males are explored, puberty has only been a small part of it. It could be argued that understanding young males' puberty experience in predominantly patriarchal cultures such as Pakistan is particularly important in order to investigate and propose appropriate measures to provide good puberty experiences to adolescent males. As it may improve role-relationships in adult life, and reduces the cost of many preventable and chronic diseases, such as mental illnesses and sexually transmittable infections (STIs) as these adolescents make better choices regarding their SRH in the future. Aim: This study aimed to explore how young males aged 18-21 years from an urban city of Pakistan perceived their puberty experiences, by addressing the following objectives: 1. To explore the overall experiences of puberty from young males living in Pakistan. 2. To explore the barriers/challenges/difficulties Pakistani young males encountered during puberty, and how they may have overcome these. 3. To explore potential facilitating factors for Pakistani young males during adolescence that contributed to positive puberty experiences.   Method: An exploratory, generic qualitative study using an interpretive-social constructionist approach was conducted. The study included 22 participants from two study sites using convenient sampling, followed by snowball technique. Data was collected through individual semi-structured face-to-face and Skype interviews, each interview lasted between 60-240 minutes. Interviews were transcribed verbatim into their original languages (English and Urdu both) and data analysed thematically. NVivo10 and 11 software was used to manage the data. Ethical approval was received from the University of Nottingham, UK and official permissions were granted by the respective institutions approached, with written informed consent received from all the participants. Findings: The findings showed that the puberty phase was challenging for young males, and often resulted in negative psychological impacts, along with concerns related to their identity development. The negative effects mainly resulted from being unprepared and uninformed about pubertal changes, which was due to the socio-cultural factors, considering puberty a 'taboo' subject. As a result of which, there was a lack of awareness about puberty and difficulties in accessing trustworthy information. Consequently, participants during puberty felt confused, fearful, anxious and embarrassed of their experiences, which often resulted in isolation and depression. Alongside these experiences, participants were found to have adopted several coping strategies; nevertheless, they highlighted the need for additional material and health promotion programmes to aid the transition process. Participants also described the diverse puberty experiences challenged by the societal expectations and gender norms, as they sought power, acceptance and defined their sexual orientation whilst gaining social status and identity development. Their concerns about masculinity, sexual identity and developing an adult outlook along with stereotyped gender roles and responsibilities were shared which often resulted in personal tensions while negotiating through these societal expectations. Conclusion: This study is the first known study to explore the contextualised puberty experiences of young males in Pakistan. The study has established that young males' experienced and shared significant concerns regarding their puberty transition phase. These were related to information gathering, negative psychological impacts, coping strategies and identity formation in the patriarchal Pakistani context. The findings further demonstrated that currently the puberty transition does not necessarily provide positive experiences for the male adolescents, since the conjunction of personal and social worlds exposed participants to both negative and positive psychological impacts during their puberty and influenced their identity formation as an adult male. Findings from this study provide a new theoretical insight into the complex social and ecological factors at play in Pakistan during male adolescents' puberty transition, using social and ecological model (SEM) of human development. These findings can therefore be used to understand the gender appropriate educational needs of adolescent males around puberty and develop future health promotion programmes around male adolescents' puberty. Introducing and developing appropriate health promotion programmes around puberty could improve future male adolescents' experiences and may therefore impact positively on their long-term health and well-being, and assist them in developing a vibrant adult identity.