Intervention Research and Intersectionality: Tensions and Reconciliations in a Study of Mental Health Stigma Among Asian Men

Background: Asian people, including people from China, Japan, Taiwan, & South Korea (East Asia); India, Pakistan, Nepal, Bangladesh, and Sri Lanka (South Asia); and Cambodia, the Philippines, and Indonesia (SE Asia) represent about 15% of the Canadian population and are the fastest- growing ethnic group in Canada (Statistics Canada, 2013). Asian men tend to perceive mental illness as both compromising their ability to satisfy the ideal standards of masculinity and fulfill their moral obligation to provide for others (Weiss et al., 2001), making it difficult to acknowledge mental health concerns and seek help (Good & Wood, 1995; Smith, Tran, & Thompson, 2008; Ando, Yamaguchi, Aoki, & Thornicroft, 2013). To reduce mental health stigma among Asian men, a priority of the Canadian government, the Strength in Unity study, a large demonstration project funded by the Movember Foundation, sought to test the efficacy of two stigma-reducing workshop interventions across 3 sites (Vancouver, Calgary, Toronto).

Methods: This presentation uses an autoethnographic approach to document the multiple ways Vancouver-based research team members of the Strength in Unity project used an intersectional lens to examine the methodological assumptions and needs of a population-based demonstration project. Findings from five 2-hour data analysis conversations are presented.  

Results: At every step in the study process—study design, recruitment, data collection, data analysis, and knowledge translation—researchers adopted intentional strategies to reconcile their commitment to intersectionality with the needs of a randomized controlled trial.  These strategies included: 1) deconstructing “Asian” and “men” as monolithic but strategically essentialist signifiers; 2) building in opportunities for qualitative data collection to capture intersectionality in the center and margins of manualized interventions; 3) contesting ethnoracial policing in recruitment; 4) examining assumptions about age, language  group, and ethnoracial unity in assigning participants to intervention groups; 5) observing difference within groups; 6) observing participant gender reactions to the presence of female cisgender researchers; 7) modeling counter masculinities in the delivery of interventions; 8) using interaction terms to build intersectionality into quantitative analysis; and 9) leveraging research team intersectionality  to theorize complexity.

Implications: Centering intersectionality required researchers to question many routine assumptions typically made in an RCT—everything from sample inclusion criteria to multivariate modeling. However, centering intersectionality did not dictate method; rather, it suggested pathways to more nuanced and complex measurement, such as Ragin’s (1997) fuzzy set methodology to measure socially contested categories like gender using continuous rather than dichotomous variables. Thinking intersectionally could produce meaningful advancements in research methods and population health interventions alike.