Date of Award

Fall 12-9-2018

Degree Type

Capstone Project

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Eric R. Wright, PhD

Second Advisor

Dr. Laura F. Salazar, PhD

Third Advisor

Dr. Rachel M. Powell-Lewis, PhD



A Qualitative Analysis of the Environmental and Personal Factors which Influence the Help-Seeking Behaviors of Men who have Sex with Men in Light of the Emerging Threat of Antimicrobial Resistance to Shigella Bacteria


Kathleen McCready Jacobson

November 29, 2018

INTRODUCTION: Compared to their male counterparts, men who have sex with men (MSM) in the U.S. are burdened by a number of health disparities. Surveillance has confirmed that the MSM population are disproportionately impacted with shigellosis, a diarrheal condition caused by Shigella bacteria. The bacteria are showing signs of antimicrobial resistance, resulting in a reduction of treatment options and raising the risk of critical outcomes for those with HIV.

AIM: The aim of this study was to determine which elements of the triadic reciprocal causation model most influences the help-seeking behaviors of men who have sex with men both in general and as they relate to the emerging threat of antimicrobial resistance to Shigella bacteria/shigellosis.

METHODS: A total of n=24 participants recruited in metro Atlanta, Georgia took part in one of six focus groups designed to explore the personal and environmental factors which influence and guide their help-seeking behaviors as they relate to the new and emerging threat of antimicrobial resistance to Shigella bacteria. Employing the principles of grounded theory, the data were analyzed using MAXqda to identify themes that emerged during the discussions.

RESULTS: Themes surrounding the factors that influence the help-seeking behaviors of MSM are that most use the internet to search for general and sexual health information because it is convenient and widely available; information from the internet is viewed as less credible and trustworthy than the information received from a doctor, many participants stated a preference for a doctor who is gay-friendly; most turn to their social network for help and advice in finding a gay-friendly doctor. Relating to the emerging threat of shigellosis, the participants revealed an absence of or limited knowledge of the condition; they perceive there is a lack of awareness in the wider population and the medical community; they feel targeted by current shigellosis-related health materials; some feel encumbered by one more life-threatening disease; outcome expectancies related to shigellosis may drive help-seeking behaviors; varying opinions as to whether shigellosis should be labeled an STD; and cost may be a barrier to seeking a medical test for this condition.

DISCUSSION: Understanding the factors which influence help-seeking behaviors of MSM will inform those in research and public health and assist in the design of future health communication campaigns to raise awareness of new and emerging threats.