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The power of connections: How a novel Canadian men’s wellness program is improving the
health and well-being of Indigenous and non-Indigenous men
Iloradanon Efimoff,* Lyana Patrick,* Viviane Josewski, Paul Gross, Sandy Lambert, Vicki
Smye
*Please note Iloradanon Efimoff and Lyana Patrick share first authorship on this manuscript.
Acknowledgements: We would like to dedicate this article to the late Mr. Richard Johnson and
the late Mr. Henry Charles. Mr. Richard Johnson co-founded the DUDES Club. Richard Johnson
was an Outreach Worker for the Positive Outlook Program at Vancouver Native Health Society
and laid the strong foundation on which the DUDES Club was built. Henry Charles was our
elder from 2011-2017 and joined the spirit world on a very sad and tragic rainy Friday night in
late January 2017. He was a source of comfort, culture, humor, and knowledge for all members.
Abstract
Indigenous and men’s health represent challenging policy issues around the world. The DUDES
Club, a novel men’s health organization founded in 2010 in Vancouver, B.C., attempts to address
these issues. With the help of the First Nations Health Authority, the DUDES Club has expanded
to 40 sites in British Columbia and two nationally. The purpose of this study was to evaluate
men’s experiences with DUDES Club. To that end, we analyzed five interviews and 15 focus
groups (n ≈ 101). We focused on men’s experiences with the DUDES Club to identify four
themes: brotherhood and community; accessible health care information; disrupting colonial
constructions of masculinity; and systemic and structural challenges. We conclude with policy
recommendations.
Keywords (3-5): Indigenous men, community-based health promotion programming, men’s
health, qualitative program evaluation, social support
Introduction
Every two weeks in Vancouver’s Downtown Eastside (DTES) neighborhood, a group of
men gather together for a few hours in the evening to share food and ideas, to learn and have fun,
and to take a break from their often difficult daily realities. This unlikely gathering started ten
years ago when frontline workers recognized the need for a safe and supportive space for men to
gather. What started as a support group organized around the Positive Living Outreach Program
at the Vancouver Native Health Society has blossomed into a national model for men’s health
and well-being. This group is called the DUDES
1
Club. The purpose of this study was to
investigate Indigenous and non-Indigenous men’s experiences with the DUDES Club and how
the model might be extended to other communities. We conclude with five policy
recommendations for those interested in creating their own DUDES Club.
Indigenous Peoples in Canada experience a disproportionate burden of both mental and
physical health issues (Rotenberg, 2016; Nelson & Wilson, 2017). These health inequities must
be understood in light of colonialist and neo-colonialist practices (such as residential school, the
sixties scoop, and the overrepresentation of Indigenous children in care), widespread poverty,
homelessness, and racism (Press, 2019; Patrick, 2014; Currie et al., 2012; Spence et al., 2016). In
healing from the past and ongoing effects of colonization, culture is a key source of strength for
many Indigenous communities (Gone, 2013; Assembly of First Nations & Health Canada, 2015);
an emerging body of evidence for “culture as treatment” points to the significance of
interconnectedness in healing and underscores the need to incorporate Indigenous cultural
practices into health programming (Barker et al., 2017).
Men, in general, are less likely to seek medical attention than women; a fact that has
1
DUDES is an acronym that stands for Dudes United Defending Equality and Solidarity.
tragic consequences, as men are three times more likely to die by suicide than women
(Goldenberg, 2014; Statistics Canada, 2019). Indigenous men are at an even higher risk for
suicide (Kumar & Tjepkema, 2019). Men’s high rates of suicide might, in part, be due to
inadequate diagnosis and treatment of men’s mental health issues (Oliffe et al., 2010; Wide et al.,
2011). To this end, the American Psychological Association issued its first guidelines for
practice with men and boys (Pappas, 2019). Conformity to dominant ideas of masculinity that
stress male independence and fearlessness (“the strong silent type”) may further lead men to
disregard their health and avoid seeking timely health care (Goldenberg, 2014, p. S142); a
concern that is particularly pressing for older men (Tannenbaum & Frank, 2011).
Despite the disproportionate burden of poor health outcomes in Indigenous communities
and the low likelihood of men seeking medical care, there is a dearth of research on Indigenous
men’s health services in Canada (e.g., Hackett et al., 2020). Internationally, Men’s Sheds are a
successful men’s health promotion program, with research indicating that effective health
programming for men has unique features (Wilson & Cordier, 2013). However, more research is
needed to fully and rigorously evaluate Men’s Sheds (Milligan et al., 2016). One important
factor is peer support. Peer support groups can increase social support, resilience (Robinson et
al., 2015), and health (Heisler et al., 2010; Richmond et al., 2007).
The DUDES Club is another promising men’s health promotion program, with an
Indigenous focus, founded in British Columbia, Canada in 2010. In 2016, a quantitative
evaluation of the DUDES Club showcased the Club’s ability to promote overall well-being
through culturally safe health services (Gross et al., 2016): Compared to infrequent attenders,
frequent attenders experienced improved quality of life, mental health, physical health, health
confidence, peer support, spiritual wellness, and social support. Furthermore, compared to non-
Indigenous members, Indigenous members felt more trust and support with the group and felt
that the Club helped them connect to their cultural heritage (Gross et al., 2016). In this article, we
discuss themes that we identified in the qualitative findings from our evaluation of the DUDES
Club. There are many overlapping themes and in this paper we describe how they interconnect
and inform one another.
Program Background: How the DUDES Club Began
The DUDES Club is a grassroots initiative that formed in 2010 in response to community
concerns about the relative lack of men’s health programming in the DTES of Vancouver. The
Downtown Eastside forms part of the traditional territories of the Squamish, Tsleil-Waututh, and
Musqueam First Nations. One of Vancouver’s earliest neighbourhoods, the DTES was a vibrant
working-class area that provided a social, cultural, and retail hub for the growing city. In the
1980s, intersecting factors contributed to increasing social problems including homelessness, an
open drug market, poverty, crime, and mental illness. These factors disproportionately impact
Indigenous people who in 2016 made up 2.2% of the population in Vancouver, but 14% in some
areas of the DTES (Huang, 2019). In 2013, two pilot sites were established (one in Smithers and
one in Prince George, B.C.). To date, there are 40 partner sites throughout B.C. (The DUDES
Club, n.d.). The objectives of the Club are threefold: (1) to build solidarity, brotherhood, trust,
and positive role models together with men; (2) to promote holistic, cost-effective men’s health
through accessible dialogue, education, and health screening opportunities; and (3) to enable men
to regain a sense of pride, purpose, and fulfillment in their lives. In carrying out these objectives,
the Club adheres to the values of holistic health, inclusivity, and non-judgment (anyone
identifying as male is welcome). The Club’s motto, “leave your armor at the door,” sets the
groundwork: Men may wear “armor” to protect themselves on the street, but in the DUDES
Club, there is no need for it. The men share openly with each other on a variety of topics, ranging
from diet to sexual abuse. Members are always welcome regardless of their physical or mental
state as long as they are respectful during the gatherings.
The three different Clubs discussed in this paper are held in a cultural drop-in center, an
HIV outreach office, and alongside a clinic. The Vancouver site hosts 50-60 members regularly.
In contrast, the gatherings at the pilot sites are smaller with 10-12 men attending each meeting.
Each site has an Indigenous framework, which includes elders, the medicine wheel, and health
care practitioners with cultural safety training; this is to provide a culturally safe space for the
mostly Indigenous membership attending the DUDES Club. Sites routinely incorporate bonding
activities, such as bingo or ice fishing. All sites share a meal and engage men in a health
discussion: If a health care provider is present, it may be a technical conversation, if only the
members and the elders are present, discussions are much more anecdotal and personal. Some
Club members are extensively involved in governing the Club through “think tank meetings,”
planning activities, meals, and discussion topics. Those who formally volunteer at the Club
receive modest financial compensation for their time.
Method
Indigenous and Critical Theoretical Perspectives
This research was informed by Indigenous and critical theoretical perspectives (e.g.,
Battiste, 2009; Collins, 2015; Innes & Anderson, 2015) that emphasize Indigenous voices and
narratives and draw attention to the intersecting contexts that shape men’s experiences of health
and health care. Thus positioned, we use intersectionality as an analytical lens for gaining a rich
and complex understanding of how and why the DUDES Club improved men’s quality of life,
mental health, and physical health.
Data Collection
This paper draws on data from 15 focus groups (n ≈ 101)
2
and five individual interviews
with Club members, elders, providers (e.g., site managers), and health care professionals (e.g.,
doctors and nurses at the Club). We conducted six focus groups and three individual interviews
at the Vancouver site, three focus groups and one individual interview at the Smithers site, four
focus groups and one individual interview at the Prince George site, and two focus groups at a
gathering of all three sites. There were 3-10 participants at each focus group and a few
participants attended more than one focus group. We conducted individual interviews with
providers and Club elders. We conducted these separately from the focus groups with members
because we thought elders and providers would have unique insights about the Club’s impact on
members, and their sharing of such insights during a focus group might influence member input.
Overall, we include data collected from approximately 30 Club members, four elders, one
provider, and six health care professionals. All of the focus groups and interviews but one were
audio-recorded (one interviewee opted not to be recorded). Focus groups lasted between
approximately two and two-and-a-half hours, and individual interviews ranged from
approximately 15 to 60 minutes. We used semi-structured interviews with a set of prompt
questions to guide each focus group and interview. Our questions focused on the men’s
experiences in the DUDES Club (both positive and negative), how the Club impacted their
health and well-being, how the Club compared to other local groups, and how to improve the
Club and their experience. All focus group members were asked for their input, and all
participants received a $30.00 honorarium. Our research procedures were approved by the
2
We could not obtain the exact number of participants for four of the focus groups due to data recording errors. We
used the average number of participants in the 11 focus groups where we had the exact number of participants to
estimate the number of participants for these four focus groups. We then added these four estimated values to the
actual values to calculate the total n.
institutional Research Ethics Board.
All the men in our study came from a context of disenfranchisement, such as unstable
housing, unemployment, and poverty (Gross et al., 2016), and many lived with complex histories
of trauma, mental health, and/or substance use issues as well as other comorbid conditions. For
example, based on a survey conducted at the Vancouver site (Gross et al., 2016), more than 80
percent reported living in the DTES of Vancouver, a neighborhood widely known as one of the
poorest neighborhoods in North America, and more than 60 percent reported experiencing
unstable housing. The majority of participants in this survey self-identified as Indigenous
(63.3%) and most reported being in their middle years of life. Lastly, though almost 75% of
participants reported being single at the time of the study, nearly 60% had children but less than
5% lived with their children. Notably, these characteristics only describe the membership at the
Vancouver site, as this demographic information was collected as part of the larger program
evaluation survey.
Data Analysis
We undertook an interpretive thematic analysis using procedures described in the
literature for qualitatively-derived data (Thorne, 2016). We began with transcribing all audio
recordings of the interviews. Once transcribed, we cleaned and anonymized the transcripts (to
correct any transcriber errors and protect participant and organizational privacy) and then
uploaded them into NVivo (a qualitative analysis software). Our team, consisting of Indigenous
and non-Indigenous members, then analyzed the data in a multi-step process. First, we looked at
the data inductively, systematically and reflectively reading and re-reading the transcripts and
discussing initial impressions and ideas. Second, we independently coded all transcripts based on
an evolving coding structure. The purpose of the coding was to identify key concepts that we
identified in the data as well as conceptual linkages and patterns of relationships. Throughout the
coding process, we created, combined, and discarded codes in an iterative process to further
refine the codes. This involved creating hierarchical models through NVivo to see the codes
from a macro perspective and concept maps to further identify connections between codes. As
our coding became less descriptive and more interpretive, we began to reflect on the theoretical
constructs behind key codes by drawing on our theoretical perspectives and making linkages
between the literature and the data.
Specifically, we drew on intersectionality as an analytical lens for examining and
developing a better understanding of how becoming DUDES Club members shaped Indigenous
men’s experiences of health and well-being; we situated participants’ experiences within the
intersecting contexts of past and ongoing colonialism, dominant gender norms, poverty, racism,
class, and other forms of stigma and discrimination. Furthermore, Indigenous elders, Mr. Sandy
Lambert and the late Mr. Henry Charles, were key members of the research team, guiding our
analysis by speaking to what they thought were the most important aspects of the DUDES Club
informed by their years of experience with the group. This helped focus our analysis and ensure
that our conclusions were grounded in Indigenous perspectives.
Through this analysis and our research team’s years of experience with the DUDES Club,
we created the policy recommendations at the end of this article. We based these policy
recommendations on members’ experiences and our perceptions of what was most effective in
facilitating the creation of a DUDES Club.
Results
Club members, elders, providers, and health care professionals shared in-depth about
their experiences with the DUDES Club. In this section, we present four themes that we
identified in participants’ stories: a feeling of brotherhood and community, accessible health care
information, disruptions of colonial masculinities, and the systemic and structural challenges the
Club helped participants face.
Feeling of Brotherhood and Community
One of the largest themes identified in all focus groups and interviews was feeling a
sense of brotherhood and community. The members, elders, service providers, and health care
professionals all described this as one of the most powerful and effective aspects of the Club.
One way the Club seemed to create feelings of brotherhood and community is by making the
members comfortable enough to share their experiences. There was consensus among the men
that members respect each other in part by respecting the rules of confidentiality. As such,
several DUDES Club members described how they openly shared many emotionally sensitive
experiences: residential school experiences, sexual abuse, anger issues, mental health concerns
like PTSD and suicidal ideation, historical trauma, loneliness, and experiences with HIV. For
example, one member described
We’ve had issues discussing like big issues, prostate, we’ve had issues like male sexual
abuse where people actually came out in the room and said they had been abused. Men
don’t talk about this to other men... They feel safe enough here they can, this is a safe
haven. It’s a sanctuary they can come in, it doesn’t matter what that medical problem is,
discuss it and we don’t talk about it on the street. Because if it does the person who takes
it out is no longer coming here.
The fact that some members were able to share these types of stories highlights the safe
and trusting relationship they had with each other. While this took time to develop, it appears to
be present in all the Clubs. The safe space created at DUDES Club gatherings seems to allow
some members to be vulnerable: to open up and share stories like those above, to cry, to ask for
help, to discuss mental health issues, and to simply be comfortable in a safe space.
Some members also explained that they felt comfortable in the group because it
maintains a non-judgemental atmosphere, and actively attempts to decrease the stigma around
the men involved in the Club. One group challenged stereotypes about their members by playing
horseshoes in public with friends. An elder explained that the presence of celebrities in the Club
(such as famous football players) helped to de-stigmatize low-income areas. As one of the
members said: “You can come in here and even if you are using drugs you talk about all kinds of
stuff, it’s nonjudgmental. That’s the big thing, because you walk into most places and I’m an
addict and this is a problem.” Part of the non-judgemental atmosphere is maintained because it is
a men’s only Club, as one member explained: “a place to feel safe to share in, issues that, you
know, we confront. As a man it might be different than what women would confront.”
This sense of brotherhood and community seemed to be connected to the sense of
ownership some members had around their Clubs. Through the creation of their own Club, in
their own space, with their own rules, many of the members described an increased sense of
personal empowerment and agency. Members routinely decide on speakers, topics, activities,
and food for meetings. Discussing issues and making these decisions together seems to create a
sense of community within many of the men, and a sense of solidarity around their experiences
with the DUDES Club and as men in general. This sense of ownership and self-determination
over the Club appeared to lead to an increased sense of pride in some men, which, in turn,
seemed to allow for greater solidarity and brotherhood. Furthermore, many of the members
volunteer for their Clubs, describing a sense of purpose and meaningful occupation, which
seemed to increase their self-worth and self-esteem, further investing them in the program. This
is, in part, where members’ sense of ‘brotherhood’ came from:
The majority of my time spent here is volunteering so it gives me a sense of purpose so I
feel like I did a good job and I’m good to people and later on they remember that and
they come up to me later on and say hey dude.
Some DUDES Club members even took it upon themselves to engage the community in
their activities, building a wider community for members. They described seeking out lawyers,
town councilors, church members, legal aides, politicians, and people they met on the street to
get involved with the DUDES Club – and they were often successful. Some members attended
town meetings with council members to voice concerns and connect with politicians and
brainstormed ways to connect with the community to showcase the Club and share resources. A
few members have even talked about different public relations opportunities and were actively
involved in a Globe and Mail article about the DUDES Club (Barton, 2016). This apparent sense
of ownership over the Club appears to solidify feelings of brotherhood and community, as many
members are working together to improve their Club and their experiences.
In neighborhoods where the focus groups were conducted, men – often Indigenous men –
appeared to feel especially disempowered by the structural inequities and violence they faced
daily. In the flattened hierarchy of the DUDES Club, many members found a place where their
voice mattered:
You know I get the sense that for a lot of men, I think it, they come to the DUDES Club,
I think to finally get a better picture just how important men are in our society, especially
in the society of the Downtown Eastside. That our voice is just as important as anybody
else’s, you know, we all have a voice and it gets heard at the DUDES Club, you know,
everybody is willing to listen and start acting on what our participants share, okay.
The sense of brotherhood and community was linked to some member’s discussion of the
importance of strength in numbers. Members sometimes used their Club and their connections to
advocate for themselves and others. Attendance at the DUDES Club appeared to help many
members understand that their voice was as important as any other voice in society. Some
explained that their voices were often not heard in other arenas and it was empowering to have
their voices heard at the DUDES Club. Beyond advocacy, members, elders, providers, and health
care workers discussed being strong together as peer support:
Member: Just to chat and be friendly, get to know people – if you’re running through
people downtown you know they’re with the men’s Club or whatever, and if you get in
trouble, you know the men you run into – they will help you out in other situations – it’s
just mostly the friendship.
Elder: And if they’re drugged, under the influence of drugs or anything, everybody
knows to, they watch for each other. Basically what did I say, [word in Musqueam
language] means to pick up somebody that’s fallen right?
Health care professional: ...I could see DUDES Clubs popping up all over, and not
necessarily talking about men's health, but being a place of community and a place of
brotherhood and a place of joy and a place of sadness, and a place of bonding… after I
watched the [DUDES Club Documentary, I said] “Wow, that kind of healing is so far
beyond what I'm offering on a medical model.” ... I can help people with their medical
stuff in my ten minutes… But I can't do that… that connection with other men and
people... It's just really compelling.
Some men also discussed providing peer support as empowering. It provides a sense of
purpose as well as building community. Peer support also seemed to help many members feel
less lonely and more connected to other people. Some discussed being able to ask for help when
they need it. In fact, many men indicated that they attended the DUDES Club because of the
friendship and community they experienced. The support gained from other men is a vital
component of men’s health in general – as indicated by the health care professional’s quote
above, health care professionals cannot help with social connection, and it is vital for health.
Furthermore, some members discussed how the connection with other people at the DUDES
Club reduced their stress levels, as they socialized and sought sanctuary from their “street
identity.” Thus, the community and brotherhood created by the DUDES Club improved the
members’ health and wellness.
Members’ cultural and personal identity, sense of resilience, and healing journey were
important outcomes of their involvement in the DUDES Club and related to experiences of
brotherhood and community. For example, one member described his journey through mental
illness and overcoming barriers to being in the community and around others. His words
revealed how the DUDES Club helped him build resiliency: “…Being in a large group, building
confidence and overcoming anxiety and stuff like that. That’s the – I get a lot out of DUDES
Club – like, you know it’s helped me to be – to overcome anxiety and being in a large group...”
Many members discussed the challenges they experienced on the street: accessing
appropriate programs and services and finding personal safety and comfort, which sometimes
prevented them from attending things like the DUDES Club. In establishing a support network
and structure, the DUDES Club seems to have helped to create safety in the community and
facilitate participation in communities where men may not feel safe to freely move and travel at
certain times. Not only has this fellowship created long-term connections, but it fostered safety
on the streets and created resiliency in how some members faced day-to-day challenges. One
member described how this created an essential lifeline of information in what, for some, felt
like a vacuum: “Amongst one another we can talk, we can explore, we can see if other people
suffer the same things, you can share ideas – perhaps somebody did suffer that and they can let
us know how they overcame it.”
Many members also described how resiliency was built through ongoing participation in
the Club. They extended the values nurtured and promoted within the group onto the street where
they could put into action the things they had learned. One member explained
Part of the reason I come [to the DUDES Club] is for friendship, but also there’s
problems on the street that for me… if they see me and there’s a problem, they will help
me out, because…there’s some places where you go downtown aren’t safe.
Lastly, the presence of elders and others to guide, build confidence, and provide support
for the members was a vital aspect of the DUDES Club, and a key component in developing
cultural identity, particularly for Indigenous men. For example, Indigenous members discussed
the value of elders speaking their language and sharing cultural teachings. One explained that the
DUDES Club was a good way to connect with Indigenous culture and that most people have to
go to prison to find that cultural connection. By having Indigenous elders and ensuring
Indigenous cultural teachings are central to the Club, the Club provides another avenue for
Indigenous men to connect with their culture.
Through engagement with the DUDES Club, many members felt comfortable enough to
build authentic relationships with each other, given the men’s only status, the non-judgmental
atmosphere, and peer support. They also experienced a sense of ownership over the Club, feeling
responsible and purposeful in their engagement, which reinforced a sense of brotherhood and
community. This experience of brotherhood and community, and ownership, in turn, facilitated
resiliency, healing, and identity-development within the members. Beyond this, the DUDES
Club also facilitated observable health changes, as we will discuss next.
Accessible Health Care Information Facilitates Reconnection to Body and Mind
The majority of DUDES Club members are above 40 years of age (Gross et al., 2016). In
one focus group, providers explained that when men were young, they could ignore the doctor
and feel invincible; however, this feeling comes crashing down once they reach about 50 years of
age. Some members explained that they attended the Club because men’s health information is
more important as men age. However, accessing health care was not always easy: Some of the
members shared stories of avoiding medical care because of poor treatment. Members shared
stories where they were not given pain killers because they were stereotyped as addicts, were
hung up on by 911 operators, felt rushed in the doctor’s office, and were treated markedly better
with an advocate present. Furthermore, some were unable to seek health care because of
accessibility issues: For example, some members did not have a vehicle to attend doctor’s
appointments. Poor treatment, accessibility issues, and constructions of masculinity have made
many of the men in the group very reluctant to seek health care services, even when needed.
The DUDES Club provides highly accessible, low-barrier care: the men do not have to sit
in a waiting room and feel rushed when seeing a doctor. They appear relaxed and comfortable,
ready to learn about their health. They are allowed to participate if intoxicated, as long as they
are not disrespectful. Many members described the DUDES Club health care providers as
approachable, and there is no hierarchy; the men all call each other by their first name (including
the doctor and lawyer). As one member explained “When we go in there we're equals. Got
nurses, they show up. [Name of elder] shows up. [Name of elder] shows up, you show up, it
doesn't matter. We're all the same. It's not an us and them thing.” Some of the members turned to
the DUDES Club for help when typical health care settings were unsuccessful. Nurses have
noted that some men who would not come into the clinic would still attend the DUDES Club for
health information. A health care professional explained
...An example is a patient that had a lot of conflict coming to the clinic, because of...many
factors... it just wouldn't work well sticking with the typical appointments and waiting
because it would lead to escalated behavior in the waiting room... his needs not being
met... I stopped providing care for him. But he still found sort of that fraternity in the
DUDES Club… I feel like the DUDES Club was almost like a safety net in some way.
The health information provided at DUDES Club is also accessible. The members
explained that the health care professionals welcomed any questions and explained things
clearly. This is evidenced by the fact that members recited health advice during the focus groups:
Yes he tells us about medication, what’s new, what’s coming out and what to take and
don’t go take the one because it will give you nightmares there are better ones he says. So
for HIV he gives us that, he tells us everything about the medication when it comes in
and then what new ones are coming out.
The accessibility of health information is broadened because the information does not
remain only in the group. Many members of the DUDES Club share this information and have
pointed out that their knowledge may “save a life.” One particularly salient example was told by
a health care professional:
Health care professional: ...I had a really young guy, who was in his early to mid-
twenties… he's vomiting blood. So he's already got a lot of damage done to his liver and
he's talked about, “Yeah, there's these guys out in the community and they've got these
DUDE shirts and it's like some sort of DUDES Club thing… Yeah a few of them have
talked to me,” and I'm like “Oh yeah, I know some of those guys.” So they are getting
out, they are talking to people in the community… So the information is going beyond
the group and getting out into the community…
The physical location of the DUDES Clubs is also important for accessibility. Two of the
sites are well-located, and one site has a slightly less desirable location. Bus schedules tie into
this, with some members living in more remote locations missing meetings due to inconsistent or
non-existent bus service.
Overall, many members expressed their satisfaction with the health care they received at
the DUDES Club. Many of the men considered the doctor at the DUDES Club their family
doctor and this seemed to increase the likelihood of them seeking health care services. One
health care professional explained that the DUDES Club was how many men preferred to access
health care services. The members appeared happy with the DUDES Club doctor: “[the doctor]
explains everything to everyone... the doctor is a really great doctor like you can ask any
question about any disease and he tells you the best way to deal with it...” In particular, it is
important for health care professionals involved in the Clubs to understand the members’
experiences. For example, one member explained that it was important to have a doctor who was
aware of health issues related to their neighborhood. Others indicated the importance of being
able to voice their concerns about “housing, health, [and] support.”
The outcomes of such accessible health care are evident in members’ reconnections to
their body and mind. The men in this study shared many stories highlighting how the DUDES
Club facilitated increases in physical well-being. They expressed a variety of different ways they
coped with everyday stressors. One member said, “a bottle of whiskey, a bag of dope… It makes
me feel great,” and another said meditation is one of the ways he deals with pain and stress.
Many of the men discussed a wide range of coping mechanisms to deal with grief, loss, and low
self-worth and self-esteem. Sharing coping methods can help members learn about different
ways to deal with stress, and how that influences their physical health. Being involved in the
DUDES Club appears to have led the men to take a variety of actions to improve their health.
Some members indicated that they got blood tests, liver tests, and followed-through with
suggested tests, and participated in preventative screening, such as prostate exams, during the
annual DUDES Club Health Fair. Some attributed this improvement in health-seeking behaviors
explicitly to the DUDES Club:
Member: You know what, I never had a prostate exam before I came to the DUDES
Club, one year I wasn’t going to do it, then the second health fair the doc said you’re
getting over fifty this time we’ll check... I actually went for a prostate exam. Now I do it
every six months because there’s no shame in it. I’m at the age where prostate is a serious
thing.
Some members even brought substances in for identification:
Health care professional: ...a member of DUDES coming in and saying “what is this,”
before they take it, which is like, phenomenal. Because when I was using I didn't care
what it was, you know? I've never tried that one before. And I mean, just, being
conscientious enough to know that there's nurses in the building that they can go talk to.
Which was awesome.
The men also talked about other types of health, not just physical, but also emotional,
spiritual, and holistic health. In particular, many members discussed mental health as another
issue they faced. Some members explained that they were first helped with mental health issues
at the DUDES Club, as they felt no other doctors wanted to help them; one member discussed
other doctors as uncaring compared to the DUDES Club physician. However, mental health care
can be much harder to obtain for low-income individuals, many of whom do not have access to a
counselor when they need one. Some members seemed to view the struggle of getting help as too
much of a burden to bear: “...for myself like if I were to deal with my mental health issues I’ve
been battling for a couple of years. And if I was to deal with it I’d be fighting like a whole
system right?” The DUDES Club in Vancouver temporarily provided a counselor for the men
and some members greatly appreciated the service:
When [the counselor] first started it was rough. And my dad had died. Richard died. He
carried me through it. And I'll tell you I was really rough. Fourteen people [died] in the
next twelve and a half months, seventeen people [died] in fifteen [months]. I was done.
[The counselor] was good to have here.
Many of the members struggled with addictions, an issue intricately connected with
historical and intergenerational trauma and continued systemic discrimination and violence.
Through the Club, they safely discussed strategies and resources, often with a health care
provider present to provide accurate information. Many of the men have friends who have died
from substance use, and many have abstained from substance use for years. Many shared their
stories and supported other members to heal from addictions. The sharing of stories of addiction
with men at all different levels of substance use can help everyone to reconnect with their
physical and mental health. The DUDES Club also helped the men to try to make their lives
better despite addictions: “And if I’m going here all the time concentrating on the DUDES Club,
I’m an addict too eh, I’m an alcoholic and an addict, it makes me not think about booze and
alcohol, wanting to make my life better.”
The DUDES Club offers a safe space where men can learn about health in an accessible
way. The low barrier and non-hierarchical environment is unique for men impacted by structural
and systemic violence. Many of the men have had negative experiences with standard health
care, and the unique approach offered by the DUDES Club is particularly effective for both
physical and mental health. The information the men learn in the Club propagates in the
community as well, as the men share their knowledge and work to bring more men into the Club.
The accessibility of health care is, of course, linked to constructions of masculinity.
Disrupting Colonial Constructions of Masculinity
The men in this study explained that they attended the DUDES Club to make friends,
share their experiences and feelings, and seek health care; thus challenging colonial
constructions of masculinity that paint men as strong, stoic, independent, dominant, and
invincible. Many members also disrupted socially constructed gender norms by asserting the
importance of family and creating a new family when they were estranged from home
communities.
Many of the men discussed how social constructions of masculinity appeared to prevent
them from being mentally, physically, emotionally, and spiritually healthy. Some members
expressed opinions that rigid notions of masculinity were a barrier to accessing health care, in
line with the cultural stereotype that men do not go to the doctor: “I’m not going to get [a
prostate exam], I’d rather die, forget it.” In this case, death is a better alternative than a
preventative screening procedure. Some of the members were explicitly aware of these
stereotypes but appeared to still endorse them. Some of the anecdotes were more extreme; one
provider indicated that if certain men had gone to the doctor, then they would still be alive.
The parents in the group pushed gender boundaries by talking about their roles as
nurturers or primary caregivers. One member is a grandfather with sole custody of his grandson,
who he brings to every DUDES Club meeting. Another member is a father, and has brought his
son to several meetings, and is openly affectionate with him. One member even described how
the Club helped him to know himself better as a father and a son. Further, when children are
around, the rest of the men seem to want to be around them; almost as if they are craving the
father-son relationship that they may not have. One research team member brought her young
son to a Vancouver DUDES Club meeting. He was treated so well by the members that after his
initial hesitation at being there, by the end of the meeting he begged to come back to the next
one. Being able to identify as a father and talk with other men about what that means is an
important function of the DUDES Club.
Lastly, the many discussions of the importance of men’s only spaces deconstructs
colonial constructions of masculinity. Through this desire for men’s only spaces, members
seemingly voiced their need to connect with other men: “… I’m going through a lot of rough
stuff right now and I really wanted a men’s group in this town.” Others talked about the lack of
men’s self-care opportunities compared to women’s. Another member explained how men’s
extracurricular activities problematically conform to masculine expectations:
But for men, we literally have nothing in terms of extracurricular activities or places
where we can chill with other guys, there’s nothing, where do you go? To the bar. Where
do you go? To the park and drink, drink whatever rub, you know, just get in trouble.
Despite working to challenge colonial constructions of masculinity, there were
potentially problematic discussions in some of the Clubs. For example, in one focus group with
Club members, a member shared that he felt women now had it “easy” compared to men.
However, in addition to modeling respectful behavior toward women (e.g., our late co-founder,
Richard Johnson, used to say “we have ladies present” to cue members to be respectful to the
honorary “dudettes” who occasionally attended Club meetings), men in leadership positions in
the Club often redirected conversations to become learning moments. Other opportunities to
change unhealthy norms around gender were created through guest speakers. For example, in
2015, a player from the BC Lions football team visited the Club to increase awareness and
understanding about the impact of men’s violence against women as part of the “Be More than a
Bystander” campaign – a groundbreaking initiative between the Ending Violence Association of
BC (n.d., EVA BC) and the BC Lions football team (n.d.).
Overall, members expressed how they strived for connection: to create family, to
embrace fatherhood, and to build relationships with other men. In a way, the DUDES Club
facilitates the men’s push against traditional masculinity as part of their healing journey.
Patriarchy and constructions of masculinity are only one of the systemic challenges that
members face; we turn next to others.
The Impact of Structural and Systemic Challenges on Members’ Experiences
At the core of many of the DUDES Club members’ experiences, and intimately
connected to themes discussed above, were structural and systemic challenges. Most members
experienced a range of structural barriers including access to paid work and educational
opportunities, decent food, non-judgemental spaces, as well as ongoing experiences of trauma
and racism. As one member at a northern pilot site described
“there’s a lot of horrible racism in this town. Horrible, horrible racism. And that has to
stop. We gotta change it, it’s unsafe for any person of color in this town. Doesn’t matter
whether you’re first nations or black or Chinese or whatever. Part of that unfortunately is
because of the systemic racism in the Canadian government, and the British Columbian
government. And I can’t do too much about the whole Canadian government, but I can
make a change in my community. So, that’s why I’m here.”
Structural barriers often prevented many members from seeking the social and emotional
supports they needed as well as health services that could improve quality of life:
Member 1: I think the way the Downtown Eastside [of Vancouver] operates – and I think
a lot of people would probably agree – when they talk, especially like the health care
professionals, they don’t listen to you. They hear you…”
Member 2: They hear you but they think they know all the answers. They don’t listen to
what your real problems are. And I think that men get a better sense of the DUDES Club,
that their actually, their real concerns are actually being heard by people.
These members’ words speak to the power of belonging and ownership that they
experienced at the DUDES Club in contrast to the barriers they experience every day. The
DUDES Club is a space where they know they will be listened to and heard. It is a space of
belonging that creates trust and willingness to engage with health structures as both patients and
advocates:
Member: I’m a volunteer associated with here and the DUDES Club and all the other
organizations like it actually puts you in a position where you’re – like a delegate for, for
your brothers on the street like they can approach you and you’ve got to connect right?
And it's easier sometimes because a lot of people have issues dealing with health care,
they’re oppressed by the health care system and they can’t, they just can’t function to
deal with health care professionals; they just shut down. And that’s why advocates are
necessary but sometimes advocates are difficult to obtain.
Persistent social and health inequities can have serious consequences for mental,
physical, spiritual, and emotional well-being, making it a challenge to address health issues. The
DUDES Club mitigates some of these stressors by providing a space where men can advocate for
one another and feel that their voices will be heard.
Members frequently discussed housing as a structural and systemic challenge: “Okay so
to get decent housing, I mean you’re, you’re better off to be homeless or in a shelter. Because if
he’s got a room, he’s in SRO [single room occupancy hotel], okay, he’s got a roof, he’s okay.”
The SRO’s where many of the men live are often in deplorable conditions, and many men
appeared to struggle with the idea that you have to be homeless or in crisis to get decent housing.
Many participants discussed the lack of resources for men compared to women, and some
described the restrictions that some housing providers place on overnight guests and visitors as
more limiting than being in prison. For example, some members explained that shelters have
check-in times that may interfere with work schedules and dehumanize patrons.
Finally, accessing food in neighborhoods often characterized as “food deserts” (i.e.,
geographic areas with a need for, but limited access to, healthy and affordable food options; Lu
& Qiu, 2015) is yet another health challenge that impacted many members:
“down here food access is a hard thing. I’m HIV, some of us are, and you need to eat a
proper diet. You don’t. We eat a lot of crap because of what our budget is. We get good
balance meals [at the DUDES Club]. Balance is a big thing for my health.”
The DUDES Club is one place where the men know they will be nourished in all realms,
physical, emotional, mental, and spiritual.
Discussion
In this paper, we have presented results showcasing the impacts of the DUDES Club on
its members. The DUDES Club facilitates feelings of brotherhood and community, produces
tangible health benefits by providing accessible health information, challenges colonial
constructions of masculinity, and addresses the structural and systemic challenges the members
face. A strength of this paper is the triangulation of the findings (e.g., Tracy, 2010), whereby
members, elders, providers, and health care professionals all discussed the benefits of the Club.
We feel this is a strong assessment of the positive impacts of the DUDES Club.
The DUDES Club uniquely addressed members’ health in multiple ways. The DUDES
Club goes beyond a Western medical model of health where health care is conceptualized as a
response to narrowly identified bio-medical problems by focusing on social connection. This
focus on social connection is unique. As many members discussed, they felt there was no place
for men to go to connect with each other in their communities. The power of authentic social
connections to impact health should not be underestimated. The Club’s founders saw the need
for social connections and support for the many men who came to Vancouver Native Health tired
of sitting alone in their single-room occupancy hotels. Strong social support networks have been
shown to reduce physiological responses to stress, and in communities with little social and
emotional support, people are more likely to suffer from poor mental and physical health
(Wilkinson & Marmot, 2003). The DUDES Club also helped Indigenous men reconnect with
their Indigenous culture, which can have potent impacts on well-being. Several studies have
shown that a sense of belonging and connection to community are important aspects of urban
Indigenous health and well-being (Cardinal, 2006; Environics, 2010; Smylie et. al, 2011).
Furthermore, Indigenous connection to culture and community can buffer against the negative
impacts of discrimination (e.g., Bombay et al., 2010; Spence et al., 2016). Culture is frequently
the foundation of interventions designed by and for Indigenous Peoples (e.g., Fiedeldey-Van
Dijk et al., 2017). Participant experiences in the DUDES Club confirmed the importance of a
sense of belonging and connection to the community as key to (Indigenous and other) men’s
health and well-being.
The DUDES Club addresses men’s health by providing accessible health information.
Members described this as a unique part of the DUDES Club, as many members described how
current and common health information practices are inaccessible. Men’s groups are desperately
needed to address men’s health and well-being, including the high burden of health disparities
experienced by men, such as death by suicide (Goldenberg, 2014; Statistics Canada, 2019;
Kumar & Tjepkema, 2019). Members identified low barrier and non-hierarchical health care
spaces as important to efforts to learn about and improve their health. This research
demonstrated that the DUDES Club offers a safe and accessible space to access health
information which is crucial for men who experience ongoing structural and systemic violence
within health settings. In our discussions with members, it was evident that participation in the
DUDES Club helped them to better access health care, follow-through on medical appointments,
and to better understand what they should do to take care of themselves. Doctors and nurses that
we interviewed had similar conclusions. There also appears to be a ripple effect in which health
information gained within the Club is disseminated in the community, which brings more men to
the Club drawn by the promise of respectful and positive interactions. Multiple intersecting
factors influence how and when men access health care services. Participants in this study clearly
expressed the need for safe, accessible health care settings in which they can feel their voice is
truly heard.
Groups such as the DUDES Club may also help to address some of the systemic and
structural challenges that men, and in particular Indigenous men, face. These challenges are
inextricably linked to health. Many members discussed how the Club helped them navigate these
systemic and structural challenges through access to advocates, another unique way the DUDES
Club contributed to their health and well-being. For example, men and Indigenous people are
much more likely to experience homelessness than women or non-Indigenous people in Canada
(Gaetz et al., 2013). In some cities, Indigenous people make up 90% of the homeless population
(CBC News, 2014). This is despite research showing safe, stable housing produces better long-
term outcomes for vulnerable and marginalized populations (Goering et al., 2011). Homelessness
has undeniable negative impacts on health (e.g., Guirguis-Younger et al., 2014). Indigenous
men’s groups like the DUDES Club may help members escape homelessness by providing help
in navigating social service systems.
The DUDES Club also works to challenge the negative health impacts of toxic
constructions of masculinity. Masculinity is essential to any discussion of a men’s club. Some
people are uncomfortable with the idea of a men’s Club, and indeed, people have expressed
concerns at various community forums and online about how patriarchal structures continue to
legitimize men’s dominant position in society and justify unequal power relations between men,
women, and people of different genders. What we have to say is this: gender is a powerful
determinant of health, shaping people’s lives in many different ways. Too narrow of a focus on
gender fails to capture the complexities embedded in these men’s lives, such as the systemic and
structural challenges that the members of this Club face, including the impact of toxic definitions
of masculinity. The findings of this study challenge socially-constructed gender norms and call
for a more nuanced understanding of Indigenous men's experiences of health and well-being. The
existence of the DUDES Club, in and of itself, contributes to decolonizing notions of
masculinity. Healthy Indigenous masculinities and communities require understanding how race
and gender intersect to disadvantage Indigenous men which has negative ramifications for
Indigenous communities (Innes & Anderson, 2012). Decolonizing masculinity, to us, means
supporting healthy ways for men to express masculinity to counter harmful paternalistic
expressions of Western masculinity that differentially impact Indigenous men. This is not to say,
of course, that male privilege does not exist; but to say that acknowledging the impact of
patriarchy on people of all genders, and working to create healthier communities, will be for the
betterment of everyone. Indeed, hegemonic constructions of masculinity may be part of why
men's mental health has been largely overlooked by health authorities and policy-makers and
thus an inhibiting factor for men seeking health information (Seidler et. al, 2016). Rather than
considering systems of oppression and discrimination in isolation, our findings call for an
intersectional understanding of gender in relation to other axes of oppression and how this shapes
the needs, concerns, and priorities of particular groups of men (e.g., Collins, 2015).
Acknowledging the intersectionality of gender does not devalue the rights of any particular
gender-based or non-binary group, but provides space to validate and understand diverse
experiences.
Though the DUDES Club has benefited those involved, it is not a cure-all.
Disproportionate burdens of health on men – particularly Indigenous men – are based in deep-
rooted colonial and patriarchal systems; one men’s club cannot “solve” these issues.
Furthermore, the DUDES Club in and of itself is not perfect. For example, some men have
indicated they felt intimidated at the DUDES Club, due to the size of the gathering. Clubs might
work to include different formats to make all members comfortable. However, the DUDES Club
is one very promising way to improve men’s health and challenge colonial and patriarchal
systems that exist to the detriment of people of all genders. Next, we turn to policy
recommendations that may do the same.
Policy Recommendations
Evidence-based policy is paramount for feasible and tangible change to occur at the
community level. In this section, we provide five policy recommendations for multiple levels of
government, health care professionals, and communities interested in starting their own DUDES
Club. Following some of the recommendations, we outline further policy considerations. There
already exist many policy calls and recommendations for Indigenous health; as such, we connect
some of our policy recommendations to concrete commitments already made in the Truth and
Reconciliation Commission’s (TRC) Calls to Action and the United Nations Declaration on the
Rights of Indigenous Peoples (UNDRIP).
Honor Indigenous Practices and Traditions
In keeping with the TRC’s Calls to Action in Sections 18, 19, 20, 21, and particularly 22,
where the value of Indigenous healing practices are to be recognized and used within the
Canadian health care system, communities and health/social service organizations can:
● Ensure Club members are able to determine what Indigenous practices and traditions
are appropriate for their social/cultural/geographic context; and
● Provide funding for culturally-appropriate supports and services that honor
Indigenous healing practices.
Policy Considerations. For health care for Indigenous Peoples to be effective, it must be
situated in Indigenous culture. This can mean many different things for different groups of
Indigenous Peoples. Readers should not mistake this as an indulgence of pan-Indianism.
Appropriate cultural practices should be determined by the Club members. In our case, the
presence of elders was fundamental. Members also talked about the healing power of nature, and
indeed, since this data was collected, the DUDES Club has organized annual living-on-the-land
retreats. Clubs also incorporate various cultural activities and ceremonies. Importantly, some of
these cultural activities (like beading, drum-making, and sharing circles) challenge colonial
constructions of masculinity.
Create a Sense of Ownership Over the Club
In keeping with Article 3 (the right to self-determination) and Article 18 (rights to
decision-making) of UNDRIP, funders (including all levels of government), health-care
professionals, and community organizations can:
● Provide funding and support for DUDES Clubs that ensure members are able to
determine Club activities, meals, health topics, and make other decisions about the
Club’s function and purpose.
Policy Considerations. DUDES Clubs should not be another avenue for others to make
decisions for the members. Many of the members live in intense manifestations of systemic and
structural inequities that routinely strip them of their agency and autonomy. The sense of
ownership that the members feel over the DUDES Club creates a sense of purpose and pride in
the members and instills a sense of solidarity. Deciding on activities, meals, and health topics
provides a sense of control. Lack of a sense of control can have tangible effects on health and
well-being (e.g., Lachman et al., 2011). In this way, the DUDES Club may help to buffer the
negative health ramifications of feeling powerless.
Ground the Club in Social Connection
Funders, health-care providers, community organizations, and host communities can:
● Provide funding for Clubs that ensure space for social connections. For example,
make sure that time for building relationships is built into the Club, whether as part of
a simple social activity (e.g., playing bingo) or something more formal (e.g., a talking
or sharing circle).
Policy Considerations. Club members, Club providers, and health care workers all
discussed the importance of social connections and bonding that the Club provides. Social
support is linked to a variety of benefits, such as good mental health, positive affect, and lower
rates of depression and PTSD symptomology (Lakey & Orehek, 2011). As doctors often struggle
to prescribe social support, providing space for creating relationships is a fundamental part of a
functioning men’s group. In the DUDES Club, relationships were created between the members,
between the members and elders, and between the members and the health care workers. This
lack of hierarchy in the social support system was also important, as members see the doctor as
another “DUDE,” and thus feel a social connection with other members, regardless of their
position. Ultimately, creating men’s only spaces that are safe and trusted is a cost-effective
investment for the health care system by providing a model to successfully address upstream
determinants of men’s health.
Take an Intersectional Approach to Health and Well-being
In keeping with the TRC’s Call to Action 23 for cultural competency training for all health-care
professionals, all levels of government can work together to:
● Provide funding to train health-care professionals and other frontline workers
involved with DUDES Clubs in culturally safe practices and how to connect with
individuals deeply impacted by structural and systemic inequities; and
● Health care professionals involved in the Clubs should provide accessible health
information.
Policy Considerations. Cultural safety training must be intersectional. It must include
training to ensure providers and healthcare workers have a good understanding of the members’
lived experiences to be able to provide space and information that is appropriate for the
members’ current lived realities which are shaped by racism, socioeconomic circumstances,
gender norms, and historical factors that continue to impact Indigenous Peoples today.
Support for Indigenous-Driven Grassroots Initiatives Like the DUDES Club
In keeping with UNDRIP Article 5 (affirming the right of Indigenous people to maintain and
strengthen their own political, legal, economic, social, and cultural institutions), all levels of
government can work together to:
● Increase funding for grassroots initiatives grounded in Indigenous cultural practices,
and support the work already being done to promote holistic healing in communities,
particularly in the area of Indigenous men’s health; and
● Provide funding for culturally-responsive evaluation of grassroots, community, and
Indigenous-led initiatives.
Policy Recommendations. The DUDES Club emphasizes Indigenous practices and
traditions, ownership, social connection, and intersectional approaches. This results in somewhat
uncommon funding costs. For example, it can be difficult to secure funding to pay elders, pay
counselors, purchase food, and purchase materials for engaging in cultural activities. All of these
components are fundamental to the success of the DUDES Club, and funders should consider
them just as important as other associated costs.
Conclusion
The DUDES Club is an innovative model for addressing men’s well-being, and
physical, spiritual, emotional, and mental health. In the last 5 years, with the help of the First
Nations Health Authority and Canadian Men’s Health Foundation, the Club has expanded
rapidly to dozens of locations across British Columbia. The model offers a unique way for men
to engage with their health, by providing a space where members can build brotherhood,
challenge colonial constructions of masculinity, reconnect with their identities, access health
care, and stand in solidarity to challenge structural and systemic barriers. Through holistic and
non-judgemental approaches, the Club has successfully facilitated tangible health benefits for its
members. It is an innovative model for policy-makers to address upstream determinants of
health, particularly socio-structural determinants, for the benefit of everyone in the community.
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