Community Views of Determinants of Men's Wellbeing in Guatemala: A Study Using Fuzzy Cognitive Mapping.

Background: In post-conflict Guatemala, Indigenous men's psychological distress has been linked to violence exposure, disrupted social support systems, and structural inequities.

Purpose: We aimed to document how communities themselves understand men's wellbeing and the factors that influence men's wellbeing.

Research design and study sample: Fuzzy Cognitive Mapping with 20 stakeholder groups in Santiago Atitlán and Cuilco, Guatemala defined men's wellbeing in local terms and identified the influences community groups understood to promote and detract from men's wellbeing. Participants mapped pathways through which influences affected wellbeing and weighted their relative perceived strength.

Analysis: The researchers used thematic analysis to summarise influences into 43 factors and used fuzzy transitive closure to calculate their net causal influence for each set of stakeholders. We compared perspectives of groups of adult men, adult women, and practitioners of Mayan medicine in Santiago Atitlán, with a primarily Indigenous population, to groups in Cuilco, with a primarily non-Indigenous population. We also compared perspectives across age groups in Santiago Atitlán.

Results: Across regions, maps highlighted the importance of family and social relations, emotional distress, substance use and physical health for men's wellbeing. Basic resource insecurity and unemployment were top risk factors for men's wellbeing in maps from Cuilco but had both risk and protective influences on men's wellbeing in maps from Santiago Atitlán.

Conclusions: Findings challenge the focus on scale-up of individual biomedical interventions as the best strategy to reduce the burden of emotional distress in Guatemala and raise questions about standard development approaches that emphasize income generation and educational attainment above cultural continuity and social harmony.