Men's Health

How to Do it

David Conrad, Alan White

• Publisher: CRC Press
• Year: 2018
• eBook ISBN:
  9781315358093
• Topic: Medicine
• Subtopic: Health Care Delivery

This work includes Foreword by Ian Banks - President, Men's Health Forum. Traditionally, men have been seen as reluctant to access health services, but getting men to engage with their health isn't an impossible task once you're equipped with a few tricks of the trade. This concise, easy to read guide offers a no-nonsense, practical approach to the development and implementation of men's health programmes. Based on years of wide-ranging experience, the book is designed for anyone who is involved in service delivery for men and boys, and demonstrates what can be achieved with adequate resources, a flexible approach and a sound understanding of men's needs. It is ideal for all healthcare professionals and managers, and medicine and nursing students undertaking specialist men's health and health promotion courses. It is also of great interest to teachers and youth leaders, including school nurses. Healthcare policy makers and shapers will find it enlightening reading. 'This book is for anyone who wants to find out how to successfully set up and deliver health services aimed at men and boys. Traditionally, men have been seen as reluctant to access health services, but getting men to engage with their health isn't an impossible task once you're equipped with a few tricks of the trade. Although this is primarily intended to be a practical guide, much of the book will also be of interest to academics, policy makers and managers. It demonstrates what can be achieved with adequate resources, a flexible approach and a sound understanding of men's needs.' - David Conrad and Alan White, in the Preface. 'As an issue men's health is plagued by myth, ignorance and inequality, but most of all by a lack of solid research based on evidence-based work with men themselves. Lofty academics pontificate endlessly on the meaning of 'masculinity' yet never get their invariably white Caucasian, middle class hands dirty on what really impacts on Y chromosome owners. The Bradford team didn't just wonder about masculinity and scratch male pattern baldness, they did something measurable about men's health and ethnicity so other workers could use their evidence base to actually change the dreadful health status quo. An excellent and unique "Dirty Hands Manual".' - Ian Banks, in the Foreword.

PART ONE

CHAPTER 1

Introduction

Nigel Hughes

The Bradford Model

In 2002 Bradford was awarded a £1m grant from the New Opportunities Fund to set up a Healthy Living Centre based on men’s health. The foundation of the grant application was the work being undertaken by the Bradford Health HoM key workers, a group of practitioners who had developed innovative men’s health services for some of the hardest to reach groups in society.

This grant, with matched funding from the local trusts, enabled a cross-city programme of activities. At the time when the HoM project began, there were four primary care trusts (PCTs) in Bradford and Airedale which have now merged into a single trust, Bradford and Airedale Teaching PCT. Within each PCT there was one full-time key worker, part-funded by the Big Lottery. The Lottery also funded a ‘half post’ based within the Bradford District Public Health Partnership. Each PCT also provided additional support to the project as an ‘in-kind’ contribution. In one PCT this included two additional dedicated key workers. HoM is a cross-city initiative, with key workers originally being employed within one of the four PCTs, but having the ability to work across the city, sharing expertise and jointly setting up events.

HoM have delivered a broad range of projects, including projects in schools, work with the Youth Offending team, health drop-in sessions for homeless men, sexual health outreach work in male saunas, health-related pub quizzes, and health checks in workplaces and community settings known as health ‘MOTs’ (see Chapter 4). This book highlights the main principles for working effectively in this area by featuring a sample of some of the most successful projects, however the possibilities for delivering new types of innovative men’s health services are essentially limitless.

Traditionally, health care has been delivered in clinics where the healthcare professionals have configured services for their own convenience. The expectation is that the patient will learn to use the service and will conform to its structures and ways of working. Within the majority of the work of the HoM team there is a reversal of this expectation, with the team generally going into the men’s environment and engaging with the men on their terms. This alters significantly the nature of the relationship that the team have with the men and the way the men use their services.

During the time that the HoM team have been working with funding from the Big Lottery Fund, researchers from the Centre for Men’s Health at Leeds Metropolitan University have been exploring with the team and with the men who use their services the decision making that men go through in choosing to attend. The intention of the study was to uncover why it was that a man would access these alternative approaches as opposed to going to the traditional mainstream services on offer. The study involved interviews with boys and men who had used the services as well as fieldwork, where the researchers were present at the sessions run by the team to see what was happening at first-hand (White & Cash 2005). There were also interviews with the team members to get their perspective on what was being achieved, or not, and the latest phase of this study is to now seek the main stakeholders’ opinions on the service.

BOX 1.1 Key findings from team member interviews

▪ The team tended not to discuss men’s health in terms of disease processes or life expectancy, more in terms of lifestyle and public health issues such as smoking, alcohol and drugs.

▪ Where health issues were identified as being particularly problematic for men, such as the issue of prostate and testicular cancer, hypertension, diabetes etc., these were from an educational or screening context rather than from a treatment perspective.

▪ Men do care about their health, whether it be their physical, sexual or emotional health.

▪ Men are more than willing to discuss issues such as fatherhood, relationship problems and other broader issues as well as their physical health, but men lack the opportunities to discuss these concerns with health professionals because they perceive the health service as a place you go to when you are ‘poorly’, or because of the social constraints placed on them through being a man.

▪ The team did recognise that there was a difference between how younger men and older men saw their health and that there is a tendency for men to take the body for granted until age becomes a factor.

▪ The use of ‘incentives’ (such as time out of work, free condoms, or special events) was very helpful in getting men and boys to access the services The team were able to link the men to other services, either to explain how the systems worked or through direct referral to the general practitioner (GP) etc.

▪ It is important to be seen as a professional with expert knowledge and to be offering the services that men want.

The interviews with the team gave an insight not only into how they viewed the health of men and what did and didn’t work, but also the personal attributes that are required to undertake this form of work and to be successful in outreach work with men (see Box 1.1) (this theme is developed in Chapter 14).

From the interviews with the men and from the fieldwork there were findings that supported the views of the team (see Box 1.2).

BOX 1.2 Key findings from men

▪ There was a perception that the GPs were an ‘illness service’ where you went when ‘poorly’.

▪ The men were reluctant to ‘bother the doctor’ with what they perceived to be trivial or potentially embarrassing problems.

▪ A common response was that they would ‘go if it was needed’ but the tendency was to ‘see what it's like tomorrow'.

▪ Some men seemed to have a lack of confidence in the doctor’s ability, with a ‘what do they know?’ mentality being present.

▪ The men did not see the GP surgery as a place they felt comfortable taking the kinds of issues that they would talk to the HoM team about.

▪ There was anxiety in some of the younger men that the GPs were too close to their families, so that there was a strong possibility that parents or others might get to know that they had been to the surgery.

▪ Health centres don’t fit with the way that men like to work – men make more snap decisions. They worry about this ache or pain and when they do decide to do something about it they want to do it there and then, a spontaneity that is rare or diffi cult to manage at a health centre.

▪ Health centres tend to close early and not open at the weekend, so there appear to be barriers to the working man in accessing clinics. This is a specifi c problem for men as they are more likely to be working full time, more likely to be working over 48 hours a week and less likely to have a job that involves fl exitime.

The picture that emerged was that by the way in which the team were structuring their services and by their own personal attributes they made it easier for the men to come forward and receive support that they acknowledge they wouldn’t have sought if that service wasn’t being provided.

A key factor in the work of the HoM team is that they were able to structure their services in a way that overcame some of the difficulties the men were experiencing in using conventional health care. For instance, some of the Asian lads interviewed were very worried that if they spoke to their GP their parents would find out and so they avoided going with anything other than a medical condition that would not cause them problems. With the provision of the anonymity of the Lads’ Room they felt safe in discussing issues relating to their sexual health.

The HoM services seemed to provide a safe space that enabled the men to feel more secure in coming forward for a health check and in part this appeared to be a result of the team working on the same wavelength and talking the same language as the men. This required the team to use strategies that made them and their messages sufficiently appealing so that the men were willing to take the risk of exposing their vulnerabilities to these strangers. In part, this was achieved by having the perseverance to be able to keep a service going whilst it developed a reputation within the local male community. It was also through the use of appropriate incentives, for instance handing out free condoms or arranging for the local lads to have weekends away. The team also went into the men’s environment, which the men referred to as their ‘comfort zone’.

Local Context

Bradford district covers 141 square miles and has a population of approximately 481,000. The city was built upon the textile industry, which generated significant local wealth and attracted many immigrants from South Asia. Now the mills are mostly gone, as are employment opportunities, leaving a legacy of poverty, disadvantage and poor health. The premature ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Foreword
• Preface
• About the editors
• About the contributors
• Acknowledgements
• List of abbreviations
• Part One
• Part Two
• Part Three
• References
• Index