Strategies To Get Men To Take Their Health Seriously

Due to a variety of reasons men do not seek or receive timely and appropriate health care. Hence, men’s health is a slow emerging field. Program interventions and health promoting practices for men need to be culturally adapted and delivered in a variety of settings such as clinics, workplaces, community settings, correctional facilities and residential settings, such as hotels, motels and clubs, and retail outlets, like supermarkets and gaming outlets. Program developers and evaluators need to consider these factors when developing programs for men. In terms of messages, program developers need to consider ‘what’s in it for me’, or ‘why should I’ rather than ‘you should’. The interventions and programs need to be simple to use, easy to understand and make the healthy choice the easy choice.

Why It Matters

Late care leads to harder problems

When men do not receive the medical care they need, common health issues are often diagnosed late and are costlier to treat. High blood pressure can damage organs such as the heart, brain, kidneys, and eyes over years without symptoms. Type 2 diabetes can take years to develop before symptoms become noticeable. Yet, if detected earlier, these conditions can be managed through lifestyle changes, low-cost, daily medications, brief treatment or close monitoring rather than costly hospitalization and debilitating, long-term disease.

Prevention protects families, jobs, and communities

Men’s health affects not only their health but that of their families as well. Midlife illness can not only take the family’s breadwinner out of the home, but also lead to family members taking on caregiving responsibilities. The health of men affects workforce productivity, family stability, and the health care burden placed on family caregivers. Impacts are also felt by employers, insurers, and the health care system when a man needs emergency care, or has a preventable illness because he lacked basic health education and/or screening.

Better engagement improves safety and shared decisions

Having regular primary care visits is key to making informed decisions about a man’s health as early as possible. Minor side effects of treatment such as decreased sexual function, fatigue, and weight gain may prompt a man to stop taking potentially life-saving or life-altering medication. However, these side effects can be discussed with a physician to find alternative treatments. In addition to managing illnesses and treatments, primary care visits are ideal for shared decision-making regarding cancer screening, mental health interventions, and other healthy lifestyle choices.

There are real system trade-offs

Increasing the numbers of men attending for routine health care can put additional pressure on already constrained primary care capacity. However, a number of strategies can increase access to health care including use of nurse-led health care, protocols for issue of standing orders, group health education sessions, telehealth and community-based screening events. Payers and policymakers must weigh the near-term costs of outreach and health promotion/preventive services against the long-term savings in terms of avoided complications and unplanned admissions to Emergency Departments. An initial focus on the interventions with the greatest impact per unit of intervention (i.e., blood pressure control, tobacco cessation, diabetes prevention, vaccination, early intervention for mental health problems) would be a thoughtful and cost-effective strategy.

Culture and trust shape behavior

Historical and persistent inequities in healthcare can make some men wary of the health system. In other populations, concern about being judged, fear that confidential information will be shared, concern about immigration status, cost, or wage loss can keep men from seeking care for a health problem. But with realistic goals and solutions, effective strategies can overcome these barriers and encourage men to seek and use health services, even when social norms around masculinity suggest that asking for help is a sign of weakness. Many men suffer from poor health because they are hesitant to talk about their pain, stress, or depression.

Who It Affects

Young adult men: missed early prevention

Young men consider themselves to be healthy and typically do not come to see a doctor for vaccines and other preventive care for a variety of health related issues as well as counseling on sexual health and early detection of future health problems. This is also a time in life in which young men are establishing life long health habits such as sleeping habits, eating habits, alcohol use, and exercise. Seeing a primary care physician in your 20’s and 30’s can make future health risks much easier to manage. We also discuss various other topics of interest to young men, such as training for a marathon, managing an injury from participation in a sport, treatment of acne and hair loss, all aspects of sexual health, planning for starting a family, and stress management.

Middle-aged men: risk climbs while time shrinks

Men in their 40s and 50s have several health concerns worsen as demands on time and rigidity in the work place increase. Blood pressure and cholesterol levels are on the rise. Weight gain is easier due to nature of daily activities. The risk of diabetes also increases and due to family pressures and work, many men may delay medical care until their disease is far advanced. When you need a doctor, you want one right away. And right away can be as early as 7:30 am, after 5 pm, on weekends, via telehealth or in a convenient wellness location where you can have multiple services performed in one setting.

Older men: more benefit from steady follow-up

Older men need medication management, fall prevention strategies, physical activity counseling and cancer screening. They have also specific needs related to hearing and vision, sleep, urinary symptoms, sexual function and cognitive function. Not every test needs to be ordered. Evidence-based screening should guide cancer screening decisions for older adults. Thoughtful decisions regarding screening for cancer in older adults should take into consideration life expectancy, health status and patient preferences. Following a patient’s health status over time can help to prevent potential drug interactions, avoid hospitalizations for conditions that could be managed as an outpatient and promote independence.

Groups facing higher barriers

In addition to the choices that men with cancer make regarding their cancer care, there are also a number of structural factors that influence their care seeking behavior. First, the lack of paid sick leave for many men in lower-paying jobs creates challenges for their taking time off from work for cancer diagnosis and treatment because of fear of lost income. Next, geographic location and rural settings create challenges for the basic cancer services needed, including longer travel for patient visits. Third, racial and ethnic populations that are marginalized may avoid healthcare services or experience poor health outcomes due to perceived provider bias or lack of cultural relevance and poor communication that results in low quality of care and loss of trust in the healthcare system. Fourth, gay, bisexual, and transgender (GBT) men avoid cancer care because they perceive stigma and experience inadequate clinical care for men who have sex with men. Motivation is not enough. Structural barriers must be tackled in order to make care safe, respectful and accessible.

Other stakeholders who shape access

Many groups and individuals play a role in determining why men receive preventive health care rather than deferred care until they become critically ill and need to visit an ED. Clinicians, including primary care providers, and employers, payers and policymakers all have a stake in influencing the factors that affect trust and adherence to health recommendations. For example, primary care team members and staff can influence why patients arrive on time for appointments and whether or not they follow treatment recommendations, while employers can influence issues such as time flexibility and benefits design for the workplaces they create. Payers can decide which preventive counseling and remote monitoring and behavioral health integration services will be available and affordable for insured men and their families, and public health agencies can influence community-based programs, vaccination and screening services that are available in many locations.

What Changes

1) Make care convenient and low-friction

Design the health care system to better suit men’s needs, such as by offering extended hours of operation, same day access to appointments, appointment scheduling online or by phone and reducing bureaucracy. Offering walk-in “health checks” at workplaces, community based organisations, pharmacies and in mobile clinics located in public spaces such as shopping malls, railway stations, sporting clubs and restaurants. Telehealth can also support follow up, medication management, mental health monitoring and discussion of results from tests and investigations to save men time and avoid lost hours of production.

By grouping several services into one visit, a large number of potential health issues can be screened and addressed on the first visit, eliminating the need for additional follow-up visits to screen for and treat each individual health issue. For example, the men’s wellness bundle includes: blood pressure measurement, BMI and waist circumference measurement, diabetes risk assessment, tobacco use assessment, alcohol use assessment, depression screening, and vaccination screening. Patients find it easier to understand and follow these bundles versus addressing each health issue one at a time. Clinics also find it easier to manage.

2) Look for ‘entry points’ into your message where men are motivated to read or view the information

Our male patients often come in for specific reasons related to their sexual health issues and concerns, their fertility, sports injuries, back pain, sleep difficulties, and work/school required physicals. Each of these types of visits present wonderful opportunities to encourage healthy behaviors without making health feel a “hot” or negative topic. For example, a patient coming in for treatment of erectile dysfunction will have his blood pressure taken and Counselled as to whether he is at risk for diabetes since vascular and sexual health are related. A patient coming in for treatment of a sports injury will receive Counselling on ways to train safely, improve sleep, and manage pain as well as counsel on smoking/tobacco use and stress.

Another option for Occupational Health Screening is to include Blood Pressure, Vision Screening and Hearing Tests amongst the workplace screen. Vaccination Programmes are also a great option for screening. If an abnormal result is identified the patient should be able to easily book a follow-up appointment, informed as necessary and securely referred to another Health Professional if required.

3) Communicate in a clear, action-oriented style

Another important aspect of communication is how clinicians explain benefits and trade-offs of treatment options to their patients. Men want providers to respect their autonomy, and not view them as “less of a man” for seeking help with sexual function. clinicians should communicate the benefits of treatment by clearly connecting treatment options to the priorities that matter most to men, such as energy, stamina, sexual function, sleep, work, and family life. Clinicians should avoid discussions that elicit feelings of shame, blame, and judgment. For example, instead of saying to a 40-year-old man with high blood pressure, “You need to lose weight,” say, “Let’s identify one change that you can make in the next 2 weeks to help lower your blood pressure and increase your energy level.” Incorporating short decision aids into clinical encounters, such as creating a “menu” of options and having patients select the option(s) that will help them adhere best to recommended treatments.

Make your policy on privacy and confidentiality known to clients, either verbally or in writing eg: ‘All conversations with me are completely confidential’. Warning: it’s often less difficult to declare this out loud than to write it down, especially when working with sensitive issues such as mental health, substance use and sexual health. Show clients that you are familiar with ‘their’ problems by framing them in a positive light eg: ‘Many men experience this problem and there are effective treatments available’.

4) Leave patient management data collection and validation to your clinic’s software; let your app focus on engagement.

Studies show that men are more likely to take the recommended actions for their health when health care providers use reminders, standing orders and proactive communication rather than patient memory. First, providers and patients should establish reminders for blood pressure screening, diabetes screening and vaccinations. For healthy patients, consider using standing orders that allow nurses or medical assistants to screen patients for these conditions without first obtaining a separate order from their doctor or physician assistant. Establish a “fast track” for high blood pressure screening and treatment. This would involve a series of steps such as verifying blood pressure readings, educating the patient about healthy behaviors and their effects on blood pressure, starting the patient on home blood pressure monitoring, scheduling the follow-up visit to review readings, and medication adjustments as needed.

Digital technology can help to prevent silent worsening by allowing monitoring and tracking between appointments. A digital blood pressure cuff, glucose monitoring (if applicable) and wearable technology such as a fitness tracker or smart watch can help both patients and health professionals to make informed decisions at the right time. However, consideration must be given to data protection issues and choice of technology and apps that are accessible to those with little or no digital skills. Also important is user-friendly design and plain language-generated text.

5) Integrated care and treatment for mental health and substance use disorders is provided as routine to patients in primary care settings.

Why don’t men use specialty mental health programs? Embedding behavioral health into primary care can help increase access to services by eliminating many of the barriers to treatment. A warm handoff can be a powerful engagement strategy in counseling. Quick solutions to insomnia can be learned in a matter of weeks. Participating in a collaborative care program is another effective way to engage patients in treatment for common mental health problems. Screenings for mental health problems should be a regular, ongoing practice in your practice, not an occasional response to a patient’s report of a crisis. It is important for all clinicians to routinely ask about sleep, stress, and alcohol or drug use, without taking a judgmental attitude.

Youth of all genders deserve safe and supportive care when experiencing suicidal ideation, intimate partner violence, or severe substance use. In addition to safety planning for high-risk situations and linking to treatment as needed, clinics should have a protocol in place to support these youth. Treatment for transgender and gender non-conforming youth should be supportive, not punitive or judgmental.

6) Address cost, time off, and policy barriers

While attention is given to increasing patient motivation for cancer screening in men, several more basic barriers affect men’s use of cancer screening tests. Time off work or school, transportation to and from screening locations, and screening-related costs are often cited by men as reasons for not obtaining cancer screening tests. Employers, payers, and other stakeholders have the potential to increase men’s use of cancer screening by providing paid time off from work or school for cancer screening visits, flexible scheduling during the day, or extended hours for screening clinics. Additionally, on-site screening tests and services can increase men’s use of cancer screening, especially if all preventive counseling and screening services are covered regardless of location or mode of delivery. This includes screening tests and counseling delivered in clinical practices (urban and rural) that have been supported to enhance their capacity to provide cancer screening and other preventive services. Examples of such supported practices include free-standing cancer screening sites, health centers located within community health clinics, and mobile health units that travel to various locations and screen populations in a community-based setting.

Incentives for Incentivising Nudging should be simple, respectful and maximise positive impact whilst minimising the risk of coercion. Cash or other rewards for screening or coaching can be effective but must be designed well to avoid unduly pressurising individuals into making decisions they would not otherwise take. Programmes that reduce friction between what people are likely to do anyway and what is best for them can be particularly effective.

7) Keep screening evidence-based to avoid overtesting

While we are trying to do a better job of outreach, this does not mean we should be doing unnecessary testing. Screening recommendations and testing decisions should be based on current evidence-based guidelines and shared decision making. Providers must ensure that patients have an adequate understanding of the benefits and harms of screening, particularly in tests and indications where recommendations vary by age, risk factors and patient preferences. By educating men on the “why” of screening and involving them in the decision, we can improve adherence with follow-up tests.

8) Use community trust and familiar settings

Community-based programs can reach the men who are hesitant to visit traditional clinic and hospital based settings. Community-based programs can socialize healthy behaviors, making them the norm and helping them become behaviors that are viewed positively by the community. Ex. Community based Blood Pressure screening in a barber-shop, health fairs held in a place of faith, health programs run through a sports club, mobile screening vans to name a few. Community-based programs can also utilize the powerful voices in the community (coaches, faith leaders, workplace supervisors) to promote health as a responsible and strong behavior.

Measuring progress

Programs are most powerful when metrics are identified and data is used for program improvement. Some potential metrics to track could include: rates of patients receiving preventive screening; rate of diabetes and hypertension detection earlier than usual; improvement in blood pressure and glucose control in patients; decrease in ER visits for conditions that can be managed in office; vaccination and smoking cessation rates. Patients’ perspective or self report of sleep, function and mental health status. Improving equity in delivery of health care and tracking progress across different socio-economic statuses, rural vs. urban and diverse populations vs. non diverse populations.

References:

https://www.cdc.gov/nchs/fastats/mens-health.htm