1912 PIT STOP FINAL REPORT by lindash

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1912 PIT STOP FINAL REPORT

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									Pit Stop Evaluation
       ‘Apart from taking it down to the pub here, its
                  about as masculine as you can get’
                        Heather Hingston, Goldfields Pit Stop Coordinator




                                       Debra Chambers
            This initiative was funded by the Commonwealth Department of
                      Health and Aging PHCRED program December 2005
                                                     Table of Contents



ACKNOWLEDGEMENTS......................................................................................................... 3

EXECUTIVE SUMMARY.......................................................................................................... 4

INTRODUCTION....................................................................................................................... 5

BACKGROUND......................................................................................................................... 6

METHODS................................................................................................................................. 7

RESULTS................................................................................................................................... 8

DISCUSSION AND RECOMMENDATIONS.......................................................................... 24

REFERENCES ......................................................................................................................... 27

APPENDICES .......................................................................................................................... 28




                                                                - -                                                                       2
Acknowledgements
I would like to acknowledge the following people’s contribution to this evaluation:

   •   Marisa Gilles, Senior Lecturer CUCRH, for her extensive assistance and supervision
       in completing this evaluation
   •   Chris Hall, Pit Stop designer and coordinator, and “co-evaluator” in this fellowship
   •   David Galloway, Adjunct Lecturer, for support and feedback throughout
   •   Heather Hingston, and John White (and Gary Manning), the other Pit Stop
       coordinators who contributed so much
   •   Ann Larson, Peter Shaw and David Whyatt at CUCRH who each contributed to
       making the evaluation happen, and providing support along the way
   •   Elsa Alston, Pit Stop designer, who provided useful information about the history
       behind the program
   •   Rachel Loffler, Belynda Wheatland and Sarah Buchanan for their support with data
   •   The Men’s Health Advisory Network
   •   Jenny Payet, for fellowship advice and supportportantly,
   •   And importantly, the men who responded to the survey

   This study was made possible through the PHCRED scholarship via the Department of
   Health and Ageing, with the additional support of Pilbara Gascoyne Population Health
   Unit, and Healthways.




                                           - -                                           3
Executive summary
This evaluation is the beginning of a process of formally evaluating the Pit Stop men’s health
program. It has answered a number of questions, and identified further areas in need of
evaluation. The questions raised in this study were:

       •   Can “Pit Stop” can be implemented in different sites with local variation in content
           and delivery style, resulting in similar levels of recall and self- reported changes in
           behaviour?
       •   Does Pit stop engage men, and do the men act on the advice they are given?

The process undertaken to answer these questions was:

   • Interviews with the Gascoyne, Mid West and Goldfields Pit Stop coordinators to
       determine how the program was delivered, the variation between regions, and gather
       information about how men respond to Pit Stop.
   • An audit of the Pit Stop work order forms to assess quality of documentation and
       develop a profile of men’s health in the three regions.
   • Telephone interviews with men who had completed Pit Stop to assess their recall, and
       determine if attending Pit Stop had led to a change in their preventative health
       behaviour.

From the study a number of key themes emerged:

   • Pit Stop delivery - the Pit Stop participants’ profile suggested that Pit Stop was
      successfully reaching men with significant risk profiles in all the three regions. There
      are opportunities for improvement in its delivery, it requires updating, attention to
      details, and improvements in documentation and accuracy.

   • Changing men’s behaviour - Pit Stop was seen by the participants and the service
      deliverers as being a valuable tool in effectively engaging men to take an interest in
      their preventative health, and act on the information they are give n at Pit Stop. Men’s
      recall of their Pit Stop performance was high (70 - 90%), and for almost half (43%) of
      the men the engagement had resulted in some change in behaviour and/or a connection
      with a health professional.

   • What does Pit Stop say about men’s health? - While there are some differences
      between the regions, the overall risk profile is not positive with only an estimated 40 -
      50% of men meeting health norms. However this profile suggests that Pit Stop is
      reaching men with significant risk profiles in all the three regions – the men who
      require preventative health messages.

On the weight of this evidence, this study shows “Pit Stop” can be implemented in different
sites with local variation in content and delivery style with similar outcomes in relation to
recall and change in behaviour. It offers a major opportunity to engage men and have an
impact on their preventative health behaviour. However the study also demonstrates
weakness in delivery and documentation. In order to ensure that this engagement is of
greatest value it is strongly recommended that resources are allocated to updating the
package, further evaluation, and ongoing coordination of the program.




                                            - -                                                 4
Introduction
The “Pit Stop” Men’s Health intervention was developed in the Gascoyne in 1999 in response
to a high male mortality rate, the prevalence of smoking, drinking and obesity in the
population, and the need for a Health Promotion tool that would appeal to men. The
intervention aims to engage men in taking an interest in their own preventative health by
taking part in a series of brief interventions based on a mechanical theme, held at public
events.

After initial trials Pit Stop was developed into a package including an interactive assessment
and a manual for use with men aged 16 and over in rural settings. The Pit Stop vision, as
documented in the manual, 1 was -

      ‘to address the disparity in men’s health issues and reduce the incidence of
      preventable illness amongst men.’

It advises users to take the program -

      ‘to where men are and see it as an adaptive and flexible package that you utilise
      to create an approach that is right for the men in your area’

In 2001 the concept was a central exhibit at the National and Rural Health Alliance
Conference in Canberra and since then 120 sites throughout Australia have purchased the
package. It is utilised by health services, corporations, and in primary industry. Anecdotally
the program has been extremely popular and sites using “Pit Stop” frequently provide
feedback as to its effectiveness in engaging men, seeking permission to adapt the model to
make it more locally relevant.

Records of Pit Stop activities and participants’ data had been compiled at the Pilbara
Gascoyne Population Health Unit since its inception, however no formal evaluation had taken
place.

The Pit Stop package is due for revision and reprint. Planning regarding support for the
project’s role within Pilbara Gascoyne Population Health Unit is underway.

This study evaluated and compared the “Pit Stop” Men’s Health Program as delivered in three
regions of West Australia Country Health Services; the Pilbara Gascoyne, Kalgoorlie Boulder
and Mid West Murchison. It includes an audit of the delivery and documentation of the tool.

It tested the hypothesis that Pit Stop can be implemented in different sites with local variation
in content and delivery style resulting in similar levels of recall and self- reported changes in
behaviour.




                                            - -                                                5
Background
In 1999 the Gascoyne region was experiencing a higher mortality rate than Western Australia
with a predominance of male mortality. The top five causes of death in the region were
cardio-vascular disease, cancer, diabetes, injury, and respiratory disease. Obesity was also
identified as a problem particularly amongst males and older people 2 . Alcohol consumption
was known to be six times the average for the state, and prevalence rates of smoking were six
percent higher than in Western Australia. This was reflected in hospital admissions, with up
to one third of all Carnarvon Regional Hospital beds used for alcohol related admissions and
up to three quarters for all drug related admissions. In 1999 admission due to smoking alone
cost the Gascoyne health service $578,322 3 .

These causes of male mortality are largely determined by lifestyle and therefore are
potentially open to intervention. Brief Intervention when performed well has been shown to
be a powerful tool to initiate change in individuals 4 . Within this context, Pit Stop was initiated
by Chris Hall and Elsa Alston from the health promotion team as a “one-off” men’s health
assessment activity for a field day in Carnarvon in 1999. “Pit Stop” was developed to appeal
to, and be culturally accessible to men, engaging their interest in their personal preventative
health. It was designed to reach men in a non-“health” environment that was familiar, for
example at agricultural shows, and to attract men who do not usually access health service
programs.

Pit Stop consists of seven brief screening stations, modelled on the ana logy of the body being
likened to a car being taken to a garage for a series of “mechanical tests”. Men are invited to
participate and measure their roadworthiness i.e. health status. The tests include Chassis
Check (hip to waist ratio), Torsion (flexibility), Exhaust (smoking), Fuel additives (alcohol
consumption), Oil Pressure (blood pressure), Spark Plugs (testicles) and Duco (skin cancer).
Each intervention lasts 2-3 minutes and the entire engagement takes about 20 minutes. The
check is delivered free of charge by health staff trained as “mechanics”.

At the end of the process the participants are then given a copy of their “Work Order” form
(Appendix 1) with advice, resources and encouragement regarding their health status, and to
take responsibility for any health issues/needs identified in Pit Stop. Participants have the
option of agreeing to follow up, which is recorded on the Work Order form.




                                             - -                                                  6
Methods
The evaluation covered three areas:

1.     A review of Pit Stop delivery
2.     A review of Pit Stop work order forms
3.     A telephone survey to assess recall and behaviour change

Qualitative methods were used for item 1 and part of item 3 and quantitative methods were
used to for items 2 and 3.

1. A review of Pit Stop delivery

Semi structured interviews were conducted with the coordinators of Pit Stop in the three sites
focusing on a description of the setting and delivery of the Pit Stop program in their region,
and looking for possible similarities and differences between the three sites (Appendix 2).

2. A review of Pit Stop “Work Order” forms

A review of forms from the past year in the Gascoyne, Midwest and Goldfields was carried
out. Data from the forms was entered into an Excel spreadsheet that was then imported into
SPSS. Analysis focused on the quality of documentation, the age of men screened, and the
frequency of men reported as actually achieving each health norm as determined by the work
order sheet in that region.

3. A telephone survey

Using a similar instrument to one developed and used in the Goldfields, semi-structured
interviews were conducted with up to 20 men from the Gascoyne and Midwest Murchison,
who had undergone Pit Stop three months previously, and who had given permission for
follow up (Appendix 3). Data was entered into Excel and imported into SPSS to analyse the
men’s recall of, and behaviour change in response to attending Pit Stop.

Ethics
Exemption from formal ethical review was gained from the University of Western Australia
Ethics committee, as this was a Quality Assurance activity.




                                           - -                                              7
Results
1. A Review of Pit Stop delivery
Chris Hall – is currently Men’s Health Project Officer with Carnarvon Health and Men’s
Project. Chris, one of the original designers, is now involved in coordinating the delivery of
Pit Stop throughout the Gascoyne. In addition, Chris is the Pit Stop contact, advising on the
Pit Stop package as it is used throughout Australia. He estimated the time commitment for
these averaged one day per week.

Heather Hingston – is the coordinator with Goldfields Men’s Health Inc. in Kalgoorlie. Her
background was in Health Promotion. She uses Pit Stop as part of her overall work in Men’s
health, with funding from the Goldfields General Practice Division. The annual three day
Goldfields Mining Expo is their major Pit Stop venue. They are able to put 100 men per day
through the Pit Stop booth. Coordination of this event takes a total of three to four weeks.

John White – was the coordinator with Midwest Men’s Health, and has a background in
Education and Mental Health. John has used Pit Stop throughout the Midwest, attending
various events.

Full transcripts of the interviews can be found in Appendix 4.

Chris Hall’s interview highlighted the strong philosophical basis that defines the Pit Stop
approach. He spoke of the Pit Stop idea forming in 1999 within the Health Promotion team in
response to a crisis in men’s health in the Gascoyne. The team was searching for something
that was culturally accessible to men, and would appeal because it was fun – for men and
practitioners. Their years in the region led them to believe that using the analogy of the car,
delivering the program at male orientated events, looking like mechanics was a way to
achieve this. Despite this, Chris spoke of being surprised by the huge response when they
released the package in 2001.

     ‘Elsa (co-author) and I realised that as an engagement tool it is the best thing we
     have ever used…it strikes a universal chord amongst men, in that it looks at
     things about blokes in a mechanical sense, they understand what you are talking
     about.’
                                                                         Chris Hall

a) Design and layout

All the coordinators liked the design of the package, finding it practical and offering no
changes to the layout apart from laminating the package and fitting test guides onto one page.

     ‘Great, no changes needed, so themed all the way through, the CD ROM allows
     you to cut and paste, this flexibility a good feature…’
                                                             Heather Hingston, Goldfields

It appeals to practitioners in its “different way of working”, and coordinators found the clear
instructions easy to read. Chris Hall reported that he receives very few queries requesting
explanation of the package content.




                                           - -                                               8
b) Location and Characteristics

All three regions delivered Pit Stop at public settings where large numbers of men congregate
and feel comfortable, such as festivals, agricultural shows, expo’s, and sports events. They
ensure that they are always adjacent to, and often even include other masculine things such as
tractors, motorbikes, cars, and boats. All the coordinators set up displays with a layout that
makes it clear to the people passing that something fun is going on.

This was perfectly demonstrated in the delivery of Pit Stop at the Goldfields Mining Expo in
Kalgoorlie as described by Heather:

      ‘…a more masculine venue … apart from taking it down to the pub here, its about
      as masculine as you can get.’
                                                        Heather Hingston, Goldfields

c) Coordination – setting up and delivery of the package

Coordinators varied in their comments on this subject. Each interpreted the question
differently, which gave opportunity for discussion on their discovery of, and involvement
with Pit Stop. Heather and John focused on how they deliver Pit Stop, while Chris Hall’s
discussion of Pit Stop was heavily influenced by his role in co-creating and developing the
concept and package. In general most comments related to staffing the events and issues
relating to how these staff were recruited, trained and performed.

Coordinators use a mix of volunteers and paid staff to be the “mechanics” at Pit Stop events.
In the Goldfields and Midwest they are health professionals, students or have health related
skills, and are sourced from hospitals, population health units, TAFE, and health or welfare
organizations such as Centacare.

In general listening, intuition and questioning skills are prerequisites for an effective
mechanic. However all the coordinators were aware that it was important to match the
personality and skills of the “mechanic” to the stations. This is due to the specific demands of
the tests, where some require outgoing communication and confidence, others more focused
measuring and recording.

Mechanics generally undergo a two- hour training session prior to the event. In the Goldfields
a contract was developed to ensure mechanics adhere to the Pit Stop procedures and
recommendations. Coordinators supervise at each event, and although all coordinators felt it
would be a good idea, generally debriefing after events does not occur.

d) Resource Package Content :

Resources in the Pit Stop Package were described as “good” and “well designed”, and used
initially until coordinators are familiar with them. The coordinators felt that the media section
worked well.

      ‘The media really love this stuff.’
                                                             Heather Hingston, Goldfields




                                            - -                                                9
e) Strengths :

      ‘It listens to men – what they are saying, what they have to say’
                                                                     Chris Hall, Gascoyne

The philosophy and design of Pit Stop came across as its great strength. All the coordinators
felt that Pit Stop was an engagement tool that is non-threatening, educational, and gets men’s
attention. The public setting format works well, and information gained at Pit Stop events can
be used for agency planning.

      ‘It is a fun, informative way to engage men in Primary Health where they
      are…rather than men coming to a service they won’t go to, we go to them” …
      “We are able to promote health messages that men don’t usually see as relevant
      to them, Pit Stop repackages it to appeal and to get men’s attention… A man who
      had not been to a GP for 30yrs, his wife made a friend take him to Pit Stop’
                                                            Heather Hingston, Goldfields

f) Issues

Issues the coordinators raised fitted into five categories:

i. Recruitment of staff
All coordinators talked about the difficulty recruiting the right kind of mechanics and the
importance of organisational support in order for this to happen.

ii. The stations used
Individual coordinators had their own views about whether a station was relevant. In the
Goldfields Torsion was removed and a new station “Shock Absorbers” (coping skills) that
measure emotional strength included. The Midwest and Murchison also introduced Shock
Absorbers. Concerns were raised over the relevance of testicular cancer in men over 40, and
the absence of a screening question relating to prostate cancer. Coordinators talked about
having a larger number of possible stations to select from depending on the men they
expected to be surveying.

iii. The indices used
All coordinators questioned if the indices used were still best practice. At each site various
adaptations of the indices has already taken place and a formal review of the indices was
required.

iv. How to deliver consistent feedback at each station
Each region had it’s own method of trying to ensure a consistent message was provided
throughout the Pit stop assessment. In the Goldfields a formal contract was made with the
mechanics. Despite this it was acknowledged in all sites that mechanics don’t always adhere
to instructions. This can result in conflicting information and confusion for the men. The
Goldfields coordinator found men threw their paper Work Order away, and so wallet-sized
cards with Work Order information were developed.

v. How to evaluate the program
All sites described both the difficulty and importance of evaluating the package and the threat
of losing the program if this does not occur.




                                             - -                                            10
g) Adaptations :

Coordinators described a number of adaptations they have made to the package. As
documented above some related to how the package was used, others were modifications to
make the package easier to use. These included:

   •    New indices for the Chassis check
   •    Removal of the Torsion station
   •    Inclusion of Shock Absorber station
   •    Broadening the Spark Plug index to include a prostate review for older men and
        “Headlights” for women (breast cancer check)
   •    Developing a contract for mechanics to ensure a consistent format and information is
        given
   •    Developing wallet cards with key information
   •    Pit Stop package components laminated for durability and presentation
   •    “Fast Track” Pit Stop (developed in the Wheatbelt, includes only Chassis check, Oil
        Pressure and Shock Absorbers) used for speedy delivery and requires less staff

       ‘A woman from NSW wants to adapt it for horses!…the Wheatbelt has a woman’s
       version’
                                                       Heather Hingston, Goldfields

Coordinators also made a number of suggestions for future adaptations:

   •    New stations including assessing physical activity levels, reviewing risky behaviour
        related to sexual health, and indices for women
   •    Inclusion of a range of checks in the package, allowing selection to suit each Pit Stop
        event
   •    Review of the package to include a current literature review, evaluation information,
        and updating the presentation style
   •    Development of a Pit Stop Web site
   •    Debriefing mechanics after events

h) Threats:

The coordinators identified three main threats:

1. Resources
All the coordinators identified that a lack of resources, both financial and human, are the main
threat to Pit Stop’s survival.

There are significant costs in setting up and running Pit Stop at Public events, venues can cost
$800 to $3,000 in order to gain a display area. It can be expensive and time consuming to
recruit and train adequate mechanics, and there is the need for dedicated time for staff to
coordinate the program, including updating to ensure it still reflects evidence-based practice.

2. A lack of evidence
The coordinators were aware of criticism of Pit Stop “not being a full health screen”. It was
considered that the role of Pit Stop should be discussed and the results of the evaluation need
to be promoted to demonstrate its effectiveness.



                                            - -                                              11
3. Political and organisation climates
All coordinators identified political and organisational issues relating to partner agencies
including Population Health Units, and funding changes due to shifting organisational
priorities which impact on the delivery and support of Pit Stop in recent years.

Similarities
Chris Hall’s and the team’s vision for Pit Stop has been applied in all the sites. It appeals to
men with its location, masculine “mechanical” analogy, and the fun and humour has been
translated to the men and the staff involved.

The package has appeal, the design and instructions are easy to understand and apply, the
content is good; and similar suggestions were made for improvements.

All the coordinators identified issues of sustainability and delivery. These included cost,
recruitment and training, supportive partnerships, and the need to evaluate and update the
package to ensure it is still in line with best practice. These issues were a particular feature in
Chris Hall’s feedback, largely because of his design and advisory role. He raised the need for
resources to ensure such issues were addressed. The lack of support from population health
units in achieving this was mentioned in all the interviews – although the specific aspects
varied.

However there are a number of differences in the delivery of Pit Stop across the sites. The
Midwest and Goldfields have interpreted the implementation of the package from a more
medical model, while the Gascoyne has an emphasis on the philosophical and community
development aspects – eg using Pit Stop not specifically as a screening tool, but as a means of
engaging men to identify the health issues from their perspective, and using mechanics who
are not necessarily health professionals.

Different sites have also modified the package, adding tests and removing others. This raises
questions regarding the rigor used in the development of these adaptations and the
responsibility and liability for these modified versions. These adaptations and suggestions
need formal examination, to ensure that Pit Stop maintains its integrity, meets best practice,
and is delivered safely.




                                             - -                                                12
2. A Review of Pit Stop Work Order forms
This section presents the results of an overview of the men who attended Pit Stop and their
performance on a number of the tests. The accuracy of the Work Order form completion, a
review of the quality of documentation, and a profile of the men and their h ealth status in
significant health risk areas was undertaken.

a) Age profile of men attending Pit Stop

The age profile of men attending pit stop was younger in the Goldfields (32% between 18-29
years). The Gascoyne attracted over 50% of men over the age of 50 with a third over the age
of 60. Similarly the Midwest had a high proportion of older men attending (Graph 1). This
does not reflect the age profiles of all the regions (Graphs 2, 3, 4) 5



Graph 1: Age profile of Pit Stop attendees:


         Age categories for Pit Stop attendance - Gascoyne, Mid West, Goldfields

   35%




   30%




   25%




   20%
                                                                                   Gascoyne n=122
                                                                                   Mid West n=105
                                                                                   Goldfields n=128
   15%




   10%




    5%




    0%
            < 18        18 - 29      30 - 39      40 - 49      50 - 59      > 60

                                         Age Category




                                               - -                                                    13
Graph 2:
           Gascoyne - Percentage distribution for Age category of Pit Stop attendees and
                         normal male population distribution for the region

   35%




   30%




   25%




   20%
                                                                         Gascoyne Pit Stop attendees n = 122
                                                                         Gascoyne male population norm
   15%




   10%




   5%




   0%
           < 18     18 - 29   30 - 39   40 - 49         50 - 59   > 60

                                 Age Range

Graph 3:
           Mid West - Percentage distribution for Age category of Pit Stop attendees and
                         normal male population distribution for the region

   35%




   30%




   25%




   20%
                                                                         Mid West Pit Stop attendees n = 105
                                                                         Mid West male population norm
   15%




   10%




   5%




   0%
           < 18     18 - 29   30 - 39   40 - 49         50 - 59   > 60

                                 Age Range




                                                  - -                                                     14
Graph 4:
           Goldfields - Percentage distribution for Age category of Pit Stop attendees and
                          normal male population distribution for the region

    35%




    30%




    25%




    20%

                                                                          Goldfields Pit Stop attendees n = 128
                                                                          Goldfields male population norm
    15%




    10%




    5%




    0%
           < 18     18 - 29   30 - 39    40 - 49         50 - 59   > 60

                                 Age Range




b) Quality of documentation

This section reviewed men’s scores against indices (norm) and compares this with whether
they were recorded as passing the test. It examines the gaps in the documentation of these
records.

Tables 1 to 5 show quality of completion of Pit Stop Work Order forms at the sites reviewed
on four indices. In all regions there were discrepanc ies between the attendees who were given
a pass and those that actually met the norm. The tables also show the occasions when the
information was not recorded on the form.

Many men who attended pit stop were passed as non smokers even though there was no
formal documentation of them satisfying the norm. We can assume that indeed these men
were real non- smokers and this lack of documentation reflects a weakness in the form rather
than a true inaccuracy regarding the men’s status.

Gascoyne documentation

The discrepancy between a pass given and achieved ranged from 21 percent for blood
pressure to 29 percent for hip to waist ratio. There was a range of incomplete records,
particularly high for the smoking index at 41 percent, (Table 1).




                                                   - -                                                       15
                                 Table 1: Gascoyne Profile
Of 4 indices showing percentage of men given a Pass, percentage of men meeting/not meeting
                   norms, and percentage of indices not recorded (n 122)


       Test               % Given a     % Men meeting     % Men not        % Not recorded
                            pass            norm         meeting norm

Hip waist ratio <0.9          68                 39            58                 3

     Smoking                  81                 56            3                 41

     Alcohol                  72                 51            32                17
   consumption

 Blood Pressure               59                 38            40                22
     130/80


Mid West documentation

Table 2 shows discrepancies between the Mid West work order records with men who are
given a pass and the men who have met the norm. This ranged from four percent for
smoking to 12 percent for waist measurements. Conversely, three percent of men who met the
blood pressure norm were documented as failed.

In the Midwest only a small percentage of indices were not documented, with waist
measurement fully recorded on all forms audited.


                                 Table 2: Mid West Profile
Of 4 indices showing percentage of men given a Pass, percentage of men meeting/not meeting
                   norms, and percentage of indices not recorded (n 105)


      Test             % Given a pass   % Men meeting     % Men not         Not recorded
                                            norm         meeting norm

  Waist <94cm               42               30               70                  0

    Smoking                 90               86                7                  7

   Alcohol                  58               52               43                  5
 consumption

Blood Pressure              86               89               10                  1
    140/80



Goldfields documentation

The discrepancy between pass given and norm achieved was greatest for blood pressure with
41 percent passed whilst failing to achieve the norm set by this region (120/80). Otherwise
the discrepancy ranged from two percent for waist measurement to 24 percent for smoking.

Once again documentation was good in most areas other than smoking.


                                           - -                                          16
                                 Table 3: Goldfields Profile
   Of 4 indices showing percentage of Pit Stop attendees given a Pass, percentage of men
          meeting/not meeting norms, and percentage of indices not recorded (n 128)
                                   (Includes some women)


       Test          % Given a pass     % participants    % participants     Not recorded
                                        meeting norm       not meeting
                                                              norm

   Waist <94cm             41                   39              61                 0

    Smoking                79                   59              17                24

    Alcohol                48                   41              52                 7
  consumption

 Blood Pressure            58                   17              81                 2
     120/80



Documentation - other indices

Some indices in the Pit Stop Work Order form were noticeably poorly recorded. Those most
obvious were skin cancer and testicles.

Table 4 demonstrates the inconsistencies between the norm and passes given for skin cancer.
The participants in each site having been given a pass were approximately 20 percent more
than those recorded as meeting the norm. At the same time, 21-57 percent have no records of
meeting the norm, and pass/fail records in the Gascoyne and Goldfields were poorly recorded.


   Table 4: Profile of Skin Cancer (Duco) index showing percentage of passes given, men
               meeting norm, norm not recorded and Pass/Fail not recorded


      Site          % Given a pass      % participants        Norm not        Pass/Fail not
                                        meeting norm          recorded          recorded

    Gascoyne               78                   39               21                20

    Mid West               92                   73               25                 2

   Goldfields              66                   43               57                27



Table 5 shows large gaps in recording of norms (70-100% of norms not recorded) for testes,
with large discrepancies between participants meeting the norm and passes given.




                                          - -                                              17
  Table 5: Profile of Testicles (Spark Plugs) index showing percentage of passes given, men
                 meeting norm, norm not recorded and Pass/Fail not recorded


      Site          % Given a pass      % participants        Norm not         Pass/Fail not
                                        meeting norm          recorded           recorded

    Gascoyne               80                   30                70                18

    Mid West               86                   50                48                 2

   Goldfields              54                   0                100                 3




Summary

The Mid West documentation had the lowest rate of “not recorded” on their Work Order
forms, the Gascoyne the highest. The most common areas for lack of documentation were
smoking, skin cancer and testicles. In the Gascoyne blood pressure was not well recorded.

All sites were shown to be giving passes when participants were not recorded as meeting the
norm. Conversely, there is also evidence of some participants meeting the norm yet being
given a fail.




                                          - -                                             18
c) Profiles of measured/reported indices –

This section presents an overview and comparison of men’s health in each region based on
the measured indices, and compares this with available regional data.

Table 6 gives the percentage of men surveyed in each region who satisfy the norm on four
indices. In view of the lack of documentation for smoking norms on the work order forms,
the pass rate for smoking was included, as it was seen as a better reflection of men’s
performance in this index.

Table 7 gives results taken from regional population health data showing similar men’s health
indices6 .

Table 6: Profiles of Measured/Reported Indices by region, percentage of surveyed men meeting
norm


             Waist norm        Waist          Non          Alcohol       Blood           Blood
                                           Smoking       consumption    pressure        pressure
                               index
                                             norm           norm          norm           index
                                           (*Passed)

Gascoyne          39         Hip/waist        56              51           38            130/80
                             ratio <0.9
                                             (*81)

Mid West          30          <94cm           86              52           89            140/80
                                             (*90)

Goldfields        39          <94cm           59              41           17            120/80
                                              (79)



                                                                                                  6
 Table 7: Profiles of regional norms for males in Population health sites on reported indices


                           Weight                    Non Smoking         Alcohol consumption


Gascoyne                     46                          67                        82


Mid West                     53                          71                        86


Goldfields                   81                          71                        86




Waist - less than 40% of men surveyed had a waist measurement that was considered within
the norm, however it was difficult to make a direct comparison across the regions, as a
different index was used in the Gascoyne to the other regions.

Smoking - Compared to the regional data, Gascoyne and Goldfields participant norm
smoking levels were higher than the Mid West. However, the comparison of pass rates,

                                            - -                                                   19
which are more reflective of the participants’ real performance, were similar and more closely
reflect the regional data.

Alcohol consumption – in two of the regions, half the men were drinking at safe levels,
whereas in the Goldfields, a lesser proportion was drinking safely. In all the regions these
levels are noticeably less than the regional profile where over three quarters of the men are
drinking safely.

Blood Pressure - it was not possible to make a direct comparison across the regions of men
who had “normal” blood pressure because different indices were used. However as the
acceptable measurement becomes higher more men are reported as meeting the norm.

The norms in the three regions show a different profile to the population health data (Table 7).
The risk profile of the men attending Pit Stop in the three regions does not reflect the regional
data available.




                                            - -                                               20
3. A Telephone survey
This section presents an overview of the telephone survey conducted. It outlines participant’s
level of recall of the Pit Stop experience, and their changes in behaviour as a result of
attending Pit Stop.

Gascoyne survey – 13 out of 19 Pit Stop attendees who had consented to follow up were
contacted and agreed to participate in the survey. One declined, not having time to participate
in the survey, and five attendees could not be contacted.

Mid West telephone survey– 19 attendees were surveyed of the 20 who were contacted,
having had been through Pit Stop two months previously and given consent for follow up.
One did not consent to participate, as he was too busy.

Goldfields – 20 men were followed up three to four months after attending Pit Stop at the
2004 Mining Expo in November 2004. 7 The men were selected randomly, reviewed for
consent to follow up, and contacted. Those not contactable were passed over and the process
continued until 20 people had been interviewed. There were no refusals to participate in the
survey, although some Pit Stop attendees could not be contacted.

Level of Recall in the Gascoyne and Mid West

Recall of the Pit Stop program in the Gascoyne and Mid West was good. The men could
describe the booth, identified with its appearance and presentation, and commented on the
mechanical theme. The presentation of the booth was seen as being of a high standard and the
mechanics as being well trained.

All the men interviewed in the Gascoyne and Mid West described seeing a strong connection
between men’s health issues and the various tests e.g. chassis = waistline. They commented
that it was fun, and a good way of contacting men. They made a number of recommendations
for improvements, which are discussed below.

Table 8 shows the proportion of men who correctly recalled their overall “Work Order”
Pass/Fail across the three sites, and the level of recall on specific pass/fails. Generally recall
of Pass/Fail, and fails on individual tests was higher in the Gascoyne and Mid West.

         Table 8: Participants level of recall overall pass/fail and on specific test fails:


                                Gascoyne                  Mid West                  Goldfields
                                  n=13                       n=19                      n=20

% of participants who
 correctly recalled
                                    92                       100                        75
  overall pass/fail

% of participants who
 recalled some or all
                                    92                        95                        70
       test fails




                                              - -                                                21
Reported changes as a result of attending Pit Stop

All sites showed men reporting changes as a result of attending Pit Stop, ranging from 25% in
the Gascoyne to 50% in the Goldfields. Table 9 shows the types of changes the men reported,
some of the men undertaking one or more changes. At each site men reported seeing a health
professional following attending Pit Stop, ranging from 10% of men in the Mid West to 40%
in the Goldfields. The GP was the most common health professional seen by men after they
had been through Pit Stop.

Across the regions losing weight/improving diet, followed by reducing drinking and then
reducing/stopping smoking were the most common changes reported in men’s behaviour
following Pit Stop. Other factors such as testicular examination, using sunscreen, and visiting
a GP were mentioned.


    Table 9: The proportion of men who make self-reported changes as a result of Pit Stop


                             Gascoyne                 Mid West                Goldfields

  Reported making               25%                      47%                     50%
     changes


 Reported changes        Reduced alcohol                Diet                   Drink less
      made               Reduced smoking              Exercise                Lost weight
                          Diet/weight loss         Reduced drinking       Increased exercise
                             Exercise               Check testicles          Quit smoking
                                                     Went to GP            Reduced smoking
                                                                            Wear sunscreen
                                                                            Self examines


    Saw Health                  23%                      10%                     40%
Professional for help


   Type of Health           GP, dietitian,               GP             GP, nurse, specialist,
Professional(s) seen         specialist                                men’s health professional



Although not included in the Goldfields telephone survey, the participants in the Gascoyne
and Mid West were asked if they had undertaken any general health check-ups in the 2 years
previous to attending Pit Stop. In the Gascoyne 92% of men had done so in the period since
Jan 2003, and 79% in the Mid West.

In both sites men reported seeing a GP for their health check. The greatest number of men
went for a check up for general health reasons, closely followed by men who went for work or
recreational requirements. Two could not remember, and the remainder were related to blood
pressure, blood tests or diabetes.

Respondents were asked for suggestions for inclusion in Pit Stop. Some suggested tests that
were already included in Pit Stop e.g. skin cancer, blood pressure etc; indicating that for some
reason that test may not have been done when they attended Pit Stop or they did not recall
doing the test. Other recommendations related to health screening, for hearing, vision, drug
education, diabetes, and cholesterol.

                                             - -                                               22
The Gascoyne and Mid West surveys included the opportunity for general comment by the
participants. Overall the comments were very positive and supportive of the Pit Stop
initiative. Men reported they would rather go to Pit Stop where it was easy going, sociable
and more comfortable than a formal clinical environment. The staff were complemented on
their professionalism.

There was the overall impression that Pit Stop should be extended into other venues where
men can be contacted. One respondent reported that:

     ‘Some people refuse to go as they are afraid of the bad news – they know exactly
     what they are going to tell them – drink less, stop smoking, so they do not visit Pit
     Stop’

Others commented that there was too much wasted paper and pamphlets; a take away card
with information would be good to take to the GP.




                                           - -                                               23
Discussion and Recommendations
This study addressed two areas of investigation:

Firstly it sought to prove the hypothesis that Pit Stop can be implemented in different sites
with lo cal variation in content and delivery style, resulting in similar levels of recall and self-
reported changes in behaviour.

Secondly it sought to examine the quality of delivery of the program at three regional sites in
the Western Australian Country Health Service, and answer the question “Does Pit stop
engage men, and lead to men act on the advice given at Pit Stop?”

Three methods were used to gather information for these investigations:

   • In-depth interviews with the Gascoyne, Mid West and Goldfields Pit Stop coordinators
       to determine how Pit Stop is delivered, variation between regions, and gather
       anecdotal information about how men respond to Pit Stop.

   • An audit of the work order forms to determine the quality of documentation and develop
      a profile of men’s health in the three regions for comparison with other data.

   • Telephone interviews with men who had completed Pit Stop within the previous three
      months to assess their recall of Pit Stop, and determine if attending Pit Stop had
      precipitated change in their behaviour.

This study demonstrates three major limitations ; first there are differences between the age
profile for the regions and Pit Stop participants. Second there are differences in the Pit Stop
risk profiles compared to the regional population health data. This could mean that the men
reviewed are not representative of the general male population. Finally, the weaknesses in
documentations and accuracy further compromised the interpretation of the information
gathered.

Nevertheless some conclusions can be made from this study and from this work a number of
key themes have emerged:

   • Pit Stop delivery
   • Changing men’s behaviour
   • What does Pit Stop say about men’s health?

Pit Stop delivery

The Pit Stop model has maintained its philosophical integrity in its delivery across the
Gascoyne, Goldfields and Midwest. There are however, some differences both at the
philosophical and practical levels. These have implications particularly in its practical
application, where regions have modified the package; altering, removing or adding indices.
This study demonstrates that these adaptations need formal examination, to ensure that Pit
Stop maintains its integrity, meets best practice, and is delivered safely.

Recommendations -
   • Review and update of indices to reflect current best practice, review these on an
     annual basis, and ensure qualified practitioners review changes to indices

                                              - -                                                24
   •   Review of package to ensure compliance with i ndices

Documentation was shown to be an issue with some aspects of the use of the work order
form unclear; this was evidenced particularly in the Gascoyne but less so in the Goldfields.
Overall Mid West documentation was good. However, there was significant weakness in
documentation around smoking, testes and skin cancer. One way of addressing this, given the
number of volunteers and staff administering Pit Stop would be to make the work order form
clearer for recording.

Using the work order form to collate data was limited by a lack of basic informatio n including
date and location of Pit Stop event, the mechanic responsible for completing the form, and
clear details of agreement for follow-up. The work order forms require more extensive details
to improve record keeping processes and opportunity for evaluation and feedback.

Recommendations –
   • Review and update the work order form and package to include clear guidelines for
     completion of “performance” section
   • Include details on Work Order form for record keeping and follow-up (to include
     event location and date, coordinator or final check mechanic, follow-up signatures)

Issues of accuracy in interpreting the work order outcomes were common across the regions,
affecting its safe and responsible use. Gaps between meeting norms and passing tests were
demonstrated in this study, with more people told they had passed than should have.
Inaccurate information was given for weight, smoking and drinking. Blood pressure was
questionable due to different indices for each site. When this issue was followed up with the
coordinators, they suggested the main reason for these gaps was the reluctance mechanics
have in giving men the “bad news”. This suggests training and support is needed for
mechanics, including a compliance process. Linking this with a review of the work order
results after each event would identify any inaccuracies and allow for remediation.

Recommendations –
   • Develop a standardized training package for mechanics including Brief
     Intervention skills and a contract agreeing to compliance in administering Pit Stop
     according to instructions
   • Ensure that an experienced mechanic reviews all work order forms when men have
     been through Pit Stop to check that documentation is completed, and advice given is
     correct and consistent
   • Develop a debriefing process to review each Pit Stop event, gain feedback from
     mechanics, and respond to issues raised
   • Review results of each Pit Stop event to identify any weaknesses in accuracy of
     records and advice given, and remediate as necessary

Future of Pit Stop - The coordinators identified issues of sustainability and delivery, and the
need for resources to implement the program. The lack of support from partners was a
common feature.

The Pit Stop package is due for reprint, and current coordinator role under review.

Recommendations –
   • Resourcing the ongoing research and development of Pit Stop is required to
     undertake the recommendations of this study
   • Undertake ongoing coordination and evaluation of the Pit Stop program

                                           - -                                              25
   •   Develop a Pit Stop Web site to include updates, evaluation information, and
       opportunity for centralised communication

Changing men’s behaviour

Pit Stop is seen by both the participants and the service deliverers as being a valuable tool in
engaging men to take an interest in their preventative health.

In general all the men had enjoyed the process, their recall of their performance was high (70
- 90%), and for almost half (43%) the engagement had resulted in some change in behaviour
and/or a connection with a health professional. This potentially could have been higher
(estimated to be up to 20%) if the participants who failed but were told they passed had been
given accurate information.


What does Pit Stop say about the men and men’s health?

Acknowledging the limitations described, men in the Mid West are more likely to meet the
health norms for all indices (other than blood pressure) than those in the Gascoyne and
Goldfields. The Gascoyne and Goldfields have generally similar profiles. The problems with
the norm for blood pressure described above make comparisons between regions difficult on
this index.

Nevertheless, while there are some differences between the regions, the overall risk profile is
not positive, with only an estimated 40 - 50% of men meeting health norms across the three
regions. The Pit Stop participants’ profile suggests that Pit Stop is reaching men with
significant risk profiles in all the three regions – the men who require preventative health
messages.


This study shows that although there are some weaknesses that need to be addressed to
improve the rigour of the delivery, the Pit stop program offers a major opportunity to engage
men and have an impact on their preventative health behaviour. It is strongly recommended
that resources be allocated to updating the package, further evaluation, and ongoing
coordination of the program.




                                            - -                                              26
References

1
 Hall C, Alston E. Pit Stop – A Men’s Health Package. Gascoyne Public Health Unit,
Gascoyne Health Service, Health Department of Western Australia; 1999
2
 Achat H, McCaul P. The health of the Gascoyne residents. Gascoyne Public Health Unit,
Gascoyne Health Service, Health Department of Western Australia; 1997.
3
 Gascoyne Public Health Unit (GPHU) 1998 Strategic Plan, Gascoyne Public Health Unit,
Gascoyne Health Service, Health Department of Western Australia; 1998
4
  Roche AM, Freeman T. Brief Intervention: good theory but weak in practice. Drug and
alcohol review 2004; 23(1)11-18
5
 Cross tabulation of health service and WA country health service regions for each year from
2004 to 2031 by age (5 year groupings) by sex, information for regional male population
distribution, Table E5.xls.Western Australian Planning Commission web site Online. URL
http://www.wapc.wa.gov.au/Publications/723.aspx
6
 Gascoyne, Midwest and Goldfields-Esperance Health District epidemiological reports,
Department of Health: Health Information Centre 2003 [access 2004 October] Online. 2003
Available from URL http://www.health.wa.gov.au/epi
7
 Grisenti K & Hingston H. Goldfields Mining Expo 2004 Pit Stop Evaluation Report
Goldfields Men’s Health Inc, Population Health Goldfields South East Region, 2004




                                          - -                                             27
Appendix 1.1 - Gascoyne Work Order Form




                - -                       28
Appendix 1.2 - Mid West Work Order Form




                - -                       29
Appendix 1.3 – Goldfields Work Order Form




                 - -                        30
                                    Appendix 2
            Pit Stop Coordinator Semi Structured interview Questions

1. Tell us about your experience of setting up and delivering the Pit Stop program

2. Tell us about your thoughts about the design, layout, appeal and readability of the
   package. Give us your impressions of each of the 4 sections of the package – Package
   guide, Tests, Resources and Media/Publicity.

3. Tell us about the selection, training, supervision and debriefing of the staff.

4. Describe the locations that you use to run Pit Stop, what are the key characteristics of
   these locations?

5. Tell us about any issues or problems that you have experienced in delivering the
   package.

6. Tell us about any improvements that you would recommend for the package.

7. In your experience, what are the main strengths of the program?

8. Threats – what if any challenges are there to the program?

9. Do you have any other comments/thoughts/any other suggested questions?




                                         - -                                            31
                                        Appendix 3

                           Pit Stop Telephone survey
                 (Questions 2, 6 and 12 used in Gascoyne and Mid West only)

Date Pit Stop attended ____________________________

Location delivered             ____________________________

Surveyors name                 ____________________________

Date survey completed          _____________________________

Introduction
Hi (insert participants name), this is (insert name) from (organisation). You participated in Pit
Stop at the (place) in (insert date), at that time you agreed to a follow up phone call. Would
you mind if I asked you a few questions regarding Pit Stop?

1. Consent given.
    Yes                                           No -                survey terminated

2. TELL US ABOUT WHAT YOU REMEMBER OF P IT STOP

3. Do you remember if you passed or failed the Pit Stop overall?
Correct                                    Incorrect

4. Can you name which tests you failed? Please mark correct answers.
   Waist circumference (Chassis)
   Flexibility (Torsion)
   Smoking (Exhaust)
   Alcohol (Fuel additives)
  Blood Pressure (Oil pressure)
  Testicular self examination (Spark plugs)
  Skin cancer (Duco)
   Shock Absorbers (Coping skills) (Midwest only)

All correct                                  None correct            Some correct

5. Our records also show you failed the (insert appropriate tests)

  Waist circumference (Chassis)
  Flexibility (Torsion)
  Smoking (Exhaust)
  Alcohol (Fuel additives)
  Blood Pressure (Oil pressure)
  Testicular self examination (Spark plugs)
  Skin cancer (Duco)


                                            - -                                                32
   Shock Absorbers (Coping skills)    (Midwest only)

Did you make any changes because of Pit Stop?
Yes                                       No

If yes, how?

6. BEFORE you went to Pit Stop, when was the last time you went for a general health
checkup?
Yes        (when)                      No

If yes, what was it for?

If yes, who? (wait for a while if no answer prompt with some suggestions from boxes)
                          Please tick
Nurse

Doctor

Dietician/nutritionist

Physio

Other please state ______________________________________________

7. AFTER Pit Stop, did you follow through with any health professionals to assist with any
problems you had with…..(insert health issues)?
Yes                                        No

If yes, who? (wait for a while if no answer prompt with some suggestions from boxes)
Nurse

Doctor

Dietician/nutritionist

Physio

Other please state _______________________________


8. When you did Pit Stop did you find any of the resources given to you helpful?
Yes                                        No

If yes, which resources
    • Men’s Health Resources as relevant for site
Gascoyne:
   • Drink check/standard drinking guide
   •     Blokes Charter
   •     Carnarvon Racing Guide
   •     V8 Dad
   •     Prostate pamphlet (General standard)

                                           - -                                               33
   • Pit Stop Penknife (blue)
   • Other?
Midwest:
    • Monkeys Check theirs, do you? pamphlet
    • Prostate cancer pamphlet
    • Re Shock Absorbers – booklets on kids, money etc
    • 2 & 5 Fruit and Veg pamphlets
    • Blood Pressure pamphlet
    • Other?

9. Overall did you ENJOY participating in Pit Stop?
Yes                                        No

10. Did you feel comfortable discussing your health with Pit Stop team
Yes                                        No                    Somewhat



11. Is there anything else that you would like to see included in Pit Stop?


12. Are there any other comments that you would like to make?


                                  Thank you for your time!




                                            - -                               34
                                       Appendix 4
               Transcripts of Interviews - Interviewer: Debbie Chambers

Interview 1: 8/10/05: John White, Midwest Coordinator – Midwest Men’s Health

Experience of setting up and delivering the Pit Stop program
Got information from Chris Hall
Aug 2002 – first Pit Stop, Geraldton, ran one.
2003/4 partnership: then Mid West Division of General Practice (MWDGP) bought a package
Midwest Mental Health (MWMH) bought ute
Perth 2002 – Big Boys Toys, Sept 2002 Men’s Health Week – Forest Place, Perth
2005 MWDGP pulled out – JW paid MWDGP for resources

Thoughts about the design, layout, appeal and readability of the package
Found package good, lost package
Well designed – discreet sections good, has everything practical
Layout – practical, student issues, laminated it all, plastic boxes used to carry 8 sections
around with all components for each test, tubes for the graphics
Appeal – fine, excellent with customers, new to many men, ute wo rks well
Readability – easy to read
“Men come in” – don’t need a sales pitch
Appeals to all ages – good age range
Men don’t leave once in test
Lost package – but knows it all and boxes set up – used it in early days to get set up
Tests section – Chassis: 0.9 ratio now not valid according to MWDGP apparently, now say
94cm is the maximum for OK health
Exhaust: few smokers, now a “waste of time”, often combine alcohol and smoking in MW
region eg 5/66 smokers at a recent Pit Stop

Selection, training, supervision and debriefing of the staff
Testing crew/mechanics – uses volunteers, problems if the volunteers are unhealthy, not a
good example to men coming through Pit Stop
Selection – MWDGP Cheryl Grigsby had connections and paid people
Nurses, Insisted on having Registered Nurses (RN’s), counsellors, Physiotherapists, Dietitians
– medical people, and given roles according to their discipline
JW did not have these contacts – agreement with TAFE for RN/Enrolled Nursing (EN)
students – part of course in Health Promo tion, can use every year, some students offer to do
more as they enjoy it
Training – done at TAFE 2 hrs with students, 1-2 wks before Pit Stop conducted, John sets
it up, get them to try on a bloke
Course coordinator agrees – each student does each station
Supervision – JW always present to supervise, and TAFE lecturer 1 day, plus another male
RN associated with MWMH
Debriefing – nil, maybe should


                                           - -                                                 35
Locations
country shows
Geraldton – Blessing of fleet, end Oct, Mingenew Expo 2005, 2004 Jurien Bay – Blessing of
fleet, Geraldton – S/Shire, Chapman Valley Show, Mullewa Show, Port Authority Family
Day – Geraldton, 2003 Larry Lobster Festival, Perenjori Agricultural Show, Mingenew
Agricultural Show
Characteristics – Pit Stop does not draw people, “people are there”
Not in the family area, in the farm equipment area, more men with agricultural machinery,
trucks, blokes go off separately to family, want to look at big toys and be with mates

Issues or problems experienced in delivering the package
New waist measurement (MWGPD)
MWGPD reprinted test kit
See new work order
Bought scale, calculates BMI Body mass index, planning on using this
Spark Plugs – probably relevant for under 40 only, does not do with over 50, now do checks
re prostate cancer for the over 50’s, or ask re sons and reminds regarding testicular cancer –
fathers to tell sons and give out pamphlets, ie. modifiy tests to suit
Pass/fail not important, better to educate

Any improvements that you would recommend
-testicular cancer/prostate education
-chassis check, get more technical, use BMI
-health staff need to be a good advertisement

Strengths of the program
-depends on how you run it
-lots of humour – strong part of it
-non threatening
-educational tool

Challenges are there to the program
Cost – fairly expensive, not the package but the cost to run it eg $800 marquee rental in
Mingenew, running cost include marquee rental, pamphlets (monkeys 25c), printing,
photocopying, and staff time
Mingenew $1,000 over 2 days x 100 men = $10 per person
Plus travel to and from event – distances ++
Accommodation, preparation, set up,
Perenjori 65 men, Marquee hire $200-300
Meekatharra 1,100km return – 35 men attending
Package equipment $14 - 15,000 plus ute
Volunteers – MWDGP

Other comments/thoughts/any other suggested questions
Political issues within WACHS – Pit Stop needs support but WACHS not providing support
eg nurses from hospital not allowed to assist with Pit Stop
                                            - -                                              36
  Interview 2: 14/10/05 Heather Hingston, Goldfields Coordinator, Goldfields’ Men’s
                                       Health

Experience of setting up and delivering the Pit Stop program
Has been running PS over 3 yrs
Goldfields Mining Expo is main event, 2,000 people attend over 3 days, 300 attend Pit Stop,
which goes for the 3 days, this is all they can put through
Issues regarding space and cost
Purchased Pit Stop package 3 yrs ago, in a Goldfields Men’s Health (GMH) and Population
Health partnership
Displays – Yr 1 Ferrari, Yr 2 Speedway car, Yr 3 Motorbike, Holden posters, Flags
Watercorp – sponsors with bags and water
Laminated the Pit Stop station posters

Thoughts about the design, layout, appeal and readability of the package
Design – great, CD ROM excellent
“Worn out with all the use” – needs to be laminated in the file
Shock absorbers – not in the package
Good set up
Layout – good layout and method design
Top cover sheet – can use as a label on station on the day
Very busy on the day
Summing up – 2 people on at the end of the PS on summing up desk
Used to give out “men’s health packs” with info, now make up specific packs for each person
as per their performance
Appeal – great, no changes needed
“so themed all the way through”
CD RM allows you to cut and pasted, flexibility a good feature, Woman from NSW wants to
adapt for horses!
Wheatbelt – woman’s version
Readability – clear, would be good if all the advice fitted on 1 page, plus test on 1 page, then
can stick back to back and laminate for mechanics – makes conducting Pit Stop easier
Sections – make sections more obvious eg each section in different colour, split it up a bit
Tests – keep to 1 page where poss to laminate on the day on 1 sheet (info on front, guide for
testing on back) – helps volunteers
Resources - do not use much now, did at first but don’t need after a while
Media/publicity – eg using media “really good”, “the media really love this stuff (Pit Stop)”

Selection, training, supervision and debriefing of the staff
Mechanics called volunteers – AH staff from hospital, Population Health staff (Health
promotion and clinical), Nursing students, Health Promotion students, rural clinical school
students, Occupational Health students, Social Work Students, Centacare staff (coping skills),
other relevant agencies
difficult to fill roster at first, then end up with too many by the time of the expo

                                            - -                                               37
Match volunteers skills with relevant station, correspond volunteers to the best check
Only ever put someone qualified on Blood Pressure
Training – 1-2 sessions of 1 hr each at hospital at different times to suit different people, 1 hr
talk, cover all the checks
made up contract so volunteers stay with prescribed format
Use “station notes” including changes, summary of all, then learn their own station
Supervision - On day – volunteers “go for it ” – Heather walks around and checks people are
comfortable and shuffle them around accordingly eg not comfortable as a registration person
– need a jovial person, if quiet put on exhaust, easier
Or for example don’t put a person on exhaust if they are going to hassle the smokers
Debriefing – not usually, “its full on” ie too busy
?? of participants – especially for students

Locations
Pit Stop is a perfect activity at mining expo once a year, very big 10,000 people attend, busy
Other displays mining equipment selling/commercial, target group men in mining industry,
Pit Stop “gives men something to do” as most other exhibits are for sales and display, not an
activity
Held at the race course
Bays booked 6m x 3m, cost $2,999
Need 2 bays, 1 is supplied free “in kind”, Population health and GMH share the cost of the
other
Characteristics - Men feeling comfortable, “laid back atmosphere”, not a family atmosphere,
groups of guys wandering about
Pit Stop is the only health/interactive display at the mining expo
“more masculine” venue – “apart from taking it down the pub here, its about as masculine as
you can get”
Also do BHP Open Day – Fast Track Pit Stop – Chassis, Oil pressure, coping skills –
modified 1 pager developed by Wheatbelt

Issues or problems experienced in delivering the package
Men throw the Work Order away
Don’t give all the resources to men at each site, just specific ones relevant to man or situation
– usually always give out stubbie holder, pen, notepad, wallet card
Volunteers – need to have the right person on the right station
Ensure people/volunteers stick to the format – use contract eg counselling people tend to start
counselling men, not appropriate in the situation or nurse who is anti- smoking hassling
people, must have right people on registration and summary checkpoints
Other sections that would be good to include in Pit Stop package:
Physical activity level – ask how much they do and recommend levels
Sexual health – talk about this, give out condoms
More checks in the package – give choice what they want to cover at each event
Spark plugs – depends on age, cover prostate cancer for older men and testicular cancer for
younger men (and remind for sons, grandsons etc)

Any improvements that you would recommend

                                             - -                                                 38
Great resource – “more about men” booklet $3.20
Use wallet cards – with key information, keep with them, can take it to the Doctor
Give out specific packages, for each man
Laminate displays and working resources – information and test on 1 sheet or card for
volunteers
Title pages from Pit Stop file can be used as signs
Headlights – for women, breast cancer
Removed torsion, did not think it was that important
Ensure everyone in the team agrees with advice they are giving out at the stations, and will
follow up on this (hence contract idea)

Strengths of the program
“fun, informative way to engage men in Primary Health where they are”
“rather than men coming to a service that they won’t go to, we go to them”
“Able to promote health messages that men don’t usually see as relevant to them, Pit Stop re-
packages it to appeal and to get men’s attention eg man who had not been to a GP for 30yrs –
wife made a friend take him to PS”

Threats or challenges to the program
Men need to know it is not a full health screen, still need to have a proper health check with a
doctor
People thinking it’s a health screen, which is more than what it is, likes to describe it as a
lifestyle review
Gets criticism, people don’t understand what PS is trying to achieve
Hard to evaluate, thus hard to get funding
Recruiting the right volunteers – need people with a health background so people can ask
questions
Need supportive relationships with other health agencies and staff – interagency
collaboration. Depend on this for resources to do Pit Stop eg Volunteers, follow up
Need key people to support it
Need help with organization, generally Interagency partnership is good but some people and
organizations are not supportive

Other comments/thoughts/any other suggested questions
No



 Interview 3: 18/10/05 Chris Hall, Gascoyne Coordinator, Carnarvon Health and Men
                  Project, Pilbara Gascoyne Population Health Unit

Experience of setting up and delivering the Pit Stop program
When setting up (means at a venue) – excited, apprehensive about how things being received
know floor plan by heart, work out how to make best use of the venue
concentrate on where the greeting area is going to be, make it clear to people passing that
something good/fun is going on


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ensure the visual presentation is as good as it can be for the location, lots of hand waving (sets
it in my mind I suppose) and fiddling
Package set up process – now well rehearsed, set up components in boxes, labelled, then
wrote into floor plan
Practice – set up time minimised, took some time, and a number of Pit Stops to find
appropriate way to set up and organise
Initially each discipline brought what they thought was good for each station

Thoughts about the design, layout, appeal and readability of the package
Design – originally restricted by local resources available to create it – decided to try and use
the basic software – create a brand, decided:
Colours, flags as logo, front profile ie racing car/person pumping petrol
Banners – screenprinted
Evidence it has worked in practice – pictures of design usage and used in promotion material
Layout- thought it had been changed but in fact not, not to be overly politically correct,
glamorous, gregarious
At venue – need to meet person, give eye contact, lay hands on the person (it works!), on 1st
check - chassis
Connection with the person, physical, not misconstrued, have a good laugh, make a joke eg
need to take out wallet, farmer doing well this season, the wallet is fat
Blood Pressure BP) done next, relaxing – need to do before torsion which causes exertion and
affects BP
Used to have air pressure – lung capacity – but on reviewing parameters, smokers did well as
smoking sometimes increases lung capacity
Amendments made, cut out as not best practice
Always conclude with banter re men’s fiddly bits – good humour
File layout – Elsa (Alston)’s work, logical as possible, to provide support material, volume of
info small compared to size of file.
From marketing point of view this needs to be looked at – affected by funds available
Appeal- pack and onsite
“strikes a universal cord amongst men, that it looks at things about blokes in a mechanical
sense, they understand what you are talking about”
Seems to offer a challenge, have a serendipity, curiosity factor
Does not have a health logo, colours are not those of any government department or agency
Works because people who go to shows/field days go with curiosity, a find out notion
Appeal to practitioners – either for more information or to buy it
Not on a website – a shortcoming
Appeal –
Practical, different way of working, good laugh
Readability – very few queries about “what does this mean” referring to the manual
More about “the manual says do it this way, can we do it another way?” – asking
Now Chris is querying if the listed indices are best practice including a literature review,
directing people to organisations for brochures and promotional material for indices
4 sections – need to do a 2nd edition
Section 1 will have to be reviewed to include feedback, references (current one has
references’s from late 1990’s)
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Test Guide – look at best practice indices
Layout – no need to change
Evaluation/feedback/preamble need review
Robin Hood costing - $350-550, not going to charge an Indigenous remote community $550,
a few left now – best to sell them out

Selection, training, supervision and debriefing of the staff
Selection – who and how chosen?
Choose profile you regard as gregarious, who you think will enjoy working in a community
setting
Will not vary from script
How did you discover this?
MBTI useful, gives clear picture of personality style best suited to Pit Stop and work with
lengthy time, whole day, interactive, passing men between gregarious people – how to move
people on/encourage them, generally suited
Aspects of Pit Stop suited to J style – pedantic
You can match people to stations
People don’t only have to have a health background, other kinds of people used –
administration staff, members of voluntary groups eg men’s groups, women’s interest groups,
service clubs, community police
Use a mix of volunteers and paid workers, on occasions negotiate paid time for nurses
Training – endeavour to get every one to go through the package, direct training about
interventions
Local – recruit same/similar pool
Skill development – 2 hr station specific training eg Exmouth, Carnarvon hospital – non
health people always take up the training
Professional people – always doing specific station, individual training, meet with them
May make amendments each time based on best practice
Training at Pit Stop on day – quick speel if person there at short notice
Pit Stop volunteers – nature of them is that they are quick on the uptake
Supervision – Chris roams around and supervises people, he is the person who reviews the
work order
Medical officer/Chris/Elsa – check work order, be quite specific, tell man
Traditionally Chris does review and “men’s fiddly bits”
Supervision of mechanics – play it by ear, listen all the time, pretty much rolls along, not sure
if it’s the best way
Debriefing – On occasions go to a café afterwards, but generally no, have heard of
organizations that do, meeds to be looked at
Issue of injury – eg lower back in torsion
On occasions, strange bloke, had to provide intervention, in each instant has been related to
mental health status eg come in with psychotic or episode occurred in Pit Stop situation –
always make sure we are able to provide information and direct to assistance eg mental health
helpline

Locations
Public settings

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Events where there is likely to be large number of men congregating eg machinery days, field
days, motor events, expo’s, small town festivals where it’s the only event of the ye ar, Xtreme
sports events, eg Big Boys Toys
Where not to run them – where there is a large emotional content regarding the celebration, eg
NAIDOC celebrations, does not work well
Works well with Indigenous men, but not when the event is celebrating something else
Key characteristics – good location – has to be adjacent to other blokey things, tractors,
motorbikes, pumps
Right in the middle of these, not in the health/govt dept display section

Issues or problems experienced in delivering the package
Dealing with inquiries 15-20 per week – researchers, evaluators, student assignments,
purchasers – what is best practice, how to write a disclaimer
Yesterday I did nothing but pit stop all day
Eg aids council, can it be used in psychodrama, conferences etc
At a local level – issue recruiting mechanics due to fiscal restrictions and Chris no longer
working directly in the Carnarvon hospital – used to recruit mechanics while on the ward and
in contact with staff, good relationship with them, talking to them and able to recruit
Sometimes can get a full crew but can’t get help to set it up, eg especially needed when
there’s no easy access to the site, heavy work when you can’t back the ute up with the heavy
equipment
Evaluation of Pit Stop – follow up of men is difficult, individuals can be a bit elusive




Any improvements that you would recommend
Most pressing – compiling a second edition with a literature review, review of practice,
evidence review, evaluation information, is the software adequate - old fashioned fo rmat,
although easy for most services to reproduce
200 originally printed, taken 3 yrs to sell/distribute, only by word of mouth, no advertising
It would be interesting to see how many pit stops there have actually been done? Could be
1,000
Mountains of evaluation/information – what do you do with it?
Presentation of the package, probably now needs to be different, more condensed
New name Pilbara Gascoyne Population Health Unit (PGPHU) – needs updating
Needs to be a bit slicker

Strengths of the program
-Elsa and i realised that as an engagement tool it is the best thing we have ever used
-It has given us a clear picture of what the Gascoyne man is, what he does, how he works,
what his life’s like
-It has provided a guide to the direction of specific aspects of health services eg Community
drug and alcohol services team, CHAMP project, Nutrition project
-Tool for other disciplines – If they listen eg establish a relationship with a man, and he will
remember the discussion, if you give info, they will give something back, getting info from
individual re an index
-Being intuitive helps, listening, getting opportunity to hear, questioning
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-It listens to men – what they are saying, what they have to say
-There seems to be some pride in the fact that it is a local product eg local people call in and
say they have seen it in Bunbury, asking why
-Format – Pfizer tried to take the idea, put it in a truck, within 9 mths the truck was for sale.
Was the problem that it was not in a public setting?
Every time we have screened it off or tightened it from public view, it was a disaster
Even the ute’s not private

Threats or challenges to the program
HDWA funding (or could be an opportunity)
Everything has a natural life
Health dept funding less sustainable due to questions being asked about it – requires time,
effort and money to ensure it efficiency
PGPHU is in a different space now – Pit Stop was developed at a special time of energetic
leadership at high level of the organization change
May be less economically viable in the present climate per head cost of intervention
Biggest threat of all – coordination has to be done in context of other jobs, does not deserve
that, deserves to be somebody’s job
Needs to get on Healthway / BHP agenda to get funding
Tailor made to Gascoyne men – based on health issues in the Gascoyne, Gascoyne
demographics, which led to the choice of tests
Funding - ? GP division

Question 9: Other comments/thoughts/any other suggested questions?
No




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