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									     ‘HEALTHY MEN’
Development of a workplace-based
 model for encouraging increased
 participation of men in matters of
         health & wellbeing.

          FINAL REPORT
           TO THE
DEPARTMENT OF HUMAN SERVICES


          Gabrielle Fraser
           Jack Harvey


            August 2003
                  ‘HEALTHY MEN’
Development of a workplace-based model
for encouraging increased participation of
  men in matters of health & wellbeing.

                               FINAL REPORT
                 TO THE
      DEPARTMENT OF HUMAN SERVICES


                                 Gabrielle Fraser
                                  Jack Harvey

                                       August 2003



                                           st
Program Commencement Date:                1 July 2002
Program Completion Date:                  31st August 2003
Organisation conducting the Program:      Ballarat & District Division of General Practice Inc.
                                          P.O. Box 36W, Ballarat Victoria 3350
                                          Tel: 03 5331 6303
The views expressed and the conclusions reached in this publication are those of the authors and not
necessarily those of persons consulted. Ballarat & District Division of General Practice shall not be
responsible in any way whatsoever to any person who relies in whole or part on the contents of this report.



Project Contact Details
Ms Gabrielle Fraser
Men’s Health Program Officer
Ballarat & District Division of General Practice
105 Webster St
PO Box 36W
Ballarat Vic 3350
www.bddgp.org.au

Telephone: +61 3 5331 6303
Facsimile: +61 3 5331 5754
Email: bddgp@bddgp.org.au




State Department of Human Services Rural Health and Innovative Practice (RHIP) Fund Contact Details

Ms Pam Sheers
Rural and Regional Health Services Branch
Level 12/589 Collins Street
Melbourne
TABLE OF CONTENTS
Project Team .................................................................................................1
Acknowledgements ......................................................................................2
Executive Summary & Recommendations .................................................3
1.    Introduction: Problem Definition..........................................................5
      Outline of population health and wellbeing data that underlines project......................5
      Goal & Objectives........................................................................................................6
      Evidence-based Review ..............................................................................................6
2.    Methodology: Solution Generation ......................................................8
      Interventions and Strategies........................................................................................8
      Capacity Building for Sustainability .............................................................................9
      Budget .......................................................................................................................10
3.    Evaluation Plan....................................................................................11
      Components of the Evaluation ..................................................................................11
             Evaluation of Processes...............................................................................................................11
             Evaluation of Impacts and Outcomes ..........................................................................................11
             Evaluation of Needs .....................................................................................................................11
      Evaluation Instruments ..............................................................................................11
4.    Results of the Evaluation....................................................................13
      Processes..................................................................................................................13
             The Project: Planning and Implementation ..................................................................................13
             The Program: Workplace Visits....................................................................................................13
             Feedback from members of the program team............................................................................13
             Feedback from employer representatives....................................................................................14
             Feedback from participants..........................................................................................................14
      Achievement of Goals and Objectives: Impacts and Outcomes ................................15
             Initial participant survey form .......................................................................................................15
             Initial participant health record and participant referral record.....................................................16
             Follow-up participant survey form ................................................................................................17
             Follow-up participant health record ..............................................................................................17
      Learnings and Generalisability ..................................................................................18
      Sustainability .............................................................................................................18
References ..................................................................................................20
Appendices & Attachments .......................................................................21




         ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003
LIST OF TABLES
Budget for Mens Health Project.................................................................10
Table 1. Health Risk Assessments: Initial Visit .......................................16
Table 2. Health Risk Assessments: Initial and Follow-up Visits ............17




        ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003
PROJECT TEAM
The project was developed and overseen by the following multidisciplinary team:

            Name                    Position/Role                                    Organisation

Tim Adam                     Men & Family                    Child & Family Services, Ballarat
                             Relationships Program
                             (Dec 2002 – June 2003)

Gayle Boschert               Project Manager                 Ballarat & District Division of General Practice
                             (July 2002- May 2003)

Michael Brandenburg          Coordinator, Men &              Child & Family Services, Ballarat
                             Family Relationships
                             Program
                             (Nov 2002 – July 2003)

Meg Filip                    Project Officer                 Ballarat & District Division of General Practice
                             (July 2002 – Oct 2002)

Gabrielle Fraser             Project Officer                 Ballarat & District Division of General Practice
                             (Nov 2002 – July 2003)

Rick Gervasoni               Manager of Health               Victorian Department of Human Services,
                             Promotion                       Grampians Region

John Harrison                Consumer                        Consumer Advisory Group – Ballarat & District
                             Representative                  Division of General Practice

Dr Jack Harvey               Research and Evaluation University of Ballarat
                             Consultant

Andrew Howard                CEO                             Ballarat & District Division of General Practice

Dr Greg Malcher              GP Advisor                      Ballarat & District Division of General Practice

Judy Prendergast             Coordinator                     Ballarat Community Health Centre

Cate Ronaldson               Coordinator, Men &              Child & Family Services, Ballarat
                             Family Relationships
                             Program
                             (July 2002 – Nov 2002)




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003           1
ACKNOWLEDGEMENTS
The Project Team acknowledges the contributions of the following agencies, businesses and individuals who
have supported the ‘Healthy Men’ Project – an initiative of the Ballarat & District Division of General Practice
and Child & Family Services, Ballarat, funded by the Victorian Department of Human Services

Contributing organisations

Ballarat & District Division of General Practice
Child & Family Services, Ballarat
Ballarat Community Health Centre
University of Ballarat
Pete Amor Motors

The ‘Healthy Men’ Program Team

General Practitioners/GP Registrars
     Dr Greg Malcher – Daylesford General Practice
     Dr Colin Crook – Gillies St Medical Practice, Ballarat
     Dr Andrew Brommeyer – Lydiard St Medical Practice, Ballarat
     Dr Melinda Dalman – Victoria St Group Practice, Ballarat
     Dr Richard Patterson – Creswick Medical Centre
     Dr Li Yang – Sturt St Group Practice, Ballarat
Community Health Nurses
     Ballarat Community Health Centre
Men & Family Relationship Workers
     Child & Family Services, Ballarat

Sponsors

Andrology Australia
Child & Family Services, Ballarat - Men & Family Relationships Program
Lions Club Sight & Hearing Corporation
Sunicrust Bakeries, Ballarat

Participating Workplaces

CMI Operations Ltd
Dahlsens Building Centres
Sunicrust Bakeries

Participating workers

The employees of CMI Operations Ltd, Dahlsens Building Centres and Sunicrust Bakeries who took part in
the program.




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003       2
EXECUTIVE SUMMARY & RECOMMENDATIONS
                                                                                   1
The Victorian Burden of Disease Studies: Mortality and Morbidity indicate that men have poorer health
outcomes, morbidity and mortality compared with women. Further, comparisons indicate that men in rural
areas are more at risk compared to those in urban areas. Many studies have indicated that men access
health services less frequently and are less likely to utilise screening services than women. Blue collar
workers are even less likely to access the available medical and other wellbeing-based services.

The aim of the ‘Healthy Men’ Project was to improve the access of men in blue collar industries to health and
welfare services by implementing a workplace based health and wellbeing screening program in small to
medium businesses in the Ballarat area. The focus of the program is to improve access to medical and other
health and welfare services for as many men as practicable, to encourage them to assess their individual
health and wellbeing. The project also aimed to promote the concept of ‘men’s health and wellbeing’ in the
workplace, and increase the awareness of the issues of men’s health on the national health agenda.

Building on the experience gained in the earlier ‘GPs and Men and Work’ project, a program was refined and
trialled in three workplaces, with a total of 68 men participating in the program. Key components of the
program were an initial visit and a follow-up visit three months later, by a multi-disciplinary team consisting of
GPs, Community Nurses and Men & Family Relationships Workers. At each visit, information was provided
and data was collected about health and wellbeing issues, basic health checks were conducted, and
referrals were made as required. Additionally, free immunizations were provided.

Key learnings about implementing such a program have been identified and incorporated into the ‘Healthy
Men’ Program Model document (Attachment 1). Some key indicators and outcomes identified during the
implementation and evaluation of the program are:

Substantial proportions of the men participating in the initial visit:

q     found balancing work and family life a challenge at least some of the time
q     had experienced a wide range of health-related symptoms
q     wanted information or assistance on matters of health and wellbeing
q     had “at risk” levels of blood glucose, cholesterol, blood pressure, or girth
q     had not visited a GP in the previous 12 months
q     required referral to a GP or another service

A number of quite young men in the sample exhibited “at risk” health status.

On follow-up, it was found that:

q     the great majority of participants returned for the follow up visit
q     the majority of those for whom a referral had been made reported attending the appointment
q     the great majority reported an increased interest in their health and wellbeing
q     there was a high level of interest in changes in individual health indicators
q     overall, small improvements were observed in all four key risk factors.
q     the prospect of a follow-up visit acted as an incentive to change in behaviour
q     a number of participants reported specific behavioural changes, with respect to exercise, the balance of
      work and family life, and smoking.

Feedback about the program and its effects on the individuals and on the general culture of the workplaces
was uniformly positive, from participants, management representatives and members of the program team.

Recommendations for future activities relating to the outcomes of this project are:

q     As a means of promoting the sustainability of the workplace health and wellbeing program, it is highly
      recommended that funding is sought for promotion, marketing and distribution of the Model document,
      both locally and nationally. It is important this is done in a timely manner whilst the ownership of the
      Model is still a key item on the agenda for participating stakeholders and community organisations,
      especially in light of the recent Launch event where an official launch of the Model was held in the
      community.

1
    Department of Human Services:1999 The Victorian Burden of Disease Studies: Mortality and Morbidity

     ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003      3
q     Consideration should be given to further development and enhancement of the Model, and publication of
      a revised edition. One example of a worthwhile enhancement would be the inclusion of a “stages of
              2
      change” component, so that participants could monitor their progression through each stage on an
      annual basis, which would act as an incentive for workplaces to continue to implement the program
      annually.

q     Support and endorsement of the Model should be sought from statutory agencies such as WorkCover,
      which would encourage its uptake by workplaces.

q     Funding should be sought to enable Ballarat and District Division of General Practice and/or Child and
      Family Services Ballarat to offer an advisory and support service to assist workplaces to implement the
      Model.

q     Funding should be sought to enable the results of this project to be promulgated through conference
      presentations and publication in professional journals.




2
    Kaplin, Sallis et al “Health and Human Behaviour” 1993 pp58-59

     ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003   4
1. INTRODUCTION: PROBLEM DEFINITION
The ‘Healthy Men’ Project was developed through continuation and refinement of the previous ‘GPs:
                         3
Working for Men’ Project . Ballarat and District Division of General Practice (BDDGP), in partnership with
Child & Family Services, Men & Family Relationships Program, was funded through the Victorian
Department of Human Services - Rural Health and Innovative Practice (RHIP) Fund, to implement a men’s
health and wellbeing program (referred to as the ‘Healthy Men’ Program) in workplaces within the Division’s
boundaries, with the aim of developing a workplace-based model for encouraging increased participation of
men in matters of health and wellbeing. The Project was implemented with the support of Ballarat
Community Health Centre and the University of Ballarat.

Outline of population health and wellbeing data that underlines project
       4
Rowe defines Men’s Health as being the “biological and psychosocial aspects of the health and wellbeing of
men”. Men’s Health in Australia is such that evidence based research shows various areas where the health
of men does not equate to that of their female counterparts. Men visit doctors and other health professionals
less frequently than women, and are therefore more susceptible to complications arising from treatable
diseases, due to postponement of medical advice and treatment. Men are also often working in professions
where there are greater occupational health and safety concerns.

On a local level, males who live in Ballarat are even more at risk of premature illness and death, than the
                                                         5
state average. The Victoria Burden of Disease study has measured the male life expectancy in the
Grampians Region (74.40 years) is significantly lower than the Victorian average (75.59 years). Males in the
LGAs of Golden Plains, Hepburn Moorabool, Ballarat, Ararat, Northern Grampians and Pyrenees have low
life expectancy while males in Hindmarsh, Horsham, West Wimmera and Yarriambiack have average life
expectancy. The male burden is higher for cardiovascular disease, diabetes, chronic respiratory diseases
and cancers, than for women.

Whilst it is necessary to acknowledge the importance that diet, nutrition and health behaviours has on the
above chronic illnesses in men, it is of equal importance to highlight the significance of a man’s wellbeing on
his physical and mental health. “The two dimensions of health – physical and mental – interact with one and
other. For example, a person’s physical health can influence their mental state. People with illness or
disability may feel depressed or anxious in relation to their disease or disability, and it’s implications for their
life. More directly, their condition or medication may be associated with chemical changes that influence
emotions. Conversely, a person’s mental health can influence their physical state. Positive emotions can
contribute to a person’s ability to recover from disease, whilst unhappiness, alienation or the lack of sense of
purpose may be factors that make human immune system more vulnerable to disease. Certainly people’s
                                                                                     6
outlook on life can affect lifestyle choices, which in turn influence health status”

It has been widely researched that men’s health and well being, varies considerably in relation to socio-
                                                          7
economic status, race, culture, criminality and disability . The ‘Healthy Men’ Program specifically targets
male blue-collar workers who are identified as being an at risk group. “While men in general are suffering
higher mortality rates than women, it is actually males in the lower socio-economic sphere who are carrying
most of this burden. Men who are under/unemployed or blue collar workers generally constitute low socio-
                   8
economic males” In the report ‘Developing an Intersectoral Strategic Framework for Men’s Health
          9
Promotion Vic Health states that when compared to white collar workers, blue collar workers;
    q Have higher death rates;
    q Suffer higher accident and injury rates;
    q Experience a higher incidence of heart disease;
    q Work in more hazardous environments;
    q Have less control over work conditions; and
    q Tend to be less responsive to traditional health promotion campaigns


3
  Ballarat & District Division of General Practice, “GPs Working for Men” Final Project and Evaluation Report, Feb 2002
4
  Rowe,J “Men’s Health Promotion in General Practice: A review of the Literature” June, 2000
5
  Department of Human Services “Victorian Burden of Disease Study: Morbidity”1999
6
  Australian Bureau of Statistics, ‘Measuring Wellbeing: Frameworks for Australian Social Statistics. Chapter 4: Health –
  Defining Health’ 12 October, 2001
7
  Rowe,J “Men’s Health Promotion in General Practice: A review of the Literature” June, 2000
8
  North West Melbourne Division of General Practice “Addressing the Health Needs of low socio-economic males” 2000
9
  Vic Health “Developing an Intersectoral Strategic Framework for Men’s Health Promotion – Vol 2” 2000-01

    ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003             5
Taking the ‘Healthy Men’ Program to the workplace is a means of accessing the nominated target group of
blue-collar workers. The places chosen for inclusion in the program are locally based blue-collar industries
with a high male population. In taking the program in to these local workplaces, the program team is able to;
provide opportunities for men to access health information and health assessment in the workplace; to raise
awareness and inform men about health and wellbeing issues; to increase levels of interaction for men with
health and social services; and to be able to identify strategies and processes to engage men and
workplaces. Through the development of a step-by-step guide for workplaces to be able to implement their
own health and wellbeing program for employees, increased participation of men in matters of health and
wellbeing can be achieved.

Goal & Objectives
Goal:

To develop a workplace-based model for encouraging increased participation of men in matters of health and
wellbeing.

Objectives:

1. To provide opportunities for men to access health information & health assessment in their workplace

2. To raise awareness & inform men about health and wellbeing issues

3. To increase levels of interaction for men with health and social services

4. To Identify strategies and processes to engage men and workplaces

Evidence-based Review
Men are still not attending their GP or other health services as often as they should be and at a rate
significantly less than women. Although little is known as to why men don’t access health services, the
available research suggests that this is because of a combination on their reliance on their spouse to
organise health care for them, a perceived vulnerability, fear and denial relating to health services and their
need for medical care, and their pattern of seeking advice for specific problems rather than for more medical
concerns. It is also apparent that men don’t access health services because of system barriers, such as time
required away from work, availability of medical services – especially in rural areas, issues of confidentiality
                                                10 11
and a preference for male health care providers
        12
Bond writes that improving access to health care for men involves recognising the conflict between
masculinity and help seeking behaviours, particularly as it affects men in rural areas. This conflict being that
men who are traditionally the ‘breadwinners’ in the family are less inclined to take time off work that could
potentially result in a loss of income. This situation is further compounded in rural areas where seasonal
heavy workloads i.e. farming/harvesting, can leave many men too busy to access health services for months
at a time. This results in the abovementioned scenario, where men are more likely to attend health services
for curative health care for specific conditions, rather than preventative or general health care requirements.

The ‘Healthy Men’ Program is a model that brings a health and wellbeing-screening program to at-risk men
at their workplaces, thus overcoming the identified obstacles for men who do not often access health
services. The model largely focuses on male blue-collar workers who, as previously stated are a high-risk
                     13
group of men. Rowe states the importance of undertaking screening activities in high-risk groups, rather
than the “worried well, unworried, yet at high risk of other conditions”. Greater positive outcomes can be
reached when targeting the high-risk groups, thus making a more cost effective and beneficial exercise.

Recent activities and models of workplace health programs have been developed and implemented in
Australia and overseas. However, very little work has been achieved in bringing a workable social model of
health to workplaces that focuses on the health and wellbeing of men, as well as engaging their participation


10
   Department of Human Services “Men’s Health Planning Strategic Framework – 2001” pg 19
11
   Rowe,J “Men’s Health Promotion in General Practice: A review of the Literature” June, 2000 pg 15
12
  Bond G. (2000) “I’d sooner talk to someone….” Improving young men’s access to health and welfare services. Coburg,
  Victoria, Moreland Community Health Service: pg 1-115
13
  Rowe,J “Men’s Health Promotion in General Practice: A review of the Literature” June, 2000 pg 10

     ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003       6
                                                  14
in health screening programs. Rowe has constructed a literature review resource that serves two
purposes: to provide a literature and knowledge base; and to highlight the importance of health promotion in
the general practice setting for men’s health. This resource is invaluable in guiding men’s health activities
and undertaking health promotion. The ‘Healthy Men’ Program was developed with guidance from this
resource and has built on Rowe’s recommendations by putting them in to practice through developing a
health promotion tool for workplaces.

Similar health screening ‘check-up’ programs have been the Pfizer funded ‘Men’s Health Tune-Up’ Program,
a medical check-up program that travelled around Australia in 2001-2002. The program accessed
approximately 30,000 men who were tested for blood pressure, cholesterol and diabetes. Of the men tested,
                                                           15
96% were rated as high risk in at least one of these tests. Another men’s health check up program was Pit
     16
Stop , a men’s health check-up program which makes reference to car-related terminology that engages
men to participate in the program. The program offers men the opportunity to undergo a seven-point
inspection at the Pit Stop (check-up point), and does include a screening tool for wellbeing issues. Although
a proven tool for effectiveness in accessing men, and an excellent model to implement as a once-off health
screening activity amongst large male oriented community groups, such as agricultural field days, car racing
events etc, the Pit Stop program may not be ideal in a workplace environment. Privacy and confidentiality is
of utmost importance to men - one could assume, especially amongst workmates. Ensuring the privacy and
confidentiality of men during the health screening program, and offering an ongoing regular annual health-
screening event is integral to the success of a health and wellbeing program for workplaces.

The uniqueness of the ‘Healthy Men’ Program is that it brings a ‘social model of health’ to workplaces which
incorporates a program of screening physical health, emotional health, family & relationship support, and
preventative health care such as diet and nutrition advice, information and referral to health welfare services,
as well as immunisations and one-on-one consultations with health professionals. Short term and,
ultimately, long term follow-up is an important component of the ‘Healthy Men’ Program, as a means of
reinforcing the health and wellbeing message to participants. Another key focus of the program is to
                                                             17
encourage participants along Prochaska and DiClemente’s stages of change model, in which people move
from pre-contemplation for those who have no intention of changing their behaviour, to contemplation where
a person may start to think about making a change, the action stage where the individual is involved in
changing the behaviour and the maintenance stage in which the person is successful in sustaining a change.
Obviously different individuals will be at different stages of behaviour change when they commence
participation in a workplace health and wellbeing program, and so the focus is on supporting those
individuals to progress successfully from one stage through to the next stage. It would be overly ambitious to
aim for all participants to reach the maintenance stage as a result of a once-off health and wellbeing-
screening program. However, with regular implementation of such a program on an annual basis, the
likelihood of this occurring would be greater.




14
   Rowe,J “Men’s Health Promotion in General Practice: A review of the Literature” June, 2000
15
   http://www.menshealthtuneup.com.au/ accessed 12 August, 2003
16
   www.abc.net.au/rural/health/papers/paper4.htm accessed 29 August, 2003
17
   Kaplin, Sallis et al “Health and Human Behaviour” 1993: pp58-59

     ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003    7
2. METHODOLOGY: SOLUTION GENERATION
Interventions and Strategies
In line with the aims and objectives of the project and budget considerations, the Project Team decided to
include three blue-collar workplaces to participate in the pilot phase of the program. Identification of the
three participating workplaces for the ‘Healthy Men’ Pilot was through ad hoc identification of local
businesses that were identified as blue collar workplaces that employed a high male population, and that had
not participated in the previous GPs & Men: At Work Project. Nine qualifying workplaces received a letter
from the Project Officer to invite their participation in a free workplace health and wellbeing screening
program. Of the nine workplaces, four indicated interest in the program, with the final three workplaces
being selected on a ‘first in, first served‘ basis. Formal agreement was established with workplaces to
ensure they had the appropriate settings for the program to be run effectively in relation to the availability of
confidential rooms, support from management to allow time away from work for the participants, internal
agreement to assist in the promotion of the program, and a commitment to the health and wellbeing of
employees.

The intervention took the form of two visits to each workplace, designated in this report as Initial and Follow-
                                               th                   th
up visits. Initial visits took place between 27 March 2003 and 11 April 2003. Follow-up visits took place
                                   th               th
three months later, between 26 June 2003 and 11 July 2003.

Planning activities, prior to the initial visit involved identification of the Program Team. The Program Team
for each workplace consisted of two General Practitioners, one Registered Nurse and three Men & Family
Relationships Workers. In nominating the Program Team, the Registered Nurses and Men & Family
Relationships Workers were identified by members of the Project Team. The engagement of the GPs was
through a notice of invitation from the Project GP Advisor to six GPs who had participated in the GPs & Men:
At Work project. Of the six GPs who were invited to participate in the Healthy Men project, only three were
able to accept the invitation. The next step was to approach three GP Registrars to invite their participation
in the program. The three GP Registrars accepted the invitation. The program team then was made up of a
total of three General Practitioners, three training GP Registrars, three Registered Nurses, and three staff
from the Men and Family Relationships Program.

Recruitment of participants for the program was done on a voluntary basis by employees notifying their
supervisor of their interest in participating in the program, after they learned of it through both external
marketing by the program team, and internal advertising via memo’s and newsletters by the employers.
Participation was limited to 24 employees from each workplace.

Processes that needed to be organised prior to the implementation of the Program were: to develop the tools
for use during the initial and follow up program, such as survey forms, health assessment records,
appointment cards, explanatory statements, consent forms, referral forms etc; to identify the procedure for
the Program Team to make referrals to other agencies; to investigate Prochaska’s Stages of Change Model
and incorporate it in to the information delivery process; to undertake a training/briefing session with the
Program Team prior to the implementation of the program; to coordinate IT processes for accessing the
electronic service directories via a laptop computer connected to the internet; and development and
distribution of promotional material to workplaces.

The development of the survey tool included two pilots of the tool, one with members of the Project Team
and a final pilot with a men’s group at Child & Family Services. Alterations were made to the survey form
accordingly.

At the initial visit, the order of proceedings occurred as follows. The first 2 participants arrived at their
scheduled appointment time. Men & Family Relationships workers greeted the participants, provided them
with a copy of the explanatory statement for their record, and assisted them to complete the consent form.
A code was allocated to the participant by writing their number (as written on the appointment list) in the
code box at the bottom of their consent form.

Participants then moved through the screening process by meeting with the Men & Family Relationship
Workers to complete the survey tool and discuss any wellbeing/relationship issues they may have. The
Nurse then met with the participants to complete the prescribed health screening tests and communicate this
information to the GP. The participants then moved along to meet with the GP, to discuss any health
issues/concerns they have, as well as the GP referring to items contained in the survey form and the health
assessment form. If a referral to another service/GP was required, the GP ticked the appropriate box on

  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003        8
page 3 of the Assessment Record. The GP then completed the referral by filling out the ‘Healthy Men’
Referral Form

After meeting with the GP, all participants were directed out to see the Project Officer who followed up any
appointments/paperwork required for the participant. Upon making an appointment (if a referral was
required) through consultation with the participant, the Program Officer completed the details on the Referral
& Appointment Record (this was done informally) to capture data on the referral process. The Program
Officer then completed the details of the appointment on the ‘Healthy Men’ Referral Form, Referral &
Appointment Record, and a ‘Healthy Men’ appointment card. The Program Officer then provided the
participant with the following: ‘Healthy Men’ Referral Form (if a referral is required as per page 3 of the
Assessment Record) in an envelope, an appointment card (if an appointment has been made), and a “show
bag” filled with health and wellbeing information material.

A BBQ lunch was offered to all employees at the workplaces. This was provided as a strategy to engage
initial participation on to the program by workplaces, as well as a tool to encourage employees to volunteer
as participants in the program.

Prior to the follow up visit, in order to streamline the process and link back to the initial visit, the Project
Officer transcribed key data from the survey form from the initial visit to the survey form for the follow-up visit.
This included details of any referral made and whether the participant had previously requested information.

The process during the follow-up phase was similar to that of the initial visit, with some additions and some
omissions. Additions at the follow up stage were to send individual letters to all participants to invite their
return visit to the follow-up program, and to offer immunisations for Adult Diptheria and Tetanus (ADT), and
Measles Mumps Rubella (MMR). Omissions at the follow-up visit were: the explanatory statement, the
consent form, the BBQ lunch and the marketing material, none of which were required, since the same
participants were involved in the follow-up visit. The GP was not required to refer to the survey form at the
follow up visit because the follow-up survey form was largely related to the changes to the participants’
health and wellbeing from the initial visit to the follow-up visit.

Upon completing the follow-up program, the results from the initial visit and the follow up visit were evaluated
- see Evaluation Plan below.

Finally, a Model document in the form of a step-by-step guide was developed for distribution to workplaces to
be able to implement their own workplace health and wellbeing program (Attachment 1).

Capacity Building for Sustainability
Partnerships/stakeholders and their roles critical for the project success

The success of the ‘Healthy Men’ Program is dependent upon the level of collaboration and consultation with
other agencies, in order to ensure the program is relevant and effective to the individual needs of
workplaces. The Division is fortunate to be involved in a partnership arrangement with the locally based Men
& Family Relationships Program, who are able to provide support through professional and financial
assistance such as membership & involvement at a steering committee level, workplace engagement and
media coordination events, program launch activities and marketing assistance, as well as attendance and
provision of professional services at each workplace assessment program. Collaboration with other
agencies such as Ballarat Community Health Centre, Ballarat University Ballarat & District Division of
General Practice – Consumer Advisory Group and Peter Amor Motors (Industry Representative) are also
important agencies/business who are able to provide consultative and professional support to the program.

Development of the Model

The overarching aim of the project was “to develop a workplace-based model for encouraging increased
participation of men in matters of health and wellbeing”. In order to achieve this, the fourth and final specific
objective was to “Identify strategies and processes to engage men and workplaces”.

Following the workplace visits, the processes and instruments used in this project, together with issues
identified and learnings gleaned, were assembled into a comprehensive package to serve as a template or
model for a workplace-based program of health and wellbeing assessment and promotion (Attachment 1).




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003          9
Budget
The resources used to plan, deliver and evaluate the interventions described are outlined in the project
budget.

                                      Budget for Mens Health Project
Budget                                                               Budget              Actual         Comments
Project Management
GP project Manager(This is to include Travel Time)
2 hrs x 52 weeks @ $100/ph                                            $10,400.00          $12,591.00
Project Worker
15hrs x 52 weeks @ $30/ph (.EFT)                                      $23,400.00          $34,357.97
Travel                                                                 $2,300.00           $1,281.08
Administration Costs                                                   $8,478.00           $7,412.86
Evaluation                                                             $6,000.00           $6,000.00
GP Time
2xGP'sx12 individual visitsx2hrsx$100phr                                $4,800.00          $2,388.45
Nursing Support
2x Nurses x 12 visitsx2hrsx$30p/hr                                      $1,440.00          $1,080.00
IT Support 3hrs/month @$45                                              $1,620.00
Committee Meetings 1hr/month x 6 @ $45                                  $3,240.00          $3,601.18
Program Manager 1hr/month @$45                                            $540.00          $1,543.30
Publicity & Promotion                                                   $1,000.00            $552.81
Training & Education                                                    $2,000.00            $792.31    Budget Deficit
Budget Total exclusive of GST                                         $65,218.00          $71,600.96       ($6,600.96)
                                                           GST          $6,521.80          $7,160.10
                                                       TOTAL          $71,739.80          $78,761.06       ($7,021.26)




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003               10
3. EVALUATION PLAN
Evaluation was the responsibility of Dr Jack Harvey, Research and Evaluation Consultant, University of
Ballarat. Evaluation was undertaken with reference to the four project objectives listed above, the project
checklist supplied by DHS, and the DHS PCP Draft Health Promotion Guidelines, December 2000.

Components of the Evaluation
Evaluation of Processes

Evaluation of the processes of the Project (project planning and implementation) was based on observation
of team meetings and analysis of documents including agendas, minutes, progress reports and e-mail.

Evaluation of the processes of the Program during the workplace visits was based on:
· qualitative evaluation reports were completed by members of the Program Team (Men & Family
   Relationships Workers, Nurses, GPs, GP Registrars) after each workplace visit (Appendices 1and 2)
· qualitative evaluation reports were also requested from employer representatives after the follow-up visit
   (Appendix 3)
· questions about process on participant questionnaires (separate forms for initial and follow-up visits; see
   Appendices 4 and 5)
· interviews with the project officer after each round of workplace visits.

Evaluation of Impacts and Outcomes

Evaluation of impacts and outcomes were based on quantitative and qualitative analysis of:
· participant questionnaires (initial and follow-up visits; see Appendices 4 and 5)
· participant health records (initial and follow-up visits; see Appendices 6 and 7)
· participant referral records (initial visit; see Appendix 8).

Evaluation of Needs

The data gathered during the workplace visits from participant questionnaires and health records also
provided supporting evidence of the need for such interventions.

Evaluation Instruments
The following participant instruments were used for evaluation purposes:

Initial visit:
· Participant initial survey form (Appendix 4)
· Participant initial health assessment record (Appendix 6)
· Participant referral form (Appendix 9)
· Program Team evaluation forms.

Follow-up visit:
·   Participant follow-up survey form (Appendix 5)
·   Participant follow-up health assessment record (Appendix 7)
·   Program Team evaluation forms
·   Employer representative evaluation form.

The participant health assessment record forms were developed by the Project Officer in consultation with
the health professionals on the Project Team. The referral record was primarily used for administrative
purposes, but in addition the survey form given to each participant at the follow-up visit was personalised by
transcribing his referral details to the form. The Project Team and employer representative evaluation forms
were designed for rapid qualitative feedback from busy professionals in free text format.

The two participant questionnaires were designed for self-completion. In each case, a project team member
was available to answer any queries and assist if requested.




    ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003   11
The principal function of the initial form was to elicit factual information about relevant demographic
characteristics, health & welfare status, and access to health and welfare information. The follow-up form
included many of the same questions for the purpose of measuring any change. It also included questions
about attendance at referral appointments made at the first visit, and about perceptions of the effects of
participation in the program. The use of measurement scales was limited to a few semantic differential items
relating to perceived levels of health, fitness, and work/family balance.

Content validity of the forms was inherent in the development process, which included lengthy discussions
amongst the members of the broadly representative Project Team. The initial form was further validated by
pilot testing with the members of a Men’s Health group being run by one of the members of the Project
Team. The men first filled in the form, and then a group discussion was held about the content and format.
As a result, a few minor modifications were made. In general, the men reported that the language was
understandable, the form was unambiguous and easy to fill in, and that all items seemed relevant and
appropriate in the context of the project.

Considering that reliability is not a major issue when factual information is being elicited, as opposed to the
measurement of perceptions or the development of scales for measuring theoretical constructs, and
considering the contextual limitations, the small scale and the timeframe of the project, testing of reliability
was not considered to be or necessary, appropriate or feasible.




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003      12
4. RESULTS OF THE EVALUATION
Processes
The Project: Planning and Implementation

The full Project Team met on thirteen occasions, usually for around two hours. In addition there were
frequent telephone conferences and face-to face meetings between the Project Officer and individual team
members.

The project application had sought funding for “continuation, refinement and enhancement” of the previous
“GPs and Men: At Work” project, with particular emphasis on the development of evaluative processes as a
“crucial component”. At four meetings during the first two months of the project, the Team grappled with how
the “refinement and enhancement” could be best achieved, with clearly defining the focus and scope of the
project, and with operationalising the details of program delivery. There followed a period of staff changes in
the participating organisations, which impacted on the membership of the Project Team. During this period
limited work was undertaken on the project, as a result of staff leave, staff recruitment processes and
timelines for orientation of new staff.

During the second half of the funding period, the reconstituted Team proceeded decisively and effectively,
firstly to finalise aims and objectives, and then to achieve them by deciding on a follow-up methodology,
designing and piloting the data collection instruments, planning and implementing the initial and follow-up
workplace visits, analysing and interpreting the data collected, and finally packaging and launching the
Model.

The Program: Workplace Visits

Feedback from members of the program team

After the initial visits, members of the Program Team (Men’s Health Workers, Nurses, GPs and GP
Registrars) filled out a qualitative evaluation form (Appendix 1) with two parts: to identify aspects of the
program which had worked well, and to identify any problems and suggest improvements. All four groups
reported many positive aspects, including:
 · General planning and preparation
 · Good teamwork and partnerships
 · General atmosphere
 · Support of management
 · Positive attitude of the participants
 · Value to the GPs of having the survey tool
 · Opportunity to gain access to participants who might never bother to have a check up
 · Good process – basic investigations provide a good framework & starting point for discussion
 · Making referrals “on the spot”
 · Availability of information pamphlets

Many shortcomings and opportunities for improvement were also identified, including:
· Inadequate briefing of GPs and nurses due to time schedule pressures
· Time pressures on the day – insufficient time with a scheduled throughput of 8 participants per hour
· Inadequate preparation of team members re scheduling and workflow
· Need for flexibility – differences between workplaces
· Need for more pre-visit information (such as a brochure)
· Privacy and confidentiality issues – questionnaire and nurse phases
· Facilities – in particular, a private area needed for nurse
· Need for 2 nurses – workload too heavy for one to do properly - different tasks, good to have a team
· Provision for noting opportunistic issues which arise (CAFS, GPs, nurses)
· Method of giving participants key health status information (such as a wallet card)

These issues were discussed at length by the Project Team, and all were addressed in the implementation of
the follow-up round and in the documentation of the Model (Attachment 1).



  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003     13
After the follow-up round, members of the Program Team filled out a second qualitative evaluation form
(Appendix 2) which asked them to identify: aspects of the program which had a positive impact on the
participants; aspects of the program which had little impact on the participants; and what they perceived as
the most valuable aspect of the program.

All four groups re-iterated many of the positive aspects listed above, and also identified a number of positive
outcomes:
· Providing a first health screening for many of the young men
· Provision of the health information on wallet cards
· Interest of both team and participants in comparing results from initial and follow-up visits and identifying
     changes
· Prospect of follow up was a strong incentive to change behaviours
· Positive changes in workplace culture – willingness to discuss matters of health and wellbeing
· Success of the referral process

Less positive aspects included concerns (some of which had already been identified) about:
·  Quality of facilities
·  Privacy and confidentiality
·  Non-return of some participants - a desire to know the reasons why
·  Need for further investigation of the relationship between work patterns and health, wellbeing and
   relationships

Aspects of the program nominated as “most valuable” included:
·  Engaging with the men “on their turf” about health and wellbeing issues
·  Providing a service to men who do not usually access health services
·  Witnessing the enthusiasm and interest of the participants
·  Seeing men take a greater interest in health and wellbeing issues
·  Providing early identification of health issues
·  Assisting in behaviour change
·  Offering health promotion strategies to young men
·  Working in partnership with other professionals

Feedback from employer representatives

The three employer representatives who had responsibility for the program at each workplace were asked to
complete a brief qualitative evaluation form (Appendix 3) which asked them to identify positive aspects,
suggested improvements, and what they perceived as the most valuable aspect of the program.

At the time of writing, only one employer representative had responded in writing as follows (though the
others had given very positive verbal feedback).

Positive impacts: “A general interest in health by the “blokes” was pleasing to see and there were signs of
correlation between this program and general workplace health and safety.”

Most valuable part of the program for your workplace: “The guys were able to link OH&S into their own
health and well being and as a result a taboo topic - men’s health was discussed freely and many positive
discussions arose, such as regular checks and incorporating health checks into annual safety plans.”

Feedback from participants

The participant follow-up survey form included a number of questions about the program itself. Of the 52 out
of 68 participants who returned on the follow-up visit, only one was negative in his assessment of the
program, whilst 44 (84% of the 52 or 65% of the original 68) assessed it as “valuable”, and 7 (14% of 52 or
10% of 68) assessed it as “extremely valuable”.

The men were given a list of 10 aspects of the program and asked to identify the best and worst aspects. All
52 men nominated one or more “best” aspects, the most common being “focusing on my physical/medical
health” (62%), “focusing on my wellbeing” (46%), “contact with the GP” (44%), “BBQ” (27%), and
“information that I requested was sent to me afterwards” (25%). With regard to the worst aspects, 16 of the
52 did not nominate any at all, and a further 31 said that “nothing stood out as being particularly worst”. Of


    ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003   14
five men who nominated “worst” aspects, all five chose “completing the survey form”. Most of the other
aspects received one mention each.

Forty eight men (98% of the 49 who answered this question) thought that the survey form was easy to
understand. This, together with the results of the pilot testing, confirmed the suitability of this survey form for
use as part of the Model for future workplace interventions.

All 17 of the men who had received information on one or more topics which they had nominated, reported
that the information was either very useful (41%) or reasonably useful (59%).

All but one of the men (98%) said that they would recommend the program to other men, and that they would
like to see a regular health and wellbeing program in their workplace. However, only 6 men (12%) were in
favour of a program specifically for men; 88% favoured a program for both men and women.

Achievement of Goals and Objectives: Impacts and Outcomes
The mainly quantitative data collected on the two visits from the participants’ health records and
questionnaire responses falls into three categories:

·     Basic demographics and information about health status, including the prevalence of particular attitudes,
      opinions, behaviours and health conditions.
·     Information relating to the impacts of the project (immediate effects on knowledge, attitudes, opinions,
      behavioural intentions).
·     Information relating to the outcomes of the project (longer term change to protective and risk factors)

Only a small amount of the information can be regarded as pointing towards individual outcomes.
Considering the limited timeframe and scale of this project, it was not feasible measure any indicators of
consequential organisational outcomes, such as reduced absenteeism.

The following summary of findings is based on an extensive statistical analysis of:
·  frequency tables: one-dimensional tables showing counts of responses to each individual item.
·  selected cross-tabulations: two-dimensional tables showing the combined pattern of responses to two
   items, which are used for exploring relationships between individuals’ responses to the two items.

Initial participant survey form

Sixty eight men in three workplaces participated in the initial workplace visits. Ages ranged from 20 to 64,
with larger numbers in the range 25 to 44. The occupational breakdown was: tradespersons 28 (41%);
labourers & production workers 19 (28%); clerical, sales & service workers 6(9%); managers and
administrators 15(22%). Four fifths of the sample (79%) reported working 40 hours per week or more, and
16% worked 50 hours or more.

The great majority (81%) were married or living with a partner. The majority (59%) also had children living at
home. The great majority (81%) found balancing work and family life a challenge: occasionally (28%),
sometimes (31%), often (21%), or all the time (2%).

Almost one third of the men (29%) indicated that they wanted attention focused on particular aspects of their
health, wellbeing or relationships.

When presented with a list of seven common serious medical conditions (bowel cancer, diabetes, prostate
cancer, high cholesterol, heart attack / angina, high blood pressure, mental illness) 44 men (65%) indicated
that parents or siblings had had at least one of the listed conditions, and 27 men (40%) indicated that they
themself had had at least one of the listed conditions. The most commonly reported conditions were high
cholesterol and high blood pressure (each 15%).

When presented with a list of 22 symptoms (See Q7 on initial survey form), 58 men (85%) reported having
experienced at least one of the symptoms, with an average of just over three reported symptoms per
respondent. The most commonly reported symptoms were: heartburn/indigestion (60%), lack of energy
(33%), sleeping difficulties (24%), shortness of breath (22%), skin problems/lumps/rashes (22%) feeling
down/moody/uptight/depressed (21%) and feelings of anger/frustration (19%). Forty two men (62%)
responded to the invitation to list possible causes for their symptoms. The most frequently cited contributing
causes were work (17%), shift work (14%), smoking (14%), lack of sleep (12%), and family issues (10%).


    ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003       15
Nevertheless, most men believed that their health was good (65%) or fair (27%), and also that their fitness
was good (49%) or fair (40%).

Almost a quarter of the men (24%) had not visited a GP in the last 12 months. Forty eight men (71%)
indicated the reason for their last visit to a GP. The reasons encompassed a wide range of illnesses,
injuries, and checkups.

When presented with a list of 17 sources of health and wellbeing information, on average the men cited
between 2 and 3 sources. The most commonly cited sources were GP (55%), TV (39%), spouse or partner
(32%), and magazines (23%).

When presented with a list of 9 people with whom they might discuss their health and wellbeing concerns, on
average the men cited just under 2 sources. The most commonly cited sources, by a very clear margin,
were spouse or partner (77%), and GP (56%).

Twenty four men (35%) responded to an offer of information or assistance on any of 10 nominated areas, on
average nominating between 1 and 2 areas. The most commonly nominated areas were nutrition (42% of
the 24 respondents), sports-related health (25%) and parenting (21%).

Initial participant health record and participant referral record

The results of four key health risk assessments on the 68 men, summarised in Table 1, show that substantial
proportions of the men exhibited one or more of the risk factors, the most prevalent and the most
pronounced being excessive girth.

                                  Table 1. Health Risk Assessments: Initial Visit

                           Factor                     Low risk          At risk        High risk
                                                        %                 %               %
                           Blood glucose                90                10                -
                           Cholesterol                  72                27               2
                           Blood pressure               72                27               2
                           Girth                        41                31              28

A series of crosstabulations showed that there was a high degree of correlation between cholesterol and
blood pressure levels, but no other pairwise relationships were apparent.

Each of the first three risk factors was also crosstabulated against the men’s reported history of the
condition. In the case of blood glucose, the one man who had reported a history of diabetes had an “at risk”
blood glucose level, but so too did six others who had no history of diabetes. In the case of cholesterol, 15
men (22% of the sample) who did not report a history of high cholesterol were assessed as being at risk, one
of them at high risk. The situation was similar in the case of blood pressure, with 13 men (19% of the
sample) who did not report a history of high blood pressure assessed as being at risk, one of them at high
risk. Whilst it is recognised that blood glucose tests under uncontrolled conditions are not conclusive, in all
three cases there are indications that workplace checks have the potential to identify risks earlier than might
otherwise be the case.

It is also noteworthy that whilst high blood glucose levels occurred almost exclusively in men over 40 years
of age, many cases of “at risk” or “high risk” levels of cholesterol, blood pressure, and especially girth,
occurred among men in the younger age groups.

Other risk factors assessed included: skin abnormalities, which were self-reported in 33 (49%) of the men;
lack of exercise, with 29 (43%) reporting that they did not undertake continuous physical activity at least
three days per week; smoking, with 24 (35%) of the men being smokers, and alcohol, with 18 (27%) of the
men reporting consumption of more than 2 alcoholic beverages per day.

At the first visit, free diphtheria/tetanus (ADT) immunizations were offered to all the men on the second visit,
and free measles/mumps/rubella (MMR) immunizations were offered to the 35 men in the 18-35 age group.
Seventeen men (25%) requested ADT immunization, of whom 15 (22%) were immunized on the second visit,
and 26 (74% of the eligible 35) requested MMR immunization, of whom 19 (54%) were immunized on the
second visit.




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003      16
Thirty two (47%) of the men were assessed as requiring referrals, 3 of whom required 2 referrals, making a
total of 35 referrals. The great majority of referrals (29, representing 43% of the men) were to a GP; the
others were to Child and Family Services (3), a dietician (2) and a physiotherapist (1). In 21 cases, an
appointment was made immediately by the Project Officer, in 10 cases the men undertook to make an
appointment themselves; in one case, who made the appointment was not recorded.

Follow-up participant survey form

Of the 68 men who participated in the initial workplace visits, 52 returned on the occasion of the follow-up
visit and 16 did not. Reasons for this attrition included work commitments, and absence from work on the
day of the follow-up (although some men came in on their day off, especially for the follow-up). It is
noteworthy that of men requiring a referral, 10 out of 32 (31%) did not attend the follow-up visit. This was
almost twice the attrition rate of those not requiring a referral (6 out of 36, or 17%). It can be conjectured that
this might indicate a lower level of engagement with the program amongst the less healthy men (the referral
group). A very different explanation would be that the reduced return rate amongst those referred might be
due to a perception amongst some of this group that their health needs were being met as a result of the
referral process. Information as to whether those in the referral group who did not return actually attended
their appointments would help to shed light on this, but we have no way of knowing this.

Of the 22 men who had required a referral and who returned on the second visit, 15 (68%) reported
attending the appointment. The reported attendance rate was the same amongst those who had undertaken
to make their own appointments and those for whom an appointment was made. Among those who reported
attending their appointment, the most common reason chosen from a list of six reasons was “I felt it was
important for my health/wellbeing” (11 men, representing 34% of the 32 requiring referrals, 50% of the 22
requiring referrals who returned on the second visit, and 73% of the 15 who returned and reported attending
their appointment). This was followed by “I have decided to take more interest in my health as a result of the
Healthy Men Program” (6 men, representing 19% of the 32, 27% of the 22 and 40% of the 15).

Seven men gave reasons for not attending their appointment; these were quite evenly spread across all the
options provided.

Forty five men (88%) reported that participation in the Healthy Men Program had made them more aware of
both their health and their wellbeing. However, perceived levels of health and fitness were generally similar
on the second visit to those reported on the first visit. Three men reported that new health/medical condition
had been identified since the first visit.

Whilst the men reported similar levels of challenge in balancing work and family life as they had on the first
visit, a sizable minority (8 men or 16%) reported that they had made changes to the way they achieved this
balance. Changes included “spending more time with the family”, “better planning”, “more exercise”, and
“not volunteering for overtime”. It is noteworthy that of 7 men who assessed their health as excellent, 4
(57%) said that balancing work and family life was never a challenge. In contrast, of the 61 men who
assessed their health as less than excellent, only 4 (7%) said that balancing work and family life was never a
challenge.

Follow-up participant health record

Unsurprisingly, after only 3 months there were no spectacular changes in the overall health statistics.
Nevertheless Table 2 shows that among the 52 men who were tested on both occasions, the percentages at
risk with respect to all four key risk factors were lower at the follow-up visit.

                        Table 2. Health Risk Assessments: Initial and Follow-up Visits

                                                       Percentage ‘at risk’ or ‘high risk’
                                    All participants           Participants who returned on follow-up visit
                                          n=68                                     n=52
     Factor                            Initial visit              Initial visit            Follow-up visit
                                            %                          %                         %
     Blood glucose                          10                         12                         8
     Cholesterol                            29                         25                        19
     Blood pressure                         29                         32                        30
     Girth                                  59                         59                        57




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003         17
There was a marked change in the level of reported physical activity. Of 22 who reported at the initial visit
that they did not undertake continuous physical activity at least three days per week, 7 (32%) reported at the
follow-up visit that they did now undertake such activity.

Two out of 16 (13%) reported giving up smoking between initial and follow up visits.

Learnings and Generalisability
The ‘Healthy Men’ Project was based on refinement and enhancement of the previous ‘GPs and Men: At
Work’ Project. The major learnings from the earlier project that benefited the current project were to
implement a follow-up program to be able to measure change more effectively, including the referral process,
and how effective the project was in encouraging participants to attend their appointments. Other learnings
that were acted on were to make use of local community organisations such as the Lions Club caravan that
the was utilised to accommodate privacy and confidentiality of participants. An immunisation program was
introduced and a greater emphasis was placed on the wellbeing component of men, which was perhaps not
so evident in the earlier project.

Learnings that resulted from the implementation of the ‘Healthy Men’ Project were:

·     To consult earlier with specific program team staff regarding the times it may take for them to meet with
      individuals, to allow for a more accurate prediction of the program time. Workplace engagement is
      based on commitments made to the employer prior to them agreeing to participate in the program.

·     To undertake a practice/pilot run through of the actual process on the day, to ensure times are accurate
      and that workplace engagement is not jeopardised because of excessive time off the floor for employees

·     To ensure all program team members are well briefed on the process, and that they have the opportunity
      to comment on tools they will be required to use prior to the finalisation of these tools

·     To provide clearer labelling and identification of program team staff, and areas for participants to find
      their way through the process easier

·     Greater emphasis is needed when negotiating available consultation areas within workplaces to ensure
      privacy and confidentiality at all times

·     Development of the survey tool requires great effort to ensure the questions asked will provide specific
      data for research findings. An example of this with the Phase 2 Project was to omit asking participants
      the actual hours they worked each week, instead categorising the hours. This left the data to present
      that a certain % of participants worked between 40-45 hours per week, which rated a high response,
      however many employees can work a 40 hour week based on the availability of a rostered day off
      system.

These learnings have been incorporated in the documentation of the Model (Attachment 1).

The Model document can be utilised for men’s health programs in other workplaces, and it could also be
adapted for use in various other contexts. For example, it could be extended to include a model of health
and wellbeing for women only, a generic model for men and women, or a model for school groups. This
model could be targeted at white-collar industry groups where workplace stress may be a prominent factor.

Sustainability
Beyond the funding life of the Project, as a means of promoting the sustainability of the workplace health and
wellbeing program, it is highly recommended that funding is sought for promotion, marketing and distribution
of the Model document, both locally and nationally. It is important this is done in a timely manner whilst the
ownership of the Model is still a key item on the agenda for participating stakeholders and community
organisations, especially in light of the recent Launch event where an official launch of the Model was held in
the community.

The Model was developed and documented in its present form under some time pressure to meet deadlines
for completion of this project. Consideration should be given to further development and enhancement of the
Model, and publication of a revised edition. One example of a worthwhile enhancement would be the




    ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003   18
                                          18
inclusion of a “stages of change” component, so that participants could monitor their progression through
each stage on an annual basis, which would act as an incentive for workplaces to continue to implement the
program annually.

Support and endorsement of the Model should be sought from statutory agencies such as WorkCover, which
would encourage its uptake by workplaces.

Funding should be sought to enable Ballarat and District Division of General Practice and/or Child and
Family Services Ballarat to offer an advisory and support service to assist workplaces to implement the
Model.

Funding should be sought to enable the results of this project to be promulgated through conference
presentations and publication in professional journals.




18
     Kaplin, Sallis et al “Health and Human Behaviour” 1993 pp58-59

     ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003   19
REFERENCES
Australian Bureau of Statistics, “Measuring Wellbeing: Frameworks for Australian Social Statistics” Defining
Health’ 12 October, 2001

Ballarat & District Division of General Practice, “GPs Working for Men” Final Project and Evaluation Report”
Feb 2002

Bond G. “I’d sooner talk to someone….” Improving young men’s access to health and welfare services”
Coburg, Victoria, Moreland Community Health Service, 2000

Department of Human Services “Men’s Health Planning Strategic Framework – 2001”

Department of Human Services: “Victorian Burden of Disease Studies: Mortality and Morbidity” 1999

Kaplin, Sallis et al “Health and Human Behaviour” 1993

North West Melbourne Division of General Practice “Addressing the Health Needs of low socio-economic
males” 2000

Rowe,J “Men’s Health Promotion in General Practice: A review of the Literature” June, 2000

Vic Health “Developing an Intersectoral Strategic Framework for Men’s Health Promotion – Vol 2” 2000-01

www.abc.net.au/rural/health/papers/paper4.htm accessed 29 August, 2003

www.menshealthtuneup.com.au/ accessed 12 August, 2003




  ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003   20
APPENDICES & ATTACHMENTS
Appendices

Appendix 1           Program Team Evaluation Form Initial Visit

Appendix 2           Program Team Evaluation Form Follow-Up Visit

Appendix 3           Employer Evaluation Form Initial and Follow-Up Visit

Appendix 4           Participant Questionnaire Initial Visit

Appendix 5           Participant Questionnaire Follow-Up Visit

Appendix 6           Assessment Record Initial Visit

Appendix 7           Assessment Record Follow-Up Visit

Appendix 8           Referral & Appointment Record

Appendix 9           Referral Form

Attachments

Attachment 1         ‘Healthy Men’: A Model for a Workplace Health & Wellbeing Program




 ‘Healthy Men’ Project Final Report - Ballarat & District Division of General Practice - August 2003   21

								
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