Noel Richardson - Man Matters

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					Challenges to Engaging Men in
       Health Services

Man Matters Seminar Belfast
     18th May 2010
         Noel Richardson PhD
       Centre for Men‟s Health
  Institute of Technology Carlow &
   Men‟s Health Forum in Ireland
            EU25                                          74.8             81.1

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      Net herlands                                                        80.7
**Unit ed Kingdom                                                         80.5
            Malt a                                                         81
          Aust ria                                                             81.7
            Spain                                                                 83.1
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       *Germany                                                            81.2
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        Lit huania                                                77.5
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           Lat via                                          76
                      Li fe Expe ctan cy (ye ars )
          Health Inequalities
• Men in SEG 6 are 3 times more likely to die
  from circulatory diseases, 6 times more
  likely to die from respiratory disease and 4
  times more likely to die from suicide than
  those in SEG 1
                      (National Men‟s Health Policy)
 Men’s sense of place in a changing Ireland –
Issues highlighted in consultation process for NMHP
 • Blurring of the lines between
   more traditional male/female
 • Changing family structures
 • Labour market vulnerability and
   lack of security of job tenure
 • Access to affordable housing
 • Disintegration of rural
   communities – isolation,
   difficulties with access to
 • Rapid shift from a monocultural
   to a multicultural society
Increased attention
on the gendered
nature of lifestyle
factors - smoking,
alcohol intake, diet,
Men seen as reluctant to heed health advice…
Men are also slow to go to the doctor
• “When I woke up the next morning, my
  testicle was horrendously swollen, almost to
  the size of an orange. I pulled on my
  clothes, got my bike from the rack in the
  garage, and started off on my usual ride, but
  I found I couldn‟t even sit on the seat. I rode
  the whole way standing up on the pedals”
  (Lance Armstrong; It‟s not about the bike,
Is it „inbred‟ or in „our genes‟?
                 • PAUL: Its feeling that you
                   are a bit soft if you run to
                   the doctor…you‟re afraid
                   of being laughed at,
                   rejected I suppose, being
                   accused of being a
                   INTERVIEWER: And
                   where does that come
                   from do you think?
                   PAUL: Well, its
                   something inbred in men
                   I suppose, its in our
                   genes. Paul 58
The lessons boys learn
        • “…when I was younger, I
          mean, you didn‟t talk about
          things, if you were upset or
          down or suffering in some
          way, you just didn‟t talk, at
          least I didn‟t talk about them
          anyway.” Ray 38
        • “If you let yourself go in this
          town, you‟d get yourself
          killed… to be seen as soft like,
          or a whinger…” Mark 22
Irish men’s reluctance to seek help

Over half (52%) of Irish men surveyed
 (n=571) expressed reluctance at going to the
Three out of four men reported adopting
 strategies of „avoidance‟ or „silence‟ in the
 way that they managed themselves through
 an emotional or mental health issue.
                CLÁN Study
• In response to how students felt they would
  respond to feeling very anxious or depressed,
  male students (compared to female) were
  - significantly less likely to seek help or to access
  a counsellor
  - significantly more likely to adopt „negative
  - significantly less likely to use their social
  networks of friends, parents or other relatives
  as a source of support
         „Choosing‟ to seek help
– factors associated with delayed help-seeking
• A sliding scale of acceptability in terms of
  how ‘normal’ a problem is seen
  “I would not tell anyone that I was
  depressed…I‟d just hold it back in there and
  go on about my business” Gordon 54
           „Choosing‟ to seek help
– factors associated with delayed help-seeking
• A sliding scale of acceptability in terms of how
  „normal‟ a problem is seen
• A threshold of ill-health required before
  seeking help
• “…the reason it [counselling] came up was
  that I actually broke down in tears, talking
  to the occupational therapist, it just came
  over me like a wash, I couldn‟t believe it, I
  was blubbering like a child and…when I did
  go back to the GP, his advise to me was just
  motor on.
  I see, and were you happy enough to take
  that advise?
  Ah sure I was really, you can wallow too
  much you know. Kieran 40
           „Choosing‟ to seek help
– factors associated with delayed help-seeking
• A sliding scale of acceptability in terms of how
  „normal‟ a problem is seen
• A threshold of ill-health required before seeking
• Lack of awareness and delayed help-seeking
          „Choosing’ to seek help
– factors associated with delayed help-seeking
• Lack of awareness and delayed help-
  BILL: It‟s something you want to keep to yourself
  you know…there were times when I‟d turn around
  and break down in front of the wife…I was crying
  all the bloody time
  INTERVIEWER: And do you think you were
  aware of what you were suffering from?
  BILL: I didn‟t know for years what I was
  suffering from…I knew people got depressed, but
  I didn‟t really know what depression was… Bill
              „Choosing‟ to seek help
– factors associated with delayed help-seeking
• A sliding scale of acceptability in terms of the
  „normativeness‟ of problems
• A threhold of ill-health required before seeking help
• Lack of awareness and delayed help-seeking
• Weighing the balance – loss of autonomy/control
• Fear
• The GP practice as a female gendered space
• Practical Barriers
   –   Waiting times
   –   The waiting room
   –   The constraints of a 5 minute consultation
   –   Cost
   –   Work
       „Choosing‟ to seek help -
factors associated with prompt help-seeking
• Transitions in men’s lives (marriage,
  fatherhood, personal crises, age)
• Responsibilities as breadwinner
• Past experience of ill-health
• ‘Faith in my GP’
• Covenience
• ‘The nagging wife’
Do men prefer a male or a
     female GP?
    During the consultation process for the National
     Men’s Health Policy, a ‘male-friendly’ health
          service was described as one that is
•    accessible
•    affordable
•    provides a waiting area in which men feel at ease
•    focuses on the man, not the symptoms
•    endeavours to treat patients promptly, in a friendly way,
     respectfully and sensitively
•    operates to an agreed standard consulting time
•    ensures that all paperwork is user-friendly
•    recognizes that some men may be reluctant as patients by
     facilitating ease of communication between health service
     provider and male patient
•    supports men to make sense of health information and
•    allows for medical issues and procedures to be explained
     in „lay man‟s terms‟.
        Qualities men value when
        communicating with a GP
•   Adoption of a „frank approach‟
•   Demonstrable competence
•   Thoughtful sense of humour
•   Empathy
•   Prompt resolution of health issues
                        (Smith et al, 2008)
   Best practice in engaging men in
community development work (NMHP)
1. Adopt a positive approach to men‟s health work.
2. Create non-threatening and male-friendly
3. Make services and programmes easily
4. Use language that is positive and solution
5. Use opportunistic and innovative ways to market
   work and make initial contact.
     Best practice in engaging men in
      community development work
6. Consult and involve men in programme
    development and delivery and provide
    individual responses to individual needs.
7. Find a “hook” and a way in that will appeal to
8. Adopt a hands-on approach and make sure there
    is clear focus to the work.
9. Plan small and realistically.
10. Strive for higher standards of best practice in the
          Men‟s Health Training
            Key Learning Outcomes
• Develop a critical understanding of different
  approaches to defining and understanding
  „men‟s health‟.
• Understand and apply principles of best
  practice in working with men
• Be sensitive to the barriers & prompts
  experienced by men when accessing health
  and social services
• Be able to utilise Brief Interventions and
  Motivational Interviewing Techniques with a
  specific focus on men

9.30am    Introduction & setting the scene

10am      What is „men‟s health‟ and why do we need a specific focus on
            men‟s health
11am      Coffee

11.15am   Examining gender and men‟s health & the social determinants of
             men‟s health
1215pm    Best practice in engaging with men
1pm       Lunch

1.45pm    Health Behaviour Change and Motivational Interviewing when
            working with men – finding the hook; eliciting change talk,
            responding to resistance; assessing readiness to change
4pm       Wrap up
4.30pm    Close
             In conclusion…
• Yes, there are challenges to successfully
  engaging men in health services
• Yes, there are significant barriers that men
  have to overcome in order to be more
  proactive about their own health
• Key message for men–
  ‘Seeking help is the sensible and manly
• The provision of training to service
  providers has a key role to play in enabling
  men to present promptly to health services
•   Addis, M.E. & Mahalik, J.R. (2003). Men, masculinity and the contexts of help seeking.
    American Psychologist, 58(1), 5-14.
•   Courtenay, W. H. (2000b). Constructions of masculinity and their influence on men‟s
    well being: A theory of gender and health. Social Science and Medicine, 50, 1385-1401.
•   O‟Brien, R., Hunt, K., & Hart, G. (2005). “Its caveman stuff, but that is to a certain
    extent how guys will operate”: men‟s account of masculinity and help seeking. Social
    Science and Medicine. 61, 503-516.
•   O'Dowd, T. and O'Keeffe, F. (2004) Men and their Health – A Primary Care Initiative.
    Dublin: Department of Public Health and Primary Care, Trinity College, Dublin.
•   Richardson N. (2004). Getting Inside Men’s Health. Health Promotion Department,
    South Eastern Health Board, Kilkenny.

•   Smith J et al (2008). Qualities men value when when communicating with general
    practitioners: implications for primary care settings. MJA 189, 11/12: 618-621White,
    A., & Cash, K. (2004). The state of men‟s health across 17 Western European countries.
    Journal of Men’s Health and Gender, 1, 60-6.

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