Health Education Research Advance Access originally published online on May 5, 2005
Health Education Research 2005 20(6):730-738; doi:10.1093/her/cyh033
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‘You ain't going to say...I've got a problem down there’: workplace-based prostate health promotion with men
1 Institute of Health, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK
2 Correspondence to: A. Dolan; E-mail: a.dolan{at}warwick.ac.uk
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Abstract |
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 Top Abstract Introduction and backgroundResearch study and designFindings: men's attitudes to...DiscussionConclusionReferences |
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Prostate health has emerged as a key health issue for men. Nearly 10 000 men die from prostate cancer each year and many more live with non-cancerous, but debilitating, prostate conditions. Despite the widespread prevalence, evidence suggests that men lack knowledge about male cancers and conditions, and are more likely to ignore signs and delay seeking help. Health promotion with men in the workplace is, therefore, increasingly being advocated as an important way of providing men with health information and encouraging them to see a health professional where appropriate. However, there has not been a developed account of men's views on health promotion within the workplace. This paper presents the findings of a small-scale qualitative study that explored men's perceptions and experiences of three different workplace-based health promotion interventions to improve prostate health awareness and their attitudes towards the workplace as an appropriate setting for promoting men's health. This paper shows that men generally welcomed a workplace-based health promotion campaign targeted specifically at them. However, the masculine ‘culture’ of the workplace, where concerns about health were likely to be met with ridicule rather than concern, was one important factor in understanding these men's views of different health promotion interventions.
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Introduction and background |
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TopAbstractIntroduction and backgroundResearch study and designFindings: men's attitudes to...DiscussionConclusionReferences |
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This paper focuses on a workplace-based prostate health promotion intervention. The qualitative data originates from in-depth interviews and focus groups that aimed to identify men's perceptions and experiences of three different workplace-based health promotion interventions to improve prostate health awareness and explore their attitudes towards the workplace as an appropriate setting for promoting men's health. These qualitative data were part of a larger, predominately quantitative project (not reported on in this paper) that sought to evaluate the effect of different workplace-based health promotion interventions on men's knowledge and awareness of prostate health, and to investigate men's reported willingness to seek help should they experience a problem.
Prostate cancer is the second most common cause of cancer death in men in the UK. Currently, nearly 22 000 men are newly diagnosed with prostate cancer each year and almost 10 000 die annually from the disease (Men's Health Forum, 2002
). In addition, prostate conditions, such as benign prostatic hyperplasia and prostatitis, feature prominently as a cause of ill health among men, particularly beyond middle age, and may significantly impair quality of life (Cameron and Bernardes, 1998).
Whilst interest in men's health has increased during the past decade, relatively little is known about men's knowledge, attitudes and beliefs around prostate health. The recent review of research into men's health commissioned by the Health Development Agency in England (Health Development Agency, 2002) highlights that the majority of research around prostate conditions has tended to be biomedical in nature and concentrated on the efficacy of techniques for treatment. Barring one or two examples [e.g. (Cameron and Bernardes, 1998)], studies have not adopted a gendered approach that examines the ways in which masculine identities are woven into how men make sense of these conditions in terms of levels of knowledge, risk factors, seeking help, etc.
Living up to dominant norms of masculinity, that support emotional and physical control and reject weakness or vulnerability, may cause men to define asking for help and caring about their health as feminine rather than masculine attributes (Luck et al., 2000; Doyal, 2001; Griffiths, 2001). This can lead men to deny illness and be less prepared to report symptoms, which may account for why men use existing health services less than women and appear less prepared to accept much of the current provision of health promotion on offer to them (Carpenter, 2000; Banks, 2001). Thus, despite the widespread prevalence of prostate conditions, many men remain unaware of the symptoms and possible treatments. This leads to unnecessary suffering as well as delayed diagnosis and treatment, which, in cases of prostate cancer, can be life threatening (Wilson, 1998).
It is increasingly felt that taking health promotion messages to ‘where men are’, such as the workplace, could make a significant difference in providing men with information about their health and encouraging them to see a health professional where appropriate (Davidson, 2001). Health promotion specialists in England have included the workplace as part of their remit since the mid-1980s with the ‘Look After Yourself’ campaign (Health Education Authority, 1997; Wilkinson, 1999). The field of workplace health promotion has subsequently seen developments of interest, not only in the prevention of disease, disability or death caused by the workplace, but also because the working environment provides the opportunity to tackle health issues and improve employee health.
However, while health promotion interventions in the workplace are becoming increasingly common, they tend to be confined to larger enterprises, and often fall within the realm of traditional occupational health and safety activity, rather than having a broader health promotion focus (Sanders, 1993). It is also the case that while health promotion activity with men in the workplace is increasing, relatively little is known about how men themselves feel about such initiatives and the problems men face in participating in such initiatives (Robertson, 1995).
This study has sought to address this lack of knowledge by examining individual men's attitudes towards the workplace as an appropriate setting for promoting men's health as well as their perceptions and experiences of three specific workplace-based prostate health awareness interventions. The three different interventions were: (1) information in the form of posters, (2) a trained nurse to give additional information and (3) a group of male workers trained as peer educators as a means of providing further information.
In the past 10 years community-based peer interventions have become increasingly popular as a method of health promotion within the UK, especially in delivering health promotion to ‘hard to reach’ or socially marginalized groups (Hunter and Power, 2000). Peer intervention involves the dissemination of health-related information by members of target groups to their peers with the aim to help change health behaviour.
Various claims have been put forward for peer education (Bell et al., 1993; Mellanby et al., 2001). First, peer educators allow the efforts of health professionals to be duplicated without additional expense. Second, participants are thought to benefit in terms of improvements in levels of knowledge, confidence and self-esteem. Third, peers of the same gender, similar age and socioeconomic circumstances are thought to increase access to a target group, and any health promotion messages are considered more acceptable when coming from those with shared characteristics (Health Education Authority, 1993; Turner and Shepherd, 1999).
Despite wide advocacy of peer education, the theoretical basis for using this method in health promotion has not been fully defined nor is there a general consensus on the actual process or expected outcomes (Milburn, 1995). This lack of theory is reflected in the lack of understandings of the mechanisms underlying the success or failure of particular interventions. Thus, given our limited knowledge, caution should be exercised in making any substantive claims as to the evidence-base for peer education (Hunter and Power, 2000).
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Research study and design |
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TopAbstractIntroduction and backgroundResearch study and designFindings: men's attitudes to...DiscussionConclusionReferences |
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The study took place within Consignia (now renamed the Royal Mail group, i.e. those group of companies that comprise the postal service in the UK). These companies are the largest single employer of men in the UK. There were three separate study worksites in the West Midlands, containing nearly 300 men (N = 2730). The health promotion interventions at each site varied so that each could be separately evaluated (see Table I), but all took place over a 6-week period.
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All male employees at the three sites received a simple questionnaire, sent to their home address, before and after the interventions. All of the men had access to written information in the form of posters, placed in the men's toilets and throughout the workplace. The design of the posters, using the image of a fireman with a ‘dribbly hose’, was based on a previous poster produced by Men's Health Matters. These highlighted the symptoms of prostate problems and urged men to see their doctor if they had a problem. Posters in the men's toilets provided a direct link between the purpose of their visit and prostate problems.
Men in Sites 2 and 3 also had access to a trained nurse. The nurse visited each site on three occasions covering each of the separate shifts (early, afternoon and night shifts) in order to talk informally about the intervention, to get some understanding of what men had learned from the posters, to discuss any issues arising from this and to give additional information about prostate issues.
Site 3 also had a team of eight male employees from the ‘shop-floor’ who were trained as peer educators, as a means of giving information to other men. The men were recruited to the study either by their line manager or a representative of the Communication Workers Union (CWU). The training consisted of an explanation of the intervention, a discussion of the role of the peer educators and a presentation about prostate health. Due to constraints on time and resources, training was limited to a one-off session conducted in Site 3. With no formal supervision or follow-up system, it was not possible to monitor the peer intervention activity of the workers.
The data used in this paper are drawn from in-depth semi-structured interviews and focus groups. Ten in-depth interviews were conducted at intervention Sites 2 and 3. No access was given in Site 1. The in-depth interviews took place with a group of 10 purposively sampled ‘key’ individuals. These were the three ‘shop-floor’ managers and four CWU representatives responsible for coordination and implementation of the interventions at Sites 2 and 3; the female nurse who carried out the intervention at Site 2 and 3; and two representatives of Employee Health Services (EHS) responsible for employee health at Sites 2 and 3.
The in-depth interviews with employees of Consignia covered their role within the organization and where applicable within the CWU and EHS, their perceptions and experiences of the implementation of the interventions, the feedback they received from other workers, and their views on health promotion around men's health within the workplace. The interview with the trained nurse concentrated on her perceptions and experiences of the intervention, her interactions with men during this period, the advice given to men, and her perceptions as to how it was received. All of the interviews were conducted by the male principal researcher and, with the exception of one, were tape recorded with the respondents' consent and then fully transcribed. Extensive field notes were taken in the one case where permission was not granted.
In addition, two focus groups were conducted in Site 3. No access to conduct focus groups was given in Sites 1 and 2. One focus group was held with a group of 10 male workers who were ‘recruited’ by the two managers in Site 3. We were told that these 10 men were the only one's willing to take part. Although we asked that all male workers should be informed of the chance to participate in the focus group we do not know the processes by which these men were recruited into the study. However, a number of reasons can be suggested as to men's apparent unwillingness to take part. First, the focus group took place shortly before Christmas and the time of year meant that workers could have been reluctant to pass on work to busy colleagues. Second, the sensitive nature of the topic may have resulted in some men not being willing to participate. Finally, men intending to participate may have been working a different shift pattern on the day of the focus group and were, therefore, not available.
Despite the lack of control over the recruitment process, the men in this focus group were generally representative of the workplace population as a whole in terms of age, ethnic origin and job type. The men ranged in age from 26 to 57 years and originated from the two largest ethnic groups—nine described their ethnic origin as white and one as Indian. These men were employed across the three main ‘shop-floor’ job types—five were employed in ‘Deliveries’, three in ‘Processing’ and two in ‘Distributions’. The focus group was led by the principal researcher using a topic guide, whilst a (female) co-researcher acted as a rapporteur. The topic areas included: men's health in general, their perceptions and experiences of the three interventions, and their views on health promotion within the workplace.
A second focus group interview was held with the eight men who trained as peer educators. The topic areas in this group interview concentrated on these men's experiences of the training they received and their role as peer educators, and their general views about health promotion within the workplace. Both of the focus group interviews were audio recorded (with permission granted by all participants) and fully transcribed. The two interviewers' observations were also collated and notes synthesized into detailed accounts for analysis.
The in-depth interview data and focus group data was analysed in accordance with grounded theory (Strauss and Corbin, 1990). Issues raised by the participants were manually indexed and coded according to the themes in the respective topic guides, and were analysed within this framework. Co-researchers analysed the data separately to ensure reliability and validity. Coding and analysis was undertaken throughout the period of data collection so that analysis of early fieldwork could inform the focus of later data collection.
Given the relatively small numbers of individual and group interviews that took place, the two data sets were also integrated and analysed together. The different data sets were, therefore, analysed in two ways: (2) as a data set in itself able to answer aspects of the research questions, and (2) as a data set that was triangulated with the other and overall comparisons made to provide further understanding. Particular care was taken to consider the methodology on each data set and how this may have impacted on the findings. However, no substantive differences emerged from the two separate sources of data. In presenting its findings this paper will concentrate on the participant's views of health promotion within the workplace, and their perceptions and experiences of the three interventions.
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Findings: men's attitudes to health promotion in the workplace |
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TopAbstractIntroduction and backgroundResearch study and designFindings: men's attitudes to...DiscussionConclusionReferences |
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Without exception, all of the people interviewed, whether individually or in focus groups, felt the workforce had generally received the interventions ‘positively’:
I've only heard positive feedback about it really. And like ‘are we doing any more?’... Because a lot in the past, it's always been for women's health. So it was a change. It was like ‘Oh they're finally doing something for us’, type of thing. [Consignia manager: ‘Key Individual’ interview]All of the men in the ‘male workers’ focus group perceived the interventions as the company taking an interest in their health—something that this group of men felt was overdue—and in ways that were not related to their general fitness for work.
The use of posters
The use of posters was reported as having attracted a great deal of attention and had been the topic of conversation between groups of men (and women) throughout the workplace:
You could hear people talking about it...‘Where's your prostate?’. Women going, ‘Where's my prostate?’ [Laugh]. [Consignia manager: ‘Key Individual’ interview]One of the men in the ‘Male Worker’ focus group linked this attention to the ‘eye-catching’ design of the poster and that it was ‘not offensive to anybody’. The lack of graffiti on the posters was viewed as highly significant by the ‘shop-floor’ managers and CWU representatives in terms of the message being taken seriously:
It's the first time...nobody's written anything on 'em. Nobody's pulled 'em down. Before, if you put anything in the toilets like that...somebody's gobbed on it...or they make a sarcastic remark.... If people had...took advantage and put graffiti on 'em, then I would have been concerned thinking ‘Oh they're not really bothered. Nobody's interested’. [CWU representative: ‘Key Individual’ interview]All of the men interviewed, whether individually or in focus groups, felt that posters were generally a ‘good’ way of raising awareness about prostate health. The following quote is illustrative of these men's perceptions and experiences of the posters:
They were noticed...you can't help but read them. So in that respect it works, it worked well.... One or two people have spoken to me. Ever since they've read them they're going to the toilet every 5 minutes kind of thing.... And that's true for myself.... You notice how many times you keep looking at the poster.... That's the ideal place to do it. [Consignia manager: ‘Key Individual’ interview]All of those interviewed in Site 2 and 3 remembered the posters and the image of a fireman ‘having trouble with his hose’, and most reported that it was informative. However, the nurse involved in the intervention found that while the majority of men reported to her that they had seen the posters, few had retained any of the messages contained within them. Many of the men did not know what symptoms to look out for and tended to confuse prostate awareness with testicular awareness.
The nurse intervention
All of the men interviewed, whether individually or in focus groups, viewed the nurse intervention positively:
The feedback I got was very good. I haven't heard of anybody really here objecting to the fact of what she was talking about and that it was while they're eating their pudding [Laugh]. [Consignia manager: ‘Key Individual’ interview]All of the men in the ‘Male Worker’ focus group felt that the ‘down to earth’ approach adopted by the nurse was a key reason why so many of the men felt so positive about this experience:
She put me at rest and she laughed and she joked.... We talked about things what I would never talk to another woman.... How they find it, like, in different ways. [Shop-floor worker: ‘Male Worker’ focus group]This entire group expressed their wish for the nurse to have been present for longer periods to allow more men to see her. They also wanted such initiatives to be continued in relation to other health issues, such as cholesterol and blood pressure. These men felt there were opportunities for health checks and discussion about health to be incorporated into their ‘work-time learning’, which they believed concentrated too much on health and safety issues. They did not think that EHS were suited to such a role, as they felt it was a ‘tool of the management’. All of the men in this group agreed with the views of their colleague expressed in the following extract, which highlights the lack of confidence these men had in the EHS not to link health concerns to patterns of attendance:
They're not a health service.... All they are is some body what people go to when their attendance pattern becomes irregular.... I don't think [the EHS] is there to support the staff. I think [the EHS] is there to support the attendance procedure.... You don't go to Employee Health Services if you've got a health problem. You go to 'em if you've got an attendance problem. [Shop-floor worker: ‘Male Worker’ focus group]Somewhat in support of these claims, neither of the EHS representatives or the EHS help-line had received any enquires regarding prostate problems over the course of the intervention.
The role of peer educators
The focus group held with the peer educators showed that in general they enjoyed the training they received, but in the main they did not perform their role as envisaged. None of these men reported approaching other men ‘uninvited’ to talk about prostate health. Neither did they speak at any length to men who approached them, other than to explain their absence during their training or to hand out leaflets. The following extract from the ‘Peer Educator’ focus group is representative of these men's experiences:
- PE.5 To be honest I wouldn't expect somebody to personally come to me and say I've got a problem.... They might come and ask me for some information generally but I wouldn't expect 'em to come and say ‘yeah I've got a problem’.
- A Did anyone ask you for a leaflet or for more information?
- PE.5 I had a couple of people. Not a great deal.... But if you were telling them I've just been and done training...people would then be interested.
- PE.3 As soon as you came out of the meeting they were all asking like where have you been or where you were. And you give them the leaflets to read if they wanted them. If they didn't want them you didn't give them to them.
- A Did anyone ask you for a leaflet or for more information?
- PE.2 I don't think it...contributed to the subject.... But what it did by giving it a more focal sort of point...that people had volunteered and done training and like we'll answer questions if need be. It just...highlights it slightly more.
- PE.1 It...made the link between these are the issues out here and we are men and we can get involved. We can have an impact on this because these are men that we know.
- PE.5 It might have seemed...that none of us actually contributed to...showing somebody the light.... As the training sort of told us to do.... But it just made people aware that people had shown an interest.
- PE.1 It...made the link between these are the issues out here and we are men and we can get involved. We can have an impact on this because these are men that we know.
In many ways, the relationship between peer educators and other workers served as a microcosm of the very gender relations that are believed to contribute to the likelihood of men not accessing traditional health services. The peer educators themselves also suggested that a less sensitive topic may have provided them with more opportunities to apply the training they had received.
The role of workplace ‘culture’
The views of the men trained as peer educators were echoed by the men in the ‘Male Worker’ focus group, none of whom reported having spoken to any of their colleagues about the campaign. One reason for not speaking to their peer educator colleagues was the ‘embarrassment’ they felt talking to other men about health issues in general, but especially one they associated with ‘sex’.
However, it also became clear that these men's perceived inability to talk to colleagues about health was a feature of their male-dominated work place ‘culture’. This view was present across the two focus groups, but was most pronounced in the ‘Male Worker’ focus group. These men felt that the ‘culture’ of the workplace was the main reason why men tended to ‘take the mickey’ around health problems—especially ones they related to ability to ‘perform in bed’—though one man thought that this could be overcome by such campaigns. The following interaction comes from the ‘Male Worker’ focus group:
- MW.2 That's the male culture ain't it.... To joke about it.... It's canteen humour. If a guy come in and says...‘I had a rough night last night. I kept getting up and going to the toilet’. Nobody would...say ‘Oh you want to go and see your doctor’.... They'd make a joke about his private parts or something.
- MW.5 Whereas perhaps now somebody might be sensible enough to say, you want to go.
- MW.2 If you're talking about...prostrate problems,...it's like your sex life ain't it like.... That's like the big sort of canteen joke. It's like he's no good he can't perform any more.... It is a big worry like when you see that.
- MW.5 Whereas perhaps now somebody might be sensible enough to say, you want to go.
Humour was mixed with embarrassment and ignorance—both in terms of men not knowing what to say to other men and with other men exposing a health problem perceived to relate to sexual performance. All of the men in the ‘Male Worker’ focus group agreed that they would be ‘shocked’ should another man approach them for advice about sensitive health concerns:
If somebody did come to you and...they was quite serious and genuine about it...you'd take a step back. It'd be quite shocking really for somebody to say...‘I got this problem like. You know. What do you think I ought to do?’. [Shop-floor worker: ‘Male Worker’ focus group]In general, the men in the ‘Male Worker’ focus group were fearful that should they, or one of their colleagues, disclose particular problems then that person would become the subjects of jokes and innuendo amongst their colleagues:
- MW.5 There's health problems and health problems though.... If you've got like a headache or something you'll talk about.... If you've got problems down there...I ain't going to say...‘Me balls are aching’ or something like that.... It's a different kind of conversation isn't it.
- MW.3 It's embarrassment as well I think.... It's like what blokes don't talk about.... And you just laugh to humour it a bit like you know. Lighten it.
- MW.2 It ain't like a taboo subject. But I mean...with men like it is a bit.
- MW.3 It's a bit personal, ain't it, really?
- MW.2 You'll laugh and joke about your sex life and that but you wouldn't tell somebody...I can't perform.
- MW.5 You'd be ridiculed then. I wouldn't be able to come to work.... That'd be like signing your death sort of warrant.
- MW.4 We would give him stick. Every little joke we would take the piss out of him.
- MW.3 It's embarrassment as well I think.... It's like what blokes don't talk about.... And you just laugh to humour it a bit like you know. Lighten it.
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Discussion |
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TopAbstractIntroduction and backgroundResearch study and designFindings: men's attitudes to...DiscussionConclusionReferences |
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This paper has sought to examine men's attitudes towards the workplace as a setting for promoting men's health, and their perceptions and experiences of three specific workplace-based prostate health awareness interventions. It has done so via a relatively small-scale study employing qualitative methods, which are increasingly advocated as a more effective means of exploring issues around gender and health (Popay and Groves, 2000
). The paper has shown that those men interviewed, whether individually or as part of a group, generally welcomed a health promotion campaign targeted specifically at them. Most of the men felt the campaign was ‘overdue’ in terms of concentrating on men's health ‘for a change’ and wanted further ‘men's health’ initiatives to be considered.
Two aspects of the intervention gained the men's general approval. First, the posters placed in the men's toilets. Posters were placed above the male urinals and elsewhere based upon evidence from other studies which suggests that health promotion initiatives aimed at men are most effective when they are highly visible and leave men in no doubt that it is aimed at them (Men's Health Forum, 2002). However, while the men interviewed found the posters to be directed at them specifically, attention grabbing and informative, evidence from the nurse suggested that most of the men she spoke to had not retained the information. Thus, while the posters appear to have met most of the criteria for printed material, in that they were viewed as interesting, acceptable and directed at the reader, the health promotion message contained within the posters may have lacked some clarity [see (Hawe et al., 1990)].
Second, the pro-active and ‘no nonsense’ approach of the nurse involved in the intervention had gained universal approval, which the men felt overcame any issues of embarrassment and led them to ask her about wider health issues not related to prostate health. A growing body of evidence [see (Men's Health Forum, 2002)] suggests men will respond to outreach services when they are offered in places where they already meet and when health professionals develop ways of working that minimize the discomfort that some men feel when they engage with health services. Importantly, these services may also act as a springboard towards men's use of primary care.
The men were more ambivalent about the third intervention, which used male workers trained as peer educators as a means of providing further information. While none expressed negative comments about the use of peer educators, the men on the ‘shop-floor’ found it difficult to overcome a strong workplace ‘culture’ where concerns about health, particularly those that men generally linked to sexual performance, were likely to be met with ridicule rather than concern, which made it difficult for men to seek information from colleagues about prostate health. Thus, how men perceive their position and relationships within the workplace, and how other men might perceive them if they begin to be more open around health matters, are important factors to consider in future workplace-based health promotion initiatives with men. The peer educators also found it difficult to overcome their own as well as other men's embarrassment should they instigate a conversation around prostate health. Therefore, while the recruitment of men as peer educators does signal the fact that men will take an active part in health promotion campaigns, involving men as informants or advocates for a professional-led initiative may be a more feasible role for men in similar settings.
Inevitably this study has certain limitations. First, given the fact that this was an externally funded project we have not been able to maintain contact with the research venue and, therefore, have no way of judging the longer-term impact of the health promotion interventions. Second, we also need to be realistic about the effectiveness of a peer-based health promotion intervention founded on a one-off training session. Finally, the findings of this paper cannot be generalized, due to the small scale of the study. However, by sharing the perceptions and experiences of the small group of men who took part in the study it has sought to begin to highlight the complexities that sculpted these men's understandings of health promotion initiatives within the workplace and, as such, provide some valuable indicators for health promotion practitioners working with groups of men in the workplace.
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Conclusion |
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TopAbstractIntroduction and backgroundResearch study and designFindings: men's attitudes to...DiscussionConclusionReferences |
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While this has been a relatively small study it has shown that the workplace can provide an ideal setting in which to deliver health promotion to men. The findings from this study suggest that men are, in fact, more interested in their health than is usually assumed, but that workplace-based health promotion should be tailored to take account of men's wider concerns and experiences within their workplace. While the men interviewed in this study welcomed certain aspects of the intervention, they did not feel comfortable discussing health matters with their colleagues, because of embarrassment and fear of opening themselves up to ridicule. However, they were willing to talk to a trained health professional about their health concerns. Having said this, the men's willingness may have been influenced by the ‘no nonsense’ approach adopted by the health professional in this study.
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References |
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TopAbstractIntroduction and backgroundResearch study and designFindings: men's attitudes to...DiscussionConclusionReferences |
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Banks, I. (2001) No man's land: men, illness and the NHS, British Medical Journal, 323, 1058–1060.
Bell, R.M., Ellickson, P.L. and Harrison, E.R. (1993) Do drug prevention effects persist into high school? Preventative Medicine, 22, 463–483.[CrossRef][Web of Science][Medline]
Cameron, E. and Bernardes, J. (1998) Gender and disadvantage in health: men's health for a change. In Bartley, M., Blane, D. and Davey Smith, G. (eds), The Sociology of Health Inequalities. Blackwell, Oxford, pp. 115–134.
Carpenter, M. (2000) Reinforcing the pillars: rethinking gender, social divisions and health. In Annandale, E. and Hunt, K. (eds), Gender Inequalities in Health. Open University Press, Milton Keynes, pp. 36–63.
Davidson, N. (2001) Guidelines for practice. In Davidson, N. and Lloyd, T. (eds), Promoting Men's Health: A Guide for Practitioners. Bailliere Tindall, London, pp. 261–287.
Doyal, L. (2001) Sex, gender and health: the need for a new approach. British Medical Journal, 323, 1061–1063.
Griffiths, S. (2001) Inequalities in men's health. In Davidson, N. and Lloyd, T. (eds), Promoting Men's Health: A Guide for Practitioners. Bailliere Tindall, London, pp. 35–43.
Hawe, P., Degeling, D. and Hall, J. (1990) Evaluating Health Promotion: A Health Worker's Guide. MacLennan and Petty, London.
Health Development Agency (2002) UK Men's Health Review. Health Development Agency with the European Men's Health Development Foundation, London.
Health Education Authority (1993) Peers in Partnership. Health Education Authority, London.
Health Education Authority (1997) Health Update: Workplace Health. Health Education Authority, London.
Hunter, G. and Power, R. (2000) Assessing the Feasibility of Peer Education among Homeless People: Big Issue Vendors as Peer Educators. Health Development Agency, London.
Luck, M., Bamford, M. and Williamson, P. (2000) Men's Health: Perspectives, Diversity and Paradox. Blackwell Science, Oxford.
Mellanby, A.R., Newcombe, R.G., Rees, J. and Tripp, J.H. (2001) A comparative study of peer-led and adult-led school sex education, Health Education Research, 16, 481–492.
Men's Health Forum (2002) Men's Health: Out of the Shadows (Annual Report). Men's Health Forum, London.
Milburn, K. (1995) A critical review of peer education with young people with special reference to sexual health. Health Education Research, 10, 407–420.
Popay, J. and Groves, K. (2000) ‘Narrative’ in research on gender inequalities in health. In Annandale, E. and Hunt, K. (eds), Gender Inequalities in Health. Open University Press, Buckingham, pp. 64–89.
Robertson, S. (1995) Men's health promotion in the UK: a hidden problem. British Journal of Nursing, 4, 382–401.[Medline]
Sanders, D. (1993) Workplace Health Promotion. A Review of the Literature. Directorate of Health Policy and Public Health, Oxford Regional Health Authority, Oxford.
Strauss, A. and Corbin, J. (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage, London.
Turner, G. and Shepherd, J. (1999) A method in search of a theory: peer education and health promotion. Health Education Research, 14, 235–247.
Wilkinson, C. (1999) Management, the workplace and health promotion: fantasy or reality? Health Education Journal, 58, 55–65.
Wilson, A. (1998) Getting help. In O'Dowd, T. and Jewell, D (eds), Men's Health. Oxford University Press, Oxford, pp. 259–271.
Received on August 13, 2004; accepted on April 13, 2005
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