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PRACTICAL STRATEGIES FOR IMPROVING MEN'S HEALTH: MAXIMIZING THE PATIENT-PROVIDER ENCOUNTER

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An inconsistent or lack of access to a healthcare provider (HCP) can lead to advanced morbidity and is an oft-cited barrier to advancing health, particularly in the U.S. Review of select literature consistently suggests men are far less likely to engage within the healthcare system, which is particularly problematic relating to preventive service access. As many health conditions are preventable and/or treatable in earlier stages, delay in screening and treatment often leads to long-term adverse health outcomes. Lack of early and frequent preventive healthcare may even be perceived as "normative" where poorer health outcomes in males are expected. Some evidence demonstrates a clear connection that seeking help via healthcare runs contrary to masculinity and dominant masculine principles, such as being strong/sturdy, working through pain, avoiding weakness, and/or perceptions of femininity, among other psychosocial phenomena. Changing healthcare "culture" concerning the care of males (i.e., gender-sensitive care) may provide a salient avenue to encourage more consistent and preventive contact, or "touch points," in the patient-provider dynamic. There is a need to understand how social norms and practices in healthcare and medical settings can be effectively leveraged to address lifelong male health outcomes versus focusing on late(r)-stage palliative care. The purpose of this article is to advance dialogue concerning practical considerations, such as resources (e.g. time, money) and methods (e.g., practitioners considering whether men respond best to immediate efforts to establish rapport versus a traditional power-based dynamic during the medical interaction) to inform gender-sensitive touchpoints in the healthcare of men. Location and types of facilities where men are willing to seek care (preventative or palliative) also need to be considered in a holistic, gender-sensitive patient-provider healthcare model. Implications, policies, and evidence-based practical strategies for leveraging medical education, prevention programming, proper and improper recognition, and health management, and long-term treatment are presented and discussed with the practitioner in mind. Although there is a U.S.-focus with our proposed strategies, we aim to provide a more global context with our future work on this topic.
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Original Article
PRACTICAL STRATEGIES FOR IMPROVING MEN’S HEALTH: MAXIMIZING THE
PATIENT-PROVIDER ENCOUNTER
James E. Leone, PhD, MPH, MS, ATC, CSCS*D, CHES, FMHI1,2,3,
Michael J. Rovito, PhD, MA, CHES, FMHI4,5,
Kimberly A. Gray, PhD, MS, ATC, CSCS, CHES, RYT3, Ryan Mallo, PhD, DNP, NP-C6,7,8
1Professor, Public Health Studies, Department of Movement Arts, Health Studies and Leisure Studies,
College of Education and Health Sciences, Bridgewater State University, Bridgewater, MA 02325, USA
2Adjunct Lecturer, Master of Public Health Program, Bouvé College of Health Science, Northeastern
University, Boston, MA
3Board of Directors and Fellow, Men’s Wellness Collective, Inc. Orlando, FL
4Associate Professor, Department of Health Sciences, College of Health Professions and Sciences,
University of Central Florida, Orlando, FL
5Lecturer, Southern Illinois University, Carbondale, IL
6Director of Nurse Practitioner Programs and Associate Professor, Averett University, Danville, VA
7Adjunct Faculty, Nurse Practitioner Programs, University of Michigan Flint, Flint, MI
8Primary Care Nurse Practitioner, Private Practice, Evart, MI
Corresponding Author Information: Jleone@bridgew.edu
Submitted: November 10, 2019; Accepted: November 15, 2020; Published: January 30, 2021.
ABSTRACT
An inconsistent or lack of access to a healthcare provider (HCP) can lead to advanced morbidity and is
an oft-cited barrier to advancing health, particularly in the U.S. Review of select literature consistently
suggests men are far less likely to engage within the healthcare system, which is particularly problematic
relating to preventive service access. As many health conditions are preventable and/or treatable in earlier
stages, delay in screening and treatment often leads to long-term adverse health outcomes. Lack of early
and frequent preventive healthcare may even be perceived as “normative” where poorer health outcomes in
males are expected. Some evidence demonstrates a clear connection that seeking help via healthcare runs
contrary to masculinity and dominant masculine principles, such as being strong/sturdy, working through
pain, avoiding weakness, and/or perceptions of femininity, among other psychosocial phenomena.
Changing healthcare “culture” concerning the care of males (i.e., gender-sensitive care) may provide a
salient avenue to encourage more consistent and preventive contact, or “touch points,” in the patient-provider
dynamic. There is a need to understand how social norms and practices in healthcare and medical settings
can be eectively leveraged to address life-long male health outcomes versus focusing on late(r)-stage
palliative care.
The purpose of this article is to advance dialogue concerning practical considerations, such as resources
(e.g. time, money) and methods (e.g., practitioners considering whether men respond best to immediate
Leone_WKBK.indd 1Leone_WKBK.indd 1 12/2/20 5:03 PM12/2/20 5:03 PM
DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter
e2
eorts to establish rapport versus a traditional power-based dynamic during the medical interaction) to
inform gender-sensitive touchpoints in the healthcare of men. Location and types of facilities where
men are willing to seek care (preventative or palliative) also need to be considered in a holistic, gender-
sensitive patient-provider healthcare model. Implications, policies, and evidence-based practical strategies
for leveraging medical education, prevention programming, proper and improper recognition, and health
management, and long-term treatment are presented and discussed with the practitioner in mind. Although
there is a U.S.-focus with our proposed strategies, we aim to provide a more global context with our future
work on this topic.
Key Words: Healthcare, masculinity, men, patient education, provider.
INTRODUCTION
Although accessing health care does not necessarily
confer “health”, it does allow for “touchpoints.” It is
through these touch points where preventive health
education, screenings, and treatment are made pos-
sible. Further, organic conversations and subsequent
operative behavior change can often occur during
these interactions. Our collective belief that the ef-
fectiveness of practitioners’ facilitation of
conversation and engagement with their patient
through said
touchpoints is a primary determinant of
positive patient
health outcomes. Pinkhasov and others,
1
however, sug
gest that men are far less likely than
women to access
healthcare, particularly in a
preventive care context.
While not a universal
viewpoint as contended by other
international
research,2 we draw from our collective Western (U.S.)
experiences and literature, that males are less likely to
access and utilize healthcare. This
phenomenon,
therefore, limits the availability of
touchpoints for
wellness promotion among men and
boys. Thus, the
question emerges: What strategies can
we employ to
make these opportunities, when they occur, as
eective as possible?
Theories abound as to why males (particularly ages
18-40) infrequently engage the healthcare system,
including lack of resources (time, money), fear of be-
ing perceived as weak, inconvenient times, and access
points (i.e., appointments), and concerns regarding
gender and cultural insensitivity.3,4 Disparities impacted
by a complex confluence of socioeconomic, cultural,
ethnic, and racial issues also play a significant role
in healthcare and should be considered when tailor-
ing any intervention or outreach.5 In general, society
may just expect or accept men as genetically more
likely to experience greater morbidity and mortality
even though social determinants literature suggests
otherwise. This “normative contentment” with poorer
male health outcomes has been posited and ways to
navigate it proposed in previous research.6 Specific
gender and cultural insensitivity issues include the
lack of male-led programs7 and the perception of some
men that physicians lack appropriate communication
(e.g., tone and salient content).8
Other theories postulate as to why males do not
access healthcare. However, generally speaking, they
can be categorized into three primary areas: 1) lack of
concerted health education eorts, 2) the economic
impact of overall health status among males, and 3)
social norms perpetuating risk factors for males to
live sicker and die younger. The confluence of these
three factors contributes to the current disparate health
outcomes among males compared to their female
counterparts. Therefore, it is paramount for us to begin
to develop strategies, not just talking points, for male
engagement in the clinic, community, and classrooms
to help eliminate said disparities.
EXISTING HEALTH DISPARITIES
Between-Sex Health Disparities
A clear gap exists concerning health outcomes,
particularly morbidity, between the sexes when view-
ing U.S. national data trends (Table 1). Pertaining to
mortality in the U.S., males are significantly more
likely to die than females from nine out of the top
ten leading causes of death.6 Moreover, mortality rate
disparities worsen when viewing data on men of color
and other minority populations (Table 2).8,9 Global
rates, particularly in the West, mirror the U.S.10
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DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter
e3
These data call into question a genetic component
to male health and the role and impact of social
determinants. For example, males are more likely
to consume tobacco and alcohol overly, partake
in riskier behaviors, often leading to unintentional
injuries, and have higher risk occupations, among
others.11,12 These data illustrate that biological fac-
tors of male health, but what and how men and
boys interact with their environments is far more
predictive of health outcomes than any other
variable.
Social structures “assume” men to be
genetically
predisposed to poorer health; however,
scrutiny of
the latter reveals that society has
normalized it versus
proven it biologic fact.6
Within-Sex Health Disparities
Consistent with mortality data between males
and females, stark disparities also exist based on
within-sex comparisons. Except for suicide, chronic
lower respiratory disease, and unintentional injuries,
men of color shoulder the greatest burden of mortal-
ity across the board (Table 2). These data indicate
that Black/African American men have significantly
higher rates of all-cause mortality and heart disease,
almost double the rates of diabetes mellitus, and seven
times greater risk of HIV and homicide compared to
white (non-Hispanic) men. Further, Asian and Pacific
Islander men appear to have a relative health advan-
tage, suggesting social factors (particularly higher
socioeconomic status and education) seem to play
an influential role in mortality and health outcomes.
The latter also reinforces the lesser role of genetics
and the stronger impact of health policy and the social
determinants of male health.
Encouragingly, despite the striking disparities, all
data suggest a modifiable element to them with longer-
term hopes of improving male and population health.
Better and more consistent access to gender-sensitive
providers, comprehensive healthcare policies targeting
complete male health, and the ability of healthcare
providers to be able to help males navigate complex
systems that aect their overall health (i.e., workplace
health, reintegration from incarceration, mental health,
etc.) all can positively impact male health outcomes.
Transmen also experience a severe disadvantage
relative to the previously discussed categories of
mortality data.
13
Transmen health outcomes are likely
worse (particularly minorities) due to social stressors,
healthcare providers’ lack of training and experience
with this population, personal views and bias, and
overall social inequities at all levels, among others.14
For example, the National LGBTQ Task Force and the
National Center for Transgender Equality conducted
their second iteration of the U.S. Transgender Survey
(USTS) involving 27,715 respondents. Results showed
pervasive mistreatment and discrimination in daily
activities, and when seeking health care, compounded
by transphobic bias and structural racism.
15
Other
literature suggests that “social support, community
connectedness, eective coping strategies” and col-
lection of gender identity data appear beneficial and
would enhance appreciation of “mental health risk
and resilience factors among TGNC populations.16
TABLE 1 Top Causes of Death by Race, Sex, and Ethnicity
Causes All Male Female Ratio, m/f
All cause 728.8 861.0 617.5 1.39
Heart disease, Total 165.5 209.1 130.4 1.60
Malignant Neoplasms, Total 155.8 185.4 134.0 1.38
Diabetes 21.0 26.0 16.9 1.54
Chronic Lower Respiratory Disease 40.6 45.1 37.4 1.21
Unintentional Injuries 47.4 65.0 30.8 2.11
HIV 1.8 2.7 0.9 3.00
Suicide 13.5 21.4 6.0 3.57
Homicide 6.2 9.9 2.5 3.96
Adapted from United States (2016).6
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DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter
e4
THE ORIGINS AND COSTS OF MALE
HEALTH OUTCOME INEQUITIES WITHIN
THE HEALTHCARE SYSTEM
Origins
The discussion of male health outcome dispari-
ties is not a novel conversation. There is a rich track
record of prominent and emerging voices in the field
highlighting dierences between males and females
and within male populations. What is underrepresented
in the literature is a practical assessment of where the
disparate outcomes stem from, at least in a way that
organizes the conversation within a systems-thinking
approach. It is one thing to discuss theories of isolated
origins of disparate outcomes between groups, but it
is another to discuss it as a multifactorial unit. Ad-
mittedly, this conversation would most likely warrant
an entire series of manuscripts to pay it appropriate
homage to flesh out needed points of this system, not
just a brief mention in one article. However, our point
is that we need to begin viewing male health from a
more perched view to understand the various moving
parts. Working with individual variables in isolation
can be detrimental if confined indefinitely.
To clarify further on the context here, ‘system’
can have various meanings. We oer the preventive
healthcare ‘system’ to highlight the point. Theories
aside, lack of preventative healthcare confers risk at
all levels of prevention, both from a health and a finan-
cial perspective. For example, the lack of primordial
and primary prevention
17
via health education denies
men knowledge and opportunity to clarify presumed
assumptions about health issues with their health care
provider (HCP) [see Cohn et al.s discussion of male
eating disorders for further clarity on this issue].
18
In other words, there is a dearth of mass media and
public education eorts specifically tailored to inform
men and boys on how to avoid adopting certain risk
factors (i.e., primordial prevention) and how certain
risk factors, if already adopted, can lead to specific
adverse health outcomes (i.e., primary prevention).
Further, research consistently validates that men
avoid healthcare screenings (i.e., secondary preven-
tion) due to fear, lack of awareness, or low perceived
threat (i.e., “it cannot happen to me”), thus lessening
the cost benefits associated with early detection.
19
Lastly, tertiary prevention often does occur for many
men; however, the issue with this form of engagement
is that it often is very costly, invasive, and more often
than not, lacks restorative abilities.
17
Tertiary preven-
tion (i.e., palliative care), often serves as a touchpoint
where men have to engage the health care system
due to declining health and ability. Figure 1 (below)
provides an illustrative example of what this scenario
could resemble.
Costs
A primary concern pertaining to male health and
wellness is the economic impact of a sicker male
community with shorter life spans. Brott et al.20 sug-
gest that the fallout of reduced male activity in the
economic sector due to morbidity and/or mortality
can reach in upwards of hundreds of billions of U.S.
dollars annually. This is primarily due to rising and
TABLE 2 Top Causes of Deaths by Race and Ethnicity
Causes White
White,
non-Hispanic Black/A-A AIAN API Hispanic
All cause 729.9 749.0 857.2 591.2 392.6 525.8
Heart disease, Total 164.5 168.7 205.3 115.4 85.2 115.8
Malignant Neoplasms, Total 156.6 160.8 177.9 103.4 97.1 110.0
Diabetes 19.3 18.6 36.8 34.3 15.5 24.7
Chronic Lower Respiratory
Disease
43.3 45.8 29.3 29.7 11.7 17.1
Unintentional Injuries 50.4 53.9 42.7 53.9 16.8 31.4
HIV 1.0 0.8 7.2 1.0 0.4 1.7
Suicide 15.2 17.0 6.1 13.5 6.7 6.7
Homicide 3.5 2.9 21.4 6.7 1.8 5.3
Adapted from United States (2016).8
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DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter
e5
sustained health care costs, as well as a drop in the
amount of economic output per person. The latter
speaks to poor male health’s economic costs, but the
personal and indirect burdens to families and com-
munities cannot command a cost figure attached to
it. For instance, Rovito21 specifically discusses the
possible eects of economic truancy among males
who were diagnosed with testicular cancer. The author
suggests that the projected costs across the lifespan
for a survivor in terms of treatment, non-participation
in the workforce during recovery and beyond, among
other factors could add up to immeasurable amounts
of money when viewed in the aggregate body of
survivors. Clearly, stop-gap measures to reduce the
economic burden and ideally enhance preventative
healthcare engagement strategies for males is both an
economic priority and an ethical and moral necessity.
Social Forces
A final consideration in improving men’s access
and sustained quality engagement in the healthcare
system is truly respecting the potential issues created
when engagement requires a man to be vulnerable,
as this often runs contrary to masculine ideology and
sociocultural norms.3,19,22,23 Rapport-building, empathy,
and trust are essential in most relationships, but per-
haps even more so in the patient-provider dynamic.24
The latter builds on findings suggesting men are less
willing to be vulnerable with an HCP due to perceived
fears of embarrassing and/or invasive procedures, fear
of healthcare professionals reaction to their lifestyle
choices and practices, fear of receiving bad news,
and fear of receiving a controversial diagnosis that
would incite criticism from close family, friends, or
their partners.3,19,23,25,26
These perceived notions perpetuate lost opportunities
for building a trusting relationship with an HCP. The
issue of perceived vulnerability and trust is heightened
in men of color and has persisted for decades.
27,28
Ad-
dis and Mahalik19 and Connell and Messerschmidt22
noted how men’s perception and endorsement of
masculinity and masculine gender role norms (i.e.,
hegemonic masculinity) also create less opportunity
to engage in healthcare and help-seeking. Providers
need to be acutely aware of the possible barriers to men
FIG. 1 Potential barriers to healthcare for men.
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DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter
e6
seeking help and accessing preventative healthcare to
embed responsive best practices into this healthcare
dynamic. Rapport and trust-building strategies, along
with imbuing an awareness of developing empathy
and shared vulnerability in these relationships, will
be further discussed.
Purpose
In light of the current state of poor men’s health
outcomes and the impactful factors articulated in
the above narrative, the objective of this paper is to
present and discuss practical strategies healthcare
providers could/should consider when engaging male
patients (inclusive of trans men). Consideration of
implementing gender-inclusive strategies into a best
practices clinical approach may allow for a more en-
gaging and meaningful patient-provider interaction,
thus positively impacting men’s health and ultimately,
population health.
ADDRESSING MALE HEALTH DISPARITIES:
PRACTICAL STRATEGIES FOR
TRANSFORMATION
There is a need for more than talking points high-
lighting that disparities exist in male health. Further,
there is a need to provide real, practical strategies that
any practitioner can implement without the assistance
of grant funding, months of planning, expensive cam-
paigns or equipment. Some great work has produced
some critical individual pieces of the puzzle, but now
is the time we oer “ground-up” strategies that are
easy to execute and are eective.
What practitioners have is the “here and now” when
treating or working with males. We operate within a
system and must consider that during counsel. Often,
we only see the man once and are often limited on
how long we can speak with the individual. Most
times, we operate with limited resources; therefore,
it is time for a pragmatic approach to helping males.
In most instances, the following information
provides practical strategies and recommendations
citing evidence-based resources; however, due to the
authors’ diversity and collective experiences in a vari-
ety of healthcare settings, we also provide “tips from
the field” to round out the discussion. These authors
acknowledge that engaging and/or re-engaging men
in a healthcare setting can be challenging work. Not
all strategies may work. Some may only work after
repeated use. Some may only apply to certain age
groups or other demographic subgroups. It depends
on the specific target group in the clinic, community,
or classroom. Finally, this is not an exhaustive list of
strategies, rather, this is a developing model with plans
to expand in the future. Each subsection oers details
of why males initially disengage and then discusses
possible strategies HCPs may wish to consider and
integrate into their practice with male populations.
Interpersonal Barriers
The “interpersonal” level of an individual suggests
that we operate within a social system where others
who also work in said system influence our behaviors,
and subsequently, our health, via their opinions and
actions. To provide optimal care for men, clinicians
need to better understand interpersonal barriers that
may preclude participation in health care. Such bar-
riers include but are not limited to fear, stigma, loss
of social status, negative experiences in accessing
or negotiating the healthcare system, and masculine
norms.19,23,25,26
Story theory originated in the realm of nursing
pedagogy. Research has shown that allowing people
to share their own stories is integral to holistic health
success.29 It is important to allay fears up front. For
example, if someone comes in thinking they have
testicular cancer, it is important not to trivialize their
concern. After listening to their story, if the HCP is sure
that the fear is unfounded, they can attempt message
reframing by acknowledging their point of view and
giving praise for showing personal health advocacy.
Additionally, by addressing the primary concern up
front, they are more likely to focus through the rest
of the consultation. Utilizing phrases connoting the
inherent strength of their proactive behavior, like, “It’s
really strong of you to come in and take care of your
health” or “It shows that you have a lot of strong char-
acter to come in and take care of yourself ”, can assist
in reducing treatment-seeking stigma. This is what was
organized in the “Real Men Wear Gowns” campaign
conducted by Health Partners in Minneapolis, MN.
A means to address these barriers is to have places
that allow men to seek care without negotiating social
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Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter
e7
status. Give people opportunities to seek care where
they do not have to negotiate masculine capital with
their peers. Delivering care in places they naturally
congregate, such as work (e.g., worksite health pro-
motion) or barber shops, has been shown to increase
men’s likelihood to enter into care.23 In a factory for
example, if there is a provider on site, people can come
in o the factory floor and get injuries assessed, but
also have an outlet or opportunity to receive additional
health education and access health resources without
having to take time o or make peers and supervisors
aware of their health challenges. Holding a health
fair or taking clinics to remote places where men are
known to congregate, such as college campuses, youth
programs, barbershops, sporting events, job training
sites, local mosques, homeless shelters, soccer clubs,
bars, dance clubs, and through mobile units, also likely
will encourage participation.22,26,30-32
Fear of receiving bad news, being judged by a
HCP, perceived or actual negative reactions from
family and/or friends, and fear of what their partner
may think also are interpersonal barriers that clini-
cians caring for men need to be ready to navigate.26
This calls into question how we socialize males in
the health care system and emphasize education via
coping strategies, cultivating support systems, and
discussion/training on how to explain what is going
on to support systems. Deficits in being properly
educated in health are a substantial interpersonal
barrier that men face when seeking primordial and
primary preventive care. A lack of knowledge about
when and where to seek healthcare, especially when
no signs and symptoms are present, often delays or
precludes seeking help.
3,19,26
Sensitive issues such
as sexual health also may prove dicult due to the
nature of questions, disclosure of issues (e.g., erec-
tile dysfunction, STIs), and vulnerability during the
physical exam (e.g., disrobing). Practical approaches
to the issues raised could reside in better targeted
health education in schools, gender-sensitive social
media campaigns, and providing more opportunity
in community/work-related venues.
These authors acknowledge that getting men to an
HCP is a challenge making each interaction particularly
important. Maximizing time and topics (especially
sensitive issues) must be viewed as imperative dur-ing
the visit. When talking with male patients about
sensitive subjects (often challenging their endorse
ment of
masculinity) that they are not likely to broach
independently, HCPs need to make healthcare choices
easy and appealing.
17
Adding sexual health screenings
to
routine health visits is essential to reach young
men and
correcting their poor health.33,34 Some of the
ways to get
them are to take mobile units to screen
for STIs, having
STI and prostate screenings at social
events like
baseball games, or barbershops and more
recently
through online platforms like telehealth/
telemental
health.
Additionally, online programs have emerged to assist
men with sexual and mental health and well-being.
However, providers should be aware that some apps
and online virtual appointments could hinder patients
from engaging in holistic, primary, preventive health-
care. Holistic, primary healthcare for sexual health
needs or issues is often the means to create buy-in to
encourage engagement in primary healthcare screen-
ings. For example, if a patient knows that they can get
a prescription online for ED, they may neglect to see a
provider in person and subsequently miss out on other
needed screenings. There are also potential
benefits to
online programs and outlets. Research
has shown
online discussion boards (ODBs) “can be
used as a
potential medium to expand one’s social
network and
acquire support from people who have had a similar
experience.35
Institutional Barriers
In addition to interpersonal barriers, men also face
institutional barriers when attempting to navigate the
healthcare system. Such barriers often include: failure
to
provide up-to-date sexually transmitted infection
(STI)
information and related testing procedures; poor
communication regarding testing and treatment op-
tions; lengthy wait times to see a provider; mandating
patients to give a reason for their appointment (thus
imposing on privacy/confidentiality); judgmental and/
or
disrespectful treatment from providers; and the
expectation that men will discuss their problem with
multiple HCPs during the same visit.23,26,36 Certainly,
these issues are not unique to men, but the extant
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DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter
e8
literature on men being less likely to access health
care in the first place
1
magnifies these issues and
becomes quite apparent in morbidity and mortality
data as noted in Table 1.
Institutional solutions are complex due to the
numerous entities and power dynamics involved.
As the foundational knowledge base HCPs receive
during their professional training is slow to change,
clinicians caring for men need to alter the method in
which that knowledge is conveyed through updates
in professional literature and continuing education
eorts. The latter point also speaks to upstream health
care policy changes that likely will provide a more
consistent and sustainable impact in how clinicians
promote and engage in health care with males. Clini-
cians wishing to care for men have the daunting task
of overcoming both interpersonal and institutional
barriers. Ensuring that the most current testing modali-
ties and treatment options are understood is essential.
This will require each professional to stay up-to-date
with current literature to provide evidence-based care.
Ideally, this should be tracked, monitored and peri-
odically assessed. To combat gender identityspecific
disparitiesin cancer screenings, authors suggest it is
“critical that gender identity questions are included in
cancer and other health-related surveillance systems
to create knowledge to inform healthcare practitioners
and policymakers better of appropriate screenings
for trans and gender-nonconforming individuals.37
As previously noted, research specific to transmen is
severely lacking. To provide improved care for this
segment of the population it will require a broad as-
sessment of “knowledge and biases of the medical
workforce across the spectrum of medical training
concerning transgender medical care; adequacy of
sucient providers for the care required, larger social
structural barriers and status of a framework to pay
for appropriate care.38
Modern facilities, nearby locations, short or no
waiting times, same-day appointments, not having
to give a reason for the appointment, and availability
to receive multiple healthcare services at the same
location are all factors that have been noted to be
appealing to men entering into care.
26,36
Removing
cumbersome processes prior to entering into care, such
as multi-page registration forms, also are favored by
men and patients who identify as male. Scheduling
patients immediately for appointments is essential
and if
scheduling is not possible, then the HCP or
facility should refer them to someone with immediate
avail-ability and do a follow-up to confirm that their
needs were suciently addressed.
Yet another solution is to allow patients to schedule
appointments without having to give a reason. For
some, this may be a deterrent to utilization of online
scheduling since systems typically do not allow a
patient to schedule without providing a reason for
the appointment. When interacting with patients,
HCPs should remain as neutral as possible, even if
the actions or lifestyle of the patient do not align with
their personal beliefs. If the HCP cannot do so, it is
important that they then refer the patient to a provider
that can provide unbiased care. The oce should
have a pre-prepared list of referrals available at the
time of service. Finally, it is essential to ensure ease
of access to services. One of the things that is hard-
est for patients is gaining access to the services the
institution provides, especially to specialists. This is an
institutional/policy barrier that is beyond this article’s
scope; however, it is worth mentioning here. This will
require each system to evaluate whether they have
enough providers to meet the needs of their clientele
and available insurance. Inability to reconcile these
issues will inevitably lead to gaps in care.
Rethinking Communication Style
Individualizing the HCP-patient approach and using
a style that men are responsive to and being flexible
in the delivery of healthcare in a nonclinical environ-
ment are requisite in the successful implementation of
healthcare delivery to men.39 Research has illustrated
that males respond best to direct communication and
a
frank approach. They appreciate thoughtful use
of
humor and utilization of empathy and have high
regard for clinical competence.40 Clinicians also can
help reframe the experience positively by encouraging
men on their decision to seek help and pursue healthy
lifestyles (i.e., shared decision making).
23
In consultation
with transmen, it is also important to consider that
perception of the physician’s critical health concerns
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may be superseded by the patient’s need to arm their
gender identity.13,13,41 Providers also need to create
positive first impressions and male-friendly spaces in
which healthcare is oered. Waiting rooms that have
male interest magazines, health education materials
that target men’s issues, and TV programming of in-
terest to men are immediate and simple steps oces
can take in welcoming men into the primary care
arena. Beyond the practical strategies in this section,
we acknowledge that a greater shift in the way society
interacts with boys (and eventually men) in terms of
healthcare needs to occur. Larger systems change
that encourages emotional intelligence, engage boys
in school systems concerning their health, parental
modeling of healthy behaviors (particularly among
men), and many other considerations may help develop
a better rapport and communication style with health
and health care.
Targeted Interventions
Out-of-clinic interventions are built on the premise
that men are not as likely as women to enter a health-
care setting both nationally and internationally. “Men
almost never come to you; you always have to go to
them. They are keen, it’s just that you can’t expect
them to come to you…39 In other words, men who
are unengaged or under-engaged in the healthcare
system are not generally disinterested in their health,
but rather the forum in which healthcare is delivered.32
An example is worksite health promotion programs
that have been found to reduce medical costs by more
than 25%, and advocates for companies to oer such
programs argue that they elicit a higher return on
investment from the employee. Such programs have
been shown to decrease health system charges by as
much as $300,000 in an 18-month period.20
Interventions aimed at men’s health promotion
need to use targeted messages explicitly geared to-
wards men. Men who irrevocably adhere to strong
masculine beliefs have an even higher likelihood of
not participating in primary preventive care regardless
of increased wealth, income, or occupational status;
therefore, targeted messaging early on in a young man’s
life is paramount.42 For example, reframing stigmatiz-
ing messages like “boys shouldn’t cry” to something
more along the lines of “Strong men take time to
take care of their health so they can take care of their
family” or “It’s ok to show emotion,” can help combat
the hegemonic masculinity that often precludes men
from proactively participating in healthcare. Ideally,
these messages would be delivered from a founda-
tional perspective from a boy’s earliest interactions
with the healthcare system. As he grows, consistent,
age-appropriate messages via parents, school, social
media, and healthcare providers, among others, should
identify risks and concerns and mitigate them with
ap
propriate and consistent follow-up. Ultimately,
we
should advocate for this message to be
reinforced by educators, parents, and HCPs, both
clinically and in
community settings throughout the
lifespan, to ap
proach true social system changes.
Relationship building and open, honest dialogue
are noted to be positive catalysts in helping young
men seek medical care. One study where a provider
connected with the “ringleader” and gained his trust
was pivotal in recruiting and retaining additional men
from a specific group that had not previously sought
care.26 The latter study is unconventional, but it does
speak to the potential value of community outreach,
knowledgeable neighbor models, and development of
trust in harder to reach populations. Oering a holistic
and respectful approach to healthcare in conjunction
with targeted messaging that empowers men such as
“sexual healthcare is a way to be stronger” or “taking
care of your health is cool” has been noted to increase
oce visits by young men.26 Provider compassion
and empathy towards men also is a significant fac-
tor shown to help buer the relationship between
masculine norm adherence and acceptance of health
promoting behavior.43
Realizing that men often are drawn to technology
(e.g., mHealth, online discussion forums, online doc-
tors, telehealth, telemental health), leveraging curiosity
in the utilization of the latest technology and testing
devices can help spur interest in primary preventive
care.
32,43
Online virtual visits, patient portals, or
phone apps would be examples. One example of a
successful, targeted message is that of cell-phone
applications that will send weekly tips and education
on preventive practices and sexual health, in addition
to notifications regarding healthcare directly to the
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patient via their mobile device.32,42,44 Additionally,
for men who are less technologically inclined,
tailoring healthcare messages to patient populations
in formats they interface with regularly, such as sport-
ing events, barbershops or other social venues, these
platforms can be successful in engaging patients in
health-promoting behaviors.31,45
Finally, tailoring healthcare messages to men’s
spouses/partners may prove beneficial as data from
national health surveys have found that partnered men
were more likely than unpartnered men to undergo a
primary health care visit and screenings the last twelve
months.46 Other research suggests that it is critical to
be cognizant of interpersonal partner communication
techniques and how best to foster eective discourse.
Bottor et al.,
47
for example, discusses how wives
position themselves in regulating cigarette smoking
behaviors. Essentially, partners can play a critical part
in the facilitation of their husband quitting smoking.
This can potentially be applied to other maladaptive
behaviors beyond smoking, like not wearing sunscreen
or avoiding preventive screenings to assess colon health.
Perhaps some attention should be paid to how we can
more eectively communicate to a spouse/partner
about their role in their partners’ health maintenance
and give them some helpful tools to promote optimal
well-being among their husbands/partners. While not
an “only” strategy to reach men, further research on
partners and other relationship dynamics also could
provide rich data to integrate in health care practice
when engaging males.
Rethinking the Oce Visit
Treating patients for a concerning primary complaint
and utilizing that visit to complete a general health
assessment is one modality clinicians can utilize to
evaluate a patient’s general health status. For example,
erectile dysfunction (ED) is a common complaint that
will often bring male patients to see a primary care
provider after years of not seeking primary preventive
care.48 While addressing concerns of ED, a provider
also can assess likely concomitant issues such as blood
vessel/cardiac issues and possible psychosocial con-
cerns as well. Similarly, providers need to be cognizant
that diabetes and hypertension are often diagnosed
at the same time as ED, so, theoretically, this is an
opportunity to help patients enter into treatment. Suc-
cessful approaches to retaining men once they have
sought care are noted when providers are professional,
friendly, humorous, and possess the ability to deliver
care that is confidential.23,36,49 Men have emphasized
the need to inform a receptionist and/or nurse of the
reason for a visit as one reason they would not want
to go to a healthcare facility, as well as fear of being
judged, having a provider deliver poor treatment,
or having to wait a long time while leaving work as
barriers to seeking care.
3,23,36
Therefore, providing
alternative ways to allow a patient to check in to an
appointment or disclose his chief complaints, such
as using tablets with patient codes versus names and
conditions, would help allay fears and remove barriers
resulting from the oce visit.
Even the positioning of the provider can influence
how a man may receive health information. Side-by-
side communication and engagement seem to be more
ecacious in promoting health-based conversations
with men than face-to-face or the HCP standing while
the man is seated or lying down.50 Educational reform
in the training of all HCPs (particularly pediatric
physicians in working with parents of boys), utiliza-
tion of men’s health services in the workplace, and
campaigns to target marginalized men and vulnerable
male populations are key to improving men’s health
on a global scale.51
DISCUSSION
The evidence provided in this article and trends
consistently found in health care and other literature
(e.g., socioeconomic), construct a grim reality that
male population health lags in most if not all health
outcomes in the U.S. and globally.51 A goal in writ-
ing this piece is not solely to focus on “male health”
per se, rather, we have consistently advocated for a
population health perspective so as to advance socially
just policies and programs.51 The patient-HCP rela-
tionship is a crucial element in advancing population
health not from a perspective of “things to be done”
to a patient but rather a true focus on the individual’s
holistic health and treatment. Compassionate, engaged,
responsive, and empathic health care that can meet
men where they are (e.g., workspaces, athletic events,
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barbershops) among other factors (e.g., time, resources)
particularly earlier in the lifespan, likely will build a
strong rapport and yield a healthy return on
investment.13
In these authors’ collective experiences and profes
sional
opinions, rapport building through consistent and
continued health care “touchpoints” with men is essential.
Boys and adolescents sporadically engage with an HCP
(often a pediatrician) earlier in life and
perhaps thereafter
for general medical work physicals
or sport/activity-related
needs often to the exclusion of continuity of care and
health maintenance. Young men often are less likely to
regularly see their HCP due to a variety of factors
including, but not limited to: low
perceived vulnerability,
cost, un- or under-insurance,
lacking time and resources,
and fewer immediate health
concerns among others.
3,19,28
Also, seeing an HCP also
may be perceived as a weakness
that runs contrary to masculinity as previously
described.19 These and
several other reasons make it vital
to engage boys
and eventually men throughout the
lifespan to enact preventative health care that is
responsive to a man’s needs (physical, mental, emotional)
when needed.
First impressions with an HCP or “touchpoints”
matter! A man may not be willing to share everything
in the
first few medical encounters with a provider,
however,
focusing on gender-inclusive, empathic care
and rapport
building likely will foster trust in this
dynamic. When a
solid rapport and trust is achieved with an HCP, a man
may be comfortable and allow
himself to be vulnerable to
discussing health concerns
or simply discussing strategies
to remain healthy. The
latter may require an HCP to abandon
all assumptions
(e.g., intent, needs, masculinity) about the
interaction
and simply begin with an open and honest
dialogue.
This interaction and exercise in communication,
trust,
and compassion is likely healthy and beneficial for
both the patient and provider. How HCPs speak and
communicate with men (versus lecturing at them) mat
ters
and often runs contrary to traditional masculine
principles, thus practicing active listening, motiva
tional
interviewing, and even sitting side-by-side can
create
subtle dierences that have a lasting impact in
developing
positive, healthy patient-provider relation-
ships. There
needs to be a switch FROM vertical TO
horizontal
communication methods. This literally
and figuratively meets males where they are. We need
to speak with men, not speak to them. For example,
speaking to males as if they were a friend, family
member, or concerned neighbor tends to provide a
comfort level rather than speaking to them as their
physician or an expert in the field. The latter usually
builds up barriers and does not produce the want and
desire for males to share information and confide in
the practitioner.
The patient-provider relationship, like most things
in life, is a process. Unfortunately, in today’s society,
health care has become highly commercialized where
patients may never see a dedicated provider with the
advent of “big box” health care like Minute Clinics
and urgent care centers.
24
Research consistently points
to men desiring to see a practical outcome or need in
a health care interaction, such as with an injury, clear-
ance to participate in employment or sport, among
others.3,4,19,50 However, as promoted throughout this
article, primary prevention versus reactive health care
will yield better lifespan and population health outcomes
for men and society in general. Lack of investment in
the patient-provider relationship dynamic likely will
lead to lost follow-ups, sporadic access of HCPs only
when costly palliative care is warranted, and a loss
of holistic gender-inclusive health care dynamic for
men. Thus, shifting the health care model of “care
when needed” to a “continuity of care model” for
men may help allay misconceptions about care that
challenge masculinity, foster productive health care
touchpoints, emphasize primary preventative health
care, and imbue men with a sense of responsibility
and value in their health, because it matters!
Let us take Figure 1 and work in reverse to oer
an example of the above call to arms. Keep in mind
that appropriately targeted and specific “touchpoints”
with an HCP could be critical in ameliorating several
of the issues and gaps in holistic health care for men.
The “type” of engagement with a HCP needs to be
frequent and productive enough to allow for meaning-
ful care to maximize a patient-provider relationship
targeting primordial and primary prevention and
sparingly using secondary and tertiary approaches.
For example, creating a healthcare culture of in-
tentional rapport building with men throughout their
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lifespan may create a greater atmosphere of empathy,
trust, and shared decision-making with an HCP, as well
as the healthcare system overall. Further, involving
fathers during the entire pregnancy process may create
a sense of a health imperative in being there for one’s
family and subsequently improving male health.
52
Moreover, embedding gender-sensitive approaches
with male populations in medical education programs
(i.e., medical schools, continuing medical education
[CME]) and training HCPs to approach interactions
with men creates a sense of shared decision-making
and empathy and likely will yield more consistent
and
quality access and engagement.54 Ultimately, an
es-
sential question to the current model as to how
HCPs
engage men is, “can (should) we do better?”
Based on
the abysmal disparities in nearly all health
outcomes
for men in the U.S., (see Table 1), the
resounding
answer should be an emphatic “yes.”
FUTURE DIRECTIONS
Before we shift the focus to what can and should
be done concerning men’s health, let us pause to rec-
ognize that there are several excellent programs and
policies to improve men’s health. However, much work
needs to be done ranging from the government and
policy level down to the patient-provider interaction
discussed in this article. For example, development of
an Oce of Men’s Health via the U.S. Department of
Health and Human Services could earmark funding
for men’s health programming at the national level.
More work needs to be done at the patient-provider
level, connecting men with holistic health services at
the point of contact, such as with men’s health clinics
and community health centers (for an example, see the
Whittier Street Health Clinic site in Boston, MA: http://
www.wshc.org/blog/mens-health/). In this example, a
male patient has all needs met and likely during one
scheduled appointment, ranging from clinical evalu-
ation and diagnostic tests, to medications. There is a
prompt system of “warm hand-os” when needed, as
in substance use disorders or mental health concerns.
As in the example of Whittier Street Health Clinic,
among other practices, maximizing eciency and
adding to the value of these interactions could shift
the burden from men who already are less likely to
access health care to more robust and viable models
of health care. Even questioning the very nature of
what “access” looks like is an important
consideration. For example, is access defined solely
as
going to an HCP or is it accessing information,
patient
portals, emails/communications, seeking
preventative
versus palliative care, and ultimately, is
it meaningful
access that needs to be more fully
explored.
Leveraging masculine capital54 to challenge men
to respond to being proactive and responsible in
their life-long health and wellness can be infused
in community outreach programs as well as taught
in medical school curricula and continuing medical
education credits. We recognize that there is value
to all men at all stages of the lifespan, and the better
we can keep men connected to their families, friends,
and communities with healthy initiatives, the better
o society will be. Men’s health sheds have become
popular in countries that endorse a national men’s
health policy, such as Ireland and Australia among
others. The sheds help connect men at various life
stages, particularly older men who may experience
social isolation and mental health issues. Data have
shown men’s health sheds to be impactful in terms of
improving select health outcomes, particularly mental
and social health.30,31
Natal males and trans men who enact male-typical
behaviors also are an important and under-studied group
of the men’s health continuum. While it is a limitation
and beyond the scope of this article to fully present
issues in trans men health, we oer a brief overview
of some broader perspectives that might be considered
in future research. Consistently, HCPs recognize the
need to evolve and learn more about the care of this
segment of the population; however, evidence-based
training and education fail to meet HCP’s needs
concerning training and clinical care guidelines.
55
Some eorts by nationally recognized health care
institutions such as Fenway Health in Boston, MA
have made steady progress in educating clinicians in
the compassionate, competent, and gender-arming
clinical care of trans men (for more information, see:
https://fenwayhealth.org). For example, abandoning
assumptions about the patient (use of proper pronouns
verbally and on forms), listening with empathy and
keeping curiosity at bay (not asking unnecessary
questions), utilizing perspective-taking, and being
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well-versed in an array of medical, hormonal, and
psychological needs, all may contribute to better care
and clinical outcomes. If a “true” public health is to be
enacted for our population, all of the aforementioned
principles and needs to enhance the patient-provider
relationship need to be addressed, met, and exceeded,
especially in marginalized populations.
CONCLUSIONS
One needs only to look at the outcomes data in
Table 1 of this paper or similar data to see a discon-
certing health pattern emerge – that is, collectively,
men live sicker and die sooner than women, both
nationally and globally. With-in male populations
(i.e., minority groups) communicate an even more
dire picture than when viewed as a whole. Certainly,
this is a multifactorial public health issue and requires
systematic study at various levels using a socioecologi-
cal perspective;
1
however, accessing healthcare from a
preventative perspective likely will yield the greatest
return on investment when attending to the previously
described data trends. Creating a healthcare culture
that is gender-arming and gender-sensitive as it
pertains to men is essential in assuring that healthcare
is meeting public policy initiatives such as Healthy
People 2020/2030 and the United Nations Sustainable
Development Goals, with a stated goal of “health for
all.
58
Increasing proactive and preventative healthcare
access for men is greatly needed and places the HCP
in a pivotal position in facilitating this opportunity.
Creating a welcoming healthcare experience needs to
go beyond convenient scheduling times, technology,
and oce settings and locations; rather, we advocate
that HCPs need to build a healthcare rapport with
men through shared decision making, acknowledg-
ment of vulnerability to build trust, respect for the
role masculinities play in the healthcare narrative,
and fostering empathy during these healthcare touch-
points. Advocating for better male health outcomes
via policy, medical school training/curricula, continu-
ing medical education (CME) credit, and infusing
humanistic medical best practices into healthcare
is not only something we view as needed, but also a
medical moral perspective that continues to necessitate
improvement and development. The patient-provider
relationship dynamic may be one of the most fruitful
and salient environments to achieve the stated health
equity goals and objectives nationally and globally.
DECLARATION OF CONFLICTS OF
INTEREST
We have no conflicts of interest to disclose in the
preparation of this paper.
ACKNOWLEDGMENTS
The authors would like to express gratitude to the
many medical and health care providers who work tire-
lessly to advance patient care and population health.
We would particularly like to thank those physicians,
physician assistants, nurse practitioners, nurses, phar-
macists, and public health workers who contributed
their unique and practical ideas to this manuscript.
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... 17 In our study, according to the median values of MET-minutes per week, both groups (see Table 4 2021), who emphasised the importance of primary preventative healthcare for men and instilling a sense of responsibility and value in their health, as poor health outcomes can be limited through early screening and treatment. 61 Besides providing education through health information sessions hosted by healthcare professionals, cricketers can also contribute to educate their supporters. Short videos featuring the cricketers can be made addressing the aspects of healthy lifestyle habits and PA and shared on the cricket club's social media platforms and/or website. ...
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