Designing the Day

 Implementing a Men's Health Day


 Key features of the day must be carefully planned for by the partners.

1. Disease focus
You may choose to focus on cancer, heart disease and diabetes, as these disease have a large impact in minority and underserved communities.  Early detection and appropriate treatment of these illnesses can have a great impact on quality of life and survival, as well as lead to reduced costs for self-funded insurance programs.  We also recommend that each participant receive a general physical exam to facilitate screening for other chronic diseases and to promote chronic disease management.  Chronic diseases such as asthma, arthritis and obesity reduce the length of life, but can also cause significant pain, distress and disability.  If managed well, these negative outcomes can be reduced or avoided altogether.

2. Target age
Your target age will depend on which diseases you plan to screen for.  For example, 40 and over is an appropriate target age if you plan to screen for cancer, heart disease and diabetes.  However, you may chose a different age at which to begin screening, based on your assessment of community needs.  Please refer to the Indian Health Service, U.S. Preventive Services Task Force, the National Cancer Institute and the American Cancer Society.  You may want to allow men of all ages to participate in educational activities.

3. Method for conducting screening
There are choices for how to screen for some diseases.  The decision about which method to use should be made in consultation with local medical providers who know the community.

Prostate cancer screening

  • Below we describe prostate cancer screening tests which you may want to make available to men participating in the Men's Health Day.  Currently there is controversy about whether to screen for prostate cancer, with different professional organizations recommending different approaches, especially for the PSA test.  It is currently unknown whether men at higher risk for prostate cancer based on their race or ethnicity (such as American Indians or African Americans) should be screened differently.  The decision to screen or not screen should be based on a conversation between a man and his physician.
  • Prostate Specific Antigen (PSA).  Involves drawing blood and testing in a laboratory.  Results are usually available in several days.
  • Digital rectal exam.  Conducted by health care provider as part of physical exam.  The digital rectal exam is less sensitive than the PSA in detecting prostate cancer, but is less expensive.

Colorectal cancer screening

  • Fecal occult blood test (FOBT).  The FOBT tests for blood in the stool.  Patients take FOBT kits with them to use in the privacy of their own home. Staff must provide patients with instructions regarding food and medication restrictions and sample collection.  You must also consider how the kit will be returned to the clinic or a lab for processing (e.g., pre stamped envelope addressed to lab).  There are two main types of FOBT:  the stool guaiac test (gFOBT) and fecal immunochemical testing (FIT).  These tests have different stool collection requirements and dietary restrictions which may impact their acceptability.  Consult with local providers to determine which is the better choice for your community.
  • Colonoscopy, sigmoidoscopy.  These tests are recommended for some types of patients, based on age and other risk factors.  They are more sensitive than FOBT, and more expensive, though they permit removal of pre-cancerous polyps.

Diabetes

  • Blood sugar test.  Involves drawing blood and analyzing it in a laboratory or using a machine on site.  Two tests are usually used to screen for diabetes:  fasting plasma glucose (by finger prick) and 2-hour postload plasma glucose (by vein). The American Diabetes Association recommends the fasting plasma glucose test because it is easier and faster to perform, more convenient and acceptable to patients and less expensive than other screening tests. However, men have to fast before taking the test.

Heart disease

  • Cholesterol test.  Involves drawing blood and analyzing it in a laboratory to measure the amount of cholesterol in the blood. 
  • Lipid profile.  Involves drawing blood and analyzing it in a laboratory to measure the amount of cholesterol and triglycerides in the blood.  Also called a complete cholesterol test.

4. Incentives
A useful gift can go along way to encourage men to attend the screening event and to return the next year.  A small amount, such as $5 per participant, can pay for meaningful gifts like:

  • Fishing lures
  • Baseball caps
  • Tools (4 in 1 screwdrivers, tape measures, Swiss army knife, Leatherman tool)
  • Gloves
  • Phone cards
  • Gas cards
  • Gift cards
  • Event t-shirts

We advise offering a choice of at least two gifts at any one event.

Of course what kind of gift you choose should be sensitive to the needs and culture of your community. You may want to seek advice from potential participants, community health workers and others who know the community well.

5. Impact on regular clinic business 
The volume of expected screening day participants should be weighed against usual clinic flow.  You should consider how emergencies or urgent cases will be handled on the screening day.

6. Number of participants
The number of providers available to conduct exams and tests will determine how many men you can accommodate on each screening day.  You will also want to consider:

  • How long each screening appointment will last.  (30 minutes is usually adequate for exam and tests.)
  • If and when providers will be scheduled for lunch.
  • When the last appointment will be scheduled, in order to leave time for providers to complete documentation before clinic closing.

Please see Schedule Template for a sample.

7. Scheduling appointments and sending reminders
The most efficient way to run the screening day is ask men to schedule an appointment for the event in advance, likely through the clinic where the event will occur.

If the organizer of the event is not clinic staff, about one month prior to advertising the screening day you may want to send a scheduling template to clinic staff who will be responsible for scheduling appointments.  As the event date approaches, you should keep in close contact with patient registration or reception at the clinic.  If the schedule has not filled up within a few weeks of the event, clinic staff may call men who are due for their annual exams to make appointments, or outreach workers may pursue other means to promote the event.

8. Education stations
Health education stations have been greatly appreciated by participants in other Men’s Health programs.  The stations can be staffed by staff of the clinic, public health programs, or other community programs (see Obtaining Funding / Endorsements).  Educational materials can be displayed for the men to take home.  Brochures are available from the Native CIRCLE, National Cancer Institute, American Cancer Society, Centers of Disease Control and Prevention, Native American Cancer Researchand many local public health programs.

Educational topics may include:

  • Alcohol cessation
  • Colorectal cancer education and stool kit instructions
  • Dental health
  • Depression screening
  • Diabetes education
  • Erectile dysfuntion
  • Fiber awareness
  • Healthy cooking
  • Healthy eating
  • Heart health
  • Label reading
  • Sexually transmitted diseases
  • Stress and coping
  • Tobacco abuse cessation

We advise offering diabetes education and colorectal cancer education and stool kit instructions at every event.

Consideration should be given to the number of education stations offered at any given screening day.  A careful balance needs to be found between participant interest and the time they have available for the screening activity.  Generally 3 or 4 stations are adequate.  Printed materials on other topics in addition to the 3-4 stations can also be displayed.

9. Patient flow
You will need to consider how to navigate participants through the Men’s Health Day – exams, lab tests and education stations.  A routing slip can be helpful.  This slip lists the client name, date of birth, exam time, lab and each education station available.  As the man goes through the screening day, each provider and educator initials the routing slip.  You may want to place helpers at key points throughout the facility to guide men.

You should also consider where, along the route, men will receive their incentive / gift. One option is to distribute incentives at an evaluation station, where participants are asked to complete a brief survey

You may also want to consider offering food at the evaluation station.  Local vendors may be willing to donate healthy snacks and beverages for the event.  You may find that men want to stay to visit after their exams and thus providing refreshments makes the event more social.

10. Follow up monitoring and care
Careful consideration must be given to how follow up will be handled.  For example, if a man has an elevated PSA, who will arrange for him to be seen by a provider?  How will lab results be communicated to patients and by whom?

If you chose to use a FOBT to screen for colorectal cancer, you will need to develop a system for tracking the return of kits and the test results.  Who will follow up with patients to encourage them to return the kits?  Will you use a reminder system?  Who will track test results and communicate results to patients?

 

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