Getting the Men's Health Day Program Started

 The Standing Rock Story: How We Developed a Men's Health Day Program


Initial Meetings
The Standing Rock Men’s Health Day program started with a meeting with the Medical Director of Indian Health Services and a group of CHRs.  All agreed that there was a need for a men’s health program.  The Medical Director at that time, Dr. Pedro Rolden, was passionate about starting Men’s Health in Fort Yates, as was Dr. Richard Kraft for McLaughlin.   Items discussed at this first meeting included:

  • What age men will we target?
  • What cancer screenings will be included with the physical exam?
  • What lab tests will be done?
  • What incentives will be offered for the men to attend?
  • Will the clinic close to other patients that day?
  • How many providers will be available?
  • Who will schedule the appointments, and how?
  • Will education stations be offered at the Men's Health Day, and on what topics?
  • What system will be used to route men to exams and education stations?
  • What will be the evaluation process?
  • How will participants be recruited?
  • How will follow up care be managed?
  • How many times will a Men's Health Day be offered per year? 

Using the already established Women’s Way program as a model, we developed a plan for a men’s health day from discussion of these questions.  (See How We Design the Day.)

Target Population
The target age for men’s cancer screening on the Standing Rock Reservation is age 40 and above.  The starting age for screening recommended by the U.S. Preventive Services Task Force varies by disease and risk factor. At Standing Rock, age 40 was chosen in the face of a 10 year differential in life expectancy between Native Americans and the U.S. average.  In the Indian Health Service Aberdeen Area of which Standing Rock is part, male life expectancy is 67 years.

Partnerships
Each partner played specific roles and brought particular expertise and resources to the project which, when combined creatively, resulted in a successful event.  The same partners had worked together successfully on the Women’s Way program.  Project partner roles and responsibilities are described below.

  • Custer Health – Facilitates the partnership and organizes the Men's Health Day events; obtains funds to support staff coordination role and provide participant incentives.  On the day of the event, staff provides education on colorectal cancer screening (fecal occult blood tests, or FOBT) kits to participants.  After the event, staff tracks the return of FOBT kits and test results.  Custer Health staff developed the evaluation survey based on the Women’s Way model and summarizes evaluation results for each event.
  • Indian Health Service clinics – Provide appropriate physical space for the event, as well as providers who conduct the physical exams.  IHS staff draws and processes the blood work, provides the FOBT kits and lab processing and follows up with patients who have abnormal results.
  • Tribal Community Health Representatives Program –Coordinates on-reservation activities.  CHRs provide information to community members about men’s health; promote the event through posters, brochures and word of mouth; and provide cancer screening education through home visits.  On the day of the event, CHRs provide transportation from clients’ homes to the Indian Health Service clinic on a limited basis.  They also provide basic health counseling at the event to new clients.
  • North Dakota Women's Way Program – Helps facilitate partnerships and provides model for screening day.

Promotion
To advertise the event, we hang posters throughout the reservation.  The CHRs distribute flyers in all districts of the reservation and promote Men's Health days at other community events.  The local radio station (KLND) announces the dates of Men’s Health days in community announcements free of charge.  We have also advertised in the local newspaper (The Teton Times), including testimonials in the form of letters to the editor, but have found that readership is limited.

When we started the Men’s Health Day program, IHS partners queried local clinic records to identify all men age 40 and above who had been to one of the Indian Health Service clinics on the reservation.  We sent invitations to all of these men – approximately 500 for the first event.  In subsequent years, we have re-invited previous years’ participants and any other men identified as part of the event evaluation process.  We also send invitations to men who are due for their annual exams. 

Endorsements and In-Kind Support
Endorsements provide individuals and organizations, both on and off the reservation, an opportunity to lend their credibility, technical or financial resources and/or authority in support of the project.  We have obtained endorsements and in-kind support for the Men’s Health Day from the following:

  • Tribal Chairman – Provides two hours of paid administrative leave for employees to attend event.
  • Tribal Council – Issues tribal proclamations for both colorectal cancer awareness month in March and prostate cancer awareness in September.  These proclamations recognize the value and importance of participating in Men’s Health Day events occurring in those months.
  • North Dakota Comprehensive Cancer Prevention and Control Program – Provides technical assistance and funding support.
  • Northern Plains Cancer Coalition (a program of the Great Plains Tribal Chairmen’s Health Board) – Provides in-kind technical assistance on evaluation and programmatic resources.
  • Spirit of E.A.G.L.E.S – Provides access to American Indian/Alaskan Native cancer information, financial support and opportunities to publicize the project.
  • University of Mary, Medcenter One School of Nursing and Sitting Bull College - Provide preceptor students who assist with event planning and implementation.  Students have conducted colorectal cancer education and provided instructions for the stool kits.

Funding
Custer Health searched for grant money to start the Men’s Health program.  We submitted a proposal to the community grants program of Spirit of E.A.G.L.E.S., an NCI-funded initiative (U54 CA153605-01) which seeks to reduce cancer health disparities among native populations.  We were successfully funded in 2003 and have been funded every year through 2010.

The event is also supported through other grants from public (e.g., North Dakota and Northern Plains Cancer Coalitions) and private organizations (Prevent Cancer Foundation, Sam’s Club), as well from public health department budgets.  The Indian Health Service covers the cost of providers and lab tests.  The participation of the education station presenters (representatives of tribal, IHS, health system and university agencies) is supported through their own programs. 

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