How We Designed the Day

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

1.   Screening test
For prostate cancer screening, we use a Prostate Specific Antigen (PSA) test (from blood sample) and a digital rectal exam.

For colorectal cancer screening, initially we tested by obtaining stool during the digital rectal exam and placing this on a Hemoccult card.  Testing was done right away to determine if there was blood in the stool.  In 2006 we changed to a take home stool test (also called FOBT, fecal occult blood test), as it has greater accuracy.  In 2011 we changed to a different FOBT, the fecal immunochemical test (FIT).  The FIT is more acceptable among our Standing Rock clients because it does not require restricting red meat intake.  We provide instructions regarding food and medication restrictions and sample collection (from stool).  We also provide a stamped, addressed envelope so that participants can mail the kit back to the Indian Health Service lab for processing.

For cholesterol and diabetes screening, blood samples are taken – either by vein (blood sugar, cholesterol, lipid profile) or by fingerstick (fasting blood sugar).  If the man has not been seen for an extended period of time, some providers will order a chest x-ray, EKG or additional laboratory tests.

2.   Incentives
Men’s Health Day participants have appreciated receiving a small gift (incentive) for participation.  The average incentive has cost $5 per participant.  From the beginning, CHRs have advised on appropriate gifts.  We have provided fishing lures printed with the men’s health toll free number.  This number connects directly to Custer Health, where a nurse is available to answer questions.  Some men call to be put on a list for the next Men’s Health Day.

We have also offered baseball caps, but recommend checking that the color of the cap is acceptable.  On the Standing Rock Reservation, we were advised to avoid red.

We have also given 4 in 1 screwdrivers, tape measures, pre-paid phone cards, Swiss army knives, Leatherman tools, gloves and Wal-Mart gift cards.  We offer a choice of at least two incentives at any given Men's Health Day event.  The CHRs have sometimes partnered with the American Indian Relief Council for additional incentives.

3.   Clinic schedule 
The clinics on Standing Rock close to other appointments on Men’s Health Days, but do see emergencies as needed.

We usually schedule for 3 providers and 3 men per 30 minute time slot. (See Schedule Template.)  We confer with providers to determine when to schedule the first appointment and when and if lunch should be scheduled.  We also ask clinic staff if there will be a provider who may need more time to see clients. We usually schedule the last appointment 1 ½ hours prior to clinic closing so providers have time to finish if they are running behind and to complete documentation.  We usually run our men’s clinics from 9 am to 3 pm, and with 3 providers we see about 33 men in one day.

Appointment scheduling has been managed many different ways over the years.  We find that it is most efficient to schedule through the clinic that we are using for the event.  We send the template for scheduling about one month prior to advertising the Men's Health Day and keep in close contact with patient registration or reception at the clinic in the run up to the event.  If the schedule is not filling up, Custer Health staff calls men who are due for their annual exams to make appointments.

4.   Patient flow
To navigate participants through the Men’s Health Day, we use a routing slip.  This slip indicates client name, date of birth, exam time, lab and each education station.  As the man goes through the Men's Health Day event, each provider and educator will initial the routing slip.  We also try to have a person available in the hall to help men find their way around the facility.

The last place that participants stop is the evaluation station.  Here they are given an evaluation form to fill out.  Participants also choose their incentive at this time.

We also offer food at the evaluation station. Meat, cheese and crackers along with a fruit tray are donated by local casinos for each event.  We provide coffee and sugar-free lemonade to drink. Men often stay to visit after their exams and the day becomes a social event.

5.   Follow up 
Follow up patient care is handled by IHS providers.  Custer Health staff track the stool kit and PSA results.  To do so, they have been granted online, protected access to IHS records.  By monitoring records of Men's Health Day participants, staff can see which stool kits have been returned and which have not.  Staff sends two reminders to patients.  (Our goal is to achieve a 40 % return rate but our best result has been 36 %.)  If staff identifies a positive lab result, they notify the IHS provider and the client is referred for a colonoscopy.  It is worth noting that tracking stool kits is time consuming. 

If staff identifies that a participant’s PSA is elevated, Custer Health staff informs his IHS provider and the patient is referred for further testing.

6.   Education 
Basic cancer education is still very much needed on Standing Rock – approximately one half of the 1400 men over 40 who live on the reservation have not been screened in the past 6 years.  It is possible that some men go elsewhere for services, but more likely that they simply do not get screened.  Reasons for not obtaining screening are many and include fear, lack of awareness and not having a prevention orientation to health care.

We offer education stations at each Men's Health Day.  When we first started the Men’s Health Day program, we had up to 5 education stations at each event.  The results of our evaluation indicated that this took too much time, especially for the men who had to return to work.  We now offer 3 to 4 stations per event.  Education topics have included:

  • Diabetes education (offered at every event)
  • Colorectal cancer education and stool kit instructions (offered at every event)
  • Alcohol cessation
  • Dental health
  • Depression screening
  • Erectile dysfunction
  • Fiber assessment
  • Healthy cooking
  • Healthy eating
  • Heart Health
  • Label reading
  • Sexually transmitted diseases
  • Stress and coping
  • Tobacco abuse cessation

Presenters at education stations have been representatives of numerous agencies, including Standing Rock Tribal Health diabetes and tobacco programs, North Dakota and South Dakota State University extension services, IHS dental clinics, Medcenter One (health system) and local colleges.

Our evaluation results indicate that the men enjoy the education stations, especially the food information.  At the stations, we also display educational materials for the men to take home.  Custer Health obtains brochures from the American Cancer Society, Native CIRCLE and the Centers for Disease Control and Prevention, as well as a brochure that was developed specifically for the Standing Rock Community.  Participants are offered a Custer Health bag for the materials gathered.

The Men’s Health Day education stations have been so well received that we have developed additional men’s educational workshops.  At this time we have run three workshops attended by 82 people, some of whom attended the Men’s Health Day.  The workshops have addressed colorectal and prostate cancer risks, prevention and screening, as well as supplemental topics of interest to men, such as erectile dysfunction, Cancer 101 and advance directives.  Each event has featured local cancer survivors who share their personal stories.  The workshops also provide an opportunity to promote the Men’s Health Day.

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