Abstract
Prostate cancer is a common cancer affecting men worldwide. Few men access health services with respect to early detection. Workplace health education initiatives can promote behavior change in men. A total of 12 in-depth interviews with men were conducted in this study to examine how a workplace-based educational campaign on prostate cancer influences the knowledge, awareness, and beliefs of male workers on screening for prostate cancer. Analyses of interview transcripts identified that men had a poor overall knowledge about prostate cancer, its screening, and treatment. Participants were receptive to the introduction of workplace-based health education initiatives to promote men’s health issues but recommended an integrated health approach that incorporated information delivered by medical professionals, cancer survivors, supplemented with existing patient education materials. Further research is required to formally evaluate the impact of workplace-based education strategies on men’s health.
Prostate cancer is one of the leading cancers affecting men worldwide (Parkin, Bray, Ferlay, & Pisani, 2005). The prostate specific antigen (PSA) test and the digital rectal examination (DRE) are the primary tests used when screening for prostate cancer. Abnormal results identified using the DRE and the PSA test may be an indicator for further investigation, from which a definitive diagnosis may be achieved using a transrectal guided ultrasound biopsy of the prostate gland. The merits of screening for prostate cancer are contentious, given the limitations of both tests (Ilic, O’Connor, Green, & Wilt, 2011). For example, the DRE can only be used to examine up to one third of the prostate gland (Ilic et al., 2011). Although the only blood test available, the PSA test has varied sensitivity and specificity, which may compromise the effectiveness of the test in identifying a PSA level indicative of an aggressive form of prostate cancer (Ilic & Green, 2009). False-positive results from these tests have the potential to put the patient at unnecessary risk of harm (i.e., pain, infection) by undergoing biopsy.
Recent systematic reviews on the merits of prostate cancer screening identified several published randomized controlled trials (RCTs) that compared screening versus no screening across several European countries and the United States of America (Djulbegovic et al., 2010; Ilic et al., 2011). Both reviews performed meta-analysis of all RCTs and concluded that population-based screening did not significantly reduce prostate cancer–specific mortality (Djulbegovic et al., 2010; Ilic et al., 2011). The recommendations concluded that men who have a life expectancy of less than 10 to 15 years should be informed that screening for prostate cancer is not beneficial and has harms (Ilic et al., 2011). This recommendation contrasts with those from societies such as the American Urological Association (AUA), which recommends regular prostate cancer screening with PSA testing and DRE beginning at age 40 for well-informed men who wish to pursue an early diagnosis (AUA, 2009).
A person’s reproductive health refers their reproductive process, function, and system (including sexual performance) at all stages of life (World Health Organization, n.d.). A landmark study in 2005 investigated Australian men’s prevalence of self-reported reproductive health disorders, knowledge of reproductive health, and health beliefs (Holden et al., 2005). Approximately 6,000 men participated in the study, of which 17% reported having prostate disease (i.e., prostate cancer, prostatitis, and/or benign prostatic hyperplasia), with a further 57% expressing concern about prostate cancer. Despite this concern, less than half of these concerned participants had actually visited their general practitioner (GP) to talk about their fear about having prostate disease.
The Patient–Doctor Decision-Making Process
Despite the potential benefit in discussing preventative and early health intervention measures with GPs, relatively few men will actively seek medical advice. Rather, men have a tendency to adopt a passive approach to their health, only seeking medical assistance when the health issue significantly affects their daily activities (Clarke-Tasker & Wade, 2002; Ilic, Risbridger, & Green, 2005; McFall & Ham, 2003; Weinrich, Reynolds, Tingen, & Starr, 2000; Winterich et al., 2009). Previous research has indicated that this behavior may be multifactorial. Lack of awareness and knowledge on the health issue, limited access to quality education materials, and the negative influence of psychosocial barriers have all been identified as possible drivers of this behavior (Clarke-Tasker & Wade, 2002; Ilic, Risbridger, et al., 2005; McFall & Ham, 2003; Weinrich et al., 2000; Winterich et al., 2009).
Health promotion interventions, including patient educational materials delivered via the Internet, video, or in a written format, can positively influence consumers experience with the health system (Murray, Burns, See, Lai, & Nazareth, 2005; Stacey et al., 2011). A number of systematic reviews have identified that prostate cancer education materials increase men’s knowledge on prostate cancer while decreasing their anxiety on the issue, regardless of their mode of delivery (i.e., via the Internet, written, or video formats; O’Connor et al., 1999; Stacey et al., 2011; Volk et al., 2007). Such materials also increase men’s decision-making ability and ability to actively seek health advice and/or services regarding prostate cancer.
The Workplace as a Vehicle for Health Promotion and Education
In the past decade, greater emphasis has been placed on implemented health promotion activities within the workplace, “where men are,” to encourage men to use health services and seek medical services when required (Dolan, Staples, Summer, & Hundt, 2005). Health promotion and education within the workplace initially was developed to target specific occupational health and safety issues for workers (Dolan et al., 2005). However, such programs have since developed to not only target prevention of workplace-based related health issues but also to improve employee health through increased knowledge about general health issues (Dolan et al., 2005). Several systematic reviews have reported the success of specific health promotion interventions on improving mental health, healthy eating, physical exercise, and smoking cessation (Jepson, Harris, & Tannahill, 2010; Martin, Sanderson, & Cocker, 2009). Subsequently, it has been accepted that the implementation of health promotion activities, both direct interventions and indirect education materials, can be effectively implemented in the workplace environment and promote effective behavior change within workers.
Using the Workplace to Promote Education About Prostate Cancer Screening
Implementing health promotion messages in places such as the workplace may increase the knowledge and uptake of health services by men (Davidson, 2001). Although men favor the idea of workplace-based awareness targeting men’s health issues, few studies have explored their feasibility, design, or success (Dolan et al., 2005). Simply providing the opportunity to be screened for prostate cancer in the workplace environment has been demonstrated to be unsuccessful. The provision of prostate cancer screening to male employees was examined by Myers et al. (1997), who reported that only 13% of employees in a workplace study demonstrated an interest in being screened for prostate cancer—with only 31% of those men actually taking up the offer of screening. Similarly, an RCT explored the effectiveness of implementing a decision aid on prostate cancer screening in the workplace. Although the decision aid was successful in increasing decision making and certainty, only 30% of men took the opportunity to use the decision aid (Allen et al., 2010). A small qualitative study in 2005 identified that although men supported the idea of a workplace-based intervention for men’s health issues, discomfort with sharing discussions with colleagues was a barrier to participating in open education sessions (Dolan et al., 2005). Conversely, the same men expressed an interest to partake in workplace-based strategies if such interventions were guided by a trained health professional (Dolan et al., 2005).
Although the literature has identified that workplace-based interventions may increase awareness of prostate cancer screening and treatment, there is an information gap as to why this increased awareness does not translate into increased knowledge and ultimately greater uptake of prostate cancer–related health services. Awareness in this instance relates to the perception of knowledge (understanding that the prostate gland is part of the male reproductive system), whereas knowledge relates to having an in-depth familiarity with the information (i.e., understanding what the prostate gland does, how screening for prostate cancer may, or may not, be beneficial). Further information is also required to better understand how men feel about participating in such workplace-based health promotion initiatives, how such interventions should be structured, and potential barriers and enablers to their uptake (Dolan et al., 2005; Robertson, 1995).
Study Objectives
Currently, the best available evidence states that screening for prostate cancer at a population level is not beneficial. Conversely, medical bodies and special interest groups are advocating the use of screening, in the hope that it will detect prostate cancer at an early, treatable stage. Given this conflicting information, the aim of this study was to explore the knowledge, awareness, and perceptions of male workers about prostate cancer screening. The study also aimed to explore the perceived barriers and enablers to behavior change in promoting greater uptake of health services relating to prostate cancer as a result of workplace-based education campaigns.
Method
Educational Campaign
The “Help a Mate” (HAM) education campaign was developed to raise men’s awareness on six health issues, including prostate cancer. The campaign consisted of a pamphlet, calendar, and website with information about prostate cancer and its screening (HAM, n.d.). The HAM materials were developed based on consultations with health professionals and male consumers, within the state of Victoria (Australia), when developing the content and graphical presentation of materials, respectively. The pamphlet and website provided detailed information about the epidemiology, physiology, anatomy (where applicable), risk factors, diagnosis, and treatment options of the associated condition. Each of the six health issues were highlighted for a 2-month period on the calendar. All these materials were sent out to men in the construction industry, who were members of the industry partner (CBUS) in the specific sector.
Study Design and Theoretical Framework
In-depth interviews were chosen to explore men’s knowledge, attitudes, and perceptions on prostate cancer—a health issue that many men find sensitive to discuss. Using in-depth interviews provides a greater depth of expression by the participants on the topic in comparison with other qualitative approaches such as focus groups (Liamputtong, 2010). Thematic analysis was used to identify themes within the data and provide an inductive analysis of interviews (Ezzy, 2002). This approach provides an opportunity to better understand the experiences of men who participated in the HAM program and how it may have affected their knowledge, perceptions, and behavior on men’s health issues (Liamputtong, 2010).
Participant Recruitment and Selection
Participants were recruited using a convenience approach to sampling (Silverman, 2004). A call for volunteers was established through advertisements in brochures and newsletters to members of the construction industry partner (CBUS). Male members, aged 18 years and older, who received the HAM health promotion campaign, were eligible to participate in this study, which ran from June 2009 to June 2010. Interested members were asked to contact the chief investigator (DI) to be briefed on the project. Participants were required to provide written consent prior to their involvement in the project. Participants who did not speak or comprehend English fluently, or did not provide written consent, were excluded from participation. Participants partaking in the study were offered an honorarium for any costs incurred in travel. Ethics approval for this study was received by the University’s Standing Committee on Ethics in Research Involving Humans.
Data Collection
Twelve in-depth interviews were conducted with participants by the same male facilitator at a time convenient to participants. The male facilitator was of a European Australian ethnic background, aged in his early 30s. None of the participants had any previous contact with the facilitator or researchers. All interviews were conducted at the same research facility. All interviews were guided by a semistructured interview schedule, which was developed from a review of the literature (see the appendix for interview schedule). The interview schedule included questions about participants’ knowledge about prostate cancer, the impact of the HAM education materials, and factors that influence behavior change with respect to men’s health issues. Interviews lasted approximately 1 hour in duration, with all discussions digitally recorded and transcribed verbatim at the conclusion of each interview. Any participant observations were noted by the facilitator during the interview. Interviews were conducted until the data reached a point of theoretical (or data) saturation, which was defined when the interview did not generate any discussion points that had not been raised in previous interviews (Guest, Bunce, & Johnson, 2006; Strauss & Corbin, 1998).
Data Analysis
Transcripts from each of the focus groups were independently analyzed by two researchers (the lead investigator and a research assistant) using thematic analysis (Silverman, 2004). A six-step process was used to perform the thematic analysis: (a) familiarization with the data by reading each transcript, (b) generating initial codes, (c) searching for themes from the initial codes, (d) reviewing the themes by generating a “thematic map,” (e) defining and naming themes, and (f) producing the final analysis with this article (Braun & Clarke, 2006).
Each individual transcript was independently coded by the researchers. The two individual sets of themes were discussed by the two investigators performing the thematic analysis before a final iteration of thematic analysis was performed and final themes generated and agreed on. Thematic coding of the data was assisted with the NVivo software program (QSR International, 2010).
Results
A total of 12 men volunteered to participate in this study. Their demographic details are presented in Table 1. The following themes were identified from the analysis of the 12 interview transcripts.
Demographic Details of Interview Participants (n = 12).
Impact of Educational Campaign on Knowledge
Participants had limited knowledge about prostate cancer, its screening, and the treatment options for men diagnosed with prostate cancer. The men understood that testing for prostate cancer potentially consisted of a DRE and a “blood” (PSA) test, but were limited in their knowledge on both tests and how they were related to screening for prostate cancer.
I’ve pretty much got no knowledge of it (prostate cancer) whatsoever. I don’t even know what the side effects are . . . either or testing or getting treated for it. All I know is that I’ve heard that once you hit your 40s it’s good to get checked in general, but don’t really know anything much about prostate cancer. I guess it’s a bit silly I suppose.
Several participants believed that they had an increased awareness of prostate cancer as a result of media campaigns on prostate cancer. Conversely, other participants had an increased awareness of the disease by talking to coworkers who had been diagnosed and treated for prostate cancer. However, it was apparent that an increase in awareness did not necessarily translate into an increase in knowledge on issues associated with prostate cancer.
Even though there was a guy that I worked with who used to talk about it (prostate cancer) at our breaks and how he was going through it, and how it was going to affect his life I still to this day don’t really know that much about it.
Changing Male Perceptions Through Workplace Education
Participants were unanimously in favor of the HAM campaign. They believed that such a campaign was vital to increase men’s awareness of health issues and encourage greater utilization of health services.
The great thing about it is that something is finally coming out to the workers to try and bring some awareness about men’s health issues. You work with these guys all day and they have these real issues, whether it’s prostate cancer or depression or family stuff, but there’s got to be something that recognizes that these things happen and help you to deal with it or get help, whether it’s treatment or testing for prostate cancer for instance. And this [“Help a Mate” campaign] is a good starting point.
Participants valued the HAM initiative and believed that was something that should be targeted toward the younger male workers. The campaign was viewed as a generational shift that could increase the younger worker’s knowledge, awareness, and beliefs on health issues such as prostate cancer. It was suggested that the issues such as embarrassment and stoicism were not as overwhelming barriers in younger men, due to their perceived better educational status and greater acceptability of health issues.
It’s a slow progression; it’s not a fast one. In my 20 odd years in the industry I’ve seen more and more awareness on issues like prostate cancer, diabetes, drugs and alcohol. But it takes time and frankly you need to have these open discussions with men on site with reality in front of them. The next generation are the ones to target—they’re better educated and more emphasis is placed on issues like OH&S [occupational health and safety] and health in general.
Barriers and Enablers to Behavior Change
Although the HAM campaign was viewed positively, it did not necessarily translate into men accessing further health information or visiting their GPs to discuss their health concerns on prostate cancer. Much like previous campaigns, the HAM initiative was viewed as increasing participants’ awareness about prostate cancer, but not necessarily increasing their knowledge on the issue or changing their current health behaviors.
The calendar and booklet is good but it just doesn’t make you go out and do something about it.
The lack of behavioral change was mostly attributed to the presence of perceived psychosocial barriers and their negative impact on men accessing health information and using health services. However, the participants did note that the HAM calendar and brochure could be used as a method for overcoming perceived barriers for men wishing to discuss their reproductive health with their GP.
I think that it’s (the calendar and brochure) good as an ice-breaker. You know you go to your GP and you can say, “Hey, I got this at work and was reading it and thought that maybe you can tell me more about it (prostate cancer).”
Participants noted several barriers and facilitators to accessing further information on prostate cancer and visiting a GP to discuss their concerns and seek medical assistance. Although embarrassment was identified as a potential barrier to accessing information and health services, stoicism and the presence of masculine attitudes (i.e., qualities and characteristics perceived to be typical to the male gender) were perceived as the greatest barriers.
It’s that thing, it will never happen to me—I haven’t got time to be sick. So that’s why you tend to ignore things and symptoms even when you are sick.
Participants identified that only the presence of symptoms may compel men to go to their GP for such treatment. However, if the health issue involves the reproductive organs (including sexual performance and function), then emotions such as embarrassment may prevent men from acting on their need to seek medical assistance. Most participants indicated that having a female GP as the physician would heighten such barriers. It was suggested that consulting with a male GP, independent of their own family GP, may reduce the perceived embarrassment due to a lack of previous history with the clinician.
I haven’t been sick for years. When I’m sick and only when I can’t move—that’s when I’ll go to a doctor. But even then, if it’s got something to do with my private parts, I don’t know how keen I’ll be on going.
Participants noted that they rarely relied on their friends to seek medical advice. It was argued that the presence of the above-mentioned barriers played a significant role in discouraging men from doing so. In the instances that participants had done so, it was considered to be a useful source of information. Participants believed that listening to the personal experiences of men who had been diagnosed and treated for prostate cancer demystified the condition and encouraged others to seek information and/or medical assistance on the issue.
My mate’s had prostate cancer and it was interesting that this other bloke that I was working with was having a hard time going to the toilet. So it wasn’t until he actually talked to me that I told him about my other mate, and then we all had got together and had a chat one day about it. Since then this guy got the courage to go to his doctor and get things checked out.
Participants also considered the Internet to be a good source of health information. Participants noted that the anonymity of the Internet allowed users to access health information, in particular that relating to their reproductive health, at their own leisure and without feeling a sense of embarrassment. Participants noted that accessing information from the Internet provided users with a good method of gaining background information on a specific health topic before visiting their GP.
It’s [Internet] good, you can just jump on and see what the deal is, what to expect if you go to the doctor like in terms of tests.
Promoting Behavior Change Through an Integrated Workplace Education Intervention
Although all men interviewed in this study believed that the HAM initiative was successful in raising awareness about prostate cancer, all unanimously agreed that it required integration with other forms of patient education to further encourage men to take a greater interest in their health. Participants noted that a discussion led by a medical professional, with experiences from prostate cancer survivors and further educational materials (be it written or multimedia), would further increase men’s knowledge on the issue and encourage men to access health services.
I’ve got the calendar on my fridge and my little locker and I really haven’t taken a huge interest of the themes month to month. I mean I have a quick read but for the most part I’m just looking at the dates. But when I realized that I was coming down here for the interview . . . that’s when I actually looked at it and took some notice about the content. It (the campaign) needs more than just a brochure. You have to have some personal contact to put it in focus, like more materials . . . videos or DVDs—or even better, talks where you can listen and then get these things. You would have to combine a talk or something perhaps like a mobile unit, you know somewhere where you could get a check up for whatever if you really wanted to. But you couldn’t just have a medico do it (the talk), you’d need that personal touch from someone who’s been there and can relate to the other men.
The appeal of having a formal presentation and the option of having a medical assessment was positively viewed by all participants. However, participants suggested that any such initiatives would have to be done in the workplace environment during working hours, as it was hypothesized that few men would attend a health information session or wait for a medical examination during their free time (either before or after working hours).
It [health information session] would be during working hours. I doubt that you’d get anyone hanging around after work to listed to talks or get tested or whatever. We bring in the bus for the hearing tests. You could have a medical bus that guys could go to talk about their health or concerns and if they really wanted to get a blood test or some other health check if it’s appropriate. If guys don’t want to go there (to their doctor), then you bring it to them.
Discussion
Participants in this study had limited knowledge and understanding of prostate cancer, its screening, and treatment. This finding is in contrast to other studies that have reported an increase in participant knowledge and awareness after participating in a workplace-based education intervention (Jepson et al., 2010; Martin et al., 2009). Although those studies reporting successful increase in knowledge focused on general health issues, such as healthy eating, exercise, alcohol, and smoking, this study focused on a reproductive health topic (Jepson et al., 2010; Martin et al., 2009).
Previous work has identified that men commonly share a reluctance to discuss and access health services (including education materials) for reproductive health issues due to embarrassment or a perceived threat to their masculinity—beliefs that men in this study also identified with (Clarke-Tasker & Wade, 2002; Ilic, Risbridger, et al., 2005; McFall & Ham, 2003; Weinrich et al., 2000). Masculine attitudes are characterized by men who perceive that masculine power, dominance, competition, and control are essential to proving one’s masculinity, whereas demonstrating vulnerability, feelings, and emotions are signs of femininity and are to be avoided (Crites & Fitzgerald, 1978; O’Neil, Helms, Gable, David, & Wrightsman, 1986). By demonstrating and exhibiting these attitudes, such men may feel safe, secure, and comfortable. However, in demonstrating these behaviors, it fuels the barriers that prevent men from accessing and using health information and services, as well as exhibiting aggressive and unsafe behaviors (Lee & Owens, 2002). Health embodies more than just the physiological process—it integrates physiological and psychological well-being within a person’s social context (Lee & Owens, 2002). As the participants in this study suggested, discussing health issues with family and colleagues, and using health services (particularly with a female physician) for issues concerning their reproductive health, goes against the notion of being a “man” in this context.
Although the HAM program was not successful in increasing knowledge about prostate cancer issues, it was successful in raising awareness. Raising awareness may be the critical first step for men to seek information in an environment that is “safe” and “secure” to them. As participants in this study identified, a growing number of men are finding the Internet a “safe” and “secure” environment in which to search and self-educate themselves on health issues. Although the Internet has seen more consumers turn to it as a source of health information, consumers must also be aware of the increasing amount of poor quality and misinformation regarding health on the Internet (Ilic, Maloney, & Green, 2005).
Participants noted that raising awareness of this health issue was particularly important in younger men. Previous research has identified that older men are more likely to engage in workplace-based education interventions that promote the uptake of health services, whereas younger men are significantly less likely to do so (Myers et al., 1997). This response may be typical for prostate cancer issues, since many younger men (i.e., <40 years of age) may perceive prostate cancer as a condition that they will only be of concern when they are older, or if they present with symptoms consistent with prostate disease (Ilic, Risbridger, et al., 2005; McFall & Ham, 2003).
Health promotion activities and patient education materials on prostate cancer can increase consumer awareness, knowledge, and change behavior through informed decision making (Murray et al., 2005; O’Connor et al., 1999; Volk et al., 2007). However, simply implementing them in a workplace will not result in behavior change. Changing behavior is a complex task, which in this case requires that men are aware of the issue, agree with the information presented, and adopt and adhere to the evidence (Glasziou & Haynes, 2005). The rate of compliance declines throughout each stage, therefore simply providing patients and consumers with information will not necessarily promote any behavior change (Grimshaw & Eccles, 2004). As identified by men in this study, barriers including negative masculine attitudes, embarrassment, time constraints, and accessibility may all act as additional barriers to the uptake of evidence (Dolan et al., 2005; Ilic, Risbridger, et al., 2005).
The HAM program did not achieve its goal of increasing knowledge and changing behavior on the uptake of health services primarily because the intervention was “passive” in its design. Passive health education materials rely on providing consumer health education materials with the expectation that consumers will absorb the information and act on it (Grimshaw & Eccles, 2004). Conversely, “active” interventions promote dialogue and interaction between the consumer and the information presented. “Active” interventions may consist of seminars, meetings, and/or presentations with health professionals and patients, who can share their personal experience with the disease (Jepson et al., 2010; Martin et al., 2009). “Active” interventions may also incorporate computer-based education programs that rely on user input to convey health information. Since the materials were “passive” in their design, the presence of participants’ masculine ideals may have further acted as a barrier to the success of the HAM program.
The use of a “mobile health unit” whereby consumers may seek health advice or use medical services (if appropriate) at their workplace is an example of a multifaceted workplace-based intervention that can increase the awareness, knowledge, and uptake of health services. Recently, the Victorian state government has introduced free health assessments that are offered in the workplace (WorkHealth Victoria, 2011). These health checks focus on diet, exercise, smoking, and alcohol consumption. The use of similar “mobile health units” was discussed by participants in this study, to offer men an opportunity to access health services specific to reproductive health issues. The use of such “men’s health mobile health units” may be feasible; however, any such intervention should be accompanied by a detailed patient education session, whereby men participate in a truly informed decision-making process before undertaking any screening procedures.
The use of such “mobile health units” may be akin to existing prostate cancer support groups, which often offer similar educational content from newly diagnosed, and treated, prostate cancer patients. Such support groups require active uptake by men, in which location, time, education, and ethnicity may all be barriers to active uptake by men. Conversely, the “mobile health unit” approach would not require such an approach, if the service was integrated with the workplace.
Limitations
By its very design, this study had some methodological limitations. Research findings obtained through qualitative research techniques provide researchers with detailed content, often providing the context in which to base findings derived from quantitative research. Data analysis was performed by two researchers, who compared and discussed their interpretations of the data before final themes were agreed on. No other strategies, apart from this form interrater reliability, were implemented to increase the rigor of the study.
Generalizability of results is not possible from this type of in-depth interview study; however, such findings do provide a basis on which future interventional studies may be developed, implemented, and evaluated. As with all qualitative research, beliefs expressed by some participants may be more common in some populations rather than others. The recruitment strategy employed for this study attempted to provide information rich cases; however, its very nature might also introduce the possibility of volunteer bias as the sampling was a sample of convenience. Participants who did not speak or comprehend English fluently were not eligible for inclusion in the study. This strict exclusion criteria may also limit the reported findings as themes identified across the interviews may not be representative of men from a non-English speaking background. Because of the manner in which the audio files were transcribed, it was not possible to include demographic information with the quotes.
Conclusion
Workplace-based health education initiatives have the potential to provide a novel method of increasing men’s knowledge, awareness, and uptake of health issues and services. The results of this study demonstrate that adopting a simple workplace-based health education consisting of “passive” information will not translate into increasing men’s knowledge, and uptake of health services, regarding prostate cancer screening. The presence of masculine ideals (i.e., reluctance to seek medical assistance, avoidance of emotion) further limits the success of such health care interventions. To promote any behavior change, such workplace-based education interventions must be multifaceted, incorporating both “active” and “passive” components to health education. The structure of such a multifaceted workplace-based education intervention would include information delivered by medical professionals, cancer survivors, supplemented with existing patient education materials. Adopting a multifaceted approach may overcome the current barriers (including masculine ideals) preventing greater uptake of knowledge, awareness, and health utilization by men.
Footnotes
Appendix
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by the Construction and Building Industry Super Fund and Andrology Australia.