Despite what we might think about men, it seems they do want to talk about their health concerns, and community pharmacy might be the perfect place, reports Leanne Philpott.
- Men perceive health and community services as feminine and feminised;
- Pharmacists interested in focusing on men’s health should consider their store’s colour scheme, layout, signage, product placement and the health information available;
- Being located in retail settings, community pharmacy offers a more accessible venue for men who may be disinclined to engage with the healthcare system more generally; and
- Pharmacists are well placed to provide men with a wide range of advice, including the importance of taking their medications, quitting smoking, engaging in regular physical activity and eating a healthy diet.
IT’S CLEAR THAT many forces shape men’s health behaviours and lifestyle routines, but what’s not always well recognised is that men do want to talk about their health—they just need the right environment in which to do so, say experts.
Community pharmacists are ideally positioned to engage men about their health and wellbeing and provide advice on issues facing every male. This feature focuses on new health information and provides strategies for pharmacists to encourage men to discuss and manage their health.
Are you men-friendly?
First and foremost, pharmacists need to take stock of their stores and consider how they market to men, says Dr Anthony Brown, project manager of the Men’s Health Information and Resource Centre, a research centre linked to the University of Western Sydney.
“On the whole, men perceive health and community services as feminine and feminised and as such, think it is not set up for me,” Dr Brown says.
“This is part of the reason why you don’t see many men interacting with pharmacists as much as they should.”
He says there were two ‘great big lies’ perpetuated about men’s health.
“One is that men aren’t interested in their health and the other is that they don’t talk about their health.
“The fact is men are interested and they do talk… they may do it in a different way to women, but they do,” Dr Brown says.
He suggested pharmacies interested in focusing on men’s health consider the store’s colour scheme, layout, signage, product placement and the health information available.
“Who likes pretty colours? And who wants to walk through three rooms full of cosmetics and perfumes before they reach the band aids?” Mr Brown posed.
“Do you have signs with pictures of men on them? What products do you stock that appeal to men, and where are they placed?”
Dr Brown says men liked written information they could take away to read but it quite literally needed to be spelt out that it was targeted for men.
Dr Brown said the Cancer Council’s Men and Cancer series of brochures, which were navy blue, had the word ‘men’ on the cover and included a photograph of a male, were a good example.
As would be expected, topics such as testicular cancer and prostate cancer were covered but branding was also applied to other topics that affected both men and women, such as bowel cancer and skin cancer.
“The materials couldn’t be any clearer in saying to men, ‘Oi! This is for you’,” Dr Brown says.
“It may pay pharmacists to look at all their printed materials and assess how appealing they are to men,” he said.
Dr Carol Holden, CEO, Andrology Australia, agrees that community pharmacies were an integral part of the healthcare system and being located in retail settings, they offered a more accessible venue for men who may be disinclined to engage with the healthcare system more generally.
“As many men find it difficult to speak to their doctor about male health problems, particularly reproductive health matters such as erectile dysfunction and prostate disease, providing quality information in accessible setting such as pharmacies is essential.
“Displaying and disseminating health information in non-threatening retail settings may improve men’s health awareness and encourage men to visit their GP regularly,” she says.
Dr Holden said men who are not motivated to engage with other parts of the healthcare system may still enter a community pharmacy for a range of over-the-counter or pharmacy-only medicines or treatments for minor injuries such as sports injuries.
“Such encounters are a window of opportunity and staff in community pharmacies should be prepared for these opportunistic healthcare encounters,” Dr Holden says. (See breakout: Talking The Talk).
Studies show men generally appreciate frank, direct and matter-offact communication. Dr Holden suggests pharmacists “use active listening and pay attention to the way men speak about their health to understand what they consider important and what motivates their health-seeking behaviour”.
For example, some men may seek help to maintain regular activities such as sport rather than improving health per se, while for others maintaining their role in family or relationships was key. Dr Holden adds: “It is also worthwhile taking time to understand men’s previous illness experiences”.
As men have a higher incidence of heart disease at an earlier age than women, pharmacists could look for opportunities to help their male patients gain an understanding about the signs and symptoms of heart disease, identify their individual cardiovascular risk factors and provide advice on how to minimise their impact.
Australian research has found that even minor erection difficulties could be indicators for heart disease.
The Sax Institute’s 45 and Up study is one of the largest ongoing studies of healthy ageing in the world. Doctors who looked at more than 95,000 men found that men with erectile dysfunction have a higher risk of being admitted to hospital with heart disease even if they have no history of heart problems. Research found the worse the erectile dysfunction, the higher the risk of cardiovascular disease.
The study notes that erectile dysfunction is common with an estimated 40% of men over 40 experiencing it. It says common causes include medications, chronic illnesses such as diabetes and drinking too much alcohol.
The authors emphasise that erectile dysfunction is a risk marker for cardiovascular disease, not a risk factor that causes cardiovascular disease. The Heart Foundation says the results suggest every man suffering from any degree of erectile dysfunction should get a heart check-up from their GP.
“Erection difficulties are mainly caused by blockages in the small arteries that supply the penis and this is a good indicator of what is happening in other larger arteries in the body including those that supply the heart,” Dr Robert Grenfell, National Cardiovascular Health Director at the Heart Foundation explains.
He says pharmacists should encourage men with erection issues to visit their GP to have a heart health check. According to the Heart Foundation, men are three times more likely to have a heart attack than women.
“Around 36,000 men have a heart attack every year and sadly around 5000 men die,” Dr Grenfell says. Having a heart attack can be the first sign anything is wrong.
“Pharmacists can help teach patients the warning signs of a heart attack and encourage them to understand that it’s always OK to call Triple Zero (000) if you think you have heart attack warning signs.
“If it turns out to be a false alarm then that’s the best thing that could happen,” he says.
A man’s risk of heart attack greatly increases at 45 years of age. “It’s so important that all men at the age of 45 (or earlier if a known family history) see their GP for an ‘Absolute Risk’ heart health check to calculate their risk of having a heart attack in the next five years.”
Pharmacists can educate men about heart disease risk factors and encourage them to take their health seriously, Dr Grenfell says. Pharmacists are well placed to provide men with a wide range of advice, including, the importance of taking their medications, quitting smoking, engaging in regular physical activity and eating a healthy diet.
Men are more likely to be overweight or obese than women. “A staggering 70% of Australian men are overweight or obese, so this is another area where pharmacists can talk to men about their health and start them on the path to better health,” Dr Grenfell says.
Male baldness is another concern that has been linked with heart health recently. A study has found that balding men are around 30% more likely to develop coronary artery disease than those who retain a full head of hair.
Researchers at University of Tokyo found that male pattern baldness is linked to an increased risk of coronary heart disease but only if hair loss is from the top of the head.
The risk is also greater the younger a male loses his hair. The study reviewed six research papers that involved almost 40,000 men who were tracked over a period of at least 11 years.
The research found that on average men who had lost most of their hair by the time they were 55 years of age were 32% more likely to develop coronary artery disease than those who kept their hair.
Dr Grenfell says although the findings were interesting more research was needed to confirm any link between hair loss and heart disease.
Most men don’t need to be told what male pattern baldness is. According to Andrology Australia, most Australian men will experience some form of hair loss in their lifetime. For men between the ages of 20 and 45 who start to lose scalp hair, it is most likely male pattern hair loss.
And because hair loss may cause emotional distress and affect self-esteem, pharmacists and pharmacy staff should be supportive and empathetic to men experiencing it. There are a number of treatments for male pattern hair loss. The two main medicines used to treat male pattern hair loss are oral finasteride (Propecia) and topical minoxidil (Rogaine). For some patients hair transplantation may be an option. Andrology Australia recommends that men speak to a counsellor if upset or worried about their hair loss.
Health and wellbeing begins between the ears and perhaps the most important question a pharmacist can ask a man is “are you OK?” says Dr Michael Player, research officer at the Black Dog Institute.
Working on the Men’s Health Project, Dr Player explained the institute has been running a number of studies funded by BeyondBlue to uncover the positive coping strategies that men use for their moods in order to identify what men can do to distract their short-term mental outlook and prevent suicide.
“We know that men complete suicide a lot more than women—the ratio is about 4:1 and we know the ratio of depression is the other way round, 3:1.
“Obviously something is wrong and we think there is an underdiagnosis of depression partly because of the unhelpful strategies that men use when things start to go a little bit awry.”
The literature is full of the helpful coping strategies that men use for their moods—men use a lot of externalising behaviour and they tended to want to convert emotional pain into physical pain, he said.
“Their behaviour can be quite aggressive and they will engage in risk-taking such as fast driving and getting into fights… there’s also a lot of substance abuse issues,” Dr Player says.
“Of course, these are all unhelpful and mask the underlying problems.”
As pharmacy is “a major touch point for all the community,” Dr Player said it was really important for pharmacists be in tune with the signs and symptoms of depression in men and be proactive.
“They are not going to be coming in and getting antidepressants because 75% of men with a mental health issue will not see a health professional, so you can’t rely on this to open up the conversation.
“If they are coming in with injuries, are irritable or angry, losing concentration, dishevelled and socially isolated, these are factors [where] you should be thinking: ‘OK, there are some key symptoms here’.”
Dr Player says feedback from the early phase of research is that men do want to be asked how they are. “Men are not going to give it away, men want to be asked and sometimes it might be easier for them to talk to a pharmacist rather than a mental health professional or someone they have to see every day.
“You can say simple things like: ‘I notice that you are not your usual self today’. ‘I notice you have been down a bit lately are you OK?’. “If the man is not ready, he will brush it off but when he is ready to talk, he will,” he says.
Dr Carol Holden, CEO of Andrology Australia, suggested pharmacists could maximise opportunities to talk to men about their health by taking on board the following strategies adapted from the Andrology Australia clinical summary guide on engaging men in primary care settings.
Strategies to engage men in discussions about their health include:
• stating facts clearly during consultations;
• using terminology that is easily understood;
• providing written information to patients to read after they have left the pharmacy;
• listening to and responding to patients needs to facilitate an empathetic style of communication based on respect and trust;
• aiming to deal with their health issues quickly and comprehensively;
• referring patients onto doctors promptly particularly if the problem remains unresolved;
• keeping abreast of the latest development and conveying these to patients;
• applying and explaining the role of new knowledge;
• alleviating the perceived seriousness of health concerns by using humour thoughtfully to facilitate the building of rapport;
• being proactive and sensitive in managing patients’ sexual and mental health concerns;
• clinical guides for health professionals can be accessed on the Andrology Australia website.