RESEARCH ARTICLES
Alternative means of communication as a tool for prevention of prostate cancer
Bruna LimaI; Elizabeth Rose da Costa MartinsII; Raquel Conceição de Almeida RamosIII; Cristiane Maria Amorim CostaIV; Araci Carmen ClosV; Jaqueline Inácio Correia FerreiraVI
INursing Student of Veiga de Almeida University. Rio de Janeiro, Brasil. E-mail: brumy.lima@gmail.com
IINurse. PhD in Nursing. Associate Professor, School of Nursing at the State University of Rio de Janeiro. Brasil. E-mail: oigresrose@uol.com.br
IIINurse. Substitute Professor at the School of Nursing at the State University of Rio de Janeiro. Nurse at Piquet Carneiro Polyclinic and Urology at University Hospital Pedro Ernesto. Rio de Janeiro, Brasil. E-mail: raquel_rcar@msn.com
IVNurse. PhD student in Nursing. Assistant Professor, School of Nursing at the State University of Rio de Janeiro. Chief of the Urology Ward of the University Hospital Pedro Ernesto. Rio de Janeiro, Brasil. E-mail: cristiane.costa@ig.com.br
VNurse. Assistant Professor, School of Nursing at the State University of Rio de Janeiro. Brasil. E-mail: araciclos@yahoo.com.br
VINursing Student of Veiga de Almeida University, Rio de Janeiro, Brasil. E-mail: jaquelinelittrell@hotmail.com
DOI: http://dx.doi.org/10.12957/reuerj.2014.15517
ABSTRACT
Men became a challenge for public health policies because they present high mortality and morbidity, and social networks are a tool to attract their participation in caring for their health. The aim of this study was to analyze the media as strategies to promote men's health. This is a descriptive, quantitative, qualitative study, performed with 49 men in a university in the city of Rio de Janeiro. The data was collected through self-administered questionnaire in 2013. The content analysis of the statements pointed categories - The media, a tool for health promotion and prevention of prostate cancer and Inclusion of men in preventive health. It was concluded that traditional media have not achieved the expected results. The individuals would use alternative media - such as social networks, in an attempt to give quality to their health.
Keywords: Men's health; media; prostate cancer; health promotion.
INTRODUCTION
The male presence in the health scenario has become a major challenge for public policies and health professionals. Studies show that men account for higher mortality rates and morbidity than women, indicating that their inclusion in the primary care service is less expressive than female1,2.
One of the diseases with the highest incidence in men is prostate cancer. This is a neoplasm of slow evolution, so that mortality could be reduced or prevented with early diagnosis and prevention3. There are several factors that contribute to low inclusion of them in primary care, highlighting the issue of gender, whose barriers and symbolic aspects are faced to the examination by touch, which is still seen as invasive and masculinity compromising3,4.
Furthermore, man is marked by the stigma of head of the house, being attributed to him the economic responsibilities arising from the patriarchal role. The delay of health care services, schedules that coincide with work and lack of time are used to justify their limited participation in the primary health sector1.
Greater adherence to the male gender to health services would require a greater supply of media toward this purpose. Today, commercial and information about the health care of man are limited. These means should draw men’s attention to the promotion of health and prevention of diseases and ailments, leaving them at ease and welcomed, ensuring their space and their gender conditions.
Social networks can be a tool to greater participation of men. An example would be the movement on the Internet called Movember - mustache + November. This movement, which was born in Australia and has spread around the world through social networks (Facebook, Twitter, blogs), aims to encourage prevention of prostate cancer with a different approach. Participants are challenged to leave their mustaches grow in November as a way to remember and show the importance of conducting tests for the detection of prostate cancer. This symbol was chosen, according to the organizers, because it is a genuine and brand representation of males.
Regarding the presented problem, the following guiding question of the study arises: What is the impact of alternative communication tools - movements like Movember- on men’s health and the prevention of prostate cancer?
This study is justified by the reduced inclusion of men in health services in primary care, mainly determined by cultural factors, such as strong gender issue, of omnipotence, masculinity and even the patriarchal role and family provider. These factors have contributed and still contribute to the high morbidity and mortality of men. Consequently, the number of chronic diseases increased sharply in men, particularly prostate cancer.
Therefore, it was thought of how media works for the health promotion and prevention of prostate cancer to the point of helping to change this.
The objectives of this study were to analyze the media as strategies for promoting health and preventing disease and injury.
LITERATURE REVIEW
In order to promote greater inclusion of men in the healthcare industry, the National Comprehensive Policy for Men’s Health (NCPMH) was implemented in 2008, in Brazil. This Policy aims to qualify assistance to men’s health with a line of care in an comprehensive way, in primary care. It aims to go beyond the restoration of health to ensure the prevention of diseases and other health problems and health promotion3.
Among the principles of NCPMH, it can be emphasizes the educational one, so the man feels welcomed and part of the health system. Education would be a gateway along with primary care to universal, comprehensive and equal health system5.
METHODOLOGY
This is a quantitative qualitative study that seeks to explain and understand the phenomenon, describing profoundly the variables and the dynamics of social relations, in addition to working with values, beliefs, and opinions of participants6.
The study was performed with 49 men, including students, teachers and workers at a University in the city of Rio de Janeiro. Respondents were in the age group from 20 to 60 years old, and were chosen randomly. From 49th interview data saturation occurred - unique answers obtainment – and the data collection was closed.
The study was approved by the Research Ethics Committee of the University with CAAE number: 700 005 291, under the Opinion Nº 609 386.
All study participants received the Informed Consent Form (ICF) and, after signing the document, the self-administered questionnaires were delivered to those who agreed to answer them. It is important to highlight that confidentiality and anonymity of respondents were guaranteed, according to the requirements of Resolution 466/2012 of the National Health Council7. The subjects were identified by the letter M (man) and the sequence number of its participation in the interview.
Data were collected in the period from September to December 2013, at the University. A self-administered questionnaire was used. The first part comprised items for the characterization of the study subjects, with emphasis on the age and the number of times they sought help from a health professional (nurse, doctor, ....) or health services.
The collected data were treated according to the method of content analysis. The object of content analysis is the word, individual aspect of language; its goals are the meanings of words, trying to understand the actors and the environment where they live; is organized in three stages - pre-analysis, material exploration and processing of the results, inference and interpretation8.
RESULTS AND DISCUSSION
Characterization of subjects
Among the 49 respondents, 20 were students, 15 teachers and 14 employees of the infrastructure sectors of the University, field of study.
The majority (43) stood in the age group 20-30 years old, with minority representatives of other decades, and the majority (44) sought help from a health professional at least once in the past year.
Data analysis led to the construction of two categories: Media, a tool for health promotion and Inclusion of men in preventive health.
The media as a tool for health promotion
From this category emerged subcategories - Media and Preventing prostate cancer.
Media
When the subjects were asked if any campaign/newsletter or communication vehicle (radio, TV and internet) had motivated them to seek health services, the majority responded negatively, but those who were motivated emphasized the negative ones.
Yes, immunization campaigns. The motivation comes from campaigns to prevent disease related to viral and bacterial diseases. (M21)
Yes, TV, because it showed what happened negatively [if there were no care]. (M35)
Internet motivated me, due to skin changes. (M48)
Yes, radio and TV, it left me suspicious. (M36)
It can be seen in the presented speeches that motivation used by media was to show what would negatively happen as a result for not seeking health care. Diseases were mentioned as the most emphasized aspect.
The prevention of diseases, especially bacterial and viral, is one of the points raised. But what is shown is that incentives for men’s health promotion are still scarce in communication networks. Thus, national mobilization campaigns are calling their attention to seek for services.
Most said that no campaign, newsletter or any other vehicle motivated them.
No. None of them motivated me. (M25)
No. Even in those situations, media has not been effective. (M19)
The resistance of men to seek the services of primary care, coupled with a lack of prevention and self-care and the fragility and insecurity contrast with virility, exposure to situations of risk and invulnerability, expressing cultural traits of a hegemonic view of masculinity9.
In relation to the media that could address topics related to human health, the majority referred to advertisements, newspapers, radio and internet.
In educational advertisements and newspapers. (M4)
Advertisements in prime time and dissemination of photos on Facebook. (M12)
Through TV campaigns related to beer. (M15)
Through advertisements in prime time, and also through radio. (M21)
One of the testimonials mentions how the media can take advantage of what holds men’s attention, as the attraction of beer commercials.
Healthcare professionals should consider men as allies companions and holders of a cultural heritage, offering strategies to deconstruct negative aspects of masculinity and rebuild or emphasize positive aspects, whose sociocultural factors, values and habits10.
Preventing prostate cancer
When asked if they remembered any media, and other campaign that addressed the topic of prostate cancer prevention, most of them replied that they did not remember.
Although the study focused on men aged 20-30 years old, it is important that awareness and information to arrive earlier and earlier.
Affirmative responses show that television is still a great medium to propagate and spread the awareness and prevention of prostate cancer. The men remembered of informative advertisement and campaigns about prostate cancer.
Yes. On TV. (M45)
Yes. On TV. (M36)
TV and Internet. (M7)
When asked whether they believed that the media draw attention to men's health, and especially for preventing prostate cancer, the majority denied the proposition.
The advertising campaigns on the prevention of prostate cancer are lower when compared to breast cancer and women's health.
We see a large presence of information about breast cancer, but I have never seen an advertisement for information about prostate cancer. (M44)
It is drawn very little attention when compared to the campaigns for women's health. (M16)
The logic of services and organizing care around the mother-child axis for years has been accompanying the historical process that articulated the hegemony of medical ideas with political actions directed to the valorization of the female body11.
In the 80s, with the development of the Policy Program of Comprehensive Health Care to Women (PPCHCW), the landscape of health care was reorganized through the articulation of gender frame with the field of health by reaffirming the rights of women as individuals, with need of health and individuality12.
Thus, the greater female presence in the health sector also happens because of the appropriation of the female body, reproductive body and biomedical strategies. For the male body, it was left as a reproducer, an unknown and because of the reference to this field of reproduction, it was not invested as objects of practice13.
This formulation is explained by the man and healthy approach is latest from the perspective of health professionals and institutions. In addition, the National Comprehensive Policy on Men's Health is recent, created precisely by the high morbidity and mortality of males, included rates of morbidity and mortality from prostate cancer, losing only to melanoma among men3,13.
Several factors can prevent the greater inclusion of men in health services: the predominance of women in positions of primary health care, whether patients or to health professionals and children; it suggests to men that this is a feminized environment14.
In this sense, there are the issues of vulnerability marked by gender; it is the case of preventive examination of the prostate by means of digital rectal examination.
The digital rectal exam is a low cost and effective detection of prostate cancer; however, it is a procedure that mobilizes male imaginary, depriving countless men from prevention. This separation usually happens by strong trends and remarkable cultural roots of male behavior15.
When asked how the media treats the issue of digital rectal examination, the majority responded that the media do not address this issue.
Actually it does not address this, and when mentioned, it is shown in a painful way. (M49)
I see no publicizing, so I think I should be treated in a better way. (M38)
It is not said anything. (M36)
Do they talk about it? I have never seen or remember them dealing it with educational purpose. Only pejoratively. (M24)
In addition to the testimony evidencing the silence on the issue of digital rectal examination, the issue was associated with sexist jokes and comedies. Most reported that media approaches this exam in a derogatory and embarrassing way.
They almost do not deal about it. This leaves room for certain jokes, there is a lot of missing information, preventing the individual to seek medical care. (M47)
Most often, it is approached as comedy. (M37)
With prejudice. Mainly in comedy shows. (M14)
As a joke. (M27)
They treat the issue in a prejudicial way, making it the target of comedy shows or comic situations. (M18)
It is noted the scarcity of information about rectal examination, and even when it is approached, it is in a pejorative and comical way. It causes further separation of men rather than an open space so they do not feel constrained.
Examples of informational brochures or banners of recent prevention campaigns prostate cancer confirm the participants' reports - certain campaigns present double meaning words, leading to comedic side.
The words touch and enter are very present and detached in the visual information for prostate cancer campaigns. This generates a separation and embarrassment for the man who reads these informative.
Beyond television, new media, especially the Internet, appear to be a great way to spread information and awareness about men's health, and especially the prevention of prostate cancer. In these new spaces, the possibility of breaking myths and providing alternative forms of communication to man is increased. This is confirmed when respondents mention that alternative forms of communication (Facebook, Twitter, Orkut, blog, ...) are advantageous for the promotion of the protection of men's health.
Inclusion of men in preventive health
This category calls for the inclusion of men in preventive health. It comprises two subcategories: Alternative media and Participant man of the alternative media.
Alternative media
Participants were questioned if they knew about the movement on the Internet called Movember, which was spread in social networks around the world and was a big hit in Brazil. Most claimed not knowing.
The movement began with the initiative of five friends, Travis Garone, Luke Slattery, Justin Coughlin and Adam Garonede in Melbourne, Australia, in 2003, from a conversation about outdated styles and trends, emerging the idea to bring the mustache back. The name of the movement soon sprang: Movember (a combination of Australian slang for mustache Mo, and November). The rules were simple: to start November 1st shaven and spend the rest of the month letting grow a mustache16.
Several factors influenced the cause. The first was inspired by the best-known women's health movement, breast cancer. The second, when they realized there was lack of encouragement to involve men in their own health issues. In 2004, the group increased to 450 participants who embraced the cause which raised funds for men's health issues, particularly prostate cancer. It was raised U$ 55,000 for the Prostate Cancer Foundation of Australia, the largest donation so far received16.
So, Movember has been growing gradually, becoming a global movement, inspiring more than 1.1 million participants, all known as MoBros and women, also encouraged in this cause, are known as MoSister. In addition, the movement is funding research, such as genetic mapping of prostate cancer (Genome Sequencing Program) and another one that investigates the ability of nanoparticles attached to antibodies to enhance visualization on MRI in cases of prostate cancer and applications laser illumination of nanoparticles to allow viewing in intraoperative prostate cancer16.
What draws attention to this movement is the active participation of men. The main vehicle for this dissemination is word of mouth and social networks. It soon became a major force organized by men, which brings in its logo Changing the face of mens's health, in the struggle for inclusion of man in health and, consequently, against prostate cancer17.
It may be noted that the movement is inserted in Brazil in other ways. In the fashion world mustache is stamped on T-shirts, accessories and handbags, and also in the musical industry. The song Bigode Grosso (Bushy Mustache) was a hit, and brings a character that exposes an attitude of respect for his mustache. In this aspect, the mustache is reference of masculinity, respect and even virility, becoming a symbol of male identity.
Participant man of the alternative media
When asked if they would be part of the Movember movement, the majority answered affirmatively. They explained how they can participate in Movember in another way:
Drawing a mustache and taking a picture to share on social networks. (M2)
The use of social networking as a means of dissemination. It would be interesting to create artificial mustaches, if a man does not want to grow a mustache. (M15)
Changing the Facebook profile photo, sharing photos and real AND social events [...]. (M21)
[...] I would spread the message on Facebook and etc. (M31)
Posting on social networks. (M42)
Virtual social networks offer the possibility of an open and plural debate, where everyone can participate in the creation and dissemination of information. These media are proving to be an ideal platform for creating social events, manifestos and virtual campaigns18.
It is important to give voice to men, because they may suggest strategies for greater reach of this population. To change this scenario, action strategies of health professionals should be revised so as to broaden the participation of men in health services and self-care, helping to recognize their needs and to reflect on their behaviors10.
Most respondents reported they would be part of the movement through alternative media (Facebook, Twitter, Orkut and others).
Other forms of dissemination, such as sharing and spreading the movement through word of mouth and the inclusion of social groups are also addressed by the subjects. Statements are:
I would participate, talking to everyone I know about it. (M5)
[...] If people in my social group participated, I would participate. (M11)
Disseminating and making health education. (M20)
Other ways to participate were also presented:
Wearing a shirt supporting the movement. (M4)
[...] placement of a day in the calendar. (M9)
[...] Using a false mustache or drawing it with makeup. (M10)
Placing a cloth with specific color in the window. (M13)
I would use a wrist strap or string. (M24)
Letting the hair grow. (M28)
Using shirts about it. (M38)
[...] To encourage opinion-makers, such as actors and athletes who would spread the movement. (M44)
[...] Blue streak in her hair. (M48)
Exposed to the idea of Movember respondents were asked whether these movements could be used to raise awareness of men about self-care; most agreed that it would be effective for the promotion of men’s health and prevention of prostate cancer.
In countries like Canada, United Kingdom, United States and Australia it was realized a strong adhesion of men involved in the causes of their own health and prevention of prostate cancer, after some alternative movements, which resulted not only in increased participation in favor of men's health, but also in fund raising for projects involved in these struggles16.
CONCLUSION
The majority of survey subjects were young and sought help from health professional at least once in the past year.
In the category The media, a tool for health promotion, it was highlighted that the majority of communication vehicles does not encourage men to seek health care, and when it does, mainly through television, it is not in a constructive way and there is less emphasis compared to health campaigns for women.
In the second category, Inclusion of men in preventive health, there is a clamor for male adherence to self-care and alternative forms of propagation.
It is noticed that the current media are not presenting actual results to overcome the challenges of Public Health Policies for the inclusion of men in primary care. Resources, adversiment and informative facing this population are scarce, and when performed do not please the male audience, and it still noticed a privileged attention to health for the mother-children public.
It is worth noting the importance of the topic, mainly for the health problems and high rates of morbidity and mortality of men, including prostate cancer.
Social networks as media to men’s health and the prevention of prostate cancer are valuable, as the statements of the subjects confirmed.
It is important that Nursing participate in these actions, in alternative media such as social networks, encouraging self-care practices to achieve better quality of life and change the face of men's health.
Limitations of the study include the small sample size and a unique setting that prevent generalization of the findings.
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