This article explores the importance of screening programmes in improving men’s health outcomes, focusing on national screening programmes in the UK. The article highlights the importance of encouraging men to participate in health screening programmes for early detection and prevention of various conditions. Primary care nurses play a crucial role in promoting men’s health through preventive care, including screening programmes, the article highlights the role of primary care nurses in delivering these services.
Men’s health remains a critical issue worldwide, with challenges ranging from higher rates of cardiovascular disease to lower life expectancy compared to women. Promoting men’s health through targeted screening programmes is essential for early detection and prevention of various conditions locally, nationally and internationally.
Screening should always be a personal choice. Nurses and other health professionals can provide people with information to help them decide if they wish to accept screening. This article provides an overview of 11 screening programmes in England and explores the importance of screening programmes in improving men’s health outcomes, focusing on the role of the nurse.
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Men’s health
Defining men’s health is not easy. For many years, men’s health has been identified and discussed as a discrete health issue, and many definitions have been suggested.1 A male health issue according to Wilkins2 can be defined by meeting either of the following criteria:
It originates from physiological, psychological, social, cultural or environmental factors that specifically affect boys or men.
It requires actions tailored to males to enhance health or well-being, either at the individual or population level.
This definition implies that addressing men’s health comprehensively involves a holistic approach, encompassing the well-being of boys, both mental and physical health aspects, clinical and social concerns and the influence of male gender expectations. It also highlights the need for interventions that are specifically tailored to men at a broader societal level to enhance male health outcomes.
Global Action on Men’s Health acknowledges that the term ‘men’s health’ may not fully encompass the diverse definitions of sex, gender and sexuality, nor does it acknowledge individuals who may identify differently or use alternative concepts and language to describe themselves.3 This presents an important topic for further exploration and dialogue, inviting discussion and debate.
Men in European regions are living healthier and longer lives than before. However, the World Health Organization (WHO) notes that men’s life expectancy varies between countries by up to 17 years, and within-country differences between men from different socioeconomic backgrounds remain large.4 Many men need to pay more attention to their health.5 Compared to women, men are more likely to:
- Smoke
- Drink too much alcohol
- Make unhealthy or risky choices
- Delay regular checkups and medical care
Men who do present to health and care services usually do so when critically unwell or injured, or have been ‘encouraged’ to do so by a spouse and are more likely to downplay their symptoms. These men are more likely to access emergency care rather than making an appointment with their GP.6
Screening programmes
Primary care nurses are often the first point of contact for men seeking healthcare. They play a key role in offering men advice about the importance of screening and discussing the benefits and limitations of the various screening programmes available to men. Nurses can provide information about screening programmes, encourage men to attend and support them through the screening process. They also play a vital role in follow-up care, providing information on test results and coordinating further investigations or referrals as needed. Screening programmes for men’s health are important for several reasons (see table 1).
Screening programmes for men’s health are important because they can lead to early detection of diseases, promote preventive health care, reduce healthcare costs, promote health equity and have a positive impact on public health.
Population screening refers to the process of identifying healthy people who may have an increased chance of a disease or condition, thereby enabling early treatment. It is not aimed at those people who already have symptoms of a disease or condition.
In the UK each country sets its own screening policy based on the recommendations of the UK National Screening Committee. As a result of this there can be some differences in the screening that is offered. In England there are 11 population screening programmes (see table 2) (Wales 8, Scotland 7 and Northern Ireland 8).7
Nurses and other practice staff can help reduce screening inequalities by informing people of the NHS screening programmes and supporting them to so that they are able to make informed choices about screening. Screening tests are not compulsory they are offered to help people make informed choices about health. Screening can uncover serious conditions early, prior to any symptoms appearing
Trans and non-binary people
The various NHS screening programmes have been highly effective in preventing illnesses, saving lives and empowering individuals to make informed decisions about their health. However, disparities persist in cases where eligible individuals are not receiving invitations for screening.
NHS England has produced information for trans (transgender) and non-binary people, discussing the NHS screening programmes available and explaining who are invited for screening.8 In the information provided trans is used as an umbrella term to include the diverse range of identities that are outside the traditional male/female definitions. These include transgender, gender fluid and non-binary. This approach is undertaken as a part of NHS England’s commitment to make screening accessible and inclusive for all eligible populations.
Prostate cancer screening
Prostate cancer is the most common cancer in men in the UK with1 in 8 men being diagnosed with prostate cancer in their lifetime. Prostate cancer is the most common cancer in men. More than 52,000 men are diagnosed with prostate cancer every year (on average,144 men every day). Every 45 minutes one man dies from prostate cancer, equating to more than 12,000 men every year. There are around 490,000 men living with prostate cancer.9
Currently, there is no prostate cancer screening programme in the UK. There are a number of reasons for this. The primary reason is that there is no reliable test that can consistently detect prostate cancer requiring treatment at an early stage. Existing tests do not significantly reduce the number of men dying from prostate cancer.10
The initial diagnostic step often involves the prostate-specific antigen (PSA) blood test, but it lacks the necessary accuracy for effective primary screening. The PSA test often fails to detect many cases of prostate cancer that could potentially benefit from treatment, while also yielding elevated results in the absence of prostate cancer. Moreover, it has a tendency to identify diseases that would not pose significant health risks during a man’s lifetime, resulting in instances of overtreatment and adverse side effects.
Overtreatment means that people receive more extensive or invasive treatment than is required to improve health outcomes. In screening, overtreatment can occur alongside overdiagnosis. In those countries with prostate screening programmes, for example, men can be subject to surgery and radiotherapy for prostate cancer, with associated problems that include erectile dysfunction and urinary incontinence in situations in which the cancer may not have caused them any harm in their lifetime.11
The role of the nurse
Physical and mental health problems experienced by men require a male-focused approach.12 Encouraging men to participate in health screening programmes is key for early detection and prevention of various conditions. Primary care nurses play an important role in promoting men’s health, making every contact count and can use a range of strategies that can help to encourage participation in screening programmes.
While men have a personal responsibility to seek healthcare promptly, it is imperative that when they do, they receive individualised care. Some men may not fully understand the role of primary healthcare nurses and may downplay their symptoms to avoid being perceived as complaining or whinging. Unlike women who are more inclined to participate in health prevention and promotion efforts, men are more prone to overlooking them.6
The nurse can provide information about the specific conditions being screened for, helping men understand why screening is important for their overall well-being. Nurses offer men advice about the importance of health screening and the potential benefits of early detection.
Nurses should develop further their communicate skills with men communicating in a way that is sensitive to their preferences and concerns using a bespoke, tailored approach. Using language that is clear, non-judgmental and culturally sensitive can help build trust and rapport with male patients. Nurses can also address common misconceptions or fears about screening with the intention of alleviating anxiety and encouraging participation.
Understanding who those men are who may be at risk of certain conditions (a personalised risk assessment) can help focus initiatives and strategies to engage with men. Such an approach can help nurses identify men who may be at higher risk for certain conditions and may benefit from screening. By taking into account factors such as age, family history, lifestyle habits and medical history, nurses can tailor their recommendations for screening based on individual risk profiles.
Making it easier for men to participate in screening programmes can include offering flexible appointment options, providing convenient locations for screenings, minimising barriers to access. The provision of same-day appointments can also make it more convenient for men to be screened.
The influence of peers and social networks should not be underestimated, this can be an effective way to encourage men to participate in screening programmes. Ringrose and Wang discuss the use of digital applications in men’s health. Digital tools, they emphasise, can support the human aspect of clinical care, address the stigma of men’s health and address the need for specialised health care for men.12
Bell et al note that there are few community-based lifestyle interventions designed to target physical and mental health of men. Nurses can engage community leaders, sports clubs, workplaces and other community organisations to promote screening and encourage men to support each other in taking proactive steps towards their health.14
Following up with men who have been recommended for screening but have not yet participated can help reinforce the importance of screening and address any barriers or concerns they may have. Providing ongoing support and guidance throughout the screening process can help men feel more comfortable and empowered to take charge of their health.
Primary care nurses play a critical role in encouraging men to participate in health screening programmes. By providing education, personalised risk assessments, convenient access, peer support and ongoing follow-up, nurses can empower men to prioritise their health and take proactive steps towards early detection and prevention of disease.
Conclusion
Just as female patients have unique needs and require care tailored to their sex or gender, male patients also have specific health and care requirements. While women’s health networks and testing services have been developed extensively, there is limited provision for men that addresses their distinct needs. Primary care nurses work to ensure that care provision is responsive and tailored to meet individual and community wide needs.
Ian Peate, Visiting Professor, Northumbria University; Senior Clinical Fellow, University of Hertfordshire; Professorial Fellow, University of Roehampton
References
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