Masculinities, humour and care for penile cancer: a qualitative study.

AIM: To explore how men with penile cancer construct humour in relation to their diagnosis and treatment. BACKGROUND: Functionalist, relief and incongruity theories attempt to account for humour, but there is a dearth of empirical evidence in nursing care. This is particularly so in relation to a condition like penile cancer where some nurses think that humour in their interactions with patients would be inappropriate. DESIGN: The study employed a participative, mixed-qualitative-methods design. METHOD: Focus groups and patient-conducted interviews were both used during a one-day 'pilot workshop' in March 2011. The data were initially analysed using framework analysis. This paper explores the theme of humour in depth. FINDINGS: Humour helped participants make light of their condition, which meant that they could laugh about the consequences of treatment ('laughing about urination') and build rapport with health professionals ('humour with health professionals'). Nevertheless, the use of humour was less important than the treatment of their cancer ('humour discounted') and there was a fear that they would be subject to ridicule because of their condition ('fear of ridicule'). CONCLUSION: The findings suggest a combination of functionalist, relief and incongruity theories of humour; the emotions these men experience are contained (functionalist) and released (relief) through humorous interaction, and the potential for comedy lies in an incongruity between what is expected socially and the experiences of these men, for example, around expectations that men use urinals in public toilets. Nurses should continue to use humour to build rapport with patients, should they judge this to be appropriate, although they may want to avoid jokes about sexual and urinary functioning until after treatment.

Engaging men with penile cancer in qualitative research: reflections from an interview-based study.

AIM: To explore the challenges of engaging men with penile cancer in qualitative interview research. BACKGROUND: Qualitative interviewing offers an ideal tool for exploring men's experiences of illness, complementing and providing context to gendered health inequalities identified in epidemiological research on men. But conducting interviews with men can be challenging and embarking on a qualitative interview study with males can feel like a daunting task, given the limited amount of practical, gender-sensitive guidance for researchers. Reflecting on a researcher's experience of conducting qualitative research on men with penile cancer, this paper explores the potential challenges of interviewing this group, but also documents how engagement and data collection were achieved. REVIEW METHODS: This is a reflective paper, informed by the experiences of a male researcher (KW) with no nurse training, who conducted 28 interviews with men who had been treated for penile cancer. The researcher's experiences are reported in chronological order, from the methodological challenges of recruitment to those of conducting the interview. IMPLICATIONS FOR PRACTICE/RESEARCH: The paper offers a resource for the novice researcher, highlighting some advantages and disadvantages of conducting qualitative interview research as a nurse researcher, as well as recommendations on how to overcome challenges. CONCLUSION: Engaging men with penile cancer in qualitative interview raises practical, methodological, ethical and emotional challenges for the researcher. However, when these challenges are met, men will talk about their health. Methodological procedures must enable an open and ongoing dialogue with clinical gatekeepers and potential participants to promote engagement. Support from colleagues is essential for any interviewer, no matter how experienced the researcher is.

Men's health promotion interventions: what have we learned from previous programmes.

Concern persists in health-related literature about men's reduced life expectancy and higher premature death rates; this is often linked to difficulties in engaging with men as a client group. However, some innovative projects and programmes, often led by health visitors or other community based nurses, have developed successful health promotion work with men. This article collates existing tacit knowledge (previous learning) about men's health interventions by integrating interview data from nine practitioners who have established such initiatives with data from 35 men's health project reports to consider 'what works'. Five themes stood out as being significant across the data reviewed: using the right setting (often outside statutory services); ensuring the right approach (drawing on male-specific interests and language); actively listening to what local men say; appropriate training (initial and ongoing) for those involved in such work; and partnership working with local community groups, businesses and statutory service providers. While not a panacea for working with any and all men, these themes form a good basis for successful engagement with men and align well with what a recent review of health visitor interventions suggest works in helping bridge service provision-uptake gaps.

The impact of surgical treatment for penile cancer -- patients' perspectives.

PURPOSE OF THE RESEARCH: Penile cancer is a rare but highly treatable condition. Whilst over 80% survive for over five years, treatment can have a significant impact on quality of life. There has been little research conducted to date on men's experiences of treatment for penile cancer. The Patients Experiences of Penile Cancer study (PEPC) aimed to redress this shortfall by exploring men's experiences of surgical treatment for penile cancer. METHODS AND SAMPLE: The study used a narrative history design in which data were collected using one-on-one semi-structured interviews. Maximum variation sampling was used to acquire the widest possible range of experiences. Twenty-seven interviews of around one hour were conducted with men with an average age of 63 years at diagnosis (range = 41-82). The data were analysed using constant comparison analysis. KEY RESULTS: The physical impact of surgery was inter-connected with broader events in the lives of the men experiencing treatment. These experiences cover urinary function, sexual function and sexual relationships, healing and recovery, masculinity, mental well-being, coping and support. CONCLUSION: A key area for the development of care is to devise and evaluate procedures for ensuring that men are well-informed about the extent and potential consequences of their treatment. Men's experiences of penile cancer surgery will be informed by a complex web interlaced with their broader lives, making it difficult for health professionals to judge how surgery will impact on a men presenting to them. Further research is required to ascertain the most appropriate strategies for rehabilitation of men experiencing penile cancer surgery.

Self-care in primary care: findings from a longitudinal comparison study.

AIM: To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients. BACKGROUND: Interventions to promote self-care in frequent users of primary care services have had mixed results. This paper reports an evaluation of a self-care initiative that aimed to develop a practice-based strategy to support self-care. METHODS: A 12-month longitudinal-matched comparison study was carried out in seven intervention and four comparison practices. The intervention was a multidisciplinary training package delivered to Primary Care Trusts (PCTs) and practice staff in three workshops, over a three- to six-month period. Twenty-one managers, health professionals and other staff from participating practices and PCTs and 1454 patients were involved in the study. 'Frequently attending' patients were defined as having visited the practice more than eight times in the previous year, and were identified from practice registers and recruited by letter. Three sets of data were obtained: psychometric scores and other data from structured questionnaires; routinely collected data on use of healthcare services; and self-care beliefs and behaviour from qualitative interviews. Findings Study recruitment rate was 20% and retention rate 75%. Of those recruited 66% were female and the majority (94.8%) were White. There was poor uptake of the training programme within the participating practices, with few changes agreed or implemented. Few healthcare professionals consented to take part in the evaluation. No significant changes were seen in patients' use of health services, psychometric scores or self-care beliefs or behaviour. CONCLUSION: The initiative did not show any effects during its pilot phase. Uptake and implementation were adversely affected by competing pressures for time and resources in primary care, coupled with a lack of engagement from primary health care professionals.

'It's coming at things from a very different standpoint': evaluating the 'Supporting Self-Care in General Practice Programme' in NHS East of England.

AIM: To undertake a service evaluation of the NHS East of England Supporting Self-Care in General Practice programme. BACKGROUND: The number of people purported to live with long-term conditions continues to rise generating increasing policy emphasis on the importance of self-care. Previous work has highlighted barriers to implementing self-care interventions in general practice, including a lack of organisational approaches to providing self-care and limited engagement and training of healthcare professionals. In response to these barriers and policy drivers, NHS East of England Strategic Health Authority developed and commenced the Supporting Self-care in General Practice (SSCiGP) programme, which seeks to transform the relationships between people with long-term conditions and primary care practitioners. METHODS: This was a mixed methods study, carried out over two phases, which included interviews, survey work and practice-based case studies. RESULTS: This paper focuses on findings related to clinician and practice level change. Clinicians reported changes in their perceptions and in consultation practices following attendance on the SSCiGP programme. These changes were linked to empathy and patient-centredness that mirrored what patients valued in interactions with clinicians. There were qualitative and descriptive differences, but no statistically significant differences between clinicians who had and had not attended the SSCiGP programme. Time was recognised as a significant barrier to implementing, and sustaining skills learnt from the SSCiGP programme. Greater impact at practice level could be achieved when there was whole practice commitment to values that underpinned the SSCiGP programme. There was evidence that such approaches are being incorporated to change practice systems and structures to better facilitate self-care, particularly in practices who were early programme adopters. CONCLUSION: This evaluation demonstrates that training around clinician change can be effective in shifting service delivery when sat within a cultural framework that genuinely situates patients at the centre of consultations and practice activity.

The self-care for people initiative: the outcome evaluation.

AIM: To determine the effects of a community-based training programme in self-care on the lay population. BACKGROUND: Self Care is recognised as being a cornerstone of the populations health, but to date there have been few large-scale studies of its effectiveness on the general public. This paper reports on an evaluation of a self-care skills training course delivered in small group sessions within workplace and parent and toddler group settings to a lay population. METHODS: A quasi-experimental longitudinal study of 12-month duration was conducted in three intervention primary care trusts (PCTs) and two similar comparison PCTs in England. The sample comprised 1568 self-selecting participants: 868 received the intervention and 700 did not. FINDINGS: No changes were seen in usage of General Practitioner services, the primary outcome, however, statistical analysis suggested that being in the intervention group may be associated with increased use of out-of-hours and secondary care services. At six months' follow-up small but statistically significant positive effects of being in the intervention group were seen on self-esteem, well-being and anxiety scores. At 12 months' follow-up small but statistically significant positive effects of being in the intervention group were also seen on recovery locus of control, health literacy and self-esteem scores, and on knowledge of adult cough. The clinical significance of these very small changes is unclear. The training programme had a small but positive effect, which was still evident at 12 months, on individuals' knowledge and confidence levels with regard to managing their own health, but did not lead to reductions in health service use.

'Straight to the GP; that would be where I would go': an analysis of male frequent attenders' constructions of their decisions to use or not use health-care services in the UK.

An important consideration that needs adding to discussions of patient choice and whether or not men are reluctant to use primary care services is that many frequent attenders are male. The aim of this article is to explore how male frequent attenders construct decisions to use or not use health-care services. This is achieved through secondary analysis of baseline interviews with male frequent attenders from the Self Care in Primary Care study. As this was a complex study, a three-step analytic process was employed to incorporate the involvement of multiple researchers working together over a number of years. First, the interviewer summarised each interview and second, the summaries were read as a group to find themes across them. Subsequently, we returned to the interviews to add detail that would further illustrate or challenge the analysis. Participants talked of 'engaging health and avoiding ill-health', constructing themselves as embodied, health conscious and rational in a similar vein to constructions of feminine interactions with health. While participants talked of 'choosing health services' as if they were drawing upon a range of choices, the dominance of the image of the GP was such that seeing a GP was the only legitimate health choice.