RHP&EO is the electronic journal of the International
Union for Health Promotion and Education
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Prostate Disease Awareness
By Chih Chien Kenneth Goh, Kang Yao Lim, Michael Ng, Brenton Tay Internet publication: 15 May, 1996Work by Monash University Medical students, produced as part of the health promotion subject offered at year three. NB: Appendices are not available on the online version. Goh K, Lim K, Ng M, Tay B. Prostate Disease Awareness. Internet Journal of Health Promotion, 1996. URL: ijhp-articles/1996/4/index.htm. AbstractProstate Disease Awareness (PDA) was conceived to raise public awareness and arouse interest in prostate disease, provide knowledge on prostate disease, signs and symptoms, diagnosis and treatment options, encourage men with symptoms of prostate disease to talk to their doctor, family and friends, and highlight organisations which provide information and support on prostate disease. PDA involved the use of a preliminary survey and presentation of two seminars to be followed by a post-survey. The preliminary surveys indicated that the community had some idea on the function and location of the prostate, but lacked knowledge on prostate disease. This was addressed at the two seminars where participants acknowledged an improvement in their knowlege base. They also felt more encouraged to talk about the problem itself. It is concluded that PDA's goals were achieved despite its small magnitude. Keywords:Prostate, benign prostatic hyperplasia, prostate cancer, prostatitis. Health issueProstate disease is becoming a major public health problem. Every year 2000 Australians die from prostate cancer alone [1], which affects 1 in 10 males [1]. This year alone 5000 new cases of prostate cancer will be diagnosed [1]. Prostate disease however is still at large a subject very much in taboo, and the public's response towards it can be considered negligible compared to that received by breast cancer. There was and still is a clear need for more awareness and publicity on prostate disease. Through research, much has been learned about the prostate in the past few years. Yet there is clearly a lack of information dissemination to the wider community. Hence the evolvement of the Prostate Disease Awareness (PDA) project. Priority population groups1. Original target populationProstate disease affects mostly men above 50 years of age, with 30% of men at age 50 [2] having some form of prostate enlargement. This increases to 50% at 60 years, and 80% by 80 years [3]. Hence, it seems appropriate to have men over 50 as PDA's priority group. 2. Inclusion of women in target audienceMen seem reluctant to talk about their problems, and even less inclined to go see their doctor about it. It was realised that women can often be very influential in the Australian family, as on many ocassions it is the woman who instigates the visit to the doctor. Therefore, an ammendment was made to involve women in PDA. 3. Stretching the target to the younger generationAlthough prostate disease affects mostly men 50 and over, PDA should involve younger age groups as well. It is inevitable that the younger generation will grow old one day so why not learn and talk about the subject now. Thus, everyone in the community was invited to participate in PDA.. Goals and TargetsThe ultimate goal of PDA was to raise public awareness on the little publicised prostate disease. Other objectives were:
Strategies and Methods1. ResearchTo promote health, it was first essential to have an understanding of the health topic. Information on prostate disease was obtained through:
2. Locating the priority populationThe search for the appropriate audience proved difficult, whether it be with various senior citizens' clubs, retirement villages and Rotary Club branches. Fortunately, the Returned & Services League (RSL) of Oakleigh expressed interest and from then on, they became the focal point for the seminar and the corridor to spread awareness. The RSL with its extensive network of members also provided a means to get PDA's message across efficiently. 3. Distributing preliminary surveysFour hundred surveys were distributed, taking into account an expected return of approximately 20% (refer Appendix C). 4. Analysing preliminary surveysData obtained was analysed, specifically to assess baseline knowledge, attitudes and practices on prostate disease. Data obtained aided in the formulation of the content of the seminar and rectification of misconceptions. 5. Organising publicityA press-release was organised to raise community awareness on prostate disease and to publicise PDA, especially the scheduled seminar. The article was published in the weekly edition of a community newspaper - The Oakleigh-Springvale Times (refer Appendix H) dated 20th September '95. Promotional posters on the seminar were posted in:
6. Preparing seminar materialSeminar material was personally produced, with some provided by the AKF. It was decided that the content should accommodate an audience unfamiliar with the prostate and its diseases. Visual information was important, and overheads were designed to accompany the talk (refer Appendix E). 7. SeminarsTwo seminars were held, one at RSL-Mornington, the other at RSL-Oakleigh (refer Video - Appendix K). The seminar at RSL-Mornington was held at their request. The seminars were designed
8. Distributing post-surveysPost-surveys were distributed at the end of the seminar (refer Appendices D1, D2). The post-surveys were different to the preliminary surveys. Some questions from the preliminary survey were removed, and other questions added to assess the audience's understanding and knowledge after the seminar as well as changes in attitudes and practices. The audience was also asked to rate the presentation, organisation and usefulness of the seminars. 9. Distributing information pamphlets and leafletsInformation pamphlets from the AKF and leaflets from US Too were distributed together with the post-surveys after the seminar as a means of further disemmination of information on prostate disease (refer Appendix F). A leaflet of our own provided information on where to go for more information. 10. Analysing post-surveysData from the post-surveys were analysed to measure knowledge gained out of the seminar and changes in attitude and practices in relation to prostate disease. Opinions from the audience were used as a means of evaluating the seminar. For more detailed information of proceedings, refer to the Log Book (Appendix J). Evaluation planTwo surveys were employed in the course of PDA as a means of evaluation. 1. Preliminary surveyFour editions were printed (refer Appendix C). The 1st edition as compared to further editions did not ask about the participant's gender. The preliminary survey was designed to assess the community's knowledge on prostate disease which determined the type of seminar material to be used. The questionairre consisted of questions regarding their
2. Post-surveyTwo editions of the post-survey were used, the 1st at RSL-Mornington and the 2nd at RSL-Oakleigh (refer Appendices D1, D2), the difference being the section in regard to the seminar ratings. Basically, the questions were categorically similar to the preliminary survey but were more probing. The audience was also asked to rate the seminar (refer Appendices D1-4, D2-4). These questions were modified after the 1st seminar upon recommendation by Ms Day of Victorian Continence Foundation, hence the two editions. ResultsPreliminary surveys109 surveys were returned out of a total of over 400 distributed. Of this, 23 surveys were those of the 1st edition and classified as an unknown gender in the data analysis process. 59 were male and 18 female (refer Appendix A-1). 16 people (14.6%) answered that they (or their spouses) have been diagnosed with prostate disease (refer Appendix A-13). 1. Knowledge on prostate disease* Note: Some questions had multiple answers.
6% had heard of bone scans 38% had heard of the blood test (PSA); 20% had heard of ultrasound 41% had heard of Digital Rectal Examination 2. Attitudes towards prostate diseaseIt was important to see what they would do if they had prostate trouble. 83 of 109 people chose to see their doctor. Furthermore, only 10 would talk to their wife and 2 to their mates, highlighting the public's unwillingness to talk about such topics.
Post-surveys35 post-surveys were completed and of these, 24 were from RSL-Mornington and 11 from RSL-Oakleigh. 35% of the seminar audience were men, the remainder being women. 1. KnowledgeGenerally, the respondents rated an improvement in knowledge after the seminar (refer Appendices B-20, B-21).
a. Knowledge on the prostate
b. Knowledge on prostate disease
c. Knowledge on diagnosis of prostate disease
2. Attitudes towards prostate diseaseAfter the seminar:
3. Seminar rating
Discussion1. Preliminary surveysGenerally, the community had rudimentary knowledge on the prostate. Most had "heard" about the three main prostate diseases, but were unfamiliar about the features of prostate disease. In addition, most lacked knowledge on treatment, its complications and diagnosis. Furthermore, not many were willing to talk to others, eg. wife or mates, if they had prostate problems. By distributing the preliminary surveys, the goal to increase awareness was in the process of being realised. 2. PublicityPublicity was an integral component in attracting an audience. The press-release in a community newspaper and promotional posters were means to not only publicise PDA, but to arouse public interest and increase awareness on prostate disease. Unfortunately a delay in the distribution of The Oakleigh-Springvale Times meant that many would be unaware of the seminar. Posters also can only be effective if they reach the appropriate audience in time. Not many RSL members actually go to their respective branches regularly. Most turn up for functions only once a fortnight, if not monthly. Other forms of media, eg. RSL newsletters, radio etc., could also have been used for publicity purposes. Ample time should have been provided for publicity purposes, which in our case should have been as long as one month. 3. The SeminarsBoth seminars turned out fairly well, although there seemed to be a lack of audience at RSL-Oakleigh. Some positive feedback were received after both seminars, eg. the presented material was fairly easy to understand. This was also reflected in the ratings of the seminars. Through both seminars, we managed to provide knowledge to some members of the community. A request was made by The Bentleigh Bowling Club for a seminar to be held later on. This was however not to be as one could not be organised within the time constraints of PDA. A member of RSL-Bentleigh had even requested for a copy of our seminar script. We realised that even though our audience was small, public interest had been aroused. Pamphlets and leaflets containing additional information were distributed after the seminar. Via this method, the audience were informed of the existence of organisations which provide information and support on prostate disease 4. Post-surveysThe preliminary surveys and post-surveys were not designed to assess improvements in knowledge prior to and after the seminar. Hence a direct correlation in improvement of knowledge could not be made. Nevertheless there seemed to be a general improvement in knowledge after the seminar, as reflected in the results of the post-surveys. Thus, men are better informed to go see their doctors when they have problems. The post-surveys also indicated that the audience felt more willing to talk about problems concerning the prostate after the seminar, especially to their own family members. This may however be inaccurate due to the small and predominantly female audience. Nevertheless we believed that we had managed to encourage people to talk about the prostate as reflected in the results. 5. Post-project workThe informational poster "Prostate - the gland below the belt" was produced for the RSL's Veterans' Affairs Health Week, which is scheduled during the week 22nd-28th October '95. This was a means to continue our health promotion which is not an end in itself but an ongoing process. 6. Further recommendationsOne of the main problems about holding any seminar is audience numbers. Audience numbers may have been boosted by incorporating a seminar with some other established function, eg. some sort of luncheon event etc., as had been the case with the seminar at RSL-Mornington. Although the RSL provides an extensive network of members, it may be difficult to target the 50-65 age group as many RSL members are over 65. The 50-65 age group is furthermore a working class, and is not likely to be affiliated with RSL groups. It would also probably be not unwise to say that the majority of the community still feels that the prostate is too taboo a subject to talk about. One suggestion for 'desensitising' this sensitive issue would be to begin education at a young age. Methods may include talking about sex education, where one can encourage kids to be comfortable in voicing out their health problems related to sex, and to abate stereotypical views that an acknowledgement of their health problems is not a sign of weakness and loss of masculinity. It was stressed that PDA is not advocating mass screening since there is still much controversy over the benefits of screening and even treatment itself. ConclusionsThe turnout for the RSL-Oakleigh seminar was no doubt a disappointment. This however does not mean that PDA's goals were not achieved. A relatively simple strategy such as a press-release can do wonders in the case of raising public awareness. We believe that in spite of the small magnitude of PDA as a project, we have accomplished all our objectives. There is an abundance of information on prostate disease but there is great difficulty in getting this information across to the public. AckowledgementsWe would like to thank the following people/organisations for all their support and contributions to the Prostate Disease Awareness Project.
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