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Prostate Disease Awareness: A follow-up investigation

Brendan R. Thomas, Tuan D. Phan, Ian K. Letson, Dominic J. Hannan

Introduction

The Health Issue

Australia is currently stocked with a progressively ageing society. Fifteen percent of the population is currently aged over 60 years, and this figure is expected to rise to in excess of 20% by the year 2020. One of the many ramifications of this statistic is that the prevalence of diseases of longevity such as prostate disease will increase. At present one in four men aged over 55 have a form of prostate disease and one in ten men die from prostate cancer each year [1]. Despite the recent attention given to prostate disease in the media, there is a shortfall in awareness of the disease compared to other diseases such as breast cancer to which it exhibits similar mortality rates. Add to this the fact that men are often reticent to seek medical advice or discuss with their G.P. medical issues pertaining to prostate disease, and we find ourselves face to face with a health issue that demands attention.

Goals

1. To increase awareness of prostate disease.

2. To increase acceptance of prostate disease as a serious health issue.

3. To increase the level of empowerment as it relates to prostate disease within priority population groups.

4. To motivate the priority population groups to seek medical intervention at the appropriate time in an attempt to achieve the best possible health outcome.

Targets

1. The seminar audience on the 12/9/96 at Monash Medical Centre

2. Internet home page users

3. The general community

Priority Population Groups

• Men over the age of fifty

This represents the high risk group for prostate disease.

• Spouses and partners

These play a vital role in encouraging their male partners to seek medical advice and comply with treatment.

• The general population

Targeting this group has the advantage of influencing future risk groups.

Strategies and Methods

Research

The Prostate Disease Awareness Team (PDAT) utilised a number of resources in order to obtain a relevant, accurate, comprehensive and up to date knowledge of prostate disease.

Community Evaluation

Aim

To assess the level of awareness, acceptance, empowerment and motivation as they relate to prostate disease in the community. This was done in order to determine whether health promotion directed toward prostate disease was needed and if so provide information required to design an effective health promotion program.

Method

Community evaluation was achieved by the use of a questionnaire (Appendix B).

Questionnaire Design

Questionnaires were designed to ascertain both demographic characteristics of respondents as well as their levels of awareness, acceptance, empowerment and motivation. Questionnaires were designed to be easy to understand and take no more than 10-12 minutes to complete. A pilot study, involving the distribution of 20 questionnaires to families and friends of PDAT members, was undertaken to assess the questionnaire. Where appropriate, modifications were made. Ethical considerations were of paramount importance and all respondents were informed, via an introductory statement on the questionnaire, that they were under no obligation to complete the questionnaire and that confidentiality would be maintained at all times.

Questionnaire Distribution/Collection

One hundred and twenty questionnaires were distributed and collected via door knock, to men and women, predominantly over forty, in four geographic locations – Lilydale, Elwood, Glen Waverley and Croydon. One hundred and sixteen (97%) of the questionnaires were completed.

Questionnaire Evaluation

Of respondents, 56% were male, 44% were female, and 83% were over the age of 40. From analysis of the initial questionnaires it was obvious that there were significant deficits in the community’s awareness, acceptance, empowerment and motivation as they relate to prostate disease. These deficits clearly demonstrated the need for a health promotion program.

Michael Please note - (Results are presented in Appendix K.)

Health Promotion Program Design

The health promotion program was designed with three distinct yet overlapping components: a seminar, community promotion and an Internet home page.

The Seminar

Aims

1. To deliver a formal education program directly to a large audience and to provide the opportunity for informal small group/individual discussion and interaction.

2. To provide information devoid of medical and scientific jargon in a way that is clear, concise and readily understood by the seminar audience.

3. To cover a broad range of issues.

4. To utilise a number of different educational media in order to present and reinforce key issues from a number of different perspectives.

Method

A multifaceted interactive educational seminar was designed. The seminar included formal student, case, and specialist presentations in conjunction with informal electronic, computer, literature, and anatomical displays.

Formal student presentation

The student presentation constituted the major part of the formal presentation and covered a broad range of topics, examples of which include aetiology, symptoms, testing, diagnosis, and treatment. Visual aids such as slides incorporated text, diagrams, colour, and contrast in such a way as to clarify, reinforce and further develop the main issues thereby enhancing the oral presentation.

Formal case presentation

A case presentation was provided in order to reinforce the issues raised in the student presentation while at the same time highlighting the reality of prostate disease by putting a "real face" to the issue. Factors considered in choosing a guest speaker included: public profile, credibility, candour, knowledge, personal experiences and communication skills. Accordingly, Mr Alan Hopgood a ‘survivor’ of prostate cancer, and popular actor, author and playwright was invited to give a case presentation. Mr Hopgood provided a personal account of his experiences as they related to prostate disease symptoms, testing, diagnosis and treatment, in each case detailing the physical, social, and psychological impact on his life. The audience was given the opportunity to direct questions to Mr Hopgood during both the formal and informal stages of the seminar.

Formal specialist presentation

The services of Mr John Wheelahan, a Urological Surgeon, were utilised for the specialist presentation which was structured in a question and answer format. Audience members were provided with the opportunity during both the formal and informal stages of the seminar to direct questions, in a verbal or written form, to Mr Wheelahan. Mr Wheelahan was able to reinforce and enhance the credibility of the student presentation, provide an opportunity for audience participation and enable highly specific issues of a medical nature to be addressed.

Informal presentation

The informal presentation was designed to reinforce and develop issues raised in the formal presentation. This consisted of a number of components:

1. The distribution of walnuts to audience members reinforcing the size and shape of the prostate and providing a novel connection to act as a future prompt.

2. The distribution of a pamphlet designed by the PDAT highlighting the key issues raised in the seminar and providing a list of resources.

3. Several information stations staffed by members of the PDAT including:

• An anatomy display of the male reproductive tract.

• A poster and literature display on prostate disease.

• The provision of literature to audience members from a variety of sources including the Anti Cancer Council, The Australian Kidney Foundation and Monash University’s Institute for Reproduction and Development.

• An interactive electronic prostate disease display board.

• An Internet page, designed by the PDAT on prostate disease.

4. The opportunity for individual and small group discussion, over tea and coffee, between audience members and the PDAT/guest presenters.

Seminar Logistics

Organisation of the seminar required careful consideration of a large number of logistical matters examples of which include location, timing, duration, evening schedule, sponsorship and availability of human and non-human resources.

Seminar Promotion

Aim

To motivate members of the priority population groups to attend the seminar.

Methods

Promotion of the seminar involved a number of resources including:

1. National television "Good Morning Australia" on which Dr Sally Cockburn (Dr Feelgood) promoted the seminar and used visual aids produced by the PDAT to enhance her discussion on prostate disease.

2. Mainstream and community radio interviews and community service announcements.

3. Victorian daily and suburban weekly newspaper advertisements for the seminar as well as articles on prostate disease.

4. Direct contact by phone, fax or in person with representatives of a number of organisations, retirement villages and community groups.

Community Promotion

Aim

Achievement of the goals of the health promotion program within the general community.

Method

1. Utilisation of the seminar promotion, as outlined above, as a vehicle for increasing awareness of issues relating to prostate disease within the community.

2. Continued use of the Internet home page

3. Generation of public interest and discussion by those who attended the seminar.

The Internet

Aims

1. To access the 50 million world wide Internet users, 70% of which are male with an average age of 35 years [2].

2. To address the current Australian deficit of information about prostate disease on the Internet.

3. To provide an Internet page that is visually appealing, easy to use, attracts Internet users and enables user feedback.

Design

Careful consideration was given to the selection of background, text colours, images, animation and buttons.

Information placed on the Internet was obtained from a number of sources. This had a number of advantages. It reinforces and increases the credibility of salient issues while at the same time providing different emphasis and perspectives which ultimately enhances understanding. The option to select links to information provided by prostate disease action groups world wide was also included in the Internet page. This option increases the number of resources available to Internet users, further raising their level of empowerment. [Editorial note: the Monash Prostate Disease Awareness Homepage is located at http://www.monash.edu.au/health/pamphlets/prostate/index.html]

Promotion

The Internet Home Page has been placed under the Health Promotion Directory of the Monash University Internet Server which has a strong regular visitor base. Further, the PDAT contacted four of the largest Internet "search engines" requesting inclusion of the Internet address in their data bases. In addition, the Home Page was advertised during both the formal and informal stages of the seminar. The Internet address was included on the PDAT pamphlet. During the informal presentation audience members were given "hands on" experience of how to access and use the Home Page.

Results

The following tables and graphs represent a summary of thefindings obtained through the analysis of the initial, pre- and post-seminar questionnaires and monitoring of the access counter on the Internet. (For additional results see Appendix K.) It should be noted that while the results are categorised and evaluated under the goals of awareness, acceptance, empowerment and motivation there is a considerable degree of overlap between these categories.

Evaluation

Evaluation Design

Seminar

The seminar was evaluated via the analysis of pre- and post-seminar questionnaires. The pre-seminar questionnaire was identical in design to the initial questionnaire while the post-seminar questionnaire had additional questions relating specifically to evaluation of the seminar.

Internet

The Internet was evaluated by an anonymous on-line questionnaire and access counter.

Community Promotion

Evaluation of the community promotion, while beyond the scope of this health promotion program could include:

1. Distribution and analysis of questionnaires.

2. Evidence of an increase in prostate disease testing.

3. Evidence of a decrease in prostate disease mortality rates resulting from early recognition, identification and intervention.

Process Evaluation

Program Reach

The seminar audience consisted of 265 people of which 233 (88%) completed pre- and post-seminar questionnaires. Of the respondents 79% were male and 21% female. Seventy nine percent of respondents were above 50 years of age. The seminar reached a number of people directly affected by prostate disease with 34% of respondents being diagnosed with prostate disease. Further, in excess of 400 people have accessed the prostate disease Home Page on the Internet. In addition, an untold number of people were exposed to the media coverage associated with the seminar on prostate disease.

Participation Satisfaction

In the post-seminar questionnaire over 85% of respondents felt that as a result of the seminar they were better informed about both prostate disease and where to obtain more information. The majority of respondents indicated that the information was of sufficient detail and easy to understand, and described the seminar as interesting, informative and enjoyable. Twenty four percent of respondents indicated that there were areas of prostate disease on which they would like more information. However, in the majority of cases the information sought was highly specific to the individual and best addressed through individual consultation with their doctor.

Following the seminar, each member of the PDAT received a considerable amount of positive feedback from audience members on all aspects of the seminar.

Outcome Evaluation

From analysis of the results it is apparent that the seminar achieved significant increase in the audience’s awareness, acceptance, empowerment and motivation as they relate to prostate disease. This was evidenced by a number of findings, examples of which include:

1. A 5-15% increase in awareness of symptoms.

2. A 37% increase in awareness of the recommended frequency of testing.

3. A 19% increase in awareness of the recommended age groups for testing.

4. A 5-17% increase in preparedness of males to seek medical advice if prostate disease symptoms were experienced.

5. A 15-23% increase in preparedness of females to encourage a male partner to seek medical advice if prostate disease symptoms were experienced.

6. Over 85% of respondents indicated that as a result of the seminar they felt more informed about both prostate disease and where to obtain more information.

It can be concluded, therefore, that the PDAT achieved the goals of the health promotion program.

Discussion

Success of the Health Promotion Program

From an analysis of the health promotion program it is evident that the design and implementation of a multifaceted interactive educational seminar, in conjunction with media promotion and the Internet was successful on a number of levels.

1. The goals of the health promotion program were achieved.

2. The health promotion program reached a large number of people via the seminar, Internet and community promotion.

3. The health promotion will continue to reach a large number of people through the Internet and public discussion resulting from the seminar and community promotion.

4. A number of community groups and organisations including the Lions, Rotary and Probus clubs, have requested more seminars and offered to support prostate disease awareness.

Improvements

Possible improvements to the health promotion program are few but may include increasing the length of question time during the formal presentation, and increasing the number of PDAT staff circulating during the informal stage of the seminar in order to address all issues and answer all questions raised by audience members.

Recommendations

Doctors represent the primary source from which respondents had already obtained information on prostate disease and would obtain information in the future. Given that there is an obvious deficit in the community’s knowledge about prostate disease, and that just under half of the respondents requiring more information in the seminar had been diagnosed with prostate disease and would be expected to be under medical supervision, several questions need to be asked.

1. Are people talking to their doctors about prostate disease? If not, why not? How could this situation be addressed?

2. If people are talking to their doctors, is the medical profession providing information that people want and more importantly can understand?

3. Are doctors suitably equipped with the knowledge and resources to provide appropriate information?

4. Are doctors the most effective resource for educating the public about prostate disease? If not, who and what are the most effective resources?

The questions that arise from this health promotion program should form the basis of further health promotion initiatives which may include:

1. An evaluation of what barriers exist for men in seeking medical advice.

2. Determination of what resources are required by the medical profession to effectively deliver relevant information on prostate disease.

3. Assessment of the level and nature of information on prostate disease currently being made available to the community by the medical profession and other organisations.

4. Evaluation of different health promotion strategies in order to assess the most effective way to educate the community about prostate disease, eg. small group workshops, Internet, future seminars, National and State health promotion campaigns.

Conclusion

Prostate disease is a significant health issue facing both the increasing aged male population and the community as a whole. While there was a deficit in awareness, acceptance, empowerment and motivation as they relate to prostate disease in the priority population groups, this deficit was successfully reduced by the seminar. In addition, further reductions in this deficit may occur in the future due to public interest and discussion generated by the seminar, the community promotion and use of the Internet Home Page. While the health promotion program achieved its goals, there is an obvious need for evaluation and improvement of the existing sources of information on prostate disease as well as further community education.

References

1. Monash University Institute of Reproduction and Development. Facts about Prostate Health (brochure), 1996. [Editorial note: a collection of prostate health fact sheets may be viewed from the Monash Prostate Disease Awareness Homepage]

2. IO Communication. The Cybrarian’s Guide to Cyber-Marketing. Internet web address: http://www.iocom.be/pilot/cybermarketing/marketingpradvertising/
   interactivemarketing/demographics/generaldemographics/

Acknowledgments

We would like to thank the follow people who have made substantial contributions to the Prostate Disease Awareness Project:

1. Dr Bridget Hsu-Hage, Health Promotion Unit Convenor, Monash University

2. Dr Gail Risbridger, Associate Director, Institute of Reproduction & Development

3. Faculty of Medicine, Monash University

4. Terry Martin and others, Medical Illustration, Monash University

5. Professor Barkla, Department of Anatomy

6. Gary Spink, Public Affairs Department, Monash University

7. Gary Morrison, Public Affairs, Monash Medical Centre.

8. George Lambropoulos, George’s Guardian Pharmacy & Coburg Amcal Pharmacy

9. Sheila Cheary, Marketing & Service Development Manager, Melbourne Pathology

10. Keith Allen, Manager, Monash Print Services

11. Michael Oldfield, Systems Network Administrator, Monash Medical Centre

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