**3.3 Evolution from existing to new educational technologies**

Despite well documented challenges in educational initiatives with older learners, some researchers interested in promoting older learners' health literacy are incorporating new technological tools into health teaching to enhance learning. Most older individuals are willing to learn about new technology, even to use and master it, especially if they are under 80 years old and in good mental health (Kaszap et al., 2002; Gil-Gómez et al., 2011; Jensen et al., 2010; Mackert et al., 2009; Saposnik et al., 2010; Wallington, 2008). It seems to be just a matter of having help in learning how to use new technology and having enough time to understand and practice it. Kaszap et al. (2000), in a study exploring the experiences of rural and urban older individuals with various technologies, documented elders' preference for information-gathering contexts (see Figure 2). They preferred private contexts (such as a visit to a professional's office) for gathering information on personal matters and group


Fig. 2. Older individuals' views on different aspects of health learning

contexts (among relatives and friends, even strangers) for gathering general information about health, illness, and treatment, because belonging to a group allows discussion, idea sharing, support, and maintains motivation for continuous learning. Golding (2011) reports

Renewing Perspectives on Men's Prostate Cancer

(Prasauskas & Spoo, 2006).

**3.5.1 Clinical vignettes** 

best medicine.

the physician's office.

Literacy and Engagement Along the Disease Continuum 49

delivered in forms other than writing (Roberts & Partridge, 2011), such as story telling (Wilkin & Ball-Rokeach, 2006). Discussions should using common terminology and repeat contents taught through learner-teach-back techniques. Professionals should apply medical information to topics familiar to elders (Prasauskas & Spoo, 2006), for which professionals need to understand older patients' literacy backgrounds. No more than four essential points should be provided at a time, with any written information reflecting learners' colloquial language, framed by learners' own health culture, and stating expected health behaviors

It may take time for health professionals to learn about each elder's fears, beliefs, habits, behaviours, and conceptions of health before it is possible to discuss disease and their treatment (Orel et al., 2005). However, learning older men's communication styles and literacy backgrounds will help professionals to begin talking about prostate cancer treatment and to gain clients' trust, without inspiring too much fear. Health professionals should let older men absorb the fact that they have prostate cancer before discussing solutions – absorbing such information also takes time. The educational process should occur in several steps; otherwise it will be perceived as challenging older men's sense of masculinity. Such caution in communication is particularly relevant for physicians, who are advised to inquire, in all consultations, about older men's functional and emotional health status (Kruger et al., 2007). Finally, it is important that older men themselves examine their assumptions (about, for example, masculinity) before constructing new knowledge and accept the need to make changes in their lives; for example, they may need to change their food choices to supplement medical treatment of their prostate cancer (Mróz et al., 2011).

In the clinical vignettes presented below we present the experiences of some older men in learning about prostate cancer, including why they sought information and how

 Claudio, a 59-year-old flooring installer, receives a diagnosis of prostate cancer. He tells his urologist that he has no symptoms and feels just fine. Because he feels well, he is not concerned about the diagnosis and decides that he will not let this diagnosis affect him in any way. He is not interested in discussing treatment options and decides to leave

 When Constantin, a 67-year-old newspaper columnist, receives the diagnosis of prostate cancer, he tells his oncologist that his father had prostate cancer and experienced serious side effects from the treatment. Constantin does not want to go through what his father experienced and decides refuse any and all prostate cancer treatment offered to him. In fact, he is so concerned about possible side effects that he

 When Bernardo, a 69-year-old retired parole officer, receives a diagnosis of prostate cancer, he is initially surprised. However, within a few days he tells his wife that he has gained the distinction of joining the brotherhood of prostate cancer. Bernardo is, has lived a full life and refuses to let the prostate cancer diagnosis define who he is. Bernardo has a great sense of humor and subscribes to the adage that laughter is the

**3.5 Reflecting on men's accounts of prostate cancer health education** 

engagement in learning helped them move toward better prostate health.

does not even want to discuss treatment options with the oncologist.

that older men in community settings learn when education is social, local, practical, situated, and in groups, particularly isolated men. Prins et al. (2009) argue that social interactions are needed to support elders, and Bergsma (2004) adds that personal and social change are possible through empowerment education.

In libraries nowadays, it is common to see elders looking for information on the Web, writing emails, or chatting on Skype. Community initiatives to develop computer literacy among older learners are undoubtedly opening new avenues for learning about health, for both already and newly computer-literate elders. Twenty-first century elders are becoming more familiar with technologies such as cell phones, videos, and computers. Even interactive video games (Nintendo Wii and Wii balance board) have been introduced to older patients for curative and rehabilitation purposes (Gil-Gómez et al., 2011; Saposnik et al., 2010). Elders are open to, and like, new experiences in the context of playing and exercising in rehabilitation and homecare settings. In the news, we see older people bowling via Wii to improve their balance after surgery and using Wii-based yoga and light exercise to regain vitality after hospitalization. Technological possibilities now exist that encourage elders to access information and take care of themselves in a variety of contexts. Health educators should support them through teaching older people to make use of these new opportunities for learning about health, illness, and treatments. Along with face-to-face discussion, virtual chatting can enhance older people's lives, despite any health conditions.

#### **3.4 Rethinking prostate cancer and prostate health education**

To prevent prostate cancer and deal with the disease throughout its trajectory, both prostate cancer information and prostate cancer literacy are important. The complexity of scientific knowledge make prostate cancer education with men of all ages and education levels a real challenge, in particular with older men having low degrees of alphabetization, whose social and information networks are crucial supports for decision making (Zanchetta, 2002). According to Kaszap and Drolet (2009), health literacy appraisal should explore a person's ability to acknowledge his/her own prior knowledge, current fears, beliefs, values, misconceptions, attitudes, habits, and behaviours – all of which build the foundation for constructing new knowledge. Innovations in clinical practice will certainly be needed to reveal the dynamic relationships between health knowledge, health literacy, the internet as a source of health information along with professional guidance (Jensen et al., 2010), especially for older people who are hard to reach (Macker et al., 2009), and the advantages of other technology used in rehabilitation and prostate cancer education. Levasseur and Carrier (2010) stress that rehabilitation and health literacy share goals: both see as important individuals' overall capacities for self-care, enhancing functioning, facilitating individuals' participation in their own health care, client-centered care, and equity in access to services, for example. Inspired by Zanchetta (2002) and knowledge construction theories (Jonnaert, 2009), education about prostate health can be expanded to include all men, regardless of their conceptual and experiential knowledge.

Older individuals may actively participate in transformative learning initiatives if time and supportive social interactions to foster learning are available to them (Moon, 2011; Prins et al., 2009). Support can include helping older individuals understand how to find information on the internet and how to mobilize a supportive network of groups or individuals in the community (Wallington, 2008). Health educators should use age-specific tools and elderclient-centered instructions to promote older people's health literacy (Morrow et al., 2007). Educational materials should be prepared for specific purposes and complex information

that older men in community settings learn when education is social, local, practical, situated, and in groups, particularly isolated men. Prins et al. (2009) argue that social interactions are needed to support elders, and Bergsma (2004) adds that personal and social

In libraries nowadays, it is common to see elders looking for information on the Web, writing emails, or chatting on Skype. Community initiatives to develop computer literacy among older learners are undoubtedly opening new avenues for learning about health, for both already and newly computer-literate elders. Twenty-first century elders are becoming more familiar with technologies such as cell phones, videos, and computers. Even interactive video games (Nintendo Wii and Wii balance board) have been introduced to older patients for curative and rehabilitation purposes (Gil-Gómez et al., 2011; Saposnik et al., 2010). Elders are open to, and like, new experiences in the context of playing and exercising in rehabilitation and homecare settings. In the news, we see older people bowling via Wii to improve their balance after surgery and using Wii-based yoga and light exercise to regain vitality after hospitalization. Technological possibilities now exist that encourage elders to access information and take care of themselves in a variety of contexts. Health educators should support them through teaching older people to make use of these new opportunities for learning about health, illness, and treatments. Along with face-to-face discussion, virtual chatting can enhance older people's lives, despite any health conditions.

To prevent prostate cancer and deal with the disease throughout its trajectory, both prostate cancer information and prostate cancer literacy are important. The complexity of scientific knowledge make prostate cancer education with men of all ages and education levels a real challenge, in particular with older men having low degrees of alphabetization, whose social and information networks are crucial supports for decision making (Zanchetta, 2002). According to Kaszap and Drolet (2009), health literacy appraisal should explore a person's ability to acknowledge his/her own prior knowledge, current fears, beliefs, values, misconceptions, attitudes, habits, and behaviours – all of which build the foundation for constructing new knowledge. Innovations in clinical practice will certainly be needed to reveal the dynamic relationships between health knowledge, health literacy, the internet as a source of health information along with professional guidance (Jensen et al., 2010), especially for older people who are hard to reach (Macker et al., 2009), and the advantages of other technology used in rehabilitation and prostate cancer education. Levasseur and Carrier (2010) stress that rehabilitation and health literacy share goals: both see as important individuals' overall capacities for self-care, enhancing functioning, facilitating individuals' participation in their own health care, client-centered care, and equity in access to services, for example. Inspired by Zanchetta (2002) and knowledge construction theories (Jonnaert, 2009), education about prostate health can be expanded to include all men, regardless of

Older individuals may actively participate in transformative learning initiatives if time and supportive social interactions to foster learning are available to them (Moon, 2011; Prins et al., 2009). Support can include helping older individuals understand how to find information on the internet and how to mobilize a supportive network of groups or individuals in the community (Wallington, 2008). Health educators should use age-specific tools and elderclient-centered instructions to promote older people's health literacy (Morrow et al., 2007). Educational materials should be prepared for specific purposes and complex information

change are possible through empowerment education.

**3.4 Rethinking prostate cancer and prostate health education** 

their conceptual and experiential knowledge.

delivered in forms other than writing (Roberts & Partridge, 2011), such as story telling (Wilkin & Ball-Rokeach, 2006). Discussions should using common terminology and repeat contents taught through learner-teach-back techniques. Professionals should apply medical information to topics familiar to elders (Prasauskas & Spoo, 2006), for which professionals need to understand older patients' literacy backgrounds. No more than four essential points should be provided at a time, with any written information reflecting learners' colloquial language, framed by learners' own health culture, and stating expected health behaviors (Prasauskas & Spoo, 2006).

It may take time for health professionals to learn about each elder's fears, beliefs, habits, behaviours, and conceptions of health before it is possible to discuss disease and their treatment (Orel et al., 2005). However, learning older men's communication styles and literacy backgrounds will help professionals to begin talking about prostate cancer treatment and to gain clients' trust, without inspiring too much fear. Health professionals should let older men absorb the fact that they have prostate cancer before discussing solutions – absorbing such information also takes time. The educational process should occur in several steps; otherwise it will be perceived as challenging older men's sense of masculinity. Such caution in communication is particularly relevant for physicians, who are advised to inquire, in all consultations, about older men's functional and emotional health status (Kruger et al., 2007). Finally, it is important that older men themselves examine their assumptions (about, for example, masculinity) before constructing new knowledge and accept the need to make changes in their lives; for example, they may need to change their food choices to supplement medical treatment of their prostate cancer (Mróz et al., 2011).

### **3.5 Reflecting on men's accounts of prostate cancer health education**

In the clinical vignettes presented below we present the experiences of some older men in learning about prostate cancer, including why they sought information and how engagement in learning helped them move toward better prostate health.
