**2.5 Informing professional practice**

Knowledge of multiple aspects of culture, society, and history is important to help social and health professionals decode behavior expected of men as engaged partners in their own treatment and rehabilitation. Societies are becoming more and more multicultural, giving men opportunities to learn new meanings of being a man, and new attitudes to men's health, men's self-care, men's sexuality, and facts and myths related to prostate cancer (Zanchetta et al., 2010). For professionals, it is difficult to gather scientific evidence on men's behaviors, due to men's resistance to participating in clinical and behavioral studies (Deslauriers & Deslauriers, 2010). Again, gender-related discourse and perceived lack of control over data-collection encounters may affect men's participation in studies. To counteract resistance, researchers recommend allowing men to feel in control of their disclosure of personal information, such as feelings, fears, disagreeable symptoms, threatening thoughts, and awareness of uncertainties (Deslauriers & Deslauriers, 2010). Such research fieldwork strategies may also be helpful for assessment and follow-up interviews in clinical contexts, where professionals can use a conversational style with men, instead of a professional authoritative style of asking direct and probing questions. Despite a culturally and socially constructed trend of men being attracted to technology (Lerman et al., 2003;

Renewing Perspectives on Men's Prostate Cancer

prostate cancer and its treatment?

**2.6.2 Questions** 

prostate cancer?

health (Alpay et al., 2004).

**3.1 Older patients' acquisition of formative learning** 

literacy concepts and suggest how to use them.

Literacy and Engagement Along the Disease Continuum 43

 What strategies could health care professionals consider that might promote men's empowerment as active participants in planning preventative health actions for

What barriers might contribute to men feeling a loss of control over early detection of

This section focuses on the relationship between older people and health education, as it relates to men with prostate cancer. Men's knowledge and understanding of learning about health, both in a biomedical and socio-cultural sense, is essential during the prostate cancer trajectory. Davis et al. (2008) discuss the importance for health care professionals of recognizing factors that contribute to elder's low health literacy, which may be increasing. Health literacy is a central to successful communication between health care professionals and elderly patients. It is not only essential for elderly patients to be equipped with appropriate knowledge of the disease process so as to be actively involved in their care, but health education must support patients to become more autonomous. Education for empowerment, as pioneered by Paulo Freire, requires a health education process centered in dialog between educators and learners (Wallerstein & Bernstein, 1988). Educating today's older people about cancer requires new educational strategies, particularly new education technologies that simplify complex cancer information and facilitate learning. Older people are active users of computers and the internet; misconceptions to the contrary must not shape health care professionals' beliefs about older people's ability to learn about their

A discussion involving knowledge and learning implies talking about "alphabetization" and literacy, or even about various literacy levels and literacy backgrounds. Traditionally, literacy was defined in general terms but, currently, we tend to differentiate among a range of literacy concepts. The new term "alphabetization" belongs to the old literacy paradigm in which we assessed individuals in terms of their ability to read, write, and use numbers. The goal was to rank individuals according to their literacy level, what we now call the "degree of alphabetization." Today, some literacy researchers work within a new literacy paradigm: as a social practice reflecting the literacy background of the person (Barton et al., 1998, 2000). Kaszap and Clerc (2008) clarify both alphabetization and

must wait three to four weeks for a follow-up medical consultation.

**3. A contemporary view of educating elders for health: Insights for** 

Why is control important when it comes to men's health?

**educational practice in clinical and community settings** 

ultrasound. Silvio remembers that he barely understood his doctor`s explanations about the ultrasound. He had it in a hospital without any problems but is worried about the presence of blood in his urine for the last 5 days, which he does not understand. He believes that the doctor "saw something" during the ultrasound. He feels lost, with no clues about his situation and really wants to do something about that. Unfortunately, he

Mellstrom, 2004) and technological advances in prostate-cancer-risk identification, early detection, treatment, and rehabilitation, men still perceive that technological interventions reduce their capacity to control the responses of their bodies and emotions to such interventions (Chapple & Ziebland, 2002).

Widespread public access to prostate cancer information in popular and scientific media has uncovered current discourse surrounding uncertainty about prostate cancer among researchers and health care professionals. Certainly, men are less likely to trust the health care system's assurance that current technologies are helpful and to rely on information from health care professionals in their decision making. Regardless of men's personal level of education and health literacy, they should be supported in enhancing their ability to perceive and differentiate levels of risk when making informed decisions about treatments. Gender-related experiences are, again, important to consider in the clinical context, because men's health experiences tend not to be solitary. Men's experiences are, instead, influenced by the roles of women (mothers, wives, partners, daughters, nieces, aunts, etc.) and other caring figures (fathers, same-sex partners, coaches, etc.) in their lives. Together, caring figures influence men's decisions to seek medical help, adhere to treatments, and most important, transcend the limitations and changes imposed by prostate cancer. Such a collective view of men's health experiences challenges current organizational policies requiring that personal information remain private and neglects the social and cultural fact that men are human beings, who (in less publicly demonstrative ways than women) are influenced by intimate others in seeking health and well being (Zanchetta et al., 2010).

#### **2.6 Reflecting on control in men's experiences with prostate cancer screening**

Below are some true stories with fictitious names as clinical vignettes and reflection questions to help readers identify control as a key concept in men's experience of prostate cancer and reflect on how control plays out in clinical practice. No answers are provided, because we want to stimulate readers' recall of their own experience so that they can construct appropriate answers to the reflection questions.

#### **2.6.1 Clinical vignettes**


ultrasound. Silvio remembers that he barely understood his doctor`s explanations about the ultrasound. He had it in a hospital without any problems but is worried about the presence of blood in his urine for the last 5 days, which he does not understand. He believes that the doctor "saw something" during the ultrasound. He feels lost, with no clues about his situation and really wants to do something about that. Unfortunately, he must wait three to four weeks for a follow-up medical consultation.
