**3.5.1 Clinical vignettes**


Renewing Perspectives on Men's Prostate Cancer

seniors' apartments; and where they might ultimately die.

cancer and its treatment.

Literacy and Engagement Along the Disease Continuum 51

survive the disease, not scientific understanding of the disease process (Zanchetta et al., 2007). Erectile dysfunction, one potential consequence of prostate cancer treatment, represents failed masculinity (Knight & Latini, 2009) for men who adopt traditional masculinities. This representation undermines their motivation to learn about prostate

**4.2 A new understanding of older men's construction of prostate cancer literacy**  Through a discourse analysis technique called "abduction in communication" (Boudon, 1998, 1999, 2000), reasons why men with disparate levels of education (from three years of home schooling to doctorate) used similar information strategies were identified. Three analytical assumptions guided the analysis that revealed the similarity of these cognitive processes: (a) men's attempts to connect general health information with prostate cancer information would disclose the *modus operandi* of becoming prostate cancer literate, (b) men's key motivations for learning would determine the strategies they used to construct information strategies, and (c) external factors initially considered negative, noncollaborative, and obstructive would motivate men to construct more information strategies. The results of the analysis are (presented in the rest of Section 4.2 and in Figure 3 to 6) portray how older men's use of prostate cancer information and their discourse about prostate cancer was framed by ideas of space, distance, and possibility. Men's use of information responded to their need to deal with notions of truth, lies, and the possibility of errors; plausible and non-plausible uses of information; possible and impossible decisions; fact and illusion, and so on. In addition, men dealt with how long they might live; whether they would remain in their own homes as they grew older or move to retirement homes or

**4.2.1 Core information strategies men use to become prostate-cancer literate** 

Despite differences in men's self-reported levels of schooling and self-rated health literacy, with survival as an ultimate goal for learning, men looked for new informational support among peers, other individuals, relatives, media, and health professionals. Men mainly used hypothetical reasoning to decode the prostate cancer information they acquired from health professionals and informal sources (newspapers, television, internet, books, pamphlets, etc.). Men's struggles to become prostate cancer literate included reflecting on life and death as well as using the cognitive processes of hypothesizing, deducting, and comparing. To do that, they combined prostate cancer information they gathered from medical journals and their physicians with information from their own illness experiences. Figure 3 presents the general analytical categories and shows how the interpretative poles oscillate between the positive and negative impacts of decoded information related to the dimensions of health, diagnosis of prostate cancer and illness, men's socio-cultural identity, the external world, and the imprints of life and prostate cancer-related information. One of the key strategies men used to decode information was to compare information from different sources about the accuracy of medical prognoses, changes in lifestyle due to cancer, recovery expectations, and expected difficulties in end-of-life situations. As men felt more certain about the predictability of medical prognoses, some men's attitudes changed. Although some remained socially isolated, others enrolled in prostate cancer support groups, became more committed to their own health, or to men's collective health. Certainty also brought to older men a greater will to live and a peaceful acceptance of possible death from prostate cancer.

#### **3.5.2 Questions**

