Improving psychosocial health in men with prostate cancer through an intervention that reinforces masculine values - exercise

Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial

BACKGROUND

Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms.

OBJECTIVE

This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy.

METHODS

A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed.

RESULTS

This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (β=-5.60; P=.09; 95% CI -12.15 to -0.96) or sexual function (β=-.12; P=.97; 95% CI -7.05 to -6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15).

CONCLUSIONS

ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/11625.

Exercise in preventing falls for men with prostate cancer: a modelled cost-utility analysis

INTRODUCTION

Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia.

METHODS

A decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling; (2) at recurrent risk of falling; (3) fracture (minor or major); (4) non-fracture injury (minor or major); and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA).

RESULTS

At a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective.

CONCLUSION

This is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population.

Perceptions of wellbeing and quality of life following participation in a community-based pre-operative exercise programme in men with newly diagnosed prostate cancer: A qualitative pilot study

Background

Men with a newly diagnosed prostate cancer are often treated by surgery. The time window between cancer diagnosis and surgery causes high levels of uncertainty and stress, which negatively impact quality of life (QoL). We previously reported a larger intervention pilot study which demonstrated that participation in a community-based pre-operative exercise programme significantly improved physical fitness and health-related quality of life in men with prostate cancer prior to surgery. The aim of the current pilot study was to get an insight into men’s perceptions of wellbeing and QoL following completion of the pre-operative exercise programme.

Methods

From November 2017 to June 2018, men scheduled for prostate cancer surgery were recruited and took part in a prescribed community-based pre-operative exercise programme in the time available between referral and surgery. Following completion of the pre-operative exercise programme (within 1 week before surgery), participants took part in one semi-structured interview which explored four broad QoL domains: physical, psychological, social, and spiritual wellbeing. Data were analysed using thematic analysis (a bottom up/inductive analysis).

Results

Eleven men were recruited: mean standard deviation (SD) age was 60 ± 7 years. Data supported four main themes. Participation in the community-based pre-operative exercise training programme (over a mean (SD) of 4 ± 2 weeks) provided participants with: 1) a teachable moment; 2) a journey of preparation; 3) a sense of optimism; and 4) social connectedness prior to surgery.

Conclusion

This study provides an insight into how the exercise programme impacted wellbeing and QoL in men preparing for prostate cancer surgery. These findings highlight the important role that exercise prehabilitation plays for men preparing for prostate cancer surgery. Such exercise programmes can be easily implemented into standard cancer pathways by establishing relationships between hospital teams and community exercise programmes.

Assessing the impact of sexual function on perceptions of masculinity among prostate cancer survivors in the United States: findings from the prostate cancer registry

BACKGROUND

Prostate cancer carries emasculating symptoms and treatment effects. These symptoms and treatment effects impact a man's sexual function; a central-theme to masculinity. This study seeks to assess the impact of sexual function on perceptions of masculinity.

METHODS

A voluntary-sample of men self-selected into the registry. Data were based on a series of questions related to Health-Related Quality of Life and functional status.

RESULTS

Based on the analysis, 50.2% of men did not feel less masculine, 33.2% of men were still interested in sex, 40.2% of men still engaged in sex "a little bit," and 34.8% of men still found sex "quite a bit" enjoyable. Additionally, 31.1% of identified issues with erectile dysfunction and 45.5% of men showed no discomfort with being sexually active.

CONCLUSION

Sexual function has an impact on perceptions of masculinity but additional underlying issues outside of sexual function may contribute to perceptions of masculinity.

One small step for man, one giant leap for men's health: a meta-analysis of behaviour change interventions to increase men's physical activity

OBJECTIVE

To determine the effects of behaviour change interventions on men's physical activity (postintervention), sustained change in physical activity behaviour (≥12 months postintervention) and to identify variations in effects due to potential moderating variables (eg, theoretical underpinning, gender-tailored, contact frequency).

DESIGN

Systematic review with meta-analysis. Pooled effect size (Cohen's d) was calculated assuming a random-effects model. Homogeneity and subsequent exploratory moderator analyses were assessed using Q, T² and I².

DATA SOURCES

Medline, EMBASE, CINAHL, SportDiscus and Web of Science to April 2019.

ELIGIBILITY CRITERIA FOR SELECTED STUDIES

Randomised control trials of behaviour change interventions in men (≥18 years) where physical activity was an outcome and data were from men-only studies or disaggregated by sex.

RESULTS

Twenty-six articles described 24 eligible studies. The overall mean intervention effect on men's physical activity was 0.35 (SE=0.05; 95% CI 0.26 to 0.45; p<0.001). This effect size is consistent with an increase of approximately 97 min of total physical activity per week or 980 steps per day. Intervention moderators associated with greater increases in physical activity included objective physical activity outcome measures, a gender-tailored design, use of a theoretical framework, shorter length programmes (≤12 weeks), using four or more types of behaviour change techniques and frequent contact with participants (≥1 contact per week). 12 studies included additional follow-up assessments (≥12 months postintervention) and the overall mean effect was 0.32 (SE=0.09; 95% CI 0.15 to 0.48; p<0.001) for that sustained increase in physical activity.

SUMMARY

Behaviour change interventions targeting men's physical activity can be effective. Moderator analyses are preliminary and suggest research directions.

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

OBJECTIVE

Understanding the unmet supportive care needs of men on active surveillance for prostate cancer may enable researchers and health professionals to better support men and prevent discontinuation when there is no evidence of disease progression. This review aimed to identify the specific unmet supportive care needs of men on active surveillance.

METHODS

A systematic review following PRISMA guidelines was conducted. Databases (Pubmed, Embase, PsycINFO, and CINAHL) were searched to identify qualitative and/or quantitative studies that reported unmet needs specific to men on active surveillance. Quality appraisals were conducted before results were narratively synthesised.

RESULTS

Of the 3613 unique records identified, only eight articles were eligible (five qualitative and three cross-sectional studies). Unmet Informational, Emotional/Psychological, Social, and "Other" needs were identified. Only three studies had a primary aim of investigating unmet supportive care needs. Small active surveillance samples, use of nonvalidated measures, and minimal reporting of author reflexivity in qualitative studies were the main quality issues identified.

CONCLUSIONS

The unmet needs of men on active surveillance is an underresearched area. Preliminary evidence suggests the information available and provided to men during active surveillance is perceived as inadequate and inconsistent. Men may also be experiencing unmet psychological/emotional, social, and other needs; however, further representative, high-quality research is required to understand the magnitude of this issue. Reporting results specific to treatment type and utilising relevant theories/models (such as the social ecological model [SEM]) is recommended to ensure factors that may facilitate unmet needs are appropriately considered and reported.

Factors associated with exercise preferences, barriers and facilitators of prostate cancer survivors

OBJECTIVE

The purpose of this study was to understand the exercise levels, preferences and interests of prostate cancer survivors in Canada.

METHODS

An electronic survey was administered via a prostate cancer-specific website and assessed self-reported exercise levels, exercise preferences and interests, exercise barriers and facilitators to exercise.

RESULTS

Based on 103 participants, the majority (75.7%) of prostate cancer survivors did not meet both aerobic and resistance exercise guidelines, despite an interest in exercise. Strongest exercise preferences were shown for resistance exercise, walking, flexibility and bicycling and for performing exercise from a community-based gym or from home. Significant differences in exercise interests and facilitators were found between individuals who were meeting exercise guidelines compared to those who were not.

CONCLUSION

The majority of Canadian prostate cancer survivors are insufficiently active. Exercise preferences and facilitators appear to be influenced by current exercise levels. Resistance and aerobic exercise should be considered when programming exercise for prostate cancer survivors.

Identifying the exercise-based support needs and exercise programme preferences among men with prostate cancer during active surveillance: A qualitative study

PURPOSE

This study aims to investigate the attitudes and preferences men on active surveillance for prostate cancer have regarding exercise and exercise-based support. Exercise outcomes align with traditionally masculine values, can improve mental and physical health, and may even slow early stage prostate cancer progression. However, attitudes and preferences towards exercise and exercise support are unexplored in men on active surveillance.

METHODS

Semi-structured qualitative interviews were conducted with participants (13 males with a history of active surveillance for prostate cancer; 5 female partners). Interviews were conducted either by telephone or in person and audiotaped, transcribed verbatim, and thematically analysed.

RESULTS

Several key themes were identified relating to the two research aims: 'Attitudes and Preferences towards Exercise, and 'Attitudes and Preferences towards Exercise Support'. Despite all men engaging in exercise, the majority did not meet the recommended guidelines for cancer survivors. The majority of men either were interested in receiving exercise support or had previously received it, often recommending this for all men on active surveillance. There were varied preferences regarding delivery modality (i.e., online or face to face), the inclusion of partners, and group versus individual formats.

CONCLUSIONS

This study provides a novel insight into the attitudes and preferences of men on active surveillance regarding exercise and support. This research will help the development of acceptable and accessible person-centred support for men on active surveillance. However, further research is needed to evaluate the efficacy of different delivery modalities in this population.

Health Literacy Among Canadian Men Experiencing Prostate Cancer

The objective was to describe the health literacy of a sample of Canadian men with prostate cancer and explore whether sociodemographic and health factors were related to men's health literacy scores. A sample of 213 Canadian men (M age = 68.71 years, SD = 7.44) diagnosed with prostate cancer were recruited from an online prostate cancer support website. The men completed the Health Literacy Questionnaire along with demographic, comorbidity, and prostate cancer treatment-related questions online. Of the 5-point scales, men's health literacy scores were highest for "Understanding health information enough to know what to do" (M = 4.04, SD = 0.48) and lowest for "Navigating the health care system" (M = 3.80, SD = 0.58). Of the 4-point scales, men's scores were highest for "Feeling understood and supported by health care professionals" (M = 3.20, SD = 0.52) and lowest for "Having sufficient information to manage my health" (M = 2.97, SD = 0.46). Regression analyses indicated that level of education was positively associated with health literacy scores, and men without comorbidities had higher health literacy scores. Age and years since diagnosis were unrelated to health literacy. Support in health system navigation and self-management of health may be important targets for intervention.

A systematic review of the feasibility, acceptability, and efficacy of online supportive care interventions targeting men with a history of prostate cancer

PURPOSE

To examine the feasibility, acceptability, and efficacy of online supportive care interventions targeting prostate cancer survivors (PCS).

METHODS

Studies were identified through structured searches of PubMed, Embase and PsycINFO databases, and bibliographic review. Inclusion criteria were (1) examined feasibility, acceptability, or efficacy of an online intervention designed to improve supportive care outcomes for PCS; (2) presented outcome data collected from PCS separately (if mixed cancer); and (3) evaluated efficacy outcomes using randomized controlled trial (RCT) design.

RESULTS

Sixteen studies met inclusion criteria; ten were classified as RCTs. Overall, 2446 men (average age 64 years) were included. Studies reported on the following outcomes: feasibility and acceptability of an online intervention (e.g., patient support, online medical record/follow-ups, or decision aids); reducing decisional conflict/distress; improving cancer-related distress and health-related quality of life; and satisfaction with cancer care.

CONCLUSION

We found good preliminary evidence for online supportive care among PCS, but little high level evidence. Generally, the samples were small and unrepresentative. Further, inadequate acceptability measures made it difficult to determine actual PCS acceptability and satisfaction, and lack of control groups precluded strong conclusions regarding efficacy. Translation also appears minimal; few interventions are still publicly available. Larger trials with appropriate control groups and greater emphasis on translation of effective interventions is recommended.

IMPLICATIONS FOR CANCER SURVIVORS

Prostate cancer survivors have a variety of unmet supportive care needs. Using online delivery to improve the reach of high-quality supportive care programs could have a positive impact on health-related quality of life among PCS.

Attitudes and Experiences of Men With Prostate Cancer on Risk in the Context of Injuries Related to Community-Based Football-A Qualitative Study

Although football training may be a potent strategy for health promotion in older men, the considerable risk of injuries may constitute a barrier for referral of clinical populations. The current study explored the attitudes of men with prostate cancer on risk in the context of injuries related to participating in a community-based football program. Four videotaped focus group interviews and three individual in-depth telephone interviews were carried out with men with prostate cancer (n = 35; mean age = 68.8). The thematic networks technique was used to derive the global theme Injury-induced reinforced masculinity comprising five subthemes: "part of the game," "a good story to tell," "like boys again," "an old, carefree body," and "camaraderie." Collectively, these themes explained how football injuries may reflect masculine ideals in some men with prostate cancer. The study indicates that injuries are largely acceptable to men with prostate cancer, especially those in search of a means for expressing their masculinity.

Depression and Prostate Cancer: Examining Comorbidity and Male-Specific Symptoms

Depression in men with prostate cancer is a significant and complex issue that can challenge clinicians’ diagnostic efforts. The objective of the current study was to evaluate prototypic and male-specific depression symptoms and suicidal ideation in men with a diagnosis of prostate cancer relative to those with and without comorbidity. The Patient Health Questionnaire-9 (PHQ-9) and Male Depression Risk Scale-22 (MDRS-22) were completed online along with demographic and background variables by 100 men with a diagnosis of prostate cancer (n = 54 prostatectomy, n = 33 receiving active treatment). Hierarchical logistic regression was used to examine recent (past 2 weeks) suicide ideation. Over one-third of the sample (38%) reported a comorbidity, and this group had significantly higher total depression scores on the PHQ-9 (Cohen’s d = 0.65), MDRS-22 emotion suppression (d = 0.35), and drug use subscales (d = 0.38) compared to respondents without comorbidity. A total of 14% reported recent suicidal ideation, of which 71.4% of cases were identified by the PHQ-9 “moderate” cut-off, and 85.7% of cases were identified by the MDRS-22 “elevated” cut-off. After control variables, MDRS-22 subscales accounted for 45.1% of variance in recent suicidal ideation. While limited by the exclusive use of self-report data, findings point to the potential benefits of evaluating male-specific symptoms as part of depression and suicide risk screening in men with prostate cancer and the need to be mindful of the heightened risk for depression among men with prostate cancer who have comorbidity.

Ambiguity in a masculine world: Being a BRCA1/2 mutation carrier and a man with prostate cancer

OBJECTIVE

Increased risk of prostate cancer (PCa) is observed in men with BRCA1/BRCA2 mutations. Sex and gender are key determinants of health and disease although unequal care exists between the sexes. Stereotypical male attitudes are shown to lead to poor health outcomes.

METHODS

Men with BRCA1/2 mutations and diagnosed with PCa were identified and invited to participate in a qualitative interview study. Data were analysed using a framework approach. "Masculinity theory" was used to report the impact of having both a BRCA1/2 mutation and PCa.

RESULTS

Eleven of 15 eligible men were interviewed. The umbrella concept of "Ambiguity in a Masculine World" was evident. Men's responses often matched those of women in a genetic context. Men's BRCA experience was described, as "on the back burner" but "a bonus" enabling familial detection and early diagnosis of PCa. Embodiment of PCa took precedence as men revealed stereotypical "ideal" masculine responses such as stoicism and control while creating new "masculinities" when faced with the vicissitudes of having 2 gendered conditions.

CONCLUSION

Health workers are urged to take a reflexive approach, void of masculine ideals, a belief in which obfuscates men's experience. Research is required regarding men's support needs in the name of equality of care.

Men's perceptions of prostate cancer diagnosis and care: insights from qualitative interviews in Victoria, Australia

Background

The Victorian Prostate Cancer Registry (Australia) revealed poorer rates of survival for men diagnosed with prostate cancer in one Victorian regional area than for men in metropolitan Melbourne. We sought to explore the perceptions and experiences of prostate cancer diagnosis, treatment, and care of men diagnosed with prostate cancer who lived in regional or metropolitan areas and of men who had not been so diagnosed. Our goal was to contribute to the evidence from which can be built continuing improvements in prostate health care.

Methods

Using the qualitative method of in-depth interviews to gain access to explanation and meaning, we interviewed 21 men: 10 recruited through the Prostate Cancer Outcome Registry-Victoria and 11 from the community. Transcripts were analysed thematically.

Results

We identified four main themes within which men discussed prostate cancer: Case-finding, Diagnosis, Treatment and Care, and Spreading the Word. Contrasts revealed between regional and metropolitan areas related mostly to the more limited supportive care in regional areas.

Conclusions

It is evident from the perspectives of these men that every aspect of prostate cancer care would benefit from attention: publicising the need to check prostate health, treatment, and supporting men in the years after treatment. Continuing to work on systemic improvements is an important goal for all those committed to men’s health.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3699-1) contains supplementary material, which is available to authorized users.

The HAT TRICK programme for improving physical activity, healthy eating and connectedness among overweight, inactive men: study protocol of a pragmatic feasibility trial

INTRODUCTION

Physical activity, healthy eating and maintaining a healthy weight are associated with reduced risk of cardiovascular disease, type 2 diabetes and cancer and with improved mental health. Despite these benefits, many men do not meet recommended physical activity guidelines and have poor eating behaviours. Many health promotion programmes hold little appeal to men and consequently fail to influence men's health practices. HAT TRICK was designed as a 12-week face-to-face, gender-sensitised intervention for overweight and inactive men focusing on physical activity, healthy eating and social connectedness and was delivered in collaboration with a major junior Canadian ice hockey team (age range 16-20 years). The programme was implemented and evaluated to assess its feasibility. This article describes the intervention design and study protocol of HAT TRICK.

METHODS AND ANALYSIS

HAT TRICK participants (n=60) were men age 35 years, residing in the Okanagan Region of British Columbia, who accumulate 150 min of moderate to vigorous physical activity a week, with a body mass index of >25 kg/m² and a pant waist size of >38'. Each 90 min weekly session included targeted health education and theory-guided behavioural change techniques, as well as a progressive (ie, an increase in duration and intensity) group physical activity component. Outcome measures were collected at baseline, 12 weeks and 9 months and included the following: objectively measured anthropometrics, blood pressure, heart rate, physical activity and sedentary behaviour, as well as self-reported physical activity, sedentary behaviour, diet, smoking, alcohol consumption, sleep habits, risk of depression, health-related quality of life and social connectedness. Programme feasibility data (eg, recruitment, satisfaction, adherence, content delivery) were assessed at 12 weeks via interviews and self-report.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of British Columbia Okanagan Behavioural Research Ethics Board (reference no H1600736). Study findings will be disseminated through academic meetings, peer-reviewed publication, web-based podcasts, social media, plain language summaries and co-delivered community presentations.

TRIAL REGISTRATION NUMBER

ISRCTN43361357,Pre results.

Real World Evidence: A Quantitative and Qualitative Glance at Participant Feedback from a Free-Response Survey Investigating Experiences of a Structured Exercise Intervention for Men with Prostate Cancer

AIM

To explore patient experiences of a structured exercise intervention for men with prostate cancer (PCa).

SAMPLE

41 men with either localised or advanced PCa who had been referred for a structured exercise programme by their physician and then subsequently consented to a telephone survey.

METHOD

Participants underwent a 10-week supervised exercise programme within a large cancer centre hospital consisting of 8 sessions. They then completed a short multiple choice telephone survey, elaborating on their responses where appropriate. Views expressed by participants were analysed using an affinity diagram and common themes were identified.

RESULTS

Feedback from our telephone surveys was consistently positive and suggests that the structured exercise intervention provides exercise confidence, motivation to exercise, and social support and promotes positive health behaviour change in the context of exercise. Individual differences arose amongst participants in their perceived utility of the intervention, with 73.3% expressing a preference for structured exercise classes and 19.5% expressing a preference for exercising independently.

CONCLUSION

Design of a structured exercise intervention for patients with PCa should embrace the positive aspects outlined here but consider patients' individual differences. Ongoing feedback from patients should be utilised alongside traditional study designs to inform intervention design in this area.

Effects of resistance exercise in prostate cancer patients: a meta-analysis

PURPOSE

The aim of the present meta-analysis was to quantify effects of resistance exercise (RE) on physical performance and function, body composition, health-related quality of life (HRQoL), and fatigue in patients with prostate cancer.

METHODS

Trial data were obtained from the databases PubMed, MEDLINE, EMBASE, SCOPUS, and the Cochrane Library as of inception to 31st of December 2016. Thirty-two trials with 1199 patients were included. Results that were measured by using the same assessment method in five or more of the original studies were pooled in a meta-analysis.

RESULTS

Pooled studies showed significant improvements of muscular strength in the upper and lower body (95% CI [2.52, 7.97] kg; p < 0.001 and 95% CI [10.51, 45.88] kg; p = 0.008, respectively) after RE. Furthermore, significant improvements were seen for body composition (body fat percentage 95% CI [-0.79, -0.53] %; p < 0.001; lean body mass 95% CI [0.15, 1.84] %; p = 0.028; trunk fat mass 95% CI [-0.73, -0.08] kg; p = 0.024). Additionally, the improvement of the 400-m walk time was significant (95% CI [-21.55, -14.65] s; p < 0.001). Concerning fatigue and HRQoL, there were not sufficient data for analysis.

CONCLUSIONS

RE seems to be a promising approach in order to counteract loss of muscle mass, muscle strength, and physical performance in patients suffering from prostate cancer and its treatment-related side effects. RE should play part in interdisciplinary cancer rehabilitation and care of this patient group. Nevertheless, further research should investigate RE further to determine which protocols are the most pragmatic, yet yielding best patient outcomes.

Healthy Eating and Active Living: Rural-Based Working Men's Perspectives

There is a pressing need for health promotion programs focused on increasing healthy eating and active living among “unreached” rural-based men. The purpose of the current study was to describe rural-based working men’s views about health to distil acceptable workplace approaches to promoting men’s healthy lifestyles. Two focus group interviews included 21 men who worked and lived in northern British Columbia, Canada. Interviews were approximately 2 hours in duration; data were analyzed using thematic analysis. Themes inductively derived included (a) food as quick filling fuels, (b) work strength and recreational exercise, and (c) (re)working masculine health norms. Participants positioned foods as quick filling fuels both at work and home as reflecting time constraints and the need to bolster energy levels. In the theme work strength and recreational exercise, men highlighted the physical labor demands pointing to the need to be resilient in overcoming the subarctic climate and/or work fatigue in order to fit in exercise. In the context of workplace health promotion programs for men, participants advised how clear messaging and linkages between health and work performance and productivity and cultivating friendly competition among male employees were central to reworking, as well as working, with established masculine health norms. Overall, the study findings indicate that the workplace can be an important means to reaching men in rural communities and promoting healthy eating and active living. That said, the development of workplace programs should be guided by strength-based masculine virtues and values that proactively embrace work and family life.