Promoting Testicular Cancer Awareness and Screening: A Systematic Review of Interventions

Enhancing Men's Awareness of Testicular Diseases (E-MAT) using virtual reality: A randomised pilot feasibility study and mixed method process evaluation

INTRODUCTION

Testicular cancer is among the most common malignancies in men under the age of 50 years. Most testicular symptoms are linked to benign diseases. Men's awareness of testicular diseases and testicular self-examination behaviours are suboptimal. In this pilot feasibility study and process evaluation we examine the feasibility of conducting a future definitive randomised controlled trial (RCT) to test the effect of the Enhancing Men's Awareness of Testicular Diseases using Virtual Reality intervention (E-MATVR) compared to the Enhancing Men's Awareness of Testicular Diseases using Electric information control (E-MATE). The study protocol is registered on ClinicalTrials.gov (NCT05146466).

METHODS

Male athletes, engaged in Gaelic games, and aged 18 to 50 years were included. Recruitment was via FacebookTM, XTM (formerly TwitterTM), and posters. Participants were individually randomised to either E-MATVR or E-MATE. Data were collected at baseline (T0), immediately post-test (T1), and three months post-test (T2) using surveys. Qualitative interviews were conducted with participants and researchers.

RESULTS

Data were collected from 74 participants. Of those, 66 were retained. All E-MATVR participants and most E-MATE participants (n = 33, 89.2%) agreed/strongly agreed that the device was easy to use and that they were engaged to learn by the device. Most E-MATVR participants (n = 34, 91.9%) and all E-MATE participants agreed/strongly agreed that the time it took them to complete the intervention was reasonable. All 74 participants were extremely satisfied/somewhat satisfied with their overall participation in the study. E-MATVR was described as interactive, easy, fun, and close to real life. Initial difficulty using VR equipment, nausea, and technical issues were identified as challenges to engaging with E-MATVR. Recommendations were made to make VR more accessible, shorten the survey, and incorporate more interactivity. Across all participants, mean testicular knowledge scores (range 0-1) increased from 0.4 (SD 0.2) at T0 to 0.8 (SD 0.2) at T1. At T2, overall mean scores for participants were 0.7 (SD 0.2). Mean knowledge scores did not differ by trial arm at any timepoint. At T2, all E-MATVR participants and 29/32 E-MATE participants (90.6%) reported purposefully examining their testes within the past three months.

CONCLUSION

Findings are promising, highlighting the feasibility of using VR to promote young athletes' awareness of testicular diseases. Considering the strengths, limitations, and lessons learned from this study, some modifications are required prior to conducing an RCT. These include but are not limited to shortening survey questions, incorporating more interactivity and visual content, and targeting more heterogenous male-dominated environments.

Codesign and Launch of 'On the Ball': An Inclusive Community-Based 'Testicular Awareness' Campaign

INTRODUCTION

Increased awareness of testicular diseases can lead to early diagnosis. Evidence suggests that men's awareness of testicular diseases is low, with many expressing their willingness to delay help-seeking for symptoms of concern. The risk of testicular diseases is higher in gender and sexual minority groups. In this study, we discuss the codesign, refinement and launch of 'On the Ball', an inclusive community-based 'testicular awareness' campaign.

METHODS

The World Café participatory research methodology was used. Individuals from Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, policymakers, media/marketing experts and graphic designers were recruited. Participants were handed a brief for 'On the Ball', which was designed based on feedback from a previous World Café workshop. They were assigned to three tables. Participants rotated tables at random for three 20-min rounds of conversations. Each table had a facilitator who focussed on one element of the campaign brief. Data were collected using audio recorders and in writing and were analysed thematically.

RESULTS

Thirteen individuals participated in the workshop. The following themes emerged from the data: (i) campaign identity, (ii) campaign delivery and (iii) campaign impact. Participants recommended enhancements to the campaign logo, slogan, social media posts and poster. They suggested delivering the campaign online via social media and offline using various print and broadcast media. Participants recommended targeting areas with a large number of men such as workplaces. To help measure the impact of the campaign, participants proposed capturing social media analytics and tracking statistics relating to testicular diseases. Recommendations were used to refine the 'On the Ball' campaign and launch it in a university. In total, 411 students engaged with the various elements of the campaign during the soft launch.

CONCLUSIONS

'On the Ball' campaign visuals ought to be inclusive. Online and offline campaign delivery is warranted to reach out to a wider cohort. Campaign impact can be captured using social media analytics as well as measuring clinical outcomes relating to testicular diseases. Future research is needed to implement the campaign online and offline, explore its impact and evaluate its feasibility, acceptability, cost and effect on promoting testicular awareness.

PATIENT OR PUBLIC CONTRIBUTION

The 'On the Ball' campaign was codesigned and refined with members of Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, health policymakers, media and marketing experts and graphic designers using the World Café participatory research methodology.

A Survey on the Knowledge and Awareness of Testicular Cancer and Testicular Self-Examination Among Men in Saudi Arabia

Objectives The aim of the study was to assess the knowledge and awareness of testicular cancer (TC) and testicular self-examination (TSE) and to identify the associated factors in men in Saudi Arabia. Methods An online questionnaire-based study was conducted in Saudi Arabia with a representative sample of 794 participants. The questionnaire comprised knowledge, awareness and attitude questions regarding TC and TSE in addition to signs/symptoms and risk factors. Multivariate logistic regression analysis was conducted to identify the significant variables associated with knowledge of TC and TSE. Results Around 43% (n=340) of the participants had inadequate knowledge of TC, whereas 26% (n=205) had heard about TSE and only 65 (8.2%) performed TSE. The first model for knowledge found that participants with a low level of education [2.75 (1.18, 6.42)]; no past history of a testicular problem [2.20 (1.22, 3.95)] and those who had not heard about TSE [1.79 (1.24, 2.57)] were at higher odds for inadequate knowledge, whereas those whose mothers had received college-level education [0.39 (0.19, 0.79)] and those who received information from school/college [0.61 (0.37, 0.97)] were more likely to have adequate knowledge about TC. The second model for TSE found that a low level of education 5.24 (1.34, 20.52) was associated with not performing TSE. Receiving information from social media [0.08 (0.03, 0.17)], school/college [0.06 (0.02, 0.13)], family and friends [0.17 (0.05, 0.57)] and medical staff [0.08 (0.03, 0.17)] were associated with higher odds of performing TSE. Conclusion The majority of Saudi males have knowledge about TC. On the contrary, only a small percentage of the respondents have heard of or performed TSE as a screening technique. Educated sources of information can be a reliable way of giving correct knowledge on sensitive topics like TSE.

Promoting 'testicular awareness': Co-design of an inclusive campaign using the World Café Methodology

INTRODUCTION

Testicular cancer is the most common cancer in men aged 15-44 years in many countries. Most men with testicular cancer present with a lump. Testicular symptoms are more likely to occur secondary to benign diseases like epididymo-orchitis, a common sexually transmitted infection. Gender and sexual minorities are at an increased risk of testicular diseases and health disparities. The aim of this study was to co-design an inclusive community-based campaign to promote testicular awareness.

METHODS

This study uses the World Café methodology. Participation was sought from Lesbian, Gay, Bisexual, Transgender and Queer+ friendly organisations, testicular cancer survivors, health policy makers, media and marketing experts and graphic designers. Participants engaged in three rounds of conversations to co-design the campaign. Data were collected using drawing sheets, artefact cards, sticky notes, coloured markers and a voice recorder. Deductive thematic analysis was conducted.

RESULTS

Seventeen individuals participated in the study. Six themes emerged from the analysis as follows: (i) online communication; (ii) offline communication; (iii) behavioural targeting and education; (iv) campaign frequency and reach; (v) demographic segmentation; and (vi) campaign identity. The use of social media for campaign delivery featured strongly in all conversations. Participants also recommended offline communication using posters and radio/television advertisements to scale up the campaign and achieve wider reach. Advertisements to overcome embarrassment surrounding testicular health were particularly recommended. Participants emphasised that campaign delivery must be dynamic whilst ensuring that the health-promoting messages are not diluted or lost. They stressed the importance of being inclusive and tailoring the campaign to different age groups, gender identities and sexual orientations.

CONCLUSIONS

Study recommendations will be used to design and deliver the campaign. Future research will be needed to evaluate the feasibility, acceptability, cost and effect of the campaign on promoting testicular awareness and early detection of testicular diseases.

PATIENT OR PUBLIC CONTRIBUTION

A participatory research approach was used to co-design the campaign with members of Lesbian, Gay, Bisexual, Transgender and Queer+ (LGBTQ+) friendly organisations, LGBTQ+ student bodies, LGBTQ+ staff networks, LGBTQ+ sports clubs, men's health organisations, testicular cancer survivors, health policy makers, media and marketing experts and graphic designers.

Patients and general practitioner knowledge and perception of testicular self-examination for cancer

PURPOSE

Testicular cancer (TC) predominantly affects young men and early detection enhances survival. However, uncertainty surrounds the impact of population-wide screening. Testicular self-examination (TSE) is a simple detection method but there is a gap in current practices that needs to be assessed. Our goal was to assess the perceptions and knowledge of male subjects in the general population (MP) and general practitioners (GPs) regarding TSE for TC.

METHODS

Two distinct surveys evaluating knowledge and perceptions of TSE for TC were administered to GPs and MP, aged 15‒45-years. Factors that could favour the realisation of TSE or improve the knowledge of TC were evaluated by multivariable logistic regression.

RESULTS

Overall, 1048 GPs (mean (SD) age: 35.1 ± 10.3 years) and 1032 MP (mean (SD) age: 27 ± 8.2 years) answered the survey. Among the GPs, only 93 (8.9%) performed scrotal examination for TC screening. Although the majority (n = 993, 94.8%) were aware of the age of onset of TC, most (n = 768, 73.3%) did not know the overall survival rate from TC. GPs familiar with the guidelines were more likely to explain TSE to their patients (OR = 2.5 [95% CI 1.5‒4.1]; p < 0.01). Among the MP, 800 (77.5%) admitted that they did not know how to perform TSE and 486 (47.1%) did not know the main symptoms associated with TC. MP who had already undergone TC screening were more likely to be familiar with the main symptoms (OR = 2.1 [95% CI 1.6‒2.7]; p < 0.001) and MP who knew someone with TC or who had already undergone TC screening were more likely to be aware of the correct prevalence of TC (OR = 1.9 [95% CI 1.3‒2.7], p < 0.01; and OR = 1.6 [95% CI 1.2‒2.1], p < 0.01; respectively).

CONCLUSION

The knowledge of both GPs and MP regarding TC could be improved. TSE screening and knowing someone close with TC improved the awareness of our subjects.

Promoting men's awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions

Background: Testicular cancer (TC) is among the most commonly diagnosed cancers in men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders, such as testicular torsion and epididymitis, can lead to testicular ischemia, sepsis, and infertility if left untreated. This updated systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular disorder symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsycINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, and Clinicaltrials.gov were searched for studies published between April 2018 and August 2023. Methodological quality was assessed and results were synthesised meta-narratively. Results: Five studies were included. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination, including a PowerPoint presentation, an online educational brochure, video-assisted teaching, a motivational video, and a virtual reality game. Only one study addressed help-seeking for testicular symptoms and promoted men's awareness of benign as well as malignant testicular diseases. Conclusions: This review highlights the importance of evaluating innovative educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular disorder symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The protocol of the previous version of this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.

Small Testicular Masses: Contemporary Diagnostic and Treatment Strategies, Future Directions, and Knowledge Gaps

The incidental discovery of small masses in the testicles of young men is becoming an increasing clinical dilemma. We are learning that the malignancy rate in masses ≤ 2 cm is much lower than traditionally thought and could be as low as 13% to 21%. The challenge remains in identifying which of these patients harbor malignant tumors that need to be treated, and benign lesions that could be safely surveilled. The aim of this narrative review is to discuss the current scientific evidence, diagnostic work-up, and treatment strategies for small testicular masses. We also discuss selection criteria, follow-up schedules and triggers for intervention for the surveillance of these small testis masses. Furthermore, we give a set of recommendations for assessing and treating these patients, based on the available literature and our experience at a dedicated testicular cancer clinic.

Impact of an educational intervention on the knowledge of testicular self-examination and attitudes toward it

INTRODUCTION

There is evidence that the percentage of adolescents that practice testicular self-examination is low.

OBJECTIVE

To assess the short-term and long-term (6 months) impact in male adolescents of an educational intervention on the knowledge of testicular self-examination and attitude toward it.

METHODS

We conducted a quasi-experimental pre-test post-test study in male adolescents. A questionnaire was validated to assess knowledge on testicular self-examination and attitudes towards it (awareness, intentions, and behaviour). The educational intervention was group-based and consisted in an instructional talk with the aid of diagrams and brochures. The questionnaire was administered before and after the intervention. A follow-up was scheduled 6 months later, and the talk was delivered again, with administration of the questionnaire before and after.

RESULTS

The study included 139 adolescents with a median age of 14 years. We found an improvement in knowledge (18.3% vs 78.9%; P = 0.02) and attitude (5.6% vs 53.5%; P = 0.02) after the initial intervention. At the 6-month follow-up (n=98), there was no change in knowledge (87.0% vs 93.0%; P = 0.671), but attitude improved after the second intervention (58.0% vs 78.0%; P = 0.009).

CONCLUSION

An educational intervention on testicular self-examination improved the proportion of adolescents with an adequate attitude (5.6% vs 53.5%) and adequate knowledge (18.3% vs 78.9%). The repetition of the intervention at 6 months increased the proportion of adolescents with an adequate attitude (53.5% vs 86.4%).

The Association Between Testicular Self-Examination and Stages of Testicular Cancer Diagnosis: A Cross-Sectional Analysis

Purpose: Testicular cancer (TC) is the most prevalent tumor diagnosed in men 15-40 years of age. Survivorship and quality of life dramatically decrease with late-stage diagnosis. Testicular self-examination (TSE) is a diagnostic method used to discover early-stage tumor incidence. This study examines the relationship between practicing TSE and stage of diagnosis for TC survivors. Methods: A cross-sectional study design was employed, a 40-item survey among TC survivors (n = 619). Bivariate analyses consisted of Spearman Rho correlations of all primary variables with stage diagnosis of TC. Multivariate analysis employed an ordered logistic regression to determine stage diagnosis predictors. Results: "Regular" TSE practice significantly related with awareness (r = 0.4533) and knowledge of (r = 0.4866) TSE, confidence performing TSE (r = 0.4961), and feeling shape/feel differences of the testicle before diagnosis (r = 0.2115). Factors that had a statistically significant negative association with later-stage diagnosis included awareness (r = -0.1180) and knowledge of (r = -0.1586) TSE, confidence performing TSE (r = -0.1138), and feeling shape/feel differences of the testicle before diagnosis (r = -0.2938), among others. Regular TSE practice significantly predicted decreased odds of later-stage diagnosis within the sample subset reporting delay (odds ratio = 0.1628; p < 0.05); however, there was no significant relationship between regular TSE practice and stage diagnosis within the other model variations. Conclusion: This exploratory analysis aimed to provide baseline evidence of the possible association between the practice of TSE and the stage of TC diagnosis, and therefore making an indirect claim that TSE has the potential to improve quality of life and decrease TC mortality, particularly among adolescents and young adults.

The impact of compassionate care education on nurses: A mixed-method systematic review

AIMS

To identify, describe, and summarize evidence from quantitative, qualitative, and mixed-method studies conducted to prepare nurses and nursing students to lead on and/or deliver compassionate care.

DESIGN

Mixed-method systematic review.

DATA SOURCES

CINAHL, Medline, PsychINFO, and SocINDEX (January 2007-February 2018).

REVIEW METHODS

Papers were screened by two independent reviewers using an online screening tool and data were extracted using a standardized data extraction table. Parallel-results convergent synthesis was used to synthesize evidence from included qualitative, quantitative, and mixed-method studies. Quality appraisal and risk of bias assessment were conducted.

RESULTS

Fifteen studies were included with three main themes and six sub-themes: (a) programme impact (impact on ward-level and senior nurses and impact on nursing students and educators); (b) programme characteristics (characteristics leading to positive outcomes and characteristics leading to negative outcomes); and (c) programme implementation (implementation barriers and implementation facilitators). Compassionate care education programmes helped enhance nurses' ability to engage in reflective practice, deal with clinical challenges, and gain confidence. The importance of nurturing compassionate care delivery in nursing education was highlighted in the literature. Various nursing-level, patient-level, and organizational barriers to compassionate care delivery were identified.

CONCLUSION

The impact of compassionate care educational programmes on nurses was predominantly positive. Further evaluation of the long-term impact of these programmes on nurses, patients, and organizations is warranted.

IMPACT

Optimal delivery of compassionate care can be achieved by building organizational infrastructures that support nurses from all levels to attend education programmes and lead on compassionate care delivery.

Enhancing Men's Awareness of Testicular Disorders Using a Virtual Reality Intervention: A Pre-Post Pilot Study

BACKGROUND

The incidence of benign and malignant testicular disorders is on the rise. Three literature reviews and one qualitative study found that men's awareness of testicular disorders was lacking, and their intentions to seek help for symptoms of testicular disease were low.

OBJECTIVES

The aim of the study was to enhance men's awareness of testicular disorders, help-seeking intentions for testicular symptoms, and intention and behavior to feel their testes.

METHODS

Men aged 18-50 years were recruited from a university and asked to engage in a three-level, educational, virtual reality experience. The Medical Research Council framework guided the development and pilot testing of the intervention. Knowledge, awareness, perceived risk, implementation intentions, help-seeking intentions, and behaviors were measured at pretest (T0), immediately posttest (T1), and 1 month posttest (T2).

RESULTS

Data were available from 49 participants. In comparison to T0, a significant increase in knowledge (mean difference [MD] = 3.5, 95% CI [2.8, 4.26]); testicular awareness (MD = 0.2, 95% CI [0.01, 0.41]); implementation intentions (MD = 0.6, 95% CI [0.33, 0.90]); and help-seeking intentions for testicular swelling (MD = 0.3, 95% CI [0.12, 0.51]), lumpiness (MD = 0.3, 95% CI [0.08, 0.46]), and pain (MD = 0.6, 95% CI [0.25, 1.01]) was noted at T1. This increase was maintained at T2. Participants who expressed an intention to feel their testes at T0 were more likely to report performing this behavior at T2.

DISCUSSION

The intervention succeeded in promoting knowledge, testicular awareness, implementation intentions, help-seeking intentions, and behaviors. A randomized controlled trial of the Enhancing Men's Awareness of Testicular Disorders intervention with a larger sample size is warranted.

The Preconscious Awareness to Action Framework: An Application to Promote Testicular Awareness

BACKGROUND

Health outcomes among men are markedly poorer than women. Testicular disorders can be life-threatening if left untreated. Few studies promoting awareness of testicular disorders have been underpinned by theory. Theory-based interventions are more likely to achieve positive health outcomes than interventions that lack a theoretical foundation.

OBJECTIVES

The purpose of the study is to present a theory-focused analysis of the preconscious awareness to action framework (PAAF), developed to enhance testicular awareness and help-seeking intentions and behaviors among men.

METHODS

The following approach was used to develop the PAAF: The empirical literature on men's awareness of testicular disorders was reviewed. A qualitative study was conducted to explore men's awareness of testicular disorders, help-seeking intentions for testicular symptoms, and preferred learning strategies in relation to testicular disorders and symptoms. An iterative narrative review process of the theoretical literature on health promotion and symptom appraisal was undertaken.

RESULTS

The PAAF comprises seven steps: preconscious awareness, unconscious awareness, conscious awareness, unconscious appraisal, conscious appraisal, intention, and behavior. The concept of testicular awareness was developed to familiarize men with their own testes and promote timely help-seeking.

DISCUSSION

Researchers are encouraged to use the PAAF to design health-promoting interventions aimed at enhancing testicular awareness, symptom appraisal, and help-seeking.

Promoting men's awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions

Background: Testicular cancer (TC) is commonly diagnosed among men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders such as testicular torsion and epididymitis can lead to testicular ischemia, sepsis, and infertility if left untreated. This systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsychINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, Clinicaltrials.gov, Grey Literature Report, and Open Grey were searched for studies published between November 2014 and April 2018. The methodological quality and level of evidence per outcome were assessed.  Results: There were five papers included: two were experimental studies, two were systematic reviews, and one was an integrative review. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination. Examples include a television show featuring a celebrity with TC, a university campaign, and interactive educational sessions. The impact of the reviewed interventions on health beliefs (i.e. perceived susceptibility, severity, benefits, barriers, and self-efficacy) varied across the reviewed literature. Studies promoting help-seeking for testicular symptoms and awareness of benign testicular disorders were lacking. Conclusions: This review highlights the importance of evaluating educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.

Promoting men's awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions

Background: Testicular cancer (TC) is commonly diagnosed among men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders such as testicular torsion and epididymitis can lead to testicular ischemia, sepsis, and infertility if left untreated. This systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsychINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, Clinicaltrials.gov, Grey Literature Report, and Open Grey were searched for studies published between November 2014 and April 2018. The methodological quality and level of evidence per outcome were assessed.  Results: There were five papers included: two were experimental studies, two were systematic reviews, and one was an integrative review. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination. Examples include a television show featuring a celebrity with TC, a university campaign, and interactive educational sessions. The impact of the reviewed interventions on health beliefs (i.e. perceived susceptibility, severity, benefits, barriers, and self-efficacy) varied across the reviewed literature. Studies promoting help-seeking for testicular symptoms and awareness of benign testicular disorders were lacking. Conclusions: This review highlights the importance of evaluating educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.

Exploring awareness and help-seeking intentions for testicular symptoms among heterosexual, gay, and bisexual men in Ireland: A qualitative descriptive study

BACKGROUND

The incidence of malignant and benign testicular disorders among young men is on the rise. Evidence from three reviews suggest that men's knowledge of these disorders is lacking and their help-seeking intention for testicular symptoms is suboptimal. Qualitative studies have addressed men's awareness of testicular cancer, with none exploring their awareness of non-malignant diseases such as epididymitis, testicular torsion, and varicocele and none including sexual minorities.

OBJECTIVE

To explore, in-depth, heterosexual, gay, and bisexual men's awareness of testicular disorders and their help-seeking intentions for testicular symptoms in the Irish context.

DESIGN

This study used a qualitative descriptive approach. Data were collected via face-to-face individual interviews and focus groups.

SETTINGS

Participation was sought from a number of community and youth organisations and one university in Southern Ireland.

PARTICIPANTS

Maximum variation and snowball sampling were used to recruit a heterogeneous sample. A total of 29 men partook in this study. Participants were men, aged between 18 and 50 years, and residents of the Republic of Ireland.

METHODS

All interviews were audio-recorded and transcribed verbatim. Reflective field notes were taken following each interview. A summary of the interview was shared with selected participants for member-check. Data were analysed and validated by three researchers. Inductive qualitative analysis of manifest content was used. Latent content was captured in the field notes. Data analysis yielded two key themes.

RESULTS

The themes that emerged from the interviews were: Awareness of testicular disorders and their screening, and help-seeking intentions for testicular symptoms. Although most participants heard of testicular cancer, most did not know the different aspects of this malignancy including its risk factors, symptoms, treatments, and screening. Several men had a number of misconceptions around testicular disorders which negatively impacted their intentions to seek prompt help. Intentions to delay help-seeking for testicular symptoms were often linked to a number of emotional factors including fear and embarrassment, and social normative factors such as machoism and stoicism. In this study, culture was perceived by some participants as a barrier to awareness and help-seeking. In contrast, many believed that young men, especially those who self-identify as gay, are becoming increasingly interested in their own health.

CONCLUSION

Findings suggest the need to educate young men about testicular disorders and symptoms. This could be achieved through conducting health promotion campaigns that appeal to younger men, drafting national men's health policies, and normalising open discussions about testicular health at a young age.

Males' Awareness of Benign Testicular Disorders: An Integrative Review

Disorders that affect the testes can range from painless and benign to debilitating and life threatening. Despite the availability of literature on the etiology, diagnosis, and treatment of benign testicular disorders (BTD), very little is known about men's awareness of these conditions. The aim of this review was to extract and analyze evidence from studies that explored males' awareness of BTD. Four e-databases (CINAHL, MEDLINE, PsychINFO, and PubMed) were thoroughly searched and four articles met the review inclusion criteria. The quality of the included studies was appraised and data were extracted and cross-checked using a standardized data extraction table. It was determined that participants lacked education about testicular self-examination and scrotal signs and symptoms which contributed to their lack of awareness of BTD. Help seeking in the event of scrotal abnormalities was suboptimal which is alarming given the acuteness of some BTD such as testicular torsion. Individuals who are at risk for health disparities were underrepresented in the reviewed literature. Findings from this review highlight the need to address barriers to BTD knowledge and help seeking. This could be achieved through making use of past interventions that succeeded in increasing men's awareness of testicular cancer such as university campaigns and mass media. From a practical standpoint, clinicians must be encouraged to educate young men about BTD. This could be attained through tailoring creative educational interventions that are sensitive to the needs of individuals who are at risk for health disparities.