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In the same way that many men won't stop to ask directions, they also try to "find their own way" with health care and rarely seek it, said Will Courtenay, PhD, founder and director of Men's Health Consulting in Berkeley, Calif.

In fact, men are more likely than women to adopt behaviors and beliefs--including beliefs about manhood--that increase their health risks, says Courtenay, who studies the psychological, behavioral and social factors that influence men's health.

At a session on men's health during APA's 2001 Annual Convention, Courtenay presented an evidence-based model he developed for health professionals to use when helping men manage their health. He's dubbed it the HEALTH plan:

  • Humanize. This step focuses on creating a sense for the man that his situation is normal and legitimate, which increases communication effectiveness and reduces noncompliance. "Illness and vulnerability threaten masculinity," said Courtenay. Men need help realizing they're not weak by resting, being ill, reporting pain and seeking help. "They need to know these aren't signs of inadequacy," he said.

Courtenay urged clinicians to express surprise when a man says that his condition isn't painful when it is usually reported to be so and to frame men's help-seeking as positive, such as saying, "Getting in here today was the best thing you could have done!"

  • Educate. Men are not socialized into health care like women. They "don't get annual exams or get taught how to listen to, talk about and take care of their bodies. And research shows that people with the least health knowledge often have the greatest health risks," Courtenay said. Because men lack the knowledge needed to help them reduce their risks, health professionals need to educate them and do so creatively.

Say to a man, "You know, most of the things that have the biggest impact on your health are completely within your control."

  • Assume the worst. Men are experts at hiding pain and weakness, explained Courtenay. This is a reminder that a man is "not likely to tell you when he's in pain or needs help." And, as Courtenay pointed out, since health professionals are not immune to stereotypes, it's "also a reminder of our own tendency to overlook men's vulnerability." (Mental health clinicians, for example, are less likely to correctly diagnose depression in men than women.) He added that it is important to help men assume the worst for themselves in order to help them to know when to seek help. "Research shows," said Courtenay, "that to practice good health habits and modify unhealthy ones, a man must perceive his risks as real and see himself as vulnerable."

  • Locate supports. Self-sufficiency, said Courtenay, is the "hallmark of manhood in this society." Since men are taught to value and develop this in themselves, they develop "fewer friendships and smaller social networks than women do and they don't use the supports they do have." Health professionals can help men identify these supports and encourage them to reach out, suggests Courtenay. Ask, for example, "Who are the people you're most comfortable asking to give you a hand?" Also, it's helpful to remind him "how good it can feel to help someone" and that their friends are most likely happy to help. Courtenay added that health professionals are "an important source of support, too, particularly for single men."

  • Tailor a plan. Just as men may have a maintenance schedule for a car, said Courtenay, men should have one for their health. The plan should be customized to the individual. Courtenay suggested making the plan realistic, with achievable goals, to possibly include regular physicals, diets and exercise. Health professionals should invite input and suggestions, help identify potential obstacles and perhaps develop a verbal or written contract with dates for achieving specific goals, Courtenay said.

  • Highlight strengths. Courtenay suggested using the strengths men develop for the benefit of health. "Reason with men about the logic of changing their behaviors," and help it to make sense through use of metaphors already used by them--whether it's sports (such as with goal setting, score keeping and giving men "targets to shoot for") or the importance of family, said Courtenay. Emphasis on working together as a team to improve health is also positive and may help men feel comfortable. "For most guys," said Courtenay, "health care is something that's done to them--not something they participate in." So, emphasizing a man's control over his own health can "empower him to be engaged in his health care."

Further Reading

For more information about his six-point HEALTH plan, contact Courtenay at courtenay@menshealth.org.

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