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PRACTICAL STRATEGIES FOR IMPROVING MEN'S HEALTH: MAXIMIZING THE

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DOI: 10.22374/ijmsch.v4i1.36

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 Original Article

PRACTICAL STRATEGIES FOR IMPROVING MEN’S HEALTH: MAXIMIZING THE

PATIENT-PROVIDER ENCOUNTER
James E. Leone, PhD, MPH, MS, ATC, CSCS*D, CHES, FMHI1,2,3,
Michael J. Rovito, PhD, MA, CHES, FMHI4,5,
Kimberly A. Gray, PhD, MS, ATC, CSCS, CHES, RYT3, Ryan Mallo, PhD, DNP, NP-C6,7,8
1
Professor, Public Health Studies, Department of Movement Arts, Health Studies and Leisure Studies,
College of Education and Health Sciences, Bridgewater State University, Bridgewater, MA 02325, USA
2
Adjunct Lecturer, Master of Public Health Program, Bouvé College of Health Science, Northeastern
University, Boston, MA
3
Board of Directors and Fellow, Men’s Wellness Collective, Inc. Orlando, FL
4
Associate Professor, Department of Health Sciences, College of Health Professions and Sciences,
University of Central Florida, Orlando, FL
5
Lecturer, Southern Illinois University, Carbondale, IL
6
Director of Nurse Practitioner Programs and Associate Professor, Averett University, Danville, VA
7
Adjunct Faculty, Nurse Practitioner Programs, University of Michigan Flint, Flint, MI
8
Primary Care Nurse Practitioner, Private Practice, Evart, MI

Corresponding Author Information: Jleone@bridgew.edu

Submitted: November 10, 2019; Accepted: November 15, 2020; Published: January 30, 2021.

ABSTRACT
An inconsistent or lack of access to a healthcare provider (HCP) can lead to advanced morbidity and is
an oft-cited barrier to advancing health, particularly in the U.S. Review of select literature consistently
suggests men are far less likely to engage within the healthcare system, which is particularly problematic
relating to preventive service access. As many health conditions are preventable and/or treatable in earlier
stages, delay in screening and treatment often leads to long-term adverse health outcomes. Lack of early
and frequent preventive healthcare may even be perceived as “normative” where poorer health outcomes in
males are expected. Some evidence demonstrates a clear connection that seeking help via healthcare runs
contrary to masculinity and dominant masculine principles, such as being strong/sturdy, working through
pain, avoiding weakness, and/or perceptions of femininity, among other psychosocial phenomena.
Changing healthcare “culture” concerning the care of males (i.e., gender-sensitive care) may provide a
salient avenue to encourage more consistent and preventive contact, or “touch points,” in the patient-provider
dynamic. There is a need to understand how social norms and practices in healthcare and medical settings
can be effectively leveraged to address life-long male health outcomes versus focusing on late(r)-stage
palliative care.
The purpose of this article is to advance dialogue concerning practical considerations, such as resources
(e.g. time, money) and methods (e.g., practitioners considering whether men respond best to immediate

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

efforts to establish rapport versus a traditional power-based dynamic during the medical interaction) to
inform gender-sensitive touchpoints in the healthcare of men. Location and types of facilities where
men are willing to seek care (preventative or palliative) also need to be considered in a holistic, gender-
sensitive patient-provider healthcare model. Implications, policies, and evidence-based practical strategies
for leveraging medical education, prevention programming, proper and improper recognition, and health
management, and long-term treatment are presented and discussed with the practitioner in mind. Although
there is a U.S.-focus with our proposed strategies, we aim to provide a more global context with our future
work on this topic.
Key Words: Healthcare, masculinity, men, patient education, provider.

INTRODUCTION likely to experience greater morbidity and mortality

even though social determinants literature suggests
Although accessing health care does not necessarily
otherwise. This “normative contentment” with poorer
confer “health”, it does allow for “touchpoints.” It is
male health outcomes has been posited and ways to
through these touch points where preventive health
navigate it proposed in previous research.6 Specific
education, screenings, and treatment are made pos-
gender and cultural insensitivity issues include the
sible. Further, organic conversations and subsequent
lack of male-led programs7 and the perception of some
operative behavior change can often occur during
men that physicians lack appropriate communication
these interactions. Our collective belief that the ef-
(e.g., tone and salient content).8
fectiveness of practitioners’ facilitation of
Other theories postulate as to why males do not
conversation and engagement with their patient
access healthcare. However, generally speaking, they
through said touchpoints is a primary determinant of
can be categorized into three primary areas: 1) lack of
positive patient health outcomes. Pinkhasov and others,1
concerted health education efforts, 2) the economic
however, suggest that men are far less likely than
impact of overall health status among males, and 3)
women to access healthcare, particularly in a
social norms perpetuating risk factors for males to
preventive care context. While not a universal
live sicker and die younger. The confluence of these
viewpoint as contended by other international
three factors contributes to the current disparate health
research,2 we draw from our collective Western (U.S.)
outcomes among males compared to their female
experiences and literature, that males are less likely to
counterparts. Therefore, it is paramount for us to begin
access and utilize healthcare. This phenomenon,
to develop strategies, not just talking points, for male
therefore, limits the availability of touchpoints for
engagement in the clinic, community, and classrooms
wellness promotion among men and boys. Thus, the
to help eliminate said disparities.
question emerges: What strategies can we employ to
make these opportunities, when they occur, as
EXISTING HEALTH DISPARITIES
effective as possible?
Theories abound as to why males (particularly ages Between-Sex Health Disparities
18-40) infrequently engage the healthcare system, A clear gap exists concerning health outcomes,
including lack of resources (time, money), fear of be- particularly morbidity, between the sexes when view-
ing perceived as weak, inconvenient times, and access ing U.S. national data trends (Table 1). Pertaining to
points (i.e., appointments), and concerns regarding mortality in the U.S., males are significantly more
gender and cultural insensitivity.3,4 Disparities impacted likely to die than females from nine out of the top
by a complex confluence of socioeconomic, cultural, ten leading causes of death.6 Moreover, mortality rate
ethnic, and racial issues also play a significant role disparities worsen when viewing data on men of color
in healthcare and should be considered when tailor- and other minority populations (Table 2).8,9 Global
ing any intervention or outreach.5 In general, society rates, particularly in the West, mirror the U.S.10
may just expect or accept men as genetically more

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.
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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

TABLE 1 Top Causes of Death by Race, Sex, and Ethnicity

Causes All Male Female Ratio, m/f
All cause 728.8 861.0 617.5 1.39
Heart disease, Total 165.5 209.1 130.4 1.60
Malignant Neoplasms, Total 155.8 185.4 134.0 1.38
Diabetes 21.0 26.0 16.9 1.54
Chronic Lower Respiratory Disease 40.6 45.1 37.4 1.21
Unintentional Injuries 47.4 65.0 30.8 2.11
HIV 1.8 2.7 0.9 3.00
Suicide 13.5 21.4 6.0 3.57
Homicide 6.2 9.9 2.5 3.96
Adapted from United States (2016).6

These data call into question a genetic component and the stronger impact of health policy and the social
to male health and the role and impact of social determinants of male health.
determinants. For example, males are more likely Encouragingly, despite the striking disparities, all
to consume tobacco and alcohol overly, partake data suggest a modifiable element to them with longer-
in riskier behaviors, often leading to unintentional term hopes of improving male and population health.
injuries, and have higher risk occupations, among Better and more consistent access to gender-sensitive
others.11,12 These data illustrate that biological fac- providers, comprehensive healthcare policies targeting
tors of male health, but what and how men and complete male health, and the ability of healthcare
boys interact with their environments is far more providers to be able to help males navigate complex
predictive of health outcomes than any other systems that affect their overall health (i.e., workplace
variable. Social structures “assume” men to be health, reintegration from incarceration, mental health,
genetically predisposed to poorer health; however, etc.) all can positively impact male health outcomes.
scrutiny of the latter reveals that society has Transmen also experience a severe disadvantage
normalized it versus proven it biologic fact.6 relative to the previously discussed categories of
Within-Sex Health Disparities mortality data.13 Transmen health outcomes are likely
Consistent with mortality data between males worse (particularly minorities) due to social stressors,
and females, stark disparities also exist based on healthcare providers’ lack of training and experience
within-sex comparisons. Except for suicide, chronic with this population, personal views and bias, and
lower respiratory disease, and unintentional injuries, overall social inequities at all levels, among others.14
men of color shoulder the greatest burden of mortal- For example, the National LGBTQ Task Force and the
ity across the board (Table 2). These data indicate National Center for Transgender Equality conducted
that Black/African American men have significantly their second iteration of the U.S. Transgender Survey
higher rates of all-cause mortality and heart disease, (USTS) involving 27,715 respondents. Results showed
almost double the rates of diabetes mellitus, and seven pervasive mistreatment and discrimination in daily
times greater risk of HIV and homicide compared to activities, and when seeking health care, compounded
white (non-Hispanic) men. Further, Asian and Pacific by transphobic bias and structural racism.15 Other
Islander men appear to have a relative health advan- literature suggests that “social support, community
tage, suggesting social factors (particularly higher connectedness, effective coping strategies” and col-
socioeconomic status and education) seem to play lection of gender identity data appear beneficial and
an influential role in mortality and health outcomes. would enhance appreciation of “mental health risk
The latter also reinforces the lesser role of genetics and resilience factors among TGNC populations.”16

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

THE ORIGINS AND COSTS OF MALE assumptions about health issues with their health care
HEALTH OUTCOME INEQUITIES WITHIN provider (HCP) [see Cohn et al.’s discussion of male
THE HEALTHCARE SYSTEM eating disorders for further clarity on this issue].18
Origins In other words, there is a dearth of mass media and
The discussion of male health outcome dispari- public education efforts specifically tailored to inform
ties is not a novel conversation. There is a rich track men and boys on how to avoid adopting certain risk
record of prominent and emerging voices in the field factors (i.e., primordial prevention) and how certain
highlighting differences between males and females risk factors, if already adopted, can lead to specific
and within male populations. What is underrepresented adverse health outcomes (i.e., primary prevention).
in the literature is a practical assessment of where the Further, research consistently validates that men
disparate outcomes stem from, at least in a way that avoid healthcare screenings (i.e., secondary preven-
organizes the conversation within a systems-thinking tion) due to fear, lack of awareness, or low perceived
approach. It is one thing to discuss theories of isolated threat (i.e., “it cannot happen to me”), thus lessening
origins of disparate outcomes between groups, but it the cost benefits associated with early detection.19
is another to discuss it as a multifactorial unit. Ad- Lastly, tertiary prevention often does occur for many
mittedly, this conversation would most likely warrant men; however, the issue with this form of engagement
an entire series of manuscripts to pay it appropriate is that it often is very costly, invasive, and more often
homage to flesh out needed points of this system, not than not, lacks restorative abilities.17 Tertiary preven-
just a brief mention in one article. However, our point tion (i.e., palliative care), often serves as a touchpoint
is that we need to begin viewing male health from a where men have to engage the health care system
more perched view to understand the various moving due to declining health and ability. Figure 1 (below)
parts. Working with individual variables in isolation provides an illustrative example of what this scenario
can be detrimental if confined indefinitely. could resemble.
To clarify further on the context here, ‘system’ Costs
can have various meanings. We offer the preventive A primary concern pertaining to male health and
healthcare ‘system’ to highlight the point. Theories wellness is the economic impact of a sicker male
aside, lack of preventative healthcare confers risk at community with shorter life spans. Brott et al.20 sug-
all levels of prevention, both from a health and a finan- gest that the fallout of reduced male activity in the
cial perspective. For example, the lack of primordial economic sector due to morbidity and/or mortality
and primary prevention17 via health education denies can reach in upwards of hundreds of billions of U.S.
men knowledge and opportunity to clarify presumed dollars annually. This is primarily due to rising and

TABLE 2 Top Causes of Deaths by Race and Ethnicity

White,
Causes White non-Hispanic Black/A-A AIAN API Hispanic
All cause 729.9 749.0 857.2 591.2 392.6 525.8
Heart disease, Total 164.5 168.7 205.3 115.4 85.2 115.8
Malignant Neoplasms, Total 156.6 160.8 177.9 103.4 97.1 110.0
Diabetes 19.3 18.6 36.8 34.3 15.5 24.7
Chronic Lower Respiratory 43.3 45.8 29.3 29.7 11.7 17.1
Disease
Unintentional Injuries 50.4 53.9 42.7 53.9 16.8 31.4
HIV 1.0 0.8 7.2 1.0 0.4 1.7
Suicide 15.2 17.0 6.1 13.5 6.7 6.7
Homicide 3.5 2.9 21.4 6.7 1.8 5.3
Adapted from United States (2016).8
DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

FIG. 1 Potential barriers to healthcare for men.

sustained health care costs, as well as a drop in the as this often runs contrary to masculine ideology and
amount of economic output per person. The latter sociocultural norms.3,19,22,23 Rapport-building, empathy,
speaks to poor male health’s economic costs, but the and trust are essential in most relationships, but per-
personal and indirect burdens to families and com- haps even more so in the patient-provider dynamic.24
munities cannot command a cost figure attached to The latter builds on findings suggesting men are less
it. For instance, Rovito21 specifically discusses the willing to be vulnerable with an HCP due to perceived
possible effects of economic truancy among males fears of embarrassing and/or invasive procedures, fear
who were diagnosed with testicular cancer. The author of healthcare professionals reaction to their lifestyle
suggests that the projected costs across the lifespan choices and practices, fear of receiving bad news,
for a survivor in terms of treatment, non-participation and fear of receiving a controversial diagnosis that
in the workforce during recovery and beyond, among would incite criticism from close family, friends, or
other factors could add up to immeasurable amounts their partners.3,19,23,25,26
of money when viewed in the aggregate body of These perceived notions perpetuate lost opportunities
survivors. Clearly, stop-gap measures to reduce the for building a trusting relationship with an HCP. The
economic burden and ideally enhance preventative issue of perceived vulnerability and trust is heightened
healthcare engagement strategies for males is both an in men of color and has persisted for decades.27,28 Ad-
economic priority and an ethical and moral necessity. dis and Mahalik19 and Connell and Messerschmidt22
Social Forces noted how men’s perception and endorsement of
A final consideration in improving men’s access masculinity and masculine gender role norms (i.e.,
and sustained quality engagement in the healthcare hegemonic masculinity) also create less opportunity
system is truly respecting the potential issues created to engage in healthcare and help-seeking. Providers
when engagement requires a man to be vulnerable, need to be acutely aware of the possible barriers to men

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

seeking help and accessing preventative healthcare to in a healthcare setting can be challenging work. Not
embed responsive best practices into this healthcare all strategies may work. Some may only work after
dynamic. Rapport and trust-building strategies, along repeated use. Some may only apply to certain age
with imbuing an awareness of developing empathy groups or other demographic subgroups. It depends
and shared vulnerability in these relationships, will on the specific target group in the clinic, community,
be further discussed. or classroom. Finally, this is not an exhaustive list of
Purpose strategies, rather, this is a developing model with plans
In light of the current state of poor men’s health to expand in the future. Each subsection offers details
outcomes and the impactful factors articulated in of why males initially disengage and then discusses
the above narrative, the objective of this paper is to possible strategies HCPs may wish to consider and
present and discuss practical strategies healthcare integrate into their practice with male populations.
providers could/should consider when engaging male Interpersonal Barriers
patients (inclusive of trans men). Consideration of The “interpersonal” level of an individual suggests
implementing gender-inclusive strategies into a best that we operate within a social system where others
practices clinical approach may allow for a more en- who also work in said system influence our behaviors,
gaging and meaningful patient-provider interaction, and subsequently, our health, via their opinions and
thus positively impacting men’s health and ultimately, actions. To provide optimal care for men, clinicians
population health. need to better understand interpersonal barriers that
may preclude participation in health care. Such bar-
ADDRESSING MALE HEALTH DISPARITIES: riers include but are not limited to fear, stigma, loss
PRACTICAL STRATEGIES FOR of social status, negative experiences in accessing
TRANSFORMATION
or negotiating the healthcare system, and masculine
There is a need for more than talking points high- norms.19,23,25,26
lighting that disparities exist in male health. Further, Story theory originated in the realm of nursing
there is a need to provide real, practical strategies that pedagogy. Research has shown that allowing people
any practitioner can implement without the assistance to share their own stories is integral to holistic health
of grant funding, months of planning, expensive cam- success.29 It is important to allay fears up front. For
paigns or equipment. Some great work has produced example, if someone comes in thinking they have
some critical individual pieces of the puzzle, but now testicular cancer, it is important not to trivialize their
is the time we offer “ground-up” strategies that are concern. After listening to their story, if the HCP is sure
easy to execute and are effective. that the fear is unfounded, they can attempt message
What practitioners have is the “here and now” when reframing by acknowledging their point of view and
treating or working with males. We operate within a giving praise for showing personal health advocacy.
system and must consider that during counsel. Often, Additionally, by addressing the primary concern up
we only see the man once and are often limited on front, they are more likely to focus through the rest
how long we can speak with the individual. Most of the consultation. Utilizing phrases connoting the
times, we operate with limited resources; therefore, inherent strength of their proactive behavior, like, “It’s
it is time for a pragmatic approach to helping males. really strong of you to come in and take care of your
In most instances, the following information health” or “It shows that you have a lot of strong char-
provides practical strategies and recommendations acter to come in and take care of yourself ”, can assist
citing evidence-based resources; however, due to the in reducing treatment-seeking stigma. This is what was
authors’ diversity and collective experiences in a vari- organized in the “Real Men Wear Gowns” campaign
ety of healthcare settings, we also provide “tips from conducted by Health Partners in Minneapolis, MN.
the field” to round out the discussion. These authors A means to address these barriers is to have places
acknowledge that engaging and/or re-engaging men that allow men to seek care without negotiating social

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

status. Give people opportunities to seek care where sensitive issues) must be viewed as imperative dur-ing
they do not have to negotiate masculine capital with the visit. When talking with male patients about
their peers. Delivering care in places they naturally sensitive subjects (often challenging their endorsement of
congregate, such as work (e.g., worksite health pro- masculinity) that they are not likely to broach
motion) or barber shops, has been shown to increase independently, HCPs need to make healthcare choices
men’s likelihood to enter into care.23 In a factory for easy and appealing.17 Adding sexual health screenings to
example, if there is a provider on site, people can come routine health visits is essential to reach young men and
in off the factory floor and get injuries assessed, but correcting their poor health.33,34 Some of the ways to get
also have an outlet or opportunity to receive additional them are to take mobile units to screen for STIs, having
health education and access health resources without STI and prostate screenings at social events like
having to take time off or make peers and supervisors baseball games, or barbershops and more recently
aware of their health challenges. Holding a health through online platforms like telehealth/ telemental
fair or taking clinics to remote places where men are health.
known to congregate, such as college campuses, youth Additionally, online programs have emerged to assist
programs, barbershops, sporting events, job training men with sexual and mental health and well-being.
sites, local mosques, homeless shelters, soccer clubs, However, providers should be aware that some apps
bars, dance clubs, and through mobile units, also likely and online virtual appointments could hinder patients
will encourage participation.22,26,30-32 from engaging in holistic, primary, preventive health-
Fear of receiving bad news, being judged by a care. Holistic, primary healthcare for sexual health
HCP, perceived or actual negative reactions from needs or issues is often the means to create buy-in to
family and/or friends, and fear of what their partner encourage engagement in primary healthcare screen-
may think also are interpersonal barriers that clini- ings. For example, if a patient knows that they can get
cians caring for men need to be ready to navigate.26 a prescription online for ED, they may neglect to see a
This calls into question how we socialize males in provider in person and subsequently miss out on other
the health care system and emphasize education via needed screenings. There are also potential benefits to
coping strategies, cultivating support systems, and online programs and outlets. Research has shown
discussion/training on how to explain what is going online discussion boards (ODBs) “can be used as a
on to support systems. Deficits in being properly potential medium to expand one’s social network and
educated in health are a substantial interpersonal acquire support from people who have had a similar
barrier that men face when seeking primordial and experience.”35
primary preventive care. A lack of knowledge about
when and where to seek healthcare, especially when Institutional Barriers
no signs and symptoms are present, often delays or In addition to interpersonal barriers, men also face
precludes seeking help.3,19,26 Sensitive issues such institutional barriers when attempting to navigate the
as sexual health also may prove difficult due to the healthcare system. Such barriers often include: failure to
nature of questions, disclosure of issues (e.g., erec- provide up-to-date sexually transmitted infection (STI)
tile dysfunction, STIs), and vulnerability during the information and related testing procedures; poor
physical exam (e.g., disrobing). Practical approaches communication regarding testing and treatment op-
to the issues raised could reside in better targeted tions; lengthy wait times to see a provider; mandating
health education in schools, gender-sensitive social patients to give a reason for their appointment (thus
media campaigns, and providing more opportunity imposing on privacy/confidentiality); judgmental and/ or
in community/work-related venues. disrespectful treatment from providers; and the
These authors acknowledge that getting men to an expectation that men will discuss their problem with
HCP is a challenge making each interaction particularly multiple HCPs during the same visit.23,26,36 Certainly,
important. Maximizing time and topics (especially these issues are not unique to men, but the extant

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

literature on men being less likely to access health as multi-page registration forms, also are favored by
care in the first place1 magnifies these issues and men and patients who identify as male. Scheduling
becomes quite apparent in morbidity and mortality patients immediately for appointments is essential
data as noted in Table 1. and if scheduling is not possible, then the HCP or
Institutional solutions are complex due to the facility should refer them to someone with immediate
numerous entities and power dynamics involved. avail-ability and do a follow-up to confirm that their
As the foundational knowledge base HCPs receive needs were sufficiently addressed.
during their professional training is slow to change, Yet another solution is to allow patients to schedule
clinicians caring for men need to alter the method in appointments without having to give a reason. For
which that knowledge is conveyed through updates some, this may be a deterrent to utilization of online
in professional literature and continuing education scheduling since systems typically do not allow a
efforts. The latter point also speaks to upstream health patient to schedule without providing a reason for
care policy changes that likely will provide a more the appointment. When interacting with patients,
consistent and sustainable impact in how clinicians HCPs should remain as neutral as possible, even if
promote and engage in health care with males. Clini- the actions or lifestyle of the patient do not align with
cians wishing to care for men have the daunting task their personal beliefs. If the HCP cannot do so, it is
of overcoming both interpersonal and institutional important that they then refer the patient to a provider
barriers. Ensuring that the most current testing modali- that can provide unbiased care. The office should
ties and treatment options are understood is essential. have a pre-prepared list of referrals available at the
This will require each professional to stay up-to-date time of service. Finally, it is essential to ensure ease
with current literature to provide evidence-based care. of access to services. One of the things that is hard-
Ideally, this should be tracked, monitored and peri- est for patients is gaining access to the services the
odically assessed. To combat gender identity specific institution provides, especially to specialists. This is an
disparities in cancer screenings, authors suggest it is institutional/policy barrier that is beyond this article’s
“critical that gender identity questions are included in scope; however, it is worth mentioning here. This will
cancer and other health-related surveillance systems require each system to evaluate whether they have
to create knowledge to inform healthcare practitioners enough providers to meet the needs of their clientele
and policymakers better of appropriate screenings and available insurance. Inability to reconcile these
for trans and gender-nonconforming individuals.”37 issues will inevitably lead to gaps in care.
As previously noted, research specific to transmen is Rethinking Communication Style
severely lacking. To provide improved care for this Individualizing the HCP-patient approach and using
segment of the population it will require a broad as- a style that men are responsive to and being flexible
sessment of “knowledge and biases of the medical in the delivery of healthcare in a nonclinical environ-
workforce across the spectrum of medical training ment are requisite in the successful implementation of
concerning transgender medical care; adequacy of healthcare delivery to men.39 Research has illustrated
sufficient providers for the care required, larger social that males respond best to direct communication and a
structural barriers and status of a framework to pay frank approach. They appreciate thoughtful use of
for appropriate care.”38 humor and utilization of empathy and have high
Modern facilities, nearby locations, short or no regard for clinical competence.40 Clinicians also can
waiting times, same-day appointments, not having help reframe the experience positively by encouraging
to give a reason for the appointment, and availability men on their decision to seek help and pursue healthy
to receive multiple healthcare services at the same lifestyles (i.e., shared decision making).23 In consultation
location are all factors that have been noted to be with transmen, it is also important to consider that
appealing to men entering into care.26,36 Removing perception of the physician’s critical health concerns
cumbersome processes prior to entering into care, such
DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
This article is distributed under the terms of the Creative Commons Attribution-
Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

may be superseded by the patient’s need to affirm their take care of their health so they can take care of their
gender identity.13,13,41 Providers also need to create family” or “It’s ok to show emotion,” can help combat
positive first impressions and male-friendly spaces in the hegemonic masculinity that often precludes men
which healthcare is offered. Waiting rooms that have from proactively participating in healthcare. Ideally,
male interest magazines, health education materials these messages would be delivered from a founda-
that target men’s issues, and TV programming of in- tional perspective from a boy’s earliest interactions
terest to men are immediate and simple steps offices with the healthcare system. As he grows, consistent,
can take in welcoming men into the primary care age-appropriate messages via parents, school, social
arena. Beyond the practical strategies in this section, media, and healthcare providers, among others, should
we acknowledge that a greater shift in the way society identify risks and concerns and mitigate them with
interacts with boys (and eventually men) in terms of appropriate and consistent follow-up. Ultimately,
healthcare needs to occur. Larger systems change we should advocate for this message to be
that encourages emotional intelligence, engage boys reinforced by educators, parents, and HCPs, both
in school systems concerning their health, parental clinically and in community settings throughout the
modeling of healthy behaviors (particularly among lifespan, to approach true social system changes.
men), and many other considerations may help develop Relationship building and open, honest dialogue
a better rapport and communication style with health are noted to be positive catalysts in helping young
and health care. men seek medical care. One study where a provider
Targeted Interventions connected with the “ringleader” and gained his trust
Out-of-clinic interventions are built on the premise was pivotal in recruiting and retaining additional men
that men are not as likely as women to enter a health- from a specific group that had not previously sought
care setting both nationally and internationally. “Men care.26 The latter study is unconventional, but it does
almost never come to you; you always have to go to speak to the potential value of community outreach,
them. They are keen, it’s just that you can’t expect knowledgeable neighbor models, and development of
them to come to you…”39 In other words, men who trust in harder to reach populations. Offering a holistic
are unengaged or under-engaged in the healthcare and respectful approach to healthcare in conjunction
system are not generally disinterested in their health, with targeted messaging that empowers men such as
but rather the forum in which healthcare is delivered.32 “sexual healthcare is a way to be stronger” or “taking
An example is worksite health promotion programs care of your health is cool” has been noted to increase
that have been found to reduce medical costs by more office visits by young men.26 Provider compassion
than 25%, and advocates for companies to offer such and empathy towards men also is a significant fac-
programs argue that they elicit a higher return on tor shown to help buffer the relationship between
investment from the employee. Such programs have masculine norm adherence and acceptance of health
been shown to decrease health system charges by as promoting behavior.43
much as $300,000 in an 18-month period.20 Realizing that men often are drawn to technology
Interventions aimed at men’s health promotion (e.g., mHealth, online discussion forums, online doc-
need to use targeted messages explicitly geared to- tors, telehealth, telemental health), leveraging curiosity
wards men. Men who irrevocably adhere to strong in the utilization of the latest technology and testing
masculine beliefs have an even higher likelihood of devices can help spur interest in primary preventive
not participating in primary preventive care regardless care.32,43 Online virtual visits, patient portals, or
of increased wealth, income, or occupational status; phone apps would be examples. One example of a
therefore, targeted messaging early on in a young man’s successful, targeted message is that of cell-phone
life is paramount.42 For example, reframing stigmatiz- applications that will send weekly tips and education
ing messages like “boys shouldn’t cry” to something on preventive practices and sexual health, in addition
more along the lines of “Strong men take time to to notifications regarding healthcare directly to the
DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
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patient via their mobile device.32,42,44 Additionally, opportunity to help patients enter into treatment. Suc-
for men who are less technologically inclined, cessful approaches to retaining men once they have
tailoring healthcare messages to patient populations sought care are noted when providers are professional,
in formats they interface with regularly, such as sport- friendly, humorous, and possess the ability to deliver
ing events, barbershops or other social venues, these care that is confidential.23,36,49 Men have emphasized
platforms can be successful in engaging patients in the need to inform a receptionist and/or nurse of the
health-promoting behaviors.31,45 reason for a visit as one reason they would not want
Finally, tailoring healthcare messages to men’s to go to a healthcare facility, as well as fear of being
spouses/partners may prove beneficial as data from judged, having a provider deliver poor treatment,
national health surveys have found that partnered men or having to wait a long time while leaving work as
were more likely than unpartnered men to undergo a barriers to seeking care.3,23,36 Therefore, providing
primary health care visit and screenings the last twelve alternative ways to allow a patient to check in to an
months.46 Other research suggests that it is critical to appointment or disclose his chief complaints, such
be cognizant of interpersonal partner communication as using tablets with patient codes versus names and
techniques and how best to foster effective discourse. conditions, would help allay fears and remove barriers
Bottorff et al.,47 for example, discusses how wives resulting from the office visit.
position themselves in regulating cigarette smoking Even the positioning of the provider can influence
behaviors. Essentially, partners can play a critical part how a man may receive health information. Side-by-
in the facilitation of their husband quitting smoking. side communication and engagement seem to be more
This can potentially be applied to other maladaptive efficacious in promoting health-based conversations
behaviors beyond smoking, like not wearing sunscreen with men than face-to-face or the HCP standing while
or avoiding preventive screenings to assess colon health. the man is seated or lying down.50 Educational reform
Perhaps some attention should be paid to how we can in the training of all HCPs (particularly pediatric
more effectively communicate to a spouse/partner physicians in working with parents of boys), utiliza-
about their role in their partners’ health maintenance tion of men’s health services in the workplace, and
and give them some helpful tools to promote optimal campaigns to target marginalized men and vulnerable
well-being among their husbands/partners. While not male populations are key to improving men’s health
an “only” strategy to reach men, further research on on a global scale.51
partners and other relationship dynamics also could
provide rich data to integrate in health care practice DISCUSSION
when engaging males. The evidence provided in this article and trends
Rethinking the Office Visit consistently found in health care and other literature
Treating patients for a concerning primary complaint (e.g., socioeconomic), construct a grim reality that
and utilizing that visit to complete a general health male population health lags in most if not all health
assessment is one modality clinicians can utilize to outcomes in the U.S. and globally.51 A goal in writ-
evaluate a patient’s general health status. For example, ing this piece is not solely to focus on “male health”
erectile dysfunction (ED) is a common complaint that per se, rather, we have consistently advocated for a
will often bring male patients to see a primary care population health perspective so as to advance socially
provider after years of not seeking primary preventive just policies and programs.51 The patient-HCP rela-
care.48 While addressing concerns of ED, a provider tionship is a crucial element in advancing population
also can assess likely concomitant issues such as blood health not from a perspective of “things to be done”
vessel/cardiac issues and possible psychosocial con- to a patient but rather a true focus on the individual’s
cerns as well. Similarly, providers need to be cognizant holistic health and treatment. Compassionate, engaged,
that diabetes and hypertension are often diagnosed responsive, and empathic health care that can meet
at the same time as ED, so, theoretically, this is an men where they are (e.g., workspaces, athletic events,

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
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Non Commercial 4.0 International License. © Leone et al.

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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

barbershops) among other factors (e.g., time, resources) and figuratively meets males where they are. We need
particularly earlier in the lifespan, likely will build a to speak with men, not speak to them. For example,
strong rapport and yield a healthy return on speaking to males as if they were a friend, family
investment.13 member, or concerned neighbor tends to provide a
In these authors’ collective experiences and professional comfort level rather than speaking to them as their
opinions, rapport building through consistent and physician or an expert in the field. The latter usually
continued health care “touchpoints” with men is essential. builds up barriers and does not produce the want and
Boys and adolescents sporadically engage with an HCP desire for males to share information and confide in
(often a pediatrician) earlier in life and perhaps thereafter the practitioner.
for general medical work physicals or sport/activity-related The patient-provider relationship, like most things
needs often to the exclusion of continuity of care and in life, is a process. Unfortunately, in today’s society,
health maintenance. Young men often are less likely to health care has become highly commercialized where
regularly see their HCP due to a variety of factors patients may never see a dedicated provider with the
including, but not limited to: low perceived vulnerability, advent of “big box” health care like Minute Clinics
cost, un- or under-insurance, lacking time and resources, and urgent care centers.24 Research consistently points
and fewer immediate health concerns among others.3,19,28 to men desiring to see a practical outcome or need in
Also, seeing an HCP also may be perceived as a weakness a health care interaction, such as with an injury, clear-
that runs contrary to masculinity as previously
ance to participate in employment or sport, among
described.19 These and several other reasons make it vital others.3,4,19,50 However, as promoted throughout this
to engage boys and eventually men throughout the
article, primary prevention versus reactive health care
lifespan to enact preventative health care that is
will yield better lifespan and population health outcomes
responsive to a man’s needs (physical, mental, emotional)
for men and society in general. Lack of investment in
when needed.
the patient-provider relationship dynamic likely will
First impressions with an HCP or “touchpoints”
lead to lost follow-ups, sporadic access of HCPs only
matter! A man may not be willing to share everything in the
when costly palliative care is warranted, and a loss
first few medical encounters with a provider, however,
of holistic gender-inclusive health care dynamic for
focusing on gender-inclusive, empathic care and rapport
men. Thus, shifting the health care model of “care
building likely will foster trust in this dynamic. When a
when needed” to a “continuity of care model” for
solid rapport and trust is achieved with an HCP, a man
men may help allay misconceptions about care that
may be comfortable and allow himself to be vulnerable to
challenge masculinity, foster productive health care
discussing health concerns or simply discussing strategies
touchpoints, emphasize primary preventative health
to remain healthy. The latter may require an HCP to abandon
care, and imbue men with a sense of responsibility
all assumptions (e.g., intent, needs, masculinity) about the
and value in their health, because it matters!
interaction and simply begin with an open and honest
Let us take Figure 1 and work in reverse to offer
dialogue. This interaction and exercise in communication,
an example of the above call to arms. Keep in mind
trust, and compassion is likely healthy and beneficial for
that appropriately targeted and specific “touchpoints”
both the patient and provider. How HCPs speak and
with an HCP could be critical in ameliorating several
communicate with men (versus lecturing at them) matters
of the issues and gaps in holistic health care for men.
and often runs contrary to traditional masculine
The “type” of engagement with a HCP needs to be
principles, thus practicing active listening, motivational
frequent and productive enough to allow for meaning-
interviewing, and even sitting side-by-side can create
ful care to maximize a patient-provider relationship
subtle differences that have a lasting impact in developing
targeting primordial and primary prevention and
positive, healthy patient-provider relation-ships. There
sparingly using secondary and tertiary approaches.
needs to be a switch FROM vertical TO horizontal
For example, creating a healthcare culture of in-
communication methods. This literally
tentional rapport building with men throughout their

DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
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 Practical Strategies for Improving Men’s Health: Maximizing The Patient-Provider Encounter

lifespan may create a greater atmosphere of empathy, of health care. Even questioning the very nature of
trust, and shared decision-making with an HCP, as well what “access” looks like is an important
as the healthcare system overall. Further, involving consideration. For example, is access defined solely
fathers during the entire pregnancy process may create as going to an HCP or is it accessing information,
a sense of a health imperative in being there for one’s patient portals, emails/communications, seeking
family and subsequently improving male health.52 preventative versus palliative care, and ultimately, is
Moreover, embedding gender-sensitive approaches it meaningful access that needs to be more fully
with male populations in medical education programs explored.
(i.e., medical schools, continuing medical education Leveraging masculine capital54 to challenge men
[CME]) and training HCPs to approach interactions to respond to being proactive and responsible in
with men creates a sense of shared decision-making their life-long health and wellness can be infused
and empathy and likely will yield more consistent in community outreach programs as well as taught
and quality access and engagement.54 Ultimately, an in medical school curricula and continuing medical
es-sential question to the current model as to how education credits. We recognize that there is value
HCPs engage men is, “can (should) we do better?” to all men at all stages of the lifespan, and the better
Based on the abysmal disparities in nearly all health we can keep men connected to their families, friends,
outcomes for men in the U.S., (see Table 1), the and communities with healthy initiatives, the better
resounding answer should be an emphatic “yes.” off society will be. Men’s health sheds have become
popular in countries that endorse a national men’s
FUTURE DIRECTIONS
health policy, such as Ireland and Australia among
Before we shift the focus to what can and should others. The sheds help connect men at various life
be done concerning men’s health, let us pause to rec- stages, particularly older men who may experience
ognize that there are several excellent programs and social isolation and mental health issues. Data have
policies to improve men’s health. However, much work shown men’s health sheds to be impactful in terms of
needs to be done ranging from the government and improving select health outcomes, particularly mental
policy level down to the patient-provider interaction and social health.30,31
discussed in this article. For example, development of Natal males and trans men who enact male-typical
an Office of Men’s Health via the U.S. Department of behaviors also are an important and under-studied group
Health and Human Services could earmark funding of the men’s health continuum. While it is a limitation
for men’s health programming at the national level. and beyond the scope of this article to fully present
More work needs to be done at the patient-provider issues in trans men health, we offer a brief overview
level, connecting men with holistic health services at of some broader perspectives that might be considered
the point of contact, such as with men’s health clinics in future research. Consistently, HCPs recognize the
and community health centers (for an example, see the need to evolve and learn more about the care of this
Whittier Street Health Clinic site in Boston, MA: http:// segment of the population; however, evidence-based
www.wshc.org/blog/mens-health/). In this example, a training and education fail to meet HCP’s needs
male patient has all needs met and likely during one concerning training and clinical care guidelines.55
scheduled appointment, ranging from clinical evalu- Some efforts by nationally recognized health care
ation and diagnostic tests, to medications. There is a institutions such as Fenway Health in Boston, MA
prompt system of “warm hand-offs” when needed, as have made steady progress in educating clinicians in
in substance use disorders or mental health concerns. the compassionate, competent, and gender-affirming
As in the example of Whittier Street Health Clinic, clinical care of trans men (for more information, see:
among other practices, maximizing efficiency and https://fenwayhealth.org). For example, abandoning
adding to the value of these interactions could shift assumptions about the patient (use of proper pronouns
the burden from men who already are less likely to verbally and on forms), listening with empathy and
access health care to more robust and viable models keeping curiosity at bay (not asking unnecessary
questions), utilizing perspective-taking, and being
DOI: http://dx.doi.org/10.22374/ijmsch.v4i1.36
Int J Mens Com Soc Health Vol 4(1):e1–e16; January 30, 2021.
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well-versed in an array of medical, hormonal, and and salient environments to achieve the stated health
psychological needs, all may contribute to better care equity goals and objectives nationally and globally.
and clinical outcomes. If a “true” public health is to be DECLARATION OF CONFLICTS OF
enacted for our population, all of the aforementioned INTEREST
principles and needs to enhance the patient-provider
relationship need to be addressed, met, and exceeded, We have no conflicts of interest to disclose in the
especially in marginalized populations. preparation of this paper.
CONCLUSIONS ACKNOWLEDGMENTS

One needs only to look at the outcomes data in The authors would like to express gratitude to the
Table 1 of this paper or similar data to see a discon- many medical and health care providers who work tire-
certing health pattern emerge – that is, collectively, lessly to advance patient care and population health.
men live sicker and die sooner than women, both We would particularly like to thank those physicians,
nationally and globally. With-in male populations physician assistants, nurse practitioners, nurses, phar-
(i.e., minority groups) communicate an even more macists, and public health workers who contributed
dire picture than when viewed as a whole. Certainly, their unique and practical ideas to this manuscript.
this is a multifactorial public health issue and requires
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