Last time we spoke, you discussed your ambitions to implement men-sensitive and community-based health interventions in the New Brunswick area; can you outline your new research focus and how it builds on previous endeavours?

To prevent and better manage major prevalent chronic conditions in men, we need to support them in improving their use of health services, including regular visits to the family physician and adequate utilisation of emergency rooms and walk-in clinics. Gaining a better understanding of how to deliver preventive health messages and provide healthcare in a gender appropriate manner can aid us in this task – as well as an appreciation of men as a heterogeneous group. There is agreement that the wider determinants of health must be taken into account, including health policy, employment and education. Access to health for underserved populations must be improved. In groups of men with increased vulnerability to illness, there needs to be more attention given to promoting healthy lifestyles and improving timely access to healthcare.

Policy, practices and interventions should aim to address how men’s behaviours and lifestyles contribute to their immediate and long-term health needs. Those involved in the local delivery of healthcare should consider how men can be specifi cally targeted, in order that their healthcare requirements can be identifi ed and addressed in a timely and personalised manner.

New Brunswick, however, has not yet developed a clear policy, or even a strategic initiative, to address men’s health and improve gender-equality in terms of public health programmes.

What is the C4Men Team and how will it work collaboratively with men and major stakeholders? Can you give examples of some of these stakeholders?

The C4Men Team is interprovincial, interdisciplinary and holds complementary expertise. I have pre-existing relationships with all the researchers and key partners involved, based on collaborative projects funded by public organisations or under review. C4Men as an acronym comes from the four guiding principles of our research team on boys’ and men’s health: centredness, commitment, capacity and communication. These principles will guide the team’s projects and activities to ensure that fundamental goals are achieved through appropriateness, performance, effectiveness, effi ciency and equity at the systemic, professional and community levels. The C4Men Team involves stakeholders representing the Department of Health, regional health authorities, health foundations and charities, health professionals and men from the community.

Does your team include healthcare practitioners who work with the conditions that are primarily affecting men, such as obesity-related diseases?

C4Men includes clinicians, clinical researchers, public health professionals and population health researchers. This diverse group of collaborators has come together naturally based on our previous research interests and joint work, but has also been infl uenced by strategic considerations at the community, clinical and policy level. This allows our team to design and lead experimental research that is context sensitive to ensure its acceptability and feasibility in the community, clinical and organisational context.

Can you explain some of the characteristics of current primary care services that make them off-putting to men?

Primary care is designed to be the healthcare system’s fi rst point of contact with patients. Some of its major characteristics are that it is sensitive to the needs of the community, accessible in

an easy and timely manner, and able to deliver comprehensive care including health promotion and disease prevention. These characteristics have to be designed based on needs, expectations and realities that vary between patient genders. However, at this time, healthcare managers and clinicians are not looking to gender as a major factor to take into account when it’s time to design and deliver primary care services. Thus, the actual provision of primary care lacks effective men-sensitive health communication skills, adapted working hours, clinical outreach programmes and men-sensitive health promotion material and tools – the list goes on.

How are you monitoring and quantifying engagement in positive healthy practices?

We measure healthy practices through the following outcomes: health literacy; anthropometric, clinical and lab measurements; daily behaviour adoption; and long-term maintenance. This fi nal outcome refl ects the uptake of the following behaviours: healthy eating, active living, avoiding smoking, moderating alcohol intake, stress and anger control, and self-health management.

What unique factors must be considered when working with the men of New Brunswick?

On top of the challenges already mentioned, it is also vital for us to tailor our material to the low level of literacy and numeracy in the men of New Brunswick, as well as adapt to economic factors and adjust to time and geographic constraints.

Men’s health expert, public health researcher and medical doctor Professor Jalila Jbilou returns to International Innovation to discuss the state of medicine for men in Canada’s New Brunswick province, as well as her most recent endeavours to improve it

Medicine, manPRO

FESSOR JALILA JBILO

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Necessity is the mother of interventionA diverse team of public health researchers, medical specialists and physicians of numerous disciplines has come together under the leadership of the Université de Moncton to address the pressing issue of healthcare inequity for men

PROFESSOR JALILA JBILOU

82 INTERNATIONAL INNOVATION

THE PROVISION OF targeted, personalised, accessible healthcare to citizens from all walks of life is among the primary goals of every nation in the world – but the obstacles faced in its pursuit are manifold. Quite aside from constraints imposed by time and other sparse resources, the fact is that often, on an individual level, healthcare is thwarted simply because some patients are harder to reach than others. The injustice of medical inequity between countries at different stages of development presents a complex and emotive problem – but also galling are people who have access to adequate healthcare systems but suffer and die unnecessarily because they fail to take advantage of this service in a timely manner.

Unfortunately, the disconnection between would-be patients and their healthcare providers does not have to be extreme in order to delay access and impact negatively on treatment – it can even be a simple matter of demographics. Men, perhaps unsurprisingly, approach healthcare systems in a different way to women, and have different needs – but what is more surprising is the impact this has on their health. In the New Brunswick province of Canada, for example, men not only have a lower life expectancy than women – a skew that is present worldwide – but are also subject to higher rates of obesity and concomitant health problems including heart disease and diabetes. Furthermore, New Brunswick men are four times more likely to commit suicide than their female counterparts.

HEALTHCARE FOR HIM

These concerns are no doubt the product of multifarious causes, but ultimately they are all at least exacerbated by the fact that men are less likely to request health services than women. Between the ages of 18 and 50, a crucial period for their health, adult men become difficult for the healthcare system to reach; it is also during this time that many individuals will cement into habit unhealthy behaviours such as alcohol consumption and smoking. The question of whether this disconnection proceeds from some predisposition in men towards stoicism and self-reliance, or perhaps fundamental qualities of healthcare policies and interventions that are retrograde to their participation is somewhat unproductive. It is likely that both causes are partly responsible. The real question is: how can primary healthcare be adapted to suit the needs of men, both in New Brunswick and worldwide?

A research group at one of the region’s leading institutions, the Université de Moncton, has been looking into this and related issues for a long time. Dr Jalila Jbilou is a research professor in the University’s centre for medical training and the School of Psychology; an expert on men’s health, she has in recent years led a dedicated team in the development of a novel man-sensitive intervention to affect weight loss and control. The PEER4MEN® programme, as it has been dubbed, has proven highly successful in an experimental trial. In order to reproduce this success across all areas of health, Jbilou has convened an interdisciplinary team known as C4Men to work collaboratively with men and

other major stakeholders to design, evaluate and validate novel interventions. One of these interventions is MindTheHeart, a programme to address the mental health concerns of men with heart disease in general and acute coronary syndrome in particular. MindTheHeart is a three-year project that has been submitted for funding by Movember Canada, the Canadian Mental Health Initiative and the New Brunswick Health Research Foundation.

PROFITING FROM PEERS

The intervention designed by the Canadian team began with a comprehensive review of the literature and examination of results gathered in a series of studies on healthcare for men. Speaking with clinicians and managers of community health centres in New Brunswick and Ontario, as well as six focus groups of men drawn from two French-speaking rural communities, the researchers set out to determine exactly how useful a targeted men-sensitive intervention would be – and what qualities such an intervention would have in order to be useful. It was on the basis of these endeavours that they were able to create the PEER4MEN® intervention, which aligned the needs of both groups of stakeholders insofar as possible.

PEER4MEN® includes a structured, peer-led 12-week educational intervention, whereby participants attend informative group sessions on important and relevant healthcare topics and are supported in making changes to their behaviour. Designed to be accessible for men,

100 per cent of the recruits were retained throughout the 12 weeks of the

programme, and therefore received complete healthcare information

INTELLIGENCE

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ENGAGING MEN IN POSITIVE HEALTHY PRACTICES: A KNOWLEDGE TO ACTION STRATEGY IN NEW BRUNSWICK

OBJECTIVE

To design, evaluate and validate male-sensitive healthcare interventions that can affect weight loss and improve other health metrics both in New Brunswick, Canada, and worldwide.

KEY COLLABORATORS

Nathalie N Brodeur PhD (c) (Project Coordinator), Professor Salah-Eddine El Adlouni, Professor Éric Hervet, Professor Sarah Pakzad, Professor France Talbot, Université de Moncton, Canada; Bronwyn Davies, PhD (c), Department of Health, New Brunswick, Canada; Professor Judith MacIntosh, Professor Ted McDonald, University of New Brunswick, Canada; Dr Ansar Hassan, Saint John Regional Hospital, New Brunswick Heart Centre, Canada; Professor William Montelpare, University of Prince Edward Island, Canada; Professor Marie-Hélène Chomienne, Professor Jean Grenier, Université d’Ottawa, Canada; Professor Isabelle Gaboury, Professor Catherine Hudon, Université de Sherbrooke, Canada; Professor Alain Gauthier, Université Laurentienne, Canada; Professor Paul Greenman, Université du Québec en Outaouais, Canada; Professor Marie-Thérèse Lussier, Université de Montréal, Canada; Professor Gilles Tremblay, Université Laval, Canada; Professor Steven Robertson, Leeds Beckett University, UK

FUNDING

External: Consortium National de formation en Santé (CNFS) • Canadian Institute of Health Research • New Brunswick Health Research Foundation • New Brunswick Innovation Foundation • Internal: Université de Moncton CNFS-Université de Moncton – GRIOSS

CONTACT

Professor Jalila Jbilou, MD, PhDPrincipal Investigator

Université de MonctonMoncton CampusPavillon Léopold-Taillon18 Antonine-Maillet AvenueMoncton, New Brunswick, E1A 3E9Canada

T +1 506 858 4931E jalila.jbilou@umoncton.ca

JALILA JBILOU is a medical doctor with specialty training in public health. She is the leader of the PEER4MEN® programme.

the programme can be delivered in a workplace setting and improves not only health, but also health literacy. To test the system, Jbilou and her team implemented an experimental study in a rural region of New Brunswick. In collaboration with a local community health centre, the researchers recruited 15 men from three different workplaces, which – although not entirely representative – fi t well with the overall makeup of male professionals in New Brunswick: a trucking company, a supermarket and a fi nancial institution.

The results were very revealing. Impressively, 100 per cent of the recruits were retained throughout the 12-week programme, and therefore received complete healthcare information. “The results show that a fl exible, workplace-based and men-delivered educational intervention has a positive impact on health literacy in men,” Jbilou explains. Indeed, participants gained a more detailed knowledge of the benefi ts of proper nutrition, physical activity, stress management and regular visits to primary care providers. The intervention also had an impact on related day-to-day behaviours, as well as anthropometric parameters: participants saw an average decrease of 2.67 cm in waist circumference and 7 mmHg in systolic blood pressure. The greatest improvements were seen in the participants from the trucking company.

FURTHER DEVELOPMENT

Although the work of Jbilou and her collaborators was precipitated by the weight problems facing New Brunswick men, the interventions they have designed and are currently working on have applications across many regions and a variety of health concerns. The assembly of the C4Men consortium, which includes both academic and

governmental partners on an international scale, will help to realise this potential, both in terms of expansion through healthcare disciplines and across geographical regions. Since New Brunswick is constitutionally bilingual, the materials produced so far are already available in both English and French – and the Canadian researchers are ready to translate them into Arabic, Spanish and Portuguese, as well as providing a comprehensive framework to facilitate implementation.

Language, however, may not be the biggest barrier to bringing PEER4MEN® and other interventions to new countries. As the project expands beyond the two provinces within which it has operated so far, the Canadian scientists have increasingly encountered pronounced cultural differences in the treatment of gender. Far from being put off by these challenges, the scientists are engaged: “We are excited by how these aspects will impact on the content and format of the educational session and the tools,” Jbilou enthuses. The production of specifi c materials for men suffering from chronic diseases such as diabetes, chronic obstructive pulmonary disease and cardiac diseases will also be a goal for future work.

REACHING PROBLEM PATIENTS

Aiming to deal with such a broad and non-homogenous group of patients, especially using targeted interventions, is challenging work, but the success enjoyed by Jbilou and her associates is testament to their commitment and ability. The simple fact is that, regardless of the nature of a patient group or the problems of that group in accessing treatment, preventing unnecessary death from treatable affl ictions is one of the most pressing demands facing healthcare today.