Team:SDU-Denmark/Human Practices/Gamification
Fun Learning
Throughout our project development, we gained knowledge of men’s health-related behaviour. This was especially catalysed by our end-user interviews and conversation with Rochester University on sex education for all ages. We learned that men’s age from 45 and onwards is termed andropause – a very under-investigated life phase among men leading to changes in physical, social and mental health. Changes that are often subjected to taboo! Also, it is the phase of life where prostate cancer is typically diagnosed. This inspired us to make the gamification campaign Early Detection.
What is andropause and gamification?
Andropause is the term for the age-related decline in serum testosterone, which shows with symptoms such as diminished libido, urinary problems and a low feeling of mental and physical well-being [1]. Andropause symptoms are especially prominent among men suffering from - and in treatment for - prostate cancer, and it can be hard to tell prostate cancer symptoms apart from the more harmless andropause symptoms.
Gamification is a term of relatively new origin with the first documented academic use dating back to only 2008. We have utilized the term based on the definition: Gamification is the use of game design elements in non-game contexts [2].
Campaign Content
After processes of idea generation based on the baseline below, we created and produced a gamified campaign package. The aim of the campaign is to detect significant health issues earlier by changing health-seeking behaviour among men. We believe that behavioural change requires a light and fun approach instead of a raised finger as we have seen so often seen with health campaigns. We target this with a gamified approach to campaign design.
The campaign package contains brochures with integrated conversations starter cards, instructions for a new card game called Early Detection Game , design of a deck of cards including facts, quotes and conversation starters about men’s health. Making the campaign buzz, we designed and produced rolls of toilet paper with the phrase “How is your prostate today?”.
The brochures and toilet paper were distributed with corona-safe distance to happy receivers on the street! The decks of cards were distributed at bars, sports clubs and other places where men often hang out together.
Baseline for the campaign
Via empirical research as well as reading peer-reviewed research we recognized that gendered inequality in health seeking behaviour exists. In the following, we present a baseline which has functioned as a research-based foundation for the campaign we made.
Trend in researching men’s health in the millennium shift - a faded frontier?
The millennium shift indicated an increased research-wise focus on men and symptoms from age-related decline in physical and mental wellbeing. Especially it influences on quality of life. Men’s health was coined a “new frontier” in western research, and it was highly recommended that boundaries should be broken between research, practice and policy [3]. However, despite 20 years of a “new frontier” emerging, gendered inequality in help-seeking behaviour still exists widely across western countries. This is present across a variety of health care- and welfare systems.
In the following the conjunctions and differences between prostate cancer symptoms and therapy side effects and andropause is presented. Having a profound knowledge of bodily conditions as a foundation can arm men with taking the best decisions before and if facing a diagnosis of e.g. prostate cancer.
How side effects from men in therapy for prostate cancer and andropause coincide
Andropause is a term covering age-related decline in the feeling of mental and physical wellbeing amongst men. Menopause is the term covering a similar process in women. Symptoms of andropause involve diminished libido, decreased generalized feeling of wellbeing, hot flashes, cognitive decline and reduced physical function. These symptoms are greatly enhanced in men under (hormonal ablation) therapy for prostate cancer but are also present in men having undiagnosed prostate cancer [1]. It is said that andropause is typically starting from the age of 45 but is on-set from 60 years old. These changes do not only exist inside the body but also affects one’s relational and occupational circumstances.
Two different studies in a time span of 16 years throw light on men’s mental wellbeing in different courses of prostate cancer treatment. In one study from 2003, a group of men was asked about how they perceive their quality of life. This was asked before their prostate cancer treatment. Six months later the same questions were asked. The answers were quite the same indicating that e.g. low sexual interest and a feeling of physical decline was somewhat non-related to the progress of the therapy process. The study suggests that before the treatment, the general feeling of wellbeing among the men was already low [1].
A later study from 2019 showed that men undergoing radical prostatectomy due to prostate cancer have a greater risk to develop depression afterwards [4]. Both studies, relating to prostate cancer, recommend that more awareness towards men’s physical and mental wellbeing, in general, is needed as a foundation. Especially for individuals to make the best treatment decisions if facing a prostate cancer diagnosis. In the following, we take a deeper look into which structures can be contributors to the awareness/behavioural issues identified.
An expectation of independence and hegemonic masculinity as reasons for inequality in gender and health
The above-mentioned side effects of prostate cancer therapy and andropause can have a vast impact on social life. At the same time, studies show that it is the construction of social norms that contribute to this avoidant help-seeking behaviour.
An indirect influence on social capabilities is the feeling of lacking independence. A marker of successful ageing comes with the ability to maintain independence, which often leads to notions such as “I should be able to handle this on my own” [5]. Consequentially this can lead to a risky or reluctant attitude towards seeking help. Such hegemonic construction fosters a culture of self-reliance. If the man is only to rely on himself, how can he reach out if in need of help? This is obviously putting it on the edge, but it shows us where the issue can be approached.
The study conducted by Smith et al. in 2007, displays that men typically favour being in control and being independent as long as possible when experiencing symptoms of some sort. Simultaneous, a resistance to rely on others was also expressed, as it was common not wanting to be a burden to others (be it society or individuals). Being a burden not only in the specific moment of booking a consultation at a general medical practitioner but also in the prospect of possible compliances with a serious diagnosis [5]. Additionally, great unwillingness to consult the doctor with “minor problems” is avoided, because it is considered a weakness to masculinity [6]. On the other hand, there is a greater tendency to consulting the doctor if there are obvious injuries at the place [6]. These are observations we also made independently in our End user interview
What the above-mentioned studies have in common is, that interest in subtle bodily changes can come across as a feminine practice. This can then cause neglect of bodily changes among men. Findings also display the willingness to consult, if men earlier have been diagnosed with severe illness or are currently enrolled in regular check-ups due to other diagnoses [6]. We wish to spread awareness and contribute to make it a common practice for men to be aware and act on even mild symptoms.
Breaking the boundary between research and cultural practice
Looking at the above-mentioned studies shows the many-fold reasons why men in general can be reluctant to consult a medical practitioner. Widespread and thorough reading of studies also shows that findings contradict from time to time. It is though recurrent in most studies we came across, that men, in general, tend to act less if experiencing a mental or physical decline in well-being. At the beginning of this baseline it was mentioned that dedicated research, policy and practice is needed in order to address the problem of men’s help-seeking behaviour. In this part of our project, we chose to address the problem through a cultural practical approach with gamification strategies in order to break the boundary between research and practice. Such a strategy addresses the problem with a light, playful and subtle approach fostering the feeling of independence and eliminating the raised finger in health campaigns. Ultimately, we aim our campaign strategy towards engaging men in the discussion and awareness around their own health.
Disclaimer
We recognize that the mentioned attitudes towards help-seeking differ from individual to individual and especially from culture to culture. One solution does not fit all. By choosing a strategy such as gamification a space for playfulness can unlock. The socio-cultural intervention is aimed to be published in Denmark but maybe down- or upscaled to fit other countries as well. Additionally, we recognize that the presented research and practice is coming from a western point of view and may differ in other parts of the world.
References
[2] Deterding S, Khaled R, Nacke LE, Dixon D. Gamification: Toward a definition. CHI 2011 gamification workshop proceedings; 2011 May 7; Vancouver BC, Canada. 2011.
[3] Smith JA, Robertson S. Men’s health promotion: a new frontier in Australia and the UK? Health Promot. Int. 2008 Jul 1;23(3):283-289.
[4] Friberg AS, Dalton SO, Larsen SB, Andersen EW, Krøyer A, Helgstrand JT, Røder MA, Johansen C, Brasso K. Risk of Depression After Radical Prostatectomy—A Nationwide Registry-based Study. Eur. Urol. Oncol. 2019 Jul 20. Available from: https://doi.org/10.1016/j.euo.2019.06.020.
[5] Smith JA, Braunack-Mayer A, Wittert G, Warin M. “I’ve been independent for so damn long!”: Independence, masculinity and aging in a help seeking context. J. Aging Stud. 2007 Jul 27;21(4):325-335.
[6] O’Brien R, Hunt K, Hart G. ‘It’s caveman stuff, but that is to a certain extent how guys still operate’: men’s accounts of masculinity and help seeking. Soc. Sci. Med. 2005 Feb 16;61:503-516.
