Author Michelle Hunt, BA, RGN, Advanced Professional Diploma in Continence Care, is clinical nurse specialist continence, Berkshire East PCT, St Mark’s Hospital, Maidenhead.
Abstract Hunt, M. (2008) The benefits of a male patient focus group. Nursing Times; 104: 13, 72–74.
Michelle Hunt describes the development and benefits of a male patient focus group.
One of the challenges for continence services is to actively involve consumers and carers in planning services (Department of Health, 2003; 2001; 2000a; 2000b; White and Getliffe, 2003). There appears to be a wealth of information and examples of patient focus groups for areas such as cancer services. However, there are few in continence care.
At the Berkshire East PCT Continence Advisory Service, patients had been invited to a stakeholder meeting to develop an integrated pathway across primary and secondary care for male patients with lower urinary tract symptoms. However, many were from a specific patient group, for example, they had prostate cancer. Some had continence problems but associated themselves with people who had prostate problems rather than being part of a group with continence problems.
Setting up a continence focus group
The user group was a joint initiative organised with our continence product supplier. We were very aware that our service had a female focus and the majority of our patients were female. We wanted to obtain feedback and opinions from men about:
How accessible our service was and how it could be improved for male users;
Planned service developments and gain their feedback on these;
Continence pads for men, including styles, marketing ideas and how they obtained products – whether this was through NHS services or purchased from retail outlets.
Patients were selected from our specialist continence clinic and home delivery service databases. The selection criteria is listed in Box 1.
Letters were sent to 35 patients inviting them to a session lasting two hours at a local hotel. Sixteen patients responded and 12 agreed to attend. On the day, 11 patients attended.
Outcomes of the group
To encourage openness at the meeting, ground rules were agreed by all participants. To our surprise, patients openly discussed all aspects of their treatment and incontinence. Five themes emerged from the focus group (Box 2).
The men felt that male patients could benefit from more highly absorbent products designed specifically for men.
Disposal of the products was a problem for male users, particularly when using pads for moderate to heavy incontinence. There are no disposal units in male toilets, and while units are available in unisex toilets, it is difficult to fit a large pad into the container.
Issues were also raised about the location of products in shops. Men had no idea where to look for them and felt that it was inappropriate for them to be within the feminine hygiene section.
Products that could be disposed of in a compost bin were highlighted as a potential area for development.
The group said that once they had reached the continence advisory service, the service and level of treatment was excellent. However, patients who had surgery and then became incontinent felt that they were initially unsupported and that there were no channels of communication between the acute sector and primary care.
They felt that they were not given advice or information about how to manage their problem or where to access further treatment. Some patients felt that prior to surgery they were given a huge amount of information, while what they required was a steady flow of advice and support throughout the course of their treatment.
Patients who had not had surgery had difficulties finding the continence advisory service. This depended very much on the advice and signposting they received from their GP.
Feelings about incontinence
Patients who had had surgery which resulted in incontinence expressed feelings of anger. They felt the risks of becoming incontinent were much higher than they were told and that they had been abandoned by the hospital following discharge.
The group suggested that men do not talk openly about their incontinence so they did not know how to obtain help.
Participants felt that the freedom they had previously had in their lives had gone as they planned their life around where toilets are and were conscious of wearing dark clothing to prevent any ‘leaks’ showing.
Only three of the group used the internet to find information. Others found information from their GP or pharmacist. Information provided varied in usefulness and not all GPs and pharmacists provided information about available services available or signposted them in the right direction to receive treatment and advice.
The group felt that there should be information in continence pad packaging outlining where to go for help. They also suggested a ‘starter pack’ of information and products be issued on discharge from hospital.
It was felt that most marketing of continence products was focused on women so new information leaflets and commercials needed to be focused on men.
The men felt that products are designed for women and that they would like to see future development focused on men.
Men experience specific problems when using continence products, for example around product disposal. The focus group has provided essential information for future product design, product disposal and marketing.
As a result of the ideas expressed by the group, the product manufacturer is developing a starter pack for men experiencing incontinence following surgery, to be issued on discharge.
This will include information on where to find help as well as how products can be purchased.
Although the patients felt the service from the continence advisory service was good, channels of communication between primary and secondary care needed to be improved. There is a need to continually raise awareness of the service with other healthcare staff to ensure they point patients with continence problems in the right direction.
The experiences of this group are being shared with secondary care to facilitate closer working. Mailshots to raise awareness of our service are planned, particularly among GPs and pharmacists.
The focus group shared its views on where men look for information. They suggested advertising the services in order to raise awareness, for example in the sports page of local newspapers.
We now have essential information about how to target men successfully. As a team we hope to use this information during events such as Continence Awareness week.
Evaluation and conclusion
The focus group was sent evaluation forms to find out whether they felt there was a benefit in attending from a patient’s perspective. The group was considered a success. Only one person felt it was not beneficial – the rest found it useful, enjoyed the opportunity to give opinions on services and said they would take part in future meetings.
The participants found the group useful for peer support as well as to find out more about products and services. They suggested that the session should have been longer than two hours.
Patients who attended the focus group had all been seen in clinic and knowing staff from the department may have influenced their decision to attend. This may have created a higher response rate than would normally be expected. There was also a high number of patients who had previous prostate surgery and in future a more balanced mix of patients with different conditions could produce different responses. n
Box 1. Selection criteria
Box 2. Focus group themes
Promoting Continence: A Clinical and Research Resource. London: Baillière Tindall.
Department of Health (2003) Essence of Care: Patient-focused Benchmarks for Clinical Governance. London: DH.
Department of Health (2001) Health and Social Care Act. London: DH.
Department of Health (2000a) The NHS Plan: A Plan for Investment, A Plan for Reform. London: DH.
Department of Health (2000b) Good Practice in Continence Services. London: DH.
White, H., Getliffe K. (2003) Incontinence in perspective. In: Getliffe, K., Dolman, M. (eds)
This work with supported by SCA Hygiene Ltd who funded the venue and refreshments so that this event could take place.