The challenge and impact of engaging hard-to-reach populations in regular physical activity and health behaviours: an examination of an English Premier League ‘Football in the Community’ men's health programme

Investigating inequalities in men's health: a literature review

As part of a project to review the delivery of healthcare services in Torbay and South Devon, England, the author undertook a literature review focusing on the specialty of men's health. Men have a shorter life expectancy than women and this discrepancy is particularly pronounced in areas of social deprivation such as those found in the coastal and rural communities of the author's locality. The concept of men's health is complex, and this literature review identified five main themes that can have a significant influence on the delivery of healthcare services for men: masculinity, ethnicity, mental health, relevance of place, and access to services. In this article, the author discusses these themes and considers approaches that could be used to improve the provision of men's healthcare.

Reduction in Substance-Related Composite Harm Scores Through Street Soccer

Introduction Street soccer makes the sport accessible to people affected by homelessness or precarious housing. There is overwhelming evidence that exercise improves physical and mental health. In addition, sport facilitates positive peer pressure that leads to beneficial life changes. Method To examine participants' accounts of the effects of street soccer in a sample of socially disadvantaged players from Western Canada, we collected 73 cross-sectional self-reports of life changes via a questionnaire. The questionnaire included questions on social, mental, and physical health, including substance use. This allowed the calculation of a modified composite harm score. Results Participants reported improved physical (46% of participants) and mental (43% of participants) health, reduced cigarette (50% of smokers), alcohol (45% of users), cannabis (42% of users), and other non-prescribed drug use, increased number of friends (88% of participants), improved housing (60% of participants), increased income (19% of participants), increased community medical supports (40% of participants), and decreased conflicts with police (47% of those with prior recent conflict). Perceived reductions in substance use were supported by significant changes in composite harm score. Conclusion Street soccer appears to promote improved physical, mental, and social health among people affected by homelessness or precarious housing, with reduction in substance use likely to be a key factor. This work builds upon past qualitative research showing the benefits of street soccer and supports future research which may help elucidate the mechanisms by which street soccer has beneficial effects.

Evaluating physical activity interventions for socioeconomically disadvantaged adults through the RE-AIM framework: A systematic review of experimental and non–/quasi-experimental trials

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The review evaluated internal and external validity using the rE-AIM Framework.

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Results indicate an overall low reporting of validity factors.

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Information on adoption and maintenance was particularly low.

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Future studies should improve the reporting across all rE-AIM dimensions.

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Future studies should consider adaptations during the implementation phase.

The promotion of physical activity in people from lower social strata is a public health priority. Previous reviews of physical activity interventions among socioeconomically disadvantaged adults have focused on intervention effectiveness without considering their translation into practice. This review utilised the RE-AIM framework (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) to (1) evaluate the extent to which experimental and non–/quasi-experimental trials of interventions to promote physical activity among socioeconomically disadvantaged adults report on issues of internal and external validity and (2) to provide recommendations for future intervention studies.

Four databases were searched through June 2021. We included studies published in English or German since 2000 that tested physical activity interventions for socioeconomically disadvantaged adults. Two researchers coded all studies using a validated RE-AIM data extraction tool with 61 indicators referring to internal and external validity. Binary coding (yes = 1/no = 0) was applied to calculate the number and percentage of studies reporting each of the indicators.

We included 39 studies of which 22 were non–/quasi-experimental trials. Indicators of reach were most frequently reported (59.2%), followed by implementation (38.9%) and efficacy/effectiveness (28.9%). Dimensions related to external validity were least frequently reported (adoption: 21.9%, maintenance: 17.8%). Few differences were found between experimental and non–/quasi-experimental trials.

Analysis showed overall poor reporting of components related to internal and external validity. We recommend that future research should increase attention on reporting indicators of internal and external validity to facilitate their translation and implementation into real world settings.

Trial registration: The review was registered with PROSPERO (CRD42021283688).

Investigating the delivery of health improvement interventions through professional football club community trusts-strengths and challenges

Objectives

This study audits health improvement provision delivered in/by English professional Football Club Community Trusts and reports the strengths and challenges around the implementation of interventions.

Study design

Multi-methods design: Data were collected through (i) a review of trust websites (n ​= ​72), (ii) an online survey (n ​= ​34/47.2%) and (iii) semi-structured interviews (n ​= ​11/32.3%) with a sub-sample of trust managers.

Results

The review of websites confirms all trusts provided physical activity-led interventions. The online survey showed most managers were male (n ​= ​23/67.7%) and white British (n ​= ​30/88.2%). Two thirds held management roles, (n ​= ​23/67.6%) and represented Championship (n ​= ​12/35.2%), League 1 (n ​= ​13/38.2%) and League 2 clubs (n ​= ​9/26.5%). Trusts provided physical activity and most provided diet (n ​= ​31/91.2%) as well as smoking (n ​= ​20/58.8%) and alcohol (n ​= ​19/55.9%) interventions. Weight management, (n ​= ​25/73.5%), mental health interventions (n ​= ​28/82.4%) were offered. Trusts provided male-specific (n ​= ​20/58.8%), with fewer providing female-specific interventions (n ​= ​15/44.1%). Most trusts (n ​= ​30/88.2%) evaluated interventions. 80.8% (n ​= ​21/26) used public health guidance for programme design, 69.2% (n ​= ​18/26) delivery, 57.7% (n ​= ​15/26) needs assessment and 50% (n ​= ​13/26) evaluation. Interviews and qualitative reports identified strengths including, using football, the ‘club brand’, ‘meeting health needs’ and ‘working as a strategic collaboration with partners’. Challenges included ‘short-term funding staffing, mainstreaming, and evaluating interventions’.

Conclusion

Football Community Trusts deliver interventions, but challenges were encountered when implementing these programmes.

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Football club community trusts provide important physical activity and health interventions.

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Trusts encounter several challenges when implementing health interventions.

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Challenges include sustaining interventions, funding and adopting public health guidance.

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Trusts do not always view public health guidance as useful.

Experiences of outdoor nature-based therapeutic recreation programs for persons with a mental illness: a qualitative systematic review

OBJECTIVE

The objective of this review was to identify, appraise, and synthesize the best available evidence related to participation in outdoor nature-based therapeutic recreation programs for adults with a mental illness living in the community.

INTRODUCTION

Therapeutic recreation is posited to be beneficial for persons living with a mental illness. Research evidence indicates that therapeutic recreation programs can foster mental health recovery. It is important to understand the effectiveness of this from the perspective of persons living with mental illness how outdoor nature-based therapeutic recreation programs are meaningful and helpful for recovery.

INCLUSION CRITERIA

This review considered studies that collected qualitative data on the experiences and perspectives of adults with a mental illness regarding their participation in outdoor nature-based therapeutic recreation programs.

METHODS

The databases PsycINFO, CINAHL, MEDLINE, Scopus, and Informit, as well as unpublished sources in gray literature (Google Scholar, OpenGrey), were searched and reference lists were checked to locate any additional studies. Studies published in English were considered, with a date range from inception to 2019. Three reviewers independently assessed the methodological quality of the studies that met the inclusion criteria using the JBI critical appraisal approach for qualitative research. Data were extracted by one reviewer using the standardized qualitative extraction tool and checked for accuracy by three other reviewers. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings, and a level of confidence was assigned to both synthesized findings.

RESULTS

Eighteen papers met the inclusion criteria and were included in the data extraction phase. A total of 84 findings were extracted and aggregated into six categories based on similarity of meaning and two synthesized findings. The methodological quality of the studies varied, and the overall level of confidence of the synthesized findings was determined to be moderate.

CONCLUSIONS

This review identified that persons living with mental illness perceive outdoor nature-based therapeutic recreation as enjoyable and that therapeutic recreation makes a positive contribution to mental health. Congruent with the literature, therapeutic recreation offers a socially inclusive and psychologically safe environment. The intentionally structured social milieu enhances the formation of social relationships and meaningful connections for persons with mental illness. Elements linked with psychological well-being, such as intrinsic motivation, overcoming perceived challenges, and finding purpose and meaning, are enhanced through participation in therapeutic recreation in outdoor nature-based settings. Increased levels of physical activity, greater self-esteem, and enhanced sense of identity were some of the perceived positive changes. This review provides important insights into the subjective needs of persons with mental illness who undertake therapeutic recreation in outdoor nature-based settings. The qualitative findings can inform health care providers, or those interested in therapeutic recreation programming, to use alongside quantitative evidence of effectiveness to design nature-based therapeutic recreation activities that are meaningful for persons with mental illness. Limitations of the research were that papers published in languages other than English were not searched, and papers not located may have influenced the findings of this review.

Study protocol: evaluation of sheds for life (SFL): a community-based men's health initiative designed "for shedders by shedders" in Irish Men's sheds using a hybrid effectiveness-implementation design

Background

Men’s Sheds (“Sheds”) offer a unique opportunity to reach a captive audience of “hard-to-reach” men. However, attempts to engage Sheds in structured health promotion programmes must respect the ethos of Sheds as highly variable, autonomous, non-structured spaces. This paper captures the key methodologies used in “Sheds for Life’ (SFL), a men’s health initiative tailored to the Shed setting.

Methods

A hybrid effectiveness-implementation study design is used to test effectiveness and implementation outcomes across multiple levels (participant, provider, organisational and systems levels). A dynamic, iterative and collaborative process seeks to address barriers and translation into the real world context. Using a community-based participatory research approach and guided by established implementation frameworks, Shed members (‘Shedders’) assume the role of key decision makers throughout the evaluation process to promote the systematic uptake of SFL across Shed settings. The protocols pertaining to the development, design and implementation of SFL and the evaluation of impact on participants’ health and wellbeing outcomes up to 12 months are outlined.

Conclusions

There is a dynamic interplay between the intervention characteristics of SFL and the need to assess and understand the diverse contexts of Sheds and the wider implementation environment. A pragmatic and context-specific design is therefore favoured over a tightly controlled efficacy trial. Documenting the protocols used to evaluate and implement a complex multi-level co-developed intervention such as SFL helps to inform gender-specific, community-based men’s health promotion and translational research more broadly.

Trial registration

This study has been retrospectively registered with the ‘International Standard Randomised Controlled Trial Number’ registry (ISRCTN79921361) as of the 5th of March 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10823-8.

Reasons for (not) participating in a community-based health promotion program for low-income multi-problem households in the Netherlands: A qualitative study

People living in low-income multi-problem households may benefit from participation in a community-based health promotion program. Yet, low participation rates are often a problem. It is important to assess reasons for (not) participating to better tailor programs to the needs of this particular at-risk group. Back2Balance is a health promotion program for low-income multi-problem households from Apeldoorn, the Netherlands. We performed qualitative interviews among participants (n = 16) and non-participants (n = 12) of the program and asked them for their reasons for (not) participating in the program. Interview transcripts were thematically analysed using the Framework method. Participants indicated that reasons for participating encompassed intrapersonal motivators (e.g. to become healthier), interpersonal motivators (e.g. participating to get to know new people) and program level motivators (e.g. learning about a healthy lifestyle, and free or very low cost). Participants and non-participants outlined the importance of intrapersonal barriers (e.g. physical health problems), interpersonal barriers (e.g. family circumstances) and program level barriers (e.g. logistic issues, and not understanding or knowing about some part of the program). Concluding, combining health promotion with social interaction motivated participants to participate in the Back2Balance program. Yet, both participants and non-participants experienced many barriers for participation, some of which were related to their multi-problem situation.

'When you have the adrenalin pumping, it kind of flushes out any negative emotions': a qualitative exploration of the benefits of playing football for people with mental health difficulties

BACKGROUND

Physical activity is a factor by which mental health can be improved. However, the association between mental health and physical exercise, in a "team-based sport" setting within the community, remains unclear.

AIMS

The current paper aims to provide an evaluation of a football programme, implemented by Time to Change Wales, funded by the Welsh Government, to improve mental health.

METHODS

Participants attended weekly 90-120 minute football sessions, held in local community venues across Wales, UK, with no requirement on the number of sessions that participants had to attend. A qualitative method was employed to explore the experiences of those who took part.

RESULTS

Individuals who participated in the programme reported psychosocial and physical benefits, such as improved physical and mental health, improved social confidence and having a sense of purpose added to their day-to-day living. Factors affecting participation were also identified within the data, such as environmental barriers. Conclusion: The findings provide both support and contextual extension to previous research in this area; demonstrating the positive effects of sport-based therapy for those with mental health difficulties. Implications and conclusions should be used to inform future research into developing community sport-based programmes to improve mental health.

The Physiological, Physical, and Biomechanical Demands of Walking Football: Implications for Exercise Prescription and Future Research in Older Adults

The aim of this investigation was to profile the physiological, physical, and biomechanical responses during walking football. A total of 17 male participants (aged 66 ± 6 years) participated. Heart rate; blood lactate; accelerometer variables (biomechanical load [PlayerLoad™], changes of direction); and rating of perceived exertion were measured. Participants mean percentage of maximum heart rate was 76 ± 6% during the sessions, with rating of perceived exertion across all sessions at 13 ± 2. Blood lactate increased by ∼157% from presession (1.24 ± 0.4 mmol/L) to postsession (3.19 ± 1.7 mmol/L; p ≤ .0005). PlayerLoad™ values of 353 ± 67 arbitrary units were observed, as well as ∼100 changes of direction per session. In conclusion, walking football is a moderate- to vigorous-intensity activity. The longitudinal health benefits of walking football remain to be elucidated, particularly on bone health, cardiovascular fitness, and social and mental well-being.

Western Bulldogs Sons of the West Program ripple effects: building community capacity

Professional sporting organisations can provide lifestyle-based community health improvement programs. Since 2014, the Western Bulldogs Australian Football League Club, through its Western Bulldogs Community Foundation (WBCF), has invested with community partners in the Sons of the West (SOTW) Program, a 10-week program targeted at hard-to-reach men aged ≥18 years living in Victoria's West. The SOTW Program aims to increase its participants' physical activity, social connectedness and overall health. Evaluations by the WBCF revealed the SOTW is positively contributing to improved healthier lifestyles and health of participants. Anecdotal reports revealed the SOTW was creating ripples far beyond the Program's expectations. In 2016-17, the WBCF funded the University of Melbourne to evaluate the SOTW Program ripple effects. An adapted 'Ripple Effect Mapping' approach was used, including 13 focus group discussions with 100 SOTW participants. The SOTW Program is improving men's social connections, health promoting behaviours, health literacy and creating ripple effects including: local community participation; increased volunteerism; enhanced reciprocity; and increased leadership. Community capacity-building frameworks can explain the SOTW Program ripple effects. Professional sporting organisations can provide lifestyle-based health improvement programs and empower men to contribute to building community capacity.

Postprandial lipaemia 10 and 34 hours after playing football: Does playing frequency affect the response?

Elevated postprandial triglyceride (TG) is associated with increased risk of cardiovascular disease. The time window for the last bout beneficial effect on postprandial lipaemia after football play is unknown. The aim of the present study was to examine whether playing affects postprandial TG during 1.5 day of reduced activity. Eighteen males were randomly allocated to perform either 1 (1FOOT; n = 9; age = 33.0 ± 5.0 yrs; body mass index = 24.2 ± 3.6 kg/m²) or 3 (3FOOT) consecutive days of 60-min 5 vs 5 football (n = 9; age = 32.8 ± 5.2 yrs; body mass index = 26.2 ± 4.1 kg/m²) matches across a 5-day study period. They arrived to the laboratory 10 hrs and 34 hrs after the final football session and blood samples were collected at fasted (0 min) and 45, 90, 240 and 360 min post a high fat load meal. There were non significant increase for postprandial TG AUC (9.1%; p = 0.17; 95%CI = -0.43 to 2.0; ES = -0.23) and iAUC (14.2%; p = 0.43; 95%CI = -0.92 to 1.9; ES = -0.24) between 10 and 34 hrs after the 1FOOT. For the 3FOOT, there was a non significant decrease in postprandial TG AUC (-2.7%; p = 0.73; 95%CI = -2.0 to 1.5; ES = 0.05) and iAUC (-17.5%; p = 0.41; 95%ci = -2.5 to 1.1; ES = 0.31) from 10 to 34 hrs, respectively. Performing three consecutive days of football exercise may offer no greater protective effect for postprandial TG before a period of reduced activity, compared to a single session.

Exploring the Effectiveness of an Integrated Mixed Martial Arts and Psychotherapy Intervention for Young Men's Mental Health

This research sought to establish the impact of a 10-week program combining mixed martial arts (MMA) and one-to-one psychotherapy on young males’ mental health and determine factors that predict help-seeking behavior in at-risk males. Preparticipation and post-participation interviews were employed as the method of data collection. Seven males (20–35 years; M = 24.57) completed preparticipation interviews and five completed follow-up interviews. Thematic analysis of preparticipation revealed that help-seeking behavior in at-risk males is impeded by the presence of male gender stereotypes, the absence of positive role models, as well as difficulty navigating challenging social landscapes. Post-participation interviews revealed that the sport provided structure and fitness for at-risk males, while the counseling was pivotal for personal growth. Improved relationships, work life, and self-esteem were also observed. The sporting element of the program helped to reduce stigma associated with engaging in psychotherapy, and positive male relationships were noted as particularly impactful. Findings support previous research indicating that combining sports and psychotherapy positively impacts young males’ mental health. Sport provides an acceptable doorway to psychotherapy, providing space to explore personal issues.