Men's Perspectives of a Gender-Sensitized Health Promotion Program Targeting Healthy Eating, Active Living, and Social Connectedness

Gender-sensitive community weight-loss programmes to address overweight and obesity in men: a scoping review

OBJECTIVES

To examine how gender-sensitive community weight-loss programmes have been used to address overweight and obesity in men and to identify what can be learnt from this rapidly evolving field.

DESIGN

Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist for reporting.

DATA SOURCES

A database search was conducted using EBSCOhost (Academic Search Complete, CINAHL Complete, Global Health, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition and Medline Complete), Google, Google Scholar, Open Access Theses and Dissertations platform and Scopus.

ELIGIBILITY CRITERIA

All weight-loss programmes using a gender-sensitive approach to address men's overweight and obesity in community settings.

DATA EXTRACTION AND SYNTHESIS

Narrative synthesis was conducted based on the research questions and objectives. Primary outcomes include operationalisation, context and concept of the gender-sensitive approach. Information was reviewed and extracted to Microsoft Excel by two reviewers.

RESULTS

A total of 40 studies (28 quantitative, eight mixed methods and four qualitative) were identified from 4617 records. Gender-sensitive approaches were undertaken in a range of settings and contexts including professional sports clubs (n=21), non-professional sporting clubs (n=16), workplace-based (n=2) and commercial organisation-based (n=1). The most common analysis approaches were evaluating the effect of the programmes (n=31) where positive impact was predominantly shown (eg, up to 3.9 kg weight reduction at 3-month follow-up). Programmes (ie, Football Fans in Training) were short-term cost-effective (eg, the cost was £862-£2228 per 5% weight reduction at 12-month follow-up). Qualitative evidence highlights factors that influenced men's participation (eg, camaraderie) and identifies areas for improvement.

CONCLUSION

The findings demonstrate that gender-sensitive programmes for men's weight loss have been effectively applied using a range of different approaches and in a range of different contexts. Further evidence is needed to confirm the effectiveness of the programmes across diverse groups of men.

Influences on clinical trial participation: Enhancing recruitment through a gender lens - A scoping review

Background

Suboptimal clinical trial recruitment contributes to research waste. Evidence suggests there may be gender-based differences in willingness to participate in clinical research. Identifying gender-based differences impacting the willingness of trial participation may assist trial recruitment.

Objectives

To examine factors that influence the willingness of men and women to participate in clinical trials and to identify modifiable factors that may be targeted to optimise trial participation.

Material and methods

Electronic databases were searched with key words relating to 'gender', 'willingness to participate' and 'trial'. Included studies were English language and reported gender-based differences in willingness to participate in clinical trials, or factors that influence a single gender to participate in clinical trials. Studies were excluded if they described the demographic factors of trial participants or if the majority of participants were pregnant. Extracted data were coded, categorized, analysed thematically and interpreted using Arksey and O'Malley's framework.

Results

Sixty-three studies were included. Two main themes were identified: trial characteristics and participant characteristics. A number of gender-based differences moderating willingness to participate were observed although only one, 'concern for self' was found to influence actual trial participation rates between genders.

Conclusion

The relationship between factors influencing willingness to participate in clinical trials is complex. The influence of gender on willingness to participate, while important, may be moderated by other factors including socioeconomic status, ethnicity and health condition. Exploring factors that influence willingness to participate specific to a study cohort likely offers the most promise to optimise trial recruitment of that cohort.

Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

INTRODUCTION

Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community's needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts.

METHODS

The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria.

RESULTS

Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised.

DISCUSSION

CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.

The utility of nostalgia for unhealthy populations: A systematic review and narrative analysis

Nostalgic reverie (i.e. sentimental longing) has received increased attention as a predictor of health and well-being, but only a handful of reviews have summarized this literature. The available reviews (Dementia: The International Journal of Social Research and Practice, 19, 2020, 330; Intimations of nostalgia: Multidisciplinary explorations of an enduring emotion, Bristol University Press, 2022) left a critical gap in explicating the function of nostalgia among people engaged in unhealthy behaviour. In the current systematic review and narrative analysis, we sought to answer whether and under what conditions emotion serves to help or hinder people engaged in unhealthy behaviours in terms of taking action to change. We identified 14 studies and categorized them into two themes. In Theme I, nostalgising about a time in one's life when one was healthier motivated both readiness to change and action to change unhealthy behaviour. In Theme II, nostalgizing about the perceived benefits of engaging in unhealthy behaviour (e.g. social connectedness related to drinking) was associated with the continuance or acceleration of the unhealthy behaviour. This review highlights not only the presence of a link between nostalgia and unhealthy behaviour but also that the content of one's nostalgising matters for understanding whether the unhealthy behaviour is undermined or bolstered.

Lessons Learned From a Community-Based Men's Health Fair

INTRODUCTION

Strategies are needed to promote the uptake of preventive health services among Black, Hispanic, and rural men because these men underutilize health services. Previous research indicates that men prefer community-based health promotion programming, such as health fairs; however, specific guidance on how to tailor health fairs for Black, Hispanic, and rural men are lacking. The present seeks to study provides that guidance.

METHODS

A multisectoral team developed, implemented, and evaluated a men's health fair in a county of South Carolina with a sizeable Black, Hispanic, and rural-dwelling population. Although the health fair was open to all men in the county, specific outreach campaigns were implemented to attract Black and Hispanic men. The health fair occurred on Father's Day weekend in 2023 and consisted of health screenings, health information, and other resources (eg, condoms, research studies). Participants who attended the health fair were asked to complete a check-in survey (N = 103) that assessed demographic information and how they heard about the health fair, followed by a survey (N = 58) that assessed facilitators/barriers to participation in a men's health fair.

RESULTS

Results were stratified by the gender of respondent. The results highlight the facilitators/barriers experienced by men to attending health fairs and also highlight important differences in facilitators/barriers for men to attend a health fair as perceived by men and women.

CONCLUSIONS

These findings have implications for the design and implementation of future men's health fairs to promote preventive health service use among Black, Hispanic, and rural men.

Older Mens' Experiences with and Preferences for Physical Activity

We aim to describe older mens' experiences with physical activity (PA) and their preferences for PA programs. We interviewed 14 men from a Canada-based PA intervention study called Men on the Move, and 5 men from a supplementary sample (who were not intervention participants). Content analysis was used to describe their experiences with PA and program preferences. The socio-ecological perspective and the hegemonic masculinity framework guided the research. PA barriers were low motivation, poor health, lack of time, interests other than PA and a lack of interest in PA, finances, lack of knowledge about PA, injury fear, social influences, inconvenience, weather, caregiving, built/natural environments, low-quality fitness instructors, and program structure. PA facilitators were chores, health, interest, time, motivation, social influences, active transportation, built/natural environments, good weather, program structure, and skilled/knowledgeable fitness instructors. PA program preferences were small group atmosphere, individualized attention/programming, equal number of men and women, sports programming, PA classes, and experienced instructors. Older men have distinct PA experiences. Promoting and designing programs that address their experiences may increase their PA.

Working with men in the context of distressed and disrupted intimate partner relationships: A qualitative study

OBJECTIVE

To describe key considerations for working with men experiencing distressed and disrupted intimate partner relationships.

METHODS

Individual Zoom interviews were conducted with help-seeking men (n = 25) who had experienced an intimate partnership break-up, and health service providers (n = 30) working with men in the relationships space. Interpretive Description methodology was used to generate considerations for working with men in distressed and disrupted relationships.

RESULTS

Three thematic findings were inductively derived; 1) A whole life approach for deconstructing relationships, wherein men engaged in discussions about their broader experiences and circumstances within the context of intimate partnerships; 2) Affirming men's relationship emotions and vulnerabilities as normative and changeable, comprising coaching for embodying transformative masculinities; and 3) Tangible 'to do's' in and after a relationship, outlining men's present and prospective self-work with action-oriented strategies.

CONCLUSION

Strategies tailored to men's receptivity and needs can increase connection with professional services and providers to bolster the mental health of men in and after disrupted intimate partner relationships.

PRACTICE IMPLICATIONS

With men increasingly accessing professional mental health services, the present study offers key considerations and recommendations regarding assessment, communication, and treatment for health service providers working with men in the relationships space.

Social support buffers young men's resilient coping to psychological distress

AIM

Social support and resilient coping can aid mental health. The aim of this study was to examine age effects of social support on men's resilient coping for psychological distress.

METHODS

The sample consisted of 434 help-seeking Canadian men who completed standardized measures. Regression analyses tested a moderated moderation model, controlling for COVID-19 pandemic impact.

RESULTS

Greater resilient coping was associated with lower psychological distress and this relationship was moderated by social support. Higher levels of social support had a significant positive effect on men's resilient coping for psychological distress. Findings indicated that younger men (18-24 years) were most positively buffered by social support.

CONCLUSIONS

Social support appears to be particularly important for young men's coping response to psychological distress. This is an important finding in the context of the COVID-19 pandemic, where social support networks have been challenged. Community-based and clinical programs and initiatives that proactively target young men's development of social connections and robust supportive networks, while bolstering their individual resilient coping skills, are likely to provide protections from psychological distress.

Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review

The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-022-04017-7.

‘Sheds for Life’: delivering a gender-transformative approach to health promotion in Men’s Sheds

Research has highlighted the importance of gendered approaches to engage men with health. Sheds for Life (SFL) is a health and wellbeing initiative that utilizes evidence-based and gender-specific approaches to engage hard to reach men with health promotion directly in the Men’s Sheds (Sheds) setting. To understand the impact of SFL and how participants (Shedders) experienced SFL in practice, this qualitative study applied a framework of constructivism and aimed to explore how gendered approaches impacted engagement with SFL through Shedder’s own accounts of their attitudes, opinions and experiences. Qualitative methods incorporating ethnographical observations, focus groups (n = 8) and short semi-structured interviews (n = 19) were conducted with SFL participants in the Shed setting. Reflexive thematic analysis was used to analyse the data to faithfully capture Shedders’ experiences while acknowledging the reflexive influence of the researcher. Findings led to three key themes: Creating the ‘right environment’; Normalizing meaningful conversations; a legacy for ‘talking health’ with subthemes of creating safety and trust and strengthening of bonds; and transforming perceptions of how men ‘do health’ with subthemes of reaping the benefits of engaging with health and reframing attitudes towards health. This is first study to capture Shedders’ experiences of a structured health promotion initiative in the Shed setting. Findings highlight the value in utilizing the Shed setting to engage men with health and the importance of gender-specific strategies which encourage a gender-transformative approach to men’s health promotion.

Sheds for life: health and wellbeing outcomes of a tailored community-based health promotion initiative for men’s sheds in Ireland

Background

Gender is increasingly recognised as a critical factor in designing community-based health promotion programmes. Men’s Sheds (‘Sheds’) are community-based informal environments that represent a safe space in which to engage cohorts of hard-to-reach (HTR) men in health promotion. Sheds for Life (SFL), the first structured health promotion initiative evaluated globally in Sheds, is a 10-week initiative co-designed with Shed Members (Shedders) and delivered directly in the Shed setting in Ireland. This research describes the health and wellbeing outcomes experienced by SFL participants.

Methods

Purposive sampling was used to recruit a diverse representation of Shedders (n = 421) participating in SFL alongside a wait list control (n = 86). Questionnaires assessing constructs of health and wellbeing were administered one-to-one in Sheds at baseline, 3, 6 and 12 months. Descriptive data for health outcomes were generated for each time point and assessed for significant changes using inferential testing, while considering COVID-19 impact.

Results

Outcomes related to subjective wellbeing, mental wellbeing, physical activity, social capital and healthy eating significantly increased post SFL (p < 0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly higher than baseline despite COVID-19 impact (p < 0.05). Binary logistic regression indicated that the odds of a meaningful SWEMWBS change was significantly higher for shedders that had lower SWEMWBS (OR 0.804), less loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with lower SWEMBWS had higher odds of experiencing positive changes in life satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had also higher odds of experience positive changes in healthy eating (OR 0.481). Finally, inactive Shedders at baseline had higher odds of experiencing increased levels of physical activity (OR 0.582).

Conclusions

Findings suggest that the inclusive, community-based SFL model is effective in engaging Shedders and facilitating positive and sustained changes in health and wellbeing outcomes. Using gender-specific approaches in the informal and safe environment of the Shed are effective in engaging men in structured health and wellbeing initiatives, particularly those who may be more vulnerable, isolated or lonely.

Trial registration

This study has been retrospectively registered with the ‘International Standard Randomised Controlled Trial Number’ registry (ISRCTN79921361) as of 05/03/2021.

Dietary Behavior and Risk of Orthorexia in Women with Celiac Disease

Evidence points to a link between celiac disease and eating disorders. Although with the current limited knowledge, orthorexia cannot be formally recognized as an eating disorder, some features are similar. This study is the first to examine individuals with celiac disease in terms of the prevalence of risk of orthorexia. Participants were 123 females diagnosed with celiac disease. The standardized ORTO-15 questionnaire was used to assess the risk of orthorexia. In this study, eating habits and physical activity were assessed. The effect of celiac disease on diet was self-assessed on a 5-point scale. Taking a score of 40 on the ORTO-15 test as the cut-off point, a risk of orthorexia was found in 71% of individuals with celiac disease, but only in 32% when the cut-off point was set at 35. There was a positive correlation between age and ORTO-15 test scores (rho = 0.30). In the group with orthorexia risk, meals were more often self-prepared (94%) compared to those without risk of orthorexia (78%) (p = 0.006). Individuals at risk for orthorexia were less likely to pay attention to the caloric content of food (46%) relative to those without risk of orthorexia (69%) (p = 0.001). For 64% of those at risk for orthorexia vs. 8% without risk had the thought of food that worried them (p = 0.001). Given the survey instrument for assessing the prevalence of orthorexia and the overlap between eating behaviors in celiac disease and orthorexia, the prevalence of orthorexia in celiac disease cannot be clearly established. Therefore, future research should focus on using other research tools to confirm the presence of orthorexia in celiac disease.

"People say men don't talk, well that's bullshit": A focus group study exploring challenges and opportunities for men's mental health promotion

Men’s mental health promotion presents unique challenges including gender-related barriers and stigmas, which demand novel approaches to prevention, treatment, and management. The aim of this study was to explore men’s perceptions of mental health and preferences for mental health promotion. Seven focus groups (N = 59) were conducted in Sydney, Australia, including 5 groups of men (M = 50.65, SD = 13.75 years) and 2 groups of stakeholders who had frontline experience working with men (e.g., men’s groups, health clubs, mental health advocates). Data were analysed using thematic analysis and interpreted using a gender relations approach to explore connections between gender roles, relations and identities, and men’s mental health. Three overarching themes were identified; (1) Roles, identities, and the conceptualisation and concealment of mental health challenges, revealing challenges to mental health promotion related to perceptions of men’s restrictive emotionality and emotional awareness as well as difficulties with conceptualising the internalised experiences of mental health, (2) Constraining social contexts of stigma and gender relations, identifying how social context and the policing of gender roles often obscured opportunities for discussing mental health and help-seeking behaviour, (3) Anchoring mental health promotion to acceptable lifestyle practices, highlighting potential remedies included leveraging men’s social practices related to reciprocity, normalising mental health promotion relative to other behaviours, and embedding mental health promotion within acceptable masculine practices. Discussed are directions for men’s community-based mental health promotion and opportunities for how masculinities may be negotiated and expanded to embody mental health promoting values.

Strategies for effective implementation and scale-up of a multi-level co-designed men's health initiative "Sheds for Life" in Irish Men's Sheds

Sheds for Life is a gender-specific tailored men's health initiative engaging "hard-to-reach" men in the Men's Shed setting in Ireland. It is implemented by multiple stakeholders at individual, provider, organization and systems level and thus multiple contextual factors influence its scalability. This research used established implementation science frameworks to guide participatory research approaches that captured the process and identified facilitators of and barriers to implementation and scale-up. Active recruitment, co-design processes, leadership and stakeholder engagement emerged as key facilitators of implementation. Prominent barriers were institutional capacity and funding. Acceptability, adoption and appropriateness of the initiative were high among stakeholders with sustainability largely contingent on funding and staff resources. Findings make a valuable contribution to knowledge by capturing the process involved in the implementation of a complex multi-level men's health intervention. It provides a "how to" guide of strategies to engage hard-to-reach men with health promotion, the operationalization and application of implementation frameworks in community-based health promotion, and the implementation of health promotion in Men's Sheds. Documented barriers and facilitators that impact implementation of a community-based men's health program are rare and provide a valuable blueprint for practitioners, researchers and policy makers in the field.

Factors Influencing Men's Experiences and Engagement with the Rugby Fans in Training-New Zealand Pilot Trial: A Healthy Lifestyle Intervention for Men

Health promotion programs designed specifically to support men to improve their lifestyle behaviours are required to improve men's health. This study explored factors that influenced men's experiences of, and engagement with, the Rugby Fans in Training-New Zealand pilot trial, a professional sport-based healthy lifestyle intervention for overweight men. Thirty-five men (mean age = 45, SD = 10 years) who completed the 12-week intervention participated in one of eight semi-structured focus groups. Using inductive thematic analysis, five themes represented the meanings in the data. First, a group of like-minded men all in the same boat recognised the importance of being in similar life situations and having similar reasons for joining the programme. Second, the men described the importance of the support and motivation provided by the team atmosphere created through the programme. Third, the motivational coach recognised the characteristics, skills and knowledge of the coach delivering the programme which created engagement with it. Fourth, the education sessions were valued for the knowledge gained and underpinning philosophies that guided them. Finally, the involvement of the rugby franchise influenced commitment to the programme and created initial interest. These results provide evidence for the key components that should be incorporated into the future development of and improvement to healthy lifestyle interventions for men.

Can lifestyle interventions improve Canadian men's mental health? Outcomes from the HAT TRICK programme

Engaging men in mental health promotion can be difficult because of reticence about help-seeking, especially for gender neutral programmes. Developments in men's health research has pointed to the success of gender-sensitized programmes to increase men's engagement in healthy lifestyle interventions targeting physical activity and healthy eating; however, less is known about the impact of these interventions on men's mental health. This study explored changes to men's depression risk and health-related quality of life at post-intervention (12 weeks) and 9-month follow-up, after participating in HAT TRICK, a gender-sensitized lifestyle intervention for overweight men. Participants completed validated self-report measures of mental health at baseline, post-intervention (12 weeks) and 9-month follow-up. Men's scores on the Male Depression Risk Scale (MDRS) and the SF-12 questionnaire, including physical health (PH12) and mental health (MH12) composite scores, were analyzed using mixed linear models to assess linear trends. At baseline, men (N = 62) had a mean age of 50.98 (SD = 10.09) years and BMI of 35.87 (SD = 5.51) kg/m2. Results show that both the MDRS and the MH12 showed improvements in participants' mental health, with significant linear trends (p = 0.003; p = 0.003) qualified with significant quadratic trends over time (p = 0.02; p = 0.03). There were no significant changes in the PH12 over time. Gender-sensitized programmes for overweight men, such as HAT TRICK, are a promising approach to positively influence components of men's mental health, with the potential for sustained improvements over the long term.

Using Google Trends and Twitter for Prostate Cancer Awareness: A Comparative Analysis of Prostate Cancer Awareness Month and Breast Cancer Awareness Month

Background

We evaluated (1) whether the public interest in prostate cancer and prostate cancer screening increased following Prostate Cancer Awareness Month (PCAM) and (2) whether PCAM was as effective as Breast Cancer Awareness Month (BCAM) at generating public interest.

Methods 

Using Google Trends, we measured search volume in PCAM and BCAM. We used the search volume in Google Trends as a proxy for changes in public interest from January 01, 2009 to December 31, 2018 worldwide, including the specific keywords: “Prostate Cancer”; “Prostate-Specific Antigen”; “Prostate Cancer Screening”; “Prostate Cancer Management”; “Breast Cancer”; “Breast Cancer Screening”; “Mammography”; and “Breast Cancer Management”. Also, we measured tweets containing “prostate cancer” and “breast cancer”. We used an autoregressive integrated moving algorithm (ARIMA) to forecast expected weekly search volumes during PCAM and BCAM. We then compared the Google Trends data from during PCAM and BCAM to the forecasted values and determined a “greater than expected” range.

Results

The mean pooled percent increase in tweets associated with “prostate cancer” during PCAM from 2012 through 2018 was 15.9% (95% CI, -1% - 33%). The mean pooled percent increase in tweets associated with “breast cancer” during BCAM from 2012 through 2018 was 318.5% (95% CI, 268% - 369%). BCAM was associated with a 302.6% greater effect on increasing tweets referencing the disease of interest than PCAM from 2012-2018. “Breast cancer” Google searches were found to be 36.7% (95% CI, 34% - 39%) more frequent than “prostate cancer” per month from 2009-2019. Google Searches for “breast cancer screening” were 29.6% (95% CI, 28% - 31%) greater than “prostate cancer screening”.

Conclusions

Our results indicate that PCAM is not generating substantial internet interest, especially when compared to BCAM. The search volume for Google Trends search terms related to PCAM was less than BCAM in every comparison, and Twitter indicated only a slight increase of Tweets during the month of PCAM. Suggestions are provided to improve the effect of PCAM and men’s health.

Process evaluation of HAT TRICK: feasibility, acceptability and opportunities for programme refinement

Preventive lifestyle interventions are needed to address challenges in engaging men in conventional health programmes. This process evaluation examined the feasibility and acceptability of HAT TRICK, a gender-sensitized programme targeting physical activity, healthy eating and social connectedness. A mixed-methods approach was utilized to examine the effectiveness of recruitment and selection processes, facilitators' experiences and challenges and participant experiences with the programme. Evaluation measures included participant flow data and baseline assessments, facilitator debriefs, a post-intervention process evaluation questionnaire and telephone interviews with a subsample of participants. Participants (n = 62) were overweight (body mass index [BMI] > 25 kg m-2) and inactive (<150 min of moderate to vigorous physical activity [MVPA] per week) men with a mean age 51 ± 10.1 years. Participants reported high levels of satisfaction, acceptability and engagement with the intervention programme, content and resources. Facilitators noted the importance of creating a friendly, non-judgemental environment and observed that intervention content was best received when delivered in an interactive and engaging manner. Future programme refinements should consider strategies for strengthening social support, as well as opportunities for leveraging participants' interest in other health-related issues (e.g. mental health). Findings yield valuable information about the implementation of gender-sensitized interventions for men and demonstrate the importance of male-specific engagement strategies for reaching and engaging overweight, inactive men.

Positive Lifestyle Behavior Changes Among Canadian Men: Findings From the HAT TRICK Program

PURPOSE

To estimate program effectiveness regarding physical activity (PA), diet, and social connectedness as part of a feasibility study.

DESIGN

Pre-post quasi-experimental.

SETTING

HAT TRICK was delivered in collaboration with a Canadian semi-professional ice hockey team and offered at the arena where they trained and played games.

PARTICIPANTS

Participants (N = 62) at baseline were overweight (BMI >25kg/m²) and inactive (<150 minutes of MVPA/week) men age 35+ years.

INTERVENTION

Gender-sensitized 12-week intervention for men targeting PA, healthy eating and social connectedness.

METHOD

Baseline, post-intervention (12 weeks) and 9-month follow-up self-report and accelerometer data were collected. Multi-level modeling assessed growth trajectories of outcome measures across time.

RESULTS

Accelerometer measured weekly/min. of moderate PA showed significant linear trends (95%CI: 42.9 - 175.3) from baseline (147.0 ± 104.6), 12-week (237.7 ± 135.5) and 9-month follow-up (204.89 ± 137.7) qualified with a quadratic trend. Self-reported weekly/min of moderate and vigorous PA showed significant linear trends (95%CI: 94.1, 264.1; 95%CI: 35.1, 109.6) from baseline (52.6 ± 83.8, 22.42 ± 44.9), 12 week (160.1 ± 157.4, 66.6 ± 74.4) and 9-month follow-up (118.6 ± 104.6, 52.2 ± 59.2) qualified with quadratic trends. DINE measured fat score rating showed linear trends over time (95%CI -14.24, -6.8), qualified with a quadratic trend. DINE fibre score and social connectedness showed no trends.

CONCLUSION

Findings yield valuable information about the implementation of gender-sensitized lifestyle interventions for men and demonstrate the importance of male-specific strategies for reaching and engaging overweight, physically inactive men.

Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT

Background

In 2016, 26% of UK men were estimated to be obese. Systematic reviews suggest that few men engage in formal weight loss interventions that support weight reduction and improve health.

Objective

To co-produce, with patient and public involvement, an acceptable and feasible randomised controlled trial design to test a men-only weight management intervention.

Design

This was a two-phase feasibility study. Phase 1 was the development of intervention components, study procedures and materials including a discrete choice experiment with survey questions. Phase 2 was an individually randomised three-arm feasibility trial over 12 months. Qualitative interviews were conducted at 3 and 12 months.

Setting

The setting was two sites in Scotland that had disadvantaged urban and rural areas and differed in employment levels and ethnic groups.

Participants

In phase 1, 1045 men with obesity were recruited by Ipsos MORI (London, UK; www.ipsos.com/ipsos-mori/en-uk) to represent the UK population. In phase 2, 105 men with obesity were recruited in the community or through general practice obesity registers. Qualitative interviews were conducted with 50 men at 3 months and with 33 men at 12 months.

Interventions

The trial arms were narrative short message service (SMS) for 12 months (SMS only), financial endowment incentive informed by loss aversion and linked to achievement of weight loss targets plus narrative SMS for 12 months (SMS + I), and waiting list control group for 12 months followed by 3 months of an alternative SMS style developed based on feedback from men who had received the narrative SMS (control).

Main outcome measures

The main outcome measures were acceptability and feasibility of recruitment, retention, engagement, intervention components and trial procedures. Outcomes were assessed by examining procedural, quantitative and qualitative data at 3, 6 and 12 months.

Results

The most acceptable incentive strategy, based on the discrete choice experiment results, was to verify weight loss of 5% at 3 months, verify weight loss of 10% at 6 months and maintain weight loss of 10% at 12 months. Overall, 105 men with obesity from across the socioeconomic spectrum were successfully recruited to target, 59% of whom lived in more disadvantaged areas. Retention at 12 months was acceptable (74%) and was higher among individuals from disadvantaged areas. Narrative SMS were acceptable to many men, with a minority reporting negative reactions. Incentives were acceptable but were not the primary motivation for behaviour change. Twelve men in the incentive arm (33%) secured at least some money and three (8%) secured the full amount. Both intervention arms lost some weight, with greater weight loss in the arm that received SMS and incentives. The alternative SMS based on men’s feedback received no strong negative reactions.

Limitations

Fewer participants from the SMS + I arm (64%) completed the study at 12 months than did those in the SMS-only (79%) and control (83%) arms. The reasons for this difference were complex.

Conclusions

The men-only weight management intervention consisting of narrative SMS and financial incentives was acceptable and feasible, meeting the progression criteria for a full trial. Tailoring of SMS may improve acceptability and retention.

Future work

Minor refinements to the intervention components based on the study findings will be made prior to testing in a multisite definitive randomised controlled trial.

Trial registration

ClinicalTrials.gov NCT03040518.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.

One small step for man, one giant leap for men's health: a meta-analysis of behaviour change interventions to increase men's physical activity

OBJECTIVE

To determine the effects of behaviour change interventions on men's physical activity (postintervention), sustained change in physical activity behaviour (≥12 months postintervention) and to identify variations in effects due to potential moderating variables (eg, theoretical underpinning, gender-tailored, contact frequency).

DESIGN

Systematic review with meta-analysis. Pooled effect size (Cohen's d) was calculated assuming a random-effects model. Homogeneity and subsequent exploratory moderator analyses were assessed using Q, T² and I².

DATA SOURCES

Medline, EMBASE, CINAHL, SportDiscus and Web of Science to April 2019.

ELIGIBILITY CRITERIA FOR SELECTED STUDIES

Randomised control trials of behaviour change interventions in men (≥18 years) where physical activity was an outcome and data were from men-only studies or disaggregated by sex.

RESULTS

Twenty-six articles described 24 eligible studies. The overall mean intervention effect on men's physical activity was 0.35 (SE=0.05; 95% CI 0.26 to 0.45; p<0.001). This effect size is consistent with an increase of approximately 97 min of total physical activity per week or 980 steps per day. Intervention moderators associated with greater increases in physical activity included objective physical activity outcome measures, a gender-tailored design, use of a theoretical framework, shorter length programmes (≤12 weeks), using four or more types of behaviour change techniques and frequent contact with participants (≥1 contact per week). 12 studies included additional follow-up assessments (≥12 months postintervention) and the overall mean effect was 0.32 (SE=0.09; 95% CI 0.15 to 0.48; p<0.001) for that sustained increase in physical activity.

SUMMARY

Behaviour change interventions targeting men's physical activity can be effective. Moderator analyses are preliminary and suggest research directions.

Rugby Fans in Training New Zealand (RUFIT-NZ): protocol for a randomized controlled trial to assess the effectiveness and cost-effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs in New Zealand

Background

A healthy lifestyle program that appeals to, and supports, obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. In Scotland, Football Fans in Training (FFIT), a weight management and healthy lifestyle program for overweight and obese men aged 35–65 years , delivered by community coaching staff at professional football clubs, has been shown to be beneficial and cost-effective. A pilot program inspired by FFIT but delivered by professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, improved physiological outcomes, and adherence to healthy lifestyle behaviors in overweight and obese men. The objective of this trial is to determine the effectiveness and cost-effectiveness of the Rugby Fans in Training New Zealand (RUFIT-NZ) program.

Methods

A pragmatic, two-arm, multi-center, randomized controlled trial involving 308 overweight and obese men aged 30–65 years, randomized to either an intervention group (n = 154) or a wait-list control group (n = 154). The intervention-group participated in the 12-week RUFIT-NZ program, a gender-sensitized, healthy lifestyle intervention adapted to the environment and cultural diversity of NZ and delivered through professional rugby clubs. Participants in the intervention group undergo physical training sessions, in addition to workshop-based sessions to learn about nutrition, physical activity, sleep, sedentary behavior, and a range of behavior-change strategies for sustaining a healthier lifestyle. The control group receives the program after 52 weeks. The primary outcome is change in body weight from baseline to 52 weeks. Secondary outcomes include change in body weight at 12 weeks; waist circumference, blood pressure, fitness, and lifestyle behaviors at 12 and 52 weeks; and cost-effectiveness. A process evaluation informed by the RE-AIM framework will evaluate potential implementation of RUFIT-NZ as an ongoing program in NZ after the trial.

Discussion

This trial will investigate the effectiveness and cost-effectiveness of the RUFIT-NZ program in overweight and obese NZ men.

Trial registration

Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered on 18 January 2019, according to the World Health Organization Trial Registration Data Set. Universal Trial Number, U1111-1245-0645.

Scale-Up and Scale-Out of a Gender-Sensitized Weight Management and Healthy Living Program Delivered to Overweight Men via Professional Sports Clubs: The Wider Implementation of Football Fans in Training (FFIT)

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs that can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs that are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents: the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries; and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change.

Community-based men’s health promotion programs: eight lessons learnt and their caveats

Long-standing commentaries about men’s reticence for accessing clinical medical services, along with the more recent recognition of men’s health inequities, has driven work in community-based men’s health promotion. Indeed, the 2000s have seen rapid growth in community-based programs targeting men, and across this expanse of innovative work, experiential and empirical insights afford some important lessons learnt, and caveats to guide existing and future efforts. The current article offers eight lessons learnt regarding the design, content, recruitment, delivery, evaluation and scaling of community-based men’s health promotion programs. Design lessons include the need to address social determinants of health and men’s health inequities, build activity-based programming, garner men’s permission and affirmation to shift masculine norms, and integrate content to advance men’s health literacy. Also detailed are lessons learnt about men-friendly spaces, recruitment and retention strategies, the need to incrementally execute program evaluations, and the limits for program sustainability and scaling. Drawing from diverse community-based programs to illustrate the lessons learnt, caveats are also detailed to contextualize and caution some aspects of the lessons that are shared. The express aim of discussing lessons learnt and their caveats, reflected in the purpose of the current article, is to guide existing and future work in the ever growing field of community-based men’s health promotion.

Celiac Male's Gluten-Free Diet Profile: Comparison to that of the Control Population and Celiac Women

The aim of the present work was to analyze the body composition and dietary profile of Spanish celiac men and to compare them to control men and celiac women from our previous studies. Forty-two celiac men (31.5 ± 11.9 years) were recruited and anthropometric measurements were taken. Analysis of energy consumption, macro- and micronutrient intake and food frequency consumption was carried out. Celiac men were more overweight and obese than celiac women, but less than the control population, reporting the same energy intake and macronutrient distribution. Most micronutrient deficiencies in celiac men were not directly related to a gluten free diet; these were also observed for the entire population. The least adherence to Dietary Reference Intakes in women was reported for iron, iodine, potassium and selenium, whereas magnesium intake was higher than in men. Among celiac participants (both genders), cereal, vegetable and legume consumption was poor and meat intake was contrastingly excessive. In conclusion, the dietary profile of celiac men is as unbalanced as that of control men but slightly more than that of celiac women. General nutritional education should be given to both general and celiac populations, and specific advices to celiac men, in order to decrease the risk of celiac disease-related pathologies.