Dr Simon Rowlands

Food preferences, dieting practices and healthy eating are all interlinked and can be considered as socially constructed and gendered phenomena. As this chapter will discuss, men and women are thought to have different approaches to nutrition – although sex differences are often overstated and changing gender ideals suggest that the relationship between gender and food is complex, dynamic and context-bound. In this chapter, we look closely at ‘masculinity’ (or ‘masculinities’) and its important influence on men’s health generally and on nutrition specifically. We look beyond medical and psychological perspectives to social science theory and research of relevance to men’s food-related activities and highlight concepts which could inform recommendations for improving men’s engagement with healthy eating.

This chapter reports learning from students participating as peer researchers in a pedagogically focused study. The chapter documents the peer research model used, its challenges, and its successes, to add to the evidence base about the reality of using participatory approaches, specifically with and for students. The chapter details findings from a study about the lived experiences of postgraduate students as they transition into learning at master's level. By exploring experiences qualitatively through the voices of students, lessons about the ways in which these inform lived experiences, enable better understanding of the wider circumstances affecting postgraduate student transitions, and their associated support needs are detailed. This chapter adds to the evidence base around postgraduate student transitions.

This paper explores the qualitative perspectives of women about a community embedded fathers initiative in Northern England. Projects to improve the wellbeing of men and their children are less common within the landscape of parent and child support, with mothers more often being the target recipients. Asking women about their perceptions of an initiative for fathers then offers original insights from women who are positioned as ‘related outsiders’, in that they were ‘outside’ the project but ‘inside’ the family and community. Findings suggest that women are able to see the positive impact of such a project, identifying that it offers a shared space for men and children, time for mothers without their children and can help with shifting roles and attitudes around child care and emotional labour in the home. The initiative was also seen by the women as offering men more healthy means of coping, including men moving away from traditional hegemonic practices, which in turn shifted some women’s long held gendered beliefs about men as fathers. This research then offers a relational gendered backstory to a father’s initiative, demonstrating how such initiatives can potentially ‘undo’ gender and the positive implications this could have for families.

Although under-researched and under-theorised compared to other settings, there is potential for the family setting to be harnessed to support the development of healthy children and societies and to reduce health inequalities. Within this setting, the role of fathers as health facilitators has yet to be fully understood and considered within health promotion. This paper draws on a two year evaluation of a community embedded intervention for fathers and children in an area of multiple deprivation in North West England. The evaluation integrated a variety of qualitative methods within a participatory evaluation framework to help understand the development and impact of a programme of work co-created by a social enterprise and fathers from within the community. Findings suggest that allowing fathers to define their own concerns, discover solutions to these and design locally appropriate ways to share these solutions can result in significant change for them, their children and the wider community. Key to this process is the provision of alternative spaces where fathers feel safe to share the substantial difficulties they are experiencing. This improved their confidence and had a positive impact on their relationships with their children and with significant others around them. However, this process required patience, and a commitment to trusting that communities of men can co-create their own solutions and generate sustainable success. We suggest that commissioning of services delivered ‘to’ people could be replaced, or supplemented, by commissioning appropriate organisations to work with communities to co-create solutions to needs they themselves have recognised.

Background National Health Service England piloted a low-calorie diet programme, delivered through total diet replacement and behaviour change support via 1 : 1, group or digital delivery, to improve type 2 diabetes in adults with excess weight. Aim To coproduce a qualitative and economic evaluation of the National Health Service low-calorie diet pilot, integrated with National Health Service data to provide an enhanced understanding of the long-term cost-effectiveness, implementation, equity and transferability across broad and diverse populations. Research questions What are the theoretical principles, behaviour change components, content and mode of delivery of the programme, and is it delivered with fidelity to National Health Service specifications? What are the service provider, user and National Health Service staff experiences of the programme? Do sociodemographics influence programme access, uptake, compliance and success? What aspects of the service work and what do not work, for whom, in what context and why? Can the programme be improved to enhance patient experience and address inequities? What are the programme delivery costs, and policy implications for wide-spread adoption? Methods A mixed-methods study underpinned by a realist-informed approach was delivered across five work packages, involving: semistructured interviews with service users (n = 67), National Health Service staff (n = 55), service providers (n = 9); 13 service provider focus groups; and service user surveys (n = 719). Findings were triangulated with clinical data from the National Health Service England’s first cohort analysis (n = 7540). Results Fifty-five per cent of service users who started total diet replacement completed the programme and lost an average of 10.3 kg; 32% of those with data available to measure remission achieved it. Examination of programme mobilisation identified barriers around referral equality and the impact of COVID-19, while effective cross-stakeholder working and communication were key facilitators. Service delivery and fidelity assessments identified a drift in implementation fidelity, alongside variation in the behaviour change content across providers. Perceived barriers to programme uptake and engagement aligned across service providers and users, resulting in key learning on: the importance of person-centred care, service user support needs, improvements to total diet replacement and the social and cultural impact of the programme. Early National Health Service quantitative analyses suggest some socioeconomic variation in programme uptake, completion and outcomes. Insights from the evaluation and National Health Service data were combined to develop the programme theory and underpinning context, mechanisms and outcomes. These were used to develop a list of recommendations to improve the cultural competency of programme delivery, total diet replacement delivery, peer support and address psychological support needs. Cost-effectiveness analyses using short-term follow-up data indicated there is potential for the programme to be cost-effective, but not cost saving. Conclusions The National Health Service low-calorie diet can provide a clinically effective and potentially cost-effective programme to support weight loss and glycaemic control in adults with type 2 diabetes. However, this evaluation identified areas for improvement in referral equity, uptake and completion, and fidelity of delivery, which have informed the development of the programme, which has now been rolled out nationally. Ongoing programme monitoring and long-term follow-up are now required. Future work and limitations The real-world setting limited some data collection and analysis. Future work will focus on the analysis of long-term clinical and cost-effectiveness, and addressing inequalities. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132075.