Professor Alan White

This unique volume explores a growing collaboration between the sport and health sectors to deliver innovative public health interventions in the community. It explores the role of sport and sports settings as a vehicle for achieving health outcomes, as well as some of the practical and moral challenges presented by sport and public health partnerships working together. Twenty detailed examples illustrate the broad range of programs which have already been developed around the world, from across the spectrum of public health activity. Chapters include: • Time Out for Your Health: A sports-based health intervention approach with American football teams • Promoting Mental Wellbeing in Rugby League communities • Slum Soccer – female empowerment through football • Football 4 Peace • Sport as a post-disaster psychosocial intervention for children in Bam, Iran • Sex and Sport: An Australian rules football-based chlamydia screening initiative As well as showcasing what has been achieved in this exciting new field, Sports-based Health Interventions shares valuable advice and lessons learnt to inform the next generation of sports-based public health initiatives.

Background: Globally, the uptake of health screening is suboptimal, especially in men and those of younger age. In view of the increasing internet access and mobile phone ownership, ScreenMen, a mobile Web app, was developed to improve health screening uptake in men. Objective: This study aimed to evaluate the utility and usability of ScreenMen. Methods: This study used both qualitative and quantitative methods. Healthy men working in a banking institution were recruited to participate in this study. They were purposively sampled according to job position, age, education level, and screening status. Men were asked to use ScreenMen independently while the screen activities were being recorded. Once completed, retrospective think aloud with playback was conducted with men to obtain their feedback. They were asked to answer the System Usability Scale (SUS). Intention to undergo screening pre- and postintervention was also measured. Qualitative data were analyzed using a framework approach followed by thematic analysis. For quantitative data, the mean SUS score was calculated and change in intention to screening was analyzed using McNemar test. Results: In total, 24 men participated in this study. On the basis of the qualitative data, men found ScreenMen useful as they could learn more about their health risks and screening. They found ScreenMen convenient to use, which might trigger men to undergo screening. In terms of usability, men thought that ScreenMen was user-friendly and easy to understand. The key revision done on utility was the addition of a reminder function, whereas for usability, the revisions done were in terms of attracting and gaining users’ trust, improving learnability, and making ScreenMen usable to all types of users. To attract men to use it, ScreenMen was introduced to users in terms of improving health instead of going for screening. Another important revision made was emphasizing the screening tests the users do not need, instead of just informing them about the screening tests they need. A Quick Assessment Mode was also added for users with limited attention span. The quantitative data showed that 8 out of 23 men (35%) planned to attend screening earlier than intended after using the ScreenMen. Furthermore, 4 out of 12 (33%) men who were in the precontemplation stage changed to either contemplation or preparation stage after using ScreenMen with P=.13. In terms of usability, the mean SUS score of 76.4 (SD 7.72) indicated that ScreenMen had good usability. Conclusions: This study showed that ScreenMen was acceptable to men in terms of its utility and usability. The preliminary data suggested that ScreenMen might increase men’s intention to undergo screening. This paper also presented key lessons learned from the beta testing, which is useful for public health experts and researchers when developing a user-centered mobile Web app.

BACKGROUND: Globally, the uptake of health screening is suboptimal, especially in men and those of younger age. In view of the increasing internet access and mobile phone ownership, ScreenMen, a mobile Web app, was developed to improve health screening uptake in men. OBJECTIVE: This study aimed to evaluate the utility and usability of ScreenMen. METHODS: This study used both qualitative and quantitative methods. Healthy men working in a banking institution were recruited to participate in this study. They were purposively sampled according to job position, age, education level, and screening status. Men were asked to use ScreenMen independently while the screen activities were being recorded. Once completed, retrospective think aloud with playback was conducted with men to obtain their feedback. They were asked to answer the System Usability Scale (SUS). Intention to undergo screening pre- and postintervention was also measured. Qualitative data were analyzed using a framework approach followed by thematic analysis. For quantitative data, the mean SUS score was calculated and change in intention to screening was analyzed using McNemar test. RESULTS: In total, 24 men participated in this study. On the basis of the qualitative data, men found ScreenMen useful as they could learn more about their health risks and screening. They found ScreenMen convenient to use, which might trigger men to undergo screening. In terms of usability, men thought that ScreenMen was user-friendly and easy to understand. The key revision done on utility was the addition of a reminder function, whereas for usability, the revisions done were in terms of attracting and gaining users' trust, improving learnability, and making ScreenMen usable to all types of users. To attract men to use it, ScreenMen was introduced to users in terms of improving health instead of going for screening. Another important revision made was emphasizing the screening tests the users do not need, instead of just informing them about the screening tests they need. A Quick Assessment Mode was also added for users with limited attention span. The quantitative data showed that 8 out of 23 men (35%) planned to attend screening earlier than intended after using the ScreenMen. Furthermore, 4 out of 12 (33%) men who were in the precontemplation stage changed to either contemplation or preparation stage after using ScreenMen with P=.13. In terms of usability, the mean SUS score of 76.4 (SD 7.72) indicated that ScreenMen had good usability. CONCLUSIONS: This study showed that ScreenMen was acceptable to men in terms of its utility and usability. The preliminary data suggested that ScreenMen might increase men's intention to undergo screening. This paper also presented key lessons learned from the beta testing, which is useful for public health experts and researchers when developing a user-centered mobile Web app.

This Third Edition of Men’s Health provides a comprehensive and authoritative reference source to urologists, andrologists, family practitioners, and all professionals dealing with the male patient who diagnose and treat males with a variety of health problems, such as prostate cancer, male osteoporosis, and testicular cancer. The new edition been completely reorganized into disease- and problem-based sections, to highlight important topics such as cancer and premature cardiovascular disease. There is also new material on some of the less frequently explored areas of men’s health, such as Tourette’s Syndrome, depression, and cosmetic surgery.

Background: Men in New Zealand (NZ) do not enjoy the same level of health and wellbeing as women. Men generally experience a higher incidence of, and mortality from, major diseases; most importantly, life expectancies for men in NZ are approximately four years less than for women. Such disparities vary across rural and urban communities, and across ethnic sub-groups. In particular, Māori men live some seven years less than other NZ men. Despite such inequalities, men’s health is not recognised as a priority by healthcare providers, government, or at the wider societal level. This qualitative study seeks to address this, by contributing to our understanding of factors associated with health and wellbeing for men in the ageing process. Study findings will also inform the development of a national survey of older men. Method: Focus groups will be used to explore the expectations and experiences of health and wellbeing in a cohort of older men (≥45 years) in the Otago and Southland regions. Topics to be explored will include gender role conflict, health service help-seeking, lifestyle behaviours, social engagement, and self-identified health risks. In total, five groups are planned (6-10 men per group) and will be conducted in urban, rural, and urban-rural adjunct areas. Focus groups will be recorded, and transcribed verbatim. Transcriptions will be coded for themes using the abductive thematic analysis approach. Results: This paper presents a protocol of a study in progress, and results are not yet known. Discussion: This is the first qualitative study focussing on ageing well in men in NZ. It will contribute to our understanding of this aspect of men’s health, and–ultimately–help to inform interventions and policies to better support men to age positively.

The aim of this study is to examine the experiences of men treated with radiotherapy for localized prostate cancer. The recognition that little research has been carried out about the impact of illness in men, or how they recover following radical treatment, forms the basis for this study. The objectives of this study are to explore men's experiences of radiotherapy for prostate cancer and to consider if current services meet the needs of these men. This investigation took the form of a descriptive qualitative approach using focus groups. The focus group meetings were audiotaped and a qualitative thematic analysis of transcripts was carried out. The analysis of the data yielded five themes that were common to most of the men. The findings from this study suggest: a fragmented approach to the overall care and treatment for men with prostate cancer; a need to evaluate the provision of information and identify areas for improvement in all areas of practice; and an holistic approach to examine each aspect of the patient's journey.

There has been a proliferation of nursing and other research on women's health over the last thirty years but a similar interest in men's health has not materialised. Within this paper we seek to explore the issues that need to be taken into consideration when conducting research with (or on) men. It outlines the current thinking on men and masculinity and the social development of stereotypes of men. The position of men with regard to the development of feminist thinking is also explored. The paper develops the argument by an examination of the different stages of the research process in nursing. The effect of gender on the setting of the research question; the choice of methodology; obtaining the data; analysis; discussion and dissemination of the findings of research conducted upon men are considered. We suggest that there is a requirement to consider the gender of both researched and researcher during the research process. © 1998 Elsevier Science Ltd. All rights reserved.

• Participant observation was undertaken of the early admission period of 25 men admitted to hospital with acute chest pain, followed by in‐depth interviews of 10 of the men after discharge.

• Grounded theory methods were used in the analysis to develop a model of how the men came to interpret their experiences.

• An emerging feature of the men’s experiences was that, although they had suffered intense pain prior to admission, there had been a series of delays whilst they tried to rationalize their symptoms.

• We relate our discussion to literature on men and masculinity and the notion of Foucault (1975) of self‐surveillance, to offer an insight into the men’s self concept and social situation.

• Our conclusions suggest that men’s self concept as ‘healthy’ may inhibit a speedy response to the signs and symptoms of acute coronary occlusion, increasing the risk of cardiac arrest without nearby life support.

Aims of the study. This paper examines the argument that certain qualitative research methods can be used in 'pure' forms. Whilst rigid adherence to particular published procedures might be possible, we argue that in many cases this is neither necessary nor more likely to increase the validity of the research outcome. Methodological purity. In examining the works of well-known claimants to particular research approaches such as grounded theory and phenomenology we show that purity of method is uncommon. In particular it is possible to demonstrate that all published qualitative methods are subject to their own underlying relativist philosophy. The implication of this is that all are social constructions and that their execution will necessarily be negotiated in time and context. Conclusion. We conclude that analysis of varied examples of qualitative research shows methods to be more flexible than is often admitted. What we describe as 'British Pluralism' is an attempt to accept this reality whilst maintaining rigour through integrity, clear accounts, reflexivity and constructive critique of one's own work and that of others.

In line with the shift towards prioritising lay accounts and narratives of chronic illness in sociology, there is an emerging literature on men, their subjectivities and experiences of mental distress. We argue in this paper that subjectivities and distress among men are an important area for critical sociological research. Very little is known about men's subjectivities or the meanings they give to - and how they cope with or seek help for - distress. At the same time, current theories of gender relations, performativity and wellbeing as they pertain to men are likely to shed further light on subjectivity and distress. However, current theories (and qualitative research involving men and women) are pointing to considerable complexity. In this paper, we outline what is known about distress and men, and consider the utility of gender relations, performativity, subjectivities and wellbeing for a better understanding of distress. We also ask: What other factors influence distress, and how should these be considered in relation to men and masculinities? What are the implications for research and policy?

Rheumatoid arthritis (RA) is a chronic disease affecting fewer men than women. We systematically reviewed the literature on impact and self-management of RA men. Twenty eight papers were included, and grouped into two categories: Psychosocial impact of RA; and Coping and self-management. This review finds gender differences relating to quality of life; work; distress; self-management; coping; and support. We conclude there is a dearth of literature focussing on RA men only, and mixed gender studies include insufficient men to draw strong conclusions about men. Thus, further research is needed to understand the support needs of men with RA in depth.

In March 2020, the World Health Organization (WHO) announced that COVID-19 (novel coronavirus) reflected a global pandemic. Early epidemiological analyses demonstrated that boys and men have similar rates of COVID-19 infection to girls and women. However, boys and men appear to be disproportionately impacted with respect to severity and mortality, including those from marginalised or minority backgrounds. Yet, considerations of sex and gender, and their relationship to health and social inequities, have been absent from recent COVID-19 policy and practice pandemic responses. This evidence-based commentary discusses the nexus between COVID-19, equity, and boys and men’s health from a broad public health perspective. Using scholarship about intersections between race and gender; and poverty, social determinants of health, and gender; we explain why a health equity lens is important to address the health and social inequities boys and men face during pandemics. This contribution provides guidance about future global public healthpandemic responses for society’s most vulnerable groups of boys and men.

Objective: Current literature has overlooked the impact of chronic illness on masculine identity. We therefore aimed to investigate the impact of Rheumatoid Arthritis (a long term condition, affecting more women than men) on masculine identity. Methods: Six focus groups with 22 men with RA (data reported elsewhere) followed by five one-to-one interviews with men (English, mean age: 59 years) sampled to reflect a heterogeneous experience of life with RA based on knowledge gained from the focus groups. Transcripts were analysed using Thematic Analysis and are presented as individual case studies. Results: Whilst the case studies provide five distinct experiences, common themes can be drawn across them, such as the importance of paid work. The men needed to renegotiate their masculine identity to deal with their RA. Two dealt with this by pushing through pain to retain masculine activities, two replaced masculine roles they could no longer do with other roles, and one rejected masculinity completely. Conclusion: Men with long term conditions may need to re-write their masculinity scripts to enable them to accept and adapt to their condition. However, some men struggle with this, which should be taken into consideration when designing self-management services for men with long term conditions.

OBJECTIVE: To investigate the existence and distribution of 2 typologies (termed "factors") of men with rheumatoid arthritis (RA) identified through our previous Q-methodology study (n = 30) in a larger sample of men with RA, and whether differences in psychosocial impact or support preferences exist between the 2 factors, and between men and women with RA. METHODS: A postal survey was sent to 620 men with RA from 6 rheumatology units across England, and the support preferences section of the survey was given to 232 women with RA. RESULTS: A total of 295 male patients (47.6%) and 103 female patients (44.4%) responded; 15 male participants had missing data, and thus 280 were included in the analysis. Of these, 61 (22%) were assigned to factor A ("accept and adapt"), 120 (35%) were assigned to factor B ("struggling to match up"), and 99 (35%) were unassigned. The two factors differed significantly, with factor B reporting more severe disease, less effective coping strategies, and poorer psychological status. For support, men favored a question and answer session with a consultant (54%) or specialist nurse (50%), a website for information (69%), a talk by researchers (54%), or a symptom management session (54%). Overall, women reported more interest in support sessions than men, with ≥50% of women reporting interest in nearly every option provided. CONCLUSION: Some men accept and adapt to their RA, but others (43%) report severe disease, less effective coping, and poor psychological status. Men's preferences for support are practical, with a focus on expanding their knowledge.

There is a lack of mobile app which aims to improve health screening uptake developed for men. As part of the study to develop an effective mobile app to increase health screening uptake in men, we conducted a needs assessment to find out what do men want from a health screening mobile app. In-depth interviews and focus group discussions were conducted with 31 men from a banking institution in Kuala Lumpur. The participants were purposely sampled according to their job position, age, ethnicity and screening status. The recruitment was stopped once data saturation was achieved. The audio-recorded interviews were transcribed verbatim and analyzed using thematic approach. Three themes emerged from the analysis and they were: content, feature and dissemination. In terms of the content, men wanted the app to provide information regarding health screening and functions that can assess their health; which must be personalized to them and are trustable. The app must have user-friendly features in terms of information delivery, ease of use, attention allocation and social connectivity. For dissemination, men proposed that advertisements, recommendations by health professionals, providing incentive and integrating the app as into existing systems may help to increase the dissemination of the app. This study identified important factors that need to be considered when developing a mobile app to improve health screening uptake. Future studies on mobile app development should elicit users' preference and need in terms of its content, features and dissemination strategies to improve the acceptability and the chance of successful implementation.

© 2017 The Dougmar Publishing Group. Target of the study Men's Health is increasingly coming into force within health research, epidemiology, health care organisation, and health policy. Over the past 10-15 years the EU Men's Health Report and reports within some countries have publicised problems of health in men. A starting point for the study of men's health is the defi nition of "Men's Health". A group of German experts in the fi eld of men's health has taken on this task. Methodology A literature review in international and national databases was performed for the years 1990-2014 by selected MeSH terms and for "experts in men's health". Further research concerned "grey literature" in Germany, especially health reports and web pages. This was followed by a conference of experts to defi ne "Men's Health" using a modifi ed Delphi method according to W. Zinn. From the expert group, minimum criteria for a defi nition of "Men's Health", which must comply with the new defi nition of men's health, were created and discussed. The fi nal defi nition was created in the third round of the Delphi method. Results The international literature review yielded seven defi nitions of "Men's Health" in the English literature and fi ve defi nitions in the German literature including within the "grey" literature. The expert group identifi ed seven minimum criteria and fi fteen relevant topics that were needed for a strong defi nition, of which, by weighting, eight criteria were considered relevant for a new defi nition. None of the existing defi nitions could fulfi l these eight criteria. Therefore, in the next step of the expert group a new defi nition "Men's Health" was elaborated. The defi nition has reference to the WHO concept of "health" and includes dimensions of health and disease, risk and protective factors that require special prevention and care services for all phases of life. All participants in the expert group agreed on the defi nition developed. Conclusions The defi nition of Men's Health is a basis for further research and practice to improve men's health in Germany and other countries.

Isolation and loneliness are risk factors for poor health, and are increasingly affecting younger men. GPs can play an important role in recognising and addressing the problems using the tools and services being developed to help tackle the issues.

The reasons behind the disproportionately higher number of deaths among men compared with women as a result of the COVID‐19 pandemic may not be clear for some time. Here the authors discuss some of the potential biological explanations for why men seem to succumb more readily to the deadly effects of the virus.

The global pandemic as a result of the SARS-CoV2 virus has seen over 16m people infected and over 650,000 deaths, with men at double the risk of both developing the severe form of the disease and mortality. There are both biological (sex) and socio-cultural (gender) factors, compounded by socio-economic factors and ethnicity, that impact on the aftermath of what has occurred over the short time that this novel coronavirus has been circulating the world. The potential life-long morbidity as a result of the infection and as a consequence of highly invasive critical care treatment needs to be factored into the rehabilitation of survivors. There are also many men whose lives will have been severely affected both physically and emotionally by the pandemic without ever contracting the disease, with the widespread disruption to normal existence and its impact on their social world and the economy. The implications of the closure of many healthcare services over the initial lockdown will also have both a shorter- and longer-term impact on other diseases due to missed early diagnosis and disrupted treatment regimes. Getting effective public health messages out to the population is critical and this current pandemic is demonstrating that there needs to be a more focused view on men's health behaviour. Without effective public support for preventative action the more likely the disease will continue its path unabated. This review explores the wider ramifications of the disease both for those men who have survived the disease and those that have been affected by the wider social effects of the pandemic. The pandemic should be a wake-up call for all involved in the planning and delivery of health and social care for the greater attention to the central role of sex and gender.

Background: Globally, there has been a growing awareness of the health challenges faced by men. The current public health agenda in Aotearoa New Zealand (NZ) does not specifically address the needs of men. The aim of this scoping review was to capture the major health issues facing men in NZ and particularly to identify the knowledge gaps in the understanding of men’s health within the NZ context. This was achieved by presenting key data on their health status and systematically mapping research in NZ related to men’s health; international data are also referenced for context as relevant. Method: A search and screening of the literature were conducted using Ovid, Web of Science and Scopus databases from January 1996 to July 2021, with advice from a medical librarian. Search terms included “men’s/male’s health” and “men’s/male’s health NZ.” An environmental scan of international literature was also carried out and information from the Ministry of Health and Statistics NZ was obtained to provide context of the status of research on men’s health in NZ. Main Findings: In keeping with international literature, the major health issues for men in NZ are life-limiting diseases including cancer and cardiovascular disease, the spread of overweight and obesity, issues with masculinity and help-seeking behaviours, unhealthy lifestyles, mental health issues and poor health literacy. The main areas of research related to men’s health from the NZ literature were highlighted. Discussion: Men’s health remains an under-recognised issue in NZ. If we are to address current inequities in health for men, clinicians, researchers and relevant agencies need to pay more attention to men’s health issues and take up the challenge to highlight and promote men’s health status in NZ.

A definition is required for men’s health that captures current thinking around men and their health and wellbeing globally. A new definition of men’s health should reflect greater complexity than that has existed in previously accepted, over-simplistic definitions of what constitutes “men’s health.” In addition, the most commonly used definitions in the field that originated from the westernised countries of the Global North do not seem to be inclusive of the heterogeneity among a significant proportion of the world’s population. Definitions are important as they help drive academic endeavour, practice and policy; they also help shape organisations working in men’s health and, as such, they need to be as broad as possible. This paper outlines the limitations and conceptual concerns in the current definitions and argues for a more inclusive definition.

Men's health is now increasingly being recognised as a key area of concern for health professionals and policy makers. However, until recently, an overview of men's health across the European countries has been lacking. This is a brief report of a study undertaken by the European Men's Health Forum into the state of men's health in 17 different European countries. ©MEP 2003.

The study aim was to explore the health and well-being experiences of a cohort of older men (≥45 years old) in the Southern region of New Zealand (Otago and Southland), and how these experiences corresponded with their expectations of ageing. It was hoped this examination of the lived experiences of older men would enhance our understanding of the enablers and challenges to ageing well for older men. Six focus groups were undertaken (n = 28) at three different locations in New Zealand. Participants ranged in age (45–92 years old) and varied in socioeconomic status. Critical studies of men and masculinities theoretical framework was adopted to underpin the study, with narrative data analyzed using a reflexive thematic approach. Three core themes were identified, including finding purpose in work and life, navigating masculine expectations in the ageing process, concerning challenges associated with social role transition. Each of these core themes incorporates a central organizing concept. Rather than steering older men toward predetermined male social roles, our findings suggest the achievement of ageing well to empower them to have life purpose and engagement should become a new expectation for policymaking.Public Significance Statement This study sheds light on the experiences of older men in the Southern region of New Zealand and their expectations of ageing. By emphasizing the importance of finding purpose and engagement in later life, the findings challenge traditional male social roles and advocate for a shift in policymaking to promote aging well among older men. This research has broader implications for improving men’s health and well-being in ageing populations and redefining societal expectations of older men.

This paper will argue that it should no longer be seen as acceptable to present data that is limited to just a population wide or age standardised sex analysis. Such blunt approaches miss the opportunity to develop our understanding of the pivotal role that sex and gender play in health, wellbeing and illness. Taking what we have referred to as a gendered epidemiological approach, would: (i) ensure the routine inclusion of sex differences, (ii) explore how sex differences can be analysed in conjunction with other factors influenced by gender (age, social class, education, marital status etc), (iii) highlight differences within each sex and not just between the sexes, and (iv) apply a gendered lens to the interpretation of the findings. This more nuanced stance is required to ensure that the complexity of men and women can be reflected in the field of public health. © 2011 The Royal Society for Public Health.

RATIONALE: Men have poorer health status and are less likely to attend health screening compared to women. OBJECTIVE: This systematic review presents current evidence on the barriers and facilitators to engaging men in health screening. METHODS: We included qualitative, quantitative and mixed-method studies identified through five electronic databases, contact with experts and reference mining. Two researchers selected and appraised the studies independently. Data extraction and synthesis were conducted using the 'best fit' framework synthesis method. RESULTS: 53 qualitative, 44 quantitative and 6 mixed-method studies were included. Factors influencing health screening uptake in men can be categorized into five domains: individual, social, health system, healthcare professional and screening procedure. The most commonly reported barriers are fear of getting the disease and low risk perception; for facilitators, they are perceived risk and benefits of screening. Male-dominant barriers include heterosexual -self-presentation, avoidance of femininity and lack of time. The partner's role is the most common male-dominant facilitator to screening. CONCLUSIONS: This systematic review provides a comprehensive overview of barriers and facilitators to health screening in men including the male-dominant factors. The findings are particularly useful for clinicians, researchers and policy makers who are developing interventions and policies to increase screening uptake in men.

Coronary artery disease (CAD) is the single leading cause of death in Europe and the most common form of cardiovascular disease. Little is known about awareness in the European population. A cross-sectional telephone survey of 2609 individuals from six European countries was conducted to gather information on perceptions of CAD, risk factors, preventive measures, knowledge of heart attack symptoms and ability to seek emergency medical care. Level of awareness was compared according to gender, age, socioeconomic status (SES) and educational level. Women were approximately five times less likely than men to consider heart disease as a main health issue or leading cause of death (OR = 0.224, 95% CI: 0.178-0.280, OR = 0.196, 95% CI: 0.171-0.226). Additionally, women were significantly less likely to have ever had a cardiovascular screening test (OR = 0.515, 95% CI: 0.459-0.578). Only 16.3% of men and 15.3% of women were able to spontaneously identify the main symptoms of a heart attack. Almost half of the sample failed to state that they would call emergency services in case of a cardiac event. Significant differences according to age, SES and education were found for many indicators amongst both men and women. Development of a European strategy targeting improved awareness of CAD and reduced gender and social inequalities within the European population is warranted.

OBJECTIVE: To explore the experiences, coping styles, and support preferences of male rheumatoid arthritis (RA) patients. METHODS: Six focus groups comprised 22 men with RA. Transcripts were analyzed using inductive thematic analysis. RESULTS: Three overarching themes describe the experiences, coping styles, and support preferences of men with RA. In "challenges to masculinity," the men described a "reduction in strength and abilities," which can lead to loss of independence, "challenges to masculine identity and role," and "loss of power and control." Coping by "getting through life with RA" meant dealing with RA by "just getting on with it," "information seeking," engaging in "destructive behaviors," and "withdrawing socially." Preferred "sources of support" tended not to include friends, as they were perceived to lack understanding or support. For acceptable support the men reported a preference for information-giving sessions rather than a discussion group, but there was no agreement on whether these should be mixed-sex or men only, or who should run the sessions. CONCLUSION: Male patients reported a range of coping styles and support preferences to address their experiences of living with RA, many of which may not be shared with women. Further research is needed to investigate whether these findings exist in a larger sample and whether the support preferences of men with RA are broadly different from those of women with RA to decide whether there is a clinical need to design a service for the potentially different needs of men.

The author points out that the majority of sport-based public health interventions tend to be aimed specifically at men, perhaps largely in response to the fact that men are less likely than women to access health service provision. Women may be seen as less in need of interventions delivered through the medium of sport. Nonetheless, there are clear gains to be achieved by increasing women’s participation in sport, as well as delivering health promotion messages and services to women through sport-related channels. Targeting women in this way, however, requires a clear understanding of how both women and men experience sport, both as active participants and as spectators. Adopting a gender perspective, the chapter sets out the factors which shape how women, and then men, experience sport in both capacities—the elements which encourage and support engagement, and those which deter and impede it. It is shown that, whilst women’s engagement in sport has generally increased in recent years, progress remains uncertain, with local periodic reverses being common, and women in many societies still being excluded from sport by religious and cultural constraints. Creating a more family-friendly environment in many (male) sports arenas (such as football stadia) is shown as having helped to encourage greater female participation, but the more limited extent, and media coverage of, women’s sport is itself viewed as a barrier to women’s increased engagement (for example, maintaining a shortage of positive female role models). Ways of improving women’s perceptions of sport are considered, including addressing girls’ experience of sport and exercise in schools. It is concluded that, with a gender-sensitive approach, there is now much more scope for reaching out to women through the medium of sport, and particularly of adopting broader public health objectives (beyond empowerment and fitness aims) in the way now being seen with men.

In this Conclusion the editors summarise and reflect on the main learning points from the book’s introductory chapters and 20 case studies before setting out two practical overarching key messages for developing the next generation of sports-based health interventions: firstly, use the evidence base and build the evidence base and secondly, acknowledge the challenges and take a critical approach. In the section on using and building the evidence base, the editors provide practical advice on applying an evidence-based approach to the design of sport-based health interventions. The section on acknowledging the challenges and taking a critical approach discusses the importance of anticipating potential problems and criticisms of sport-based public health work. The chapter concludes with a set of questions which can be used as a mental checklist when developing new sport-based health interventions.

Interest in 'men's health' as a separate issue has only recently occurred. Men's life expectancy tends to be shorter than for women when the reasons for this premature mortality are examined, serious issues of inequality emerge, both between men and women and between men from different socio-economic and cultural backgrounds. This article outlines the problems men face with their health, covering topics such as masculinity and male socialization, lifestyle, socio-economic status, and such specific health concerns as cancer, cardiac health, emotional health, and men's weight and the issue of violence. Activity in this growing field is also explored.

Objectives: Uptake of health screening is low in men, particularly among those aged <40 years. This study aimed to explore factors that influence health screening behaviour in younger men. Design: This qualitative study employed an interpretive descriptive approach. Two trained researchers conducted in-depth interviews (IDIs) and focus group discussions (FGDs) using a semi-structured topic guide, which was developed based on literature review and behavioural theories. All IDIs and FGDs were audio-recorded and transcribed verbatim. Two researchers analysed the data independently using a thematic approach. Participants and setting: Men working in a banking institution in Kuala Lumpur were recruited to the study. They were purposively sampled according to their ethnicity, job position, age and screening status in order to achieve maximal variation. Results: Eight IDIs and five FGDs were conducted (n=31) and six themes emerged from the analysis. (1) Young men did not consider screening as part of prevention and had low risk perception. (2) The younger generation was more receptive to health screening due to their exposure to health information through the internet. (3) Health screening was not a priority in young men except for those who were married. (4) Young men had limited income and would rather invest in health insurance than screening. (5) Young men tended to follow doctors' advice when it comes to screening and preferred doctors of the same gender and ethnicity. (6) Medical overuse was also raised where young men wanted more screening tests while doctors tended to promote unnecessary screening tests to them. Conclusions: This study identified important factors that influenced young men's screening behaviour. Health authorities should address young men's misperceptions, promote the importance of early detection and develop a reasonable health screening strategy for them. Appropriate measures must be put in place to reduce low value screening practices.

Epidemics and pandemics, like COVID-19, are not gender neutral. Much of the current work on gender, sex, and COVID-19, however, has seemed implicitly or explicitly to be attempting to demonstrate that either men or women have been hardest hit, treating differences between women and men as though it is not important to understand how each group is affected by the virus. This approach often leaves out the effect on gender and sexual minorities entirely. Believing that a more nuanced approach is needed now and for the future, we brought together a group of gender experts to answer the question: how are people of different genders impacted by COVID-19 and why? Individuals working in women's, men's, and LGBTQ health and wellbeing wrote sections to lay out the different ways that women, men, and gender and sexual minorities are affected by COVID-19. We demonstrate that there is not one group "most affected," but that many groups are affected, and we need to move beyond a zero-sum game and engage in ways to mutually identify and support marginalized groups.

There is growing national and international recognition that gender is an important indicator of health differences. The United Kingdom is in danger of falling behind many other countries that are beginning to recognise the crucial importance of gender to the development of effective health policy and practice. This briefing paper sets out some of the reasons why those involved in the gender and health partnership (GAHP) believe that it is time to place gender at the heart of the equalities agenda in health, and why it is important to ensure gender sensitivity in health policy, medical research and services. This briefing paper refers to the United Kingdom; however, Scotland is in the process of producing guidelines specifically on mainstreaming gender in health policy and service delivery.

This is a summary of the full report on the first year of the HOM project in Bradford, published in March 2005 and available at www.healthofmen.com . In this summary there is a concentration on three things, the background to the project, the experiences of the HOM team in setting up and managing projects and the views of the men involved in the projects. The summary is mostly a list of the things that the team found to be important in setting up projects and, equally important, some of the things not to do. There is, of course, a much fuller discussion of the details of projects, supporting data and the theoretical model of how men and health workers interact to manage health.

Men, on average, die 5 years younger than women. A meeting was held at the Royal Society of Medicine in London, UK, in October 2007, to address this issue and arrive at a consensus on how men can help themselves to live longer and healthier lives. The main focus was cardiovascular risk reduction by dietary modification, exercise, and management of risk factors together with lipid lowering therapy. Erectile dysfunction was highlighted as an important marker for and predictor for coronary heart disease. Strategies for reducing the death toll for prostate and colon cancer in men were also discussed. At the end of the conference seven action points were agreed. These were as follows: improve access of men to their general practitioner; reduce salt content in food to lower blood pressure; lower serum cholesterol levels; educate about lifestyle modification; especially exercise and diet to control weight; consider a thorough cardiovascular investigation in men presenting with erectile dysfunction; improve awareness amongst men of prostate health and erectile dysfunction; and educate men about colon cancer and encourage screening.

In general men are at significantly greater risk than women from nearly all of the common cancers that occur in both sexes (with the exception of breast cancer) (White 2009, Wilkins 2006, DH 2007). This report will consider the current overall burden of cancer among men in the UK, estimated from the latest statistics, and outline the extent of the differences between the sexes. All figures and calculations reported here are based on data extracted from the Cancer Research UK CancerStats web pages extracted in June 2009 (Cancer Research UK, 2009).

Plenary session.

Plenary session

Opening plenary session

The challenge of those working in the emerging field of men's health is outlined in this inaugural presentation given on the conferment of the first Chair in Men's Health. Discussion and debate to fully explore the parameters of what "men's health" actually means must be had with the broader academic community. In addition we have to establish what research is required to generate an evidence base in this fledgling discipline. Learning from, and guiding the development of, practice must also be a key element of this process. All this, though, requires campaigning: if our message does not get through to the politicians and the wider professional body then change will not occur. The final but most important aspect of this framework is to inform and enable men themselves. © 2006 by the Men's Studies Press, LLC. All rights reserved.

© 2014 Elsevier Inc. All rights reserved.Interest in 'men's health' as a separate issue has only recently occurred. Men's life expectancy tends to be shorter than for women when the reasons for this premature mortality are examined, serious issues of inequality emerge, both between men and women and between men from different socio-economic and cultural backgrounds. This chapter outlines the problems men face with their health, covering topics such as masculinity and male socialization, lifestyle, socio-economic status, and such specific health concerns as cancer, cardiac health, emotional health, and men's weight and the issue of violence. Activity in this growing field is also explored.

In this article, Alan White provides an overview of some of the main findings from the State of men's health in Europe report and relates them to the health of men in the UK.

Background: This epidemiological study is the first to explore patterns of mortality in young men and women (aged 15-44 years) worldwide. Its purpose was to chart differing national/regional patterns to illuminate causal factors of death in young men. Methods: Data from the new World Health Organisation Statistical Information Services Mortality Database was analysed for patterns of premature death in men and women aged 15-44 years across 44 countries. Rates of death from all causes were compared between men and women and the number of deaths calculated as a proportion of total deaths for each country. The study focused on six potentially avoidable categories of death: Accidents and Adverse Effects, Suicide, Malignant Neoplasms, Diseases of the Circulatory System, Homicide and Injury Purposely Inflicted by Other Persons, and Chronic Liver Disease & Cirrhosis. Results: Rates of death varied between countries and between men and women. The causes of death for both men and women differed markedly between the age groups 15-34 years and 35-44 years. Men's higher rates of deaths for Accidents and Adverse Effects persisted across all the age groups but deaths resulting from disease processes rose rapidly in the age group 35-44 years. Conclusions: Every country has an excess of male deaths due to potentially avoidable causes. The main causes of death are those that are more or less directly attributable to lifestyle and risk taking. More research is required but policy makers and health practitioners should already start to use the available data to develop better-targeted healthcare services for young men. © 2006 WPMH GmbH.

The meaning of acute chest pain to men and how their masculinity affects the way that men respond to the care provided have received little attention in nursing research or nursing literature. The data for this paper were collected through participant observation whilst clinically working with men who had been admitted with acute chest pain. This paper will present a key theme that emerged from this study, relating to the dissonance that the men experienced when the initial pain that brought them to the hospital was quickly removed leaving them no longer feeling 'ill'. This paper will also argue that there is a need to consider the theories on masculinity to help in interpreting the reactions of the male patient to their condition and also to help direct the care that is being provided.

Background: A European-wide study of men's health was carried out to determine the health needs of men. Methods: Mortality and morbidity statistics from the World Health Organisation Statistical Information Service (WHOSIS), the European Union (Eurostat), the Organisation for Economic Co-operation and Development (OECD), Globocan and other important European sources were used. Results: Differences were found between the health of men and women across all age groups. Wide country-to-country variations in the influence of the different health issues were evident, with clear geographical differences for some disease states. Men had a higher rate of death than women for a wide range of risks such as ischaemic heart disease, cancer of the colon, accidents and deaths due to external causes. Conclusions: There is a need to create greater equity in health status between countries and between the sexes. © 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.

This paper reports on an analysis of the interactions that occurred between nurses and men admitted with acute chest pain. Background and aim: Men admitted to hospital after experiencing chest pain were the focus of a study into men's transition from being well men to ill men. During the study it became apparent that nurses adopted strategies to manage the men through this early acute phase of their illness. Methods: Data were collected through fieldwork using participant observation on an acute medical admissions ward and an intensive care unit with dedicated coronary care beds. Twenty-five men were included in the study with 10 followed through to discharge. An interpretive grounded theory was used to direct the data collection and analysis. Results: The men and nurses were seen to be part of a complex interplay, but three main types of interaction were identified: supportive, controlling and educative/informative. Discussions with the men suggests a key factor in the men's experiences was the interactions they had with the nursing and medical staff. Conclusions: Attention should be given to nurses' awareness of men's coping strategies when faced with sudden health change and how their actions impact on their recovery.

Context: Men seem to be at greater risk of both developing and dying from those cancers that should affect men and women equally. Objective: In this review, we argue for a more proactive approach to be adopted in relation to men's increased susceptibility to cancer. Evidence acquisition: Cancer data from Cancer Research UK and the UK National Cancer Intelligence Network were reviewed. Evidence synthesis: In the United Kingdom, men have a 69% higher mortality rate and a 62% higher incidence rate for the major cancers, which should affect men and women equally. The rate of premature death is correspondingly high, with more than 37 000 additional years of life presumably lost for working-age men (15–64 yr) as a result of death from cancer. This pattern is repeated elsewhere but has received little attention. Conclusions: It is unclear why men are at greater risk, but a more proactive approach should be taken to identify this issue as worthy of exploration and to reach out to men at risk.

BACKGROUND: The prevalence of male obesity is increasing but few men take part in weight loss programmes. We assessed the effect of a weight loss and healthy living programme on weight loss in football (soccer) fans. METHODS: We did a two-group, pragmatic, randomised controlled trial of 747 male football fans aged 35-65 years with a body-mass index (BMI) of 28 kg/m(2) or higher from 13 Scottish professional football clubs. Participants were randomly assigned with SAS (version 9·2, block size 2-9) in a 1:1 ratio, stratified by club, to a weight loss programme delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss programme within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet. Primary outcome was mean difference in weight loss between groups at 12 months, expressed as absolute weight and a percentage of their baseline weight. Primary outcome assessment was masked. Analyses were based on intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN32677491. FINDINGS: 374 men were allocated to the intervention group and 374 to the comparison group. 333 (89%) of the intervention group and 355 (95%) of the comparison group completed 12 month assessments. At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (95% CI 3·95-5·94) and percentage weight loss, similarly adjusted, was 4·36% (3·64-5·08), both in favour of the intervention (p<0·0001). Eight serious adverse events were reported, five in the intervention group (lost consciousness due to drugs for pre-existing angina, gallbladder removal, hospital admission with suspected heart attack, ruptured gut, and ruptured Achilles tendon) and three in the comparison group (transient ischaemic attack, and two deaths). Of these, two adverse events were reported as related to participation in the programme (gallbladder removal and ruptured Achilles tendon). INTERPRETATION: The FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity. FUNDING: Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust. The National Institute for Health Research Public Health Research Programme funded the assessment (09/3010/06).

This article documents the authors' efforts to listen to Nicaraguan men and to explore with them the foundations of their sexual behavior and masculinities. In 1999 and 2000, the authors conducted focus groups involving ninety men from the Pacific side of Nicaragua. From analysis of the text of these interviews, five discourses were identified: a traditional patriarchal discourse ( machismo), a Catholic discourse, a Western progressive (liberal feminist) discourse, a pro-feminist discourse, and a medical discourse. The authors argue that these discourses construct a series of tensions within Nicaraguan masculinities that greatly affect Nicaraguan men's ability to play a role in change and suggest strategies through which the men may be helped to resolve these tensions and therefore play an active role in the social and political changes that are profoundly affecting the positions of both women and men in Nicaraguan society.

It is only recently that men's health has been recognized as an area that warrants specific attention. It has been known that men die sooner than women but when the reasons for this premature mortality are examined, serious issues of inequality emerge, both between men and women and between men from different socio-economic and cultural backgrounds. This chapter outlines the problems men face with their health, covering topics such as masculinity and male socialization, lifestyle, socio-economic status, and such specific health concerns as cancer, cardiac health, emotional health, and men's weight and the issue of violence. Activity in this growing field is also explored. © 2008 Copyright © 2008 Elsevier Inc. All rights reserved.

A literature search revealed no systematic enquiry into the experience of humour by nurses in the intensive care setting, suggesting that there was a need for such studies (Astedt-Kurki & Liukkonen 1994). This phenomenological study was undertaken using an interpretive human science approach of phenomenology grounded in the hermeneutics of Heidegger. The task was to investigate and describe the concept of humour in an intensive care unit (ICU) from an inductive–descriptive perspective, seeking to identify the essence of the phenomenon through an accurate description of the lived experience of humour. A sample of eight nurses with at least one year’s intensive care experience was randomly selected. Semi-structured interviews were conducted, audiotaped, transcribed into text, checked for transcription errors, and returned to participants for checking to ensure reliability and validity. Main core themes were identified and categorized, then Colaizzi’s seven steps were used for analysis. Themes and categories identified in the collected data were rich and varied, allowing for lengthy discussions on thoughts and experiences. The study revealed a rich experience of humour in the ICU, suggesting that humour is central to nursing, and therefore worthy of deeper analysis using the same methodology.

Around 630,000 men die between the working ages of 15 and 64 years across the 27 countries in the European Union, compared to 300,000 women. Most of the causes are preventable, highlighting the large number of premature deaths that could be avoided.

There is growing evidence to suggest that men are at increased risk of premature death from a broad range of health conditions. With the government’s mandate to reduce premature death, it is necessary to have an understanding of the health challenges faced by men. This article provides an overview of mortality data for men and women aged 15-64, with a focus on those aged 15-54, in England and Wales during 2011. Mortality data are viewed in relation to the main reasons for premature death in the male population. Initiatives aimed at addressing the health and social care needs of men are identified to raise awareness of the importance of targeting this population to reduce premature mortality.

During the month of November, the Movember Foundation challenges men to grow a moustache in an effort to raise vital funds and awareness for the often ignored health issues affecting the male population. Global health-care delivery and policies, which have focussed on women's, children's and minority's health for the past few decades, need now address these issues.

Zusammenfassung Ziel der Studie: Männergesundheit gerät immer stärker in den Fokus von Gesundheitsforschung, Epidemiologie, Gesundheitspflegeorganisation und Gesundheitspolitik. In den vergangenen 10–15 Jahren wurden von einigen Ländern und der EU Männergesundheitsberichte publiziert, in denen auf Probleme der Gesundheit beim Mann hingewiesen wurden. Ausgangspunkt für eine wissenschaftliche Untersuchung von Männergesundheit ist die Definition des Begriffs „Männergesundheit“. Eine Gruppe von deutschen Experten auf dem Gebiet von Männergesundheit hat sich dieser Aufgabe angenommen. Methodik: Eine Literaturrecherche in internationalen und nationalen Datenbanken erfolgte für die Jahre 1990–2014 nach ausgewählten MeSH Terms und nach „Experten für Männergesundheit“, nach „grauer Literatur“, in Gesundheitsberichten und Webseiten. Es folgte eine Expertenkonferenz zur Definitionsfindung mittels modifizierter Delphi Methode nach W. Zinn. Von der Expertengruppe wurden Mindestkriterien für eine Definition Männergesundheit erstellt und diskutiert, denen die neue Definition von Männergesundheit genügen muss. Daraus wurde in der dritten Runde schrittweise eine Definition erstellt. Ergebnisse: Die internationale Literaturrecherche ergab 7 Definitionen zu „Men’s Health“ in der englischsprachigen und 5 Definitionen in der deutschen inkl. in der „grauen“ Literatur. Aufgrund der von der Expertengruppe erarbeiteten 7 Mindestkriterien wurden 15 relevante Themengebiete gelistet, von denen durch Gewichtung 8 Themengebiete als relevant für eine neue Definition angesehen wurden. Im Abgleich mit den bisherigen Definitionen konnte keine diese 8 Kriterien erfüllen. Deshalb wurde im nächsten Arbeitsschritt von der Expertengruppe eine neue Definition Männergesundheit ausgearbeitet. Die Definition hat Bezug zum WHO-Begriff „Gesundheit“ und beinhaltet Dimensionen von Gesundheit und Krankheit, Risiko- und Schutzfaktoren, die spezielle Präventions- und Versorgungsangebote über alle Lebensphasen erfordern. Alle Teilnehmer der Expertengruppe stimmten der erarbeiteten Definition zu. Schlussfolgerung: Die Definition von Männergesundheit stellt eine Basis für weitere wissenschaftliche Arbeiten und die Praxis dar, um Männergesundheit in Deutschland und weiteren Ländern zu verbessern. ______________________________________________________________________________________ Summary Target of the study: Men’s Health is increasingly coming into focus of health research, epidemiology, health care organization, and health policy. Over the past 10–15 years have been published by some countries and the EU Men’s Health reports where problems of health noted in men. Starting point for a scientific study of men’s health is the definition of “Men’s Health”. A group of German experts in the field of men’s health has taken on this task. Methodology: A literature review in international and national databases was performed for the years 1990–2014 by selected MeSH terms and for “experts for men’s health”. Another research concerned “gray literature” in Germany, especially health reports and web pages. This was followed by a conference of experts to define “Men’s Health” using a modified Delphi method according to W. Zinn. From the expert group minimum criteria for a definition “Men’s Health” were created and discussed, which must comply with the new definition of men’s health. This definition was created in the third round of the Delphi method. Results: The international literature review yielded 7 definitions of “Men’s Health” in the English-speaking and 5 definitions in the German inkl. in the “gray” literature. Due to the developed by the Expert Group 7 minimum criteria 15 relevant topics were listed, of which by weighting 8 subject areas were considered relevant for a new definition. In comparison with the previous definitions none could fulfill these 8 criteria. Therefore, in the next step of the expert group a new definition “Men’s Health” was elaborated. The definition has reference to the WHO concept of “health” and includes dimensions of health and disease, risk and protective factors that require special prevention and care services for all phases of life. All participants in the expert group agreed on the definition developed. Conclusions: The definition of Men’s Health is a basis for further scientific work and practice to improve men’s health in Germany and other countries. Schlüsselwörter Männergesundheit - Gesundheitsressourcen - Lebensstil - Lebensqualität - Gesundheitsangebote für Männer Key words men’s health - health resources - lifestyle - quality of life - delivery of health services for men

In this article, some of the most important findings of the European research project The Role of Men in Gender Equality (2011–2012) are discussed. This project was the first systematic research study of all European Union member states and associated European Free Trade Association states regarding men and gender equality in the fields of education and paid labor, the involvement of men in care and domestic work responsibilities, men’s health, gender-based violence, and men’s participation in gender equality policy. The main objective of the study was to gain better knowledge on the role and positioning of men concerning gender equality. A number of themes were emphasized. First, as the situation of men and women in societies is relational, the role of men cannot be understood, if the role of women is neglected. Second, a perspective on men as a heterogeneous social group was chosen in order to gain insights into men’s privileges as well as disadvantages according to class, ethnicity, disability, and other social indicators. This study shows that caring masculinity emerges as a central path forward, and one that is increasingly taken up in practice, together with women’s increasing education and professional role, and rising expectations of gender-balanced task divisions. But there is a need for further research on the complex relationship between caring masculinities and gender-equal roles, including marginalized and unemployed groups and men who turn their frustrations against gender equality and women’s new roles.

Vaginal microbicides are heralded as a woman’s HIV prevention method. This ethnographic study, conducted in a trial setting in Zambia, explored how the social construction of masculinity and sexual behaviour influenced the acceptability of vaginal microbicides from the man’s perspective. The data was generated from 18 In-depth Interviews (IDIs), and 8 Focus Group Discussions (FGDs). The data was analysed thematically. The study found that hegemonic masculinity influenced the use of gel use among women in multiple ways: decision to initiate gel use, autonomous use of the gel and consistent use of the gel. Men were seen as heads of households and decision makers who approved their partners’ intentions to initiate gel use. Autonomous gel use by women was not supported because it challenged men’s position in sexual matters and at family level. The socially accepted notion that men engaged in multiple sexual relationships also influenced women’s decision to use the gel. Sustained gel use depended on the perceived effect of the gel on men’s sexual desires, sexual performance, fertility, and sexual behaviour. This study suggests that acceptability of microbicides partially lies within the realm of men, with use constrained and dictated by cultural constructs and practice of masculinity and gender.

Objective: To identify typologies of experiences and coping strategies of men with RA Design: Q-methodology (a qualitative and quantitative approach to grouping people according to their subjective opinion). Men with RA sorted 64 statements relating to their experience of living with RA according to level of agreement across a normal distribution grid. Data were examined using Q-factor analysis. Setting: Rheumatology outpatient departments in the UK Participants: 30 of 65 invited men with RA participated in this study (46%) Results: All participants ranked highly the need to be well informed about their medication and the importance of keeping a positive attitude. Two factors describing the experiences and coping strategies of male patients living with RA were identified: Factor A: “Acknowledge, accept and adapt” (n=14) take a pro-active approach to managing the impact of RA and find different ways of doing things; whilst Factor B: “Trying to match up to a macho ideal” (n=8) are determined to continue with their pre-RA lives, and therefore push themselves to carry on even if this causes them pain. They are frustrated and angry due to the impact of RA but they internalise this rather than directing it at others. Conclusion: Whilst some men adapt to their RA by renegotiating their masculine identity, others struggle to relinquish their traditional masculine roles. Further research is needed to identify whether the finding that there are two distinct groups of men with RA can be generalised, and if so whether the differences can be explained by clinical, social or psychological factors, which may inform different therapeutic approaches.

A recent European report on men’s health shows that it lags behind that of women. Alan White and colleagues analyse the problems and call for more policy, practice, and research aimed specifically at men

This report is structured into two parts. Part 1 comprises an introduction which provides a concise overview of men, maleness and masculinity. This is followed by an analysis considering the structure of the male population and provides a picture of the implications for how men live, are educated and work. A section reviewing men’s lifestyles and preventable risk factors gives a detailed overview of men’s health behaviours, which in the most part contribute to much of men’s premature mortality. In the section reviewing the issues of men’s access to health services we present the gender variations that impact on men’s interactions with health services. In Part two the section on Health Status presents the overall state of men’s health. The subsequent chapters address specific health conditions and the impact they have on men and their health. Each chapter highlights the main points followed by a stand alone summary of the contents. The rest of the chapter discusses the issues in detail supported by data as referenced. The references are provided in an alphabetical list at the end of each section.

This Third Edition of Men’s Health provides a comprehensive and authoritative reference source to urologists, andrologists, family practitioners, and all professionals dealing with the male patient who diagnose and treat males with a variety of health problems, such as prostate cancer, male osteoporosis, and testicular cancer. The new edition been completely reorganized into disease- and problem-based sections, to highlight important topics such as cancer and premature cardiovascular disease. There is also new material on some of the less frequently explored areas of men's health, such as Tourette's Syndrome, depression, and cosmetic surgery.

Men – in all their diverse groups, settings, lifestyles and stages of life – can face considerable challenges to their mental wellbeing from specific cultural and societal factors, causing difficulties for themselves and those who live and work with them. In addition, these men may respond better to certain approaches and treatment. Promoting Men’s Mental Health outlines the breadth of the challenges and provides guidance for those working in primary care on targeting and helping men who need support. Good mental health is more than the absence of mental illness, and this book therefore highlights methods to promote positive mental health by increasing psychological wellbeing, competency and coping skills, and by creating supportive living and working environments. The book highlights examples of best practice throughout the UK, Europe and America, and will be essential reading for primary care and mental health professionals, and all those with an interest in men’s mental health.

Male weight problems are a serious public health issue and can lead to hypertension, hyperlipidaemia, diabetes and cancer.

Aim.  To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan.

Background.  Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio‐economic changes, has resulted in nursing homes becoming a new and significant care option.

Design.  A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan.

Methods.  Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures.

Results.  The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, ‘becoming a problem’, ‘making a forced choice’ and ‘coping with the forced choice’.

Conclusion.  Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialisation exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice.

Relevance to clinical practice.  This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people.

This article provides population norms for the Short Form Perceived Stress Scale (PSS-4) and investigates the relationship between PSS-4 scores and sociodemographic variables. The PSS-4 was administered to an English sample ( n = 1568) and was found to have acceptable psychometric properties. Sociodemographic variables explained 19.5% of variance in PSS-4 scores, and mean PSS-4 scores were significantly different from the mean scores reported in Cohen and Williamson’s original study. Greater levels of perceived health status, greater levels of social support, being male and being older were predictive of lower PSS-4 scores. Norm values for interpreting PSS-4 scores are presented.

Background Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. There is still a dearth of understanding on where sex differences exist along the pathway from presentation to survival. The aim of this review is to identify where actions are needed to improve outcomes for both sexes, and to narrow the gap for CRC. Methods A cross-sectional review of national data was undertaken to identify sex differences in incidence, screening uptake, route to diagnosis, cancer stage at diagnosis and survival, and their influence in the sex differences in mortality. Results Overall incidence is higher in men, with an earlier age distribution, however, important sex differences exist in anatomical site. There were relatively small differences in screening uptake, route to diagnosis, cancer staging at diagnosis and survival. Screening uptake is higher in women under 69 years. Women are more likely to present as emergency cases, with more men diagnosed through screening and two-week-wait. No sex differences are seen in diagnosis for more advanced disease. Overall, age-standardised 5-year survival is similar between the sexes. Conclusions As there are minimal sex differences in the data from routes to diagnosis to survival, the higher mortality of colorectal cancer in men appears to be a result of exogenous and/or endogenous factors pre-diagnosis that lead to higher incidence rates. There are however, sex and gender differences that suggest more targeted interventions may facilitate prevention and earlier diagnosis in both men and women.

BackgroundSchizophrenia is a severe mental health condition that impacts more heavily on men. In Nigeria, studies on men and health have mainly focused on sexual health, in contrast, men’s experience of schizophrenia and the role of gender in influencing beliefs about their recovery has rarely been studied. This study explored men’s perceptions of developing schizophrenia in northern Nigeria and what emerged as facilitating factors in their recovery. MethodThis qualitative study utilized semi-structured interviews with 30 male outpatients with a previous diag-nosis of schizophrenia and 10 mental health professionals. All were recruited through Nigerian psychiatric hospital clinics. A thematic approach informed analysis of the data collected. ResultsA commitment to flexibility in gender-relations emerged as a key finding. Within household members, the meeting of financial needs was talked about interchangeably. This flexible gender-relations was then associ-ated with household poverty reduction, which was previously seen as influencing the men’s recovery from the mental illness. In particular, providing for family needs became a shared responsibility, with departure from traditional gender expectations imposing fewer family hardships. This was also reported as having a bearing on the men’s willingness to access services, which aided recovery. ConclusionThe influence of flexible gender-relations demonstrated in this study has practice implications for under-standing men’s management of recovery from schizophrenia. Community-focused gender transformative programs for the men and those involved in their care in Nigeria could help engage participants in discus-sions relevant to facilitate changes in gender expectations.

The state of men's health, internationally, is a deep public health concern. Despite pressure from the World Health Organisation that all health policy should consider the specific needs of both men and women through their push for 'gender mainstreaming', and increased interest in men's health, there have been relatively few gendered policy responses relating to men's health. In this article, we compare the men's health policy contexts in Australia, the UK and Ireland. We show that different advocacy groups have lobbied for men's health policies in these three jurisdictions and that different approaches have been adopted in order to advance or abandon men's health policy work. The absence of men's health policies or gender mainstreaming has severely limited the capacity to develop well-co-ordinated national programmes that meet the health needs of men and their families. © 2009 Taylor & Francis.

The Health of Men (HoM) network received funding from the Big Lottery Fund in 2003 to establish a five year programme of dedicated work with men and boys. This enabled a team of practitioners to be creative and to build upon their existing skills to generate models of working with those men in the community that are usually seen as hard to reach. The research which has accompanied of the work of team has explored why men use these new services and has demonstrated the following: • Men do care about their health • Men are willing and able to engage with their health when services are tailored to their needs • Men from different culture groups and socio-economic backgrounds who are normally seen as hard to reach were accessed. • A model encompassing a dedicated team working with men is worthy of further development Much has been learnt from this project that has great relevance to the local Primary Care Trust (PCT), but has also proved a great source of information for the development of services to men on a Regional, National and International level.

Tackling Men’s Health is an intervention developed out of a partnership between the Department of Health, Leeds Rhinos Rugby League Club and Leeds Metropolitan University. The intervention was designed to target men attending Headingley Carnegie Stadium, with the aim of promoting engagement with health services and therefore promoting improved health and wellbeing. The primary aim of the of the Tackling Men’s Health study is to assess engagement in an intervention targeting men attending rugby matches. Secondary aims of the research study are to: To assess the barriers and facilitators associated with implementing a health promotion intervention targeting men attending rugby league games To examine the effect of a multi-component targeted intervention on men’s self reported engagement with health services To examine the effect of a multi-component targeted intervention on men’s awareness of key health issues To examine the effect of multi-component targeted intervention on men’s perceived health status The research study monitored the evolution of the Tackling Men’s Health intervention, which was delivered in sports settings over the course of the 2009 Engage Super league Rugby league season. Seven stakeholders and 20 men who attended Rugby league matches were interviewed to achieve a broad understanding of appropriateness of the processes used in the planning and delivery of the Tackling Men’s Health intervention.

Introduction As the largest city in northern England, Leeds has a vision to be a healthy and caring city, where the poorest improve their health the fastest. Recent data show sex-differences in mortality and morbidity and the City Council highlighted concerns about men’s engagement with services. A review of men’s health was funded. Methods Interviews were conducted with commissioners. Descriptive statistics were used to analyse data (including Census 2011, GP audits and the Public Health Observatory) to determine the health, socio-economic status and local service use of the male population at a city and local area level (MSOA). Content analysis of city-wide strategies was completed to summarise their gender-sensitivity. Results Men were more likely to die prematurely than women (20% of male deaths occurring before age 65 compared to 12% of female deaths) and more likely to engage in unhealthy lifestyle behaviours, yet less likely to use available services than women. Whilst men were rarely mentioned specifically, inequalities were a consistent theme in citywide policy. Following this review, the latest Joint Health and Wellbeing Strategy highlighted the impact of gender on health outcomes and suggested a more person-centric approach to service provision. The review influenced the ageing-well, healthy living, cancer and mental health service specifications. Conclusion This review identified where men have the greatest needs and provided the evidence needed to get men’s health on the agenda in Leeds. This close working relationship between research and practice demonstrates how academic support can be utilised to improve commissioning and service design.

Objectives Men in the municipal setting of Leeds, UK were known to be at greater risk of preventable premature mortality compared to women (20% of male deaths occurring before age 65 compared to 12% of female deaths). Unhealthy lifestyles typically increase the risk of developing acute and chronic disease and dying prematurely. The objective of the research was to obtain knowledge of the difference between men’s and women’s lifestyles in order to develop specific gendered recommendations for the city’s healthy lifestyle service providers to improve men’s health behaviours. Methods Data for smoking status, alcohol consumption, physical activity status, weight classification and Healthy Lifestyles Service use of working age (16-64 years) males and females were obtained through General Practitioner (GP) audit data and reported at city level and across the 107 localities within Leeds. For each lifestyle factor, prevalence and proportion of the population with recorded data (known status) were calculated. Results The male vs. female prevalence of poor lifestyle factors were: smoker, 28% vs. 21%; alcohol consumption associated with increased or high risk to health, 20% vs. 13%; physically inactive, 24% vs. 29%; and above normal weight, 52% vs. 47%. Prevalence varied dramatically between localities, often higher in more deprived areas. Known status of unhealthy lifestyles differed across localities, with physical activity status and alcohol consumption not known for >80% of some local male populations. In total, 31.6% of Healthy Lifestyles Service users were men. Conclusions Compared to women in Leeds, men are generally more likely to engage in unhealthy lifestyle behaviours and yet are less likely to use available services. These findings suggest the importance of appreciating the different needs of men and women, and services developing suitable strategies to specifically reach out and target men. Improvements in data collection should be made to ensure those with the greatest health needs are identified.

Leeds 2013 Joint Strategic Needs Assessment highlighted a four-year lower life expectancy in men compared to women but the underlying causes of this were not thoroughly understood. A review of men’s health and service use was funded. Analysis of GP audit and Public Health Observatory data showed that men were more likely to die prematurely than women (20% of male deaths occurring before age 65 vs. 12% of female deaths), more likely to engage in unhealthy lifestyle behaviours, yet less likely to use lifestyle services or complete health checks and bowel cancer screening. Large within-sex variation was observed at a local level (MSOA level). Inequalities were a consistent theme in citywide policy, however men were rarely mentioned. Following this review, the latest Joint Health and Wellbeing Strategy highlighted the impact of gender on health outcomes and suggested a more person-centric approach to service provision. The review influenced the healthy living, community health development and preventative cancer service specifications. This review identified where men have the greatest needs and provided evidence to get men’s health on the agenda in Leeds. This close working relationship between research and practice demonstrates how academic support can be utilised to improve commissioning and service design.

This poster explores the background and methodology of an evaluation of a programme intervention for men (16+ years) that experience angry emotions and/or exhibit violent behaviour. Men who experience feelings of anger and/or that behave in violent ways are limited in where they can go for support. In one locality, men who experience angry emotions or exhibit violent behaviour can self-refer, or can be mandated by court order, to attend a programme of facilitator and group-based peer support designed to reduce angry emotions and incidence of violent behaviour. A ‘realist’ methodology is being used in this evaluation, recognising that any programme intervention is embedded in existing social processes. The research (in progress) utilises qualitative methods of data collection and analysis. Qualitative data is elicited using semi-structured interviews. Interviews with intervention staff and stakeholders have led to the development of ‘programme theories’ about how the intervention works, for whom, in what contexts and why. These programme theories are expressed as Contexts, Mechanisms and Outcomes (CMO) configurations. These CMOc will be tested and refined in future fieldwork with the participants of the 12 week programme intervention.

BACKGROUND: The social determinants of health have a disproportionate impact on mortality in men. A study into the state of health of the male population in Leeds was undertaken to guide public health commissioning decisions. This paper reports on the data relating to the social lives of men. METHODS: A cross-sectional study was undertaken, comprising descriptive analysis of data relating to educational attainment, housing, employment (including benefit claimants), marital status and relationships. Data was considered for the whole city and localised at the Middle Super Output Area (MSOA) level and mapped against the Index of Deprivation. RESULTS: Boys' educational attainment was found to be lagging behind girls' from their earliest assessments (Early Years Foundation Stage Profile, 46% vs. 60%, P = 0.00) to GCSEs (53% vs. 63%, P = 0.00), leaving many men with no qualifications. There were 68% more men than women identified as being unemployed, with more men claiming benefits. Men living in social housing are more likely to be housed in high-rise flats. Almost 50% of men aged 16-64 are single, with 2254 lone fathers. CONCLUSIONS: There appears to be a lack of sex/gender analysis of current cross city data. In areas of deprivation a complex picture of multiple social problems emerges, with marked gender differences in the social determinants of health, with males seeming to be more negatively affected. There is a need for more focused planning for reaching out and targeting boys and men in the most deprived inner city areas, so that greater efficiency in service delivery can be obtained.

Men are a numerical minority group receiving a diagnosis of, and treatment for, depression. However, community surveys of men and of their mental health issues (e.g. suicide and alcoholism) have led some to suggest that many more men have depression than are currently seen in healthcare services. This article explores current approaches to men and depression, which draw on theories of sex differences, gender roles and hegemonic masculinity. The sex differences approach has the potential to provide diagnostic tools for (male) depression; gender role theory could be used to redesign health services so that they target individuals who have a masculine, problem-focused coping style; and hegemonic masculinity highlights how gender is enacted through depression and that men’s depression may be visible in abusive, aggressive and violent practices. Depression in men is receiving growing recognition, and recent policy changes in the UK may mean that health services are obliged to incorporate services that meet the needs of men with depression.

Background: This study followed a group of men as they went through a programme of weight loss sessions run by the Health of Men team within the workplace, as part of a wider project that was exploring why men used the Bradford & Airedale Health of Men (HoM) community-based services. Method: A qualitative approach was adopted, using field notes based on the sessions observed and interviews with the men using the service and the HoM team. Results: The men were very positive about wanting to join the sessions and they all reported that they had seen changes in their health attitudes and their health behaviours. The men felt that they would not have accessed the sessions if they had been outside of the workplace. Conclusion: Going into the workplace helped recruit men onto a well received weight management programme and can be seen as an example of a wider issue of how mainstream health services can be integrated with the more traditional occupational health provision. © 2008 WPMH GmbH.

With the end of the first decade of the 21st century comes a good opportunity to reflect on where we have come from and where we appear to be going with regards to men’s health. Copyright © 2010 Wiley Interface Ltd

Background: The setting where we deliver male targeted interventions is an important factor in achieving engagement. In recent years a body of work has emerged targeting men in the workplace. There have however been much fewer examples of the use of leisure settings. While not all men enjoy watching sport, sport is an important and integral part of male, culture providing entertainment and social spaces for men from a range of different backgrounds. The key role which sport plays in the lives of many men gives sports clubs a unique position within communities, providing a hub where men convene on a regular basis. This paper presents the key findings from the evaluation of the pilot phase of the Tackling Men's Health (TMH) intervention, a health promoting intervention targeting men attending Rugby League matches at a large UK sports stadium. Methods: The presentation uses data collected for the evaluation of the TMH programme. Four data components were collected: 1) Quantitative data on awareness and use of TMH using a pre and post questionnaire, delivered to 202 male attenders of the stadium. 2) Semi-structured interviews with 20 male attenders. 3) Semi-structured interviews with 8 stakeholders involved in the planning, implementation and delivery of the TMH intervention. 4) Routinely collected service delivery data. Thematic analysis was performed on interview data, questionnaire data was analysed within SPSS v16. Results: Themes which emerged from stakeholder interviewees included the perceived importance of a strong collaborative partnership between the sports club and the intervention team, early planning, and link-up with relevant local and national campaigns. Barriers to establishing the service were perceived to include the complex layout of the stadium and conflicting agendas between being a sports fan and engagement with the service. Despite these barriers the intervention achieved strong rates of engagement, 82 men received health checks (37 of whom required follow-up checks), seven men attended the TMH male weight loss group (6 of whom lost weight) and 190 men informally engaged with the service. Conclusion: The presentation concludes with a statement on the feasibility of a male health intervention delivered within the stadium setting. A recommendation is made to commissioners and deliverers of male health services for more joined up working with sports clubs in piloting and evaluating further health interventions within stadia settings.

The NHS has required forty four identified planning footprints across England to produce a Sustainability and Transformation Plan (STP). The 44 footprint leads were given the task of breaking new ground in the battle to close the three fundamental gaps in health: health and wellbeing, care and quality, and finance and capacity 1, with the underlying message that money has to be saved. This was also opportunity to radically transform the NHS, to re-think where the majority of money is spent and identify where action may see the biggest bang for our limited buck. The cost of men to the NHS is great; they have higher rates of hospitalisation across nearly all diseases, have higher accident rates and greater rates of premature death and disability. They are less likely to take up screening and yet more likely to develop cardiovascular disease in their early years and develop and die from nearly all cancers. This is driven by higher rates of smoking, alcohol intake, hazardous working, mismanaged emotional and mental health problems combined with the issue that men are more likely to be overweight with harmful abdominal fat amongst other socio-cultural and biological factors2,3. Looking at the published STPs, 15 of the 44 note that men have higher rates of death – 29 do not. Eleven comment specifically on the more negative impact of austerity on men – including the 20 year life expectancy difference in the Humber, Coast and Vale STP4. But that’s it – there is no mention of what is to be done, no focused targeting of this biggest financial burden (as well as the health and wellbeing, care and quality gaps in provision!). That there is not a single inclusion of the word ‘men’ or ‘male’ in 22 of the STPs compounds the feeling that men have been invisible in the health service and may remain so – despite them being a protected group under the Equality Act. As these are drafts there is still time for a re-think especially as there is now talk of a new national NHS Five Year Forward View delivery plan; there needs to be a wake-up to the benefit of reaching out and targeting men on the overall health and wellbeing of the nation – as well as reducing the cost. 1. NHS. Five year forward view [Internet]. London: NHS England; 2014. Available from: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf 2. White A, Seims A, Newton R. The State of Men’s Health in Leeds: Main Report. Leeds: Leeds Beckett University, Leeds City Council; 2016. 3. Seims A, White A. The State of Men’s Health in Leeds: Data. Leeds: Leeds Beckett University, Leeds City Council; 2016. 4. NHS. Humber, Coast and Vale STP. Humber, Coast and Vale: NHS;

Patient choice is nothing new (1) but it is a motif that is increasingly mobilised by politicians, policy-makers, and health service providers across much of the Western world. Despite its global resonance, we want to make the case for considering the complexity of the contexts in which patient choice is offered. In this paper, we consider research in relation to the domain of localised prostate cancer in the UK, specifically to choosing treatment after first diagnosis. Before making some recommendations for research, the UK context is elaborated through a consideration of health policy, which is then related to changes in a specific service (the Yorkshire Cancer Centre) and research on patients’ experiences of treatment.

BACKGROUND: A feature of the health of men across Europe is their higher rates of premature mortality and shorter life expectancy at birth than women. Following the publication of the first State of Men's Health in Europe report, we sought to explore possible reasons. METHOD: We analyzed trends in life expectancy at birth in 19 European Union member states (EU19) between 1999 and 2008 using mortality data obtained from Eurostat. We then used Pollard's decomposition method to identify the contribution of deaths from different causes and at different age groups to differences in life expectancy. RESULTS: Between 1999 and 2008, life expectancy at birth in the EU19 increased by 2.74 years for men and by 2.09 years for women. Most of these improvements were due to reductions in mortality at ages >60, with cardiovascular disease accounting for approximately half these improvements for men. In 2008, life expectancy of men in the EU19 was 5.92 years lower than that of women. Deaths from all major groups of causes, and at all ages, contributed to this gap, with external causes contributing 0.96 years, cardiovascular disease 1.80 years and neoplasms 1.61 years. CONCLUSION: Improvements in the life expectancy at birth of men and women have mostly occurred at older ages. There has been little improvement in the high rate of premature death in younger men, suggesting a need for interventions to tackle their high death rate.

Background: In 2011 the European Commission launched the report ‘The State of Men's Health in Europe’ covering the health of 290 million men across 34 European countries. This is the first official statement on the health of men in Europe. The work was carried out by a team of writers from across Europe aided by a management advisory group, a reviewing group and a broader reference group. Methods: Data from major international databases were used to compile a detailed analysis based on population data, lifestyle and preventable risk factors, use of health services and morbidity and mortality data based on the ICD-10, with the results focused on the “European shortlist” of 65 causes of death. Results: Changes in male demographics are creating a reversal in the age distribution ratio, with a decreasing younger population but increasing numbers of elderly men. The data on morbidity and mortality are most striking in relation to the high levels of premature death in men across the disease spectrum with marked differences between countries. Conclusions: The very large variations seen in the health of men across Europe demonstrates that much of men's higher risk of premature death is caused by socio-cultural factors and therefore avoidable. No country should be complacent about the health of its male population.

Forty-four Sustainability and Transformation Plans (STPs) were introduced in NHS planning guidance in December 2015. Draft STPs were published in late 2016. The plans bring together providers, commissioners, local government, and third-sector organisations to develop and deliver new models of care.1 These models aim to improve the quality, efficiency, and sustainability of healthcare services, across England over the next 5 years.2 Concerns have been raised about the impact of STPs on GP provision,3 on patient groups,4 and on the number of hospital beds.5 The purpose of this study was to identify the detail relating to rehabilitation, occupational therapy, and physiotherapy in STPs. Occupational therapy and physiotherapy are two of 12 professional groups that make up allied health professionals (AHPs). AHPs are the third largest workforce in health and care in England. A recent AHP strategy from NHS England6 has provided a blueprint by and for AHPs to contribute to future services, including STPs. The Chartered Society of Physiotherapy7 has promoted STPs to move towards a model of health prevention and a rehabilitation system that supports collaboration and integration across local systems; for example, NHS trusts and local authorities. The Royal College of Occupational Therapists8 agreed that STPs can provide a vehicle for occupational therapists to deliver early action, prevent admission to hospital, and implement a reabling approach that improves patient outcomes and saves money...

A report to reflect on learning from the Leeds URBACT Project, a project between partners in the NHS and Leeds City Council which looked at the relationship between health innovation and community engagement.

Within the UK, there is growing recognition that individuals will need to take increased responsibility for managing their own health for there to be improvements in population health. The current evidence base on self care interventions reflects an interest in enhancing self care knowledge, skills and behaviour in relation to the management of long-term conditions. In contrast, this paper reports on a community-based self care initiative that was designed to promote self care approaches in the general population. The principal component was a self care skills training course delivered to groups of lay people in community and workplace settings. Self Care for People was piloted in three primary care trusts and a process evaluation was undertaken. The aim of this paper is to examine the feasibility, relevance and acceptability of the initiative. Qualitative interviews were conducted with a sample of stakeholders involved in implementation including coordinators, trainers and key informants from organisations hosting the course. In total 40 interviews and two focus groups were conducted from 2006 to 2008 and the data were analysed thematically. The evaluation found that implementation was relatively straightforward with few major barriers reported. Recruitment to the self care skills training course took place in both workplace and community group settings, including in organisations supporting socially excluded groups. The course was seen to provide a valuable space for contemplation on personal health, however, participation could raise sensitive issues that needed to be dealt with by skilled facilitators. Motivations for involvement differed markedly in host organisations and different strategies for marketing were adopted. The paper concludes by suggesting that while Self Care for People was both feasible and relevant to different stakeholder groups, there needs to be flexibility in responding to the needs of participants in different settings. © 2010 Blackwell Publishing Ltd.

Background: Penile cancer is a rare but highly treatable condition. Current guidance recommends the use of a surgical procedure to excise the primary tumour (and a margin of normal penile tissue). Whilst treatment can be effective, treatment often has a significant impact on a patient's sexual and urinary function, and physical and mental wellbeing. The objective of this study was to explore the impact of treatment for penile cancer on sexual function and relationships. Methods: Qualitative data was collected via narrative video interviews. Maximum variation sampling was used to acquire the widest possible range of experiences. All interviews were recorded using either a digital video recorder or digital audio recorder, transcribed. A method of constant comparison analysis was used to illicit themes and outliers. Results: Twenty seven men were interviewed; mean age at diagnosis = 63 (range = 41-82); Mean number of years post-surgery = 3 (range = 0-15 years) 15 men were married, a further two were in a committed relationship, the remaining 10 were single/widowed. All men had received surgical treatment ranging from circumcision to total penectomy. Just two men had attended any form of psychological therapy. The impact of treatment varied considerably. The majority of men talked about still being able to experience arousal and sexual pleasure in some way. However, for many, penetrative sex was awkward and less gratifying than before treatment. One man who had received a total penectomy was surprised to experience a form of orgasm after surgery. For a number of men, the impact of treatment on their ability to satisfy their sexual partners was a key concern. Men who were able to openly talk with their partners about sex and the impact of the treatment on sexual practice found this a great comfort. Conclusion: The significance of sex for a man can differ considerably between individuals; relationship status, age and life stage are all likely to have a bearing on the role that sex plays in a man life. A diagnosis of cancer can also affect how a man (and his partner) views sex and the level of importance which he attaches to it. For men who are sexually active prior to treatment, surgery will undoubtedly result in changes to sexual practice, however, treatment does not have to result in sexual abstinence.

To explore the challenges of engaging men with penile cancer in qualitative interview research.

PURPOSE OF THE RESEARCH: Penile cancer is a rare but highly treatable condition. Whilst over 80% survive for over five years, treatment can have a significant impact on quality of life. There has been little research conducted to date on men's experiences of treatment for penile cancer. The Patients Experiences of Penile Cancer study (PEPC) aimed to redress this shortfall by exploring men's experiences of surgical treatment for penile cancer. METHODS AND SAMPLE: The study used a narrative history design in which data were collected using one-on-one semi-structured interviews. Maximum variation sampling was used to acquire the widest possible range of experiences. Twenty-seven interviews of around one hour were conducted with men with an average age of 63 years at diagnosis (range = 41-82). The data were analysed using constant comparison analysis. KEY RESULTS: The physical impact of surgery was inter-connected with broader events in the lives of the men experiencing treatment. These experiences cover urinary function, sexual function and sexual relationships, healing and recovery, masculinity, mental well-being, coping and support. CONCLUSION: A key area for the development of care is to devise and evaluate procedures for ensuring that men are well-informed about the extent and potential consequences of their treatment. Men's experiences of penile cancer surgery will be informed by a complex web interlaced with their broader lives, making it difficult for health professionals to judge how surgery will impact on a men presenting to them. Further research is required to ascertain the most appropriate strategies for rehabilitation of men experiencing penile cancer surgery.

Objectives: Survival for penile cancer is high but treatment can have a long-term detrimental effect on urological function and quality of life. Due to its rarity, it is difficult to include men with penile cancer in research about their condition. The aim of this study was to identify aspects of their diagnosis and treatment that they would want explored in penile cancer research.    Design: The study employed a participative, mixed-qualitative-methods design; it utilised focus groups and patient-conducted interviews, combined into a one-day ‘pilot workshop’. The data were analysed using framework analysis.   Results: ‘Early signs and seeking help’, ‘disclosure of a ‘personal’ cancer’ and ‘urological (dys)function’ emerged as three key themes.   Conclusions: Men with penile cancer want research about their condition to explore early signs and helping seeking, disclosure of a ‘personal’ cancer and urological (dys)function. Research could use methodologies that include consideration of the chronological narrative of the experiences of men with penile cancer, which could be applied in clinical practice by integrating opportunities to explore specific aspects of their experiences at appropriate times along the care pathway.

In this article we outline methodological considerations for conducting research interviews with couples. We draw from two qualitative men’s health studies, both developed to explore social interactions between men and their partners of either sex in relation to their health practices. We utilized a combination of separate interviews and joint couple interviews. From these studies we offer insight into our experiences of using both types of interview styles, addressing four key areas which span elements across the research project journey: (a) choosing a mode of interview; (b) ethical concerns in couple research; (c) the interview as a platform for disclosure; and (d) analyzing data from couple research.

Poster

AIM: To explore how men with penile cancer construct humour in relation to their diagnosis and treatment. BACKGROUND: Functionalist, relief and incongruity theories attempt to account for humour, but there is a dearth of empirical evidence in nursing care. This is particularly so in relation to a condition like penile cancer where some nurses think that humour in their interactions with patients would be inappropriate. DESIGN: The study employed a participative, mixed-qualitative-methods design. METHOD: Focus groups and patient-conducted interviews were both used during a one-day 'pilot workshop' in March 2011. The data were initially analysed using framework analysis. This paper explores the theme of humour in depth. FINDINGS: Humour helped participants make light of their condition, which meant that they could laugh about the consequences of treatment ('laughing about urination') and build rapport with health professionals ('humour with health professionals'). Nevertheless, the use of humour was less important than the treatment of their cancer ('humour discounted') and there was a fear that they would be subject to ridicule because of their condition ('fear of ridicule'). CONCLUSION: The findings suggest a combination of functionalist, relief and incongruity theories of humour; the emotions these men experience are contained (functionalist) and released (relief) through humorous interaction, and the potential for comedy lies in an incongruity between what is expected socially and the experiences of these men, for example, around expectations that men use urinals in public toilets. Nurses should continue to use humour to build rapport with patients, should they judge this to be appropriate, although they may want to avoid jokes about sexual and urinary functioning until after treatment.

The COVID-19 global pandemic is accelerating investigations for effective vaccines and repurposable validated therapeutics [...]

Background This systematic scoping review was commissioned by NHS Health Scotland as one of a number of projects to investigate reasons behind ‘excess’ mortality in Scotland compared to other parts of the UK. It aimed to identify explanations for (1) the high mortality in Scotland, or parts of Scotland relative to comparable populations (2) excess mortality between otherwise comparable populations. Methods Ten electronic databases were searched in November 2014, plus searches of relevant websites and a structured internet search. Potentially relevant records were screened by one reviewer with a random 10% double screened. Data was extracted into the categories: Countries compared; Study design; Outcomes reported; Hypotheses proposed (if any). Results 27,723 articles were screened and 837 included (1) Half of the 305 included studies mentioned deprivation or deprivation-related artefacts as an explanation for excess mortality in Glasgow or Scotland. The next largest category (29%) related to health behaviours. Other significant explanations related to political attack, effects of policies, health services supply and demand, deindustrialisation, different culture of substance misuse, possible mechanisms, migration, lower social capital, poor housing, life course effects, artefacts of measurement and the external physical environment. (2) In the international literature (n = 532), the largest category related to health behaviours (37%), with deprivation featuring in 32%. Other significant explanations related to health services supply and demand, income inequalities, artefacts of measurement, political attack or effects, social capital, different culture of substance misuse, and genetic differences. Conclusions There is a great deal of relevant literature offering explanations for “excess” mortality. Further research that includes validity assessment of these studies would be necessary to understand the reasons more fully and to ascertain which are the most robust. Key messages: Further research might focus on the links between “downstream” (e.g. health behaviours), “midstream” and “upstream” levels of explanations for excess mortality both in Scotland and internationally It would be of interest to explore similarities and differences between upstream influences, health behaviours and linked outcomes in Scotland and in eastern European countries © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Background: Prevalence of cancer and dementia are strongly related to age. In the UK, 70% of care home residents have dementia. By 2040, older people (aged 65+) will account for 77% of all people living with cancer. Residents with only one of these conditions may have complex care needs. Having comorbid cancer and dementia (CCD) is likely to bring further challenges. This is the first research project to examine the care and support needs of people with CCD living in residential care homes and areas for improvement. Aims: To explore: (1) The care and support needs of people with CCD living in residential care homes. (2) What constitutes good care for people with CCD, their family/supporters, and residential care home staff. (3) Potential barriers and facilitators to providing good care for people with CCD. Methods: (1) Literature review to examine implications for cancerrelated care for people with dementia living in residential care homes. (2) Interviews with 5‐10 men and women with CCD, their family members/ supporters, and residential care home staff. (3) Ethnographic observations of 5‐10 people with CCD to further explore barriers and facilitators to good care. Results: Emergent findings from the literature review will be presented, and their implications for supporting people with CCD living in residential care homes discussed. Conclusions: Findings from this study will help improve the care and support of people with CCD and will contribute to a wider programme of research exploring the cancer care needs of people with dementia across a variety of care settings.

Background: Low rates of health service usage by men are commonly linked to masculine values and traditional male gender roles. However, not all men conform to these stereotypical notions of masculinity, with some men choosing to attend health services on a frequent basis, for a variety of different reasons. This study draws upon the accounts of male frequent attenders of the General Practitioner's (GP) surgery, examining their help-seeking preferences and their reasons for choosing services within general practice over other sources of support. Methods: The study extends thematic analysis of interview data from the Self Care in Primary Care study (SCinPC), a large scale multi-method evaluation study of a self care programme delivered to frequent attenders of general practice. Data were collected from 34 semi-structured interviews conducted with men prior to their exposure to the intervention. Results: The ages of interviewed men ranged from 16 to 72 years, and 91% of the sample (n= 31) stated that they had a current health condition. The thematic analysis exposed diverse perspectives within male help-seeking preferences and the decision-making behind men's choice of services. The study also draws attention to the large variation in men's knowledge of available health services, particularly alternatives to general practice. Furthermore, the data revealed some men's lack of confidence in existing alternatives to general practice. Conclusions: The study highlights the complex nature of male help-seeking preferences, and provides evidence that there should be no 'one size fits all' approach to male service provision. It also provides impetus for conducting further studies into this under researched area of interest. © 2011 WPMH GmbH.

Background: Penile cancer is a rare but destructive malignancy. The aim of this study was to identify published qualitative research exploring patients' experiences of being diagnosed and treated for penile cancer. As only one study met our inclusion criteria and yet there were five borderline studies, a secondary aim that emerged was to discuss those studies to see what, if anything, we could learn. Methods: We searched ASSIA, CINAHL, EMBASE, PUBMED/MEDLINE, PsycINFO & Web of Science and found 313 papers published since 1990. Two reviewers independently selected 17 papers for potential inclusion using titles and abstracts, which were obtained and independently assessed. A synthesis was not possible as only one study met our inclusion criteria. Five borderline studies, covering 4 countries, invited closer inspection because they are often reported in guidelines on penile cancer. Results: The 5 borderline studies reported using a mixed methods design combining a psychometric measure with interviews. Unfortunately, none of these studies reported the method or process used for analysing qualitative data or for integrating the interview and psychometric findings, making it difficult to understand the interview element of their research. Conclusions: If we are to understand and improve the long-term consequences of treatment for penile cancer, qualitative studies of patients’ experiences need to be conducted with high quality analysis and reporting. While pen-and-paper questionnaires may take up little of the time of clinicians conducting research about rare conditions, time could be better used by using methodologies that explore patients experiences.

To determine the effects of a community-based training programme in self-care on the lay population.

To examine the effects of self-care training workshops for primary healthcare workers on frequently attending patients.

An important consideration that needs adding to discussions of patient choice and whether or not men are reluctant to use primary care services is that many frequent attenders are male. The aim of this article is to explore how male frequent attenders construct decisions to use or not use health-care services. This is achieved through secondary analysis of baseline interviews with male frequent attenders from the Self Care in Primary Care study. As this was a complex study, a three-step analytic process was employed to incorporate the involvement of multiple researchers working together over a number of years. First, the interviewer summarised each interview and second, the summaries were read as a group to find themes across them. Subsequently, we returned to the interviews to add detail that would further illustrate or challenge the analysis. Participants talked of ‘engaging health and avoiding ill-health’, constructing themselves as embodied, health conscious and rational in a similar vein to constructions of feminine interactions with health. While participants talked of ‘choosing health services’ as if they were drawing upon a range of choices, the dominance of the image of the GP was such that seeing a GP was the only legitimate health choice.

The contributors to this volume share some of the challenges and the benefits of using professional football settings as a channel for connecting people to health improvement opportunities.

OBJECTIVES: To investigate the impact of a national programme of men's health delivered in/by English Premier League (EPL) football clubs on health profiles. STUDY DESIGN: Health promotion interventions were delivered to male supporters with heightened health risks, and hard-to-engage men who were not using primary care and health information services. Interventions included educational activities on match days and weekly lifestyle classes at the football stadia/training venues. Activities were led by the health trainers in 16 EPL football clubs. METHODS: Pre- and post-intervention, men completed validated self-report measures for demographics and health behaviours. Intention-to-treat (ITT) analysis was performed alongside a standard per-protocol (PP) analysis based on pre- vs post-intervention differences over 3 months. Descriptive statistics were used to show demographics pre-intervention and changes in the health profiles of participants. RESULTS: Predominantly, recruits were White British men aged 18-44 years. Most men (78%, 909/1159) did not see themselves as having health problems. Around 35% (364/1044) never consulted a general practitioner (GP), while 57% (591/1040) reported that they never used health advice services. In men providing pre-intervention responses, the proportions who failed to meet the recommendations for healthy behaviours were as follows: physical activity, 85% (1106/1301); sitting time, 68% (623/907); consumption of fruit/vegetables, 88% (948/1072); smoking, 33% (422/1262); alcohol consumption, 30% (203/679); and body mass index (BMI), 63.8% (570/893). ITT and PP analyses demonstrated the significant increases in weekly physical activity (P < 0.001) and daily consumption of fruit and vegetables (P < 0.001), and significant decreases in daily sitting time (P < 0.001), weekly alcohol consumption (P < 0.001) and BMI (P < 0.05). CONCLUSION: A national programme of men's health delivered in EPL football clubs reached men failing to meet health guidelines. Interventions engaged men who neither consulted a GP nor used health information services. Positive changes were found for an array of activity-related and other health behaviours on PP analysis and the more stringent evaluation condition of ITT analysis.

Men’s health is adversely influenced by the ‘amplification effect’ of multiple problematic lifestyle risk factors (LRFs), including smoking, poor diet, physical inactivity and excessive alcohol consumption. Further, too much sitting, irrespective of time spent in physical activity (PA), is connected with all-cause mortality, CVD, obesity, type 2 diabetes and the metabolic syndrome. PURPOSE: To determine associations between sitting time and the prevalence of LRFs. METHODS: Men aged 18-71(n=584) provided data for analysis. Data was collected prior to engagement in interventions at professional soccer clubs in the UK. Analysis identified LRFs totals; men sitting <4.7 hours (classed as low risk sitting, LRS), are compared with those spending >4.7 hours sitting daily (higher risk sitting, HRS). LRFs were recorded for men who did not achieve (i) 30+ minutes of MVPA on five days in the last week, (ii) ate less than 5+ portions of fruit/vegetables daily, (iii) drank ≥21 units of alcohol weekly and (iv) were current smokers. Associations between LRS and HRS groups were examined by calculating the odds ratio (OR, 95% CI). Statistical differences in LFR prevalence were identified using independent t-tests.

Aim: To undertake a service evaluation of the NHS East of England Supporting Self-Care in General Practice programme. Background: The number of people purported to live with long-term conditions continues to rise generating increasing policy emphasis on the importance of self-care. Previous work has highlighted barriers to implementing self-care interventions in general practice, including a lack of organisational approaches to providing self-care and limited engagement and training of healthcare professionals. In response to these barriers and policy drivers, NHS East of England Strategic Health Authority developed and commenced the Supporting Self-care in General Practice (SSCiGP) programme, which seeks to transform the relationships between people with long-term conditions and primary care practitioners. Methods: This was a mixed methods study, carried out over two phases, which included interviews, survey work and practice-based case studies. Results: This paper focuses on findings related to clinician and practice level change. Clinicians reported changes in their perceptions and in consultation practices following attendance on the SSCiGP programme. These changes were linked to empathy and patient-centredness that mirrored what patients valued in interactions with clinicians. There were qualitative and descriptive differences, but no statistically significant differences between clinicians who had and had not attended the SSCiGP programme. Time was recognised as a significant barrier to implementing, and sustaining skills learnt from the SSCiGP programme. Greater impact at practice level could be achieved when there was whole practice commitment to values that underpinned the SSCiGP programme. There was evidence that such approaches are being incorporated to change practice systems and structures to better facilitate self-care, particularly in practices who were early programme adopters. Conclusion: This evaluation demonstrates that training around clinician change can be effective in shifting service delivery when sat within a cultural framework that genuinely situates patients at the centre of consultations and practice activity.

"Unhealthy behaviours represent modifiable causes of non-communicable disease. In men, concern focuses on those (i) demonstrating the poorest health, exacerbated by a lack of awareness of the risks that their lifestyles pose and (ii) who neither consult their doctor nor use health services. Classed as ‘hard-to-engage’, distinctive strategies are needed to reach these men. Impact and process evaluations assessed the effect of a programme of men’s health-delivered in/by English Premier League football clubs. Men attended match-day events and/or weekly classes involving physical activity and health education. Validated self-report measures for demographics and lifestyle behaviours were completed pre- and post-intervention. Intention-to-treat analysis was performed on pre-versus-post-intervention differences in lifestyle profiles, whereas interviews (n = 57) provided men’s accounts of programme experience. Participants were predominantly white British (70.4%/n = 2669), 18–44 (80.2%/n = 3032) and employed (60.7%/n = 1907). One-third (n = 860) ‘never’ visited their doctor. Over 85% (n = 1428) presented with combinations of lifestyle risk factors. Intention-to-treat analysis showed improvements (P < 0.001) in lifestyle profiles. Interviews confirmed recruitment of men who were hard-to-engage and unhealthy. Men were attracted through football and/or the clubs, whereas specific design factors impacted on participation. Limitations include use of self-reports, narrow demographics, small effect sizes, lack of follow-up and the absence of non-completers in interviews."

Concerns about gender inequalities in longevity, particularly premature male mortality, have prompted a range of innovative approaches to health promotion work dating back to the 1980s. In developing such work, sport, and football in particular, has emerged as a gendered cultural field that has utility for engaging men in community health initiatives. Evaluations of such work have shown that health initiatives using football settings, football interventions or even club branding can have positive impact on various health measures in the short and longer term. However, little work to date has looked at the underlying mechanisms that generate success in such projects. This paper presents secondary analysis of data collected during the evaluation of the Premier League Health (PLH) programme specifically focusing on these underlying mechanisms and how/where gender (masculinities) appears in these processes. We draw on interview data with 16 staff who had been involved in the delivery of the PLH initiative and 58 men who took part. Thematic analysis highlighted two overarching (and underpinning) themes: 'Trust', what processes it was key to and how it was developed and sustained; and 'Change', including what it was facilitated by and what impact it had. The paper adds to our understanding of how active listening, flexibility and sustained engagement are key to community-based sports projects' success. Furthermore, it demonstrates how the physicality and sociability of involvement, rather than any direct focus on 'health', are important in acting as a springboard for facilitating reflection and aiding lifestyle changes for men. © 2013 Taylor & Francis.

Objectives: To investigate the key design characteristics of Premier League Health (PLH), a national programme of men's health improvement delivered in/by 16 English Premier League (EPL) football clubs. Study design: Health Trainers (HTs) were hired by EPL clubs to deliver PLH. HTs were the focus of investigations aimed at identifying the active design characteristics of male-specific health promotion interventions. Methods: Semi-structured interviews led by researchers were performed with 13/16 HTs and identified the key design characteristics influential in (I) reaching and (II) helping participants adopt health improvement interventions delivered in professional football club settings. Results: HTs believed that combining the appeal of football alongside EPL clubs, offered a unique opportunity to reach adult males, including hard-to-engage-men (HTEM). Awareness raising events held on match days aimed to connect with men, but outreach activities were especially important for engaging participants. Following initial reach,familiar settings, such as the club stadia and community venues were also important for ensuring regular involvement in health improvement sessions. Interventions shaped around men's health needs and delivered at times when participants could more easilyattend, were factors which helped to engage men. Supportive social environments and a range of exercise modes and delivery options were also seen by HTs as being similarlyimportant. Both the informality and familiarity of EPL clubs were viewed byHTsas having substantial advantages over conventional NHS settings for reaching andengaging men. Importantly, HTs contributed substantial skills to the delivery of PLH. Conclusion: Although, top flight professional football clubs can recruit men, including those regarded as hard-to-engage into health improvement programmes, considerable attention to delivery refinement is needed to support male participants adopting interventions aimed at promoting healthy lifestyles. © 2013 The Royal Society for Public Health.

For men, unhealthy lifestyle behaviours including physical inactivity, a poor diet, smoking and excess alcohol represent major, modifiable causes of non-communicable disease worldwide. Innovative approaches that seek to overcome the barriers that men experience when attempting to deploy more self-care to manage these behaviours are required. This study assessed the outcomes of a 12-week men’s health promotion intervention delivered in and by professional football clubs. Data comprised self-reports from 1667 men aged 18–75 years from 16 English Premier League and Championship football clubs. A multinomial logistic regression model estimated the probability of self-reporting a number of baseline lifestyle risk factors compared to a reference group with none. Wilcoxon signed-rank tests assessed differences in lifestyle risk profiles. Over 85% of participants presented with multiple risk factors. Men aged ≥35 years were least likely to present all four risk factors (OR: 0.45, 95% CI: 0.23–0.88), whereas unemployed men (OR: 3.64, 95% CI: 1.78–7.51) and those with no social support network (OR: 5.10, 95% CI: 2.44–10.50) were most likely to self-report all four lifestyle risks. The prevalence of risk factors was significantly reduced post-intervention (z = −7.488, p < 0.001, r = −0.13), indicating a positive effect, and potential public health significance. Findings show that men can respond positively to behaviourally-focused interventions delivered in familiar and local settings, like professional football clubs.

Objectives: To investigate the pre-adoption demographic and health profiles of men participating in a programme of men’s health delivered in English Premier League (EPL) football clubs. Study design: A series of match day and programmed health promotion interventions held in EPL clubs (n = 16), including awareness-raising activity days for supporters, weekly healthy lifestyle classes, and outreach activities targeted in local communities. Interventions were delivered at football stadia, club training venues and community facilities. Interventions were run by health trainers who received specific training in men’s health and behavioural change activities. Methods: Participants completed self-report measures for demographics and lifestyle behaviours, including physical activity, consumption of fruit and vegetables, smoking, height, weight, consumption of alcohol and perception of health. Measurement occurred before the interventions. Data were independently analysed and used to assess adoption of the interventions and pre-intervention health profiles of participants. Results: Nine hundred and forty-six men adopted the interventions, but the mode of engagement led to variations in the sample size. Demographics showed that 89% (n = 783/875) were aged 18–44 years and 78% (n = 685/878) were White British. In a subsample, the percentages of men failing to meet health guidelines were as follows: physical activity, 79% (n = 351/440); consumption of fruit and vegetables, 82% (n = 315/380); smoking, 28% (n = 103/373); high body weight, 67% (n = 245/358); and high alcohol consumption, 40% (n = 112/279). Sixty-nine percent of men (n = 242/348) considered that they had no health problems, but 67% (n = 208/310) presented with three or more risk factors for coronary heart disease. Over 40% (n = 125/307) reported never going to see their general practitioner. Conclusion: A national programme of men’s health promotion interventions delivered in EPL football clubs was effective in reaching target audiences. Interventions were predominantly adopted by men not meeting health guidelines.

Background: Understanding the reciprocal role that multiple problematic behaviours play in men's health is important for intervention delivery and for reducing the healthcare burden. Data regarding the concurrence of problematic health behaviours is currently limited but offers insights into risk profiles, and should now include total time spent sitting/day. Methods: Self-reported data on lifestyle health behaviours was collected from 232 men aged ≥18 years who engaged in a men's health promotion programme delivered by 16 English Premier League Clubs. Results: Men at risk due to high sitting display multiple concurrent lifestyle risk factors, 88.6% displayed at least two ancillary risk factors and were three times more likely to report ≥2 lifestyle risk factors (OR. =3.13, 95% confidence interval (CI). =1.52-6.42) than those with low sitting risk. Significant differences in the mean number of risk factors reported between those participants in the higher risk (2.43. ±. 0.90) and lower risk (2.13. ±. 0.96) sitting categories were also found (P=0.015). Conclusions: Hard-to-reach men displayed multiple problematic concurrent behaviours, strongly linked to total sitting time. © 2012 WPMH GmbH.

This study assessed the effect of a 12-week behavioural intervention delivered in and by English Premier League football/soccer clubs, and its influence on lifestyle behaviours, in men typically regarded as hard-to-reach. One hundred and thirty men aged 18 years or older engaging in the programme self-reported data on optimal lifestyle behaviours (OLBs) (physical activity, diet, smoking and alcohol consumption) at pre- and post-intervention. Logistic regression models were used to predict the likelihood of OLBs post-intervention. Healthy behaviours were uncommon at baseline, yet at 12 weeks, 19% (n = 24) of men displayed positive change in one behaviour and 67% (n = 87) had changed ≥2. A combination of improving diet (odds ratio [OR] = 2.76; 95% confidence interval [CI] = 1.65-4.63) and being employed (OR = 4.90, CI = 1.46-16.5) significantly increased the likelihood of reporting ≥150 min of physical activity per week. Increased physical activity significantly increased the likelihood of self-reporting a healthy diet (OR = 2.32, CI = 1.36-3.95). This study shows that a 12-week behavioural intervention can reach and engage a proportion of at risk men. Further, among such men, the intervention helped to stabilize and improve several of the most important lifestyle behaviours that impact mortality and morbidity.

In May 2014 the Movember Foundation commissioned the Centre for Men’s Health, Leeds Beckett University, in collaboration with the Men’s Health Forum (England & Wales), to gather the current research evidence and practical (‘tacit’) knowledge about the core elements that make for successful work with boys and men around mental health promotion, early intervention and stigma reduction.

There remains significant concern about men’s mental health, particularly in terms of personal and societal barriers to help-seeking, negative coping mechanisms and high suicide rates. This paper presents findings from a multi-phase study looking at ‘what works’ in mental health promotion for men. Work here reports the collection and analysis of the tacit knowledge of those working within mental health promotion interventions for men. A ‘multiple hub and spoke’ approach was used to assist data collection. Thirteen key players, active in the men’s mental health field, half from the UK and half beyond, formed an Investigative Network collecting data, mainly through interviews, from wider geographical and professional community contexts where they had networks. The focus of data collection was on ‘what works’ in mental health promotion for men. Data was analysed using thematic analysis techniques. Findings suggest that settings which created safe male spaces acted to promote trust, reduce stigma and normalise men’s engagement in interventions. Embedding interventions within the communities of men being engaged, fully involving these men, and holding ‘male-positive’ values engendered familiarity and consolidated trust. Using ‘male-sensitive’ language and activity-based approaches allowed for positive expressions of emotions, facilitated social engagement, and provided a base for open communication. Appropriate partnerships were also seen as a necessary requirement for success and as crucial for maximising intervention impact. The importance of gender and ‘masculinity’ was apparent throughout these findings and taking time to understand gender could facilitate positive ways of working alongside men, increasing levels of engagement and successful outcomes.