The systematic development of a complex community-based men’s health intervention, the 12th Man

Abstract

Across the globe life expectancy at birth is 5.1 years shorter for men than women. To address this inequality and improve overall health, lifestyle interventions are delivered through primary care, but they often fail to engage groups of men. Interventions using football as a vehicle of delivery demonstrate success in both the recruitment of men and improvements in long term physical health. However, few are designed to improve holistic health and there are no interventions in the North East of England. This thesis aimed to explore the barriers and facilitators to health intervention attendance faced by men; systematically develop a complex multi-component lifestyle intervention; and pilot the feasibility and acceptability of this intervention in groups of men. Chapter 3 used qualitative data from focus groups to study the barriers and facilitators of lifestyle intervention participation in men and highlighted key ingredients for intervention development. This study identified the need for interventions to draw parity of esteem between mental and physical health; it summarised common barriers to lifestyle change and highlighted important intervention considerations. Building on the findings in Chapter 3, insight from the literature, and guidance, frameworks, and taxonomies to systematically develop a men’s health intervention, the 12th Man, is described in Chapter 4. Chapter 5 piloted this intervention and used qualitative data from focus groups, and quantitative data relating to attendance and adherence to conclude the 12th Man to be feasible to deliver and acceptable to the participants, however improvements were suggested. Chapter 6 integrated suggestions to redevelop the intervention and outline a protocol for a subsequent pilot randomised control trial. This thesis collectively demonstrated key barriers and facilitators which informed the development of the 12th Man Intervention and offers suggestions for subsequent intervention developers when targeting traditionally hard-to-reach males. These suggestions involve key intervention components which include using football as a vehicle for delivery for a face-to-face, group-based intervention that is gender sensitised and underpinned by behaviour change theory and follows a recommended framework during development. This thesis presents an additional framework for developing complex health interventions and demonstrates how this can be used in practice. Finally, this thesis concludes the 12th Man Intervention to be acceptable and feasible, giving confidence to developers in subsequent randomised control trials.