In Ireland, increasing rates of unemployment, social isolation, and a historic reluctance to seek out health services, leaves many men vulnerable to poor mental health, depression and suicide.
A recent study by Maya Lefkowich, Noel Richardson and Steve Robertson looked at methods that can be used to effectively engage men in health services.
Their paper detailed the Men’s Health and Well-Being Programme in Dublin, which is a ten-week program that combines football (soccer) training with sessions on maintaining a healthy lifestyle. Maya Lefkowich sat down with us to discuss why this program works.
Men’s Health Research: Your paper begins by acknowledging that men are reluctant to seek health services. Can you elaborate on why you think that is?
Maya Lefkowich: When I went in to do this study – specifically within the community that I was looking at – there was a lot of reluctance with men to seek help. Part of that was a history of going to the doctor and having a bad experience. Or there was a lot of stigma around seeking help.
A lot of men also found that services just weren’t available for the kinds of things that they wanted. It was in an inner city area so what happened was the services that were around weren’t actually accessible. So it was a lot of wanting something that didn’t exist. So therein lies the challenge. If something doesn’t exist – and even if it does – there was a reluctance to actually seek it.
MHR: In your paper you described this population as, ‘hard to reach.’ Can you describe what that means?
ML: ‘Hard to reach’ is a bit of a contentious term. Some people might use the term meaning that men aren’t able to find the services. Other people might use the language, ‘hard to engage,’ which suggests that even if you’re putting services and information out, men might not necessarily take it up. So the language of ‘hard to reach’ was used in this paper to acknowledge that service providers may experience challenges when trying to reach men.
MHR: You looked at one service provider that you identified as being successful. Can you describe that program?
ML: The Men’s Health and Well-Being Program was run over the course of ten weeks. The main hook was football (soccer) training. And while the men were doing football training, they were also engaged in cooking classes. They had health sessions led by different service providers, for example one might be on mental health and another might be about sexual health. They also did health checks with nurses, so they had their blood pressure and BMI read. And at the end of it they had a big football match and a graduation ceremony to acknowledge that they’d gone through this program and completed some credentials of health.
MHR: What kind of insights can we garner from this program about how to get men more involved in health services?
ML: The football hook is an interesting one because on one hand there are certain norms of health and masculinity that come with sports culture, like the tendency to under-report sports injury. But, what I think is unique about this program is that the coaches really made a concerted effort to work within a particular sports culture that was normal or safe for men – so men would want to engage because they got to have the fun competitive football experience.
And then [the program] completely changed what those things meant over the course of ten weeks. The coaches told me that before men even got to hold a football they had to know what it meant to be a team member so they learned the language of encouragement and being supportive.
I got to go see their football games and every time a man got a ball he was celebrated. Someone would say, “Great pass!” If he scored a goal everybody went ballistic just to support him. So there was really this idea that, if you start where men are then you can change what they associate with health, masculinity, or sports and broaden what’s acceptable in those categories.
MHR: When the men graduate and leave, what do you think they take away from the program?
ML: From what I saw, there is a difference in confidence. Some of the men started walking clubs so that team spirit continued. Some got involved in the community garden program. Another story I heard was that at the local pub men would go and share recipes. They would go to the local pub, and instead of hanging out and doing what they would do before, they would bring all of their recipes and samples of what they made. So it changed a lot of the spaces and what activities might be considered normal for men.
MHR: What’s your takeaway from the work that you’ve done?
ML: For me it was an interesting study because I got to talk to people at different levels of this partnership. And the main finding was the partnership model of designing a program. So this didn’t come from one community centre. Certainly the community let it grow, but they were able to build off of other services that were available and make the most of what was already available instead of reinventing the wheel. And also challenge what everybody thought they could do within their capacity. So they were able to really build something that hadn’t been built before.
As a researcher, being able to talk to all of the partners involved in this one project, and getting to hear very different perspectives about what was working and why, was really interesting. And the most interesting thing is when they all overlapped and said unanimously this works for men.
One take home was that this was a model that worked for this community given their resources and the partnership model that they developed. And certainly a partnership model can be used elsewhere, but for other service providers looking to take on a model or program there’s no one right thing to do. Sports might not be the right answer for everyone, but being able to have something creative or unexpected when trying to appeal to a health issue or a certain population is really important.
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