Elsevier

Public Health

Volume 127, Issue 1, January 2013, Pages 18-26
Public Health

Original Research
Effect of a national programme of men's health delivered in English Premier League football clubs

https://doi.org/10.1016/j.puhe.2012.10.012Get rights and content

Summary

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.

Introduction

Men are at risk from a wide range of lifestyle-related conditions, such as cardiovascular disease (CVD), poor mental health and fat-related cancers, leaving them vulnerable to chronic disease and premature death.1, 2 Lifestyle behaviours contributing to the incidence of these preventable conditions include poor diet,3 smoking,4 unsafe drinking5 and low levels of physical activity (PA).6 Indeed, in the UK, less than 40% of men self-reported meeting the recommended adult PA guidelines.7 A combination of low levels of PA and a high incidence of sedentary behaviours including prolonged sitting time play an important role in the long-term regulation of weight.8 Further, research shows that 42% of men demonstrated a body mass index (BMI)9 that poses a heightened risk of developing a range of metabolic conditions. As such, the combinations of these unhealthy lifestyle behaviours are only amplified by men's poor awareness of health issues, meaning that many males are unwittingly incubating health conditions for later in life.10

While there is no evidence that men delay in presenting to a general practitioner (GP) when they have a symptom compared with women,11 the non-engagement of young men within primary care (PC), especially preventative healthcare, further exaggerates men's health profiles.1 It has been reported that as few as one in 10 men have consulted a National Health Service (NHS) GP within the last 14 days, whilst for men aged 18–44 years, this figure is as low as 8%.12 Research shows that men have been discouraged from going to see their GP.13 Reasons for this include feelings of embarrassment and anxiety linked to particular medical issues, such as conditions of the prostrate,12 not wanting to ‘waste’ the GP's time, and inability to fit attendance at surgeries around work commitments.1 Moreover, research has demonstrated that health promotion activities aimed at the prevention of obesity have been shown to be irrelevant to men.14 In order for similar interventions to be effective, ‘experts in men's health’ have advised that healthy eating campaigns need to overcome men's negative preconceptions linking dieting with femininity.15

These barriers, and numerous others, have encouraged practitioners to find more effective ways to connect with men on their health issues.15 This includes men who demonstrate unhealthy lifestyles10 but who do not consider these behaviours to be problematic to their well-being. It also includes men who are difficult to connect with and engage in health interventions16; that is, men who remain unresponsive to the conventional health promotion provision, including those interventions delivered in PC15 and health advice services, such as the Government's health information service, NHS Direct.17 To reach men with interventions designed to enhance their health, researchers have made a number of helpful recommendations, including the adoption of male-specific approaches,15, 18 use of lifestyle and behaviour modification programmes,19 framing interventions around activities that link to men's interests and hobbies20 (which is likely to facilitate programme adoption if not completion), and location of alternative healthcare approaches away from PC settings.15

With those thoughts in mind, researchers15, 21, 22 have also recommended using leisure and sporting contexts to connect with men over their health. Both in the UK and internationally, a number of health interventions have responded to this advice. For instance, the Boundaries for Life Project delivered medical checks to the male supporters attending international cricket matches,23 the Tackling Men's Health Project was a programme of health advice and lifestyle checks combined with follow-up activities aimed at male fans attending Rugby League matches,22 and the US NASCAR (motor racing) series21 was a programme of gender-specific health promotion activities for race car fans. However, the longer-term impact of these interventions on changes in men's health behaviours are unconfirmed. With that in mind, evidence is required to confirm the effectiveness of gender-specific interventions delivered to men in sporting settings.15

Professional football (soccer) clubs have a growing tradition of delivering health-related activities to supporters, including men.24 Recent studies have reported the impact of interventions delivered through professional football clubs for homeless men,25 men from low-income groups,26 and men demonstrating poor mental health.27 In the UK, the English Premier Football League (EPL) is attended annually by 11 million men28; worldwide, a projected 4.7 billion people and 643 million households view EPL matches on television and through the Internet.29 Given this enormous reach, the EPL acts as a foundation for the delivery of Premier League Health (PLH), the first nationally evaluated programme of men's health delivered in/by EPL football clubs.

While initial baseline findings were previously reported in mid 2011,30 this study provides outcomes emerging from this programme of research up to January 2012. More importantly, this paper documents the changes in the health profiles of participants adopting PLH that were not reported in the first paper.30 Given the significance of delivering effective men's health promotion called for in the literature,1, 15 this study provides important insights into the impact of PLH. These outcomes will be of interest to those professionals who commission and provide men's health interventions in football-based contexts. Moreover, this paper shares the learning drawn from researching PLH, as this may be of interest to both evaluators and investigators alike.

Section snippets

Study context

PLH was a £1.63-m ($2.5-m), 3-year programme of men's health promotion delivered through 16 EPL football clubs.30 Interventions were led and delivered by health trainers (HTs); allied health professionals who have received education and training in behavioural change techniques and, specifically, men's health promotion. In the majority of cases, HTs were employed by the football clubs rather than the NHS.

Men were recruited through advertising, outreach work with partners who engaged captive

Demographic profile of participants

For demographics, data are shown for three groups: all participants, ITT group and PP group. Variation in the sample sizes for these three groups is shown in the results for ethnicity, age and employment. Fig. 1 shows that the ethnicity of participants was similar in the three groups: all participants (n = 2026); ITT group (n = 1342); and PP group (n = 204).

Discussion

Men are seldom the focus of targeted gender-specific health promotion programmes.15 Recognizing the potential of top flight football to connect with men on health-related matters,24 this study investigated the impact of PLH, a national programme of men's health delivered in/by 16 EPL clubs.30 Indeed, PLH represents one of the first nationally evaluated programmes of men's health delivered in/by Premier League football clubs.

Acknowledgements

The authors wish to thank all the individuals and agencies who partnered PLH, including the Football Pools, the FA Premier League, the participants and staff in the 16 EPL clubs, their local partners, and people in the authors' organizations who supported this work.

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