Shedding light on men’s health: Evaluating the scalability of a community-based men’s health promotion programme “Sheds for Life” through the application of implementation science

McGrath, Aisling (2022) Shedding light on men’s health: Evaluating the scalability of a community-based men’s health promotion programme “Sheds for Life” through the application of implementation science. Doctoral thesis, SETU Waterford.

[thumbnail of Final PhD thesis Aisling McGrath post viva.pdf] Text
Final PhD thesis Aisling McGrath post viva.pdf

Download (6MB)


Background: Men’s Sheds (Sheds) are community-based settings that offer a unique opportunity to apply gender-specific approaches to engage ‘hard-to-reach’ (HTR) men with health promotion. Despite this, there has been no formal evaluation of structured health promotion in Sheds to date. Sheds for Life (SFL) is a 10-week initiative co-designed with Shed Members (Shedders) and delivered directly in the Shed setting in Ireland with core components comprising of a health check, physical activity, mental wellbeing and healthy diet. It is implemented by multiple stakeholders at individual, provider, organisation and systems level and thus multiple contextual factors influence its scalability. In addition, research has called for careful consideration of what health promotion in Sheds should look like, particularly with regard to respecting the ethos of Sheds as highly variable, autonomous, non-structured spaces, as part of any attempts to engage Sheds in structured health promotion programmes. This thesis evaluates the scalability of SFL through the application of implementation science. Methods: A mixed methods, hybrid effectiveness-implementation study design was used to test intervention effect and implementation outcomes across multiple levels (participant, provider, organisational and systems levels), guided by community-based participatory research and established implementation frameworks. Chapter 2 captures protocols pertaining to the development, design and implementation of SFL and the evaluation of the impact on participants’ health and wellbeing outcomes up to 12 months. Chapter 3 assesses reach of SFL through analysis of objective health measures, (body composition, blood pressure, blood lipids) captured via health screening as well as sociodemographic and health and wellbeing measures (physical activity, subjective wellbeing, mental health, social capital, cooking and diet) via questionnaires. Chapter 4 assesses the impact of COVID-19 on wellbeing (life satisfaction, mental health, loneliness, physical activity (PA), self-rated health and other lifestyle measures) among SFL participants through a comparison of two cohorts pre and post COVID-19 up to 6 months. Chapter 5 evaluates the impact of SFL on health and wellbeing outcomes through an analysis of Shedders (n=421) participating in SFL alongside a wait list control (n=86) up to 12 months. Chapter 6 applies a qualitative reflexive thematic analysis incorporating ethnographical observations, focus groups (n=8) and short semi-structured interviews (n=16) conducted with SFL participants to capture Shedders’ experiences of SFL in practice. Chapter 7 assesses costs of SFL alongside questionnaires incorporating the SF-6D administered to participants up to 12 months, generating utility scores to determine quality adjusted life years (QALYS). Chapter 8 uses implementation frameworks to capture the process of implementation, identify implementation determinants and strategies to address barriers to inform implementation outcomes and assess scalability. Results: Results from chapter 3 determine that SFL was effective in engaging HTR men (mostly older, retired with the majority in ‘at-risk’ categories for objective health measures). Chapter 4 highlights that Shedders experiencing COVID-19 at 6 months had decreased self-rated health and life satisfaction (p<0.001), with increased loneliness scores (p<0.0005). Higher loneliness scores were also correlated with lower health ratings, life satisfaction and PA during COVID-19 (p<0.001). Chapter 5 determines that outcomes related to subjective wellbeing, mental wellbeing, physical activity, social capital and healthy eating significantly increased post SFL (p<0.05). Mental wellbeing scores (SWEMWBS) post SFL remained significantly higher than baseline despite COVID-19 impact (p<0.05). Binary logistic regression indicates that the odds of a meaningful SWEMWBS change was significantly higher for Shedders that had lower SWEMWBS (OR 0.804), less loneliness (OR 0.638) and lived alone (OR 0.456) at baseline. Shedders with lower SWEMWBS had higher odds of experiencing positive changes in life satisfaction (OR 0.911) and trust (OR 0.928), while Shedders who lived alone had also higher odds of experiencing positive changes in healthy eating (OR 0.481). Moreover, inactive Shedders at baseline had higher odds of experiencing increased levels of physical activity (OR 0.582). Chapter 6 describes three key themes; Creating the ‘right environment’; Normalising meaningful conversations; a legacy for ‘talking health’; and; Transforming perceptions of how men ‘do health’. Findings demonstrate the utility of SFL to be gender transformative. Chapter 7 demonstrates that the SFL intervention group experienced an average 3.3% gain in QALYS from baseline to 3 months and a further 2% gain from 3 months to 6 months at an estimated cost per QALY of €15,724. This highlights the utility of SFL as a cost-effective initiative. Chapter 8 determines that active recruitment, co-design processes, leadership and stakeholder engagement emerged as key facilitators of SFL implementation. Prominent barriers were institutional capacity and funding. Acceptability, adoption and appropriateness of the initiative were high among stakeholders with sustainability largely contingent on funding and staff resources. Conclusion: Findings highlight that the gendered and co-design approach of SFL was effective in engaging HTR men in Sheds and that this approach offers much potential to encourage sustained changes in health and wellbeing outcomes. Findings also demonstrate the utility of SFL to be gender transformative by normalising meaningful conversations about health in Sheds, facilitated by an invested process of engagement. The programme was also found to be cost-effective where it’s community-based, partnership approach was key to its sustainability. The application of implementation science captures the process of implementation and the development of a methodology for implementation of health promotion in Sheds that can be replicated elsewhere. It identifies that SFL is a transferable, scalable model, where leadership and fidelity to the process of implementation are key to its successful scalability. This work makes a valuable contribution to knowledge by being the first study to evaluate a structured health promotion initiative in Sheds. It adds to the evidence-base for men’s health promotion and public health more broadly, particularly in the areas of economic evaluation and identification of implementation strategies where a dearth of research exists. It demonstrates the operationalisation of implementation frameworks in practice and identifies the key implementation and evaluation strategies that can act as a blueprint for health promotion in Sheds, men’s health work and health promotion more broadly.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Men's health, Health promotion
Departments or Groups: *NONE OF THESE*
Divisions: School of Health Sciences > Department of Health, Sport and Exercise Studies
Depositing User: Derek Langford
Date Deposited: 13 Sep 2022 14:48
Last Modified: 13 Sep 2022 14:48

Actions (login required)

View Item View Item