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.

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summaryThis study assessed the effectiveness and cost-effectiveness of community-based interventions to increase moderate physical activity in adults and children, aged 10 to 17 years, who were not meeting the UK guidelines for moderate physical activity. The authors concluded that all the interventions were cost-effective and a good investment for the UK National Health Service. The methods and results were not clearly reported and it is difficult to assess if the authors' conclusions are valid. Type of economic evaluationCost-effectiveness analysis, cost-utility analysis Study objectiveThe aim was to assess the effectiveness and cost-effectiveness of community-based interventions to increase moderate physical activity. The population included children, aged 10 to 17 years, and adults, particularly those aged 65 years or older, who did or did not have pre-existing health problems and were not meeting the UK guideline levels of moderate physical activity. Measure of benefit:The measures of benefit were quality-adjusted life-years (QALYs) and the number of those participants who completed an intervention, who improved by at least one activity level. Cost data:During the clinical study, quarterly interviews were conducted to identify the personnel, training, premises, transport, equipment, publicity, and other running costs. The results of these interviews were used to estimate the average monthly implementation cost, the cost per participant, and the cost per participant who completed an intervention and improved by at least one activity level. These costs were adjusted to 2003 prices and were reported in UK pounds sterling (£). Analysis of uncertainty:The sensitivity analyses estimated the uncertainty around several assumptions that were required for the original model (Matrix Research and Consulting. 2006, and Department of Health. 2007). ResultsThe change in moderate physical activity levels, from before to after the interventions, was a median improvement of 223 metabolic equivalent minutes per week or 75 minutes of brisk walking per week. Of those who completed an intervention, 37.9% improved by at least one activity level, while 59.9% of sedentary or lightly active participants who completed an intervention reached the guideline level of moderate physical activity. There was a wide variety of change in moderate physical activity levels across the intervention types and the outcomes were mixed, so that some interventions produced positive physical activity change, while others did not.The mean monthly costs to the NHS ranged from £504 for exercise classes to £9,227 for exercise referrals. Campaigns ranged from £745 to £1,809, exercise classes from £504 to £6,387, exercise referrals from £648 to £9,227, motivational interv...

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Background: Physical activity is recognised as important for diabetes management and improved overall health of individuals with diabetes, yet many adults with diabetes are inactive. Healthcare professionals have been identified as key to promoting physical activity, including individuals with diabetes, but are ill-prepared to deliver this. Our paper evaluates the barriers/facilitators of healthcare professionals' delivery of physical activity guidance to adults with diabetes and aims to inform efforts to investigate and enhance their preparedness to promote physical activity. Methods: A sequential mixed method, two-phase design was adopted involving a purposeful sample of healthcare professionals. Phase one was an online pilot survey designed to test assumptions around healthcare professionals' knowledge, training and preparedness to deliver physical activity guidance. Phase two comprised eighteen semistructured interviews, thematically analysed to provide an in-depth exploration of healthcare professionals' experiences of delivering physical activity guidance to adults with diabetes. Results: Healthcare professionals are committed to promoting physical activity to adults with diabetes and are reasonably confident in giving basic, generic guidance. Yet, significant challenges prevent them from achieving this in their practice, including: lack of education and training around physical activity, diabetes and health; ignorance of recommended physical activity and diabetes guidelines; lack of awareness of referral options; limited time and accessibility to appropriate resources. Nevertheless, healthcare professionals believed discussions around physical activity needed to be an integral part of consultations, incorporating improved communication strategies for conveying key physical activity messages. Conclusions: HCPs have a key role in the promotion of physical activity to people with long-term conditions such as diabetes and they are identified within both the strategic policy context and national interventions for physical activity. Yet, this study indicated that HCPs face multiple and at times complex barriers to physical activity promotion generally and with diabetes patients. Conversely HCPs also reported what works, why and how, when promoting physical activity. Rich information derived from the day-today , working healthcare professional is integral to shaping future practices going forward. The bottom up, iterative design adopted in this study provides an approach to tap into this information.

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.