ObjectivesWorking with men/boys, in addition to women/girls, through gender-transformative programming that challenges gender inequalities is recognised as important for improving sexual and reproductive health and rights (SRHR) for all. The aim of this paper was to generate an interactive evidence and gap map (EGM) of the total review evidence on interventions engaging men/boys across the full range of WHO SRHR outcomes and report a systematic review of the quantity, quality and effect of gender-transformative interventions with men/boys to improve SRHR for all.MethodsFor this EGM and systematic review, academic and non-academic databases (CINAHL, Medline, PsycINFO, Social Science Citation Index-expanded, Cochrane Library, Campbell Collaboration, Embase, Global Health Library and Scopus) were searched using terms related to SRHR, males/masculinities, systematic reviews and trials (January 2007–July 2018) with no language restrictions for review articles of SRHR interventions engaging men/boys. Data were extracted from included reviews, and AMSTAR2 was used to assess quality. Outcomes were based on WHO reproductive health strategy.ResultsFrom the 3658 non-duplicate records screened, the total systematic reviews of interventions engaging men/boys in SRHR was mapped through an EGM (n=462 reviews) showing that such interventions were relatively evenly spread across low-income (24.5%), middle-income (37.8%) and high-income countries (37.8%). The proportion of reviews that included gender-transformative interventions engaging men/boys was low (8.4%, 39/462), the majority was in relation to violence against women/girls (n=18/39, 46.2%) and conducted in lower and middle-income countries (n=25/39, 64%). Reviews of gender-transformative interventions were generally low/critically low quality (n=34/39, 97.1%), and findings inconclusive (n=23/39, 59%), but 38.5% (n=15/39) found positive results.ConclusionResearch and programming must be strengthened in engagement of men/boys; it should be intentional in promoting a gender-transformative approach, explicit in the intervention logic models, with more robust experimental designs and measures, and supported with qualitative evaluations.

BackgroundGlobal health organisations advocate gender-transformative programming (which challenges gender inequalities) with men and boys to improve sexual and reproductive health and rights (SRHR) for all. We systematically review evidence for this approach.MethodsWe previously reported an evidence-and-gap map (http://srhr.org/masculinities/wbincome/) and systematic review of reviews of experimental intervention studies engaging men/boys in SRHR, identified through a Campbell Collaboration published protocol (https://doi.org/10.1002/CL2.203) without language restrictions between January 2007 and July 2018. Records for the current review of intervention studies were retrieved from those systematic reviews containing one or more gender-transformative intervention studies engaging men/boys. Data were extracted for intervention studies relating to each of the World Health Organization (WHO) SRHR outcomes. Promising programming characteristics, as well as underused strategies, were analysed with reference to the WHO definition of gender-transformative programming and an established behaviour change model, the COM-B model. Risk of bias was assessed using Cochrane Risk of Bias tools, RoB V.2.0 and Risk of Bias In Non-randomised Studies of Interventions.FindingsFrom 509 eligible records, we synthesised 68 studies comprising 36 randomised controlled trials, n=56 417 participants, and 32 quasi-experimental studies, n=25 554 participants. Promising programming characteristics include: multicomponent activities of education, persuasion, modelling and enablement; multilevel programming that mobilises wider communities; targeting both men and women; and programmes of longer duration than three months. Six of the seven interventions evaluated more than once show efficacy. However, we identified a significant risk of bias in the overall available evidence. Important gaps in evidence relate to safe abortion and SRHR during disease outbreaks.ConclusionIt is widely acknowledged by global organisations that the question is no longer whether to include boys and men in SRHR but how to do so in ways that promote gender equality and health for all and are scientifically rigorous. This paper provides an evidence base to take this agenda for programming and research forward.

ObjectiveActive Surveillance (AS) allows men with favourable-risk prostate cancer (PCa) to avoid or postpone active treatment and hence spares potential adverse side effects for a significant proportion of these patients. Active surveillance may create an additional emotional burden for these patients.The aim of the review was to determine the psychological impact of AS to inform future study in this area and to provide recommendations for clinical practice. MethodsStudies were identified through database searching from inception to September 2015.Quantitative or qualitative non-interventional studies published in English that assessed the psychological impact of AS were included. The Mixed Methods Appraisal Tool was used to assess methodological quality. ResultsTwenty-three papers were included (20 quantitative, 3 qualitative). Quantitatively, the majority of patients do not report psychological difficulties, however when appropriateness of study design is considered, the conclusion that AS has minimal impact on wellbeing, may not be accurate. This is due to small sample sizes, inappropriately timed baseline, and inappropriate/lack of comparison groups. In addition, a mismatch in outcome was noted between the outcome of quantitative and qualitative studies in uncertainty, with qualitative studies indicating a greater psychological impact. ConclusionsDue to methodological concerns, many quantitative studies may not provide a true account of the burden of AS. Further mixed-methods studies are necessary to address the limitations This article is protected by copyright. All rights reserved.highlighted and to provide clarity on the impact of AS. Practitioners should be aware that despite findings of previous reviews, patients may require additional emotional support.

Objective This study aimed to explore the psychological impact of favorable‐risk prostate cancer (PCa) and associated treatment (active surveillance [AS] or active treatment [AT]), comparing prevalence and temporal variability of generalized anxiety, PCa‐specific anxiety, and depression symptoms. Methods PCa patients were recruited at diagnosis prior to treatment decision‐making and completed questionnaires assessing anxiety (State‐Trait Anxiety Inventory short form [STAI‐6] and Memorial Anxiety Scale for Prostate Cancer [MAX‐PC]) and depression symptoms (Centre for Epidemiologic Studies Depression Scale [CES‐D]) at four timepoints for 9 months. Non‐cancer controls were recruited via university staff lists and community groups. Results were analyzed using analysis of variance. Results Fifty‐four PCa (AS n = 11, AT n = 43) and 53 non‐cancer participants were recruited. The main effect of time or treatment group were not statistically significant for CES‐D scores (P > .05). The main effect of treatment on STAI‐6 scores was significant (F2,73 = 4.678, .012) with AS patients reporting highest STAI‐6 scores (T1 M = 36.56; T2 M = 36.89, T3 M = 38.46; T4 M = 38.89). There was a significant main effect for time since diagnosis on MAX‐PC (F3,123 = 3.68, .01); AS patient scored higher than AT at all timepoints (T1 M = 10.33 vs 10.78; T2 M = 11.11 vs 11.30; T3 M = 13.44 vs 10.55; T4 M = 11.33 vs 8.88); however, both groups declined overall with time. Conclusions Men undergoing AS had significantly higher anxiety symptoms than AT and non‐cancer participants, contradicting previous literature. This may be due to perceived inactivity of AS relative to traditional narratives of cancer treatment. Participant experiences appear to be less favorable relative to other international centers. Recommendations for future research and clinical practice include the need to improve diagnosis and treatment information provision particularly for lower risk patients.

ObjectivesMen who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM’s (YMSM) knowledge and attitudes towards HPV vaccination.DesignQuestionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically.SettingQuestionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student’s union in England and Northern Ireland.ParticipantsSeventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires.ResultsOver half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake.ConclusionsThis study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.

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Background There is growing recognition of the need for interventions that effectively involve men and boys to promote family planning behaviours. Evidence suggests that the most effective behavioural interventions in this field are founded on theoretical principles of behaviour change and gender equality. However, there are few evidence syntheses on how theoretical approaches are applied in this context that might guide best practice in intervention development. This review addresses this gap by examining the application and reporting of theories of behaviour change used by family planning interventions involving men and boys. Methods We adopted a systematic rapid review approach, scoping findings of a previously reported evidence and gap map of intervention reviews (covering 2007–2018) and supplementing this with searches of academic databases and grey literature for reviews and additional studies published between 2007 and 2020. Studies were eligible for inclusion if their title, abstract or keywords referred to a psychosocial or behavioural intervention targeting family planning behaviours, involved males in delivery, and detailed their use of an intervention theory of change. Results From 941 non-duplicate records identified, 63 were eligible for inclusion. Most records referenced interventions taking place in low- and middle-income countries (65%). There was a range of intervention theories of change reported, typically targeting individual-level behaviours and sometimes comprising several behaviour change theories and strategies. The most commonly identified theories were Social Cognitive Theory, Social Learning Theory, the Theory of Planned Behaviour, and the Information-Motivation-Behaviour Skills (IMB) Model. A minority of records explicitly detailed gender-informed elements within their theory of change. Conclusion Our findings highlight the range of prevailing theories of change used for family planning interventions involving men and boys, and the considerable variability in their reporting. Programmers and policy makers would be best served by unified reporting and testing of intervention theories of change. There remains a need for consistent reporting of these to better understand how complex interventions that seek to involve men and boys in family planning may lead to behaviour change.

BACKGROUND | The problemFamily planning (FP) helps people avoid unintended pregnancy, attain their desired number of children and/or determine the spacing of pregnancies. Effective FP is achieved through the use of contraceptive methods, provision of safe abortion, and prevention and treatment of infertility. FP also contributes to reduced maternal, neonatal and child morbidity and mortality, as well as the negative economic and psychosocial implications that unintended pregnancy, pregnancy complications and infertility can have. Despite determined progress since the implementation of the UnitedNations' Sustainable Development Goals (SDGs; United Nations, 2015), reports indicate that progress has been slower than expected in relation to maternal and child health and gender equality (FP2020, 2018UNICEF, 2018; World Health Organisation, 2017). If current trends continue, more than 50 low-and middle-income countries (LMICs) will not meet their SDG under-five mortality target by 2030 and 56 million children under age-5 will die (UNICEF, 2018). Equally, achieving the SDG target of a global maternal mortality rate of below 70 per 100,000 births will require a reduction in current rates of an average of 7.5% each year until 2030. This is more than three times the current 2.3% annual global rate of reduction (World Health Organisation, 2016). At the current rate of change, it will take 200 years (nine generations) to reach the SDG 5 goal of achieving gender equality and empowering women and girls (Organisation for Economic Co-operation and Development, 2019). Further, by 2018, only 46 of FP2020′s targeted 120 million additional women using contraception had been reached-a clear indicator of the work that remains to be done in order to reach the 2030 SDGs (FP2020, 2018).Every year, around 300,000 women and girls die during childbirth or from pregnancy-related complications, including unsafe abortion, with the vast majority of these deaths (94%) occurring in LMICs (World Health Organisation, 2019). Equally, unintended and mistimed pregnancies also contribute to the burden of high infant morbidity and mortality (Kozuki et al., 2013;Say et al., 2014;Singh et al., 2013). Around 2.7 million newborns die every year in LMICs and many more suffer from disease relating to preterm birth, being small for gestational age and malnutrition (Guttmacher Institiute, 2018). Provision of evidence-based interventions to accelerate the use of FP is, therefore, a matter of life and death for people in LMICs. Despite declines in global fertility rates, unmet FP needs remain high. An estimated 214 million women in LMICs would like to avoid or delay pregnancy, but are not using contraception (Guttmacher Institiute, 2018). There is, therefore, an urgent need to understand how to accelerate the use and impact of FP programmes.