Salford Royal Hospital Weight Management ServiceA study into male user participation.

5/3/2014Manchester Men’s HealthTony Sheppard

About the author

Male issues are important to me; I’m a man, so I suppose that gives me some insight. I was

brought up in a large male environment, with 3 older brothers and 1 Dad, who Mum would

call him ‘one of the boys’ because he was. We all enjoyed sport and being men I suppose.

This would be an unremarkable story, were it not from Dad having his first heart attack at 39

and his fatal one 10 years later.

Following this one of my brothers, sadly suffered with depression and ended up taking he’s

own life, so like I say, male issues are important to me.

I’ve been involved in working with men of all ages for over 14 years. I increased my

knowledge of men’s issues, whilst working on The Wyseguys Project, Wythenshawe,

Manchester. Where through a youth and community led approach we devised an

understanding of engaging successfully with 100’s of young men, improving their health and

life chances through developing an understanding of themselves as men. We devised

strategic interventions that gave young men a safe space for them to learn and take

ownership of their lives and their World.

I took this knowledge to deliver specific male health promotion for Manchester Mental Health

& Social Care NHS Trust, including working with young fathers, working with male inmates

and the delivery of the training programmes, ‘It’s a Man’s World’ and ‘No Girls Allowed’.

I subsequently went onto deliver male sexual health programmes for City Centre Project,

Manchester and Trinity House, Manchester and art and male health programmes for The

Whitworth Art Gallery, Manchester.

In 2014, I formed the Community Interest Company, ‘Manchester Men’s Health’ and have

subsequently delivered training for Salford Royal Foundation Trust, The Big Life and GP’s, as

well as a sexual health programme and creative writing project for Hope School, Liverpool.

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In 2012, my second book of poetry was published by Flapjack Press, ‘Tall Tales for Tall Men

Who Fall Well Short’, which takes a personal exploration into male issues and stories.

I continue to explore creative interventions with men and women of all ages, but I feel I’ll

always have a special interest in working with men and trying to find answers to improve

men’s health.

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Table of ContentsExecutive summary...............................................................................................................................6

The reasons for low participation by men on Weight Management Service..........................................6

Key recommendations...........................................................................................................................6

Introduction...........................................................................................................................................8

Methodology.........................................................................................................................................9

Men’s Health.......................................................................................................................................10

SRHT male demographic......................................................................................................................11

Obesity and Overweight......................................................................................................................12

Men accessing services........................................................................................................................13

Attitudes towards health.....................................................................................................................13

Findings-case studies...........................................................................................................................14

Project 1-.............................................................................................................................................14

Barnsley FC, Fit Reds Programme........................................................................................................14

Findings-case studies...........................................................................................................................17

Project 2-.............................................................................................................................................17

Fit Fans Hull.........................................................................................................................................17

Findings-case studies...........................................................................................................................18

Project 3..............................................................................................................................................18

The Camelon Centre for Men’s Health, Scotland.................................................................................18

Findings-desktop research...................................................................................................................22

Findings...............................................................................................................................................24

The service,..........................................................................................................................................24

What are the barriers to male weight loss.1.......................................................................................25

What would work-focus group ideas.1................................................................................................27

Appendix.............................................................................................................................................29

Male demographic for Salford.............................................................................................................30

Males in Salford ethnic origin, aged 65 and over.................................................................................31

Life expectancy and employment, males in Salford............................................................................31

Healthy life expectancy.......................................................................................................................31

Focus Groups.......................................................................................................................................33

Focus group 1 –...................................................................................................................................33

One to one interviews Salford Royal Hospital.....................................................................................33

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Focus group 2-.....................................................................................................................................35

Little Hulton.........................................................................................................................................35

Focus group 3-.....................................................................................................................................38

Irlam Firestation..................................................................................................................................38

SRFT ‘Men’s Health Survey’ (Irlam Firestation, 24th Feb, 2014)...........................................................40

Focus group 4......................................................................................................................................42

Consultation with staff at Salford Royal Foundation Trust-2nd April 2014...........................................42

Focus group-5......................................................................................................................................44

Langworthy Cornerstones- 30th April, 2014.........................................................................................44

Questionairre.......................................................................................................................................46

Profile former and current users.........................................................................................................47

References...........................................................................................................................................50

Additional reading...............................................................................................................................51

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Executive summaryThe reasons for low participation by men on Weight Management Service

The company ABL since Oct 2012, now engage with men with a BMI over 35, who would have previously engaged with Salford Royal Weight Management Service

After being referred by GP’s onto Weight Management Service, 18 men did not attend. Men were evasive about their reasons for non attendance when asked. Citing reasons as ‘couldn’t remember referral’ ‘wasn’t contacted’. Staff confirmed that patients contacted 3 times.

Therefore, possible reason’s for non attendance are (1) that men did not feel losing weight was important to them (2) men felt it was important, but they lacked the confidence to attend meeting and lacked confidence or desire to seek positive change (3) that the location and time of appointment was not suitable (4) That the GP’s intervention and referral process is not suitable for the needs of the men

Key recommendations Rebrand the service as a ‘new service’ aimed at men Build up database of all overweight/obese men in Salford and send out personalized

invites for appointment, which highlight, ‘why it would benefit the men themselves’ Adopt a ‘male friendly’ approach, possible staff training in ‘therapeutic interviewing’

and ‘male health approaches Explore ‘male only’ weight management group’s, with a focus on fun, sustainability

and individual ownership Engage with men around weight and lifestyle issues at key ‘life moments’ for men,

around the time of births and deaths Create a ‘sensitive gym’ environment meeting the needs of unhealthy, unconfident

males Conduct strategic promotion and publicity, with use of local and national press of

‘new and innovative’ men’s health approach Explore ‘new interventions’, such as community weight management programmes

working with Salford Fire Service, Manchester United FC, FC United, Salford Reds RFC, Cornerstones Langworthy, Little Hulton Men’s Group

Devise ‘new weight management programme’ based on The Camelon Project, Scotland

Future appointments to fit around work commitments of men Explore supporting, ‘weight management in work programmes’ Publicise and promote ‘in house’ weight management service for men at Salford

Royal, for male staff

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To verify that Salford Royal Hospital gives full backing, support and promotion of ‘in house service’

To celebrate key achievements and to publicise accordingly

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Introduction

I was asked by Salford Royal Hospital in 2013, to conduct research into improving male participation on the Weight Management Programme. As part of this research we would consult with men in Salford, about the service that would appeal to them and also to try to understand the barriers to male participation.

For the period of 2012 to 2013, 16 men attended the service. 18 men were referred to the service but didn’t attend. Given that there are 79,960 men in Salford and it is estimated that 66.5 % would be overweight or obese, then we would have expected a much larger number of men to have made use of the service.

This research very much verifies the problems the service has experienced in engaging with men, in an effort to improve their health. Men will come together for a learning or social reason, but unlike women, they are uncomfortable in attending groups, for social reasons, such as ‘stay or play’ child sessions. Men are their own people, they will meet and group, when they feel it is justified or they are comfortable in doing so. I am aware of this because so many providers tell me that they have problems in engaging with men.

For this research it would have been easier to access male groups who were comfortable in reflecting and discussing issues around weight management. However, there was only one existing group that we were aware of, the Little Hulton Group that we could access. We were concerned if we had put on events, for a focus group, attendance would have been low. Therefore, I feel it is telling that only 4 men attended for the staff focus group, despite us providing a free lunch!

The Irlam group was well attended and does give us hope that men are looking for a service, around weight management.

However, I did approach many men, and men were suspicious and unwilling to discuss these issues at times. Largely the ones that did really engage were the ones who were already doing something about their weight, or were the ‘happy healthy’.

So there is a problem. Many men are tricky customers! The projects and research, featured here reflects the barriers to engaging with men and utilizes good evidence based practice, my own experience and what the men themselves told us, to offer real solutions.

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MethodologyI utilized a mixture of one to one qualitative interviews, which was conducted with the use of a questionnaire and questions, along with qualitative focus groups.

I also utilized one to one qualitative phone interviews.

I held focus groups at Little Hulton, Methodist Church, Little Hulton, Salford, with a well established male group. At Irlam Fire Station with members of Irlam Fire Service and members of the public and at Salford Royal Foundation Trust, with male staff.

I held telephone interviews with former Weight Management Service, service users.

I held one to one interviews at Salford Royal Foundation Trust and, Cornerstones, Langworthy, Salford.

In total, I carried out 50 interviews with men in Salford.

I also carried out a desktop research.

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Men’s Health

Life expectancy for men in England is 78 years, for women it is 82 years. Life expectancy for men in Salford is 75 years, for women it’s 79 years (Public Health England 2006 -2008).

The healthy life expectancy is 63.9 years for Salford, compared to the North West of 66.4 years and England of 69.1 years.

According to The European Union’s study on Men’s Health, more than twice as many men die between the working age of 16 and 64 years, compared to women.

Men also have a poorer diet and are less knowledgeable about healthy foods. According to The Men’s Health Forum (www.menshealthforum.org.uk) 80% of men exceed the recommended maximum intake for salt consumption of no more than 6g per day, compared to 57% of women.

In terms of eating a healthy diet, again men are more at risk than women, with the consumption of the recommended 5 or more portions of fruit and veg. It was found that 25 % men, compared to 27% women, consumed the 5 a day.

There is also a link to diet and income. It was found that 37% women and 32% men at the highest income quintile consumed 5 or more portions of fruit and vegetables a day. This is compared to 19% of women and 18% men, in the lowest income quintile (www.menshealthforum.org.uk)

Alcohol has also been contributed towards male weight gain, with 27% of men drinking more than the recommended 21 units of alcohol each week and 8% of men drinking more than 50 units each week. A man who drinks 28 units a week, which is the equivalent of 2 pints a day, is consuming one days of their energy requirements for the week in beer alone (White & Pettifer 2007)

According to the World Cancer Research Fund, men in the UK are less aware than women, that eating processed meat, bacon and ham, increases the risk of cancer. Men were found to consume twice as much processed meat as women

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SRHT male demographicWithin the area of Salford, there are 79,960 males aged between 16 and 64. With the largest ethnic group being White, 70, 300, followed by Asian or Asian British, 3, 100, Black or Black British, 1, 700, Chinese or other ethnic group, 1, 700.

There are 8, 578 males, 9.8 %, aged between 16 and 74, who are in higher managerial, administration and professional occupations.

There are 6004 males, 6.8 % aged between 16 and 74, who have never worked or are long term unemployed.

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Obesity and OverweightPublic Health England’s latest research informs us that 66.5% or 6 out of every 10 men, in England, is either overweight or obese. Also by the time mid-life hits, the differences are even bigger with 76 percent of 45 to 54-year-old men being overweight or obese compared to 59 percent of women of the same age (Public Health England 2010/12)

42.2% men are said to be overweight, BMI between 25 and 30 and 24 % men are said to be obese, BMI over 30. This compares with 32 % women being overweight and 25 % women being obese (www.menshealthforum.org.uk)

32.2% of men are of a healthy weight, compared to 40. 1% of women (Public Health England 2010/12)

By 2015 it is predicted that 36% males will be obese, by 2025, 47% of males could be obese and by 2050, 60% of males could be obese. It is also predicted that men having a healthy weight, could decline to less than 10% by 2050 (www.menshealthforum.org.uk)

Being overweight can be a contributory factor to other illnesses and diseases and it is an alarming phenomenon. Men tend to put weight on around their stomachs, the famous ‘beer belly’ and it’s fat put on in this area that’s related to health problems such as insulin resistance, type 2 diabetes and heart disease.

Men over 50 have also found to be twice as likely as women to be unaware that they have Type 2 Diabetes (www.menshealthforum.org.uk)

Also it seems that men are in denial about their weight. A survey in The Independent newspaper, found that 43% of men, who were either overweight or obese, denied they had a beer belly and in fact 7% said they were proud of their belly!

Another study found that 42% of men, compared to 27% women, said that being overweight, ‘wouldn’t bother me at all’ (NOP, 2005)

It seems that changing occupations has had an effect on men’s weight. The change in male occupations which have become more sedentary and less physical, has led to a five-fold increase in obesity, between the beginning and the end of the last century (Hazardous Waist,2007)

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Men accessing servicesThere is also the problem of men accessing services with regards their own health and other similar services. Men have been found, not to take up services that are offered to them, unlike women.

According to The Men’s Health Forum (www.menshealthforum.org.uk) they found in a study in 2008/9, that men attended GP visits less than women, except at the extreme of ages, the very young or the very old. The biggest difference between attendance for men and women was in the 20-40 year old age group, where it was found that women attended the GP twice as often as men.

According to the National Pharmacy Association, (www.menshealthforum.org.uk) men on average attend a pharmacy 4 times a year, compared to 18 times for women. Although a third of men, get their partners to collect their prescriptions.

Also a survey for Bowel Cancer, discovered that 51% of men, compared to 56% women, presented for screening. Even though men are more at risk of bowel cancer, than women, (www.menshealthforum.org.uk)

Attitudes towards healthAccording to Professor Alan White of The Centre for Men’s Health at Leeds Metropolitan University, men have specific attitudes towards their own health. He believes that health is seen by men as a feminine concern. In order for men to protect their public male persona, then they must appear to be unconcerned about their own health.

Men usually state signs and symptoms of illness as just a facet of getting old. For Professor Alan White, men legitimize accessing health services, when their own perception of ill health has been exceeded (State of men’s health/White)

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Findings-case studies

The following are several projects, which have successfully delivered male weight management programmes.

Project 1-Barnsley FC, Fit Reds Programme

Summary of the project

Fit Reds is in its second year. It targets men over 35 years. Its aim is to reduce weight, waistbands and blood pressure. It is an 8 week programme. It provides information on diet, nutrition and blood pressure with exercise and football. It has organized matches with local teams and sponsored walks. So far, 188 men have benefitted from the service.

Participant Phil Sykes, 53, care coordinator for the NHS drug and alcohol treatment services, said: “I joined the Fit Reds programme in 2011, after realising I was overweight with ever-increasing blood pressure.

“The main thing for me was the team spirit of the programme as it made me feel as though we were part of a football team in pre-season.

Introduction/background

This project won an award at Medipex 2011 NHS Innovation Awards, in recognition of the projects innovative approach to patient care.

The programme seeks to reduce weight, targeted to tackle cardio vascular disease (CVD), amongst men aged 35 + living in the Barnsley area. The area has one of the highest CVD mortality rates in the UK. It delivers an 8 week programme.

It brings together staff commissioned by NHS Barnsley, including Community Development Workers, Health Workers and Health Trainers and from Barnsley FC Community Sports. The project has also teamed up with The British Heart Foundation

Between October 2012 to Sept 2013 188 men have joined the fit reds Programme and 111 have completed the programme. It is projected that 40 more men will be added to this figure from 2 new programmes which started in September. So far, 96% of participants (103 men) have increased their physical activity levels.

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Outcomes

93% have increased the amount of moderate activity they undertake in a week. 86% have increased the amount of vigorous activity they undertake in a week. A 6 month post course completion questionnaire has also revealed that 60% of

programme users have continued to maintain their activity levels since leaving the programme.

94% have lowered their blood pressure readings 89% have increased their ‘fruit and veg’ consumption. 84% have reduced their weight. 91% have reduced their waistline circumference 95% have increased their knowledge on how to keep their heart healthy

Recruitment

Referrals on to the programme have been achieved by using a variety of recruitment methods ranging from GP referrals, health trainer referrals, local media promotion, social media, i.e. internet, posters and flyers within the football ground,the Barnsley FC Website, Match Day Promotions, school newsletters, NHS and Barnsley MBC intranet staff messaging systems. The most significant and successful way of recruiting has been via word of mouth, as the participants have been so pleased with the programme and the results they have achieved. In summary, most men who join the programme because they want to get fit and lose some weight.

According to Lee Thompson, who has been helping in delivering the project for 15 months, the ‘hook of the club’ and ‘the quality of the staff’ is the biggest aids in recruitment

Summary of key achievements during the reporting period

From October 2012 to Sept 2013, 10 fit reds programmes have been delivered with 188 men attending the programme.

Total weight loss achieved - 263 kilogrammes

Total waist circumference loss achieved - 410cm

A 6 month post course evaluation has revealed that the impact of the programme goes beyond the 8 weeks of the Programme, with 100% of participants reporting and maintaining good activity levels and eating habits.

Why is the project successful ?

There is no doubt having the pull of the football club, is a major factor. Also the project helps the men set their own personal goals and enables them to celebrate their achievements.

The project also successfully enhances sport and a well being aspect to taking part.

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The Project is delivered in partnership with Barnsley FC Community Sports and Education Trust, Barnsley NHS and PSS (a social enterprise) and the British Heart Foundation.

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Findings-case studiesProject 2- Fit Fans Hull

Summary

Fit Fans, targets men in their over 40’s, with a BMI over 25. It is a 12 week programme, incorporating exercise, football, and food and nutrition information. It enables men to to examine the consequences of their behavior. So far it has attracted a 1000 men.

Background to the project

The project was commissioned by NHS Hull, to provide weight loss support. This is another project which utilises a football club, this time it’s Hull FC. This project targets men aged 40 and over, due to the fact that this age group has a poor record of accessing services, also as we have already seen, men’s health deteriorates as they get older, in comparison to women’s.

The programme

The programme lasts for 12 weeks and comprises of physical coached activities, including football, along with information, support and advice. The programme operates in a variety of venues and utilises a positive mentoring approach. The rationale behind the Fit Fans project is for the professional sports industry to promote and encourage healthier lifestyles from the individuals within their community. During each session the participant will receive 12 interactive nutritional topics and within each session clients will be encouraged to take part in a supervised group activity class led by a qualified “Fit Fans” Instructor. All staff will have undergone the necessary training to be able to deliver both the nutrition and physical activity components. Individuals receive a member’s pack and periodic handouts on the subjects covered over the duration of the 12-week programme. The programme will focus on educating clients, and encouraging them to concentrate on health related issues that will impact their medium and long-term wellness.

Recruitment

The project is keen to recruit men, aged 40 and over and in particular those that are hard to reach from high socio economic deprivation backgrounds.

Why is the project successful ?

The project is structured and utilises a specific coaching type brief that the men appreciate. The project acknowledges that not all men would necessarily find this programme appealing and there is no doubt that the project successfully utilises the men’s love of football.

The men interviewed (via the programmes website, www.fitfans.co.uk) appreciate the social aspect of the programme and they can see the benefits to themselves.

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Findings-case studiesProject 3The Camelon Centre for Men’s Health, Scotland

Summary

A specific community based health initiative aimed at men. Utilizing an awareness of the barriers of masculinity to healthcare, in the delivery of a person centered ‘therapeutic intervention’.

Background

This project was the idea of Community Nurses Jim Leishman and Alison Dalziel. The project is situated in one of the most deprived areas of Scotland. Jim and Alison wanted to improve men’s health through a health intervention. They were fully aware of the problems in working with men and wanted to try something different, which ultimately went onto become very successful and has been modelled by other health interventions.

Recruitment

They applied a personal touch sending out personal invites to men in the area, 1 in 6 men responded to this. It was a new service, so they were able to promote it as such. They utilised the press, radio, they produced posters and leaflets. They also ran the service in the evening.

Background to assessment

The project identified that men did not ordinarily access health care, therefore making any contact with them very important. They saw this therefore as an opportunity for education, assessment and intervention.

They also identified that the assessment would fulfill certain criteria-

1. That the assessment would adopt a holistic approach, with enough time to facilitate this.2. Practitioners would have a good understanding of a male specific approach and how gender

and masculinity, shapes a man’s thoughts and actions.3. That to make the most of the encounter, that the assessment itself would have a therapeutic

value.4. That the assessment would have 2 focuses-

(a) A technical appraisal of the health needs of the man, with a directed action.(b) To encourage the man to reflect on their own health experience and their expectations

and for them to connect these with proposed changes to their behavior and well being.5. That staff have the necessary skills to develop a good rapport, empathy and compassion.

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Human therapeutic encounter

As part of the project, staff was trained by Dr David Kelly, in ‘Human therapeutic encounter’. This practice is made up of some general principles-

1. The encounter is person centered, holistic2. An attention on the individual and the intention of the encounter3. To recognize the importance of the first impression4. Allows men to tell their own story5. Work towards a common understanding of the past, present and future, with regards the

man’s life6. Develops empathy7. Recognises that compassion, comes before action8. To emphasise compassion in both participants9. To consider actions to emerge from the process, based on the realisation of new possibilities10. Allows the men themselves11. To recognize that we are all on a journey with many states and stages12. To realize, that all of this can be learnt

Assessment

Initial assessments would last up to 45 minutes. There would be blood and cholesterol tests as well as chats about lifestyle and behaviour. There was a conscious effort to make men part of the process. An emphasis was placed upon each man recognising that change was required. The men themselves had to see the need. It was important that the men took ownership of, rather than being told what to do.

At these initial assessments, for the first 1000 men, 80% of them had risk factors linked to disease or showed symptoms of illness. They also found that-

28% were depressed or suffering with stress 42% had raised blood pressure 45% were unable to exercise or did very little exercise 12% had sexual health problems, such as ‘erectile dysfunction’ 1 in 4 had no previous contact with health professionals in the past year

The methods

As has already been mentioned, the men themselves were encouraged to take ownership of their own health. The team were mindful about the process of change, for instance, around the issue of alcohol. A man may disclose his drinking habits and this may have been a cause of concern. However, they were aware that the man must be ready to make that change, themselves, so the issue would be left, with the opportunity to be resolved or discussed in the future.

‘It is rare for change to take place in an individual because someone else feels it should happen’ The Camelon Project.

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Which is a very mindful and sympathetic approach, it also recognises the role that masculinity has upon a man’s thoughts and actions and that for a man, and he must feel that he is in control.

This ownership of their own health by the men, is further exemplified by the project,

‘At the end of the full assessment, findings are summarised and each man encouraged identifying, as well as prioritising, actions that would help maintain or improve his health’ The Camelon Project.

Weight management

Weight management was highlighted as a major issue for the men; therefore a programme was put into place. They employed both understanding and honesty regarding the men’s weight and they found that the men responded positively. Places for the programme, soon filled and there was a large waiting list.

Men were shocked when their waistlines were measured and their BMI recorded. There was shock and embarrassment around being labelled as obese. They found that men often underestimated their own body size.

They found that a stepped weight programme worked. Celebrating small steps and reaching achievable goals.

They found that motivation and confidence was the key to success. There was the use of a baseline exercise at the beginning, where the men rated, how confident they felt about losing weight. This was a good indicator for the team to start with, as quite often, the men, were lacking in confidence.

They found that a group approach was more effective, than one to one approach. This was even the case, even if the man had specifically requested a one to one approach.

The venue

The venues used were NHS facilities. Men were consulted about the use of other possible locations, like pubs or barbershops. The men couldn’t understand why these would be used, for such a health related activity?

The men said, that their reluctance to access health centres before was due to the fact that they ‘only tended to use these services when they had a problem and couldn’t deal with it themselves’.

Which informs us, what we already know about men’s view about their own health, that they wish to take ownership of their health, sometimes, as we have seen to their own detriment, regarding health.

Success

Due to the success of the first project, the initiative has gone onto open 5 further centres. Within each team there is a small nursing team, specialising in men’s health.

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Why is the project successful?

As has already been discussed, the project recognises that they have to work within the framework of masculinity. They have built in the time to develop positive relationships with the men, giving them good information. Men can handle the truth. However, they are also keen to be mindful that change takes time and this must come from the men themselves.

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Findings-desktop researchThe Gender and Access to Health Services Study, 2008, commissioned by the Department of Health by the Men’s Health Forum.

This report identified key aspects that those proposing working with men, around health should be aware of.

Flexible hours

The report identified that men were twice likely than a woman to have a full time job. They were also 3 times as likely to work more than 45 hours a week. Men have also indicated that they would be reluctant to take time off work to attend appointments. Therefore, a service must be willing to be available to men, in the evenings.

The setting

The report identified the successful use of non clinical settings, such as workplaces and social and community settings.

Recruitment

Personalized invites for ‘health checks’ were also seen to be successful.

T he Knowsley PCT’s, ‘Pitstop’ project

In 2002 Men’s Health was featured for the first time in The Annual Public Health Report for Knowsley PCT. A previous survey in Kirby revealed that men had a broad understanding of the factors that affect their health, including smoking, alcohol and unemployment. It was also indicated that men wanted to receive health information in informal settings and for services to be more male friendly.

This survey prompted further research and the development of the Pitstop Project. The Pitstop Project provided health checks for men.

It achieved this through a social marketing campaign.

Its overall objective was to raise the awareness of men’s health and encourage men aged between 50 and 65 to change their behavior and to improve their health. It wanted to encourage men to talk about their health and to have a health check.

Men indicated that they wanted health messages to be hard hitting, but to also make them laugh and not to feel that they were to blame for being unhealthy.

This resulted in comedy shows and plays, with health checks available immediately afterwards.

1,020 health checks were carried out in 2004/5.

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More than half of these were in the age target range.

A Haynes style, ‘Knowsley Man’ resource produced, in conjunction with Male Health Forum.

Project went onto new project tackling heart disease, ‘Knowsley @ heart’, which again used health checks. There were a total of 3,700 health checks, 1/3 of these were men. 43% of men checked had a high risk of heart disease, in comparison to 13% of women.

key factors

Men said that the Pitstop health checks reassured them and they felt positive coming away from the sessions.

The men appreciated the convenient times and locations. The men said that staff were approachable and friendly, this was important The men felt that the health checks were a service that could be accessed regardless of how

their own health was at the time.

Men managing health review 2003

Found that men need to legitimize a visit to a health professional Interventions need to link to life changing events, for men That a positive approach can draw on the man’s own family history of ill health and death That you should seek to improve men’s knowledge

Bradford health of Men project

Found that men care about their health That men don’t see a GP as an appropriate place to go, unless they are ill That they like to act on the ‘spur of the moment’ with regards a health intervention That men favour, non medical settings That men liked to have ownership of sessions and the freedom to set the ‘topics’, rather than

having particular health messages forced upon them

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FindingsThe service, Promotion

At the focus group 4, with staff at the hospital, it was clearly identified that the men ‘didn’t know there was a service’, that, ‘There is no real drive for you to come’ and that there was ‘No real promotion’.

This is something that could be explored, the use of posters and publicity around the hospital, leaflets, the use of outreach and promotion. To publicise the Weight Management Service aimed at men.

Rebranding, 1

In terms of the identity of the service, in focus group 1, it was identified that the name of the service could be changed. One man said that a service,’ is something you do to your car‘and a ‘different title’ would be good, such as ‘Healthy men to lose weight’ or ‘Helping men to lose weight’.

This is something that could be explored.

Rebranding, 2

The launch of The Camelon project was able to promote their service as a new service. They utilized the local press and radio, as well as posters and leaflets and they also sent out personal invites.

I feel this could have a really positive impact on the service, if it was to be re- launched, following the findings of this report. The local press and radio and TV could be utilized, discussing the outcomes of this report and promoting the service to men.

The type of service, 1

There is no doubt that the men in focus group 2, wanted the service to be, ‘A relaxed friendly service with people that you know’. That it, ‘must be fun’.

For the men in Little Hulton, an informal, accessible, friendly service was important to them, as they went onto say, ‘medical staff must have a personal touch’ and that it must be ‘somewhere where the staff, don’t have official uniforms’.

The type of approach is very significant for men as were informed by all of ‘The successful interventions and practices, with regards Weight Management and Male participation’.

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The two football projects utilize a male centered, friendly, informal, accessible and fun service.

The Camelon project utilizes a ‘male centered’ approach with its use of its ‘therapeutic interventions’.

From the Knowsley PCT, ‘pitstop’ project, we were told that the men said that the ‘staff were approachable and friendly and that this was important’

Type of service, 3

From the men in focus group 3, we were told to,

‘Create a weight management service just for men. Weight watchers and slimming world is off putting for men as it is mainly women that attend, ‘Hairy Bikers.’

And to

‘Make the service available more long term rather than 12 weeks only’.

Also to,

‘Make fitness groups available, sessions where people can exercise together and maybe target it at men with specific conditions (heart, blood pressure, cholesterol) and make them fun.’

That the sessions could include, ‘Food/nutrition classes for men to get ideas on eating healthy and staying healthy.’

From the questionnaire’s, we found from focus group 1, that ‘attending a support group’, was the most popular response.

From focus group 2, we discovered that the most popular approach would be ‘A programme you do yourself, supported by Salford Royal’. This was followed by ‘A Sport related programme and then a ‘Male only weight programme’. It is worth noting in this focus group, 4 of the men said they were either ‘fit’ or ‘healthy’ and 3 of the men stated they had a BMI of 25 or 27. This group largely made up of men from the fire service, did undertake regular exercise, therefore, it’s not surprising that a ‘DIY’, ‘Sport’, related programme would score highly.

What are the barriers to male weight loss.1In focus group 2, when the question was asked, ‘Why don’t men look after themselves?’, the men replied that, ‘Men don’t face their problems’, ‘Men think they’re invincible’.

I feel that this is a really interesting contribution, especially with regards, ‘not facing problems’ and ‘think invincible’. This definitely fits in with what I’ve learnt about the way

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masculinity impacts on a man’s thoughts and actions. As a man, we are taught that we must be strong and in control. Poor health and health promotion can go to the heart of man’s masculinity. Either being told that you’re not invincible is like telling a man he isn’t strong and therefore, no longer in control.

As with The Camelon project, this ownership of health must be placed in the hands of the men themselves, similarly, with the football projects. The men are taking ownership of their own health, by playing a Sport that they love and being surrounded by other men, who are working as a team, to lose weight.

This is further evidenced by the Bradford Health of Men Project, that found that men liked having ownership of the sessions and the freedom to set the ‘topics’, rather than having particular health messages forced upon them.

What are the barriers to male weight loss.2

There was also a concept that motivation maybe a factor to lose weight. Again from focus group 2, we were told that ‘some haven’t got the get up and go’, and ‘the mind maybe willing, but the body may not’, and ‘Men are too lazy’.

From focus group 3 in answer to the question, ‘What barriers do men face when trying to live a healthy lifestyle and keep their weight down?’. We were informed of again ‘laziness’ and ‘lack of motivation’.

This would also probably be true for women trying to lose weight, although, we know that women, do attend weight management interventions. Therefore, we perhaps could learn something from the contribution from Dr Nadir Ibrahim, from Salford Royal.

He felt that advertising could help in a similar way to shock men, much like the ‘quit smoking’ campaign. He also talked about a ‘window of opportunity’, when he has had to inform patients that they cannot have surgery, due to them being overweight. If a dietician could be present, then a man may take on board an intervention to lose weight.

This corresponds with the evidence of appealing to men around their health, during life changing moments, of either birth or death. From focus group 2 we were informed that,

‘Acquiring a new illness/condition can force you to change your lifestyle, resulting in weight loss’. Other initiatives utilize these moments to impart health interventions to men, as it is as these moments that men may question their own fallibility. So for a moment, a man’s masculinity has been negated.

We also saw again how The Camelon project, was able to successfully reach out to men, with the personalized letters, which informed the men, that it would be in their best interests to attend the sessions. Men are concerned about their health; we just have to find the right way to approach it with them.

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What are the barriers to male weight loss.3

The concept of Gyms was significant in focus group 3, where we were told that, ‘Gym memberships too expensive’, ‘Gyms are full of young, fit and healthy men and that is intimidating’.

In focus group 2, we were informed that, ‘at a gym, we wouldn’t be allowed to use the machines, a smaller gym at the hospital would be better’, ‘not embarrassed if in own environment, if you happen to fall over or have a turn etc’.

In focus group 4, a man also revealed that ‘‘I feel I’m being watched at a gym’. And also from focus group 4, a man felt that there, ‘should be an on site gym’.

The message from the men is that they can be put off gyms, by the culture and the fit and well people. A health intervention would have to be considerate of the starting point of these men.

Perhaps, again, through community interventions such as the fire service, a localized, sensitive, male only environment, which was friendly, would overcome this, in addition to a gym, at the hospital.

What would work-focus group ideas.1Men from the focus groups offered a range of ideas. Employers can play a role within this. From focus group 3, men said an effective intervention would be effective where, ‘Employers encouraging staff to stay healthy by allowing you time in work to exercise’.

There is evidence of the success of weight management programmes within the workplace. Is this a role Salford Royal Weight Management Team could support?

In order for these interventions to be successful, then the employer must be willing to support the initiative in terms of allowing employees time to attend interviews etc.

Perhaps, this initiative could begin at the hospital, where each member of staff, would be able to take advantage of a service and have time ‘off’ within work to work on this.

The setting

This is really interesting. From The Camelon project, we found that the men preferred a NHS location and couldn’t understand why locations such as pubs or barbershops, would be used for a health activity?

This contradicts The Department of health Gender and Access to Health Services Study, where they found that men favored workplaces and social and community settings.

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This was further exemplified by The Bradford Health of Men project, where the men favored ‘non medical settings’.

The location

For the men in Little Hulton, the location of the service would be a factor, in them attending. They said that ‘it depends where it is, it’s getting there, and it can be expensive’.

Given that they already enjoyed a safe, well established and friendly group. Perhaps it was no surprise that a ‘service that could come to the men’s group’, would be appealing.

From the focus group at Cornerstones we were told, that the location could be, ‘Something local, like here!’

This locality was further emphasized by the Focus Group in Irlam, where out of the 10 men, 6 of the men identified the fire station itself being the best location, for attending a weight management programme.

I do feel that providing an outreach service could be explored. Graham Rothwell, Salford Fire Service’s, fitness advisor. Offered all of Salford Fire stations as locations for community weight management programmes.

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Appendix

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Male demographic for SalfordIn Salford there are 79,960 males aged between 16 and 64

Male population by age

Age Population16 – 24 15, 90025 - 49 44, 40050 - 64 19, 60065 over 15, 100

Males in Salford ethnic origin, aged between 16 and 64

Ethnic origin PopulationWhite 70, 300White British 65, 300White Irish 900Other White 4, 100Mixed 1, 100Mixed White & Black Caribbean 300Mixed White & Black African 200Mixed White & Asian 300Mixed other 300Asian or Asian British 3, 100Asian or Asian British : Indian 1500Asian or Asian British : Pakistani 800Asian or Asian British : Bangladeshi 400Asian or Asian British : Other Asian 500Black or Black British 1700Black or Black British : Caribbean 400Black or Black British : African 1200Black or Black British : Other Black 100Chinese or other ethnic group 1700Chinese or other ethnic group : Chinese 600Chinese or other ethnic group : other ethnic group

1100

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Males in Salford ethnic origin, aged 65 and overEthnic group PopulationWhite 14,100White British 13, 400Other White 200White Irish 500Mixed 0White & Black Caribbean 0White & Black African 0White & Asian 0Other mixed 0Asian & Asian British: Indian 100Asian & Asian British: British 100Asian & Asian British: Pakistani 0Asian & Asian British: Bangladeshi 0Other Asian 0Black or Black British 100Black or Black British: Caribbean 0Black or Black British: African 0Other Black 0Chinese or other Ethnic Group 100

Life expectancy and employment, males in SalfordLife expectancy

Salford North West England73.2 years 74.6 years 76 years

Healthy life expectancySalford North West England63.9 years 66.4 years 69.1 years

Males aged 16 to 74, Higher Managerial, Administration and Professional

Salford North West England8, 578 30, 1948 26, 381639.8 % 11.7 % 13.7 %

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Males aged 16 – 74, Never worked and long term unemployed

Salford North West England6004 139, 946 899, 5236.8 % 5.4 % 4.7 %

Males aged 16 – 74, Never worked

Salford North West England3, 765 8, 2444 51, 93884.3 % 3.2 % 2.7 %

Males aged 16 – 74, Long term unemployed

Salford North West England2239 57502 38, 01352.6 % 2.2 % 2 %

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Focus GroupsFocus group 1 – One to one interviews Salford Royal HospitalThese interviews were held as part of National Obesity Week. I attended an outreach programme as part of The Weight Management Team. The event was to raise awareness of the service, to promote a healthy lifestyle and to weigh and record people’s BMI.

I interviewed 16 men. Some men were more forthcoming than others with their views and opinions. The men were a mix of staff, including medical staff and the general public.

The following are the significant outcomes from this research.

1. Have you ever tried to lose weight?

9 men said that they had

4 said they had not

2. Some of the men gave the following comments, regarding weight loss Gastro by pass, it was successful, had to do it lost ½ stone, I changed my diet and cut down beer used WI Fit not very well alrite a bit weightwatchers- lost a bit then tailed off but fluctuated reduced a little and changed diet ok at first-walking

3. Are you worried about your weight?

4 said they were5 said no

4. Some of the men offered further comments about being worried Yes, I’d try anything Yes, watching what I eat and exercise Conscious of it Not too worried, though Dr giving me grief5. What is the best way to lose weight? (By attending a support group) - 6 (By visiting your GP)-2 (By doing it yourself) -2 (By reading and researching)-2 (Through the internet)-26. Additional comments

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A different title ‘Service is what you do with your car’ Talk about Diabetes ‘Healthy men to lose weight’ ‘Helping men to lose weight’ stick to a plan Go to the gym, stop eating shit For me (a Dr) a busy lifestyle a problem. How can I fit in exercise? It must be part of a daily

routine. The title of the programme should be different. Not about losing weight, but about being healthy, getting active and looking great. I had a personal trainer, it worked for a bit. Tempted by less healthy foods when at work and need the energy.

You have to be self conscious-do it yourself I do it myself, have a routine at home Other men recognise a need- get together for a male exercise programme To visit the team, I’m motivated by having heart attacks and trouble with insurance on

holiday Booze needs to be looked at. I don’t drink and I exercise everyday, I’m 79 and a former body

builder Exercise should be part of your routine Use weightwatcher meals Willpower If told to lose weight, quite happy going on a diet

The following is a longer interview with a member of the staff at the hospital

Dr Nadir Ibrahim

He didn’t believe groups would work for men. He felt that men would be uncomfortable in revealing health issues with other men.

He therefore felt that the best approach would be for the man, to do it ‘secretively’, keeping it between himself and his consultant or health professional.

He felt that TV could play a vital role, in shocking men. He used the example of his father. A prolonged, heavy smoker. Who quit, after seeing a shocking health initiative, which graphically demonstrated the effects of smoking on the body. Weight management could be emphasised to the same extent. Men would have to see, what’s going on in their body and what will happen to them, unless they lose weight. The notion of death needs to be emphasised.

He also felt that you need to utilise a window of opportunity for men. As a consultant he had to inform a patient, that they could not undergo surgery, due to being overweight. He felt that at that moment, if there was a dietician available, then they could give the patient a weight management programme. The patient would then have had a clear goal, over a number of weeks, leading to his operation, after successfully losing weight.

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Focus group 2- Little HultonAs part of the research into exploring positive interventions with regards the Weight Management Service, I made contact with this established Men’s Group.

I visited the group on the 7th of February. There were 4 men present. There seemed to be a loose structure to the group and the group existed largely as a friendship group.

They informed me of past activities, trips out etc. They all had experience of mental health problems. The group was originally developed through the local PCT. However, they no longer support the group and the group has little access to funds. The group is largely self supportive, with the men themselves, making a weekly financial contribution.

21 st February

I wished to return to the group, to discuss their ideas for interventions into the Weight Management Service.

I was interested in consulting with this group as they fitted with the demographic profile of the type of men; the service was looking to engage. I was also interested as these men, had attended the group for a significant length of time and I was interested to establish if there was anything we could learn from this.

Aims of consultation

To record key information To record key data To listen to the views of male participants To inform male participants of the SRFT Weight Management Service To make sessions relaxed and informative To offer a ‘safe space’ for men to feel as comfortable as possible in order to discuss

crucial health issues for themselves and their peers

outline of session

1. Introductions2. Men introduce themselves and how long lived in Salford3. Men’s Health Quiz4. Discussion ‘Why don’t men look after themselves?’5. What would work

The session

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5 men attended session

They were all local residents.

All of the men had associated health problems including heart disease, diabetes, arthritis, high blood pressure, weight issues.

Their ages were as follows-

69 years 73 years 68 years 52 years 32 years

Problems in losing weight

When I introduced the purpose of my visit, there followed a general discussion on problems in losing weight and ideas for a future weight management service.

These are some of their comments –

‘It can be difficult to get into a routine’ ‘There is a stigma in being overweight, you can get called names’ ‘At a gym, we wouldn’t be allowed to use the machines, a smaller gym at the

hospital would be better’ ‘it depends where it is, it’s getting there, it can be expensive’ ‘not embarrassed if in own environment, if you happen to fall over or have a turn

etc’

Why don’t men look after themselves?

‘I look after myself’ ‘men should be encouraged to do it themselves’ ‘I had breathing problems, so I gave up smoking, after 40 years’ ‘Men are too lazy’ Men think their invincible’ ‘Men don’t face their problems’ ‘The mind maybe willing, but the body may not’ ‘some haven’t got the get up and go’ ‘They need the motivation, if they can get to a gym, once a week’

What would work ?

‘A relaxed friendly service with people that you know’ ‘somewhere where the staff, don’t have official uniforms’

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‘a service that could come to the men’s group’ ‘must be fun’ ‘medical staff, must have a personal touch’ ‘Tai Chi’ ‘armchair exercises’

Overall

Overall, I feel that the men would be reluctant to travel far for a service due to their lack of funds. It was also really apparent, that they really wanted an informal service. Something that was fun and friendly, where they would feel comfortable and unembarrassed.

The future

I have a real affinity and respect for this group. They are really supportive to each other. A structured programme would be really useful for them and they said that they missed having someone who would organise activities for them.

I praised them for the way they have kept the group going and indicated that they could apply for funds themselves. I will try to make some enquires to see if I may be able to support them in any way.

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Focus group 3- Irlam FirestationMen’s health awareness event – Monday 24 February

Salford Royal Weight Management Service and Greater Manchester Fire and Rescue Service

Irlam Fire station

AttendeesGeneral public – 7 menFire Officers – 6 men

Q3. What barriers do men face when trying to live a healthy lifestyle and keep their weight down?

Not enough time to do exercise Gym memberships too expensive Gyms are full of young, fit and healthy men and that is intimidating Laziness Healthy food takes longer to prepare and is more expensive Bad habits – too much alcohol, drugs Not keen on exercising alone, would prefer in a group/with friends Sedentary jobs Affluence – more money = more food. On the flip side, some people can’t afford gym

membership/healthy food Lack of motivation

Q4. From your own/family/friend’s experience, what has helped encourage men lose weight and keep active?

Acquiring a new illness/condition can force you to change your lifestyle, resulting in weight loss

Employers encouraging staff to stay healthy by allowing you time in work to exercise Sponsored weight loss events can help with the initial kick start to weight loss Friends and family encouraging you to lose weight can be effective

Q5. What could be done to encourage more men to use weight management services and live a healthy lifestyle?

Embed/hide the real reason for the service underneath another service that might not be off putting

Continue with the fitness sessions at Fit City gyms – run by Health Improvement Team

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Advertise what is on offer, not much coverage of what is available. Good places to advertise would be GP surgeries, supermarkets, gyms, job centres, local newspaper

Create a weight management service just for men. Weight watchers and slimming world is off putting for men as it is mainly women that attend. Hairy Bikers.

Make the service available more long term rather than 12 weeks only Make fitness groups available, sessions where people can exercise together and

maybe target it at men with specific conditions (heart, blood pressure, cholesterol) and make them fun

Food/nutrition classes for men to get ideas on eating healthy and staying healthy

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SRFT ‘Men’s Health Survey’ (Irlam Firestation, 24th Feb, 2014)(1) Age

18-35 (E)

35-50 (C) (G) (H)

50-65 (D) (F)

Over 65 (A) (B)

(2) Ethnicity

How would you describe your ethnicity?

(A: WB) (B:WB) (C:WB) (D:WB) (E:WB) (F:WB) (G:WB) (H:WB)

(3) Your postcode (A: M445YY) (B:M27 8AL) (C:M44 5OJ) (D:M27 OLN) (E:M44 6BJ) (F:M44 6NJ) (G:M44 6BJ) (H: M44 6BJ)

(4) What is your BMI? (A: Unhealthy) (B:25) (C:30) (D: 45.8) (E:27.5) (F :?) (G:30.3) (H:25)

(5) Would you describe yourself as- Very unhealthy Unhealthy (A) (C) (D) (F) Healthy (G) (H) Fit (B) (E) Very fit

(6) If you needed to lose weight, what kind of support or service would be useful to you? (number your preferences between 1 and 7)

By attending a Male only Weight Programme (A:2) (B:6) (C:4) (D:1) (G:4) A mixed Weight Programme (A:1) (B:5) (D:4) (G:3) A Sport related programme (such as Football or Rugby) (A:7) (B:7) (D:2) (E:1) (G:2)

(H) A programme you do yourself, supported by Salford Royal Hospital (A:3) (B:2) (C:1)

(D:3) (F) (G:1) ‘One off’ workshops (on diet, cooking etc) (A:6) (B:3) (C:2) (D:5) (G:5) Leaflets, books, fact sheets (A:5) (B:1) (C:3) (D:7) (F) (G:6) An internet programme (A:4) (B:4) (C:5) (D:6) (G:7)

(7) In terms of attending a Weight Programme, what would be the best location?

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Salford Royal (A:3) (B:1) Fire Station (A:1) (C: 1 Irlam) (E:1) (F) (G) (H) Gateway Centre (A:2)

(D:any)(8) Any other comments

(C) I’d like information on diet, especially the energy content of the food I eat.(F) Cater for men who work and may not be able to make AM/PM appointments

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Focus group 4Consultation with staff at Salford Royal Foundation Trust-2nd April 2014

Background

We held a lunchtime drop in consultation over the lunchtime period, between 12-2pm. The aim was to ensure an informal discussion.

The session had the following aims – To identify barriers to male participation on the weight management service for staff To identify positive interventions with regards male weight management To explore male attitudes towards weight management and other male health issues

The session

4 men in total attended. 2 men attended together and spent a considerable time and were very frank and forthcoming with their views. The other 2 men attended separately.

Interesting aspects of the discussions

How can we encourage men to attend the Weight Management Service for men?

‘There is no real drive for you to come’

‘No real promotion’

‘didn’t know there was a service’

‘Use of good visual promotional images’

‘Posters’

‘Use of the press, highlight as a male only service’

The men began by highlighting this issue, the fact that the men were unaware of the service.

‘Should be an on site gym’

One of the men, who already regularly attend a gym, thought this was a good idea.

‘You should be prompted to lose weight’

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They thought a more direct approach would be beneficial. They believed that staff had a duty to patients to set a good example, by losing weight and a more direct approach could bring benefits, to the staff and patients.

There was a discussion on the benefits of attending the gym. One of the men said he attended the gym to ‘release pressure’s’.

Another reason was offered as an incentive to exercise and that was the influence of a relationship. ‘Men think for ladies’.

‘A 1 to 1 service with goals and checks and feedback’ was put forward.

The type of service was also raised; they said it should be ‘a comfortable service’ with ‘banter’ and a ‘mate to do it with’

Why do you feel, men don’t attend, or take care of their health?

‘Men can be embarrassed’ when it come to admitting they have a problem

‘Men struggle to talk about it’

‘I feel I’m being watched at a gym’

‘Before, I’ve comfort eat, with too bigger portions’

What’s worked for you, in terms of weight loss?

‘Cut out booze, takeaways and having a vegan partner’

‘Walking the dog, I’m not a gym person’.

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Focus group-5Langworthy Cornerstones- 30th April, 2014Background

These contributions were offered by 5 men, that I met at the centre. The centre offers a range of services. A café, offering a range of healthy options, an early year’s provision, a GP service and a variety of courses and activities aimed at the full range of age groups.

When I met the men, I informed them about the Weight Management Service and the problems the service had experienced, in terms of men attending. I then asked them their ideas to enable men to attend.

Man 1 (aged 25-35 years)

‘Free gym passes would be a good idea. There should be something aimed at the youths.’

‘Something local, like here!’

Man 2 (aged 25 – 35 years)

‘Not worried about my weight’

‘A male only exercise class, would appeal’

‘Something, cheap, or free’

Man 3 (aged 70 +)

This man informed me, that he was diabetic. He said he lost ¾ of a stone. He says that ‘he is fitter now, now that he has retired’. His job before, was sedentary, where he used to keep the weight off before this job through physical manual labour.

He now walks, he has cut down on food and he is now more aware. He though, still gets short of breath.

He said he was ‘shocked when he couldn’t bend down to put on his socks’. And this was the catalyst for him to change.

He doesn’t know, what would be appealing to men? Something attractive, but he didn’t know what that would be.

Man 4 (aged 70 +)

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This man informed me that he was told he was morbidly obese. The man a former publican, told me that he still enjoyed his beer.

He wondered why his GP had not referred him onto the Weight Management Service ?

He said he had an exercise bike, but had problems in staying on the bike, physically, saying that ‘he’d fall off’ and ‘didn’t feel right’.

He said that his friends took care of their own weight, by walking together.

Man 5 (aged 30 -35 years)

This man worked in the café. He told me it was hard to maintain a healthy weight and said that ‘it was the booze’.

He didn’t know what would appeal to men. He said that they had tried several initiatives at the centre to get men in, but had struggled.

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QuestionairreSRFT ‘Men’s Health Survey’

(9) Age

18-35

35-50

50-65

Over 65

(10)Ethnicity

How would you describe your ethnicity?

(11)Your postcode

(12)Have you ever tried to lose weight?

(13)Are you worried about your weight?

(14)In your opinion, what would be the best way to lose weight?

By attending a support group By visiting your GP By doing it yourself By reading and researching Through the internet

(15)Any other comments

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Profile former and current usersUsing data supplied by the Weight Management Service, I explored the data for possible trends or causes for attendance and non attendance.

The data was for the period 2012-2013.

Those that did attend the service

During this period at total of 16men accessed the service. These were referrals and were not staff.

Age -

(18-35) - 3

(35-50) - 4

(50-65) - 7

(Over 65) - 2

Number of visits –

(1 -5) - 5

(5 – 9) – 3

(9 – 12) - 8

BMI -

(26 – 30) - 1

(31 – 35) – 3

(35 – 40) - 6

(40 – 45) – 1

(45 +) - 5

12 out of 16 men who did attend BMI over 35

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Those that did not attend (after being referred)

Total 18 men

Age

(18-35) - 2

(35-50) - 4

(50-65) - 8

(Over 65) -4

BMI

(26 – 30) – 5

(31 -35) - 12

(35 – 40) – 1

12 out of 18 men who did not attend BMI 31- 35

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Additional info with reference referrals who attended

1. Man aged 41. Did not return after 2 sessions. BMI 45.5 (onto other project?)

2. Man aged 38. Attended 5 sessions, lost 11 Ib, BMI 48.8 3. Man aged 78. Lost 7 ½ Ibs. 4 sessions, then DNA 2 occasions4. Man aged 52. Motivated after stroke to lose weight. Frustrated couldn’t

exercise as much following stroke. Lost 8 ½ pounds. Did access services, gym and did cut down on portion sizes and eat healthy.

5. Man aged 52. Lost 15 ½ Ibs. 6 sessions, BMI 39.96. Man aged 41. Lost 6 lbs. 7 sessions. BMI 30.67. Man aged 53. Lost 6 ½ Ibs. 2 sessions. BMI 31.5. Initially lost weight then

put on again.8. Man aged 49. Attend 1 session. Lost 3 ½ IIbs. BMI 389. Man aged 28. Lost 35 ½ Ibs. BMI 46.9. Attended 12 sessions.10. Man aged 56. Lost 28 ½ Ibs. BMI 34.511. Man aged 28. Lost 2 Ibs. BMI 46.8. Attended 2 sessions.12. Man aged 34. Lost 39 ½ Ibs. Attended 12 sessions.

Telephone interviews (mixture of those that attended and not attended)

1. Man aged 41. BMI 30.6, lost 6Ibs. 7 sessions. He didn’t remember coming, says hopefully will return.

2. Man aged 53. Lost 6 ½ Ilbs. BMI 31.5. 2 sessions. He missed 3 weeks, says ‘didn’t get a letter ‘and given ‘wrong dates’ also said a ‘bit awkward to get to’.

3. Man aged 59. BMI 34.5. Said be very keen to attend (previously didn’t attend). Said used to walk, go to gym and swim.

4. Man aged 47. BMI 31.3. Invited to attend clinic (after not previously attending)5. Man aged 66. BMI 26.9. Believed to get men to attend need to appeal to their vanity.

Tell them about well being. Tell them to lay off booze a bit and curries. Says a lot of it is ‘male pride’. Should make men aware of long term problems. Should employ shock tactics, leaflets etc.

6. Man aged 52. BMI 32.9. Told couldn’t get hold of this man after trying 3 times, so was discharged. Talked on phone, given drop in details of Walkden Gateway.

7. Man aged 59. BMI 32.1. Couldn’t remember referral. Had to ask wife.

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References1. www.menshealthforum.org.uk 2. http://www.menshealthforum.org.uk/key-data-understanding-health-and-access-

services3. www.mhfi.org/resources/research-policies-and-reports.html4. Hazardous Waist, Tackling male weight problems, Alan White & Maggie Pettifer,

Radcliffe Publishing 20075. www.partnersinsalford.org/jsnaprofilesalford.htm6. http://www.noo.org.uk/slide_sets , Public Health England 2010/127. http://www.noo.org.uk/uploads/doc/vid_11171_Attitudes.pdf8. http://www.barnsleyfccommunity.co.uk/health/join-the-fit-reds-programme 9. http://www.wmc.uk.com/fit-fans/10. http://www.fitfans.co.uk/the-programme/11. Men’s Health Service Report, 2008. James Leishman &Alison Dalziel (The Camelon

Project)12. Working to improve the health of men, Men’s Health Service 10 year report. James

Leishman &Alison Dalziel (The Camelon Project) NHS Forth Valley, 4/4/201213. The Gender and Access to Health Services Study, 2008, commissioned by the

Department of Health by the Men’s Health Forum. David Wilkins Dr Sarah Payne Dr Gillian Granville Dr Peter Branney

14. http://www.knowsley.gov.uk/pdf/public-health-annual-report-2012-2013.pdf15. http://ec.europa.eu/health/population_groups/docs/men_health_extended_en.pdf 16. info.wirral.nhs.uk/document_uploads/evidence-reviews/Mensaccesshealthservices-

completedMay09_e2283.pdf17. repository-intralibrary.leedsmet.ac.uk/open_virtual_file_path/i1173n141603t/

Report%20on%20the%20first%20phase%20of%20the%20study%20on%20mens%20usage%20of%20the%20Bradford%20Health%20of%20Men%20services.pdf

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Additional reading1. Men’s health-how to do it. David Conrad & Alan White, Radcliffe Publishing, 20082. Men and primary care: IAN BANKS AND PETER BAKER, TRENDS IN UROLOGY &

MEN’S HEALTH SEPTEMBER/OCTOBER 2013 www.trendsinurology.com3. http://www.partnersinsalford.org/obesityphysicalactivity-tableschartsmaps.htm 4. http://www.theguardian.com/society/2009/feb/25/mens-health 5. http://www.biomedcentral.com/1471-2458/14/50

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