In Ireland, men's health is becoming a priority. In line with global trends, indicators of poor mental health (including rates of depression and suicide) are increasing alongside rates of unemployment and social isolation. Despite the growing awareness of men's health as a national priority, and development of the first National Men's Health Policy in the world, there is still a concern about men's nonengagement with health services. Health and community services often struggle to appropriately accommodate men, and men commonly avoid health spaces. A growing body of literature suggests that a persistent lack of support or resources for service providers contributes to their inability to identify and meet men's unique health needs. This study aims to provide further insight into the ways in which this gap between men and health services can be closed. Semistructured, qualitative interviews were conducted with nine project partners (n = 9) of a successful men's health program in Dublin. Interviews captured reflections on what processes or strategies contribute to effective men's health programs. Findings suggest that gender-specific strategies-especially related to community-engagement and capacity building-are necessary in creating health programs that both promote men's health and enable men to safely and comfortably participate. Moreover, including men in all aspects of the planning stages helps ensure that programs are accessible and acceptable for men. These findings have been operationalized into a user-driven resource that illustrates evidence-informed strategies and guiding principles that can be used by practitioners hoping to engage with men.

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Europe's men need their own health strategyA recent European report on men's health shows that it lags behind that of women. Alan White and colleagues analyse the problems and call for more policy, practice, and research aimed specifically at men Ten years ago the BMJ published a special issue on men's health.1 It noted how, although men fare better than women in most conventional measures such as top jobs and earnings, this advantage is not reflected in their health. A report we produced this summer, The State of Men's Health in Europe, 2 3 shows that little has changed. At any given age, men are still more likely than women to die from most of the leading causes, and in the European Union men have more than twice as many deaths a year as women throughout the working ages (15-64 years). This high level of premature mortality in men has psychological, social, and economic consequences for relatives, households, communities, and the workplace. Yet, in both national and European health policy, men and "masculinity" are largely taken for granted. This has limited the development of evidence based programmes that meet their health needs.Differences in mortality and morbidity are not simply the result of biological factors; nor are they intractable. In fact, the health gap between men and women varies considerably. It is much greater in eastern Europe than in western Europe, 4 and within countries it is influenced by class, education, employment, and other social determinants. 5 The clustering of material, cultural, and psychosocial factors seems to be particularly detrimental to the health of many men. 6 These factors contribute to gendered lifestyles and behaviours that have traditionally been seen as predominantly "masculine" 7 and that cause many of the premature deaths in men. Traditional masculine attitudes are associated with unhealthy behaviours such as poor diet, 8 smoking, excessive alcohol consumption, 9 non-use or delayed uptake of health services, 10 and higher likelihood of injury. All of these factors are more common among men living in eastern Europe than those in western Europe and in poorer material and social conditions everywhere.11 Men also seem to have adapted less well than women to the changes that have accompanied the political and social upheavals in eastern Europe in recent decades, such as more transient and unstable working conditions, increasing unemployment, and changing family structures (reduction in marriage and increased divorce). 12Yet, paradoxically, men often view themselves as having better health than women. There is some justification for this view: those men who survive into old age report less disability than women of the same age 2 ; but what is overlooked is that fewer live this long.13 Though the average difference in life expectancy between men and women in the European Union is 6.1 years, it ranges from 11.3 years in Latvia to 3.3 years in Iceland and Lichtenstein.2 Thus, men in general, and younger men in particular, tend to minimise the potential consequences of pra...

Summary Men with the poorest health outcomes are, paradoxically, the least likely to access health services or to engage with health promotion interventions. This has focused attention on developing gender-sensitive and strengths-based approaches to engage so-called ‘hard-to-reach’ men. Men’s Sheds (‘Sheds’) are recognized as an alternative space in which to engage older and more marginalized groups of men in health. The aim of this study was to establish key principles that could align the ethos of Sheds with a national health promotion initiative (‘Sheds for Life’; SFL) in terms of methods of engagement, programme content and models of delivery. Qualitative methods incorporating semi-structured interviews, focus groups and observations were conducted with men in Sheds (‘Shedders’; n = 38), oversight/advisory groups (n = 11) and partner organizations (n = 8). The principles of grounded theory were used to inform data collection and analysis. Findings revealed a range of mediating factors in terms of how Shedders engage with or ‘do’ health that were grounded in a recognition of the health-enhancing ‘essence’ of Sheds and in ‘making men’s health men’s business’. Key learnings arising from the process of engaging with Shedders included the importance of investing in relationships, establishing credibility and tailoring SFL programme content and delivery to individual Sheds. In terms of conceptualizing SFL, attention was drawn to the need for a coherent and formalized SFL strategy and ‘rules of engagement’, as well as a robust and sustainable system for implementation. This is the first study that informs a more systematic and formal approach to health promotion in Sheds.

Background Men’s Sheds (“Sheds”) offer a unique opportunity to reach a captive audience of “hard-to-reach” men. However, attempts to engage Sheds in structured health promotion programmes must respect the ethos of Sheds as highly variable, autonomous, non-structured spaces. This paper captures the key methodologies used in “Sheds for Life’ (SFL), a men’s health initiative tailored to the Shed setting. Methods A hybrid effectiveness-implementation study design is used to test effectiveness and implementation outcomes across multiple levels (participant, provider, organisational and systems levels). A dynamic, iterative and collaborative process seeks to address barriers and translation into the real world context. Using a community-based participatory research approach and guided by established implementation frameworks, Shed members (‘Shedders’) assume the role of key decision makers throughout the evaluation process to promote the systematic uptake of SFL across Shed settings. The protocols pertaining to the development, design and implementation of SFL and the evaluation of impact on participants’ health and wellbeing outcomes up to 12 months are outlined. Conclusions There is a dynamic interplay between the intervention characteristics of SFL and the need to assess and understand the diverse contexts of Sheds and the wider implementation environment. A pragmatic and context-specific design is therefore favoured over a tightly controlled efficacy trial. Documenting the protocols used to evaluate and implement a complex multi-level co-developed intervention such as SFL helps to inform gender-specific, community-based men’s health promotion and translational research more broadly. Trial registration This study has been retrospectively registered with the ‘International Standard Randomised Controlled Trial Number’ registry (ISRCTN79921361) as of the 5th of March 2021.