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What works with men: a systematic review of health promoting interventions targeting men |
Robertson L M, Douglas F, Ludbrook A, Reid G, van Teijlingen E |
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CRD summary This review appraised the available evidence of effective interventions aimed at improving men's health and concluded that there was little published evidence on how to improve men's uptake of services. It was unclear whether it would be more effective to provide different services or the same services in a different way. Despite some limitations, the conclusions appeared broadly appropriate. Authors' objectives To appraise the available evidence of effective interventions aimed at improving men's health. Searching Fourteen electronic databases (British Nursing Index, Campbell Collaboration Library Catalogue, CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, ERIC, Health Development Agency Publications database, HEBS Library Catalogue, HMIC, MEDLINE, PsycINFO, ISI Science and Technology Proceedings, Science Citation Index Expanded and Social Sciences Citation Index) were searched to identify relevant published and unpublished studies in the English language from 1990 to April 2006. Search terms were reported. Also, several websites, three key journals, reference lists of retrieved studies and personal contacts were used to identify further relevant evidence. Study selection Studies evaluating interventions aimed at improving health in free-living adult men (aged over 18 years) were eligible for inclusion. These had to be randomised controlled trials (RCTs), quasi-randomised controlled trials or controlled before-and-after studies measuring health status, knowledge, attitudes, behaviour or behaviour intentions. Studies concerned only with sexual health were excluded.
Included studies evaluated a range of interventions in the areas of smoking cessation, diet/physical activity, cardiovascular disease, prostate cancer, testicular cancer, preventive health screening, skin cancer and alcohol. Most studies were in primary care and were US-based. A theoretical framework was used in the development or delivery of the intervention in around half the identified studies.
Two reviewers independently selected studies for inclusion in the review; any disagreements were resolved by discussion with a third reviewer. Assessment of study quality Studies were classified according to the following criteria: use of an appropriate control group; reporting of pre- and post-intervention data for all participants; and reporting results for each outcome specified in the aims of the study. Sample size and generalisability were considered during the presentation of study findings.
It was not clear how many reviewers performed the validity assessment. Data extraction Two reviewers independently extracted data from using standardised extractions forms, with any disagreements resolved by discussion. Methods of synthesis Studies were combined in a narrative synthesis grouped by the target of the intervention being evaluated. Results of the review A total of 27 (n=23,705) studies were included in the review; 18 studies met all the quality criteria.
Twenty-three interventions were found to be effective or partially effective. A wide variety of interventions (predominately related to information provision) were evaluated in the areas of interest: smoking cessation (media campaign, self-help manuals); diet/physical activity (health promotion programme, nutrition counselling and/or serum cholesterol measurement); cardiovascular disease (stress management, nutrition/exercise interventions); prostate cancer (verbal and written information on prostate cancer screening, educational sessions, posters, videos and websites); testicular cancer (leaflets, information resources on testicular self-examination); preventive health screening (combined health provider stickers, letter/pamphlet, postcard); skin cancer (personalised letter and information brochure) and alcohol (self-help pamphlet). Authors' conclusions The authors stated that they could not conclude that targeting men worked better than delivering a general service to all people. There was little published evidence on how to improve men's uptake of services. It was unclear whether it would be more effective to provide different services or the same services in a different way. CRD commentary This review was based on a research question clearly defined in terms of the participants, interventions, outcomes and study designs of relevance. A wide range of sources was searched to identify relevant studies. But, the search was limited to English language studies, so the potential for language bias remained. Attempts were made to minimise the potential for errors and bias in the selection and extraction of studies. The validity of included studies was assessed according to predefined criteria, although the results of this assessment and other study details were presented only briefly in the article. The decision to combine the studies using a narrative synthesis was appropriate, given the clear differences between the studies. Although the authors searched for unpublished studies, they acknowledged that publication bias could not be ruled out. Despite the lack of details provided in the review, the authors' conclusion that the evidence was insufficient to determine whether specifically targeting men was effective appeared appropriate given the evidence presented. Implications of the review for practice and research Research: The authors stated that large-scale studies were needed to provide evidence that was sufficiently robust to add to the small evidence base that existed in this field.
Practice: The authors did not state any implications for practice. Funding Funded as part of a larger evaluation of well men health service pilots by the Scottish Executive Social Research. One author's institution received core funding from the Chief Scientist Office, Scottish Government Health Directorate. Bibliographic details Robertson L M, Douglas F, Ludbrook A, Reid G, van Teijlingen E. What works with men: a systematic review of health promoting interventions targeting men. BMC Health Services Research 2008; 8:141 Indexing Status Subject indexing assigned by NLM MeSH Adult; Decision Making; Health Promotion /methods; Health Services Research; Humans; Male; Mass Screening /utilization; Men's Health; Preventive Health Services /utilization; Sex Factors AccessionNumber 12008104851 Date bibliographic record published 02/03/2009 Date abstract record published 20/05/2009 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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