Promoting men's health through sports clubs: A systematic rapid realist review

Background: Health promotion (HP) interventions delivered through sports clubs have demonstrated promising outcomes among men, but less is known about which aspects of the interventions work, for whom, and under what circumstances. This rapid realist review aimed to understand the contexts, mechanisms, and outcomes of HP interventions for men delivered through sports clubs. Methods: A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SPORT- Discus databases. Included studies: (a) were delivered by or in collaboration with sports clubs, (b) targeted men aged 18+ years, and (c) reported 1 or more HP outcomes. A grey literature search was also performed. Studies were included in a realist synthesis based on richness and rigor. Hereafter, context-mechanism-outcome (CMO) configurations were developed. Results: We identified and screened 3358 studies, finally including 59 studies describing 22 interventions. Most HP interventions were delivered in high income countries, included Caucasian men aged 35-65 years with overweight/obesity, and used professional sports clubs (mostly football) for recruitment and facilities. Quantitative HP outcomes were reported across 19 interventions. Of these 19 interventions, the majority reported on weight (n = 18), physical activity (n = 12), mental health (n =10), and diet (n = 9). We identified 13 CMOs related to how HP interventions affected men's recruitment, engagement, and health behavior maintenance. Conclusion: Our findings show that using sports clubs for HP interventions is effective for engaging men. Recruitment was facilitated by leveraging sports clubs' identity, addressing masculinity-related barriers, improving accessibility, and building trust. Engagement was enhanced through shared identity experiences, safe spaces, inclusive competition, and self-efficacy. However, there's limited evidence on behavior maintenance post-intervention, though involving community stakeholders seemed vital. In general, considerations should be made to avoid perpetuating traditional masculine norms, which may exclude some men and reinforce unhealthy behaviors. These findings can guide intervention development, emphasizing the need to harness men's perspectives in the process.