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ManAlive!

Health Literacy

Organisation: 
Cancer Focus Northern Ireland
Date of Project: 
Pilot 2010 – 2013, extended to 2015
Geography of Project: 
Rural areas of Northern Ireland
Keywords: 
rural, men's health, health inequality, cancer prevention
Aim, Background, What Happened: 

Cancer Focus NI has existed for over 40 years providing a range of services in Northern Ireland.

Launched in 2010, ManAlive! is a partnership programme that was developed in direct response to the inequality in health outcomes, and use of health related services by men generally and men in rural and isolated areas in particular. The project aimed to work with 400 men and succeeded in working with 4000.

Context of Community or Target Group: 

The ManAlive! intervention is aimed at improving the physical and mental health of men living in one of the most deprived rural areas in Northern Ireland. The programme started in the Southern Health and Social Care Trust.

ManAlive! is targeted at men in rural settings and had specific targets to engage with men from minority ethnic groups and male Travellers. The project provides a range of health initiatives including: health checks, health awareness and personal development sessions and involves men from local communities to provide volunteers with opportunities for training and service experience.

The ManAlive! intervention is delivered by a full-time project co-ordinator, one part-time nurse and sessional nurses. A small mobile unit, ‘The Man Van’, is used for one-to-one health awareness sessions and to provide physical health assessments (health checks). ManAlive! has also worked with local retailers to support them in the provision of health information. It supports dissemination of information and networking between project partners through conferences, trainings and meetings.

Interventions used include ManVan, health awareness sessions, self-development programmes, retail outlets, information sharing and involving men. Actives included health check with 400 men, education with special interest groups such as traveller men and BME and training with retail businesses. Expected programme outcomes included activities, social inclusion, health improvement, capacity development, behavioural change and governance.

The ManAlive! health check comprises of a physical health assessment and a detailed discussion of health and related behaviours. The consultation lasts on average 30 minutes and is divided into two parts of approximately 15 minutes each.  (In some events less time was available and a shorter health check was conducted consisting of BP, BMI and BM and health awareness information).

The ManAlive co-ordinator meets each man, records his weight, height, BMI and body composition. The co-ordinator will also discusses lifestyle, health behaviours, risk factors and cancer specific issues including testicular and prostate cancer. The client then moves through to an adjoining room in the Man Van to consult with the nurse. This second stage includes recording blood pressure (BP), blood sugar (BM) and to discuss any specific medical concerns.  The ManAlive! health check offers a universal service that is then tailored to the needs of each individual person.  For example one consultation might focus on stress management and relaxation techniques, another on information and advice or brief intervention to help someone stop smoking and another may be tailored to meet the needs of a man wanting advice or guidance about weight loss.  A small number of clients used this consultation session to seek advice about types of cancers or support information. Depending on the results of the health checks men were advised to seek further advice from a health professional or a range of smoking cessation in the local community.

The personal development programme was delivered over six weeks and tailored to meet the needs of the group. Some programmes looked at lifestyle issues such as nutrition, hydration and exercise, while others focused on physical activity to improve mental health. The Warwick-Edinburgh Mental Well-being Scale (WEMWEBS) was used to assess mental health at the beginning of the programme.

Influences on Case Study: 

ManAlive! was influenced by South Armagh Family Health Initiative who rented a transit van to deliver a health check service to the male traveller population. This project was very successful and served as an effective model for future work. This service is greatly valued by the community and it was identified that greater provision was needed.

Policy and Other Problems: 

Health and Safety - The ManVan visited male dominated work environments such as construction sites which had various health and safety considerations.

Weather conditions- in cold weather the measures of BM and cholesterol were less reliable as the cold affected the meters. Some events had to be abandoned due to adverse weather conditions in rural areas being visited.

Prior Experience with Health Literacy Across Sectors: 

Cancer Focus NI has experience delivering clear message about cancer awareness to men in voluntary, community, statutory and private sectors. While the project does not explicitly mention health literacy it seeks to promote positive health literacy outcomes.

The project was delivered in partnership with a range of partners with extensive experience of using the community development approach to health and social model of health.

Concept of Health and Health Literacy: 

Cancer Focus NI is a local cancer champion, supporting individuals and families with cancer.  They also provide support for communities to take positive steps to a healthier life, lower risk of cancer and funding ground-breaking research.

There is not explicit mention of health literacy within the programme however techniques are used to ensure clear communication of health messages during all events.

Prioritisation of Issue: 

Northern Ireland Cancer Registry suggests men present later.

Northern Ireland Statistics and Research agency (NISRA) identifies Newry & Mourne as one of the most deprived rural areas.

Promoting Mental Health Strategy and Action Plan (2003-2008)

An Exploration of the Impact of Rural Isolation on Poverty and Disadvantage in Families with Children in the Southern Investing for Health Partnership Area (January 2007)

Northern Ireland Health and Social Wellbeing Survey (2005-2006)

Priority issues under the Big Lottery Funding ‘Reaching Communities Programme’

Keeney, Sinead, McKenna, Hugh, Fleming, Paul and McIlfatrick, Sonja (2010) Attitudes to cancer and cancer prevention: what do people aged 35–54 years think? European Journal of Cancer Care, 19 (6). pp. 769-777

A Report on the Excess Burden of Cancer on Men in Ireland, Irish Cancer Society, 2013.

Men’s Health Forum Ireland 2004, A report from the Men’s Health Forum.

Formal Processes: 

The project is governed by a cross sectoral advisory group.  ManAlive! is managed by the Head of Cancer Prevention at Cancer Focus Northern Ireland. The strategic support and guidance for the project is provided by an inter-sectoral operational group and an advisory group comprising of Cancer Focus Northern Ireland, the Public Health Agency, the Community Development and Health Network and the Southern Health and Social Care Trust.

The day to day project is delivered primarily by a full-time project co-ordinator, a part-time health promotion nurse and two nurses working on a sessional basis. All workers are employed by Cancer Focus Northern Ireland.

Availability of Resources: 

The ManAlive! Project was funded by Big Lottery’s ‘Reaching Communities Programme’ from 2010-2013 and is managed and delivered by Cancer Focus Northern Ireland.

Due to the success of the project the Big Lottery extended funding to 2015, the project has now expanded with 3 mobile units on the road serving the province (all 3 vans are now funded by Cancer Focus NI) health checks and sessions are delivered to both men and women.

Capacity-Building Activities: 

Capacity building is a central focus of ManAlive! , the project seeks to improve men’s health, by increasing understanding of health and find ways in which they can take more control of and responsibility for their health.  ManAlive! promotes capacity building by improving: access to services, education, training and cross-sectoral collaborations. ManAlive! Works with men at the individual level, as a group and with other organisations.

The ManAlive! Intervention provides health assessment, capacity development and strengthening networks. As part of the health check men are provided with printed literature of relevance to their particular circumstances and a print-out summary of their physical health assessment.

ManAlive! contributed to eight personal development programmes and hosted two conferences.

Was there an increase of men presenting earlier with cancer symptoms? Evidence of prevention work being successful?

Social Mechanisms: 

ManAlive! developed the capacity of men as a group through personal development programmes and by creating a male environment which enabled conversations about health.

Acceptability: 

A key aspect of the project is the specially designed ManVan which enables the ManAlive! workers to bring screening and health promotion materials, directly to men living and working in isolated and rural areas.

The convenience and the drop-in nature of the service made it convenient for the target group of the project.

The project was acceptable to partner organisations as it targeted an identified need for men’s health, in rural areas.

Feasiblity: 

The pilot project was funded through Big Lottery, bringing services to isolated rural areas focused on Men’s Health.  The flexible nature of the service enabled men to avail of the services without an appointment. ManAlive! staff have experience in delivering tailored health information and advice.

Creating a male friendly environment made conversations about health ‘normal’ and ‘acceptable’.

Sustainability: 

The pilot project was funded by Big Lottery Fund ‘Reaching Communities NI’ from 2010-2013. Big Lottery Fund extended funding to 2015; the project has now expanded with three mobile units working across Northern Ireland to provide health checks to both men and women. Three vans are now funded by Cancer Focus NI; ManAlive!, Keeping Well service Van, for men and women 18+ and Well aware 60+.

Other Comments / Information: 

The key elements behind the success of ManAlive! is the accessibility of the service, the commitment to partnership working, the calibre of the staff and the reputation and experience of Cancer Focus NI.

Headline Message(s): 

Mobile health unit, convenient to meet your needs offering free, advice on Men’s Health in your local community and workplace.

Evaluation: 

The ManAlive! project had an ongoing external evaluation during 2011 – 2013. The evaluation used a range of methods including observation, interviews and analysis of quantitative data. Key findings highlight ManAlive! as a model for service delivery across the health and social care sector.

Over 4,000 men have availed of the ManAlive service.

The average age of men accessing the service is 45 years.

ManAlive has carried out over 4,000 health checks (target was 400).

19% of men assessed were found to have high blood pressure.

78% of men were classified as overweight or obese.

ManAlive contributed to eight personal development programmes and has hosted two highly successful conferences.