Football Cooperative – An Open Goal for Promoting Positive Men’s Health Outcomes

Description

Physical inactivity negatively impacts all facets of health and damages our economy, environment and propagates social dissolution within our urban and rural areas. Physical inactivity is a major riskfactor for the most common non-communicable diseases and a significant cause of chronic disease. Globally, physical inactivity is estimated to kill more than five-million-people-every-year. Physical inactivity has been identified by the World Health Organisation (WHO) as the fourth leading riskfactor for global-mortality.

The 2022 Eurobarometer on Physical Activity for Ireland reported an excessively high level of physical inactivity with only 46% of adults meeting the public health recommendations for physical activity. The evidence demands urgent action to get our population moving, especially men. Repeated studies have revealed increased trends of adult males failing to achieve even the minimum WHO Guidelines on physical activity and sedentary behaviour that are required to mitigate mental and social health risks and offset cardiovascular disease, cancer, diabetes and obesity. The evidence demands urgent action to get our populations moving, especially men. The need to focus a spotlight on men’s health has been well documented. It is acknowledged that men’s poorer health outcomes are not solely biologically determined, and that lifestyle behaviours, social factors and gender, play a significant role. Men, and poorer men in particular, continue to experience an excess burden of ill-health, mortality and premature death.

Men’s underuse of health and social-related services also often compounds health risk. As a result, male ill-health can go undiagnosed and untreated. Gender is one of the most important social determinants of health associated with influencing health related behaviour and needs to be considered when addressing the health outcomes experienced by men globally. There is a growing body of good practice of gender competent services for men that are tailored in terms of context, content and delivery. Recognising the need to account for male gender norms, these programmes use opportunities for peer support and connecting masculine ideals [autonomy, control, resilience] with being healthy. It is therefore not surprising that in recent years, ‘football sports setting’ and ‘playing football’ in community and/or sports settings have been increasingly used as a medium to engage men in their health, and to very good effect. Various initiatives to increase male physical activity have often been extended however many of these have not always aligned with the needs, barriers and facilitators to attract male participants. The focus of these programmes have traditionally been away from ball based team activities as they present various complexities of participant coordination and venue management in addition to a liability risk that are seen to be prohibitive for stakeholders.

Recreational football is viewed as an important medium to engage men who are seen as reluctant or unwilling to access traditional health services and can be an effective broad spectrum non-pharmacological treatment of lifestyle diseases. Research suggests that men ‘do’ emotion through action like playing football, and the emotional connection that many men have with football appears to enable men to feel safer engaging with football-based health initiatives. Recreational football traditionally has been known to be unstructured with that unreliable as a means of obtaining regular physical activity. Additionally, capacity for activities to continue are limited to a period-of-weeks which do not always bring significant lifestyle changes for men. Football Cooperative places ‘pick-up’ recreational football as ‘a hook’ to bring men together to increase physical activity with the objective to improve overall health. Our approach focuses on removing barriers, building-community and making-organising-easy. Through a place based model, we incorporate a consolidated network of recreational football sites that each deliver weekly games year round. Our community based volunteer Game Coordinators (multiple at each site) lead out games that are a) accessible i.e. local amenities are used for games; b) flexible regarding attendance (games played 2-3 nights/week), c) affordable to ensure financial barrier is removed and d) inclusive – participation is offered to all levels of fitness and football capacity.

Beyond game delivery, our intervention promotes increased participant social connection, mental wellbeing and health literacy through added-value-activities that range from our ‘goal post chats’ to engagements to help participants think about their health and understand the early signs of health issues that affect men i.e testicular/prostate-cancer. Football Cooperative’s organisational structure enables the engagement of multiple-stakeholders to support, endorse and mandate it with the responsibility to become the main ‘go-to’ solution for recreational football.We have developed an Advisory Board that consists of a panel of experts from already on-boarded key stakeholders – Health Service Executive, the Department of Health, Football Association of Ireland, UEFA, Sport Ireland and Volunteer Ireland.

Football Cooperative membership consists of 608 men who are registered across 2 sites. In 2023, we delivered 188 gamenights translating into 349 games, 15,420 minutes of physical activity and 6,382 instances of participation.

Aim of Initiative

Football Cooperative primary aim is to get men active. In doing so, physical health is directly impacted however additional positive impacts are experienced on participant mental wellbeing and social connectedness. Key to our success is that we are led wholly on a volunteer basis driven by a core team that oversees; governance responsibilities for managing the venues [bookings, insurance, health and safety], drives the strategic direction [advancement of delivery model, stakeholder engagement], communicates with all members, facilitates the added-value-activities, and ensures that the values are upheld. Specifically, these values centre around fair play, respect, integrity, inclusivity and community.

In 2021, we formed an enterprise-academic partnership with the SETU to assess the feasibility for scale up which was pinned to the Social Return on Investment (SROI) framework. With regard to the immediate beneficiaries – participants; mean body mass index (BMI) was 27.2 ± 3.5 Kg/m2, with 60% classed as overweight and a further 13.9% as obese. A large majority [83.1%] had three or more CVD risk factors. Some 68.9% failed to meet the recommended PA levels, and 66.1% met the threshold for an at-risk waist circumference of ≥94cm. Almost half [49.3%] were considered at risk by reporting their sleep quality as fair or poor. Notably, very poor or poor aerobic fitness was the next most common risk factor [31.7%].

In short, this data suggests that despite most participants being middle aged (ages 40 to 65) and well educated, a large number were at risk of Cardiovascular disease. Notably, despite their health risk, 90.1% of participants described their general health as good, very good or excellent and this lack of awareness of health risk among men has been well established in men’s health research. All immediate stakeholder groups reported positive outcomes; participants, their significant Others. The volunteer Game Coordinators and Community Partners. The SROI of the games was calculated and found to be €17.60 for every €1 invested and therefore The SROI supported feasibility for scale nationally. As a result of the evidence within the social value study, strategic efforts moved towards impact scale up of our intervention for population health benefit with key stakeholders – Health Service Executive, the Department of Health, Football Association of Ireland, UEFA, Sport Ireland and Volunteer Ireland providing expert advice on how best to implement the model at scale.

Who is it aimed at

Football Cooperative games provide an opportunity for flexible, inclusive, and team based physical activity focused on friendship, enjoyment with a competitive edge. Each of these needs have been identified as fundamental within physical activity programme development for men.

Football Cooperative primary aim is to get men active. In doing so, physical health is directly impacted however additional positive impacts are experienced on participant mental wellbeing and social connectedness. Key to our success is that we are led wholly on a volunteer basis driven by a core team that oversees; governance responsibilities for managing the venues [bookings, insurance, health and safety], drives the strategic direction [advancement of delivery model, stakeholder engagement], communicates with all members, facilitates the added-value-activities, and ensures that the values are upheld. Specifically, these values centre around fair play, respect, integrity, inclusivity and community. In 2021, we formed an enterprise-academic partnership with the SETU to assess the feasibility for scale up which was pinned to the Social Return on Investment (SROI) framework. With regard to the immediate beneficiaries – participants; mean body mass index (BMI) was 27.2 ± 3.5 Kg/m2, with 60% classed as overweight and a further 13.9% as obese. A large majority [83.1%] had three or more CVD risk factors. Some 68.9% failed to meet the recommended PA levels, and 66.1% met the threshold for an at-risk waist circumference of ≥94cm. Almost half [49.3%] were considered at risk by reporting their sleep quality as fair or poor. Notably, very poor or poor aerobic fitness was the next most common risk factor [31.7%].

In short, this data suggests that despite most participants being middle aged (ages 40 to 65) and well educated, a large number were at risk of Cardiovascular disease. Notably, despite their health risk, 90.1% of participants described their general health as good, very good or excellent and this lack of awareness of health risk among men has been well established in men’s health research.

All immediate stakeholder groups reported positive outcomes; participants, their significant Others. The volunteer Game Coordinators and Community Partners. The SROI of the games was calculated and found to be €17.60 for every €1 invested and therefore The SROI supported feasibility for scale nationally. As a result of the evidence within the social value study, strategic efforts moved towards impact scale up of our intervention for population health benefit with key stakeholders – Health Service Executive, the Department of Health, Football Association of Ireland, UEFA, Sport Ireland and Volunteer Ireland providing expert advice on how best to implement the model at scale.

3 Steps critical to success

1. Having kept an active participation in sport, I found that like many other adults when dual responsibilities from work and childcare became prominent, I could no longer make the requisite commitment demanded by traditional team sport. It was here I discovered that other pathways to engage with physical activity in a team environment were close to non-existent. The few options that did exist were noted to be both unreliable and unsustainable.For me, chasing a footpath, be it walking or running, does not come close to the motivation and enjoyment I get from chasing a ball. My experience has shown that this was not an isolated occurrence. Upon setting up the first Football Cooperative site, it was quickly established that other men were also interested in getting active through recreational football but just needed the structure from which to engage with it. My experience from leading our activities has helped me to witness first hand how football can bring people together to create a community of peers to support one another. I have witnessed firsthand how team environments drive healthy lifestyle choices and promote additional exercise beyond its own existence.
2. All of this has only served to motivate me further to evaluate the impact participation has.In 2020, we undertook Social Entrepreneurs Ireland Idea’s Academy which provided an enhanced understanding of the problem we are tackling as well as an introduction to stakeholder mapping and impact measurement.

   Coming out of this, we endeavoured to engage with multiple potential academics within third level institutions across Ireland to elicit their support us with an impact assessment. In 2021, we formalised an enterprise partnership with Waterford IT (now South East Technological University) to commence a first of its kind PhD research study in Ireland with the objective to investigate the health impacts from participation in recreational football using the Social Return on Investment framework.

3. Having established the academic partnership, we supported the research team by delivering the intervention across 12 months post baseline; facilitating data collection across multiple timepoints across each identified stakeholder, assisted the assessment of all inputs, outputs and outcomes which resulted in the calculation of the Social Return on Investment assessment to be made. This confirmed the feasibility of replicating our health intervention across multiple sites.In 2023, coming out of the evidence established within the Impact Research, we formulated an additional enterprise partnership with SETU; this time co-funded by UEFA for a PhD studentship to undertake qualitative research to inform the development of our model. An expected outcome from this in the coming months will be the production of an implementation strategy for national replication at scale.

3 Challenges in Planning / Delivery

1. Growing evidence linking low levels of physical activity to poor health has resulted in sports policy becoming an important contributor to public health. However, this has as yet translated into increased participation rates. The latest Irish Sports Monitor Report produced by Sport Ireland noted a participation rate among adults of only 40% which represented a 6% decline from the previous report.The traditional approach of clubbased sport has been the primary focus of national governing bodies of sport. However, societal preferences for physical activity have changed dramatically over recent decades. Limited progress in response to these changes has been made to enable sustainable and reliable participation outside of the competitive structures and environments. What is clearly needed is a shift from extrinsic drivers such as winning and competitiveness to intrinsic factors of flexibility, fun and enjoyment. If we are serious about increasing participation and minimising dropout we need to consider what makes getting active fun, because enjoyment is now proven to be the main reason individuals play community club-based sport. This change not only raises the potential of increasing participation but also delivers retention and reduced drop out from physical activity.
2. Various initiatives to increase male physical activity have been undertaken however many of these initiatives have not always aligned with the needs, barriers and facilitators of the male participants that we have identified through our academic research. Capacity for activities to continue are limited to a period-of-weeks which do not always bring significant lifestyle changes for participants. The focus of these programmes have also traditionally been away from ball based team activities as they present various complexities of participant coordination and venue management which in addition to an insurance liability risk are seen to be prohibitive for stakeholders.
3. Football Cooperative’s organisational structure enables the engagement of multiple-stakeholders to support, endorse and mandate it with the responsibility to become the main ‘go-to’ solution for recreational football.We have developed an Advisory Board that consists of a panel of experts from already on-boarded key stakeholders – Health Service Executive, the Department of Health, Football Association of Ireland, UEFA, Sport Ireland and Volunteer Ireland.We can be considered to implement the fee-for-service business model where a social enterprise charges the customer directly for the socially beneficial services it provides. The traded income is derived from games fees asked of participants. These are not only necessary to cover the costs associated with delivering activities but in themself provide the psychological contract from which the participant commits to attend the game being delivered.

   The trading income earned allows Football Cooperative to offer a standard affordable rate to our participants. However, participants are never turned away from taking part for financial reasons. We also facilitate lower scaled rates based on whatever the participant can afford to pay, thereby making activities accessible to all, regardless of financial means.

   The cumulative surplus across the consolidated network of recreational football sites delivers sustainability to our organisation. This surplus supports the scaling upward (to more sites) and outward (to more targeted participant groups) of our model.

   Football Cooperative’s model moves away from one individual having sole responsibility for all of the various aspects of organising a recreational football game to a more coordinated, disseminated and shared voluntary approach. In formalising the academic studies, we have brought together key stakeholders to support the research activity as well as guide and support the direction of Football Cooperative. Through this, I believe we have moved recreational football towards a sustainable trajectory, proven our feasibility for scale and can activate the most sedentary and excluded members of society into our football community.

3 Outcomes / Benefits

1. It is evident that the our games are reaching men who are at risk of cardiovascular disease. From the academic research, the mean age of the players was 49.3 ± 7.0 years and the majority had some/completed 3rd level education [87.3%], were married/cohabiting [84.6%] and living with partner/children/parents/friends [94.3%]. Mean body mass index (BMI) was 27.2 ± 3.5 Kg/m2, with 60% classed as overweight and a further 13.9% as obese. A large majority [83.1%] had three or more cardiovascular disease risk factors. Most participants [81.7%] failed meet recommended guidelines for fruit and vegetable consumption, while habitual weekly alcohol consumption was also prevalent [71.9%]. Some 68.9% failed to meet the recommended PA levels, and 66.1% met the threshold for an at-risk waist circumference of ≥94cm. Almost half [49.3%] were considered at risk by reporting their sleep quality as fair or poor. Notably, very poor or poor aerobic fitness was the next most common risk factor [31.7%] Finally, smoking was also a modifiable risk factor for a minority [11.3%]. In short, this data suggests that despite being from an affluent area, being relatively young and well educated, a large number of FC members are at risk of cardiovascular disease. Notably, despite their health risk, 90.1% of participants described their general health as good, very good or excellent and this lack of awareness of health risk among men has been well established in men’s health research.
2. It was evident that games are achieving health outcomes for participants;Aerobic Fitness: Significantly improved at 3 Months, 6M & 12M & 82% achieved the 10% improvement threshold at 12M. Waist Circumference: Reduction of 2.5±4.6 cm at 12M and 49% of those who attended at 12M achieved the 3cm reduction threshold.
   Psychological Measures: Loneliness was reduced at 6M with a corresponding increase in sleep quality. Health Behaviours: When asked whether participation had led to modifying health behaviours, modifications were evident at all time points; the majority increased their Physical Activity (up to 74%) while many increased fruit and vegetable consumption (~43%).

   The consolidated findings established after 12 months showed that 50% achieved the physical health benefit [self-reported benefit AND 5% reduction in weight/3cm reduction in waist circumference/10% improvement in aerobic fitness], 31% achieved the mental health benefit [self-reported benefit AND 10% increase in self-esteem] and 37% achieved the social health benefit [self-reported benefit AND 10% reduction in loneliness].

3. The SROI of the Football Cooperative games was calculated and found to be €17.60 for every €1 invested. It is evident that the social value returned from this volunteer-led, community based initiative is substantial. In fact, when compared to other sports clubs or community-based projects these findings would indicate that the social return from the FC initiative is exemplary. For example, an exercise-based programme delivered by Sport Ireland Local Sports Partnership for individuals with COPD in Ireland returned a social value of €10 per €1 invested.As a result of these findings, plans are underway to scale the delivery of the Football Cooperative initiative across multiple sites for the benefit of population health.