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Table 3 Intervention characteristics and outcomes

From: Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men’s health in sub-Saharan Africa

Intervention category

Intervention aims

Intervention activities

Intervention outcomes

Findings specific to men

Intervention gender typology

References

Health campaigns and community mobilisation and sensitization interventions (n = 11)

Aimed to create awareness, improve knowledge and attitude (through group education or mass media) on specific social and health issues—such as HIV related care and prevention [32] and gender-based violence [GBV] [30]—or provide specific health services or to encourage men and community members to utilise them

They involved activities such as diffusion of HIV information, promotion of condom uses and HIV testing, promotion of men’s involvement in MCH and promotion of gender equitable attitudes. For example, one such intervention involved community-based health education sessions about family planning using flyers, booklets, and group discussions (sometimes at household level) to promote husband-wife discussions on family planning [FP] and increase uptake of FP services [49].

It appeared that exposure to health campaigns resulted in improved health seeking behaviour, condom use and uptake of HIV tests [32, 33] especially when promoted health services were free of charges [53, 58]. Additionally, most media campaigns improved knowledge of and attitudes towards GBV, family planning, maternal health issues and HIV [30, 49, 61].

Particularly, men were reported to be interested in practical programmes such as those demonstrating proper use of condoms [32]. However, it was also noted that men’s gendered role of household’s breadwinner was one of the main barriers for men not attending health campaigns as they will often be away working [33]. Therefore, a need for a more inclusive approach, as regard to men, was identified, which would integrate specific men’s need for health education and address structural barriers of access to health information [32, 49].

Majority of interventions were either gender neutral (n = 4) [32, 53, 55, 58] or gender sensitive (n = 4). Among the later, two were urology related [59, 77], one involved MSM [48] and one intervention specifically introduced a form of monetary incentives for men [33]. Only one intervention was gender transformative [30]

[30, 32, 33, 48, 49, 53, 55, 58, 59, 61, 77]

Community-based health services (n = 8)

 

Health services provided included community-based TB diagnosis, HIV testing, care, and treatment and comprehensive SRH. Few other interventions were church based [73, 84]

Gender norms of traditional masculinity (bodily resilience, self-reliance, and control) and the perceived stigma relating to specific health conditions such as HIV or TB were described as main intersecting barriers for men to seek help for their health. It also appeared that locating health service facilities in places where men socialise, or where women and children frequent, amplified not only men’s anticipated stigma relating to illness itself but also men’s perceived threat to their adequate masculinity enactment [43]. However, the integration of income-generating activities in health programmes appeared to cushion the perceived stigma related to health seeking [43].

findings suggested that to improve men’s engagement with the community service delivery, there was need to implement interventions which integrate gender transformative and stigma-reduction dimensions [43, 47, 79]. it also appeared that specific age-group’s health needs for men have an important role when designing men health programmes [79].

Majority (n = 5) were gender-neutral [43, 44, 67, 73, 84] but two interventions were gender sensitive as they seemed to recognise and explore men specific health needs. In fact, one of these involved MSM [79]. One intervention was gender partnering [47]

[43, 44, 47, 63, 67, 73, 79, 84]

Home-based training and health services

(n = 1)

Aimed to improve men’s and households’ members skills to recognize danger signs in pregnancy and promote health seeking behaviour and, to improve knowledge of attitude toward and men utilisation of contraceptives

consisted of a maternal and child health training conducted by a community health worker at household level, involving household’s members, including men.

The study found a significant improvement in male involvement and knowledge of maternal and child health issues. The proportion of men in the intervention group accompanying their wives to antenatal and delivery significantly increased as well as the frequency of shared decision-making for health matters.

The intervention showed a significant improvement in male involvement in women’s health and in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods.

Gender partnering

[31]

peer education

(n = 1)

Aimed to promote equitable gender, to transform harmful gender attitudes and behaviours, and to improve men’s engagement in FP and HIV services.

Use of male peer educator to act as peer models for groups of men and train other men during supervised community.

In relation to men’s health seeking, the intervention managed to achieve an increase in reported health-seeking behaviours such as visiting health facilities for health matters, using of condom with main partners, testing for HIV, and communicating with main partners on using a method to avoid pregnancy.

 

Gender transformative

[37]

Health self-service

(n = 1)

Provision of self-test kits for HIV to men, delivered by women attending PMTCT clinics.

Aimed to improve male involvement in PMTCT

The approach was reported as widely accepted by men who, seemingly, expressed higher preference for it as compared to the standard facility-based testing, partly due to flexibility. Most men first preference was self-test alone, followed by testing as a couple

However, it was noted that post-test linkage remained an issue. Participants suggested that financial incentives and phone call reminders could be one way of addressing this.

Gender partnering

[56]