Table 1 Characteristics of included studies
Name of intervention and acronyms used in this review | Literature | Short description of intervention, including area of health and population | Location | Theoretical engagement with masculinities | Components of interventions that operationalise masculinities (summary) | Outcomes or findings in relation to intervention aim |
|---|---|---|---|---|---|---|
Boys to Men (BTM) | Intervention with groups of disadvantaged young men and boys to challenge harmful gender norms with view to gendered violence and relational well-being | USA | Relational accountability, reflexive practice for gender/social justice, intersectionality, feminist framework and pedagogy of empathy based on Freire | 18-h small group discussions by trained community members to support young men and boys in ethical self-reflection helps in emphatic ways; content focusses on raising awareness of restrictive masculinities and how this shapes identity, emotions, sexual consent, and violence | Qualitative findings highlight role of facilitators in developing empathy and affective intensities; facilitators also grow as part of the shared journey; general focus on the importance of affect in transformative work | |
Coaching Boys into Men (CMIB) | Violence prevention programme that teaches sports coaches to talk to their male athletes about non-violence, respect and healthy masculinities thus fostering bystander intervention | USA and India | Social norms theory and other theories of social influence; no HM | Training course for coaches to teach them about how to help athletes adapt positive masculinities, call out gender-inequitable behaviour, and foster bystander intervention | 3 months post intervention evaluation indicates more bystander intervention, less dating abuse, more gender-equitable attitudes and a general appreciation of meaningful conversations with coaches | |
First batterer intervention program | [76] | Intervention aimed at men convicted of gender-based violence with the aim to conform participants to ‘good manhood’ and prevent re-offending; intervention participation was a choice participants made over additional prison sentence | USA | HM, additional focus on social norms theory, rational choice theory, and interactionalist approach | Facilitator-led group discussions over six months that confront men with right choice to make which helps them take appropriate actions in accordance with ‘good manhood’, including reflections on feeling and acceptance of aggressorship | Ethnographic study demonstrates that programme failed in its intention to have men take full responsibility of their action, and adapt a pro-feminist masculinity; men learned egalitarian rhetoric but might have been mere lip service |
Machofabriken | Interventions to reduce violence and foster positive health behaviours, aimed at mixed-gender young people in schools and leisure activity clubs | Sweden | HM with addition of hypermasculinity, gender systems theory, poststructuralism, queer theory, intersectional theory; study focusses on how HM is operationalised | Reflection on male privileges and patriarchal order through short films and subsequent association exercises that help translate critical challenges to HM into everyday practices | n/a | |
Men’s Story Project (MSP) | Social and behaviour change communication initiative based on public sharing of personal masculinity narratives to prevent gender-based violence | USA and Chile (as well as other planned locations) | HM with additional focus on social constructivist and intersectional characteristic; social cognitive theory | Public live performances of diverse personal masculinity narratives through prose, poetry or music demonstrating cost of HM; operationalised through Transportation-Imagery Model which helps men “transport” themselves into someone’s point of view and shift entrenched views on, e.g., sexism or homophobia; intervention easily scalable movement-building | Focus groups highlight building safe spaces, challenging stereotypes and prejudices, empowerment and healing, reinforced commitment to end violence, raised awareness of gender justice and various, intersectionally aligned masculinities; building of empathy, positive role modelling and spreading of reflections outside intervention context | |
Reducing Sexism and Violence Program | [8] | Violence prevention programme for Middle School boys | Maine, USA | HM with additional focus on Pleck’s gender strain model, positing that (non-)adherence to traditional masculine norms causes acute stress and anger in men and violence is a way to regain social dominance | Four one-hour sessions that foster critical thinking about rigid gender norms and bystander intervention | Randomised control trial showed significant decrease in treatment group in tolerance of violence; but neither control group nor treatment group showed a change in norms supporting violence |
Soils, Food and Healthy Communities (SFHC) | [58] | Participatory nutrition education intervention that tackles child malnutrition, focussing on intra-household relationships | Malawi | HM and critical men’s studies; postcolonial feminist framework with participatory approach | “Recipe days” as participatory activity to promote healthy feeding, share skills and encourage gender-equitable household relations using dialogue approach | Qualitative research shows more male involvement in care and household work, including cooking; improved knowledge of nutrition and its link to gender roles amongst whole community; defining strategies for new, emergent masculinities |
The Young, Black Men, Masculinities, and Mental Health (YBMen) | Social-media-based intervention aimed to improve the mental health of young, black men | USA and online | HM with focus on what this means for intersectional challenges of young, black men; role of (online) social networks is highlighted in understanding how masculinities are shaped and changed; intervention design engages with social cognitive theory, theories of social network and support and social network approach | Gender-sensitive, age-appropriate and culturally-sensitive educational messages around black men’s mental health on Facebook and Instagram with group activities scheduled over six weeks | n/a | |
Unnamed “diploma course” | [4] | Peer- education course for civil servant aimed to prevent violence against women | Medellin, Columbia | HM with additional focus on intersectionality and Freire’s transformative pedagogy | 100 h training course based on peer support (men educating men); built on encounter, belonging and subjective responsibility for shared knowledge creation within everyday spaces; course content covered gender norms, sexuality, violence, health, (verbal) violence, bullying at school and general awareness raising | Mixed method evaluation finds that a change in understanding of masculinity happened on practical, cognitive and affective level; students highlighted improved relationships as central achievement |
Unnamed intervention for perpetrators of violence | [12] | Prison-based intervention with a feminist collective that works with male perpetrators of violence against women | São Paulo, Brazil | HM with feminist framework and focus on minority standpoint theory | 16 group discussion meetings with feminist collective that aimed to increase critical reflection through dialogues | Ethnographic study found that men might have learned to play along with “feminist language games” but continue to perceive themselves as victims rather than perpetrators; norms remain unchallenged although behaviour might have changed |
Unnamed intervention operated by “Valley Trust” | [52] | Livelihood intervention with men in poor, rural neighbourhood with a view to prevent HIV/AIDS and improve sexual and reproductive health | South Africa | HM | Group meetings which focussed on land-use and other concrete challenges men faced; participatory workshops about household roles | Qualitative case study describes the creation of safe space to share experiences and worries about poverty and learn about HIV; focus on land-use allowed men to be active in provider role, affirming a positive aspect of traditional masculinity |
Unnamed intervention in Italian Prison | [80] | Prison-based intervention with male perpetrators of violence against women | Italy | HM with focus on links to criminality and cultural elements of Italian culture, like Madonna and whore dichotomy and specific role and relationship to (their) mother | Arts-based methodology that includes psychodramatic techniques and photo-based therapy | Interviews showed that intervention only partially achieved objectives as men shifted towards a more benevolent sexism; possible factors include that prison culture reinforces macho behaviour based on a code of honour |
WiseGuyz | Participatory healthy relationship promotion programme for Grade 9 boys, aimed to improve mental and sexual health and reduce male-perpetrated violence | Canada (primarily urban) | HM with focus on marginalised masculinities; intersectional feminism; and various theories of social influence including: capability, opportunity, motivation and behaviour model; information-motivation behaviour model; theory of social influence; role of (ethnocultural) friendships highlighted | 20 sessions develop through school-community partnerships over one academic year, content on: healthy relationships; sexual health; gender, sexuality, and media; and advocacy and leadership | Various quantitative and qualitative photo-based evaluations point towards improved mental wellbeing, improved friendship quality, enhanced emotional expression through creation of safe spaces, ability to identify social support, improved capabilities to resist adhering to stereotypes, and a general shift in masculinity norms | |
Stepping Stones/ Creating Futures | Participatory behavioural and structural intervention aimed to reduce gender-based violence and HIV, reduce substance abuse, and improve overall sexual health | South Africa (various urban, informal settlements) | HM with focus on hypermasculinity; and Freire’s transformative pedagogy | 21 three-hour sessions (e.g., group discussions, role-play, or body mapping) on skills building, critical thinking around gender equality, communication, safer sex, and livelihoods based on building personal responsibility and critical consciousness on collective level | Studies using longitudinal in-depth interviews with men and their partners, focus groups indicate importance of safe spaces for critical reflection and vulnerability thus building alternative masculinities; men engaged more with formal and informal economy on basis of intervention; unclear if masculinities were radically shifted, outcomes perhaps more modest shift to less violent but still hegemonic masculinities | |
[39] | Randomised control trials across various urban settlements indicate significant reduction in violence and alcohol consumption; economic benefits with significantly better earnings for women | |||||
[41] | Ethnography with focus on facilitator role shows centrality of emotion in their work, facilitators position themselves as ‘successful men’ that participants tried to emulate e.g. by establishing condom use and consent; unclear if change was merely behavioural with no shift in norms and attitudes | |||||
[36] | Post-hoc analysis of RCT followed latent class analysis and reports that intervention has greatest impact on men in most violent class (hypermasculine men associated with gang membership, economic hardship, and adverse childhoods) | |||||
One Man Can (OMC) | [18]a | Intervention with various foci on improving men’s relationship, reducing spread and impact of HIV/AIDS, and reduce violence against women, children and other men | South Africa | HM and wider consideration of gender norms on community level with focus on roots and causes of violent behaviour, including childhood trauma | Workshops on six topics: gender and power, critical reflections on the norms and practices associated with hegemonic masculinity, gender and violence, gender and HIV/AIDS, healthy relationships, and taking action for social change. The workshops are facilitated by men and are held in groups of fifteen to twenty. The sessions provide ample space for men to reflect upon human rights, women’s rights, and how masculinities are defined, practiced, reified, and can be challenged in relationships, communities, and broader society | ‘Local cultural’ view upon gender norms and ‘human rights’ were not only perceived as naturally given, but also contrasting each other as being in an antagonistic relationship. OMC efforts to establish a human-rights perspective upon gender by gently giving space for discussion, providing information and critical self-reflection; yet recognizing that gender-transformation remains a long-lasting and ongoing process |
[26] | 60 in-depth interviews focussing on masculinities, gender relations and rights, violence, gender and HIV risk, alcohol, fatherhood, and relationships reveal how men reconfigured notions of HM in terms of beliefs and practices in relationships, households, and women’s rights | |||||
[33] | 60 in-depth interviews fosucssing on HIV, HIV- related stigma, attitudes about HIV testing, care, and treatment, and how OMC changed beliefs and behaviours related to the HIV treatment cascade showed an increased capability to overcome masculinity-related barriers to testing/care/treatment. Interviews revealed an increased ability to express vulnerability and discuss HIV openly with others and greater willingness to be tested for HIV/ receive HIV care and treatment | |||||
[45] | 53 in-depth interviews with men shows that men reduced their alcohol intake and improved partner communication (e.g., sexual decision making) | |||||
[81] | Longitudinal interviews report positive change in gender-equitable norms and reduction in violent behaviour, most notably amongst community mobilisers. Some participants struggled to implement non-violence in life, suggesting that more needs to be done for men with history of violence | |||||
[84] | 60 in-depth interviews revealed changes in fatherhood beliefs and practices due to the participation in OMC (shifts in parenting style from financial ‘providership’ role to one of increased involvement, companionship, nurturing, and affection). Several fathers described a shift towards being less violent and being more caring and protective | |||||
[79] | Uganda | HM, including a focus on Greene’s (2006) model of engagement (men as clients, men as partners, men as agents for change) | Health education through various community channels and engagement with stakeholders, like churches; training of 120 peer educators who created safe spaces for peer learning | Surveys and focus groups show men reporting greater understanding of sexual and reproductive health and more equitable decision making in household; degree of change remains unclear | ||
Promundo: Program H/ Manhood 2.0/ Men Care + / Young Men’s Initiative/ Yaaro Dosti/ EngenderHealth | Manhood 2.0 extends Program H by addressing social media use (e.g., internet pornography) and taking an intersectional stance through examining privileges (e.g., white privilege) and practicing bystander skills, aiming to reduce sexual and intimate relationship violence and enhance gender equitable practices with socially disadvantaged African American adolescents | Pennsylvania, United States | HM and ‘rigid masculinity’, including Social Norms Theory Theory of Reasoned Action and Heise’s Framework of Gender and Power | Design of group-Intervention sessions that include discussions on critical analysis of internet pornography, exploration of intersectionality by sharing experiences of racism and marginalization, including an examination of white privilege and male privilege through art based-activities, information on sexual health, scenarios on bystander interventions | n/a | |
[66] | Young Men’s Initiative changes dominant masculine ideals that underlie violence, sexual risk-taking and other unhealthy behaviours for adolescents attending vocational schools | Bosnia and Herzegovina, Croatia, Kosovo and Serbia | HM | The programme included 21 modules organised into four content areas (gender, violence, sexual and reproductive health, and substance use). Workshops utilised participatory and interactive techniques (e.g. role play, group brainstorming, games, etc.) and emphasised asking provocative questions and creating space for boys to reflect on issues themselves | In-depth Interview and focus-group discussions reflected an appreciation of multiple masculinities and a growing ability to recognise gender norms as socially constructed and changeable | |
Yaaro Dosti (friendship) promotes gender equity, prevents gender-b | India | HM | The intervention started with an intensive week of group education activities, facilitated by both peer leaders and gender specialists, followed by 2–3 h sessions every week, led by peer leaders, over the six months. Main themes: STI/HIV risk and prevention, partner, family and community violence; gender and sexuality; and reproductive health. The group educational activities were based on participatory methods of learning with extensive use of role plays, games and exercises that engaged young men in discussion, debate and critical thinking | Pre-and post-intervention survey and qualitative interview indicate positive changes in attitudes towards gender, sexuality and intimate relationships | ||
MenCare + addresses sexual, reproductive and maternal health, aims to reduce harmful gender norms, and promotes fatherhood involvement for young men and couples | Rwanda and South Africa | HM | Group education on sexual and reproductive health and rights and equality for young men and women, and on maternal, newborn and child health and caregiving for fathers and mothers. Groups were accompanied by community-level campaigns to change social and gender norms. Partner organisations worked with health services to improve the quality and accessibility of sexual and reproductive health services | Randomised control trial (couples) showed substantial improvements in women’s experience of physical and sexual intimate-partner violence, contraceptive use, and partner support during pregnancy. Men’s dominance in household decision-making and improvements was significantly reduced. Young men’s gender equitable attitudes increased significantly post-intervention. The use of health care services by young men regarding sexual and reproductive health issues did not increase. However, more men did report feeling comfortable asking a health care professional for information about sexuality related issues | ||
EngenderHealth tackles the fields of HIV and gender-based violence preventions for young male factory workers and vocational students aged 15–24 years | China | HM | Eight participatory educational sessions focused on gender, sexuality, relationships, HIV/STI (sexually transmitted infection) risk, and violence | Quantitative and qualitative findings indicate that positive changes in gender-related attitudes, gender-based violence, and partner communication for both school and workplace setting in China |