The Challenge

The Men’s Health Forum and Food Nation answered the call to the Movember Foundation’s Social Innovation Challenge (SIC) to tackle loneliness in men with the Men’s Pie Club. The pilot project is running for two years from November 2017 and the impact of the project is being evaluated by Propel Centre for Population Health at the University of Waterloo, Canada.

What is loneliness?

One thing it is not, is isolation, though I think many, including myself, have confused the two over the years. Someone much more learned on the topic than I am described loneliness as follows:

“Loneliness is a subjective, unwelcome feeling of lack or loss of companionship, which happens when we have a mismatch between the quantity and quality of social relationships that we have, and those that we want. It is often associated with social isolation, but people can and do feel lonely even when in a relationship or when surrounded by others” (Jo Cox Commission on Loneliness).

This means pretty much anyone can feel lonely at any time. I used to think of someone that was lonely as living in some remote area with only a post office and Happy Shopper nearby, but it makes perfect sense that loneliness is more a sense than a state and rings true for me at different times in my own life. It might ring true for you when thinking about it like this.

Who does it affect?

I suppose, being honest, I also thought older people were more likely to feel lonely than younger people. I thought this more when I was younger myself, filling my time with parties, movies, comedy clubs, etc. but I realise now that it isn’t just older people. In fact, on reflection, there were many times when I felt lonely at points despite being surrounded by people.

In fact:

  • “over 9 million people (almost one-fifth of the population) reporting they are always or often lonely” (Co-op and Red Cross, Trapped in a Bubble). 9 million people!? Wow!
  • “8 in 10 people caring for loved ones “have felt lonely or socially isolated”” (Carers UK)
  • “More than half (52 per cent) of UK parents have suffered from loneliness – with a fifth (21 per cent) having felt lonely in the last week” (Action for Children)
  • 43% of young people aged 17 to 25 report experiencing challenges with loneliness (British Medical Journal)
  • “Half of disabled people say they are lonely, and one in four feel lonely every day” (Sense).
  • “58% of migrants and refugees taking part in the research described loneliness and isolation as their biggest challenge living in London” (Campaign to End Loneliness)
  • “An estimated eight million (35 per cent) men feel lonely at least once a week, whilst for nearly three million (11 per cent) it’s a daily occurrence.” (Royal Voluntary Service)

That is anyone, at any time of their lives! In this case, however, we’re focusing on men and that last statistic is eye catching. Further research suggests that 35 is when men report feeling loneliest. A study conducted by Beyond Blue, in Australia shows that 35 is the age when men’s social support networks begin to dwindle and that they don’t get back to the levels they were at the age of 34 until the age of 55, so there is some evidence of this being a cross-cultural phenomenon.

How does loneliness affect men?

When I considered this, the first thoughts were loneliness could be linked to depression or other forms of poor mental health. And there are correlations but there are many more, some pretty surprising.

In 2010, academics Holt-Lundstad, Smith and Layton conducted a meta-analysis of studies on loneliness that showed, “the influence of social relationships on the risk of death are comparable with well-established risk factors for mortality such as smoking and alcohol consumption and exceed the influence of other risk factors such as physical inactivity and obesity.” Comparable mortality risks to smoking and drinking? Potentially more lethal than physical inactivity and obesity? Are we not constantly hit with messages to move more and eat less? I can’t recall the last time I saw a public health message saying “Catch up with a friend to improve your health”!

Again the physical health impact of loneliness is reflected cross-culturally. Dr Jaremka from Ohio State University, showed there was a correlation between self-reported loneliness heart disease, type 2 diabetes, arthritis and an elevated risk of attempted suicide.

I am not going to labour a point here. It is enough to say that loneliness affects a number of people, both physically and mentally.

What is the Social Innovation Challenge?

The Movember Foundation is well aware of these challenges and are well placed to take a global view of the issue to better understand what could work, both at a country level and a global level, to address the issue. “We know that in their 30s, men tend to start letting go of key relationships,” says Craig Martin, Global Director, Mental Health & Suicide Prevention, The Movember Foundation. “This is having a far-reaching and very negative impact because social relationships are a key protective factor for men against anxiety, depression and potentially suicide. We need to tackle this issue, and fresh ideas are needed because the status quo isn’t working for men.”

And so, the Movember Foundation called for innovative, outside-the-box ideas that could lead to game-changing products or services to increase the quantity and quality of men’s relationships, thereby strengthening their sense of belonging to improve mental wellbeing.

The solution

The first question we posed ourselves was “what is the fastest way to a man’s heart?” I jest, but we know guys like food and, therefore, the initial thought was to bring people together around food. Now this might not sound all that innovative, afterall in 1950, Elizabeth David (the Jamie Oliver of her time) presented a very simple path to psychological and physical health; come together to eat simple and great food. The innovation comes in applying the idea of producing food to address the challenges posed by loneliness among men or using something simple to address something complex. And thus, Men’s Pie Club was born.

Working with the Men’s Health Forum brings together the regional with the national, Food Nation delivering the work in Newcastle and the Men’s Health Forum supporting the reach of the project across the UK.

Colin Mallen, Project Co-ordinator from Food Nation, says it best, “A pie club may seem odd given the bad press they receive for being unhealthy, but at the end of the day, who doesn’t love a hearty and comforting pie? The Men’s Pie Club will be a place of leisure where males can come together to informally learn about food, share skills and knowledge, achieve and socially interact”.

Professor Steve Robertson, an expert in men’s health, went to Newcastle to find out what men thought about the idea and what they felt would work best. 34 men, from 19 to 65, across five sites and from various backgrounds gave their thoughts on the notion. There was a great deal of support, saying it was a “really good idea” and that “everyone likes food don’t they?”

Suggestions around where to deliver the sessions from focused on the need for them to be easy to access, “within walking distance”, even the possibility of using a pub, but certainly somewhere male-friendly while also realising the venues needed the proper facilities to make and cook pies. Views differed in regards to how often the clubs should be, some stating weekly was best, others monthly and some saying “start off establishing the group, keep it open ended”. Making it “men only” was seen as important, while opinions differed about whether to bring people from diverse backgrounds together or people with “similar interests … on the same wavelength”. Some focused on the idea of learning cooking skills, while others were keen on “Eating lovely pies!”

The general feeling was, Men’s Pie Club could work.

How could we make Pie Club work best?

In 2014, the Men’s Health Forum produced a practice guide on “How to make Mental Health Services Work for Men” based on the work conducted by Professor Steve Robertson (yep, the same person from above. I told you he was the expert!) and commissioned by the Movember Foundation. The guide provides an overview of principles and practice techniques that have been shown to be effective in delivering mental health services to men, a group often deemed “hard-to-reach”. You’re saying “but isn’t Men’s Pie Club about loneliness and not mental health?” and of course you’re right and while there are links between loneliness and poor mental health, we would not say they are the same, however we would suggest using some of the principles in the practice guide to effectively engage men.

A few of these ideas have already been mentioned, such as making it men only and making sure the sessions are delivered in male-friendly space. Men’s Pie Club makes use of these principles as well as many others.

Bringing people together around a shared activity – making pies – has been shown to be effective in engaging men possibly because it reduces the stigma for why the group is coming together.
The research conducted by Professor Robertson also shows that men prefer to be able to give skills while also taking advice which is made more possible when coming together around a shared activity.
We wanted to make sure our idea was a good idea and one that men, more broadly, felt could work, hence the work to engage groups of men for their thoughts, opinions and insights into what could work and what could support it to work as well as it could. This principle is called co-design and highlighted barriers such as travel costs and time that could factor into the delivery of the Club.
It is important to work with people in ways that respect their communication methods and men, as a group, are no different. Other work delivered by the Men’s Health Forum called “Mind Your Language” highlighted some common words and phrases that were found to be acceptable, across groups of men, for talking about mental health such as “overwhelmed” or “not feeling 100%” as opposed to more medical terms associated to mental health.

We highlight successes, whatever size, through our social networks to encourage the group to be proud of what they are doing and to encourage other men to think about their own situations and consider joining in.

The pie-makers

Finding the Right People

How do you find people that are lonely? Aren’t they, by definition, hard-to-reach? While this may be broadly true, a number of risk factors that might lead to loneliness. With that in mind, Food Nation set out to build relationships with organisations that work with men from these broad groups, let them know about Men’s Pie Club and set up referral pathways. Referrals have come from Move on Tyne and Wear, Benfield Park Medical Group, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Mental Health Concern, Newcastle City Council and Karbon Homes, one of the largest housing associations in the North. Added to this burgeoning network, Men’s Pie Club has taken self-referrals and hopes to bring in more through this pathway in the future.

You might be asking, “even with a robust referral network in place, how do you know these men are lonely?” Excellent question! As part of the evaluation process (more on this next week) participants are asked to complete a questionnaire that can be used to assess their sense of loneliness. We don’t kick people out if they don’t report themselves as being lonely enough, but it just so happens that the majority are not feeling satisfied with their relationships, friends or family, at the moment.

In a short period of time, referral numbers, attendance and retention have increased, but we strive on … while balancing quantity with quality. Like anything, we could stuff the venues with big groups of people but would they feel listened to? Would they have the time and space to find themselves in a mass? Our present thinking is that groups of not-more-than 12 might be the ideal, and we will continue to engage and listen to make sure we are not going past the tipping point of benefits.

With time and further spreading of awareness of Men’s Pie Club, we feel certain that we will continue to engage the right men in the right way.

Dumb Phones vs Smart Ones

When you hear the word “innovation”, what’s the first image in your mind? I’m going to take a wild stab in the dark and suggest it is not a Nokia 3310, Snake or texting, preserves of the ‘90s. But, those in marketing will know that texts produce results. According to Business to, texts have a 98% open rate compared to emails’ 49.7%

In July, we started to send text reminders to participants (adhering to GDPR guidance in the process!) and saw the attendance rate pick up to the higher levels mentioned above.

Of course we don’t just send out a dry, here is the time and location of Men’s Pie Club text. They are personal and enticing. For example:

“Hi Chris (that’s me in case anyone is wondering about a breach of non-consensual anonymity!). Hope all is well. At today’s Pie Club, we’re making Corned Beef and Potato Pies. 5:30pm Foundation Futures, 71 Wolsely House, Dunn Terrace, NE6 1DA. Hope you can make it along. Reply STOP to unsubscribe (the GDPR bit!)”

The impact of the text reminder has been to drive attendance from between 4 and 6 to between 7 and 9!

What men are saying

All of the above is all well and good, but it’s a bit technical and a bit dry. What about the feedback from participants?

Dr Dawn Scott, Independent Consultant and Researcher, conducted an interim evaluation with four participants on the 29th of June using the GROW model as a reference. Of the four, three were signposted to MPC to engage in more social activities. The fourth person attended of their own volition. All four reported mental health problems and being socially isolated of various degrees. “I’m very socially isolated, I go to the Gym and the library, but it’s like ground hog day”

The degree of difficulty to attend was different for each, with one person saying, “Quite easy, I can get to groups quite easily, no barriers.” Another person however, said they find it “Extremely difficult” when asked about emotional barriers to attendance.

When asked, “What did you personally hope to achieve by attending the Pie Club?” and whether they felt they’d achieved this, of the four, three were positive they had met their goals and one was not. In terms of social skills, one participant stated “My confidence has grown. I’m getting out of the house, and it’s a good mix of people.” The person who did not feel he’d achieved his aims cited that the same people did not return for each session making it difficult to form bonds with people, though he did also state he felt he could have become friends with some of the other participants if they attended each session. One person felt the groups might benefit from being curated, meaning that people could be brought together by need as opposed to hoping everyone would get along and this speaks to the consultation findings from Professor Steve Robertson, in which one person consulted suggested that it would be best bring together like-minded people. This is an interesting comment from the perspective of diversity because the statement indicates that, for this person at least, socially connecting might be less challenging where their is reassurance granted by a common ground.

To sum up, one person stated when asked what success looks like for Men’s Pie Club, “For people to turn up, if one person turns up it’s a success. The pie is inconsequential. Getting them out of their four walls.”

The Evaluation

Standing on the shoulders of Giants

In August of 2017, the Movember Foundation convened a two day gathering in Toronto to begin to build a knowledge community to share perspectives, build understanding and co-design the evaluation protocol. The Knowledge Community was composed of representatives from the 12 funded Social Innovators Challenge (SIC) projects, the global evaluation team from the Propel Centre for Population Health Impact at the University of Waterloo (Canada) and First Person Consulting (Australia), Movember and several review panel members and mentors.

This sounds heavy! But the guiding idea is that the projects should look beyond the work they are doing to understand what is working and what is not working so well in terms of what is helping men build broader and deeper social connections. I am going to lean on the words of Professor Steve Robertson from the “How to … Make mental health services work for men” when he says:

“Good practice is dependent on people making information about interventions widely available, even if their intervention has not been a success. This enables good practice to be replicated and helps to avoid the repetition of approaches that have been shown not to work.”

Even before the gathering in Toronto, the evaluation team read through a number of journals, reports and research papers about men’s health initiatives in order to better understand what work has been done in this field. However, while there is some basis of understanding (have I mentioned the “How to Guide” from the Men’s Health Forum?) there is certainly space for more water in the pool of knowledge and the Social Innovation Challenge is a fantastic space to add to that body of knowledge.

Toronto brought all the key project players together and the outcome was an agreement on the evaluation priorities:

  • How are projects sensitised to men’s needs and characteristics?
  • How are different groups of men recruited, engaged and retained in the SIC projects?
  • What activities are implemented by projects, and how does implementation adapt over time?
  • How effective are the SIC projects in improving social connectedness among participants?
  • What is the potential for sustainability and scalability of the SIC projects?
  • How did different components of the SIC model influence applicants – those funded and not?

In a nutshell, how do the different projects, funded through the Social Innovation Challenge, support men to build broader and deeper social connections. (I can hear you saying “why didn’t you just say that in the first place!?”)

Make a beeline for the baseline

That was me in my twenties in the nightclubs of London!

Joking aside, I’ve mentioned that when men self-refer or are referred, they are given a chance to tell us more about themselves. This is in the form of a survey which asks the participants about themselves – marital status, and employment status for example – how they came to hear about the project, their general health – making use of the The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) – and their social connections – employing the Duke Social Support Index (DSSI).

This information tells us how the participants understand their lives at the point of coming on to the project and provides us with a baseline of understanding against which the impact of the various projects can be evaluated.

Food Nation keeps track of attendance, the impact of the texting reminder system on attendance, takes video and photo evidence and records people’s thoughts either through vocal recording or testimonials. As mentioned in the blog post on Early Learning Dr. Dawn Scott, Independent Consultant and Researcher, used the GROW model to conduct an interim evaluation of the project. At six month intervals, Propel sends out more in-depth report templates that the Men’s Health Forum and Food Nation work on collaboratively to provide details of the process being followed, how the project is being sensitised to men, how the groups are responding, and what lessons we’re learning along the way.

The report template is rigorous and immensely useful. The questions focus the mind on doing the best for the participants and not just as men, but taking people’s multi-layered identities into consideration.

The Finish Line

Well almost … I’m going to talk about the end of each club and not the final evaluation which will happen some months after the two years of project delivery, over 12 projects, across four countries. Good luck to the evaluation team!

At the end of each Men’s Pie Club – a six week period – the participants are given follow up surveys. These surveys ask similar questions to those asked at the beginning of the six week period: about the participants, their living circumstances and employment status, for example; about the programme, their participation with it, the impact it has had on building their personal networks, etc.; their health and their social connections using the frameworks mentioned above.

All of this information is then bundled up and sent to the evaluation team and will provide an understanding of the types of participants that each project attracted and an indication of impact on their well-being and connections.

Participants will also be invited to talk with a member of the evaluation team about their experience with the project. These conversations will provide an opportunity to seek a deeper understanding of participant characteristics and project impact. Additional evaluation components will also include interviews with project leads, and a survey of SIC project partners.

When all is said and done, Movember, the projects in the Social Innovation Challenge, the evaluation team and the Knowledge Community built through the project filtering into the wider world of men’s health and health more broadly will have added a great deal of new knowledge to the deepening pool of what works for men’s health, with a specific focus on what helps men to build social connections.

Chris Stein, Men’s Pie Club team, Men’s Health Forum

  • Men's Pie Club Original Pitch To Movember
  • Featuring John Ryan
  • Date March 2016