Men's mental health and the arts: perceived benefits and dynamics of engagement.

Arts engagement is gaining recognition as a non-clinical approach to promote mental health and well-being. However, the perceived utility of the arts to promote mental health among men with low socioeconomic status (SES) and how to best engage them is underexplored. This study explores the lived experiences of men with low SES who engage with the arts in Northern Ireland (n = 41). Data collected via focus groups (n = 5) and interviews (n = 11) were analysed using reflexive thematic analysis to inductively derive four themes. Theme 1 highlights how the arts facilitated friendship, a collective identity, peer support and a reason to socialize. Themes 2 and 3 explore how the arts enhanced self-esteem and emotional regulation by developing a routine, purpose, sense of mastery, a sense of catharsis through immersion in a soothing endeavour and an alternative outlet for self-expression. Theme 4 covers strategies that facilitate male engagement in the arts such as using a familiar space, delivering to an existing male group, framing the programme around male interests not health or creativity, building on existing strengths and capacities, enabling ownership, using tangible action-orientated activities, and being non-authoritative and flexible with delivery. This is one of the first studies to highlight the gendered dimensions in which men with low SES engage with and experience mental health benefits through arts engagement. This study points towards relevant theories to further understand the pathways between the arts and improved mental health among men which can inform development of tailored arts programmes for men.

Adolescent condom use in Southern Africa: narrative systematic review and conceptual model of multilevel barriers and facilitators.

BACKGROUND: Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group. METHODS: This review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a 'best-fit' framework synthesis approach. RESULTS: We coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors. CONCLUSION: SRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. Given the existence of multilevel barriers and facilitators, interventions should, likewise, take a multilevel approach that incorporates locally relevant understanding of the individual-, interpersonal- and structural-level barriers and facilitators to condom use among adolescents in the region.

Nothing so practical as theory: a rapid review of the use of behaviour change theory in family planning interventions involving men and boys.

BACKGROUND: There is growing recognition of the need for interventions that effectively involve men and boys to promote family planning behaviours. Evidence suggests that the most effective behavioural interventions in this field are founded on theoretical principles of behaviour change and gender equality. However, there are few evidence syntheses on how theoretical approaches are applied in this context that might guide best practice in intervention development. This review addresses this gap by examining the application and reporting of theories of behaviour change used by family planning interventions involving men and boys. METHODS: We adopted a systematic rapid review approach, scoping findings of a previously reported evidence and gap map of intervention reviews (covering 2007-2018) and supplementing this with searches of academic databases and grey literature for reviews and additional studies published between 2007 and 2020. Studies were eligible for inclusion if their title, abstract or keywords referred to a psychosocial or behavioural intervention targeting family planning behaviours, involved males in delivery, and detailed their use of an intervention theory of change. RESULTS: From 941 non-duplicate records identified, 63 were eligible for inclusion. Most records referenced interventions taking place in low- and middle-income countries (65%). There was a range of intervention theories of change reported, typically targeting individual-level behaviours and sometimes comprising several behaviour change theories and strategies. The most commonly identified theories were Social Cognitive Theory, Social Learning Theory, the Theory of Planned Behaviour, and the Information-Motivation-Behaviour Skills (IMB) Model. A minority of records explicitly detailed gender-informed elements within their theory of change. CONCLUSION: Our findings highlight the range of prevailing theories of change used for family planning interventions involving men and boys, and the considerable variability in their reporting. Programmers and policy makers would be best served by unified reporting and testing of intervention theories of change. There remains a need for consistent reporting of these to better understand how complex interventions that seek to involve men and boys in family planning may lead to behaviour change.

Family planning (FP) programmes aim to enable people to achieve their desired family size. Successful programmes are essential for encouraging better health outcomes for individuals and families. Historically, FP programmes have focused on the sexual and reproductive health and rights of women and girls, and while this is necessary, it has also contributed to the exclusion of men and boys from FP programmes. There is growing evidence to suggest, however, that involving men and boys in FP may increase its uptake and improve health outcomes for all. However, we still know relatively little about the best ways to involve men and boys in FP programmes in order to ensure success. Research is ongoing to rectify this.When we look at public health behaviour change programmes in general, we find that many successful programmes incorporate theories of behaviour change into their design. These theories guide the kinds of activities and materials that the programme employs in order to promote behaviour change. In the field of FP, there is little information about the kinds of behaviour change theories that might be used to design programmes. This review aimed to address this by reviewing the global literature on FP programmes that involved men and boys to identify relevant behaviour-change theories. We found a range of theories that will be of use to programme planners. We also found, however, that there was lots of variability in the way theories were reported. We make recommendations for how this problem might be resolved.

Engaging parents in digital sexual and reproductive health education: evidence from the JACK trial.

BACKGROUND: Research evidence and international policy highlight the central role that parents play in promoting positive sexual behaviour and outcomes in their children, however they can be difficult to engage in sexual and reproductive health (SRH) education programmes. Digital health promotion that uses online and mobile technologies (OMTs) to promote parent-child communication may offer an innovative solution to reach parents, however, few programmes have used OMTs to involve parents in SRH, and none have reported lessons learned in relation to optimising engagement. This study addresses this gap in the literature by reporting acceptability and feasibility of using OMTs to engage parents in SRH education. Findings will be relevant for those wishing to develop and implement digital SRH programmes with parents internationally. METHODS: The Jack Trial is a UK-wide cluster randomised controlled trial recruiting over 8000 adolescents from 66 socially and religiously diverse post-primary schools. An embedded mixed-methods process evaluation explored user engagement with parent components of the If I Were Jack SRH education programme, which include online animated films and a parent-teen homework exercise. RESULTS: A total of 109 adolescents, teachers, parents and SRH policy experts took part in semi-structured interviews and focus groups, 134 parents responded to an online survey, and 3179 adolescents completed a programme engagement and satisfaction questionnaire. Parents who accessed the materials were positive about them; 87% rated them as 'good or excellent' and 67% said they helped them have conversations with their child about SRH. Web analytics revealed that 27% of contacted parents accessed the digital materials, with 9% viewing the animated films. Only 38% of teachers implemented the homework exercise, mainly because they assumed that students would not complete it or it might result in backlash from parents. CONCLUSIONS: While digital parental materials show promise for engaging parents in SRH education, this study suggests that in order to optimise engagement, parental components that give parents the necessary skills to have conversations with their children about sex should be coupled with efforts to increase school and teacher confidence to communicate with parents on sensitive topics. TRIAL REGISTRATION: ISRCTN99459996 .

Young people's sexual readiness: insights gained from comparing a researchers' and youth advisory group's interpretation.

This study explored young people's understandings of sexual readiness and what influenced their decision to initiate first sex. Interviews conducted with 20 heterosexual young people aged 16-18 years, attending sexual health clinics in Northern Ireland, were analysed using a combined approach. This included comparing a researchers and youth advisory group's interpretations of the same data. Thematic analysis enabled comparison to draw out insights across both interpretations. Three themes emerged from each analysis that aligned closely with one another: Mental/Intimate Contact; People/Peer Influences; Self/Socio-Cultural Influences. One additional theme, Adult Control, emerged from the researchers' understanding alone. Results suggest that young people actively deliberate about sex as inevitable and find it difficult to resist the peer and social influences that regulate their lives, with many initiating sex 'to-get-it-over-with'. Gender ideologies and relationship status influenced expectations, motivations and the context surrounding first sex. Sexual readiness was informed by whether first sex was 'good', 'not so good' or 'bad', highlighting the gaps in young people's understanding. Health, law, and education sectors should co-produce interventions with young people to provide relevant and realistic information that explores the effects of gender equality in everyday life on related concepts such as respect, rights, responsibility and resilience.

Immigrant parents' experiences of accessing child healthcare services in a host country: A qualitative thematic synthesis.

AIM: To explore voluntary immigrant parents' experiences of child healthcare services in host countries. DESIGN: Thomas and Harden's qualitative thematic synthesis method. DATA SOURCES: Five electronic databases (CINAHL, Medline, PubMed, Psych INFO and Web of Science), were systematically searched from January 2000 - October 2018. REVIEW METHODS: Included studies focused on voluntary migrant/immigrant parents' experiences of child healthcare services. Data were abstracted independently by two authors. Critical Appraisal Skills Programme tools were applied, and qualitative thematic synthesis was performed. FINDINGS: Nine studies were eligible for inclusion. Five descriptive themes were identified: (a) seeking information and reassurance, (b) seeking information from "people like me", (c) comparison between child healthcare services in home and host countries, (d) effective communication, and (e) cultural isolation and perceived discrimination. Three analytical themes emerged: navigation of parenting in a health context in a new environment; trust; and balance. CONCLUSIONS: Many immigrant families reported positive experiences, others felt patronized and disrespected, leading to a lack of trust and making them less willing to access universal child health care. Trusted advocates, who are culturally competent, have a role in helping immigrant parents navigate the child healthcare system and negotiate with healthcare professionals. Health registration of children of immigrants may encourage the uptake of universal healthcare services. More research is required into the specific health needs of voluntary immigrants. IMPACT: Less is known about the experiences of voluntary immigrants than those of refugees/asylum seekers in accessing child healthcare. Navigating health systems is difficult. This can be due to language difficulties, differences in systems of healthcare, and differences in culture/health beliefs. When both parties have some understanding of the others' healthcare practices and beliefs, balance can be found; helping the families to positively compare healthcare and incentivising them to engage in universal child healthcare.

Improving sexual healthcare delivery for men in prison: A nurse-led initiative.

AIMS AND OBJECTIVES: The study aim was to develop and evaluate a nurse-led sexual health service and health promotion intervention for men in prison. BACKGROUND: Men in prison are particularly marginalised members of our society, negatively impacting on their ability to making healthy choices. In relation to sexual health, prison provides an opportunity for curative and preventive care, for an otherwise often hard-to-reach, priority population. DESIGN: Practice development, audit and evaluation. METHODS: Employing a practice development and participatory methodology, we empowered prison nursing staff to provide robust asymptomatic testing for sexually transmitted infections, including the management of chlamydia, with appropriate treatment and partner notification. Collaboratively with young men and nursing staff, a short animation video to promote the service was developed. A case note audit of 172 patients seen in the service during the 6-month period 1 July 2018-31 December 2018 was undertaken. The Standards for Quality Improvement Reporting Excellence (SQUIRE, see Supplementary Material) checklist was followed. RESULTS: National outcome measures were exceeded for some clinical outcomes. During the 6-month period, there were 12 chlamydia-positive (7% positivity rate) and 3 gonorrhoea-positive results. In addition, two new cases of syphilis were detected and a further two cases of known HIV were highlighted. There were seven cases of hepatitis C (3 previously diagnosed) and three cases of hepatitis B. A short animation Dick Loves Doot was developed. CONCLUSION: Successful partnerships between sexual health and prison healthcare services, in partnership with service users, can achieve well-coordinated services and health promotion interventions. RELEVANCE TO CLINICAL PRACTICE: This nurse-led model of care increased detection and early treatment of asymptomatic STIs among men in prison, impacting positively the men, their partner (s) and the public health of the society to which they return.

Adolescent men's attitudes and decision making in relation to pregnancy and pregnancy outcomes: An integrative review of the literature from 2010 to 2017.

INTRODUCTION: The review updates a previous review conducted in 2010 (Lohan et al.), summarizing the available literature on young men's attitudes and decision-making in the context of addressing two questions: (1) What are adolescent men's attitudes to adolescent pregnancy? (2) What are adolescent men's attitudes and decision-making in relation to pregnancy outcomes? METHODS: Using Whittemore and Knafl's process for conducting an integrative review, 38 studies published between 2010 and 2017 reporting on young men's attitudes and decision-making in relation to pregnancy and pregnancy outcomes were analysed. RESULTS: One of the most important conclusions of this review is that the findings of studies can often be contradictory. This is because attitudes to unintended pregnancy, contraception and abortion can be contextual and contingent on the dominant or prevailing social norms and roles within a given time, space or social group. In general, we can conclude that in the vast majority of studies young men perceive actual or potential unintended pregnancies as a life event that will present them with moral and material dilemmas. CONCLUSIONS: This review exposes gaps in the academic literature, concerning young men's experiences of unintended pregnancy and pregnancy decision making. This review argues that a greater understanding of young men's experiences when they experience an unintended pregnancy with a partner within a relationship or beyond it is a fundamental first step in offering reproduction and sexual health counselling and services to men. As it stands, we do not yet have a significant body of literature to inform practice development.

Traumatic brain injury and abuse among female offenders compared to non-incarcerated controls.

OBJECTIVE: To examine the prevalence of traumatic brain injury (TBI) and past abuse experienced by adult female offenders. METHODS: Twenty-nine female offenders from a UK women's prison and twenty-nine age and gender matched university controls were recruited. In addition to demographic data, the Brain Injury Screening Index was utilized alongside the Childhood Trauma Questionnaire and the Abusive Behaviour Inventory. RESULTS: Approximately 79% (n = 21) of female offenders reported a history of TBI, with 38% (n = 8) reporting six or more injuries. However, only 28.5% of female offenders reporting injury (n = 6) believed they had sustained a brain injury. Prevalence of both childhood (n = 15, 51.7%), and partner (n = 19, 65.5%) abuse was also high among offenders. TBI Index scores correlated with past childhood and past partner physical abuse. Past mental illness, partner physical abuse, and number of convictions were predictive of greater TBI severity. CONCLUSION: This is the first European study to examine combined TBI and abuse among an exclusively female offender population. It suggests that TBI is as prevalent among incarcerated females as it is among males. The unique presentation of female offenders must be acknowledged if effective rehabilitation programs are to be implemented.

Can Teenage Men Be Targeted to Prevent Teenage Pregnancy? A Feasibility Cluster Randomised Controlled Intervention Trial in Schools.

The World Health Organisation advocates a direct focus on adolescent men in reducing adolescent pregnancy; however, no trials have been conducted. This trial (ISRCTN11632300; NCT02092480) determines whether a novel Relationship and Sexuality Educational intervention, If I Were Jack, is acceptable and feasible to implement in mixed sex UK classrooms. The intervention is a teacher-delivered intervention that emphasises male alongside female  responsibility in preventing unintended pregnancies and is designed to prevent unprotected sex. The trial was a parallel-group cluster randomised controlled feasibility trial with embedded process and cost evaluation in eight secondary schools (unit of randomisation) among 831 pupils (mean age 14) in Northern Ireland, alongside a qualitative evaluation of transferability in ten schools in Scotland, Wales and England. The sampling strategy was a maximum variation quota sample designed to capture a range of school management types. Four schools were randomised to each arm and the control arm continued with usual practice. Study duration was 12 months (from November 2014), with follow-up 9 months post-baseline. Results demonstrated that the intervention was acceptable to schools, pupils and teachers, and could be feasibly implemented, cost-effectively, with minor enhancements. The between-group difference in incidence of unprotected sex (primary outcome at pupil level) of 1.3% (95% CI 0.5-2.2) by 9 months demonstrated a potential effect size consistent with those reported to have had meaningful impact on teenage pregnancy. The study responds to global health policy for a paradigm shift towards inclusion of men in the achievement of sexual and reproductive health goals in a practical way by demonstrating that a gender-sensitive as well as a gender transformative intervention targeting males to prevent teenage pregnancy is acceptable to adolescent men and women and implementable in formal education structures. If I Were Jack now merits further effectiveness testing.

A systematic review and qualitative synthesis of adolescents' views of sexual readiness.

AIM: The aim of this study was to synthesize the qualitative evidence investigating adolescents' views on heterosexual readiness. BACKGROUND: Adolescents' understandings of sexual readiness are often missing in research and debates on sexual health and related concepts like sexual consent. Research to date has predominantly focussed on age and socio-cultural predictors of sexual debut, thus failing to explain how adolescents themselves conceptualize their readiness for heterosexual relations. DESIGN: A systematic review and thematic synthesis of qualitative evidence. DATA SOURCES: CINAHL, Psychinfo, PubMed, Web of science were searched, 1985-Feb 2016. REVIEW METHODS: Critical Appraisal Skills Programme checklist was used to assess methodological quality. A thematic synthesis focused on commonalities and variations in the data from included studies on adolescents' perspectives of their readiness for sex. RESULTS: Sixteen studies were included. Themes identified were: social learning, relationships and implications for sexual health promotion and practice. CONCLUSIONS: Adolescents may not view initiating sex as problematic, focusing instead on the rewards sex brings and less on health concerns. Adolescents tend to reproduce dominant gender norms of masculinity and femininity in communication about sexual decision-making, which are sometimes influenced by social scripts of career aspirations and ethnic identity. Age was also significant in adolescents' accounts. Early adolescence is a critical period when understandings of gender equality become embedded, thus an opportunity to engage adolescents in critiquing ideas about gender equality and sexual rights. Further research exploring adolescents' understandings of sexual readiness is required. We recommend a participatory approach to support the inclusion of adolescent voices to inform contextually relevant sexual health promotion strategies.

A logic model approach to the development of an educational app.

Technological educational resources require planning and structure to ensure successful implementation. This article describes the development, and evolution of, an online educational training package for third-year undergraduate nursing students. It explains how a 'logic model' was used as a framework to help develop and implement an online clinical supervision supervisee-training programme, and describes evolution of the framework to an app for mobile devices.

Traumatic brain injury and co-occurring problems in prison populations: A systematic review.

BACKGROUND: A growing body of epidemiological research suggests high rates of traumatic brain injury (TBI) in prisoners. The aim of this review is to systematically explore the literature surrounding the rates of TBI and their co-occurrences in a prison population. METHODS: Six electronic databases were systematically searched for articles published between 1980-2014. Studies were screened for inclusion based on pre-determined criteria by two researchers who independently performed data extraction. Study quality was appraised based on a modified quality assessment tool. RESULTS: Twenty-six studies were included in this review. Quality assessment ranged from 20% (poor) to 80% (good), with an overall average of 60%. Twenty-four papers included TBI prevalence rates, which ranged from 5.69-88%. Seventeen studies explored co-occurring factors including rates of aggression (n = 7), substance abuse (n = 9), anxiety and depression (n = 5), neurocognitive deficits (n = 4) and psychiatric conditions (n = 3). CONCLUSIONS: The high degree of variation in TBI rates may be attributed to the inconsistent way in which TBI was measured, with only seven studies using valid and reliable screening tools. Additionally, gaps in the literature surrounding personality outcomes in prisoners with TBI, female prisoners with TBI and qualitative outcomes were found.

The perceived impact of interprofessional information sharing on young people about their sexual healthcare.

This article presents the results from an analysis of data from service providers and young adults who were formerly in state care about how information about the sexual health of young people in state care is managed. In particular, the analysis focuses on the perceived impact of information sharing between professionals on young people. Twenty-two service providers from a range of professions including social work, nursing and psychology, and 19 young people aged 18-22 years who were formerly in state care participated in the study. A qualitative approach was employed in which participants were interviewed in depth and data were analysed using modified analytical induction (Bogdan & Biklen, 2007). Findings suggest that within the care system in which service provider participants worked it was standard practice that sensitive information about a young person's sexual health would be shared across team members, even where there appeared to be no child protection issues. However, the accounts of the young people indicated that they experienced the sharing of information in this way as an invasion of their privacy. An unintended outcome of a high level of information sharing within teams is that the privacy of the young person in care is compromised in a way that is not likely to arise in the case of young people who are not in care. This may deter young people from availing themselves of the sexual health services.

Men's depression and suicide literacy: a nationally representative Canadian survey.

BACKGROUND: Male suicide prevention strategies include diagnosis and effective management of men's depression. Fundamental to suicide prevention efforts is public awareness, which in turn, is influenced by literacy levels about men's depression and suicide. AIM: The aim of this study is to examine sex differences in mental health literacy with respect to men's depression and suicide among a cohort of Canadian respondents. METHODS: About 901 English-speaking Canadian men and women completed online survey questionnaires to evaluate mental health literacy levels using 10-item D-Lit and 8-item LOSS questionnaires, which assess factual knowledge concerning men's depression and suicide. Statistical tests (Chi-square, z-test) were used to identify significant differences between sex sub-groups at 95% confidence. RESULTS: Overall, respondents correctly identified 67% of questions measuring literacy levels about male depression. Respondents' male suicide literacy was significantly poorer at 53.7%. Misperceptions were especially evident in terms of differentiating men's depressive symptoms from other mental illnesses, estimating prevalence and identifying factors linked to male suicide. Significant sex differences highlighted that females had higher literacy levels than men in regard to male depression. CONCLUSIONS: Implementing gender sensitive and specific programs to target and advance literacy levels about men's depression may be key to ultimately reducing depression and suicide among men in Canada.

Knowledge translation in men's health research: development and delivery of content for use online.

BACKGROUND: Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men's health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation. OBJECTIVE: Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men's health. METHODS: We present experiences of KT across two case studies of men's health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men's depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men's depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled "If I Were Jack". RESULTS: For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men's health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset. CONCLUSIONS: The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work.

"If I Were Nick": Men's Responses to an Interactive Video Drama Series to Support Smoking Cessation.

BACKGROUND: Men continue to smoke in greater numbers than women; however, few interventions have been developed and tested to support men's cessation. Men tend to rely on quitting strategies associated with stereotypical manliness, such as willpower, stoicism, and independence, but they may lack the self-efficacy skills required to sustain a quit. In this paper, we describe the development of and reception to an interactive video drama (IVD) series, composed of 7 brief scenarios, to support and strengthen men's smoking cessation efforts. The value of IVD in health promotion is predicated on the evidence that viewers engage with the material when they are presented characters with whom they can personally identify. The video dramatizes the challenges unfolding in the life of the main character, Nick, on the first day of his quit and models the skills necessary to embark upon a sustainable quit. OBJECTIVE: The objective was to describe men's responses to the If I were Nick IVD series as part of a study of QuitNow Men, an innovative smoking cessation website designed for men. Specific objectives were to explore the resonance of the main character of the IVD series with end-users and explore men's perceptions of the effectiveness of the IVD series for supporting their quit self-management. METHODS: Seven brief IVD scenarios were developed, filmed with a professional actor, and uploaded to a new online smoking cessation website, QuitNow Men. A sample of 117 men who smoked were recruited into the study and provided baseline data prior to access to the QuitNow Men website for a 6-month period. During this time, 47 men chose to view the IVDs. Their responses to questions about the IVDs were collected in online surveys at 3-month and 6-month time points and analyzed using descriptive statistics. RESULTS: The majority of participants indicated they related to the main character, Nick. Participants who "strongly agreed" they could relate to Nick perceived significantly higher levels of support from the IVDs than the "neutral" and "disagree" groups (P<.001, d=2.0, P<.001, d=3.1). The "agree" and "neutral" groups were significantly higher on rated support from the videos than the "disagree" (P<.001, d=2.2, P=.01, d=1.5). Participants' perception of the main character was independent of participant age, education attainment, or previous quit attempts. CONCLUSIONS: The findings suggest that IVD interventions may be an important addition to men's smoking cessation programs. Given that the use of IVD scenarios in health promotion is in its infancy, the positive outcomes from this study signal the potential for IVD and warrant ongoing evaluation in smoking cessation and, more generally, men's health promotion.

A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education.

AIM: To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing. BACKGROUND: The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited. DESIGN: Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5. DATA SOURCES: Computerized searches of five databases were undertaken for the period 1995-August 2013. REVIEW METHODS: Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results. RESULTS: Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies. CONCLUSION: The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology.

Gay men and intimate partner violence: a gender analysis.

Though intimate partner violence (IPV) is predominately understood as a women's health issue most often emerging within heterosexual relationships, there is increasing recognition of the existence of male victims of IPV. In this qualitative study we explored connections between masculinities and IPV among gay men. The findings show how recognising IPV was based on an array of participant experiences, including the emotional, physical and sexual abuse inflicted by their partner, which in turn led to three processes. Normalising and concealing violence referred to the participants' complicity in accepting violence as part of their relationship and their reluctance to disclose that they were victims of IPV. Realising a way out included the participants' understandings that the triggers for, and patterns of, IPV would best be quelled by leaving the relationship. Nurturing recovery detailed the strategies employed by participants to mend and sustain their wellbeing in the aftermath of leaving an abusive relationship. In terms of masculinities and men's health research, the findings reveal the limits of idealising hegemonic masculinities and gender relations as heterosexual, while highlighting a plurality of gay masculinities and the need for IPV support services that bridge the divide between male and female as well as between homosexual and heterosexual.

Feasibility trial of a film-based educational intervention for increasing boys' and girls' intentions to avoid teenage pregnancy: Study protocol.

The World Health Organisation, amongst others, recognises that adolescent men have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. This study seeks to fill this gap by determining the feasibility of conducting an effectiveness trial of the If I Were Jack intervention in post-primary schools. This 4-week intervention aims to increase teenagers' intentions to avoid unintended pregnancy and addresses gender inequalities in sex education by explicitly focusing on young men. A cluster randomised feasibility trial with embedded process evaluation will determine: recruitment, participation and retention rates; quality of implementation; acceptability and feasibility of the intervention and trial procedures; and costs.