Project objectives

One in five of the UK population is an older man (aged over 65 years), and although men report better health than women, mortality rates are higher and the number of potential life years lost by men is double that for women. Loneliness and social isolation are common in this age group, and are known to be associated with poor physical and mental health, higher risk of disability, poor recovery from illness and premature mortality. Older men find it harder than women to make friends late in life, and are less likely to join community based social groups that tend to be dominated by women. They also use fewer community health services than women, and are less likely to participate in preventive health activities. This combination of greater needs and lower rates of engagement with services has prompted the third sector to develop a range of interventions specifically targeted at older men. Men in Sheds is one of the fastest growing innovations. Sheds provide a space for older men to meet, socialise, learn new skills and take part in activities with other men. They may also engage men in informal adult learning activity, provide health related information or signposting to relevant services. Many of the Sheds are supported by Age UK, but all are tailored to their local context and not standardised. Hence, a Shed is a complex intervention, with broad aims to improve physical, emotional, social and spiritual health and well-being that go beyond alleviating loneliness or social isolation. Sheds have captured the public imagination, but to date, there is little robust evidence that demonstrates how, and to what extent, Sheds are effective at improving health and wellbeing. Identifying the active core components of Sheds interventions will be particularly important, given the diverse nature of Sheds. To address these issues in we will undertake a systematic review of the literature around social activities specifically targeted at older men and of the Men in Sheds literature in particular. In preparation for Phase 2 of this project, we will also undertake a ‘mapping’ of the location and contextual characteristics of existing Men in Sheds projects in England.

Aim

The aim of this project is to apply the principles of the MRC Framework for the design and evaluation of complex interventions to Men in Sheds programmes, in order to produce:

1. A systematic review of the evidence for the effectiveness of gendered social activities, and Sheds in particular, at influencing health and wellbeing amongst older men, including differential outcomes by socioeconomic status and for black and minority ethnic groups;
2. Identification of the effective components of a Shed and other gendered social activity interventions;
3. Identification of the practical barriers/facilitators (financial/structural) of Shed and other gendered social activity interventions;
4. A synthesis of relevant theory on the likely process of change, to support the subsequent evaluation of Shed interventions;
5. Review of outcome measures used in studies to assess health and wellbeing outcomes of interventions, to inform the proposed evaluation of Men in Sheds.

Methods

The research team will work closely with Age UK at all stages of this project, to ensure that the review and subsequent evaluation are sensitive to the needs of Shed funders, organisers and participants. In this phase, a systematic review will be conducted using the principles of the ESRC narrative synthesis guidance, which allows for the inclusion of a diverse body of evidence. The review will involve a search of all published academic research, third sector, local and central government reports and grey literature that focuses on Men in Sheds and related gendered social activities for older men.  Studies will be identified by electronic and manual searching, including searching of bibliographies and reference lists of included papers and the identification of, and contact with, research centres, individual experts and activists in the field.

Concurrent with the review, Age UK will collaborate with the research team to identify, characterise and map all Sheds in England, in preparation for the proposed evaluation of Sheds.

Changes to project objectives

The systematic review has been completed as scheduled.

The mapping exercise, to be undertaken by Age UK rather than by the research team, has been completed. Initial mapping was started by an intern at Age UK who left to take up full-time employment. Age UK were unable to appoint a new intern to complete this work. As a consequence some additional days were added to Pam Irwin’s time (RA Lancaster) to complete this work with support from Anthony Greenwood (technical support at Lancaster) who has the expertise to turn the database into a map. This was all completed within the existing timeframe and budget.

Brief summary

Twenty five studies met the inclusion criteria, 15 for Men in Sheds and 11 for other gendered interventions. There was considerable heterogeneity in the outcome measures used across these studies. Most studies were qualitative and/or had small sample sizes and were unable to exclude important sources of bias.

These studies provided some evidence that involvement in Men’s Sheds or other gendered interventions has a significant effect on the physical health of older men, but this is limited. There was some evidence on a positive effect on the mental health of older men, based mainly on self-report from participants. There was also some evidence of the beneficial effects of interventions on older men’s wellbeing, although this is limited by the lack of robust longitudinal studies and conceptual imprecision. Finally, there was limited evidence about the acceptability, accessibility and effectiveness of Men in Sheds or other gendered interventions for older men from differing backgrounds, or with specific health conditions.

The interpretive data synthesis indicated that the beneficial effects of Men in Sheds are likely to be mediated through reductions in social inclusion and isolation, with voluntary participation leading to the building of friendships, strengthening of social networks and providing a sense of purpose and identity.

Conclusions

Links between social activity, health and wellbeing exist, but directions of causality are not clearly established. Qualitative research provides insights into the workings of social capital, including the re-creation of masculinity post-retirement. Men’s Sheds and other gendered interventions may play a vital and valued part in the lives of some older men, including promoting ‘health by stealth’.  There is an urgent need for high quality research to provide evidence for potential funders and guidance for good practice.

Plain English summary

One in five of the UK population is an older man (aged over 65 years), and although men report better health than women, their mortality rates are higher. Loneliness and social isolation are also common in this age group, and are known to be associated with poorer health outcomes. This is important as older men find it harder than women to make friends late in life, and are less likely to join community based social groups that tend to be dominated by women. They also use fewer community health services than women, and are less likely to participate in preventive health activities. This combination of greater needs and lower rates of engagement with services has prompted the third sector to develop a range of interventions specifically targeted at older men.

Men in Sheds is one of the fastest growing of these innovations. Sheds provide a space for older men to meet, socialise, learn new skills and take part in activities with other men. They may also engage men in informal adult learning activity, provide health related information or signposting to relevant services. Sheds can be supported by third and private sector funding but can also be voluntary run and self-sustaining, whichever the case, all are tailored to their local context and so are not standardised. So a Shed is a complex intervention, with broad aims to improve physical, emotional, social and spiritual health and well-being that go beyond alleviating loneliness or social isolation. To date, there is little robust evidence that demonstrates how, and to what extent, Sheds are effective at improving health and wellbeing.

This project aimed to produce a systematic review of the evidence for the effectiveness of gendered social activities, and Sheds in particular, at influencing health and wellbeing amongst older men. Where were particularly interested in any differences in outcomes based on socioeconomic status and ethnicity. We also aimed to identify the effective components of a Shed and other gendered social activity interventions; any practical barriers; any relevant theory on the likely process of change; and to review the outcome measures used in these studies.

Twenty five studies met the inclusion criteria, 15 for Men in Sheds and 11 for other gendered interventions. There was considerable difference in the outcome measures used across these studies. Most studies were qualitative and/or had small sample sizes and were unable to exclude important sources of bias.

The studies provided some evidence that involvement in Men’s Sheds or other gendered interventions has a significant effect on the physical health of older men, but this was limited. There was some evidence on a positive effect on the mental health of older men, based mainly on self-report from participants. There was also some evidence of the beneficial effects of interventions on older men’s wellbeing, although this too was limited by the lack of robust longitudinal studies and conceptual imprecision. Finally, there was limited evidence about the acceptability, accessibility and effectiveness of Men in Sheds or other gendered interventions for older men from differing backgrounds, or with specific health conditions.

The data indicated that the beneficial effects of Men in Sheds are likely to be mediated through reductions in social inclusion and isolation, with voluntary participation leading to the building of friendships, strengthening of social networks and providing a sense of purpose and identity.

Conclusions

Links between social activity, health and wellbeing exist, but directions of causality are not clearly established. Qualitative research provides insights into the workings of social capital, including the re-creation of masculinity post-retirement. Men’s Sheds and other gendered interventions may play a vital and valued part in the lives of some older men, including promoting ‘health by stealth’. There is an urgent need for high quality research to provide evidence for potential funders and guidance for good practice.

Dissemination

Published articles

1. Milligan C, Neary D, Payne S, Hanratty B, Irwin P, Dowrick C. (2015) Older men and social activity: a scoping review of Men's Sheds and other gendered interventions. Ageing and Society. doi:10.1017/S0144686X14001524.
   http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9593098&fileId=S0144686X14001524
2. Milligan, C. (2014) Men in Sheds: gendered activity interventions for older men, commissioned book chapter in Age UK Publication ‘Supporting Later Life: what works in services for older people’, Age UK London pp.64-68.
   http://bit.ly/1ufdOSY
3. Milligan C, Dowrick C, Payne S, Hanratty B, Irwin P, Neary D, Richardson D. (2013) Men’s Sheds and other gendered interventions for older men: improving health and wellbeing through social activity. A systematic review and scoping of the evidence base. Apr 2013. (briefing report for Age UK).
   http://bit.ly/1Bvvxy0
4. Milligan C, Dowrick C, Payne S, Hanratty B, Irwin P, Neary D, Richardson D. (2013) Men’s Sheds and other gendered interventions for older men: improving health and wellbeing through social activity. A systematic review and scoping of the evidence base. Mar 2013. (final report).
   http://sphr.nihr.ac.uk/wp-content/uploads/2014/12/SPHR-LIL-PH1-MIS-Age-UK-brief-report-FINAL.pdf

Conference presentations

1. Milligan C. Shedding Light on Care in the Neighbourhood: The Men in Sheds initiative. Building the Future of Health Conference: Groningen, The Netherlands. 2 Jun 2016. (key note speaker)
2. Milligan C. Men in Sheds – community interventions to address loneliness and social isolation amongst older men. School of Environmental Sciences, University of Auckland, New Zealand. 8 Mar 2016. (public lecture)
3. Milligan C. Men in Sheds: improving the health and well-being of older men through gender-based activity interventions: a systematic review and scoping for an evaluation. NIHR SPHR Annual Scientific Meeting, London, 8 Oct 2013.
4. Milligan C. Improving the health and wellbeing of older men through gender-based activity interventions: a systematic review of Men in Sheds interventions. NIHR SPHR Annual Scientific Meeting, Sheffield, 10 Oct 2012.

Seminars and workshops

1. Hanratty B. Loneliness and social isolation amongst older people: Some implications for health services? One day Seminar organised by Lancaster Centre for Ageing Research on: Gender, social isolation and the role of continued learning for wellbeing in older age. Lancaster, 20 Feb 2014. (presentation)

Public involvement

Age UK was a collaborator on this project and provided input and support throughout – attending project meetings and supporting with dissemination through their website.

Impact

Age UK remains committed to supporting Men in Sheds initiatives, and sees the findings of our systematic review as helpful intelligence in making the case for additional funding in this field, as do other independent Shed organisers. We have received numerous requests for copies of our final report from those looking for evidence to support Shed development.

Since beginning the study a further 17 Sheds have been developed across England. There are now 151 Sheds across the UK (including N. Ireland and Scotland) with a further 47 in development. Bids have also been submitted for funding to support an additional new Shed in Inverness, Scotland and for a Shed attached to a hospice in England.

The Men in Sheds study has been included in NICE Public Health Guidance on ‘Older People: independence and mental wellbeing’ (June 2015). 

This project was funded by the National Institute for Health Research School for Public Health Research (project number SPHR-LIL-PH1-MIS).

Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Public Health Research, NIHR, NHS or the Department of Health.