Football cooperative: a pragmatic controlled trial of a community-based physical activity social intervention for men...

BACKGROUND: Across the western world, men tend to have lower life expectancy compared to women and have higher mortality rates for most of the leading causes of deaths at all ages. While biological factors such as genetics and hormones may seem to contribute to men’s heightened vulnerability to certain diseases and health conditions, these elements alone do not fully explain the significant disparities observed in health outcomes between men and women. To address this challenge, the Football Cooperative (FC) initiative provides social recreational football games for men aimed at reducing social isolation and improving their overall health and wellbeing. Since 2021, the FC initiative has been the subject of a feasibility study for scale up and an implementation science study to develop an implementation strategy to replicate across multiple sites. METHODS: Adopting a pragmatically controlled design within a social return on investment (SROI) framework, this study proposes to assess the efficacy of the FC initiative when replicated from two to twelve sites to (a) determine the SROI of FC games when replicated (b) the biopsychosocial health impacts the FC games (c) the game play demands of the FC games and (d) the reach of FC games at scale. To comprehensively address the aims, a mixed methods approach will be employed whereby each step of the seven steps of the SROI framework will be treated as separate studies; steps 1, 2 and 3 will adopt a qualitative approach (interviews and focus group discussions) to develop Theories of Change (TOC) for each stakeholder group, while steps 4, 5 and 6 will adopt quantitative approaches (objective assessments and surveys over time). Step 7 will detail the processes involved in the calculation of the final SROI figure. CONCLUSIONS: The findings from this study will inform fidelity of delivery and equitable benefit for participants when the FC initiative is scaled up nationally and internationally. The use of SROI strengthens the case for investment while providing insights into how Evidence Based Practices (EBPs) can be adapted and scaled in other settings. TRIAL REGISTRATION: This study has been registered with the ‘International Standard Randomised Controlled Trial Number’ registry [ISRCTN14888262] as of the 2nd of July 2025.