Nuancing null results: Why a soccer plus vocational training health promotion intervention did not improve outcomes for South African men

Background: Male engagement with public health programming, especially around stigmatised issues, is often low, which may have adverse health outcomes. Eyethu, a behavioural intervention delivered using soccer to reduce multiple risks associated with HIV and substance use among young men, was shown in a randomised trial to be ineffective. This study explored the trial's null findings to identify considerations for future male-targeted programming tackling multiple risks concurrently. We explored trial participants’ perceptions of factors influencing engagement and effectiveness. Methods: The descriptive, qualitative sub-study was nested within the RCT, conducted in two peri-urban townships outside Cape Town. Data was collected post-intervention, in November-December 2020. In-depth interviews, at a single timepoint, were conducted with individuals (n = 30) who had participated in the RCT. Data were analysed using thematic analysis. Results: Three major themes emerged from the data: 1) participants’ positive perceptions of the programme's impact, despite the trial's null results; 2) reflections on the intervention's mechanisms, related to its impact on group cohesion, and 3) perceptions of contextual factors influencing intervention engagement and effectiveness. Conclusion: Behavioural interventions that are embedded in communities and utilise sport to influence health-related outcomes have the potential to expand knowledge, foster social capital, and offer platforms for positive, meaningful connections for young men exposed to multiple adversities. However, these programmes need to be sustained over time to effectively enable behaviour change to take hold and be sustained when implemented with other environmental constraints.