Developing an implementation strategy to scale a community-based football intervention for Men's health: an implementation science study.

Background: Men experience poorer health outcomes than women and are less likely to engage with traditional healthcare services, highlighting the need for gender-responsive, community-based approaches. The Football Cooperative (FC) initiative in Ireland uses recreational football as a socially engaging setting to support men's health and wellbeing. Although football-based initiatives demonstrate strong acceptability and health benefits, translating locally successful models into sustainable systems capable of large-scale delivery remains challenging. Methods: This study aimed to identify multilevel determinants influencing implementation of the FC initiative and to develop a prioritised implementation strategy to support national scale-up. A two-part qualitative design was employed, comprising (1) multilevel data collection through semi-structured interviews, focus groups, and reflective logs with stakeholders across participant, provider, organisational, and community/system levels, and (2) strategy development and prioritisation through an adapted Delphi consensus process. Data were analysed using a framework-informed approach guided by the Consolidated Framework for Implementation Research (CFIR), and scalability was further examined using the Intervention Scalability Assessment Tool (ISAT). Results: Findings indicate that implementation of the FC initiative is underpinned by relational facilitators supporting sustained engagement, including psychological safety, inclusive gameplay, and accessibility and operational practicality at participant level. However, while these support local delivery, they do not readily translate to scale. Critical determinants constraining scale-up were identified across ecological levels, including reliance on volunteer coordination and limited role clarity at provider level, informal administrative and digital systems and limited workforce capacity at organisational level, and the absence of formalised governance, cross-sector collaboration, and sustainable funding at system level. Conclusions: In response, seven implementation strategies were prioritised: maintaining psychological safety and accessibility (participant level); strengthening coordination systems and volunteer capacity and role support (provider level); developing monitoring and digital infrastructure and supporting governance transition and distributed leadership (organisational level); and establishing cross-sector collaboration and funding mechanisms to support scale (community/system level). This study provides a theory-informed, stakeholder-endorsed implementation strategy to support the transition of a community-based men's health initiative from local delivery to scalable systems. The findings contribute to implementation science by demonstrating how multilevel determinant analysis can be translated into prioritised strategies supporting scale-up of gender-responsive interventions.