Football for Health: Increasing physical activity levels and improving mental health and wellbeing of girls and women in Somalia

Being physically active is important as it reduces the risk of heart disease, type 2 diabetes and certain types of cancer. Both physical activity and the social engagement that accompanies sport activities are also beneficial for mental health and wellbeing. In Somalia, girls and women are less active than boys and men, especially in urban areas. Physical education in schools is not compulsory and there are fewer girls enrolled in school than boys. Furthermore, the number of women who have depression is higher compared to men.

A grassroots football initiative offers a case study that can inform the development of a scalable women's sports intervention in Somaliland. Somaliland Women's Football Club in Hargeisa was established in 2016 by local girls and women who wanted a safe space for physical activity and socialising. It offers community football sessions and coaching and works with community partners to organise tournaments and sport festivals. It has proven to be popular; growing from 6 to 50 girls and women between the ages of 13 and 45 years playing weekly.

However, it is not clear who it reaches and whether it leads to change. We would also like to know more about its potential impacts (positive and negative), how it works, what is needed for it to work best, and what stops it working. We aim to develop an effective intervention to increase physical activity levels and improve mental health and wellbeing of girls and women in Somalia by examining and refining this 'real-world' grassroots football initiative.

Sport has been promoted as a way to encourage physical activity. Sport-based programmes, including football have been used across sub-Saharan Africa as a platform to promote personal and social development. Despite attracting huge funding and support from the UN and FIFA, such initiatives tend to focus on men and have not been rolled out extensively in Somaliland. Furthermore, the evidence base for such interventions in low income settings is poor, in contrast to higher quality evaluations of football interventions in high income settings (e.g. Football Fans In Training). To our knowledge, there are no evidence-based strategies to improve physical activity levels or mental health and wellbeing in girls and women in Somalia.

This study will be co-produced with founders of Gobanimo Women's Football Club and will take place in Hargeisa, an urban area. It will be implemented in four phases. Phase 1: Define the grassroots football 'intervention' by interviewing club founders and members to find out what activities take place and how they are delivered. In Phase 2, we will conduct a workshop with girls and women who are non-club members to explore the barriers to playing sport and interview stakeholders to understand the conditions that affect how the intervention works. Stakeholders will include community faith and lay leaders, parents, women and health organisations, funders, and policy-makers. Phase 3: Using information from the workshop and interviews, we will work with the founders of the club and a Somali woman football referee to develop a new intervention and further refine the Theory of Change (i.e. how intervention activities are understood to produce a series of results that contribute to achieving the final intended impacts). We will also identify methods to measure potential impacts of the intervention. In Phase 4, we will get feedback from stakeholders to make adjustments and improve on the proposed intervention. We will find out if it is acceptable and feasible. Finally, we will develop a manual for supporting implementation of the intervention in new settings and pilot the intervention with 30 girls and women.

At the end of this study, we will have an intervention for increasing physical activity as well as improving mental health and wellbeing of Somali girls and women. We will take this forward by testing the intervention in new communities and settings in a future feasibility study.

The aim of this study is to develop an effective intervention to increase physical activity levels and improve mental health and wellbeing of girls and women in Somalia by examining and refining a real-world grassroots football initiative. In Somalia, girls and women are less active than boys and men, especially in urban areas. The number of women who have depression is higher compared to men. Gobanimo Women's Football Club in Hargeisa was established in 2016 by local girls and women who wanted a safe space for physical activity and socialising. It has proven to be popular; growing from 6 to 50 girls and women between the ages of 13 and 45 years playing weekly. However, it is not clear who it reaches and whether it produces desired change. We would also like to know more about its potential impacts, how it works, what is needed for it to work best, and what stops it working.
We will (1) Define the football intervention by conducting individual interviews with club founders and members to find out what activities take place and how they are delivered. (2) Understand the individual, contextual, and system-level factors that impact the intervention. (2a) We will conduct a workshop with girls and women to explore perceived barriers and facilitators to sport participation and impact of playing sport (or not) (2b) We will interview stakeholders to explore perceptions on norms and beliefs related to sport participation, and existing resources, facilities and opportunities for girls and women. (3) Develop or adapt the intervention and further refine a Theory of Change to make explicit the causal pathways leading to intended impacts. We will also identify instruments for assessing factors underlying the mechanisms of change. (4) Refine the proposed intervention through workshops with stakeholders to elicit feedback and develop a manual for delivering the intervention in new settings and pilot the intervention. This study will inform the design of a future feasibility study.