Process evaluations of health-promotion interventions in sports settings: a systematic review

Implementation of an Australian football themed men's health program in rural Australia: a mixed-methods study

Rural men face a greater risk of ill-health than their urban counterparts but often lack access to appealing health programs. Aussie Fans in Training (Aussie-FIT) is an engaging men's health program delivered in urban professional sports contexts. This study examines the feasibility of implementing an adapted version of Aussie-FIT in rural Western Australia, focussing on the recruitment and retention of program coaches and participants. Men (aged 35-65) with overweight or obesity were recruited via Facebook, word of mouth, and local media for the 12-session Aussie-FIT program in 3 rural towns. Coaches were recruited via local stakeholder networks. A mixed-methods approach included process data relating to the number of coaches expressing interest and delivering programs, program reach, attendance registers, and five post-program participant focus groups (total n = 25). Qualitative data exploring barriers and facilitators to engaging men were analysed using reflexive thematic analysis. Eighty-three of 124 men (67%) expressing interest enrolled, with most residing in low-to-middle socioeconomic areas (n = 77; 96%) and not university educated (n = 60; 74%). Half (n = 40) were recruited via Facebook and a third by word of mouth. Average attendance was 8.2 of 12 sessions, with 57 (69%) completers. Retention varied by site (59-79%), partly due to Covid-19. An inclusive and supportive environment, the football theme and setting, and intragroup connectedness supported engagement. Findings suggest that it is feasible to implement Aussie-FIT in rural Western Australia without a professional club affiliation or setting, and that popular local sporting codes and community sports settings can be utilized to engage rural men in behavioural health programs.

Psychological Interventions to Improve Elite Athlete Mental Wellbeing: A Systematic Review and Meta-analysis

BACKGROUND

Mental wellbeing, one continuum alongside mental illness in a dual-continua mental health model, has attracted less attention compared with substantial studies concerning mental illness amongst elite athletes. Notably, the promotion and protection of mental wellbeing contribute to not only a positive status of flourishing but also a reduction in the future risk of mental illness, which can potentially facilitate a status of complete mental health. Despite the critical role of wellbeing promotion and protection, there are limited evidence-based strategies to design and implement wellbeing interventions in elite athletes.

OBJECTIVE

This review aims to identify the different types of interventions to improve mental wellbeing amongst elite athletes and meta-analyse their effects. Further, the study aims to narratively identify the factors affecting implementation success in elite athletes.

METHODS

Peer-reviewed articles were systematically searched through five electronic databases (SPORTDiscus, PsycINFO, PSYCArticles, Academic Search Complete and MEDLINE) in July 2023 and updated in May 2024. To enrich the overall findings and reduce the risk of publication bias, grey literature was also included in this review. Dissertations and theses were the main foci and were searched in September 2023 and updated in May 2024. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to estimate the effects of the different types of interventions on mental wellbeing. Further, a narrative synthesis under the Consolidated Framework for Implementation Research was conducted to identify the potential factors that influenced the implementation success.

RESULTS

A total of 27 studies were found from peer-reviewed and grey literature, of which 15 studies were subject to meta-analyses. Results indicated that psychological skills training (SMD = 0.78, 95% CI 0.24, 1.32), third-wave interventions (SMD = 0.32, 95% CI 0.01, 0.63) and positive psychology interventions (SMD = 0.58, 95% CI 0.31, 0.85) were all potentially effective in improving overall wellbeing amongst elite athletes. However, when quasi-experimental studies in the third-wave interventions were removed for the sensitivity analysis, the effect was no longer significant. Further, 11 facilitators and 3 barriers to implementation success were identified, of which adaptability, coach and teammate support, and instructor's capacity to connect with athletes were the key facilitators, and busy schedules and complex intervention contents were the main barriers.

CONCLUSIONS

This review indicated that psychological skills training, third-wave interventions and positive psychology interventions could be potentially effective for elite athlete mental wellbeing, but more studies with robust experimental designs are needed in future to increase confidence in the favourable results. Moreover, future researchers and practitioners need to be aware of context-specific implementation facilitators and barriers, optimising elite athletes' engagement and uptake of interventions.

PROSPERO

CRD42023437986.

Insufficient structure and reporting of process evaluations of complex interventions for musculoskeletal conditions in randomized controlled trials: a systematic review

OBJECTIVES

To explore how process evaluation of complex interventions alongside randomized clinical trials (RCTs) in musculoskeletal conditions are conducted.

STUDY DESIGN AND SETTING

Systematic review.

METHODS

We searched the MEDLINE, SCOPUS, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Studies were included if they reported process evaluation conducted alongside RCTs, within the main report or as separate reports, that assessed process evaluation of RCTs of complex nonsurgical and nonpharmacological interventions for musculoskeletal conditions. We performed a descriptive analysis of the included studies based on process evaluation parameters.

RESULTS

Data were extracted from 61 studies from 17 countries. Our findings showed studies used qualitative, quantitative, and mixed methods for process evaluations, typically reporting within the main RCT. Most studies were conducted in primary care settings. Only a few studies (16%) included a theoretical model to guide their process evaluation. Studies reported reach (8%), patients' and clinicians' perceptions of the interventions (44% and 8%, respectively), treatment fidelity and adherence (52% and 43%, respectively), training of patients and clinicians (eg, workshops, manuals and additional training) (54%), how the integration of process evaluation and outcome evaluation findings was performed (68%), barriers to perform the process evaluation (2%), and the strengths and weaknesses of the process evaluation (65%).

CONCLUSION

Reporting of process evaluations within RCTs is insufficiently reported. Researchers rarely adopted a theoretical model or framework to guide their process evaluation. Studies used a variety of methods to conduct process evaluations. We identified barriers, strengths, and weaknesses of methods used for assessing process evaluation as reported by authors from studies included in this review.

The health promoting sports coach: theoretical background and practical guidance

The sports club setting is a key context for health promotion, but it can also be associated with risky behaviours. Sports coaches play a crucial role in supporting the physical, mental and social health of sport participants but often lack the resources and support to do so. This paper proposes a guide to help coaches become health promoters by aligning their actions with the Health Promoting Sports Club model, which represents the setting-based approach applied to sports clubs. An embedded mixed-method study with a QUAL (qual) design was used, where 15 experts took part in 5 meetings and 299 coaches provided input through an online survey. Four steps were carried out: (1) defining the health-promoting sports coach and key action principles, (2) co-constructing progression stages using the settings-based approach, (3) identifying key actions for promoting health in different moments of coaching (i.e., before, during, and after training and competition, and outside of coaching), and (4) developing long-term intervention components. A definition of the health-promoting sports coach was produced, and eight key action principles have been identified, divided into three dimensions: connection with the system, adoption of a coaching philosophy, and focus on participants. Five stages of progression for integrating health promotion into coaching have been established, ranging from risk prevention to a global approach involving the entire sports system. Specific actions for each moment of coaching (before, during, and after training and competition, and outside of coaching) have been identified, such as monitoring the physical, mental, and social health of participants or plan the coaching session to ensure safety, inclusion, and well-being for all sports participants, staying open for last-minute changes. Finally, long-term intervention components to support the implementation of these actions in practice have been developed, based on what coaches are already doing, the skills they possess and the five stages of progression. This paper enables the development of a guide to help sports coaches promote health by identifying concrete actions and short- and long-term interventions, whilst making links with the health promoting sports club model. It broadens the scope of coaching by incorporating health principles, while emphasising the need to adapt to the environment and context of the club. This work calls for future research to test the effectiveness and feasibility of these approaches in various sporting environments.

Utilisation of New Zealand Rugby's concussion management pathway: A mixed methods investigation

Concerns around concussion highlight the need for strategies to improve the implementation and translation of concussion guidelines in community sports. This study assessed players' utilisation and compliance with New Zealand Rugby's Concussion Management Pathway (CMP). This pragmatic, mixed methods study comprised of concussion injury surveillance and mapping of players' healthcare touchpoints through the CMP. Semi-structured interviews were conducted to understand stakeholders' experiences. Over the season, 27 different healthcare pathways were identified with 28% of players progressing through all phases of the CMP (ideal pathway). Of the 206 suspected concussions reported over the season, 70% were logged in the CMP phone App, and 89% of these had an associated valid baseline concussion assessment. Prior to returning to contact training, 64% of players obtained a medical clearance. One theme, 'belief in the value of pathway' was identified as a facilitator across all CMP components. Themes such as 'concussion knowledge and the nature of concussion'; 'communication between stakeholders and sufficient information on the process'; and 'strong relationships and clarity around responsibilities' were identified as facilitators across several pathway components. Other facilitators included 'ease and timing of general practitioner access'; 'the phone App as facilitator to logging'; and 'spotting for concussion as a team'. Additionally, the findings signify baseline testing as a potential pre-cursor to overall CMP compliance. Strategies that support the facilitators identified in this study may further enhance compliance.

Promoting men's health through sports clubs: A systematic rapid realist review

BACKGROUND

Health promotion (HP) interventions delivered through sports clubs have demonstrated promising outcomes among men, but less is known about which aspects of the interventions work, for whom, and under what circumstances. This rapid realist review aimed to understand the contexts, mechanisms, and outcomes of HP interventions for men delivered through sports clubs.

METHODS

A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SPORTDiscus databases.

INCLUDED STUDIES

(a) were delivered by or in collaboration with sports clubs, (b) targeted men aged 18+ years, and (c) reported 1 or more HP outcomes. A grey literature search was also performed. Studies were included in a realist synthesis based on richness and rigor. Hereafter, context-mechanism-outcome (CMO) configurations were developed.

RESULTS

We identified and screened 3358 studies, finally including 59 studies describing 22 interventions. Most HP interventions were delivered in high income countries, included Caucasian men aged 35-65 years with overweight/obesity, and used professional sports clubs (mostly football) for recruitment and facilities. Quantitative HP outcomes were reported across 19 interventions. Of these 19 interventions, the majority reported on weight (n = 18), physical activity (n = 12), mental health (n = 10), and diet (n = 9). We identified 13 CMOs related to how HP interventions affected men's recruitment, engagement, and health behavior maintenance.

CONCLUSION

Our findings show that using sports clubs for HP interventions is effective for engaging men. Recruitment was facilitated by leveraging sports clubs' identity, addressing masculinity-related barriers, improving accessibility, and building trust. Engagement was enhanced through shared identity experiences, safe spaces, inclusive competition, and self-efficacy. However, there's limited evidence on behavior maintenance post-intervention, though involving community stakeholders seemed vital. In general, considerations should be made to avoid perpetuating traditional masculine norms, which may exclude some men and reinforce unhealthy behaviors. These findings can guide intervention development, emphasizing the need to harness men's perspectives in the process.