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Background Injury is a barrier to sport/physical activity (PA) participation, but the impact of this barrier for insufficiently active (not meeting minimum PA guidelines) women is unknown. Method Insufficiently active women, who identified injury as a barrier to engagement in sport/PA, participated in an online concept mapping exercise. Results Brainstorming (n=45) elicited 208 impacts of injury. After synthesis and editing, participants (n=25) sorted 94 impact statements into groups (mean no. of groups, 9.3; mode 6; range 4–15). Multidimensional scaling and hierarchical cluster analysis identified a nine-cluster solution listed from highest to lowest mean importance rating out of 5: Fear and frustration (17 statements;, importance 3.92); Physical implications of injury (15; 3.71); Activity restrictions (8; 3.66); Financial implications (4; 3.63); Worries (6; 3.46); Adjustment and management (14; 3.39); Mental and emotional wellbeing (14; 3.2); Impact on daily life (6; 3.03); and Social impact and engagement (10;2.82). Conclusion The impact of injury extends beyond physical engagement in sport/PA. To increase PA in insufficiently active women who experience injury as a barrier, public/health professionals, governing sport bodies, insurance providers, and program deliverers need to be educated to understand the breadth of this barrier. Learning Outcomes The impact of injury is multi-dimensional. Women who experience injury need access to evidence-based advice, affordable rehabilitation options, support (psychological/physical/logistical), and information about suitable sport/PA options. The program deliverer has an opportunity to provide information that will potentially reduce the impact of this barrier, see these women return to sport/PA earlier, and increase their levels of PA.

Background Researchers and policymakers have acknowledged sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to offer SCs guidance to develop health promotion interventions. As implementation science insists on theoretically grounded interventions, this work's objective was to provide SCs an evidence-driven intervention framework for planning health promotions. Methods A 4-step process was undertaken: 1) investigate indicators for SCs to be considered health promoting, 2) adapt the theoretical HPSC concept to create a HPSC model, 3) reformulate published evidence-driven guidelines into implementable intervention components (ICs) and 4) merge the model with the ICs to provide an intervention planning framework for SCs. During 3 workshops, researchers defined the model elements and ICs. Workshop participants classified ICs into the HSPC model. Each IC could be classified multiple times within the model. Results Researchers drafted 5 HPSC indicators: 1) an approach embracing all SC actions, 2) involve all SC levels in actions and decisions, 3) involve external partners, 4) promoting health is continuous and iterative and 5) base actions on needs. To create the HPSC model, elements were defined: 3 SC levels (club, management, coaches) and 4 health determinants (organizational, social, environmental, economic) per level based on the indicators. Published guidelines from literature reviews aided in developing 14 strategies with 55 ICs. Workshop classification of ICs into the model included: club (n = 79), management (n = 67) and coaches (n = 48). Conclusions The theoretical HPSC model and intervention planning framework act as starting points to develop and implement interventions to increase HP efforts by stakeholders in several ways: 1) SCs can apply strategies based on goals, 2) SCs can target specific levels with corresponding ICs or 3) ICs can target specific health determinants. Key messages A Health Promoting Sports Club model defines 4 health determinants at 3 levels (coach, management operational) of sports clubs to plan, develop and implement targeted health promotion activities. This HPSC intervention planning framework has 14 strategies with 55 intervention components targeting multiple sports club levels giving stakeholders a path to become a health promoting sports club.

Sports injuries have negative consequences on team performance, acute and long-term impact on individual well-being and quality of life, and cost implications for individuals and society. This chapter focuses on various Human Factors and Ergonomics (HFE) methods that can be used to facilitate the design of tools and methods to optimize and enhance injury prevention efforts. First, a basic overview of the epidemiology and historical frameworks for injury prevention research is presented. Second, we provide an example of how HFE methods have been applied to optimize observational risk analysis assessment and training. Third, we highlight the need, and strategies for, optimizing uptake and adherence to evidence-based injury prevention efforts. Finally, we comment briefly on opportunities for future work and integration of HFE methods to help reduce the risk of sport injuries.

Background: Sports clubs (SCs) offer a unique position to increase physical activity levels and offer additional health promotion opportunities. Purpose: To gather French stakeholder ideas on support SCs need to increase health promotion efforts and prioritized them. Methods: This concept mapping study included 4-steps: 1) drafting a key issue focus prompt, 2) brainstorming ideas in response to the focus prompt, 3) sorting ideas into themed piles and 4) rating ideas (1-6) based on two indicators. French sports and health stakeholders (45) were invited to respond using web-based groupwisdom��� software. Based on multi-dimensional scaling and hierarchical cluster analysis, visual cluster maps of piles and Go-Zone graphs displaying ideas rated as important and feasible were produced. Results: Participants generated 62 ideas from the focus prompt: ���What assistance would benefit SCs to become a health-promoting setting?���. Final idea sorting formed 9 clusters: Tools for health promotion, Communication tools, Stakeholder training courses, Diagnostic and Financing, Awareness and Mobilization, Advocacy, Policies and Methods, Sharing and Networking and Communication and Dissemination. Ratings produced Go-Zones with 34 ideas above the mean for both indicators. Priority areas include increasing awareness of health promotion benefits, mobilizing actors, advocating for support and educating club actors. Conclusions: Generating and organizing stakeholder ideas gives insight into perceptions of what support is needed to develop and implement health promotion interventions in the sports club context which increases the possibility of acceptance and integration into policies. Funding: Study was funded by a grant from Sant�� publique France., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

Objectives Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years). Methods Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach. Results Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization. Conclusions Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required.

National strategies to prevent sports injuries can potentially improve health outcomes at a population level and reduce medical costs. To date, a compilation of the strategies that countries have attempted, and their effectiveness, does not exist. This scoping review sets out to: identify nationwide attempts at implementing sports injury prevention strategies; examine the impact of these strategies; and map them onto the Translating Research into Injury Prevention Practice (TRIPP) framework. Using Levac's scoping review method, we: (a) identified the research questions, (b) identified relevant studies, (c) identified the study selection criteria, (d) charted the data, and (e) reported the results. A search of MEDLINE, Scopus, SPORTDiscus, CINAHL, and Web of Science databases for articles published pre-June 2019 was conducted. We identified 1794 studies and included 33 studies (of 24 strategies). The USA (n = 7), New Zealand (n = 4), Canada (n = 3), the Netherlands (n = 3), Switzerland (n = 2), Belgium (n = 1), France (n = 1), Ireland (n = 1), South Africa (n = 1), and Sweden (n = 1) have implemented nationwide sports injury prevention strategies with 29 (88%) of the included studies demonstrating positive results. Mapping the strategies onto the TRIPP framework highlighted that only four (17%) of the 24 included strategies reported on the implementation context (TRIPP Stage 5), suggesting an important reporting gap. Nationwide sports injury prevention efforts are complex, requiring a multidimensional approach. Future research should report intervention implementation data; examine the implementation context early in the research process to increase the likelihood of real-world implementation success; and could benefit from incorporating qualitative or mixed research methods.

ObjectiveThe public health benefits of injury prevention programmes are maximised when programmes are widely adopted and adhered to. Therefore, these programmes require appropriate implementation support. This study evaluated implementation activity outcomes associated with the implementation of FootyFirst, an exercise training injury prevention programme for community Australian football, both with (FootyFirst+S) and without (FootyFirst+NS) implementation support.MethodAn evaluation plan based on the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Sports Setting Matrix was applied in a controlled ecological evaluation of the implementation of FootyFirst. RE-AIM dimension-specific (range: 0–2) and total RE-AIM scores (range: 0–10) were derived by triangulating data from a number of sources (including surveys, interviews, direct observations and notes) describing FootyFirst implementation activities. The mean dimension-specific and total scores were compared for clubs in regions receiving FootyFirst+S and FootyFirst+NS, through analysis of variance.ResultsThe mean total RE-AIM score forclubs in the FootyFirst+S regions was 2.4 times higher than for clubs in the FootyFirst+NS region (4.73 vs 1.94; 95% CI for the difference: 1.64 to 3.74). Similarly, all dimension-specific scores were significantly higher for clubs in the FootyFirst+S regions compared with clubs in the FootyFirst+NS region. In all regions, the dimension-specific scores were highest for reach and adoption, and lowest for implementation.ConclusionImplementing exercise training injury prevention programmes in community sport is challenging. Delivering programme content supported by a context-specific and evidence-informed implementation plan leads to greater implementation activity, which is an important precursor to injury reductions.

Objective: Sports clubs provide an opportunity to tackle childhood obesity rates through targeted interventions. Our study aimed to investigate if coaches providing healthy snacks to participants before junior netball sessions at five clubs in Melbourne, Australia, increased consumption of healthy foods and influenced coach perceptions of participants’ attention/participation levels. Methods: Coaches provided healthy snacks to participants before each netball session for one school term. Children's food consumption was observed at one session before, during and after the intervention. Parents attending the observed session completed pre- and post-intervention questionnaires. Coaches rated participants’ attention/participation at the observed sessions before and during the intervention, and completed a questionnaire post-intervention. Results: Baseline: Ice cream and cake were the most frequently consumed snacks. During intervention: Fruit, cheese and crackers and vegetables were the most frequently consumed snacks. Coaches ratings of participants’ attention/participation increased significantly (baseline: 6.4 ± 0.17, intervention: 7.5 ± 0.36; p=0.02) where the same coach undertook ratings at both time points. Conclusions: Coaches providing healthy snacks before sessions at sports clubs increased consumption of nutrient-dense foods at the session, and may have positively affected participants’ attention/participation. Implications for public health: This study highlights how a simple intervention could improve the diet of Australian children.

To explore sports organisation members' attitudes to sponsorship of sport by energy-dense, nutrient-poor food and drink ('junk food') brands.The study design is a cross-sectional study.An online survey of adult members of three sports organisations that did not accept junk food sponsorship in Victoria, Australia in 2018: one was responsible for an elite team in a national competition (5000-10,000 members); one managed a team sport competition across Victoria (50,000-100,000 registered junior and adult participants, referees and coaches); and one administered a junior team sport competition for boys and girls in a major city (10,000-15,000 participants).Most (71%) of the 2224 respondents reported it was important/very important that their organisation did not accept junk food sponsorship. A higher proportion was concerned/very concerned about junk food companies sponsoring children's sport (60%) compared with such companies sponsoring elite (49%, P 0.001) or community adult (39%, P 0.001) sport. A higher proportion of respondents were likely/very likely to support a policy that restricted junk food sponsorship of children's sport (84%), compared with a policy restricting sponsorship of elite (76%, P 0.001) and adult community (74%, P 0.001) sport. Two-thirds of respondents supported restricting junk food companies from sponsoring sport, even if fees for children's (66%) and community adult (65%) sport increased, or if membership and attendance costs for elite sport supporters increased (63%).In the Australian context of this study, junk food sponsorship of sport, particularly children's sport, is a concern to members of sports organisations. Although still high, support for restricting such sponsorship declines if members perceive it will lead to increases in participation costs and decreases in participation opportunities. Initiatives restricting junk food sponsorship of sport are likely to receive strong support from the sports community, particularly when the focus is on children's sport, and participation costs and opportunities are not negatively impacted.

Background Youth handball players are vulnerable to injuries. Because there is no available injury prevention training specifically developed for youth handball players targeting both upper and lower limbs or incorporating psychological aspects of injury, we undertook the ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ project. We used an ecological participatory design incorporating the perspectives of multiple stakeholders (health beneficiaries, programme deliverers and policy makers). The aim of this paper was to describe the process of developing the I-PROTECT model, featuring injury prevention training and an accompanying implementation strategy. Design We used the generalisable six-step intervention development process, outlined to guide researchers when developing implementable, evidence-based sports injury prevention interventions, to develop the I-PROTECT model. The six-step process involves establishing a research–stakeholder collaborative partnership to (1) identify and synthesise research evidence and clinical experience; (2) consult with relevant experts; (3) engage end users to ensure their needs, capacity and values are considered; (4) test the feasibility and acceptability of the intervention; (5) evaluate the intervention against theory; and (6) obtain feedback from early implementers. Two community handball clubs in southern Sweden, offering organised training for youth male and female players, and the district handball federation, participate in the intervention development. Drafts of the I-PROTECT model will be developed and revised with key stakeholder advice and input throughout all six steps. Conclusion The I-PROTECT model described will be an end user-driven intervention, including evidence-based, theory-informed and context-specific injury prevention training for youth handball, and an associated implementation strategy.

There is a need for research to identify effective implementation strategies for injury prevention training within real-world community sports. The aim of this ecological participatory study was to identify facilitators, among stakeholders at multiple levels, that could help injury prevention training become part of regular training routines in youth team handball. Concept mapping, a mixed-method approach for qualitative data collection and quantitative data analysis, was used. Stakeholders (n = 196) of two community team handball clubs (29% players, 13% coaches, 38% caregivers, 11% club, district and national handball administrators, 9% unknown) participated in a brainstorming process. After the research team synthesized the 235 generated statements, 50 stakeholders (34% players, 22% coaches, 24% caregivers, 20% administrators) sorted 89 unique facilitator statements into clusters and rated them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis yielded five clusters (stress value 0.231): "Understanding and applying knowledge," "Education, knowledge, and consistency," "Set-up and exercises," "Inspiration, motivation, and routines," and "Club policy and expert collaboration." The cluster "Understanding and applying knowledge" had the highest mean importance (3.17 out of 4) and feasibility (2.93) ratings. The 32 statements rated as both highly important and feasible (Go-zone) indicate action is required at the individual (end-users) and organizational (policymakers) levels to implement injury prevention training. Results suggest that developing evidence-based context-specific injury prevention training, incorporating physiological, biomechanical and psychological components, and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to facilitate the implementation of injury prevention training in youth team handball. Funding Agencies|Kocks Foundation; Anna-Greta Crafoords Foundation; Pia Stahls Foundation; Swedish Research Council for Sport Science; Crafoord Foundation

Objective Implementation of effective population-level injury prevention interventions requires broad multiagency partnerships. Different stakeholders address this from varying perspectives, and potential conflicts in priorities need to be addressed for such partnerships to be effective. The researcher-led National Guidance for Australian football Partnerships and Safety (NoGAPS) project involved the engagement and participation of seven non-academic partners, including government health promotion and safety agencies; peak sports professional and advocacy bodies and health insurance organisations. Design The partnership9s ongoing development was assessed by each partner completing the Victorian Health Promotion Foundation Partnership Analysis Tool (VPAT) annually over 2011–2015. Changes in VPAT scores were compared through repeated measures analysis of variance. Results Overall, mean total VPAT scores increased significantly over the 5-year period (125.1–141.2; F 5,30 =4.61, p=0.003), showing a significant improvement in how the partnership was functioning over time. This was largely driven by significant increases in several VPAT domains: ‘determining the need for a partnership’ (F 5,30 =4.15, p=0.006), ‘making sure the partnership works’ (F 5,30 =2.59, p=0.046), ‘planning collaborative action’ (F 5,30 =5.13, p=0.002) and ‘minimising the barriers to the partnership’ (F 5,30 =6.66, p Conclusion This is the first study to assess the functioning of a multiagency partnership to address sport injury prevention implementation. For NoGAPS, the engagement of stakeholders from the outset facilitated the development of new and/or stronger links between non-academic partners. Partners shared the common goal of ensuring the real-world uptake of interventions and research evidence-informed recommendations. Effective multiagency partnerships have the potential to influence the implementation of policies and practices beyond the life of a research project.

The study aim was to evaluate the implementation of group- and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability—all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery.A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs.

Coaches are essential to participant safety, particularly by implementing injury prevention programs. The evidence-based injury prevention programs developed by sports scientists will not prevent injuries in real-world sports settings if they are not properly implemented. This study investigated the knowledge and use of the highly efficacious 11+ injury prevention program among coaches of adolescent, female football teams, in Victoria, Australia. A cross-sectional online survey based on the RE-AIM framework identified that nearly half (42%) of the 64 respondents (response rate = 36%) were not aware of the 11+, and only one-third (31%) reported using it. Three-quarters (74%) of the 19 respondents who reported on the 11+ components they used, did not use the entire program. Nearly half (44%) of the 18 respondents who reported the frequency with which they used the 11+, used it less than the recommended twice a week. Barriers to implementing the 11+ included: limited awareness of the 11+; lack of knowledge about how to implement it; not having time to implement it; and believing that the 11+ does not incorporate appropriate progression. This study suggests that it is unlikely that the 11+ prevents a significant number of injuries in real-world football settings due to the lack of awareness and use among coaches. Football-governing bodies should use evidence-based strategies to raise awareness of the 11+, build coach competency to implement it, and address time-related implementation barriers that coaches experience. Coaches should keep up-to-date with injury prevention research evidence and prioritize injury prevention at training, including allocating time to implement injury prevention programs properly.

This study evaluated the impact of a brief (20-min) nutrition education intervention embedded in an existing mandatory coach education course for coaches of junior (8–12 years old) Australian football teams. A total of 284 coaches (68% of 415 coaching course participants) completed a presession questionnaire, and 110 coaches (27% of coaching course participants) completed an identical postsession questionnaire. The responses to the pre- and postsession surveys were matched for 78 coaches. Coaches’ ratings of their own understanding of the nutritional needs of young athletes (6.81, 8.95;p p = .001), their confidence in their own nutrition knowledge (7.24, 8.64;p p 95%) provided a correct response to six of the 15 nutrition and hydration knowledge questions included in the presession questionnaire. Even with this high level of presession knowledge, there was a significant improvement in the coaches’ nutrition and hydration knowledge after the education session across five of the 15 items, compared with before the education session. The results of this study suggest that a simple, short nutrition education intervention, embedded in an existing coach education course, can positively influence the nutrition knowledge and self-efficacy of community-level, volunteer coaches of junior sports participants.

Objectives To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian Football (AF). Design Observational. Methods The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly. Results The raters agreed on 61/70 observations (87%) (Kappa = 0.72, 95% CI: 0.55; 0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed. Conclusions The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.

Objectives The “Mayday Safety Procedure” (MSP) is included in the Australian Rugby Union (ARU) Medical and Safety Recommendations and the mandatory SmartRugby training for coaches. Previous research indicates that translating the Mayday Safety Procedure into practice among community rugby coaches is challenging. This study investigated whether Mayday Safety Procedure translation could be enhanced by systematically planning and implementing a range of theory-informed and context-specific diffusion strategies. Design A controlled before-and-after study. Methods Coaches of senior community rugby teams in five zones in New South Wales (Australia) were invited to complete a questionnaire about their Mayday Safety Procedure knowledge and practice at the end of the 2010 and 2011 rugby seasons. During 2011, coaches in the intervention zone were exposed to a range of strategies to promote Mayday Safety Procedure diffusion which were planned by following Step 5 of the Intervention Mapping protocol. Coaches in the other four zones were exposed to usual strategies to promote Mayday Safety Procedure diffusion. Results Using the RE-AIM evaluation framework, statistically significant improvements were found among intervention zone coaches in: knowledge of most Mayday Safety Procedure key criteria; the number of coaches recognising their zone policy requiring them to train players in the Mayday Safety Procedure; frequency of provision of Mayday Safety Procedure training to players; coach perceptions of the quality of Mayday Safety Procedure training for players; and in confidence that referees could implement the Mayday Safety Procedure during a game if required. Conclusions The findings suggest that the translation of injury prevention policy into community practice can be enhanced by developing and implementing a theory-informed, context-specific diffusion plan, undertaken in partnership with key stakeholders.

Background and aimUnderstanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme.MethodsConcept mapping with data collected from 19 soccer coaches and administrators.ResultsBrainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3–10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the ‘Lack of 11+ knowledge among coaches’ cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the ‘Lack of facilities and resources’ cluster received the lowest mean importance rating (2.23), while statements in the ‘Lack of time at training’ cluster received the lowest mean feasibility rating (2.19).ConclusionsA multistrategy, ecological approach to implementing the 11+—with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership—is required to improve the uptake of the 11+ among the targeted coaches.

Exercise programmes to prevent injuries, such as lower-limb injuries that are common in community Australian Football,1 exist but are not widely used. Often, such programmes are developed using research evidence and clinical best practice without consideration of real-world implementation factors. This means that work still needs to be done to make them suitable for use in community sports settings.2 Implementing evidence-based injury prevention exercise programmes into ‘real world’ practice remains challenging.2 A ‘plan of action’ to implement such interventions seems to help coaches use them. However, there is little guidance about how best to create such a plan. Donaldson and colleagues3 describe how researchers developed a ‘plan of action’ for implementing the …

Background/aim Concussion guidelines exist for multiple community sports. Parents are key stakeholders in guideline implementation and in appropriate responses following concussive injury. The purpose of this qualitative investigation was to understand how parents of community-level Australian Football (AF) players experience and perceive concussion guidelines in order to inform the design and implementation of concussion guidelines in community sport. Methods A cross-sectional qualitative approach was adopted to allow for an open and detailed exploration of the views of parents of junior community AF players (ie, those aged

Musculoskeletal injuries during military and sport-related training are common, costly and potentially debilitating. Thus, there is a great need to develop and implement evidence-based injury prevention strategies to reduce the burden of musculoskeletal injury. The lack of attention to implementation issues is a major factor limiting the ability to successfully reduce musculoskeletal injury rates using evidence-based injury prevention programs. We propose 7 steps that can be used to facilitate successful design and implementation of evidence-based injury prevention programs within the logical constraints of a real-world setting by identifying implementation barriers and associated solutions. Incorporating these 7 steps along with other models for behavioral health interventions may improve the overall efficacy of military and sport-related injury prevention programs.

Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.

Despite recent interest in understanding the implementation context for sports injury prevention interventions, little research attention has been paid to the management structures and processes of community sporting organisations. This study developed expert consensus about the importance of Occupational Health and Safety (OHS) setting-related safety management system (SMS) principles and performance indicators in the context of Australian community sporting organizations, and the feasibility of these organisations meeting the requirements for the SMS performance indicators. Twenty-nine sports injury prevention, community sports administration and OHS SMS experts participated in a three-round online Delphi study by rating the importance of 64 SMS performance indicators categorised under the five principles of Commitment and Policy; Planning; Implementation; Measurement and Evaluation; and Review and Improvement. Overall, consensus agreement – define as rated ‘essential’ or ‘very important’ on a five-point scale by ⩾75% of the participants in Round 3 – was reached for 57 performance indicators. Ten (15%) performance indicators were rated as ‘very difficult’ or ‘relatively difficult’, and six (9%) were rated as ‘very easy’ or ‘relatively easy’ on a four-point scale, by ⩾75% of participants. This research suggests that the guiding principles and associated performance indicators that underpin OHS safety management systems in the workplace are very relevant and applicable to community sporting organisations in Australia. However, considerable work is required to build organisational capacity to be able to develop and implement meaningfully and useful SMSs to prevent sports injuries in the most common setting in which they occur.

Objectives Energy-dense, nutrient-poor food and drink (‘junk food’) brands sponsoring sport is a growing public health concern. This study explored sports administrators' perceptions of the barriers to rejecting junk food sponsorship. Study design This study used concept mapping. Methods The Concept Systems Global MAX™ web platform was used to collect and analyse data from 29 sports administrators across all levels of sport in Victoria, Australia. Results Brainstorming generated 33 barriers to rejecting junk food sponsorship. After the barriers were synthesised and edited, participants sorted and rated 32 barriers. Multidimensional scaling and hierarchical cluster analysis identified a four-cluster solution: community attitudes and values (seven barriers); junk food is the easy sell (retail; five barriers); financial viability (16 barriers); and organisational capability (policy and governance; four barriers). The financial viability barriers were rated the most important (mean = 3.65 of 5) and the hardest to overcome (1.42). The organisational capability (policy and governance) barriers were rated the least important (2.14) and the easiest to overcome (3.20). Conclusions Sports administrators clearly perceive that rejecting junk food sponsorship could place significant financial strain on their organisations. There appears to be considerable scope to build the capacity of sporting organisations to rejecting junk food sponsorship. Despite the literature indicating that most parents think junk food companies are not suitable sponsors, sports administrators perceive that there is a broad public acceptance of junk food sponsorship in sport. The fact that sports administrators perceive a link between junk food sponsorship and the lack of healthy options at club canteens and venue food outlets adds an additional, not previously identified, level of complexity to the junk food sponsorship in sport debate.

Aim The need for accurate diagnosis and appropriate return-to-play decisions following a concussion in sports has prompted the dissemination of guidelines to assist managing this condition. This study aimed to assess whether key messages within these guidelines are reflected in the knowledge of coaches and sports trainers involved in community sport. Methods An online knowledge survey was widely promoted across Australia in May–August 2012 targeting community Australian Football (AF) and Rugby League (RL) coaches and sports trainers. 260 AF coaches, 161 AF sports trainers, 267 RL coaches and 228 RL sports trainers completed the survey. Knowledge scores were constructed from Likert scales and compared across football codes and respondent groups. Results General concussion knowledge did not differ across codes but sports trainers had higher levels than did coaches. There were no significant differences in either concussion symptoms or concussion management knowledge across codes or team roles. Over 90% of respondents correctly identified five of the eight key signs or symptoms of concussion. Fewer than 50% recognised the increased risk of another concussion following an initial concussion. Most incorrectly believed or were uncertain that scans typically show damage to the brain after a concussion occurs. Fewer than 25% recognised, and >40% were uncertain that younger players typically take longer to recover from concussion than adults. Conclusions The key messages from published concussion management guidelines have not reached community sports coaches and sports trainers. This needs to be redressed to maximise the safety of all of those involved in community sport.

Background This paper describes the development of a theory-informed and evidence-informed, contextspecific diffusion plan for the Mayday Safety Procedure (MSP) among community rugby coaches in regional New South Wales, Australia. Methods Step 5 of Intervention Mapping was used to plan strategies to enhance MSP adoption and implementation. Results Coaches were identified as the primary MSP adopters and implementers within a system including administrators, players and referees. A local advisory group was established to ensure context relevance. Performance objectives (eg, attend MSP training for coaches) and determinants of adoption and implementation behaviour (eg, knowledge, beliefs, skills and environment) were identified, informed by Social Cognitive Theory. Adoption and implementation matrices were developed and change-objectives for coaches were identified (eg, skills to deliver MSP training to players). Finally, intervention methods and specific strategies (eg, coach education, social marketing and policy and by-law development) were identified based on advisory group member experience, evidence of effective coach safety behaviour-change interventions and Diffusion of Innovations theory. Conclusions This is the first published example of a systematic approach to plan injury prevention programme diffusion in community sports. The key strengths of this approach were an effective researcher–practitioner partnership; actively engaging local sports administrators; targeting specific behaviour determinants, informed by theory and evidence; and taking context-related practical strengths and constraints into consideration. The major challenges were the time involved in using a systematic diffusion planning approach for the first time; and finding a planning language that was acceptable and meaningful to researchers and practitioners.

Background Increasing participation by women in Australian football (AF) has made understanding their specific injury prevention needs a priority. In other sports, men and women have different injury profiles. This study aims to provide the first overview of self-reported injuries in women9s AF. Methods Nationwide survey of women aged 17+ years who played in an AF competition was conducted following the 2014 playing season. The players9 self-reported worst injury from the 2014 season is presented according to injury type, body part injured, treatment sought and games/training missed. Results Three-quarters of 553 respondents (n=431, 78%) reported at least 1 injury. Over half (n=235, 55%) of injuries were to the lower limb. Ankle ligament tears/sprains (n=50, 12% of all injuries) and knee ligament tears/sprains (n=45, 10%) were most frequent lower limb injuries reported. Two-thirds (65%) of all lower limb injuries led to at least 1 missed game. Of 111 (26% of all injuries) upper limb injuries reported, over half (n=57, 62%) were to the hand/fingers/thumb, including fractures (n=28, 6% of all injuries), ligament tears/sprains (n=18, 4%) and dislocations (n=11, 3%). Half of the upper limb injuries (51%) resulted in players missing matches/training. Conclusions The most frequent self-reported worst injuries for women playing AF were joint damage to the ankle and knee. A prospective injury study is needed to confirm the causes and rate of these lower limb injuries to identify the most suitable prevention interventions.

Ensuring community clubs implement centrally developed sports policy is a challenge for most sports. One hundred and eighty four (70% male, 68% aged 40 to 59 years) community Australian football club representatives (first-aid providers, administrators, parents, coaches, etc.) from across the country provided their perceptions of an Australian Football League-developed sports trainer policy and associated workforce training structure (jointly referred to hereafter as ‘the policy’) via an online survey. This article presents a qualitative analysis of the open-ended questions within the survey using the analytical lens of symbolic interactionism. Respondents generally supported the intent of the policy and identified many potential benefits of the policy, if adopted. They also provided insight into the organization and operation of community sports clubs and stressed that the volunteer intensive nature of community sport needs to be accommodated in the policy to enhance the likelihood of community-level acceptance and implementation. Successful community club implementation of this type of centrally developed micro-level sport policy requires that policy-makers understand and address the implementation context-related perspectives raised in this study.

Multi-purpose recreation facilities (MPRFs) are a popular setting for physical activity and it is therefore important that they are safe for all patrons. However, the attitudes of MPRF users towards safety are a potential barrier to the success of injury prevention programmes implemented within MPRFs. This article reports a survey of the safety attitudes of over 700 users of four indoor MPRFs. Factor analysis of 12 five-point Likert scale statements showed that the attitudes clustered around three major dimensions - the importance of safety, the benefits of safety and the perceptions of injury risk. Together, these three dimensions accounted for 49% of the variability in the attitudes. More than 85% of respondents agreed/strongly agreed that: safety was an important aspect of physical activity participation; being injured affected enjoyment of physical activity; people should adopt appropriate safety measures for all physical activity; and individuals were responsible for their own safety. The MPRF users, particularly women and older people, were generally safety conscious, believed in adopting safety measures, and were willing to take responsibility for their own safety. Facility managers can be confident that if they provide evidence-based injury prevention interventions in these settings, then users will respond appropriately and adopt the promoted behaviours.

Objective For effective sports injury prevention, information is needed about the implementation context for interventions. This study describes coaches9 feedback on the implementation of an evidence-informed injury prevention programme in community junior netball using coaches9 perceptions and the RE–AIM framework. Methods A lower-limb injury prevention programme (Down to Earth; D2E), for teaching safe-landing techniques, was delivered to 31 coaches from 31 junior community netball teams in a 1-h workshop. Coaches then delivered a 6-week programme at team training sessions starting in the week before the competition season commenced. 65% of coaches completed a feedback survey 17 weeks after they had delivered the programme. Results Most (88%) coaches believed that D2E improved their players9 ability to perform correct landing techniques in games and that players had retained these improvements over the season. The majority (83%) indicated that an improvement in player athletic attributes was the greatest advantage of D2E, followed by a reduction in injury risk. Identified barriers to implementing D2E were running out of time and very young players finding the drills too difficult. Coaches reported that they needed more ideas for training drills that could be incorporated into their programmes and believed that their own coaching training did not adequately prepare them to implement an injury prevention programme. Conclusions Although coaches believed that D2E was effective in developing correct landing techniques, some modifications are needed to make it more suitable for younger players and coach education by accreditation courses could be improved to support the implementation of injury prevention programmes.

This research investigated the under-explored area of safety in multi-purpose recreation facilities (MPRFs). Facility managers and other managerial staff (key informants) from four MPRFs in Victoria, Australia participated in semi-structured interviews. Safety was considered important from Occupational Health and Safety (OHS external (e.g. weather, demographic change); and governance (e.g. insurance, industry standards). Comprehensive, relevant and accessible industry safety standards, which focus not only on OH&S but equally on health promotion principles and public health perspectives linked to injury prevention, are required. Training is needed to reflect these broader and equally important perspectives. Health/injury, fitness/recreation and insurance sector links should be improved to ensure a consistent, sustainable approach to safety.

There has been increasing recognition of the need for effectiveness research within the real-world intervention context of community sport. This is important because, even if interventions have been shown to be efficacious in controlled trials, if they are not also widely adopted and sustained, then it is unlikely that they will have a public health impact. There is very little information about how to best conduct such studies, but application of health promotion frameworks, such as the RE-AIM framework, to evaluate the public health impact of interventions could potentially help to understand the implementation context. Care needs to be taken when directly applying the RE-AIM framework, however, because the definitions for each of its dimensions will depend on the level/s the intervention is targeted at. This paper provides a novel extension to the RE-AIM framework (the RE-AIM Sports Setting Matrix (RE-AIM SSM)), which accounts for the fact that many sports injury interventions need to be targeted at multiple levels of sports delivery. Accordingly, the RE-AIM components also need to be measured across all tiers of possible influence on the rate of uptake and effectiveness. Specific examples are given for coachdelivered exercise training interventions. The RE-AIM SSM is specific to the community sports setting implementation context and could be used to guide the delivery of future sports safety, and other health promotion, interventions in this area.

Issue addressed: Little is known about the effectiveness of once-weekly strength training programs for older adults based in community settings. This pilot study evaluated such a program to assess changes in the functional fitness of participants. Methods: A pre-test/post-test within subjects study design was used with new participants in the 10-week Staying Active, Staying Strong (SASS) program (all aged 50+ years). The Seniors Fitness Test (SFT) and SF-36 were used to assess functional fitness and health-related quality of life respectively. Perception of physical ability was assessed using a study-specific questionnaire. Pre- and post-test SFT and SF-36 scores were compared using paired t-tests. Frequency of responses was used to describe participant perceptions. Results: 110 evaluation participants (mean age 68.2 years; 85% female), 49% of those who completed the pre-test, also completed the post-test. Evaluation participants significantly improved their strength (assessed using arm curls and sit-to-stand); endurance (two-minute step test); flexibility (sit and reach, back scratch); and agility/dynamic balance (eight-foot up and go). SF-36 physical-functioning domain scores also significantly improved. Most participants reported improved strength, fitness, mobility, general well-being and confidence in performing daily activities. Conclusion: Weekly, community-based strength training programs show promise in improving the functional capacity, including the strength, of older adults. More thorough evaluation is now required to confirm these findings.

To evaluate a sports safety-focused risk-management training programme.Controlled before and after test.Four community soccer associations in Sydney, Australia.76 clubs (32 intervention, 44 control) at baseline, and 67 clubs (27 intervention, 40 control) at post-season and 12-month follow-ups.SafeClub, a sports safety-focused risk-management training programme (3x2 hour sessions) based on adult-learning principles and injury-prevention concepts and models.Changes in mean policy, infrastructure and overall safety scores as measured using a modified version of the Sports Safety Audit Tool.There was no significant difference in the mean policy, infrastructure and overall safety scores of intervention and control clubs at baseline. Intervention clubs achieved higher post-season mean policy (11.9 intervention vs 7.5 controls), infrastructure (15.2 vs 10.3) and overall safety (27.0 vs 17.8) scores than did controls. These differences were greater at the 12-month follow-up: policy (16.4 vs 7.6); infrastructure (24.7 vs 10.7); and overall safety (41.1 vs 18.3). General linear modelling indicated that intervention clubs achieved statistically significantly higher policy (p0.001), infrastructure (p0.001) and overall safety (p0.001) scores compared with control clubs at the post-season and 12-month follow-ups. There was also a significant linear interaction of time and group for all three scores: policy (p0.001), infrastructure (p0.001) and overall safety (p0.001).SafeClub effectively assisted community soccer clubs to improve their sports safety activities, particularly the foundations and processes for good risk-management practice, in a sustainable way.

Background and aim The impact of any injury prevention programme is a function of the programme and its implementation. However, real world implementation of injury prevention programmes is challenging. Lower limb injuries (LLIs) are common in community Australian football (community-AF) and it is likely that many could be prevented by implementing exercise-based warm-up programmes for players. This paper describes a systematic, evidence-informed approach used to develop the implementation plan for a LLI prevention programme in community-AF in Victoria, Australia. Methods An ecological approach, using Step 5 of the Intervention Mapping health promotion programme planning protocol, was taken. Results An implementation advisory group was established to ensure the implementation plan and associated strategies were relevant to the local context. Coaches were identified as the primary programme adopters and implementers within an ecological system including players, other coaches, first-aid providers, and club and league administrators. Social Cognitive Theory was used to identify likely determinants of programme reach, adoption and implementation among coaches (eg, knowledge, beliefs, skills and environment). Diffusion of Innovations theory, the Implementation Drivers framework and available research evidence were used to identify potential implementation strategies including the use of multiple communication channels, programme resources, coach education and mentoring. Conclusions A strategic evidence-informed approach to implementing interventions will help maximise their population impact. The approach to implementation planning described in this study relied on an effective researcher-practitioner partnership and active engagement of stakeholders. The identified implementation strategies were informed by theory, evidence and an in-depth understanding of the implementation context.

This paper seeks to review the current international health-promoting sports club (HPSC) research, drawing together findings based on case studies from various countries to illustrate the status of HPSCs. In addition, future challenges for HPSC research and implementation are considered. The review includes six case studies from five countries. In summary, there are two major research themes in this area, namely ‘research into HPSC activity’ and ‘research into HPSC networks’. The first theme investigates the extent to which sports clubs and/or national sports organisations invest in health promotion (HP) – both in policy and practice. The latter theme is driven by an intention to widen the scope of HPSCs to reach novel internal actors, like parents, siblings, etc., and/or external non-sporting bodies, like communities, schools, etc. The future challenges for HPSC research require a better understanding of the motives, barriers and capacities of sports clubs and coaches. Sports organisations, clubs and coaches generally support the intent of the HPSC concept, but even with the best evidence- or theory-based HP programmes/guidelines/standards, nothing will happen in practice if the nature and capacities of sports clubs are not better acknowledged. Therefore, a call for embracing implementation science is finally made to enhance implementation.

Objectives Far fewer injury surveillance systems exist within community sport than elite sport. As a result, most epidemiological data on sports injuries have limited relevance to community-level sporting populations. There is potential for data from community club-based injury surveillance systems to provide a better understanding of community sports injuries. This study aimed to describe the incidence and profile of community-level Australian football injuries reported using a club-based injury surveillance system. Design Prospective, epidemiological study. Methods Sports trainers from five community-level Australian football leagues recorded injury data during two football seasons using the club-based system. An online surveillance tool developed by Sports Medicine Australia (‘Sports Injury Tracker’) was used for data collection. The injury incidence, profile and match injury rate were reported. Results Injury data for 1205 players were recorded in season one and for 823 players in season two. There was significant variability in injury incidence across clubs. However, aggregated data were consistent across football seasons, with an average of 0.7 injuries per player per season and 38–39 match injuries per 1000 h match exposure. A large proportion of injuries occurred during matches, involved the lower limb and resulted from contact. Conclusions Data from the club-based system provided a profile of injuries consistent with previous studies in community-level Australian football. Moreover, injury incidence was consistent with other studies using similar personnel to record data. However, injury incidence was lower than that reported in studies using player self-report or healthcare professionals and may be an underestimate of true values.

Physical inactivity (PI), a leading modifiable cause of disease and injury, is endemic in industrialised nations. Although considerable research has been undertaken in this field, we lack a system to synthesise the research literature to inform policy and identify research needs. The aims of this study were to (1) develop a system to classify physical inactivity intervention studies, (2) examine the distribution of PI interventions published in the peer-reviewed health literature using the system, and (3) consider implications for future research. We developed the Physical Inactivity Matrix (PIM), with 12 intervention points, created by the intersection of two dimensions: the intervention target (individual, physical environment and social/cultural environment) and the activity focus (transport, work/school, leisure and consumer). A formal search of the health research literature identified 529 eligible studies and each was classified into one of the 12 cells of the PIM. Most studies were categorised as: individual-leisure (68%), individual-work/school (12%) or social/cultural environment-leisure (13%). Only 4% targeted the physical environment. The findings of this initial application of the PIM support the call for greater investment in policies, interventions and research that focus on the relationship between the environment and PI, and transportation in particular. There would be merit in establishing the inter-rater reliability of the PIM and applying it to a wider variety of studies, including those published in the transportation and urban planning literatures. The PIM could be a useful tool for monitoring trends in research directions and funding levels over time and across countries.

Injuries in team ball sports (eg, soccer, handball, volleyball and basketball) are common, accounting for 44% of all non-fatal sports injuries in the 27 EU Nations.1 Combined with high participation rates, this gives team ball sports the potential to pose significant health burdens, and highlights the importance of preventing injuries in this context. As neuromuscular injury prevention programmes for team ball sports gain increasing attention,2–⇓⇓⇓⇓7 the need to establish the effectiveness of these interventions in real-world sports settings has been emphasised.8–⇓⇓⇓⇓13 Conceptual models and frameworks from the broader field of health promotion can potentially facilitate the translation of efficacious interventions into practice, and examples of applying implementation science to sports injury prevention have been reported.9 ,14 ,15 The RE-AIM framework16 ,17 was developed to enhance the translation of research into practice, and has been applied in such diverse fields as falls prevention,18 weight loss19 and mental health.20 Recently, an extension of the framework specific to the community sport context, the RE-AIM Sports Setting Matrix, has also been developed (table 1).14 The RE-AIM framework can be applied across all research phases, from planning and implementation, to reporting and reviewing.17 However, there have been very few assessments of how RE-AIM has actually been used in any context. Recently, the RE-AIM Model Dimension Items Checklist (MDIC) was developed to assist the reviewing of project grant applications.21 This checklist comprises 31 items covering the five RE-AIM dimensions of Reach (4 items), Effectiveness (5 items), Adoption (8 items), Implementation (5 items) and …

Objectives: To compare the safety policies and practices reported to be adopted during training and competition by community sports clubs in northern Sydney, Australia. Methods: This cross sectional study involved face to face interviews, using an 81 item extensively validated questionnaire, with representatives of 163 community netball, rugby league, rugby union, and soccer clubs (response rate 85%). The study was undertaken during the winter sports season of 2000. Two separate 14 item scales were developed to analyse the level of safety policy adoption and safety practice implementation during training and competition. The statistical analysis comprised descriptive and inferential analysis stratified by sport. Results: The reliability of the scales was good: Cronbach's α = 0.70 (competition scale) to 0.81 (training scale). Significant differences were found between the safety scores for training and competition for all clubs (mean difference 11.2; 95% confidence interval (CI) 10.0 to 12.5) and for each of the four sports: netball (mean difference 14.9; 95% CI 12.6 to 17.2); rugby league (mean difference 10.3; 95% CI 7.1 to 13.6); rugby union (mean difference 9.4; 95% CI 7.1 to 11.7); and soccer (mean difference 8.4; 95% CI 6.5 to 10.3). Conclusions: The differences in the mean competition and training safety scores were significant for all sports. This indicates that safety policies were less often adopted and practices less often implemented during training than during competition. As injuries do occur at training, and sports participants often spend considerably more time training than competing, sporting bodies should consider whether the safety policies and practices adopted and implemented at training are adequate.

Issue addressed: This paper describes and compares the first aid policies and practices of community sports clubs in northern Sydney, Australia. Methods: A piloted and validated questionnaire was used to assess the first aid policies and practices of 163 community netball, rugby league, rugby union, and soccer clubs. Response rate was 85%. Scales were developed to compare the adoption of first aid policies (range 0-14) and practices (range 0-32) across sports. Descriptive and inferential statistics were calculated to compare scores across sports. Results: The mean policy scores (95% Cl) were: netball 6.4 (5.9-7.0); rugby league 7.0 (6.0-8.0); rugby union 6.2 (5.5-6.9); soccer 3.9 (3.34.5). The mean practice scores were: netball 24.4 (23.2-25.6); rugby league 26.2 (24.3-28.1); rugby union 23.0 (21.1-24.9); soccer 17.6 (16.3-18.9). Soccer clubs achieved significantly lower mean policy (p 50% of all clubs reported not having a policy were: the attendance of qualified first aid providers at training (88%), infectious disease control (77%), pre-participation screening (72%), and head injury management (51%). Conclusions: There is room for improvement in the first aid policies and practices of community sports clubs, particularly soccer clubs, in northern Sydney. The lack of policies on the management of head injuries, preparticipation screening and infectious disease control and the poor attendance of qualified first aid providers at training should be addressed. (author abstract)

Despite increased national effort directed at sports injury prevention in Australia since the mid 1990s, there is a lack of information available about the sports safety policies and practices of community sports clubs. The aim of this study was to develop a valid and reliable sports safety audit tool (SSAT) to identify these safety policies and practices. A literature review identified issues to be covered by the SSAT. Consultation with "experts" and piloting the SSAT with 19 community sports clubs in metropolitan Sydney established face and content validity. Test-retest reliability was assessed in six clubs. Inter-rater reliability was assessed using twenty-four independent representatives from eight clubs. Face and content validity studies identified issues to include in the SSAT and improvements to language and layout. Test-retest reliability was 91% (range 68-100%). Inter-rater reliability ranged from 40-65% when missing data and 'don't know' answers were included, and from 62-75% when only 'definitive' answers were included. Club presidents and secretaries provided more definitive information than other informants. A preliminary list of safety issues that clubs addressed well or poorly was identified. The SSAT is a useful tool for gathering baseline data, benchmarking and targeting sports safety interventions with community sports clubs. Club presidents and secretaries are the preferred contact point and a face-to-face interview is the best administration mode. A tool to identify safety policies and practices is now available for use by anyone supporting community sports clubs to improve safety.

If an infectious agent is to maintain itself within a closed population by means of an unbroken serial chain of infections, it must maintain the level of infectiousness of individuals through time, or termination of the transmission chain is inevitable. One possible cause of diminution in infectiousness along serial chains of transmission may be that individuals are unable to amplify and transmit comparable levels of the infectious agent. Here, the results are reported of a novel experiment designed specifically to assess the effects of serial passage of foot-and-mouth disease virus (FMDV) in experimental groups of sheep. A virus isolate taken from an epidemic of foot-and-mouth disease (FMD) characterized by rapid fade-out of infection was passed serially through four groups of sheep housed in an isolation unit. Although it was not possible to measure individual infectiousness directly, blood virus load from infected individuals was quantified using a real-time PCR assay and used as an underlying indicator of the level of infection. The results of this assay concurred well with those of the traditional tissue-culture assay and were shown to be highly repeatable. The level of peak viraemia was shown to fall significantly with the time of infection and with passage group, both in terms of the group mean and regression analysis of individual values, suggesting that this isolate of FMDV may, under certain conditions, be unable to maintain itself indefinitely in susceptible sheep populations. The results of these experiments are discussed in terms of the epidemiology of FMD in sheep.

Background Female participation in Australian football (AF) has increased substantially over the last 5 years. Measures for reducing injury, whether through coaching, training or rules, are currently based on anecdotal injury experiences and research from male participants. To ensure the safety of female participants, consideration of their specific injury profile is required. Objective To provide the first understanding of injury in women9s AF. Design Two approaches were used. [1] compilation of four data sources: hospital-admissions, emergency department presentations, insurance claims, club-based collection; [2] online self-report survey of the worst injury sustained in the previous season. Setting Australia-wide Patients (or Participants) Female AF participants. Interventions (or Assessment of Risk Factors) Not applicable. Main Outcome Measurements Injury frequencies, injury types. Results The survey provided information on 431 self-considered ‘worst’ injuries. Over half (55%) were lower limb injuries of which joint ligament tears/sprains (29%), muscle strains (18%) and fractures (13%) dominated. The knee (18%), hand/fingers (16%), and ankle (14%) were most common body parts injured. Concussion comprised 6% of all injuries. Upper limb injuries were featured in the hospital admissions (n=500 injuries in total) and emergency presentations (n=1879), 47% and 51% of all injuries, respectively. These were largely wrist/hand injuries (32% and 40%). Most (65%) insurance claim injuries (n=522) involved the lower limb, 27% for knee ligament damage. A high proportion of concussions (33%) were reported in the club collected data (n=49). Conclusions Three injuries of particular significance were identified (knee joint ligament injuries, concussion, and wrist/hand/finger fractures, dislocations and sprains), which differ from key injuries identified in men9s football where lower limb muscle strains are most prevalent, particularly hamstring/groin strains. A comprehensive prospective injury study in women9s Australian football is now needed to support a robust collection of injury data, with a focus on identifying the cause and injury rates.

Background Evidence-based injury preventive exercise programs (IPEPs) usually have limited public health impact because they are not widely implemented into regular training routines. Objective To identify facilitators that could help make IPEPs part of regular training routines in youth team handball. Design Ecological participatory approach incorporating the perspective of multiple stakeholders. This is the first phase in a series of studies within the “Implementing injury Prevention exercise ROutines in TEams and Clubs in youth Team handball (I-PROTECT)” project. Setting Two community team handball clubs in Sweden offering organized training for youth players. Participants Stakeholders from multiple levels of youth handball. Methods Concept Mapping (CM), a mixed-method approach for qualitative data collection and quantitative data analysis, was used. CM involves steps from generating statements from stakeholders to conceptualizing a framework for developing an implementation plan. Results 179 stakeholders (32% players, 14% coaches, 42% caregivers, and 12% club, district and national handball administrators) participated in a brainstorming in response to the question “In order to make injury prevention training a part of our regular handball training routines I need….”. This generated 89 unique ‘facilitator’ statements which are currently being sorted into clusters and rated for ‘importance’ and ‘feasibility’ by 35 stakeholders. To date, data collection is completed for 11 of 35 stakeholders, yielding 5 clusters (stress value 0.255): “Understanding and motivation”, “Education, knowledge and consistency”, “Exercises and set-up”, “Routines and quality assurance”, and “Club policy and expert collaboration”. Statements rated as both highly important and feasible indicate that developing an IPEP and an associated implementation plan in partnership with all stakeholders should be a high priority. Conclusions The preliminary results suggest that developing an evidence-based context-specific IPEP and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to ensure successful IPEP implementation in youth team handball.