The effects of the iPlayClean education programme on doping attitudes and susceptibility to use banned substances among high-level adolescent athletes from the UK: A cluster-randomised controlled trial

Barriers and enablers in doping, anti-doping, and clean sport: A qualitative meta-synthesis informed by the theoretical domains framework and COM-B model

To protect the integrity of sport, and the health of athletes, global anti-doping programmes seek to prevent doping, and elicit anti-doping and clean sport behaviours, through education, deterrence, detection, enforcement, and rules. To guide programme development, this meta-synthesis of qualitative research applied a behavioural science framework to identify barriers and enablers to doping, anti-doping, and clean sport. A systematic search of electronic databases up to May 2022, followed by critical appraisal, resulted in 73 included articles. Fifty-two articles reported the athlete perspective, thirteen included athletes, athlete support personnel (ASP), and other experts, and eight focused on ASP only. Rigorous methods of thematic synthesis were drawn upon to construct analytical themes in line with the theoretical domains framework (TDF) and the capability, opportunity, and motivation model of behaviour (COM-B). A wide range of barriers and enablers were identified which influenced capability, opportunity, and motivation to participate in a clean sport environment. The weight of evidence pointed to limitations in the current anti-doping education system in providing athletes and ASP with the knowledge and skills to protect against doping, as well as the significant influence of social and cultural norms in shaping doping and clean sport behaviours through a shared social identity, and risky contexts leading to moments of vulnerability to doping. We identified a need for anti-doping programmes to move beyond the current focus on athlete capability, and address the opportunity and motivation components of clean sport behaviours through a targeted and tailored focus on education, training, persuasion, modelling and environmental restructuring interventions.

Impact of an educational flyer and sensitization on performance-enhancement attitudes of bodybuilders in United Arab Emirates

Background

A high proportion of bodybuilders use supplements to improve performance, with some turning to prohibited substances and methods. The attitudes of bodybuilders towards performance enhancement may be gauged through surveys such as the Performance Enhancement Attitude Scales (PEAS). Educational interventions are recommended as part of anti-doping measures. The objective of this project was to assess the impact of a pharmacy-led intervention using an antidoping educational flyer and the performance enhancement attitude scale to measure the attitude of bodybuilders in the United Arab Emirates (UAE).

Methods

The PEAS eight-item short form questionnaire was administered to male bodybuilders in the UAE. The PEAS was conducted before and after administration of an educational flyer concerning the problems associated with supplement use among bodybuilders. The Wilcoxon Signed-Rank and Kruskal Wallis tests were used for data analysis.

Results

A total of 218 bodybuilders, who reported taking dietary supplements, filled out the survey both pre and post viewing the antidoping educational flyer. A difference was observed between the full-time professional bodybuilders, students, and part-time bodybuilders with other primary occupations (p-value <0.05). In addition, PEAS score decreased among the study population for all eight PEAS items (p-value <0.05).

Conclusions

The pharmacy-led intervention using an antidoping educational flyer and sensitization by PEAS achieved more favorable scores, suggesting a significant shift of opinion toward avoiding use of performance enhancing substances among the bodybuilder study population. More research is required on sustaining the attitude and demonstrating the impact on doping behavior.

"I Am on Top!": An Interactive Intervention Program to Promote Self-Regulation Processes in the Prevention of the Use of Doping in Sports High Schools

The use of substances to improve sports performance is a widespread phenomenon among adolescents. Several anti-doping programs have been developed, mainly based on knowledge-based evidence. The main aim of the present study was to implement an anti-doping intervention in sports high school students, based on a psychological framework, such as Socio-Cognitive Theory, through the development of a Serious Game (SG), i.e., digital learning based on the game. The experimental design included an intervention group (n = 167; F = 37.7%; Meanage = 17.5 years; SD = 0.58) and a control group (n = 112; F = 42%; Meanage = 17.6; SD = 1). Both of the groups completed the same questionnaire on two different occasions (i.e., time 1 and time 2) for measuring doping intention, self-regulatory efficacy to resist social pressure for the use of substances, moral disengagement, and doping knowledge. Data were analyzed through repeated measures of Group X Time ANOVA, demonstrating some degree of efficacy of the intervention, in particular in terms of the decrease in doping intention and the strengthening of doping knowledge. Moreover, the study demonstrated that the score obtained during the implementation of the SG could partially represent a coherent measure of the participants' beliefs regarding doping. These results could be considered a starting point for future research to better develop technological anti-doping interventions.

A national anti-doping education programme reduces doping susceptibility in British athletes

The World Anti-Doping Agency's International Standard for Education instructs that national and international sport organisations evaluate their education programmes. We addressed this directive by examining the effectiveness of a national anti-doping programme. Athletes (N = 302, 41% female) completed measures of doping susceptibility, intention to use dietary supplements, Spirit of Sport and moral values, anti-doping knowledge and practice, and whistleblowing, prior-to and three-months after attending an anti-doping education programme. At three-month follow-up, athletes reported decreased doping susceptibility and intention to use dietary supplements coupled with increased importance of values, anti-doping knowledge, anti-doping practice and whistleblowing. Within-participant, moderated-mediation analyses revealed that programme-related changes in doping susceptibility were indirectly related to changes in intention to use dietary supplements, and, that this indirect relationship was moderated by moral values. These findings confirm the effectiveness of a national anti-doping education programme and highlight the contribution of dietary supplement use and personal values to changes in doping susceptibility.

Study of an Anti-Doping Education Program in Spanish Sports Sciences Students

Doping continues to be one of the biggest risks to the credibility of elite sports, and its practice remains widespread among athletes despite improved controls. Athletes' support personnel could be key to preventing doping behavior. In this sense, anti-doping education for this population appears as a possible strategy to reduce doping behaviors in elite sport, but these programs must be evaluated and designed based on scientific evidence. The aim of this research is to explore the impact of an anti-doping education program about substances perceived efficacy, ill-health short- and long-term effects, and the morality of doping substance use in Spanish sports sciences students.

METHOD

A total of 145 students of Physical Activity and Sport Sciences (PASS) from different Spanish universities who took an online anti-doping educational course of the Spanish Anti-Doping Commission (CELAD) answered a questionnaire on their perceptions about doping before, after, and four months later.

RESULTS

The results show that the course reduced students' ignorance about the effects of substances on performance and health and increased their moral judgment and feelings against doping.

DISCUSSION

The results are in line with previous research that showed that the moral stance against doping can be improved through educational programs.

CONCLUSION

Online educational interventions can be effective in reducing doping behavior, so their future implementation among ASP can be an effective strategy to reduce doping behavior.

Effectiveness of the world anti-doping agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes

Background

This study aimed to evaluate the effects of the World Anti-Doping Agency's e-learning programme for anti-doping education on knowledge of, explicit and implicit attitudes towards, and likelihood of doping among Chinese college athletes and non-athletes.

Method

Thirty-two young adults (including 16 college athletes) were recruited to receive the Athlete Learning Program about Health and Anti-Doping (ALPHA) intervention (Zh-hans version). Another 32 young adults were recruited for no-treatment control purposes. Before and immediately after the intervention, the ALPHA test, performance enhancement attitude scale, doping likelihood scale, and brief implicit association test (BIAT) were performed. Cortical activity during the BIAT test was monitored using a functional near-infrared spectroscopy instrument.

Results

Significant intervention effects were observed for knowledge (p < 0.01, η² = 0.21) and explicit attitude (p < 0.05, η² = 0.12) but not for doping likelihood (p > 0.05; benefit situation: η² = 0.04; cost situation: η² = 0.02). Compared with the non-athletes, the college athletes reported lower doping likelihood scores in benefit situations (e.g., financial gain, p < 0.05, η² = 0.10). Regarding the BIAT task, the experimental effect was successfully induced by different semantic associations between the concepts and the attitude (doping + like vs. doping + dislike). The mean reaction times (p < 0.01, η² = 0.36) and error rate (p < 0.01, η² = 0.34) in the doping-like block were higher than those in the doping-dislike block. Moreover, oxygenated haemoglobin (oxy-Hb) in response to BIAT interference in the temporoparietal junction-related channels was increased during the post-intervention test (p < 0.05, η² varied from 0.09 to 0.16).

Conclusions

The findings suggest that the online anti-doping education programme is partially effective among Chinese college athletes and non-athletes. Furthermore, our findings reflect enhanced cognitive control after the education intervention to suppress a prepotent implicit attitude towards doping.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-022-00459-1.

Answering the call for values-based anti-doping education—An evidence-informed intervention for elite adolescent athletes in Germany and Austria

Doping has serious negative consequences for athletes and the integrity of sports, implying the need for effective prevention programs. Since educating young athletes about doping-related knowledge is deemed to be not sufficiently effective to minimize doping, a focus on values, emotions and morality is seen as a promising approach and previous research indicates which variables exactly could be addressed in anti-doping efforts. These variables are anticipated guilt, empathy, moral disengagement, and collective moral norms, since these constructs have been strongly and consistently linked to doping intention, likelihood, or behavior. Therefore, the purpose of this study was to develop a values-based anti-doping intervention, which targets the aforementioned variables, and to evaluate its effectiveness in producing changes in outcomes in comparison to an information-based intervention and a waiting control group. To evaluate their effectiveness, both interventions, which each consist of six 45-min sessions (one session per week) were implemented in a sample of 321 young elite athletes, aged 13–19 years, from a broad range of team and individual sports. Thirty different teams, training groups or classes were randomly assigned to either the values-based intervention, the information-based intervention, or to a waiting control group. Doping intention, doping susceptibility as well as the above mentioned variables were assessed at pre- and posttest and, for participants of the values- and information-based conditions also at a 3 to 4-month follow up. Within a multilevel modeling framework general linear mixed regression analyses revealed that the values-based intervention, compared to the control group, was able to decrease athletes' moral disengagement and increase their anticipated guilt immediately after the intervention (at posttest), whereas no effects for the information-based intervention emerged. Looking at how the outcomes developed over time (i.e., at the follow up measurement), it could be demonstrated that the reduction in moral disengagement sustained. The increase in anticipated guilt, however, was not sustainable and, surprisingly, decreased from post to follow up. Furthermore, athletes in the values-based intervention reported higher empathy from post to follow up, which could possibly indicate a “delayed” effect. This study provides support that a values-based approach can produce changes in some, yet, not all addressed variables and specific elements from this intervention could potentially be a useful addition to traditional anti-doping education (i.e., information provision).

Efficient Ways to Combat Doping in a Sports Education Context!? A Systematic Review on Doping Prevention Measures Focusing on Young Age Groups

Youth is characterized by testing and crossing natural boundaries, sometimes with the help of performance-enhancing substances. In this context, doping prevention measures play a crucial role to protect individuals both within and outside the context of elite sport. Based on the PRISMA guidelines, a systematic literature search was conducted in the databases ProQuest (ERIC), Scopus, PSYNDEX/PsychInfo, PubMed, and Web of Science Core Collection to provide an overview of the impact of doping prevention measures, with particular attention to the underlying understanding of learning. As a result of the screening process, 30 of the initial 5,591 articles met the previously defined and recorded eligibility criteria. The analysis led to heterogeneous results regarding content, implementation, target group, or outcome variables considered relevant. Two-thirds of the studies related to the competitive sports context. Nevertheless, there has been a growing interest in studying doping prevention and its effects on non-elite athlete target groups in recent years. In terms of effectiveness, many measures did not achieve long-term changes or did not collect any follow-up data. This contrasts with understanding learning as sustained change and reduces the intended long-term protection of prevention measures, especially for adolescent target groups. Even young age groups from 10 years upwards benefited from doping prevention measures, and almost all doping prevention measures enabled their participants to increase their physical and health literacy. No conclusion can be drawn as to whether doping prevention measures based on constructivist ideas are superior to cognitivist approaches or a combination of both. Nevertheless, programs that actively engage their participants appear superior to lecture-based knowledge transfer. Most of the prevention measures offered a benefit-orientation so that participants can achieve added value, besides trying to initiate health-promoting change through rejection. Because of the lack of sustained changes, a further modification in doping prevention seems necessary. The review results support the value of primary prevention. Doping prevention measures should enable tailored learning and development options in the sense of more meaningful differentiation to individual needs. The implementation in a school context or an online setting is promising and sees doping as a problem for society. The review highlights the importance of accompanying evaluation measures to identify efficient prevention components that promote health and protect young people.

Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review

The misuse of dietary supplements and doping substances is commonly associated with toxicity, nutritional imbalances, and health and psychological consequences. This is alarming especially in light of the increasing prevalence of the use of dietary supplements and doping, particularly among young adults including athletes. There is evidence that education interventions can lead to improved knowledge, intentions, and practices. However, no review has summarized and evaluated the effectiveness of such interventions. The aim of this article is to review the characteristics, contents and effects of education interventions that were designed and implemented to improve knowledge, attitudes, beliefs and intentions with respect to the use of dietary supplements and doping agents in different populations. PubMed, Scopus, CINAHL, PsycInfo and Google Scholar were searched for English-language education interventions targeting dietary supplements and doping substances. A total of 20 articles were identified and have generally provided consistent findings. Most interventions reported a significant improvement in knowledge on dietary supplements and doping agents. Unfortunately, the heavy reliance on self-reported assessment tools limits the validity of these interventions, with almost all articles targeting athletes and adolescents.

Snitches Get Stitches and End Up in Ditches: A Systematic Review of the Factors Associated With Whistleblowing Intentions

Blowing the whistle on corruption or wrongdoing can facilitate the detection, investigation, and then prosecution of a violation that may have otherwise gone undetected. The purpose of this systematic review was to identify the factors that are associated with intentions to blow the whistle on wrongdoing. We searched Academic Search Premier, CINAHL Complete, Education Research Complete, ERIC, Medline, PsycARTICLES, PsycINFO, Regional Business News, and SPORTDiscus in January 2020. The quality of evidence was assessed using the Cochrane risk of bias tool. Of the 9,136 records identified, 217 studies were included in this systematic review. We identified 8 dimensions, 26 higher-order themes, and 119 lower-order themes. The whistleblowing dimensions were personal factors, organizational factors, cost and benefits, outcome expectancies, the offense, reporting, the wrongdoer, and social factors. Based on the findings, it is apparent that organizations should empower, educate, protect, support, and reward those who blow the whistle, in order to increase the likelihood on individuals blowing the whistle on corruption and wrongdoing. A combined approach may increase whistleblowing intentions, although research is required to test this assertion. From a policy perspective, more consistent protection is required across different countries.

A Moral Intervention Reduces Doping Likelihood in British and Greek Athletes: Evidence From a Cluster Randomized Control Trial

OBJECTIVES

The authors aimed to develop a moral intervention and to determine whether it was more effective in preventing doping than an educational (i.e., knowledge-based) intervention; their primary outcome was doping likelihood, and the secondary outcomes were moral identity, moral disengagement, moral atmosphere, and anticipated guilt.

METHODS

Eligible athletes (N = 303) in the United Kingdom and Greece took part in the study. The authors randomly assigned 33 clubs to either the moral or the educational intervention. They measured outcomes pre- and postintervention and at 3- and 6-month follow-up.

RESULTS

Athletes in both interventions in both countries reported lower doping likelihood and moral disengagement and higher guilt from pre- to postintervention. These effects were maintained at the 3- and 6-month follow-ups. There were no effects on moral identity or moral atmosphere.

CONCLUSIONS

In addition to disseminating information about doping, doping prevention programs should include content that focuses on moral variables.

Performance and image enhancing drug interventions aimed at increasing knowledge among healthcare professionals (HCP): reflections on the implementation of the Dopinglinkki e-module in Europe and Australia in the HCP workforce

BACKGROUND

Healthcare professionals (HCPs) provide an important point of contact through which people who use performance and image enhancing drugs (PIEDs) could access reliable information, advice, and interventions on a range of PIEDs, their use and related harms. However, HCPs often report difficulties engaging and building rapport with people who use PIEDs, and research suggests that they often lack specialist knowledge on these substances. Providing credible evidence-based resources to support HCPs is thus important. However, educational materials in this area are generally absent and the ones that exist have not been assessed for their utility in the HCP workforce. This paper examines the acceptability and usability of a PIED e-learning module (the Dopinglinkki e-module) targeted at HCPs in three EU Member States and Australia.

METHODS

A standardised two stage, mixed methodology was implemented. Stage 1 involved HCPs completing the e-module and completing an online survey (N = 77). Stage 2 involved conducting individual structured interviews with a subset of survey respondents (N = 37). Normalisation Process Theory and the Theoretical Framework of Acceptability were used as conceptual lenses.

FINDINGS

The e-module provided information that was perceived as useful for HCPs' current and future practice. However, several individual, organisational and societal level barriers were reported as preventing the e-module becoming an accepted and normalised aspect of the HCP workforce, including the need for up to date evidence, the time-consuming nature of completing the e-module, lack of organisational support, the use of over-complex language, and the module's potential to reinforce the stigmatisation of PIEDs.

CONCLUSION

Providing credible evidence-based resources to support HCPs' knowledge development is important. Evidence-based and theory informed interventions are needed to equip HCPs with knowledge that can aid culturally sensitive interactions and effective engagement with people who use PIEDs. Reflecting on our study findings, it is important that the development of interventions should include the voices of both HCP and those using PIEDs, and that careful consideration is given to the various factors that may act as a barrier to effective implementation.

Feasibility randomised controlled trial examining the effects of the Anti-Doping Values in Coach Education (ADVICE) mobile application on doping knowledge and attitudes towards doping among grassroots coaches

Objectives

Sports coaches are influential in whether athletes dope, but receive very little antidoping education, particularly within entry-level coaching qualifications. We tested the feasibility of an antidoping intervention, delivered via a mobile application, which was designed to increase coaches’ knowledge of doping and to reduce favourable doping attitudes.

Methods

A two-arm randomised controlled trial, with grassroots coaches who coach young amateur athletes aged between 14 and 18 years of age, was conducted. The Anti-Doping Values in Coach Education (ADVICE) mobile application included modules on fair play, substances, nutritional supplements, rules and leadership. The primary outcome was the change in doping knowledge, 6 weeks after receiving the mobile application. The secondary outcome was changes in doping attitudes.

Results

Grassroots coaches (n=200; aged between 18 and 71 years, with between 1 and 42 years of coaching experience) from 29 different countries completed baseline assessments, and 85 completed follow-up assessments, and were included in mixed analysis of variance analyses. The intervention increased coaches’ knowledge about doping and also reduced favourable doping attitudes in the experimental arm.

Conclusion

The ADVICE mobile application is a feasible method for delivering and increasing grassroots coaches’ knowledge of banned substances and the potential side effects of doping. Mobile application-based resources could facilitate a much wider dissemination of antidoping education.

The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes

Although there are few high-profile cases of adolescent athletes being caught doping, up to a third of young athletes may dope. In order to generate a more accurate understanding of why adolescent athletes dope, it is important to validate models that help to explain this behavior. The aims of this study were 3-fold: firstly, to test the Sport Drug Control Model for Adolescent Athletes (SDCM-AA); secondly, to generate athlete profiles that would help quantify the proportion of athletes who are at risk of doping; and thirdly, to create norm values for the Adolescent Sport Doping Inventory (ASDI), which would allow national doping organizations, sporting organizations, and clubs to benchmark the scores of their athletes for key psycho-social variables linked to doping. A total of 2208 adolescent athletes from the United Kingdom, Australia, Hong Kong, and the United States completed the ASDI. The data presented an appropriate fit to the SDCM-AA model, in which 54% of the variance in susceptibility to doping was explained in the model, and 44.8% of attitudes toward doping was accounted for. Four distinct clusters of athletes emerged: the Susceptibles (i.e., identified with the benefits of doping, were willing to cheat, and viewed little threat), the Chancers (i.e., identified with the benefits of doping, scored high on willingness to cheat, and were highly influenced by their reference group, but had an average score for threat, self-esteem, and legitimacy), the Pragmatists (i.e., did not engage with any aspects of doping, but were more susceptible than the fair players), and Fair Players (i.e., high levels of sportspersonship, unwilling to cheat, and viewed doping as a threat). The revised SDCM-AA appears a valid model that helps explain the factors associated with doping attitudes and doping susceptibility. Adolescent athletes can be classified into one of four clusters, in relation to doping. Their cluster group could influence the content of the anti-doping education they receive.