Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study

BACKGROUND

Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging.

OBJECTIVE

The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills.

METHODS

We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences.

RESULTS

Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual's health condition, and improvement in the user-experience design to accommodate older users' specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions.

CONCLUSIONS

The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults' digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults.

What Enables Child Sexual Abuse in Sport? A Systematic Review

Sporting environments provide opportunities for perpetrators to commit child sexual abuse (CSA). While awareness of CSA in sport and preventative interventions are increasing, CSA in sport still occurs at alarming rates. A systematic review was conducted to identify and synthesize the extant literature on the enabling factors for CSA in sport. The 34 included articles were peer-reviewed and were primary sources; had full-text versions in English; included the individual, situational, environmental, or systemic antecedent factors and characteristics which enable CSA in organized sport (clubs, schools, universities, and representative teams); and focused on abuse in children (0-18 years old), and included retrospective incidents. The enabling factors from across the broader sports system were identified and mapped using a systems thinking-based approach, the Risk Management Framework (RMF) and the associated AcciMap method. The results indicated that enabling factors for CSA in sport were identified at multiple levels of the sporting system hierarchy. The results show that 24.1% (n = 46) of the enabling factors identified in the literature relate to the hierarchical level of the Athlete, teammates, opponents, and fans levels, and 52.9% (n = 101) of the enabling factors relate to the level of Direct supervisors, management, medical, and performance personnel level. However, only 13% (n = 25) of enabling factors to CSA in sport were identified at the combined top four hierarchical levels. Results indicate that the problem of CSA in sport is a systems issue, and future research is required to explore how these factors interact to enable CSA in sport.

Sexual Harassment/Abuse Policies in U.S. Youth Sport Programs

Sport governing bodies, such as the International Olympic Committee, have recommended youth sport organizations develop policies, procedures, and/or ethical guidelines to prevent and respond to sexual harassment and abuse (SHA) experienced by young athletes. To our knowledge, no studies have investigated SHA policies or procedures in U.S. youth sport programs. The purpose of this exploratory study was to examine U.S. youth sport programs' policies regarding SHA. The results are based on a cross-sectional survey completed by youth sport coaches (n = 200) from various organizations (e.g., public recreation organizations, private nonprofit organizations, and interscholastic sports). Findings suggest that most organizations have several SHA policies, such as education and training requirements, written policies and codes of conduct regarding coach-athlete sexual relationships, and formal complaint and disclosure procedures for investigating SHA. A bivariate analysis suggests that the presence of several SHA policies was associated with an increased number of self-reported SHA incidents. Moreover, youth sport programs located in urban areas had a greater extent of SHA policies compared to those located in suburban or rural areas. These results are discussed with respect to the potential relationships between the presence of policies and increased cases of SHA. Also, we discussed advocating for equitable resources among youth sport programs regardless of geographic and/or demographic factors. Future research should identify social and cultural barriers that inhibit the successful implementation of SHA policies. While developing and implementing SHA policies is a step in the right direction, it may not be used as the only means to address this complex, systematic, and structural issue.

Standardization and Implementation of a Surgical Coaching Model for Pediatric Urology

To bridge gaps in proficiency and encourage life-long learning following training, coaching models have been utilized in multiple surgical fields; however, not within pediatric urology. In this review of our methodology, we describe the development of a coaching model at a single institution. In our initial experience, the perceived most beneficial aspect of the program was the goal setting process with logistics around debriefs being the most challenging. With our proposed coaching study, we aim to develop a model based upon prior coaching frameworks,1,2 that is feasible and universally adaptable to allow for further advancement of surgical coaching, particularly within the field of pediatric urology.

User Engagement, Acceptability, and Clinical Markers in a Digital Health Program for Nonalcoholic Fatty Liver Disease: Prospective, Single-Arm Feasibility Study

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in the world. Common comorbidities are central obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome. Cardiovascular disease is the most common cause of death among people with NAFLD, and lifestyle changes can improve health outcomes.

OBJECTIVE

This study aims to explore the acceptability of a digital health program in terms of engagement, retention, and user satisfaction in addition to exploring changes in clinical outcomes, such as weight, cardiometabolic risk factors, and health-related quality of life.

METHODS

We conducted a prospective, open-label, single-arm, 12-week study including 38 individuals with either a BMI >30, metabolic syndrome, or type 2 diabetes mellitus and NAFLD screened by FibroScan. An NAFLD-specific digital health program focused on disease education, lowering carbohydrates in the diet, food logging, increasing activity level, reducing stress, and healthy lifestyle coaching was offered to participants. The coach provided weekly feedback on food logs and other in-app activities and opportunities for participants to ask questions. The coaching was active throughout the 12-week intervention period. The primary outcome was feasibility and acceptability of the 12-week program, assessed through patient engagement, retention, and satisfaction with the program. Secondary outcomes included changes in weight, liver fat, body composition, and other cardiometabolic clinical parameters at baseline and 12 weeks.

RESULTS

In total, 38 individuals were included in the study (median age 59.5, IQR 46.3-68.8 years; n=23, 61% female). Overall, 34 (89%) participants completed the program and 29 (76%) were active during the 12-week program period. The median satisfaction score was 6.3 (IQR 5.8-6.7) of 7. Mean weight loss was 3.5 (SD 3.7) kg (P<.001) or 3.2% (SD 3.4%), with a 2.2 (SD 2.7) kg reduction in fat mass (P<.001). Relative liver fat reduction was 19.4% (SD 23.9%). Systolic blood pressure was reduced by 6.0 (SD 13.5) mmHg (P=.009). The median reduction was 0.14 (IQR 0-0.47) mmol/L for triglyceride levels (P=.003), 3.2 (IQR 0.0-5.4) µU/ml for serum insulin (s-insulin) levels (P=.003), and 0.5 (IQR -0.7 to 3.8) mmol/mol for hemoglobin A1c (HbA1c) levels (P=.03). Participants who were highly engaged (ie, who used the app at least 5 days per week) had greater weight loss and liver fat reduction.

CONCLUSIONS

The 12-week-long digital health program was feasible for individuals with NAFLD, receiving high user engagement, retention, and satisfaction. Improved liver-specific and cardiometabolic health was observed, and more engaged participants showed greater improvements. This digital health program could provide a new tool to improve health outcomes in people with NAFLD.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05426382; https://clinicaltrials.gov/study/NCT05426382.

Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study

BACKGROUND

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy.

OBJECTIVE

This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase.

METHODS

The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes.

RESULTS

Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model.

CONCLUSIONS

The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

Mobile Mindfulness Meditation for Cancer-Related Anxiety and Neuropathy: Protocol for a Randomized Controlled Trial

BACKGROUND

Anxiety- and cancer-related neuropathy are two persistent effects related to treatment for cancer. Mindfulness meditation has been used with substantial impact as a nonpharmacologic intervention to mitigate side and late effects of treatment. Mobile apps are ubiquitous for most of the general population, yet have a particular relevance for cancer survivors, given that physical and geographic limitations can be present.

OBJECTIVE

This study aims to describe an ongoing trial of the Mindfulness Coach mobile app for cancer survivors.

METHODS

In this randomized waitlist controlled trial, cancer survivors experiencing anxiety- or cancer-related neuropathy (200 for neuropathy and 200 for anxiety) and who had finished primary cancer treatment were invited to participate. Data were collected at 3 time points regardless of randomization condition: baseline, 8 weeks, and 16 weeks. Both face-to-face and web-based recruitment strategies were used. The trial was opened for 2 separate primary outcomes (anxiety- or cancer-related neuropathy). The goal was not to compare these groups but to compare treatment and waitlist groups for each condition. In addition to evaluating the impact of mobile mindfulness on reported anxiety- or cancer-related neuropathy, other pain, fatigue, trauma, sleep, and satisfaction with the Mindfulness Coach app will also be assessed.

RESULTS

Outcomes of the study are expected in early 2024.

CONCLUSIONS

Mindfulness meditation has become widely practiced, and the use of mobile technology has become ubiquitous. Finding ways to deliver mindfulness meditation to people who have been treated for cancer allows for the intervention to be accessible to a larger number of survivors. The results of this intervention could have implications for further understanding the impact of mindfulness meditation on 2 persistent side and late effects of treatment of cancer, namely anxiety- and cancer-related neuropathy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03581357; https://ClinicalTrials.gov/study/NCT03581357.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47745.

Improvements in Adolescents' Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study

BACKGROUND

Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors.

OBJECTIVE

This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents' disordered eating behaviors.

METHODS

Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care.

RESULTS

Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001).

CONCLUSIONS

Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms.

Mental Health in Elite Coaches

CONTEXT

Coaches play an important role in promoting mental health in elite sports. However, they themselves are exposed to risks affecting their mental health, and their fears and worries are often overlooked. Moreover, it remains unclear how coaches' mental health affects their athletes' mental health.

OBJECTIVE

To create a compilation of the literature on (1) elite coaches' mental health and (2) how coaches' mental health influences elite athletes' mental health. Building on this, recommendations for improving coaches' psychological well-being should be elaborated upon and discussed.

DATA SOURCES

A literature search was conducted up to November 30, 2021, using the following databases: PubMed, PsycINFO, Scopus, Web of Science, and SportDiscus.

STUDY SELECTION

Studies reporting elite coaches' mental health symptoms and disorders and the influence of elite coaches' mental health on elite athletes' mental health were included.

STUDY DESIGN

Scoping review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Data regarding elite coaches' mental health, as well as their influence on athletes' mental health and performance, were included in a descriptive analysis. The PRISMA guidelines were used to guide this review.

RESULTS

Little research has been done on elite coaches' mental health disorders, although studies confirm that they do experience, for example, symptoms of burnout, anxiety, and depression. The influence of coaches' mental health on their athletes is underinvestigated, with research focused mainly on the influence of coaches' stress.

CONCLUSION

Knowledge about coaches' mental health is still limited. Coaches' poor mental health diminishes coaching performance and might impair athletes' mental health. Coaches should receive more support, including sports psychiatric care and education on the importance of mental health. This could improve the mental health of both coaches and athletes, and positively affect athlete performance.

The role of mentoring and coaching of healthcare professionals for digital technology adoption and implementation: A scoping review

Objective

Mentoring and coaching practices have supported the career and skill development of healthcare professionals (HCPs); however, their role in digital technology adoption and implementation for HCPs is unknown. The objective of this scoping review was to summarize information on healthcare education programs that have integrated mentoring or coaching as a key component.

Methods

The search strategy and keyword searches were developed by the project team and a research librarian. A two-stage screening process consisting of a title/abstract scan and a full-text review was conducted by two independent reviewers to determine study eligibility. Articles were included if they: (1) discussed the mentoring and/or coaching of HCPs on digital technology, including artificial intelligence, (2) described a population of HCPs at any stage of their career, and (3) were published in English.

Results

A total of 9473 unique citations were screened, identifying 19 eligible articles. 11 articles described mentoring and/or coaching programs for digital technology adoption, while eigth described mentoring and/or coaching for digital technology implementation. Program participants represented a diverse range of industries (i.e., clinical, academic, education, business, and information technology). Digital technologies taught within programs included electronic health records (EHRs), ultrasound imaging, digital health informatics, and computer skills.

Conclusions

This review provided a summary of the role of mentoring and/or coaching practices within digital technology education for HCPs. Future training initiatives for HCPs should consider appropriate resources, program design, mentor-learner relationship, security concerns and setting clear expectations for program participants. Future research could explore mentor/coach characteristics that would facilitate successful skill transfer.

Development and validation of the Chinese coaches' interpersonal style scale

Purpose

Coaches' behaviors and coaching styles play a critical role in influencing athletes' psychological experiences and performance. According to the self-determination theory (SDT), coaches' interpersonal behaviors are commonly categorized as autonomy-supportive and controlling. Due to less focus on the unique behaviors of Chinese coaches, this study incorporated coaches' parental care for athletes, referred to as paternalistic benevolence, in their interpersonal styles in the context of the Chinese culture.

Methods

Exploratory factor analyses were used in studies 1 and 2 to find items associated with benevolent coaching behaviors and items to create the Chinese Coaches' Interpersonal Style Scale. Study 3 used the constructed scale, as well as the Subjective Vitality Scale and Athlete Burnout Questionnaire, with a sample of athletes to examine scale reliability. The 15-item Chinese Coaches' Interpersonal Style Scale contained three dimensions: benevolent, autonomy-supportive, and controlling coaching styles.

Results

The findings showed that: (1) benevolent coaching behaviors held significant explanatory weight in the Chinese cultural context; (2) controlling and autonomy-supportive coaching styles were culturally congruent among both Eastern and Western athletes; and (3) benevolent and autonomy-supportive coaching behaviors positively impacted athletes, whereas controlling coaching behaviors had a negative impact.

Conclusion

The measure showed strong validity and reliability, making it useful for future practice and research on the interpersonal style of Chinese coaches.

'It's more like checking in with an old friend': A qualitative study of medical students' experiences with longitudinal coaches throughout medical school

PURPOSE

Coaching in medical education facilitates learners' growth and development through feedback, goal-setting and support. This study explored how coaching relationships evolve throughout medical school and the impact of longitudinal coaching relationships on medical students' approach to feedback and goal setting in the clinical years.

METHOD

In this qualitative study using a constructivist paradigm, authors purposively sampled 15 senior medical students at University of California, San Francisco, to participate in individual semi-structured interviews (October-November 2021). The authors used an inductive approach to thematic analysis.

RESULTS

The authors identified four themes: First, the student-coach relationship deepened over the course of medical school. Second, students identified factors that sustained and strengthened the student-coach relationship over time: a strong foundation to the relationship, the non-evaluative nature of the relationship, coach supportiveness and responsiveness, and coach knowledge of the institutional landscape. Third, coaches provided individualized advice, assessed trajectory, and guided feedback interpretation. Lastly, students applied skills of soliciting and responding to feedback and creating learning goals, originally learned through coaching experience.

CONCLUSIONS

Coaching relationships, grounded in trust, evolve to meet students' changing needs as they grow into physicians. Students apply feedback and goal-setting skills learned with the coach in clinical settings with other supervisors.

Quality of Life and Wellbeing Parameters of Academic Dental and Nursing Personnel vs. Quality of Services

Quality of life (QOL) is based on one's perception of one's position in life with respect to one's goals, expectations, standards, and concerns. It is also influenced by one's culture and value system, workflow, and workplace situation; in turn, QOL influences the quality of service one is able to provide. In this study, we aim to report on dental and nursing academics' QOL and wellbeing at the end of the third year of the COVID-19 pandemic. There are several studies on the impact of the COVID-19 pandemic on health professionals (nurses and dentists), but it is important to investigate their quality of life three years later; furthermore, knowledge about academic staff is very limited. The World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF) tool, recording the physical, psychological, social, and environmental dimensions of QOL, was used. The WHOQOL-BREF was modified using a spiritual coaching/mentoring approach in a two-step design and validation procedure. The modified SHQOL-BREF (Spiritual Healthcare version) designed for this study was uploaded and filled in online during April-June 2023. The staff (N = 120, 75% female) of the Departments of Dentistry (44.2%) and Nursing (55.8%) of the National and Kapodistrian University of Athens participated anonymously. QOL in terms of physical health was reported at a higher level (M = 72.2 points) compared to social relationships (M = 69 points), psychological health (M = 65 points), and environment (M = 59 points) (scores reported on a 0-100 scale). Overall, QOL was rated at 66 points, while satisfaction with one's health was at 72 points. Job satisfaction (M1 = 3.2) and spirituality (M2 = 3.0) were reported at a medium level on a five-point scale, while personal beliefs and values were reported at a high level (M3 = 4.0). The four areas of QOL are associated with job satisfaction, personal beliefs, and spirituality. Participant age presented a significant moderate-strong effect on physical health (F (3.97) = 2.89, p < 0.05, η2p = 0.08) and on the environment (F (3.97) = 2.80, p < 0.05, η2p = 0.08), and marital status had a significant effect on social relationships (F (1.97) = 9.66, p < 0.05, η2p = 0.09). Married participants reported consistently higher levels of QOL compared to single participants, for all age groups. The department had a significant moderate effect on social relationships (F (1.97) = 5.10, p < 0.05, η2p = 0.05), and education had a significant moderate-strong effect on psychological health (F (2.97) = 3.74, p < 0.05, η2p = 0.07). PhD-level participants in both departments presented higher levels of psychological health compared to those with lower educational levels. Also, participants from the Department of Dentistry reported higher levels of social relationship QOL in all educational groups compared to the Department of Nursing. Overall, according to our findings, PhD participants generally had better psychological health. Those under 40 years of age had higher levels of physical health and environmental quality of life, while married participants and those from the Department of Dentistry had higher levels of social interactions than those from the Department of Nursing. Strategic planning on sustainability and QOL initiatives should be introduced after the COVID-19 pandemic for dental and nursing academic personnel to promote resilience and QOL scores. Enhancing the QOL of academic staff is essential for developing health promotion activities at universities and can help boost performance among staff and students.

Satisfaction, Perceived Usefulness, and Therapeutic Alliance as Correlates of Participant Engagement in a Pediatric Digital Mental Health Intervention: Cross-Sectional Questionnaire Study

BACKGROUND

Although evidence suggests that digital mental health interventions (DMHIs) are effective alternatives to traditional mental health care, participant engagement continues to be an issue, especially for pediatric DMHIs. Extant studies of DMHIs among adults suggest that participants' satisfaction, perceived usefulness, and therapeutic alliance are closely tied to engagement. However, these associations have not been investigated among children and adolescents involved in DMHIs.

OBJECTIVE

To address these gaps in extant DMHI research, the purpose of this study was to (1) develop and implement a measure to assess satisfaction, perceived usefulness, and therapeutic alliance among children and adolescents participating in a DMHI and (2) investigate satisfaction, perceived usefulness, and therapeutic alliance as correlates of children's and adolescents' engagement in the DMHI.

METHODS

Members (children and adolescents) of a pediatric DMHI who had completed at least one session with a care provider (eg, coach or therapist) were eligible for inclusion in the study. Adolescent members and caregivers of children completed a survey assessing satisfaction with service, perceived usefulness of care, and therapeutic alliance with care team members.

RESULTS

This study provides evidence for the reliability and validity of an adolescent- and caregiver-reported user experience assessment in a pediatric DMHI. Moreover, our findings suggest that adolescents' and caregivers' satisfaction and perceived usefulness are salient correlates of youths' engagement with a DMHI.

CONCLUSIONS

This study provides valuable preliminary evidence that caregivers' satisfaction and perceived usefulness are salient correlates of youths' engagement with a DMHI. Although further research is required, these findings offer preliminary evidence that caregivers play a critical role in effectively increasing engagement among children and adolescents involved in DMHIs.

Beyond the border of the athlete-centered approach: a model to understand runners' performance

Our purpose is to move beyond the borders of the athlete-centered approach by examining the runners' environment interplay as a key factor for performance. Based on the ecological systems theory, the micro-level (intrapersonal, interpersonal, and training characteristics), meso-level (a direct association with athletes is not observed, but the environment plays an influence on the relationships built at the micro-level), and macro-level (contextual features that influence athletic systems) were theorized and contextualized as important factors for the expression of different outcomes, including performance and participation. We also conceptualized the microtime, mesotime, and macrotime as a constraint. Through this model, we aimed to provide applications and conclusions about how this conceptual model provides advances in the scientific research field. By understanding how environmental factors influence their performance, runners can make informed decisions about where and how to train and compete. Furthermore, by recognizing the role of culture and social context in shaping runners' experiences and outcomes, we can work toward creating a more equitable and supportive running culture for all.

Comparing Implementation Strategies for an Evidence-Based Weight Management Program Delivered in Community Mental Health Programs: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Among people with serious mental illness (SMI), obesity contributes to increased cardiovascular disease (CVD) risk. The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE) randomized controlled trial (RCT) demonstrated that a behavioral intervention tailored to the needs of individuals with SMI results in clinically significant weight loss. While the research team delivered the ACHIEVE intervention in the trial, community mental health program staff are needed to deliver sessions to make scale-up feasible. Therefore, we adapted the ACHIEVE-Dissemination (ACHIEVE-D) curriculum to ease adoption and implementation in this setting. Designing and testing of implementation strategies is now needed to understand how to support ACHIEVE-D delivery by community mental health program staff coaches.

OBJECTIVE

This study aims to conduct a pilot trial evaluating standard and enhanced implementation interventions to support the delivery of ACHIEVE-D in community mental health programs by examining effects on staff coaches' knowledge, self-efficacy, and delivery fidelity of the curriculum. We will also examine the effects on outcomes among individuals with SMI taking part in the curriculum.

METHODS

The trial will be a cluster-randomized, 2-arm parallel pilot RCT comparing standard and enhanced implementation intervention at 6 months within community mental health programs. We will randomly assign programs to either the standard or enhanced implementation interventions. The standard intervention will combine multimodal training for coaches (real-time initial training via videoconference, ongoing virtual training, and web-based avatar-assisted motivational interviewing practice) with organizational strategy meetings to garner leadership support for implementation. The enhanced intervention will include all standard strategies, and the coaches will receive performance coaching. At each program, we will enroll staff to participate as coaches and clients with SMI to participate in the curriculum. Coaches will deliver the ACHIEVE-D curriculum to the clients with SMI. Primary outcomes will be coaches' knowledge, self-efficacy, and fidelity to the ACHIEVE-D curriculum. We will also examine the acceptability, feasibility, and appropriateness of ACHIEVE-D and the implementation strategies. Secondary outcomes among individuals with SMI will be weight and self-reported lifestyle behaviors.

RESULTS

Data collection started in March 2021, with completion estimated in March 2023. We recruited 9 sites and a total of 20 staff coaches and 72 clients with SMI. The expected start of data analyses will occur in March 2023, with primary results submitted for publication in April 2023.

CONCLUSIONS

Community mental health programs may be an ideal setting for implementing an evidence-based weight management curriculum for individuals with SMI. This pilot study will contribute knowledge about implementation strategies to support the community-based delivery of such programs, which may inform future research that definitively tests the implementation and dissemination of behavioral weight management programs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03454997; https://clinicaltrials.gov/ct2/show/NCT03454997.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45802.

Effects of workplace stress, perceived stress, and burnout on collegiate coach mental health outcomes

Introduction

Given the continuously changing job demands of coaches, coach burnout continues to be an important area of study. Coaching literature highlights the role occupational stressors play in the development and management of burnout. However, research highlights the potential need for the field to differentiate feelings of burnout from those of other sub-clinical mental health indicators (e.g., anxiety, depression). This study sought to examine the relationship between workplace stress, perceived stress, coach burnout, coach well-being, and sub-clinical health issues (anxiety, stress, depression).

Methods

One hundred forty-four NCAA collegiate coaches completed online questionnaires measuring the proposed variables. Structural equation modeling was used to test the proposed hypothesis that burnout would serve as a partial mediator between workplace and perceived stress and mental health indicators (e.g., depression, anxiety, stress, and well-being).

Results

Workplace stress and perceived stress were positively associated with both burnout subscales. Additionally, perceived stress alone exhibited a positive association with depression, anxiety, and stress and a negative association with well-being. While there was a positive significant relationship between disengagement and depression in the model and a negative significant relationship between disengagement and well-being, most relationships between the two burnout subscales and mental health outcomes were negligible.

Discussion

It can be concluded that while workplace and perceived life stressors may impact feelings of burnout and mental health indicators directly, burnout does not appear to exhibit a strong effect on perceptions of mental health and well-being. In line with other research studies, it may be worth considering whether burnout should be considered another type of clinical mental health issue instead of as a direct contributor to coach mental health.

A bibliometric review of coach leadership studies

This study examined published articles concerning sports leadership within the sport psychology domain over the last 30 years using bibliometric analysis that centered on the written content of the publications as unit of analysis in order to explore the intellectual base, particularly the structural relationships among relevant research components about coach leadership. Leximancer version 5.0 (Leximancer Pty Ltd.) was used to extract data from 100 sports leadership-related articles from four sport psychology journals. Overall, the most relevant concepts generated were coaches (100%) and athletes (59%), followed by study, sport, support, and motivation, and behaviors. Also, relevant concepts produced for each journal were quite similar which included coaches, athletes, behaviors, study, support and team. Further, publications related to coach leadership have shown a steady growth rate since 1990 with 76% of all published articles were conducted via quantitative research method. Finally, United States, Canada, the United Kingdom, and Belgium were the top countries involved in the area of coach leadership. Coach leadership studies generally focus on behaviors and perceptions related to the coach and relationships between leadership and psychological outcomes. Each journal has a similar but distinct rationale when publishing papers about coach leadership. Bibliometric analysis can be applied as an alternative methodology to summarize large volumes of relevant data in order to map the current knowledge as well as identify potential future research directions.

Perceived transformational leadership from the coach and athletes' subjective well-being: A moderated mediated model

Based on human motivation theory and self-determination theory, this study investigated the impact of coaches' transformational leadership on athletes' well-being, and the influences of gender and athletes' basic psychological needs. The survey objects comprised of 432 athletes participating in the Hebei Games in China. The results showed that coaches' transformational leadership could significantly and positively predict athletes' well-being. Basic psychological needs had a mediating effect on the relationship between coaches' transformational leadership and athletes' well-being. Gender significantly moderated the effect between athletes' basic psychological needs satisfaction and subjective well-being. Compared with male athletes, female athletes had their basic psychological needs met, and the improvement in their well-being was more significant than the males. Coaches should adapt their transformational leadership to directly improve athletes' well-being and indirectly achieve their well-being by satisfying the athletes' basic psychological needs.

Co-Operative Design of a Coach Dashboard for Training Monitoring and Feedback

Athlete development depends on many factors that need to be balanced by the coach. The amount of data collected grows with the development of sensor technology. To make data-informed decisions for training prescription of their athletes, coaches could be supported by feedback through a coach dashboard. The aim of this paper is to describe the design of a coach dashboard based on scientific knowledge, user requirements, and (sensor) data to support decision making of coaches for athlete development in cyclic sports. The design process involved collaboration with coaches, embedded scientists, researchers, and IT professionals. A classic design thinking process was used to structure the research activities in five phases: empathise, define, ideate, prototype, and test phases. To understand the user requirements of coaches, a survey (n = 38), interviews (n = 8) and focus-group sessions (n = 4) were held. Design principles were adopted into mock-ups, prototypes, and the final coach dashboard. Designing a coach dashboard using the co-operative research design helped to gain deep insights into the specific user requirements of coaches in their daily training practice. Integrating these requirements, scientific knowledge, and functionalities in the final coach dashboard allows the coach to make data-informed decisions on training prescription and optimise athlete development.

Coaching: A Strategy for Breast Radiologists' Professional Development

The continually increasing demands placed on physicians have led to high levels of burnout, and breast radiologists are no exception. Professional coaching is a means to guide and support the radiologist through a process of positive thinking, stress reduction, goal setting, mental growth, work-life balance, and behavioral change. Professional coaching may be effective in preparation for leadership roles or in response to workplace issues or conflict. The radiologist, with the help of a coach, establishes goals, expands perception and mindset, and collaboratively may find ways to resolve issues by taking new and different approaches. This article discusses why radiologists should seek out a certified coach and what a coach can offer radiologists during these trying times, as well as outlining the coaching process. Coaching has proven useful in addressing professional growth, workplace issues, and physician burnout. At the conclusion of the article, the readers will be able to discern whether coaching can support a better quality of life for them.

Sports Elite Means Vaccine Elite? Concerns and Beliefs Related to COVID-19 Vaccines among Olympians and Elite Athletes

(1) Background: The purpose of this study was to investigate the concerns and beliefs of Olympians and elite athletes toward COVID-19 vaccination. (2) Methods: The study was framed by a quantitative method and was conducted using the PAPI (pen and paper interview) technique among 895 Polish elite athletes representing 34 sports. (3) Results: Three-quarters (76.3%) of the athletes were vaccinated against COVID-19; statistically participants were more likely to be women, and athletes who participated in the Olympic Games. Four in ten (39.2%) were in favor of vaccination. Athletes were mainly concerned that COVID-19 would exclude them from training/competition (19.3%) and could have a long-term impact on their health (17.2%). Athletes who were vaccinated reported much higher confidence in the composition of the vaccine and the doctors who recommended vaccination than unvaccinated athletes. Athletes who competed at the Olympic level were more likely than others to disbelieve that vaccines were produced too quickly and were not well tested. National-level athletes showed the highest degree of distrust in the government regarding COVID-19 vaccination, with one in six respondents distrusting doctors with respect to COVID-19 vaccination. Four in ten respondents said they were in favor of vaccination. (4) Conclusions: Athletes' attitudes toward COVID-19 vaccination were significantly influenced by their environment-especially coaches and relatives. The power of social norms with respect to the decision to vaccinate against COVID-19 was very strong. Therefore, it is essential to build awareness about preventive policies among athletes and their social environment.

A Coach Development Program: A Guided Online Reflective Practice Intervention Study

Coaches can influence athlete outcomes, such as performance and personal development; yet, coaches themselves are learners in their own right, who seek to develop their coaching craft. Reflective practice is essential for coaches' development; however, coaches might engage and benefit from reflective practice in myriad ways. This study aimed to evaluate if online reflective journaling (ORJ) enhances the depth of reflection of sports coaches in a 4-week coach development programme (CDP). Participants were a convenience sample of 83 sports coaches from several sports, divided into an intervention group (N = 42) and a control group (N = 41). Data collection used a mixed-methods approach, examining a CDP focused on the coaches' reflective practice. The results revealed that reflection was the only dependent variable that showed significant differences over time. Participation in ORJ showed positive effects on reflection in both groups; however, only the experimental group was statistically significant. For this sample, ORJ was found to help enhance coaches' reflection towards critical reflection. All texts included in pre-, post-, and follow-up tests were coded for trustworthiness purposes. This finding supports the potential of ORJ in nurturing reflective practice, which is considered a core competency in becoming a successful sports coach.

The Effectiveness of Combining Nonmobile Interventions With the Use of Smartphone Apps With Various Features for Weight Loss: Systematic Review and Meta-analysis

Background

The effectiveness of smartphone apps for weight loss is limited by the diversity of interventions that accompany such apps. This research extends the scope of previous systematic reviews by including 2 subgroup analyses based on nonmobile interventions that accompanied smartphone use and human-based versus passive behavioral interventions.

Objective

The primary objective of this study is to systematically review and perform a meta-analysis of studies that evaluated the effectiveness of smartphone apps on weight loss in the context of other interventions combined with app use. The secondary objective is to measure the impact of different mobile app features on weight loss and mobile app adherence.

Methods

We conducted a systematic review and meta-analysis of relevant studies after an extensive search of the PubMed, MEDLINE, and EBSCO databases from inception to January 31, 2022. Gray literature, such as abstracts and conference proceedings, was included. Working independently, 2 investigators extracted the data from the articles, resolving disagreements by consensus. All randomized controlled trials that used smartphone apps in at least 1 arm for weight loss were included. The weight loss outcome was the change in weight from baseline to the 3- and 6-month periods for each arm. Net change estimates were pooled across the studies using random-effects models to compare the intervention group with the control group. The risk of bias was assessed independently by 2 authors using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials.

Results

Overall, 34 studies were included that evaluated the use of a smartphone app in at least 1 arm. Compared with controls, the use of a smartphone app–based intervention showed a significant weight loss of –1.99 kg (95% CI –2.19 to –1.79 kg; I²=81%) at 3 months and –2.80 kg (95% CI –3.03 to –2.56 kg; I²=91%) at 6 months. In the subgroup analysis, based on the various intervention components that were added to the mobile app, the combination of the mobile app, tracker, and behavioral interventions showed a statistically significant weight loss of –2.09 kg (95% CI –2.32 to –1.86 kg; I²=91%) and –3.77 kg (95% CI –4.05 to –3.49 kg; I²=90%) at 3 and 6 months, respectively. When a behavioral intervention was present, only the combination of the mobile app with intensive behavior coaching or feedback by a human coach showed a statistically significant weight loss of –2.03 kg (95% CI –2.80 to –1.26 kg; I²=83%) and –2.63 kg (95% CI –2.97 to –2.29 kg; I²=91%) at 3 and 6 months, respectively. Neither the type nor the number of mobile app features was associated with weight loss.

Conclusions

Smartphone apps have a role in weight loss management. Nevertheless, the human-based behavioral component remained key to higher weight loss results.

Survey with Innovations to Increase Response Rate Reveals Low Compliance with Guidelines among Youth Baseball Coaches - Including a Survey of Differences between Cities

Background

Compliance rates of youth baseball team coaches with guidelines regarding pitch count limits have been reported, but response rates from previous surveys have not been high, which may introduce substantial non-response bias. In addition, differences between cities in guideline compliance rates have remained unclear.

Purpose

The aim of the present study was to obtain data on coach compliance with guidelines for pitch count limits with a high survey response rate. Secondary aims were to determine compliance with guidelines other than pitch count limits, and to determine whether differences in compliance exists between cities.

Methods

A questionnaire was developed for coaches of youth baseball teams in Gunma to assess knowledge of and compliance with the Japan Softball Baseball Association's recommendations for preventing injuries. In the preparation, distribution, and collection of the questionnaire, four strategies were applied to increase the response rate. The questionnaire surveyed basic descriptive information about the team and coach and coaches compliance with guidelines. Survey items were compared between compliant and non-compliant groups for pitch count limits, and by city.

Results

Valid responses to the questionnaire were obtained from coaches of 58 of 62 teams surveyed for a response rate of 93.5%. Despite the fact that almost all coaches were aware of the recommendations regarding pitch count limits and felt these limits were needed, only 15.5% were compliant. For guidelines other than the pitch count limits, the recommended values were exceeded for practice time on holidays. Differences between cities were evident in the compliance rate with the pitch count limit, but no differences between cities in other items were observed.

Conclusion

The results of this research revealed that compliance with pitch count limits in this sample of youth baseball coaches was much lower than previously reported. Differences between cities were identified in rates of compliance with pitch count limits. These results suggest a need to increase compliance rates with guidelines for pitch count limits and to address differences between cities.

Level of Evidence

Cross-sectional survey study, 3b.

Parental and training coaches' knowledge and attitude towards dental trauma management of children

BACKGROUND

The aim of this study was to evaluate parental and training coaches' knowledge and attitude towards traumatic dental injuries (TDIs) among children.

MATERIAL AND METHODS

A 31-item questionnaire was distributed to the parents and training coaches attending local sporting clubs in Brisbane region, Australia. The questionnaire consisted of five parts (i) demographic and professional information; (ii) TDIs in the primary dentition; (iii) fractures and subluxation of permanent teeth (iv) avulsion of permanent teeth, and (v) information and knowledge related to the management of traumatized teeth. The jamovi (Version 1.6.3) and GraphPad Prism were used for data analysis.

RESULTS

A total of 233 participants were surveyed, 211 parents and 22 coaches. Of all types of injuries, parental knowledge of managing avulsion to permanent teeth was poorest (9.5%), followed by management of injuries of primary teeth (17.5%) and management of fractures or subluxation of permanent teeth (29.4%). Parents in health care occupations had higher satisfaction on self-knowledge in managing TDIs however there was no significant difference in knowledge levels between health care personnel and other professions (P = 0.128). There was a discrepancy between the lack of knowledge and willingness to further self-educate with online platforms being the preferred medium.

CONCLUSION

The study showed a gap in parents' and training coaches' knowledge regarding the management of TDIs among children.

The Inter-Rater and Intra-Rater Reliability of the Actual Aquatic Skills Test (AAST) for Assessing Young Children's Motor Competence in the Water

As children’s actual aquatic skills are important for the prevention of drowning as well as their engagement in lifelong aquatic physical activity, researchers and practitioners should be able to assess this vital concept accurately and reliably. Therefore, this study aimed to investigate the inter-rater and intra-rater reliability of the Actual Aquatic Skills Test (AAST), consisting of 17 different test items for the assessment of young children’s motor competence in the water. Six raters received a training and evaluation session on scoring the AAST, after which five of them assessed four test videos (of various children (n = 38) performing the test items) twice, with one to two weeks in between (i.e., test and re-test). Inter-rater and intra-rater reliability were determined per test video and for the different AAST test items across videos using Gwet’s Agreement Coefficient 2 (Gwet’s AC2). The Gwet’s AC2 for inter-rater reliability at the test varied from 0.414 to 1.000, indicating a moderate to perfect agreement between raters. For intra-rater reliability, it ranged from 0.628 to 1.000, demonstrating a good to perfect agreement between test and re-test scoring. In conclusion, the AAST is a promising tool to reliably assess young children’s actual aquatic skills in an indoor swimming pool.

Effectiveness of an Education Platform (GoHuddle) for Increasing Likelihood of Coach Concussion Communication with Athletes

Research suggests coaches play a central role in establishing a context conducive to concussion reporting, particularly via direct verbal communication about concussion. Informed by qualitative interviews and stakeholder feedback, we developed a web-based concussion education platform for collegiate coaches (GoHuddle). The goal of GoHuddle is to encourage concussion safety-supportive coach communication using behavioral modeling and experiential learning. We then conducted a pre-post survey study to examine the impact of engaging with the platform on coach concussion communication, with outcomes of: (a) expected likelihood of communicating with athletes about concussive symptom reporting; (b) expected likelihood of pressuring medical staff to return athletes to play; and (c) belief in the usefulness of engaging in the communication described in a and b (i.e., response efficacy). We also assessed feasibility and acceptability of the platform in the collegiate sport context. The platform was sent to 435 coaches at five institutions, and 334 (77%) completed surveys (70% male, 37.8 years mean age). After completing GoHuddle, coaches had 2.5 greater odds of expecting to discuss concussion with their team (odds ratio [OR] 2.53, p < 0.001). Response efficacy for talking about concussion also increased significantly post-intervention (OR 3.78, p < 0.001). No significant change was seen in expectancies regarding pressure on medical staff to return athletes to play "as soon as possible." A high proportion (82%) of coaches would recommend this platform for coach concussion education. In conclusion, this study suggests GoHuddle is a feasible and acceptable approach to coach concussion education, and use of this platform holds promise for shifting coach communication about concussion.

The Effect of a Brief, Web-Based Animated Video for Improving Comprehension and Implementation Feasibility for Reducing Anterior Cruciate Ligament Injury: A Three-Arm Randomized Controlled Trial

Neuromuscular injury prevention training (IPT) has been shown to reduce anterior cruciate ligament (ACL) injury risk by approximately 50%, but the implementation rate is low. One of the most important modifiable barriers for implementation is coaches' comprehension of risk and intervention strategies. This study aimed to evaluate the effect of a brief, web-based, animated video on ACL injury prevention comprehension and IPT implementation feasibility. Coaches in landing and cutting sports were recruited and randomized into three groups. (1) Intervention: brief multimedia animated video about ACL injury and prevention. (2) Active control: commonly accessed, text-based web resource about ACL injury and prevention. (3) Placebo control: brief multimedia video about concussions. Overall ACL comprehension-composed of basic ACL knowledge, risk knowledge, prevention knowledge, and severity knowledge-as well as implementation feasibility were all measured prior to and immediately following the interventions. Overall ACL comprehension improved the most in the animated video group (Cohen's d = 0.86) and, to a lesser degree, in the active control web-based article group (Cohen's d = 0.39). Both video and web-based article groups had greater implementation feasibility compared to the control group (p = 0.01). Overall, these initial results suggest that a brief, web-based, animated video has the potential to be a superior method for informing stakeholders in order to reduce traumatic injuries in sport.

The Influence of the Coach's Autonomy Support and Controlling Behaviours on Motivation and Sport Commitment of Youth Soccer Players

The coach is one of the most influential agents in the sport commitment of youth players. Grounded in self-determination theory (SDT), numerous studies have examined the influence of the coach’s autonomy-supportive behaviours on athletes’ motivation. However, fewer studies have examined the influence of the coach’s controlling behaviours. The aim of this cross-sectional study was to analyse the influence of young soccer players’ perception of their coach’s autonomy-supportive and controlling behaviours on the satisfaction and frustration of their basic psychological needs (BPN) and sport commitment. A total of 203 soccer players (86% boys), aged 10–19 years (M = 14.88; SD = 1.54) participated. Coach autonomy support positively predicted BPN satisfaction which, in turn, positively explained sport commitment. Coach intimidation behaviours positively predicted BPN frustration, which, in turn, negatively explained sport commitment. In cross-relationships, autonomy support negatively explained BPN frustration, while intimidation behaviours and the controlling use of rewards negatively predicted BPN satisfaction. To conclude, these results suggest that it is important for the coach not only to support autonomy, but also to avoid the use of controlling behaviours, especially intimidation and controlling use of rewards, because of their influence on the motivational processes and sport commitment of youth soccer players.

An innovation involving self-surveillance and serious gaming to increase smoking quit rate: Protocol for a pilot randomized controlled trial

Smoking is a health hazard. Current smoking cessation measures such as behavioral change counselling by trained professionals, nicotine replacement therapy and medications have limited success. Smoking intensity is assessed using a portable device to measure the smokers’ exhaled breath carbon monoxide (eCO) level. A systematic review suggests the potential of serious gaming to increase smoking quit rate. However, the related studies were unable to explain and determine the effect gamification on smoking cessation.

A handy personalized eCO measurement device linked to a smart-phone applications (app) has been developed (integrated STEADES-2 system). This novel system incorporates app-based video and print learning resources, authentication function and gamification using the eCO data as game element. Trained multidisciplinary healthcare professionals access the STEADES-2 data to monitor smoking status and support smokers via asynchronous virtual coaching. The pilot randomized controlled trial will enroll 20 smokers to use the STEADES-2 system (intervention group) and another 20 to the existing smoking cessation programme (control group) in primary care. The primary feasibility outcomes will include the recruitment response rate, the smokers’ usability of the STEADES-2 system, their self eCO monitoring, frequencies of participation in the serious games and interactions with their virtual coaches. Their smoking literacy, utility and experience of the STEADES-2 system are other outcomes. Smokers in both groups will be compared on their cigarette abstinence as secondary outcome based on eCO levels and urine cotinine test (primary outcomes after 12 weeks).

The results will be disseminated via conferences and publications.

Career Development of Adapted Sports Coaches: Systematic Review of Qualitative Evidence Literature

This study aims to synthesize and understand the qualitative and empirical evidence previously published on adapted sports career development. This systematic literature review also aimed at developing a conceptual model of the training and career path of adapted sports coaches. The research was carried out through the following databases: PubMed, Erid, EBSCO, Web of Science and Scopus. We selected nine qualitative studies according to the specific eligibility criteria. Data extraction was carried out independently by different authors, including the assessment of the methodological quality of the articles. We developed a conceptual model composed of four descriptive subjects (adapted sport option; perception of training athletes in adapted sports; development of the adapted sports coach’s learning; adapted sports coach reality) about the adapted sports coach’s pathway and added three analytical subjects about the difficulties, opportunity and reality of adapted sports. The conceptual model suggests inclusion of practical activity programs, the specificities of related contents with the adapted modalities, and observation in a real context are fundamental.

Canadian High School Rugby Coaches Readiness for an Injury Prevention Strategy Implementation: Evaluating a Train-the-Coach Workshop

Background: Canadian rugby coach injury prevention beliefs and attitudes have not been studied, yet are key to informing injury prevention strategy implementation. Despite neuromuscular training (NMT) warm-up success in reducing injury, adoption of these programs is variable. Therefore, objectives of this study included (1) describing Canadian youth rugby coach injury prevention beliefs and attitudes and current warm-up practices and (2) evaluating intention to use a rugby-specific NMT warm-up.

Methods: High school rugby coaches completed a questionnaire before and after a rugby-specific NMT warm-up workshop. The pre-workshop questionnaire captured demographics, current warm-up practice, and NMT warm-up knowledge and use. Both questionnaires captured injury prevention beliefs, attitudes and behavioral intention.

Results: Forty-eight coaches participated in the workshops. Pre-workshop, 27% of coaches were aware of NMT warm-ups. Coaches primarily included aerobic and stretching components, while balance components were not common in their warm-ups over the past year. Additionally, 92% of coaches agreed to some extent they would “complete a rugby-specific warm-up program prior to every game and training session this season.” Post-workshop, 86% of coaches agreed to some extent that they would use the program in every rugby session. No differences were observed between pre- and post-workshop intention to implement the warm-up (p = 0.10).

Interpretation: This is the first study to examine current Canadian youth rugby coach warm-up practices and intention to use NMT warm-ups. Canadian rugby coach intention to use a rugby-specific NMT warm-up is high, providing ample opportunity to investigate the efficacy of a NMT warm-up in youth rugby.

The Use of Recovery Strategies in Professional Soccer: A Worldwide Survey

PURPOSE

To survey soccer practitioners' recovery strategy: (1) use, (2) perceived effectiveness, and (3) factors influencing their implementation in professional soccer.

METHODS

A cross-sectional convenience sample of professional soccer club/confederation practitioners completed a web-based survey (April to July 2020). Pearson chi-square and Fisher exact tests with Cramer V (φ - c) assessed relationships and their strength, respectively, between the perceived effectiveness and frequency of strategy use.

RESULTS

A total of 80 soccer practitioners (13 countries) completed the survey. The 3 most important recovery objectives were "alleviating muscle damage/fatigue," "minimizing injury risk," and "performance optimization." The most frequently used strategies were active recovery, structured recovery day, extra rest day, massage, cold-water therapy, and carbohydrate provision (predominantly on match day and match day + 1). Relationships were identified between perceived effectiveness and frequency of strategy use for sleep medication (P < .001, φ - c = 0.48), carbohydrate provision (P = .007, φ - c = 0.60), protein provision (P = .007, φ - c = 0.63), an extra rest day (P < .001, φ - c = 0.56), and a structured recovery day (P = .049, φ - c = 0.50).

CONCLUSIONS

The study demonstrates that professional soccer practitioners have a range of objectives geared toward enhancing player recovery. A disconnect is apparent between the perceived effectiveness of many recovery strategies and their frequency of use in an applied setting. Novel data indicate that strategies are most frequently employed around match day. Challenges to strategy adoption are mainly competing disciplinary interests and resource limitations. Researchers and practitioners should liaise to ensure that the complexities involved with operating in an applied environment are elucidated and apposite study designs are adopted, in turn, facilitating the use of practically effective and compatible recovery modalities.

Examining Controlling Styles of Significant Others and Their Implications for Motivation, Boredom and Burnout in Young Swimmers

The aim of the study was to examine the controlling style in two contexts of social influence: the team (i.e., coach and teammates) and the family (i.e., father and mother), as well as the mediational role of motivation (autonomous, controlled, and amotivation) and its relationship with boredom and burnout in young swimmers. To this end, 267 swimmers (140 girls and 127 boys) between 12 and 18 years of age (M = 14.26; SD = 1.61) were assessed. The results showed that in the team context, coaches’ controlling style directly promoted controlled motivation and boredom in their swimmers, and indirectly influenced burnout through the mediating role of swimmers’ controlled motivation. Teammates’ controlling style was directly associated with controlled motivation, amotivation, and burnout, and indirectly associated with boredom and burnout through the mediating role of amotivation. Regarding the family context, the father’s controlling style showed direct associations with controlled motivation and burnout, and indirect associations with boredom through the mediating role of swimmers’ controlled motivation. Finally, the associations of the mother’s controlling style with all the variables studied were neutralized by the father’s controlling interpersonal style. This study emphasizes the differentiating role of significant others when displaying controlling styles, and it confirms that the controlling style has a significant relationship with maladaptive sport practice experiences.

Utilising a Behaviour Change Model to Improve Implementation of the Activate Injury Prevention Exercise Programme in Schoolboy Rugby Union

The Health Action Process Approach (HAPA) is a behaviour change model showing promise in positively changing youth sport coaches’ injury prevention behaviours. This study incorporated the HAPA model into coach training workshops for Activate, an efficacious rugby injury prevention programme. Primary aims were to investigate the effect of the workshop on schoolboy rugby union coaches’ (1) perceptions towards injury risk and prevention, (2) Activate adoption and adherence. Secondary aims were to (3) assess the differences in post-season HAPA constructs between workshop attendees and non-attendees, (4) explore associations between HAPA constructs and Activate adherence. In the pre-season, all participants (n = 76) completed a baseline survey, with 41 coaches electing to attend a workshop. Participants completed a post-season survey assessing HAPA constructs and Activate adoption and adherence throughout the season. The workshop did not affect coach perceptions of injury risk and prevention. Attendees had significantly greater rates of Activate adoption (95% vs. 54% χ² = 17.42, p < 0.01) and adherence (median = 2 sessions vs. ≤1 session per week; z = 3.45, p = 0.03) than non-attendees. At post-season, attendees had significantly greater task self-efficacy (z = −3.46, p < 0.05) and intention (z = −4.33, p < 0.05) to use Activate. These results support the delivery of coach workshops that utilise a behaviour change model to maximise programme implementation.

The Time to Change for Mental Health and Wellbeing via Virtual Professional Coaching: Longitudinal Observational Study

BACKGROUND

Optimal mental health yields many benefits and reduced costs to employees and organizations; however, the workplace introduces challenges to building and maintaining mental health that affects wellbeing. While many organizations have introduced programming to aid employee mental health and wellbeing, the uptake and effectiveness of these efforts vary. One barrier to developing more effective interventions is a lack of understanding about how to improve wellbeing over time. The current study examined not only whether employer-provided coaching is an effective strategy to improve mental health and wellbeing in employees; but also how this intervention changes wellbeing in stages over time.

OBJECTIVE

The goal of this study was to determine whether BetterUp, a longitudinal one-on-one virtual coaching intervention, improves components of mental health and psychological wellbeing and whether the magnitude of changes vary in stages over time. This is the first research study to evaluate the effectiveness of professional coaching through three repeated assessments, moving beyond a pre- to post-intervention design. The outcomes of this study will enable coaches and employers to design more targeted interventions by outlining when to expect maximal growth in specific outcomes throughout the coaching engagement.

METHODS

Three identical assessments were completed by 391 users of BetterUp - prior to the start of coaching, after approximately 3-4 months of coaching, and again after 6-7 months of coaching. Three scales were used to evaluate psychological and behavioral dimensions that support management of mental health - stress management, resilience, and life satisfaction. Six additional scales assessed psychological wellbeing - emotional regulation, prospection ability, finding purpose and meaning, self-awareness, self-efficacy, and social connection.

RESULTS

Using mixed effects modeling, varying rates of change were observed in several dimensions of mental health and psychological wellbeing. Initial rapid improvements in the first half of the intervention, followed by slower growth in the second half of the intervention, were found for prospection ability, self-awareness, self-efficacy, social connection, emotional regulation, and a reduction in stress (range of unstandardized βs for each assessment: .10-.19). Life satisfaction improved continuously throughout the full intervention period (β: .13). Finding purpose in meaning at work and building resilience both grew continuously throughout the coaching intervention, but larger gains were experienced in the second half of the intervention (βs: .08-.18), requiring the full length of the intervention to realize maximal growth.

CONCLUSIONS

The results demonstrate the effectiveness of the BetterUp virtual one-on-one coaching to improve psychological wellbeing, while mitigating threats to mental health such as excessive and prolonged stress, low resilience, and poor satisfaction with life. The improvements across the collection of outcomes were time-dependent and provide important insights to users and practitioners about how and when to expect maximal improvements in a range of interrelated personal and professional outcomes.

CLINICALTRIAL

Which Are the Most Determinant Psychological Factors in Olympic Shooting Performance? A Self-Perspective from Elite Shooters

Psychological aspects like anxiety, injuries’ effects, professional psychological support (PPS), psychological training (PT), or athlete-coach relationships could influence shooters’ performance. This study tried to determine which aspects were critical from the shooters’ perspective. Eight elite shooters were interviewed. After using qualitative methods, the following categories were obtained: importance of PT; anxiety and competition relationship; mental preparation; PPS; stress during training; injuries’ psychological effects and coach’s influence. PT is important for shooter’s performance, being PPS a key aspect. Moreover, anxiety levels are critical, raising during the pre-competitive period and oscillating during competition. Furthermore, shooters considered more effective the stress placed on training by the coach than by themselves. Accordingly, the coach plays a key role. Surprisingly, injuries did not affect shooters psychologically, nor in their competitive performance. We conclude that the combination of PPS, shooter competitive experience and the optimal coach’s work can promote a greater performance in Olympic shooting.

Attitudes and opinions towards the prevention of orofacial injuries among water polo coaches in Catalonia: A cross-sectional study

BACKGROUND/AIM

Although orofacial injuries are frequent in water polo, fewer than 10% of players use mouthguards. The aim of this study was to determine the degree to which coaches and sports club managers encourage mouthguard use in water polo and to explore their opinions regarding other strategies designed to reduce the prevalence of orofacial injuries.

MATERIAL AND METHODS

This was a cross-sectional study in which the coaches and sports club managers of 16 water polo clubs in Catalonia were invited to participate. An online questionnaire was administered to the coaches to obtain general data, to determine whether they had recommended mouthguard use to their players and to record their opinions on other strategies designed to reduce the prevalence of orofacial injuries. Sports club managers were interviewed about the facilities offered by their clubs for players to obtain mouthguards and about their attitudes regarding the prevention of orofacial injuries.

RESULTS

The questionnaire was administered to 72 coaches who trained 111 teams during the 2019-2020 season, together with 14 sports club managers. Coaches of only 11 teams (10%) recommended mouthguard use to their players. Two clubs (14%) offered some facilities to their players to obtain mouthguards. Interestingly, only 18% of the coaches believed that mouthguard use should be mandatory, in contrast to 50% of the sports club managers (p = 0.017; Fisher's exact test). Most coaches and sports club managers believe that a video monitoring system should be used to identify dangerous play and that orofacial injuries should be reported under a surveillance programme.

CONCLUSIONS

Few water polo coaches recommend mouthguard use to their players and very few clubs offer facilities to obtain custom-made oral protection. However, most coaches and sports club managers agree that the rules should be modified to protect players from aggressive play.

Bullying Trends Inside Sport: When Organized Sport Does Not Attract but Intimidates

Bullying is acknowledged by scientists as a considerable and still unresolved problem in sport. By triggering stress-related emotions, they determine the behavior of those experiencing bullying and cause various negative effects on their physical and mental health. However, in the presence of the tenacious trend in sports "to put one's own house in order," athletes, coaches, teams, and sports organizations themselves often do not emphasize bullying or state that they do not encounter the problem at all, and adheres to the belief that athletes may use negative emotions instrumentally in order to perform tasks given to them more effectively. The aim of this research was to reveal the determinants of the internal environment of sports organizations, causing trends of bullying in organized sport. To achieve the research aim, a qualitative research paradigm was chosen. The empirical study involved eight coaches working in organized sport in Lithuania. The survey was conducted using the semi-structured interview method. Data were analyzed employing inductive content analysis. The presented research results encompass the transcriptions of interviews, which are conceptually divided into three main categories revealing coaches' opinion on trends of bullying in organized sport, related to the sports organization's internal environment. Categories identified during the study can be equated to interrelated levels of model of Organizational behavior. The micro level-interrelationships; the mezzo level-sports professionals' (coaches') behavior; and the macro level-management of interrelationships. These results revealed which determinants of the sports organization's internal environment can be favorable for emergence of bullying and its dynamics in both interrelationships among athletes and interrelationships between athletes and coaches. And these trends of bullying, revealed on the basis of the responses of coaches involved in the study, allow us to see harmful principles of coaching, bullying-promoting traditions of team/group leadership, existing in sport, and to predict how this may effect both the athlete himself, his environment and attractiveness of the sporting activity itself.

Pilot Study on the Reliability of the Coach's Eye: Identifying Talent Throughout a 4-Day Cadet Judo Camp

A typical assumption found in talent identification literature is that different coaches, given the same athletes and circumstances, will identify the same subset of athletes as “talented”. However, while coaches play a major role during talent identification in practical sport settings, there is limited empirical research exploring the processes which underpin this. The purpose of this study was to explore the reliability of “the coach's eye” during the assessment of talent in a group of athletes. Specifically, this project compared inter-coach agreement between nine judo coaches (ages 35.8 ± 10.6 years) with varying levels of experience (12.9 ± 8.9 years) in the evaluation of 24 talented cadet judo athletes (13–15 years) at seven timepoints throughout a 4-day development training camp. Without discussion of their scores with other coaches, coaches provided a single score representing each athlete's “potential for future performance” on an 11-point Likert scale at each timepoint. Scores from each coach were converted into rankings from 1 to 24 to create a normalized scale to facilitate comparison of athletes. Based on their rankings at each timepoint, athletes were placed into one of three evenly distributed groups (high, medium, and low rank). Inter-coach agreement at each timepoint was determined by the number of coaches who ranked each athlete in the same group, categorized at three levels: 50, 75 or 100% agreement. Overall results showed that at completion of the camp, coaches reached 100% agreement on only two athletes, both of whom were in the high rank group. When inter-coach agreement was set at 50%, 15 athletes (62.5%) were placed into like groups. The first timepoint at which coaches were able to differentiate between the majority of athletes was Timepoint 3 (end of day 2). The findings suggest that, in isolation, coaches do not agree on the talent or potential of athletes. This indicates that the “coach's eye” is subjective and variable, and, given the same context, there is poor inter-coach agreement in the identification of talented athletes. In turn, these findings may have significant implications for both future talent identification research and athlete selection processes by sport organizations.

Development and Validation of a Well-Being Measure on Young Basketball Players: The NFAPW Scale

Basketball is a sport in which, beyond the physical and technical skills, the psychological aspects are a decisive factor and could negatively affect the well-being of the player. The present study analyzes how 11 items belonging to two stakeholders (coach and player) could negatively affect the well-being of the athlete. A sample of elite young basketball players (n = 121) consisting of 55 males and 66 females, ranging in age from 16 to 23 (M = 20.12 ± 1.71), completed the Negative Factors Affecting Players’ Well-being (NFAPW) Questionnaire. This questionnaire was designed ad hoc and demonstrated good psychometric properties that confirmed that it is a valid and reliable instrument to measure how those factors negatively affect their well-being. The results showed that females have a greater perception of the factors that negatively affect their well-being, especially those related to the actions of the coach. However, no differences were found regarding the experience. Although this research provides an initial tool for measuring the well-being of the player during competition, future studies are encouraged to provide guidance to the coaches and players in dealing with the psychological variables in a better way.

Understanding the "gut instinct" of expert coaches during talent identification

Coaches are an integral part of talent identification in sport and are often used as the "gold standard" against which scientific methods of talent identification are compared. However, their decision-making during this process is not well understood. In this article, we use an ecological approach to explore talent identification in combat sports. We interviewed twenty-four expert, international-level coaches from the Olympic disciplines of boxing, judo, and taekwondo (age: 48.7 + 7.5 years; experience: 20.8 + 8.3 years). Findings indicated that when coaches identify talent they rely on "gut instinct": intuitive judgements made without conscious thought, used to direct attention to particular athletes or characteristics. Our analysis revealed four major contributors to coaches' intuition: experiential knowledge, temporal factors, seeing athletes in context, and what can be worked with. Our findings demonstrate that i) athlete selections may be influenced by the coaches' perceived ability to improve certain athletes (rather than solely on athlete ability); and ii) "instinctual" decisions are the result of years of experience, time spent with the athlete, and the context surrounding the decision. Based on these findings, we recommend that future research focuses on the duration and conditions that are required for coaches to confidently and reliably identify talented athletes.

Motivational Coaching Improves Intrinsic Motivation in Adult Fitness Program Participants

The purpose of this study was to measure intrinsic motivation following the implementation of motivational coaching strategies in a semester long personalized adult fitness program. Sixty individuals (40 female/ 20 male, age= 48 ± 15 yrs) participated as clients in an undergraduate exercise training program led by student trainers at Taylor University. The program took place during two consecutive semesters, therefore subject participation ranged from one to two semesters. In addition to personalized exercise prescription, student trainers implemented motivational strategies using a motivational coaching guide aimed at increasing individuals' overall intrinsic motivation. Trainers utilized a coaching checklist to record the motivational strategies used with their client each session. Intrinsic motivation was assessed before and after each program semester using an Intrinsic Motivation Inventory (IMI) and Motivational Client Scale (MCS). Clients' scores on the IMI increased from 3.38 ± 0.37 to 3.58 ± 0.31 (p<0.001; d= 0.587). Particularly, perceived competence increased from 3.01 ± 0.52 to 3.41 ± 0.49 (p<0.001; d= 0.793). Correspondingly, MCS scores also increased from 3.47 ± 0.72 to 3.87 ± 0.60 (p<0.001; d= 0.608). Specifically, clients' response to challenge increased from 3.48 ± 0.98 to 4.15 ± 0.65 (p<0.001; d=0.809). Our data indicate that it is possible to improve intrinsic motivation by implementing motivational strategies into a supervised adult fitness program. This finding suggests motivational coaching may be an important part of a standard training protocol for fitness trainers to help combat a public health concern: initiation and adherence to exercise.

Transformational leadership and creativity in sport: Examining the mediating role of support for innovation

Understanding how and when transformational leadership is related to followers' perceptions is an important issue. The present study aims to investigate the potential mediating role of support for innovation in the relationship between transformational leadership and creativity in team sports. We also propose that players' team tenure could moderate this relationship.

A cross-sectional design was used. Athletes (N_players = 447, N_team = 45, M_age = 22.12; SD = 5.09) completed questionnaires assessing transformational leadership, support for innovation and creativity.

Support for innovation mediated the positive relationship between inspirational motivation, intellectual stimulation and high-performance expectations as exogenous variables and creativity as a dependent variable. Moreover, the relationship between intellectual stimulation and creativity was significantly weaker when players' team tenure was high. The relationship between transformational leadership behaviours (inspirational motivation, intellectual stimulation, and high-performance expectations) and support for innovation was stronger when players' team tenure was low.

The current study provides the first evidence of a relationship between transformational leadership and creativity through support for innovation in team sports. This study is also the first to have provided evidence of the role of players' team tenure in those mediational relationships. Theoretical and practical implications are discussed.

Parents' Own Experience of Verbal Abuse Is Associated with their Acceptance of Abuse towards Children from Youth Sports Coaches

Verbal or physical abuse from coaches has negative effects on young athletes, and the parents of athletes also have an influence on the sports environment. It is therefore important to understand parents' attitudes towards abuse against their children from the coaches. This study aimed to elucidate the characteristics of parents who accept the infliction of verbal or physical abuse on their children from coaches of youth sports teams. A cross-sectional study using self-report questionnaires was conducted with parents of young athletes (n = 6,493). Multivariate logistic regression models were used to assess the factors associated with parents' acceptability of verbal or physical abuse against their children. The proportion of parents who were accepting of verbal or physical abuse was 21.5%. Acceptability of verbal or physical abuse was significantly associated with male (odds ratio: 1.67, 95% confidence interval: 1.43-1.95), younger age (1.24, 1.09-1.41), lower educational attainment (1.32, 1.17-1.50), smoking habits (1.42, 1.23-1.63), experience of playing on a team with high levels of competition during their junior or high school days (1.31, 1.15-1.50), and experience of verbal and physical abuse by their own former coaches (3.59, 3.03-4.26 and 1.17, 1.02-1.35). About 58% and 28% of parents had experienced verbal and physical abuse from their own former coaches, and parents who had experienced verbal abuse themselves were most likely to be accepting of verbal or physical abuse towards their children. Educating parents is considered to be important for preventing and eradicating abuse against young athletes.

Do You Transfer Your Skills? From Sports to Health Management in Cancer Patients

Skill transfer is a process where personal cognitive and behavioral abilities are applied to contexts that are different from the one in which they were originally learned. Literature demonstrates that skill transferability is possible: for example, people can apply skills learned in sports to other life-domains (such as school, work, or health management) with the aim to improve individual characteristics and reach personal goals. To do this, several factors, such as positive communication, adequate context, a person-centered perspective, and specific strategies, are necessary. On the basis of this, the aim of this contribution is explore the relationship between sports and health management skills to enhance the coach/athlete as well as the patient/physician relationships. Useful strategies for skill transfer from sports to cancer management are shown.

Effects of Motivational Climate on Fear of Failure and Anxiety in Teen Handball Players

The aim of this study was to examine the effects of the motivational climate created by the coach and perceived by a group of young, high-performance handball players on their fear of failure and precompetitive anxiety. The study participants were 479 young handball players. The age range was 16–17 years old. Players were administered a battery composed of a Perceived Motivational Climate in Sport Questionnaire, a Performance Failure Appraisal Inventory, and Competitive State Anxiety Inventory-2R, to measure the aforementioned theoretical constructs. Using structural equation modelling (SEM), the results showed that the handball players experienced high levels task-involving climate and moderate values of self-confidence. In contrast, players experienced lower levels of ego-involving climate, fear of failure, and cognitive and somatic anxiety. The obtained model shows that fear of failure positively mediates the association between an ego-involving climate with both cognitive and somatic anxiety, and negatively in terms of self-confidence. In contrast, fear of failure does not mediate the associations between a task-involving climate and both somatic and cognitive anxiety and self-confidence.