Doping in sport: a review of medical practitioners' knowledge, attitudes and beliefs.

BACKGROUND: Central to the work of many medical practitioners is the provision of pharmaceutical support for patients. Patients can include athletes who are subject to anti-doping rules and regulations which prohibit the use of certain substances in and out of competition. This paper examines the evidence on medical practitioners' knowledge, attitudes and beliefs towards doping in sport. METHODS: A systematic search strategy was followed. Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches limited to English language articles published between 1990 and 2010. Articles were assessed for relevance by two independent assessors and the results of selected studies were abstracted and synthesised. Outcomes of interest were knowledge, attitudes and beliefs in relation to doping in sport. RESULTS: Six studies met the inclusion criteria and were examined in detail. Samples reflected a range of medical practitioners drawn from the UK, France (2), Greece, Italy and Ireland. The investigations varied with respect to outcome focus and quality of evidence presented. CONCLUSION: Whilst the extant empirical research posits a negative attitude towards illegal performance enhancement combined with a positive inclination towards doping prevention, it also exposes a limited knowledge of anti-doping rules and regulations. Insufficient education, leading to a lack of awareness and understanding, could render this professional group at risk of doping offences considering Article 2.8 of the World Anti-Doping Agency Code (WADC). Moreover, in light of the incongruence between professional medical codes and WADC Article 2.8, medical professionals may face doping dilemmas and therefore further discourse is required. At present, the current evidence-base makes it difficult to plan developmentally appropriate education to span the exposure spectrum. Addressing this situation appears warranted

A qualitative analysis of the factors that protect athletes against doping in sport

Design: Ten competitive athletes (M = 5, F = 5) representing five different sports (field hockey, boxing, football, triathlon, rugby) were recruited through convenience sampling to undertake a semi-structured interview to enable a qualitative analysis of athletes' lifelong athletic careers. Method: Verbatim transcripts were analysed using an established three-stage coding process to identify the common themes within the narratives. Results: Personal and situational protective factors were identified in the accounts. Personal factors included: (i) a strong moral stance against cheating; (ii) an identity beyond sport; (iii) self-control; and (iv) resilience to social group pressures. Situational factors included secure attachments to people at all stages of the athlete's life. This facilitated both the promotion of moral decision making and assisted in the development of anti-doping attitudes. When situational factors – such as a pro-doping climate – arose, key attachments in the athletes' lives interplayed with personal factors to reduce the risk of doping. Conclusions: These findings offer insights into factors that protect competitive athletes against using PEDs in sport and further our understanding of the complex interaction between risk and protective factors at individual, psychosocial and societal levels among competitive athletes. As a complex behaviour, doping in sport cannot be prevented by solely focussing on the individual athlete; contextual factors beyond the athlete's control also impact on this behaviour. Thus, a paradigm shift is warranted to move beyond an athlete-centred approach to anti-doping

Doping prevention: Exploring coaches’ experiences and opinions of their role.

Objectives: To explore coaches’ perceived roles in doping prevention and investigate their previous experiences of working with athletes on doping related matters. Design: A cross-sectional online survey design was adopted. Methods: UK-based coaches (n=28) from various sports and coaching domains completed a self-devised web-based questionnaire. This consisted of thirty-eight questions divided into four sections (Demographics, Awareness, Experiences and Opinions). Data was analysed via non-parametric tests where applicable. Results: Almost half of the coaches (n=12, 43%) had never been approached by their athletes to discuss doping-related topics. Yet, 86% of coaches felt that they had to encourage an anti-doping viewpoint. Coaches working in the performance development domain were approached more often than those in participation domains. Coaches reported that athletes approach them because they value their opinions, believe they are knowledgeable and will tell them what to do (i.e. make the decision for them). Coaches also reported that athletes might not approach them because they gain support from elsewhere. When approached (n=16), nutritional supplements (n=15, 94%) and prohibited substances/methods (n=14, 88%) were most commonly discussed. Conclusions: Findings indicated that coaches are a source of anti-doping information or advice for athletes. When approached, there was a diverse exchange between the coach and athletes regarding the use of licit and illicit means of performance enhancement. Although coaches within the performance development domain were most commonly approached, coaches from other domains acknowledged that they have a role in doping prevention. Further research should explore coaches’ role expectations, including how anti-doping influences their every-day practice

Doping in sport: An analysis of sanctioned UK rugby union players between 2009 and 2015

To inform anti-doping policy and practice, it is important to understand the complexities of doping. The purpose of this study was to collate and systematically examine the reasoned decisions published by UK Anti-Doping for doping sanctions in rugby union in the UK since the introduction of the 2009 World Anti-Doping Code. Case files were content analysed to extract demographic information and details relating to the anti-doping rule violation (ADRV), including individuals’ explanations for how/why the ADRV occurred. Between 2009 and 2015, 49 rugby union players and one coach from across the UK were sanctioned. Over 50% of the cases involved players under the age of 25, competing at sub-elite levels. Reasons in defence of the ADRV focused on functional use and lifestyle factors rather than performance enhancement. An a priori assessment of the ‘need’, ‘risk’ and ‘consequence’ of using a substance was not commonplace; further strengthening calls for increasing the reach of anti-doping education. The findings also deconstruct the view that ‘doped’ athletes are the same. Consequently, deepening understanding of the social and cultural conditions that encourage doping remains a priority

The antecedents and outcomes of dyadic coping in close personal relationships: a systematic review and narrative synthesis.

BACKGROUND AND OBJECTIVES: Theories of dyadic coping and empirical literature have intermittently and inconsistently highlighted antecedents and outcomes of dyadic coping. The purpose of this review was to systematically identify the antecedents and outcomes of dyadic coping in close personal relationships. DESIGN: A PRISMA-guided systematic review and narrative synthesis. METHODS: Literature searches were conducted using CINAHL, PubMed, PsycINFO, and citation pearl growing to identify studies that were relevant to the aim of the review. The search strategy and exclusion criteria led to a final sample of 46 studies that each highlighted antecedents and outcomes of dyadic coping among married couples. Each study was critically appraised and analyzed using narrative synthesis. RESULTS: The narrative synthesis highlighted five antecedents (learning, gender, relationship characteristics, relationship role, and cultural influences) and two outcomes (relationship functioning and personal health) of dyadic coping. CONCLUSION: The review exposes inconsistencies in the conceptualization of dyadic coping, highlights a range of antecedents that influence dyadic coping, and suggests that dyadic coping can have positive benefits for relationship functioning and personal health. The findings have implications for future research and practice (e.g. when working with couples to improve relationship functioning)

Whistleblowing versus the code of silence: A qualitative analysis of athletes’ perceptions of reporting doping in sport

Objectives: This paper qualitatively explores national level athletes’ perceptions of their role in keeping sport clean. Design: A qualitative design was utilised to enable an in-depth examination of athletes’ views on reporting doping behaviour. Method: Following ethical approval, semi-structured interviews were conducted with nine national level athletes from rugby league (n = 5) and athletics (n = 4; female = 2). Thematic analysis established the main themes within the data. Results: Contextual differences existed around the role that athletes perceived they would play in keeping sport clean. The track and field athletes indicated that they would adopt the role of a whistleblower whereas the rugby league players would adhere to a code of silence. Specifically, track and field athletes would report individuals who were doping in their sport although it was evident that the majority were unaware of the protocol for doing this. In comparison, the rugby league players highlighted a moral dilemma by suggesting they would refrain from reporting a team mate despite disagreeing with their actions. Conclusions: Prevention programmes should enhance efforts to change broader group and community norms around doping in sport. In doing so, community members’ receptivity to prevention messages may increase. Moreover, developing skills to intervene (i.e., speaking out against social norms that support doping behaviour) or increasing awareness of reporting lines could enhance community responsibility for clean sport. The findings highlight the need to consider the context of sport and emphasise that a one size fits all approach to anti-doping is not appropriate