A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: face validity and feasibility of implementation

Background Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient’s motivation and maintenance of self-management behaviours can be positively influenced by the clinician’s use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice. Methods A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe. Results Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial. Conclusion The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level

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The aim of this research was to assess the validity and reliability of a newly developed scoring tool, designed for monitoring youth soccer players during match-play performance to support coaches/scouts with the talent identification process. The method used to design the Hull Soccer Behavioural Scoring Tool comprised of a five-stage process of (i) conducting an initial literature review to establish content validity (ii) gaining content validity through a cross sectional online survey (iii) establishing face validity via expert coach feedback (iv) conducting inter-rater reliability tests and (v) intra-rater reliability tests. In stage two, twenty-two soccer academy practitioners completed an online survey, which revealed that player behaviours such as resilience, competitiveness, and decision making were all valued as the most important behavioural characteristics by practitioners (90.9%), whilst X-factor was valued as least important by a significant amount (27.2%). Stages three to five of the testing procedure included a sample of four academy coaches not involved in the preceding stage. Twenty male collegiate soccer players (under-16 to under-18) involved in the study took part in four versus four small-sided games (SSG) in a ‘round-robin’ tournament across three weeks which accumulated 14 SSG’s, 100–140 minutes of playing time and 70–98 individual player grades. Two of the four academy coaches watched the SSG’s and used the Hull Soccer Behavioural Scoring Tool to assess live evidence of desirable player behaviours, which was subsequently followed by retrospective video analysis for intra-rater reliability testing. The remaining two academy coaches watched the same SSG retrospective video footage to test for inter-rater reliability. Reliability results revealed an acceptable level of agreement with scores between 81.25%—89.9% for inter-rater whilst intra-rater provided scores between 80.35%—99.4%. Preliminary evidence here suggests that the Hull Soccer Behavioural Scoring Tool is both a valid and reliable method to assess desirable player behaviours during talent identification processes. Thus, youth soccer practitioners and researchers should seek to test and further validate the tool in order to confirm its utility as a means of measuring behavioural characteristics of youth soccer players.</div

Mean percentage agreement (± S. D) for inter-rater (between two operators) reliability.

Mean percentage agreement (± S. D) for inter-rater (between two operators) reliability.</p

Agreement level mean values (± S. D) for intra-rater (between individual operators) reliability.

Agreement level mean values (± S. D) for intra-rater (between individual operators) reliability.</p

The Hull Soccer Behavioural Scoring Tool.

The aim of this research was to assess the validity and reliability of a newly developed scoring tool, designed for monitoring youth soccer players during match-play performance to support coaches/scouts with the talent identification process. The method used to design the Hull Soccer Behavioural Scoring Tool comprised of a five-stage process of (i) conducting an initial literature review to establish content validity (ii) gaining content validity through a cross sectional online survey (iii) establishing face validity via expert coach feedback (iv) conducting inter-rater reliability tests and (v) intra-rater reliability tests. In stage two, twenty-two soccer academy practitioners completed an online survey, which revealed that player behaviours such as resilience, competitiveness, and decision making were all valued as the most important behavioural characteristics by practitioners (90.9%), whilst X-factor was valued as least important by a significant amount (27.2%). Stages three to five of the testing procedure included a sample of four academy coaches not involved in the preceding stage. Twenty male collegiate soccer players (under-16 to under-18) involved in the study took part in four versus four small-sided games (SSG) in a ‘round-robin’ tournament across three weeks which accumulated 14 SSG’s, 100–140 minutes of playing time and 70–98 individual player grades. Two of the four academy coaches watched the SSG’s and used the Hull Soccer Behavioural Scoring Tool to assess live evidence of desirable player behaviours, which was subsequently followed by retrospective video analysis for intra-rater reliability testing. The remaining two academy coaches watched the same SSG retrospective video footage to test for inter-rater reliability. Reliability results revealed an acceptable level of agreement with scores between 81.25%—89.9% for inter-rater whilst intra-rater provided scores between 80.35%—99.4%. Preliminary evidence here suggests that the Hull Soccer Behavioural Scoring Tool is both a valid and reliable method to assess desirable player behaviours during talent identification processes. Thus, youth soccer practitioners and researchers should seek to test and further validate the tool in order to confirm its utility as a means of measuring behavioural characteristics of youth soccer players.</div

Flow chart of behavioural attribute selection and exclusion for the Hull Soccer Behavioural Scoring Tool.

Flow chart of behavioural attribute selection and exclusion for the Hull Soccer Behavioural Scoring Tool.</p

Summary of highest individual and aggregated (i.e., sum of strongly disagreed and disagreed; sum of strongly agreed and agreed) agreed operational definitions for each attribute.

Survey question: Which definition do you feel best represents ‘…’ in a soccer context?.</p

Summary of individual and aggregated (e.g., sum of 1 and 2; 4 and 5) rated order of importance.

Key: 1 being the least important and 5 being the most important.</p

Qualitative analysis of the factors associated with whistleblowing intentions among athletes from six European countries

Although whistleblowing is thought to represent an effective mechanism for detecting and uncovering doping in sport, it has yet to become a widely adopted practice. Understanding the factors that encourage or discourage whistleblowing is of vital importance for the promotion of this practice and the development of pedagogical material to enhance the likelihood of whistleblowing. The current study employed a qualitative methodology to explore the personal and organisational factors that underpin intentions to blow the whistle or that may lead to engagement in whistleblowing behaviours in sport. Thirty-three competitive athletes across a range of sports took part in a semi-structured interview which sought to explore what they would do should they encounter a doping scenario. Content analysis revealed that whistleblowing is a dynamic process characterised by the interaction of a range of personal and organisational factors in determining the intention to report PED use. These factors included moral reasoning, a desire to keep the matter “in-house”, perceived personal costs, institutional attitudes to doping, and social support. Analysis revealed a number of “intervening events”, including a perceived lack of organisational protection (e.g.,ethical leadership) within some sporting sub-cultures, which present an important obstacle to whistleblowing. The intention to report doping was underpinned by a “fairness-loyalty trade-off” which involved athletes choosing to adhere to either fairness norms (which relate to a sense that all people and groups are treated equally) or loyalty norms (which reflect preferential treatment towards an in-group) when deciding whether they would blow the whistle. The promotion of fairness norms that emphasise a group’s collective interests might encourage athletes to view whistleblowing as a means of increasing group cohesiveness and effectiveness and thereby increase the likelihood of this practice.</p