, et al. Injury prevention for women and girls playing Australian Football: programme cocreation, dissemination and early adopter coach feedback.
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What is the story behind your study?
Australian Football was traditionally exclusively played by men until the introduction of a women’s elite competition (AFLW) in 2017. The competition was originally planned for 2020 but the rise in women’s sport and success of amateur games instigated an earlier start date. We suspected that women of all ages participating in this unique sport at all levels for the first time would pose challenges. One such challenge was the potential high risk of ACL injury and concussion or the perceived risk of injury, and the notion that “women’s bodies are not made to play football”.
Tell us more about yourself and the author team
Our interest in developing an injury prevention program for women playing Australian Football was sparked by a few different team members. I was a player in the first three AFLW seasons and was completing a PhD on post-traumatic osteoarthritis after ACL reconstruction at the time. I had also sustained a previous ACL injury and had only been playing Australian Football for 2 years (previously basketball), which probably fell into the “high injury risk” category. Melissa Haberfield (co-author) was also a team physiotherapist for an AFLW team. Our research centre, led by Prof Kay Crossley, was also building a research program (HER-sport) with a focus on the promotion of women’s health in sport. We approached the AFL to start a partnership, with the ultimate aim of designing and evaluating an injury prevention program—and the rest is history!
What was the main challenge you faced in your study?
Our research mainly focussed on evaluating the long-term health burden after knee and hip injury and secondary prevention strategies. Primary prevention was a new area for us!
Our goal was always to develop a program for community level coaches and players —where the majority of participants are with minimal medical support. However, the main pain point for the AFL at the time was the high rates of ACL injury in the elite (AFLW) players. So we began by co-creating Prep to Play PRO – led by co-author Andrea Bruder. She led a concept mapping study, interviews, focus groups, stakeholder meetings and an evaluation. We were fortunate that there was already a lot of great research in other sports to help us develop an “evidence-informed” program. This gave us a great foundation to then adapt the program to the community level.
One challenge was the lack of understanding of the injury profile. Injury prevention frameworks typically recommend starting with injury surveillance, and evaluation via clinical trial prior to disseminating it nationwide. However, there was an urgent need and appetite from the football community to act. The AFL did a fantastic job of promoting the program in 2019. It was challenging for us as researchers to be part of actively promoting a program that had not been evaluated in a clinical trial. But I believe this challenge ended up being our biggest strength. We were able to get feedback from real-world early adopters to help us improve the program and design an implementation strategy for a future clinical trial.
In your own words, what did you find?
We drew upon prior research, clinical experience, content, and context experts to co-create an injury prevention program (Prep to Play) for women and girls playing community Australian Football. We created Prep to Play when the “time was right” — using the momentum of AFLW and endorsement by the national sporting body. This helped generate a high rate of initial awareness and acceptability among coaches. Many coaches “gave it a go” in 2019, and we purposely recruited these coaches for the qualitative interviews, which gave us rich and informative feedback. They had many suggestions to improve the program content and format of the resources and to design future dissemination and implementation strategies to increase the use of Prep to Play.
If there is one take home message from your study, what would that be?
Co-creating an injury prevention program with the national sporting body and key stakeholders can help with buy-in and generate high rates of awareness amongst coaches. However, a suite of online resources may not translate into high rates of regular real-world use — “no matter how much I watched the videos, I still didn’t feel confident”. The ideas generated by the coaches in our study will inform future research, clinical, and industry initiatives to increase coach competency and the widespread use of sports injury prevention programs. Coaches highlighted that responsibility should be shared amongst coaches, players, parents, health and exercise professionals, football club and league administrative and leadership teams.