Successful prevention program implementation and dissemination of advice requires careful planning.
An editorial by Donaldson and Finch in the April 2012 46(5) issue of the British Journal of Sports Medicine (BJSM) stresses that such planning must be strategic, systematic and contextual. This editorial also emphasises that the perspectives of the end-users in relation to any preventive program should be a critical consideration in its design from the outset. This is because these end-users will only adopt an injury prevention intervention or participate in a safety promotion program if they can see that is directly relevant to them and easy for them to adopt. They want to know: “How is it better than what I usually do?” “Will it fit with what I usually do?” “Can I try it?” “Is it easy?” and “Can I see the results?” Importantly, the only way to ensure that these contextually relevant questions are addressed during program implementation is to engage with the end-users from the outset. This applies to end-users from all ecological layers of the settings in which implementation of programs are to occur.
This same issue of the BJSM contains papers about two screening procedures that are currently of great interest in the sports medicine community – screening for risk of sudden cardiac death and identifying when athletes are ready to return-to-play after concussion. The issue of end-user engagement with advice coming from screening programs, as one form of preventive measure, is particularly relevant.
Anderson et al. describe some of the ethical issues associated with screening athletes for risk of sudden cardiac death in sport. Whilst medical screening can be useful for identifying health concerns, its value in preventing sudden cardiac death is only as good as the efforts following this to protect the identified at-risk athlete. In some countries, this action is mandatory exclusion from further participation in the sport. The authors argue that whilst doctors can provide appropriate advice to athletes found to be at-risk, it is not their role to exclude them from sport. Rather, they consider, athletes need to be provided with enough information to make their own informed decisions about what personal level of risk they are willing to take. This study therefore considers the at-risk athlete to be the intended end-user of information provided to them by sports medicine professionals.
Another group of end-users of sports medicine screening approaches are the practitioners who need to make decisions about when concussed players should return-to-play – they require an accurate screening tool that is easy to use. Current international concussion assessment guidelines require players to be assessed for readiness to return to play with a tool such as the Sport Concussion Assessment Tool-2 (SCAT2), which includes both a symptom inventory and an objective assessment of physical signs, such as a balance examination. In their study of 214 US high school athletes, Jinguji et al. administered the SCAT2 to provide a baseline concussion assessment of this group. The authors concluded that there is considerable inter-athlete variability for some of the SCAT2 physical sign assessments. Without a baseline to compare against, decisions made based on a post-concussion SCAT2 alone could be incorrect. The practitioner end-users of SCAT2 assessments clearly need this important baseline information when using the SCAT2 after concussion because they need to determine when an athlete returns to their pre-concussion functioning and can safely resume their sport participation.
These three papers all show that prevention of injury, its adverse outcomes and sudden death in sport all require that the right information be disseminated to the relevant end-users. Achieving this will ensure that they are able either to make the appropriate decisions to guide their own safety decisions or to guide the actions they will then take to ensure the safety of others. Not considering end-user needs and perspectives from the outset, may mean that subsequent efforts to translate the latest information and advice to them will fail, largely because appropriate dissemination strategies have not been developed specifically for these target groups.
Caroline Finch is an injury prevention researcher from the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Monash Injury Research Centre, Monash University, Australia. She specialises in implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch