Facilitators to support the implementation of injury prevention training in youth handball: A concept mapping approach

Abstract

There is a need for research to identify effective implementation strategies for injury prevention training within real-world community sports. The aim of this ecological participatory study was to identify facilitators, among stakeholders at multiple levels, that could help injury prevention training become part of regular training routines in youth team handball. Concept mapping, a mixed-method approach for qualitative data collection and quantitative data analysis, was used. Stakeholders (n = 196) of two community team handball clubs (29% players, 13% coaches, 38% caregivers, 11% club, district and national handball administrators, 9% unknown) participated in a brainstorming process. After the research team synthesized the 235 generated statements, 50 stakeholders (34% players, 22% coaches, 24% caregivers, 20% administrators) sorted 89 unique facilitator statements into clusters and rated them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis yielded five clusters (stress value 0.231): "Understanding and applying knowledge," "Education, knowledge, and consistency," "Set-up and exercises," "Inspiration, motivation, and routines," and "Club policy and expert collaboration." The cluster "Understanding and applying knowledge" had the highest mean importance (3.17 out of 4) and feasibility (2.93) ratings. The 32 statements rated as both highly important and feasible (Go-zone) indicate action is required at the individual (end-users) and organizational (policymakers) levels to implement injury prevention training. Results suggest that developing evidence-based context-specific injury prevention training, incorporating physiological, biomechanical and psychological components, and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to facilitate the implementation of injury prevention training in youth team handball.

Keywords: adolescent; concept mapping; health plan implementation; preventive therapy; sports injuries; team ball sports.

Figure 1

An ecological model, adapted from Emery et al (Injury prevention in child and adolescent sport: whose responsibility is it? Clin J Sport Med. 2006;16:514‐521. https://journals.lww.com/cjsportsmed/pages/default.aspx),15 defining a responsibility hierarchy in preventing injuries in youth sport. The lowest level of responsibility assigned to the child (player) and highest level to organizations with the potential to affect the most. The modification of this Figure has been reviewed and approved by the publisher, Lippincott Williams & Wilkins

Figure 2

The five‐cluster map of facilitators, perceived by stakeholders, to enhance the implementation of injury prevention training in youth team handball. Statements that were more frequently sorted together are positioned closer together on the map, and statements that were less frequently sorted together are positioned further away from each other

Figure 3

Pattern matching graph for average cluster ratings between importance and feasibility (all stakeholders), indicating low agreement between the rating variables (r = 0.17). Significant differences observed between the ratings for the clusters “Understanding and applying knowledge” (P < 0.05), “Education, knowledge, and consistency” (P < 0.02), and “Club policy and expert collaboration” (P < 0.001), but not for the clusters “Inspiration, motivation, and routines” or “Set‐up and exercises” (P > 0.05)

Figure 4

The “Go‐Zone” graph showing ratings of importance and feasibility. The top right quadrant indicates the Go‐Zone, including statements that were rated above the mean for both importance and feasibility. Go‐Zone quadrants: 1 = Top right; 2 = Bottom right, 3 = Top left; 4 = Bottom left. The statements in the Go‐Zone (quadrant 1) represent the most actionable statements