Background Rugby union (“rugby”) players have an above-average risk of injury compared to participants of other popular team sports. The BokSmart programme attempts to reduce injury risk in players through education of injury prevention practices.

Objective To investigate whether correct knowledge, positive perceptions and education were associated with best-practice injury prevention behaviours in rugby players.

Design A questionnaire was completed annually by tournament rugby players between 2008–2012. Chi-squared analyses and a multiple correspondence analysis (MCA) map investigated associations between 18 behaviours and their corresponding knowledge, perception and education components.

Setting Junior (under-18) and senior (adult) annual rugby tournaments players.

Participants Of the 112 junior and 84 senior teams at the tournaments, 111 (99%, n=2279 players) and 81 (96%, n=1642 players) teams opted to complete the questionnaire.

Assessment of risk Factors Relationship between knowledge, education and perceptions, and injury prevention behaviours for rugby.

Main outcome measurements The assessed injury prevention behaviours were injury management (ice, compression, etc.) mouthguard use, warming-up/cooling down, practicing techniques (scrumming, tackling, rucking) and physical conditioning.

Results The average age of players completing the questionnaire was 21±4 years. There was a significant (P<.05) positive relationship between knowledge/education for all 18 behaviours. In contrast, players' perceptions of the efficacy of injury prevention behaviour did not correspond with their self-reported behaviour. These findings were confirmed visually with an MCA map.

Conclusions The findings above imply that the BokSmart intervention may have been effective in changing behaviour through knowledge and education, but not through perceptions. To improve injury prevention behaviour, BokSmart should focus on improving knowledge and education of players. Future ‘true’ prospective studies should investigate the above relationships, in particular how much influence BokSmart has on player's education/knowledge.