Background Rugby union (“rugby”) players have an above-average risk of injury compared to participants of other popular team sports. Player behaviour has been identified as a critical area of injury prevention, yet understudied.

Objective To assess whether rugby player behaviour improved over the concomitant time period of the BokSmart nationwide injury prevention programme.

Design An anonymous knowledge, attitude and self-reported behaviour questionnaire was completed by tournament players on a yearly basis from 2008-2012. A generalised linear model assessed whether the proportion of “correct” injury-prevention behaviour improved over this five year period.

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

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

Assessment of risk factors Besides age, team and year (of tournament): “perceived necessity of a coach safety course–yes/no”, “injury prevention role of coaches/referees/players–yes/no” (role), “previous injury–yes/no (injury)”, “ethnicity” and “position - forward/back” were considered as behavioural determinants.

Main outcome measurements The assessed behaviours were mouthguard use, warming-up/cooling down, injury management (ice, compression, elevation, heat, alcohol, massage, exercise), techniques (scrum, tackle, ruck) and physical conditioning.

Results Five of the 18 self-reported behaviours improved significantly (P<.005) between 2008–2012: mouthguard use (practice–36% and matches–28%), cooling down after practice/matches (32% each) and elevating injured limbs (36%). Other behaviours remained unchanged. Other important determinants of other behaviours were team and age.

Conclusions No behaviours worsened, while five of the injury prevention behaviours have improved since the launch of BokSmart (mid 2009–present). Future studies should ascertain whether the BokSmart programme had a causal effect on the improved behaviours and whether BokSmart is able to improve the remaining behaviours.