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Abstract
Objective Interpersonal violence (IV) in sport is challenging to define, prevent and remedy due to its subjectivity and complexity. The 2024 International Olympic Committee Consensus on Interpersonal Violence and Safeguarding aimed to synthesise evidence on IV and safeguarding in sport, introduce a new conceptual model of IV in sport and offer more accessible safeguarding guidance to all within the sports ecosystem by merging evidence with insights from Olympic athletes.
Methods A 15-member expert panel performed a scoping review following Joanna Briggs Institute methodologies. A seminal works-driven approach was used to identify relevant grey literature. Four writing groups were established focusing on: definitions/epidemiology, individual/interpersonal determinants, contextual determinants and solutions. Writing groups developed referenced scientific summaries related to their respective topics, which were discussed by all members at the consensus meeting. Recommendations were then developed by each group, presented as voting statements and circulated for confidential voting following a Delphi protocol with ≥80% agreement defined a priori as reaching consensus.
Results Of 48 voting statements, 21 reached consensus during first-round voting. Second-round and third-round voting saw 22 statements reach consensus, 5 statements get discontinued and 2 statements receive minority dissension after failing to reach agreement. A total of 43 statements reached consensus, presented as overarching (n=5) and topical (n=33) consensus recommendations, and actionable consensus guidelines (n=5).
Conclusion This evidence review and consensus process elucidated the characterisation and complexity of IV and safeguarding in sport and demonstrates that a whole-of-system approach is needed to fully comprehend and prevent IV. Sport settings that emphasise mutual care, are athlete centred, promote healthy relationships, embed trauma- and violence-informed care principles, integrate diverse perspectives and measure IV prevention and response effectiveness will exemplify safe sport. A shared responsibility between all within the sports ecosystem is required to advance effective safeguarding through future research, policy and practice.
- Consensus
- Sports
- Sexual harassment
- Violence
- Review
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Introduction
Interpersonal violence (IV) in sport affects all ages and competitive levels yet remains understudied. Ljungqvist et al published the first consensus statement on sexual harassment and abuse in sport in 2007.1 Since then, research has expanded to cover a wider range of abuses, leading to the 2016 International Olympic Committee (IOC) consensus statement on harassment and abuse in sport. This statement broadened the scope to include physical abuse, psychological abuse, neglect, bullying and hazing, introducing a definition of ‘safe sport’ (figure 1).2 Groups that experience higher levels of IV such as children, people with disabilities, minority ethnic groups, and lesbian, gay, bisexual, transgender and queer+ (LGBTQ+) athletes were highlighted, along with potential outcomes for athletes and sport organisations.
International Olympic Committee (IOC) safe sport definitions. Updates to the definitions of safe sport and safeguarding between 2016 and 2024.
The current consensus builds on these landmark contributions and is updated for several reasons. First, acknowledging the evolving nature of the science cited in the 2016 paper, subsequent exponential growth in evidence necessitates this timely update.2 Second, adhering to best practices, we employed a systematic approach to data identification, analysis and synthesis.3 Third, while the 2016 consensus largely focused on individual and interpersonal IV determinants using Brackenridge’s 2001 sexual exploitation continuum as its underpinning theoretical framework and conceptual model,4 our update extends the analysis to include contextual determinants, drawing from Bronfenbrenner’s ecological systems theory and ecological model of human development.5 6 Fourth, in response to the 2016 paper’s call for applicable solutions and multistakeholder approaches, we discuss IV prevention and response strategies that have received scholarly attention. Finally, aligned with current research, practice and policy, this consensus extends its scope beyond safe sport to include ‘safeguarding’ (figure 1), and beyond scholarship to include athletes’ voices.
Krug et al’s definition of IV, encompassing physical, psychological, sexual violence, and deprivation/neglect, is used throughout this manuscript.7 Following the IOC’s directive, this consensus prioritises elite sport, but data from all competitive levels are analysed for comprehension. Brofenbrenner’s model of human development underpins the consensus due to its interdisciplinary nature, relevance to both scholarly and real-world contexts, and ability to provide a holistic understanding of IV and safeguarding in sport by emphasising the bidirectional influence between sportspeople (figure 2) and their environments. As increasingly acknowledged, acts of IV in sport are not just individual acts perpetrated against victims.8–10 The wider conceptual model of IV in sport proposed here enables a more comprehensive examination of all the variables facilitating IV.
Sportspeople. A summary of all within the sports ecosystem to whom consensus recommendations and guidance are addressed (lists are non-exhaustive).
The aims of this consensus are to:
Synthesise evidence on IV and safeguarding in sport.
Introduce a socioecological model of IV in sport.
Offer more practical safeguarding guidance to all within the sports ecosystem by merging evidence and insights from experts and athletes (box 1).
Key points
Overarching Consensus Recommendations:
Address safe sport as everybody’s responsibility.
Recognise that safe sport is for all within the sports ecosystem.
Encourage awareness, adoption and implementation of current scientific knowledge on safeguarding in sport.
Encourage sport that is athlete centred, emphasising mutual care and respect.
Outreach to unheard voices and integrate global perspectives into safe sport.
Consensus Guidelines:
Prioritise relational health: Facilitating healthy relationships throughout sport supports an ethic of care within sport and boosts sport’s galvanising role in society.
Integrate safeguarding with the values of sport: This strengths-based approach may optimise performance and well-being, which go hand in hand.
Implement trauma- and violence-informed care and practice (TVIC/P): TVIC/P reinforces athlete-centredness and athlete voice.
Embed principles of implementation science: Processes that promote real world uptake may improve intervention effectiveness.
Measure effectiveness: Integrating contextually appropriate evaluation methodologies can enhance sport safeguarding.
Bronfenbrenner’s original framework is referred to as the ecological model. Given the social nature of sport, we have chosen to use the term ‘socioecological’ to evoke a broader application that includes social elements more explicitly. The paper is divided into five sections. Section 1 defines types, modes, prevalence and potential outcomes of IV in sport. The second section introduces a more holistic and widely applicable socioecological model of IV in sport. Section 3 and 4 examine individual/interpersonal and contextual (organisational, sectoral, societal, temporal) determinants of IV in sport. Section 5 discusses potential solutions. The last part offers an overall discussion and future directions, filtered through the voices of athletes.11
Methods
Panel selection
The chair and cochair established a diverse expert panel with respect to gender, scientific discipline, geographic location of background and research, and based on practical experience or relevant publications on IV and safeguarding in sport. The panel included a retired Olympic athlete, sports medicine physicians and a child psychiatrist, psychologists, sociologists, a sport integrity specialist, a criminologist, a safe sport specialist and those with lived experience. A medical librarian worked closely with the panel throughout to assist with the systematic review.
Evidence review
Four sources of evidence inform this consensus. First, a scoping review (ScR) was executed following the Joanna Briggs Institute Manual for Evidence Synthesis (Chapter 11) and published in Open Science Framework (https://osf.io/5rxkp/). Papers published between 2006 and December 2022 were considered. While elite sport was prioritised, data from all competitive levels were analysed using McKay et al’s 2022 participant classification framework which categorises athletes into five levels: tier 1 recreationally active, tier 2 trained/developmental, tier 3 highly trained/national level, tier 4 elite/international level and tier 5 world class.12 In July 2023, forward citation chaining was performed using the Citationchaser.io application on the subset of retrieved studies focused on athlete classification levels 4 and 5, satisfying IOC’s emphasis on elite sport.
Second, using a seminal works-driven approach, key grey literature that the expert panel proposed was voted on for inclusion/exclusion13; reports reaching 80% agreement were included. Third, the panel brought forward additional peer-reviewed literature that provided an overview of IV and/or safeguarding in sport or was tagged as ‘key’ during the ScR process. Fourth, the insights of two Olympic athletes engaged throughout the in-person meeting were incorporated.
Consensus process
The Research and Development (RAND)/University of California Los Angeles (UCLA) Appropriateness Method was adopted. Our process aimed to synthesise available evidence and create recommendations, draw from expert insights in areas lacking robust evidence and identify expert consensus on key issues, while mitigating the acknowledged risks of within-group power imbalances, dominant perspectives overpowering discussions, groupthink and divergent viewpoints being insufficiently considered.
Four writing groups were established focusing on:
Definitions and prevalence.
Individual and interpersonal determinants.
Contextual determinants.
Solutions related to IV and safeguarding in sport.
Each group reviewed the evidence and developed a referenced summary of the existing science related to their assigned topic. Summaries were discussed at the in-person meeting. Groups then developed recommendations, presented as voting statements and circulated for online confidential voting (Delphi method). All authors responded agree, undecided, or disagree to each statement. Undecided/disagree responses were explained via free-text comment. Three levels of agreement were used based on which subsequent discussions were held:
Agreement: ≥80% of authors agreeing on the voting statement, without any author disagreeing.
Agreement with minority disagreement: ≥80% of authors agreeing on the voting statement, but with one or more authors disagreeing.
Disagreement: <80% of authors agreeing on the voting statement.
Statements without first-round consensus underwent online discussions from October 2023 to May 2024. Voting statements were revised based on feedback, and two additional rounds of confidential online voting took place. Authors were encouraged to submit minority opinions if they disagreed with a statement after the consensus threshold was met (online supplemental table 2).
Supplemental material
Equity, diversity and inclusion statement
The author team was intentionally balanced in terms of gender, perspective, age, ability, seniority, discipline, geography and culture. Regular informal and formal consensus ensured balanced execution and presentation of the work.
Results
Selection of sources of evidence
The ScR team used Covidence to determine article inclusion. Figure 3 shows all literature considered, how it was retrieved, number of duplicate records removed, records screened at title/abstract and full text levels and records included in the ScR (n=190) and through forward citation chaining (n=15).
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. A summary of the scoping review manuscript and grey literature screening process, including the number of articles found and the selection process.
Characteristics of sources of evidence
Given the large set of extracted studies, a summary of citations included in the ScR is included as online supplemental appendix 1A. Online supplemental appendix 1B provides a similar summary for reviewed grey literature (n=21) and additional papers (n=153) tagged during the ScR.
Supplemental material
Supplemental material
Consensus results
Based on a review of their assigned topic, the four writing groups developed a total of 48 voting statements, each reviewed by the panel. Of these, 21 reached consensus in round one. In rounds two and three, 22 reached consensus. Five recommendations were discontinued because consensus was adjudged to be unachievable. This resulted in 43 final statements, presented as consensus recommendations (n=38) and corresponding guidelines (n=5). All reached 80% agreement during the Delphi process.
Summary of evidence
The ScR identified 190 primary studies addressing IV and/or safeguarding in sport in nine languages. Forward citation chaining identified 15 relevant primary studies in three languages. 21 citations were identified as key grey literature. An additional 153 citations were identified as key peer-reviewed literature that either provided a general overview of IV and/or safeguarding in sport (n=31), or were germane to a specific writing group: definitions and prevalence (n=30), individual/interpersonal determinants (n=30), contextual determinants (n=27) and solutions (n=35). Olympic athletes’ insights during the in-person meeting were recorded and reviewed during the writing phase.
Citations were initially retrieved in English, German, French, Spanish, Portuguese, Greek, Croatian, Japanese, Turkish, Mandarin Chinese and Norwegian. Of these, citations in eight non-English languages met inclusion criteria: German (n=2), French (n=1), Spanish (n=3), Portuguese (n=1), Croatian (n=1), Mandarin Chinese (n=1), Norwegian (n=1) and Turkish (n=2). After synthesising the compiled information and placing emphasis on athletes’ voices, topical insights and associated consensus recommendations are described below. Notably, data from all four writing groups contributed to the outcomes table and socioecological model.
Section 1: Definitions, prevalence and potential outcomes
The landscape of terminology in the field of IV in sport is complex (table 1). Various terms such as violence, interpersonal violence, maltreatment, abuse and harassment are often used interchangeably in the literature. Additionally, the same behaviours might have varied names or translations, influenced by factors like:
Athlete age, resulting in distinctions like child abuse and child maltreatment.
The nature of the relationship between perpetrator and victim, resulting in terms like coach-athlete abuse or peer-to-peer bullying.
Context, encompassing on-field and off-field violence, hazing and cyber/online manifestations.
The nature of the behaviours involved, including sexual harassment and psychological abuse.
Theoretical perspectives or research domains, spanning disciplines like sociology and psychology.
Variations related to language and cultural differences across countries.
Key terms and definitions
Supplemental material
In light of this, adopting a common overarching term for both child and adult sportspeople is recommended. The term ‘interpersonal violence (IV)’ is proposed because of its global recognition as a public health concern, acknowledged by prominent international organisations such as the WHO. WHO’s (Krug et al 14) widely accepted definition of violence (online supplemental table 1) includes three categories: self-directed, interpersonal and collective violence. IV includes physical, psychological, sexual and deprivation/neglect aspects.7 Moreover, this term is increasingly employed in the sports and exercise medicine (SEM) literature to encompass the range of problematic behaviours experienced by sportspeople.
Furthermore, studies identified other forms of aggression related to IV in sport, including hazing, bullying and grooming. Modes of IV in sport include contact (ie, physical interactions), non-contact (verbal and non-verbal) and cyber-enabled/online violence, leading to terminology adaptations such as ‘cyberbullying’. Notably, terms related to children, such as child maltreatment or child abuse, are also prevalent in SEM literature. Following the WHO, child maltreatment may encompass sexual abuse, physical abuse, emotional abuse and neglect. Using these two specific terms (child maltreatment or child abuse) when addressing IV against children and youth in the context of a relationship of responsibility, trust or power is recommended. Online supplemental table 1 provides an overview of IV terminology and examples of IV manifestations encountered in the primary literature, as well as selected definitions established through this consensus.
Evidence synthesis: current understandings of IV in sport
Prevalence/epidemiology
Peer-reviewed IV prevalence studies in sport predominantly originated from Europe15 and North America.10 Far fewer studies came from Asia,3 Oceania3 and Africa,2 with no studies identified from South America. Two studies used a multicontinent sample. Over the review period, peer-reviewed studies on IV epidemiology in sport have increased: publications surged from three articles before 2010 to 20 articles between 2010 and 2019, and an additional 21 articles since 2020.
Reporting patterns are presented in terms of prevalence (lifetime) and, less frequently, incidence (past 6–12 months). In the reviewed literature, overall IV prevalence in sport ranges from 44% to 86%, with most studies using a low threshold measure (having experienced at least one event).16–23 Focusing on the most well-documented type of IV, prevalence estimates for sexual violence vary between 0.5% and 78%. Sexual violence is often reported as sexual harassment and abuse, ranging from 11% to 78%,15–36 or solely as sexual abuse, with rates between 0.5% and 12%.37–42 Incidence of (past year) sexual violence ranges from 0.4% to 14%.39 43 In terms of exposure to sexual violence, multiple studies show elevated exposure in girls/women and LGBTQ+ individuals (table 2). No difference in exposure to sexual violence is found between athletes with or without disabilities. For other sociodemographic variables, available results are inconsistent.
Current prevalence estimates of lifetime experience with interpersonal violence in sport and evidence for elevated exposure
Psychological violence (often referred to as emotional abuse) is the second most documented type of IV after sexual violence and is frequently reported by athletes. Prevalence rates range from 21% to 79%.16–18 21–23 29 30 35 37 44 45 The only study examining the incidence of psychological violence reported a rate of 15%; in this case, verbal abuse from coaches was examined.46 In studies where psychological violence is combined with neglect, prevalence estimates of 76%, 81% and 68% are observed, respectively.17 19 20 Multiple studies show elevated exposure to psychological violence in disabled and LGBTQ+ athletes (table 2). Elite athletes and those training 16+ hours weekly also report more psychological violence. Differences based on biological sex or ethnicity are inconsistent in the reviewed data.
Physical violence and neglect prevalence rates are less extensively documented. Physical violence prevalence estimates ranged from 4% to 66%.16–23 29 30 35 37 44 47 48 One study reported a 6% incidence of physical violence.46 Current data support elevated exposure in males, team sports, elite athletes, LGBTQ+ athletes and athletes who train 16+ hours weekly (table 2). To date, data looking at differences based on other sociodemographic variables are inconsistent or unavailable. For neglect, prevalence estimates range from 27% to 69%.17 20 23 Regarding exposure to neglect (table 2), limited data are available.
Other forms of aggression related to IV in sport have been documented to a lesser extent (online supplemental table 1). Some studies report prevalence rates for hazing (50%)49 and bullying (ranging from 17% to 61%, including homophobic and cyberbullying).30 50–53 Bullying incidences of 14% and 48% were reported in two studies.54 55 Cyberbullying incidence estimates are available in only one peer-reviewed study: 7%.55
Clearly, IV is prevalent among athletes, exhibiting a wide spectrum of types, frequencies and contexts. From occasional incidents to chronic systemic cases often manifesting in multiple types, individual experiences of IV are highly diverse and personal.
Samples, instruments and surveillance methodologie
Relying solely on reported cases for personal, sensitive offences like IV has limitations due to the hidden nature of abuse. Retrospective self-reports, sometimes debated for accuracy,56 57 may offer a more feasible approach to the epidemiology of IV in sport. Furthermore, existing measurement tools lack precision in differentiating severity due to the subjectivity of indicators. Understanding the extent of IV against sportspeople is hampered by these and other considerations, all introducing bias:
Inconsistent terminology.
Sample composition and timeframe discrepancies.
Varied questionnaire approaches (eg, nature/meaning and number of items, factual and behaviouristic vs perception surveys).
Ethics variability in data collection (eg, anonymity, confidentiality of disclosures).
Statistical analysis differences.
Low response rates.
Lack of validated measurement tools.
The ScR identified 45 scientific and two grey literature studies23 58 that measured IV prevalence. Sample sizes varied from 59 to 10 000+ respondents, encompassing athletes at various competitive levels and the general population, often using convenience or purposive sampling. Most studies (n=20) use surveys without psychometric validation. Several studies use (and/or adapt) the Interpersonal Violence in Sport Questionnaire18 or modifications of Volkwein,59 Vanden Auweele60 and/or Alexander.61 Informed by athletes’ voices and validated, the Violence Toward Athlete Questionnaire62 was used in four articles.17 19–21 The Interpersonal Violence Against Children in Sport-Questionnaire, used in the largest study,23 awaits validation. Most tools measure IV before age 18; none address adult athletes; and none address IV experiences in sportspeople who are not athletes. Given these challenges, interpreting and comparing current epidemiological estimates requires caution. Accepting this inherent complexity, quantifying IV experiences in sport remains an incomplete endeavour. Table 3 presents consensus recommendations related to the epidemiology of IV in sport.
Consensus recommendations* related to definitions, prevalence and potential outcomes of interpersonal violence in sport
Potential outcomes of IV in sport
IV in sport can cause psychological, behavioural, physical and material damage to athletes, athletes’ entourage and sport organisations.63 64 Potential outcomes of IV in sport are presented in table 4.
Potential outcomes* of interpersonal violence in sport for athletes, athletes’ entourage members and sport organisations
Section 2: Socioecological model of IV in sport
Violence is socially constructed.7 65 Meaningful distinctions between the various types, risk factors, contexts and potential outcomes of IV overlap.66 67 In light of this, we propose an updated conceptual model of IV in sport (figure 4). Three distinct but inter-related elements anchor the model: socioecological context, displayed as five nested levels (blue) (individual/interpersonal, organisational, sectoral, societal, temporal); types and modes of IV (red); and potential outcomes of IV for athletes, athletes’ entourage and sport organisations (black). All three elements of the model interact with one another. For example, sport organisations, entourage members and athletes can influence types and modes of IV and the socioecological context itself through either proactive actions such as speaking out against witnessed or experienced IV,68–71 or passive inactions such as bystanding and enabling.64 72
Socioecological model of interpersonal violence in sport. A graphic representation of the interconnected complexities of abuse in sport (lists are non-exhaustive).
Section 3: Individual and interpersonal determinants of IV in sport
A wide array of individual and interpersonal variables shape the nature of human responses. Recent literature identifies an added layer of complexity: the intersection of overlapping forms of oppression and discrimination. Intersectionality has been adopted to facilitate the multilayered understanding of socially constructed experiences that cannot be understood simply by examining individual aspects separately,73 which are greater than the sum of their parts.74 This section explores individual/interpersonal-level variables such as sexual orientation, gender identity/expression or sex variations (SOGIESV), race/ethnicity, age and dis/ability, as they relate to IV experiences in sport which function at the innermost level of the socioecological model. These variables interact reciprocally with those on other socioecological levels, particularly societal.
Sexual orientation, gender identity/expression or sex variations
All athletes have the right to safe sporting experiences, regardless of their SOGIESV. However, sport is often a less inclusive, welcoming and safe space for LGBTQ+ persons as well as people with sex variations. As a such they can face social repercussions, discrimination and violence in sport based on their SOGIESV.75 We recognise that sexual orientation, gender identity/expression and sex variations are distinct terms that require nuanced attention. The grouping has been adopted here not to minimise importance or conflate the terms, rather to ensure that all are given attention and primacy. In addition, it is important to recognise that SOGIESV terminology continues to evolve and therefore should be updated over time.
Linked to binary gender classifications, statistical differences exist in the prevalence of various types of IV in sport (see above and table 2). Most studies examining SOGIESV and IV report an overall average of IV, and then compare boys/men, girls/women (using gender binary) and the LGBTQ+ group to that average. The common finding is that LGBTQ+ athletes experience higher levels of IV.50 51 76 With the majority of trans* individuals facing some form of physical, sexual and/or verbal aggression based on gender identity, gender expression and/or perceived gender within their lifetime,77 trans* people are among the most stigmatised and discriminated social groups in society.78 Research pertaining to other sexual identities represented within the LGBTQ+ classification is less understood, for example, the experiences of bisexual, intersex or pansexual individuals and their IV risk.
While greater evidence is required, sex testing may be considered to be a form of IV with potential physical, psychological and sociological harms to affected athletes.79 80 Future research should document and quantify the harms of sex testing, as a form of IV.
Age and sport level
The literature extensively reports on IV prevalence in (elite) sport and its detrimental impact on athlete well-being and performance.18 22 23 81–84 The stage of imminent achievement, first proposed in 199785 and tested by Brackenridge, Lindsay and Telfer86 among others, proposed linking sport career paths with athletes’ chronological ages to identify where the risk of abuse was greatest. Based on their competitive level, athletes face varying degrees of pressure from coaches87 or from athletes themselves while pursuing success.88 At elite and professional levels, athletes face high stakes and intense pressure to perform at their peak.88 At this level, coaches sometimes wield immense power over athletes’ careers.83 In extreme cases, athletes may feel pressured to tolerate IV in exchange for the opportunity to compete at the highest level. Elite sport organisations’ hierarchical structures and administrative procedures can make it challenging for athletes to report IV (see section 4: Contextual determinants of IV in sport).89–91
Concerns persist over high IV prevalence estimates among young elite athletes. While Sølvberg et al found elite athletes experience less sexual violence than other athletes, some evidence indicates young athletes in recreational-level sport encounter sexual harassment and violent treatment more frequently than elite counterparts,43 48 emphasising the need to address IV across all competitive levels.23 Despite lower training intensities, recreational-level athletes can encounter abusive behaviours from peers.53 Those willing to progress to elite sport can be particularly susceptible to IV through pressure84 and coach-driven ideologies promoting ‘growth through suffering’.92 The absence of rigorous oversight and standardised safeguards in amateur sports can leave young athletes vulnerable.21
While there are examples of balanced early sport specialisation (ESS), it is important to highlight the unique set of risks attributable to ESS as an increasingly popular lifestyle choice.93 ESS involves committing exclusively to a single sport during physical and psychological maturation for a prolonged period (at least 8 months annually).94 Parental influence is a primary driver for young athletes taking up a particular sport, while coaches influence decisions related to training intensity leading to ESS.95 96 Parent and Vaillancourt-Morel21 demonstrated that ESS is associated with increased self-reported psychological and neglect types of IV. ESS has occurred as early as 4 years old97 and research links ESS with burnout, social isolation, injury and overlooking talent in late-blooming children.98 99 This pressure can also contribute to toxic environments where children are less likely to report abusive behaviour for fear of losing specialised training opportunities.94 Of course, IV does not stop simply because specialised young athletes become adults.100 101
Race and ethnicity
Race and ethnicity can impact a person’s vulnerability for experiencing abuse inside and outside of sport.102–107 Gurgis et al 108 found that sport participants who self-identified as black athletes reported experiencing verbal microaggressions and systemic violence linked to race, among other race-related discriminatory behaviours generally falling outside current IV/safeguarding efforts in sport. Vertommen et al 18 reported that young minority athletes experienced significantly more violence in the context of sport than other athletes, despite Parent et al 20 reporting that ethnicity was not a predictor of IV towards young athletes in her work. Moreover, Wilson et al reported athletes who identified as racialised experienced significantly higher rates of physical harm than non-racialised athletes, yet significantly lower rates of emotional harm.109 Greey (2022) found that the intersection of race and gender identity in racialised transwomen made sport locker rooms particularly hostile.110 Overall, race and ethnicity remain under-represented, inconsistently reported or absent in the relevant literature.
Dis/ability
As Tuakli-Wosornu and Kirby describe, ‘rights violations in para and non-disabled sport illustrate both individual and organisational vulnerabilities.’111 Vertommen et al 18 were the first to report that young athletes with disabilities experienced the most psychological abuse among all groups of athletes studied (see table 2).18 Athletes with disabilities competing at national and international levels have self-reported experiencing transgressive behaviours more frequently.22 In contrast, Ohlert et al 31 found no significant differences in a study of German athletes based on dis/ability.31 In addition to the ways athletes in general experience discrimination, para athletes experience further financial and social discrimination,111 112 suffering the effects of labelling and often experiencing a lack of respect.112 113 Para athletes can be perpetrators of peer abuse.114
Perpetrators of IV
To understand IV against athletes and others, it is critical to examine perpetrators in sport. Relationships and the relational aspect of IV is an essential part of the narrative when identifying risk factors. IV within the coach–athlete relationship has been given primacy in the literature, however, it is widely accepted that anyone can be a perpetrator and/or victim of sport-related IV, including peer athletes, parents/caregivers and members of the athlete health and performance team.19 115–118 IV can be experienced directly and/or indirectly.64 72 119 While some studies have identified key characteristics of perpetrators,17 117 120 121 Vertommen et al 19 note how in-depth scientific analyses of characteristics, interpersonal dynamics and applied theories of offending in sport remain largely absent from sport research.19 Widely reported is the presence of power differentials within abusive relationships or environments.35 122 Power operates between all people and relationships, but further permeates high-performance environments and their relationships, bringing into question more systemic sporting practices that facilitate IV (see section 4: Contextual determinants of IV in sport).123 124
Intersectionality
While each aspect of identity presents its own risk factors for IV, there is potential risk based on the intersecting aspects of identities.74 As Gurgis et al 108 contend, critical safe sport topics to address, such as racism, ableism, sexism, misogyny and heterosexism, can uniquely define (un)safe experiences of sportspeople.108 Systemic discrimination remains a significant threat to individual welfare, thus, an intersectional approach should be used when striving for safe sport: a reality which might not yet be possible across sports, cultures, or contexts, or experienced equally by those with differing intersecting identities.105 106 125 Table 5 presents consensus recommendations related to individual/interpersonal determinants of IV in sport.
Consensus recommendations* related to individual and interpersonal determinants of interpersonal violence in sport
Section 4: Contextual determinants of IV in sport
‘No instance of abuse can be divorced from its socio-cultural context 126’
The sociocultural environment influences individual action. Below, three groups of structural variables are considered: (1) organisational factors: what individual sport organisations are directly responsible for; (2) sectoral conditions: common operating logics and regulations across the wider sport sector but not specific to individual organisations; and (3) societal systems: social norms and values underpinning society’s institutions (see figure 4). These variables interact reciprocally with those on other socioecological levels, particularly temporal.
Organisational factors
The literature generally divides organisational factors into: (1) unhealthy organisational climates in general and (2) lack of safeguarding policies and practices in particular.
Unhealthy organisational climates in sport are typified by a culture of control and coercion,81 127–131 fear,132 mistrust,133 134 secrecy135 and a code of silence132 136–138 among other aspects. These toxic environments are associated with traditional authoritarian coaching techniques48 81 138–146 which reaffirm power imbalances between athletes and coaches/officials and discourage challenges to the authority of coaches.147 In such climates, athletes and others tend to tolerate unacceptable practices,148 149 avoid raising concerns due to potential disadvantages (deselection, isolation, reprisal, etc)130 131 133 150 151 and are disempowered.143 152 153 Chillingly, a former national-level coach convicted of IV said, ‘You can do it because you are doing it with the permission of the parents. It is too easy.’144 Qualitative research with victim-survivor testimony and independent reviews of sport governing bodies point out that built environments such as residential training centres130 can elevate risk by physically isolating athletes from their support networks154–156 and potential monitoring.157 Cisnormative spaces such as locker rooms may also expose some individuals to discriminatory experiences.110 158
A more discrete organisational failure in safeguarding is a lack of safe sport measures.51 58 130 133 135 144 150 154 159–174 Behind the unpreparedness can lie organisational resistance and inaction175 that stem from deep discomfort and disconnect with the topic of IV,171 176 a dearth of attention to equity, diversity, and inclusion,134 and lack of leadership.167 For example, organisations remain unwilling to acknowledge their safeguarding issues due to potential reputational damage and resultant financial losses,177 or merely adopt a box-ticking approach.178 Further, safeguarding work remains low priority,161 under-resourced162 167 and unfairly reliant on volunteers.130 161 171 179 Because of the ‘demanding, emotional, sensitive, difficult and unheralded’172 nature of the work, often viewed as ‘not commercially productive’130 no matter how much goodwill exists, organisational safeguarding capacity fails under these conditions.171
Sectoral conditions
Sectoral conditions generally derive from the very nature of sport (its pursuit of high performance and its relatively autonomous position in society).
The naïve social belief in the ‘essential goodness of sport’,176 or the Great Sport Myth in Coakley’s180 words, hinders sportspeople from acknowledging and providing against negative dimensions of sport,131 144 176 and enables perpetrators at all competitive levels to hide under the ‘…cloak of respectability and credibility that [comes] through their association’.144 181 Entrenched and difficult to uproot, the ‘sport ethic’182 183 institutes vulnerability through ‘win at all costs’ ideologies,134 184 such as ‘accepting risk and play[ing] through pain’, ‘sacrificing health and wellbeing for success’145 185 and ‘refusing to accept limits’, which normalise harmful practices52 81 143 146 165 186 and sideline human rights and safeguarding principles.8 184
These sport-specific ideologies are reflected in, and reinforced by, sport-specific regulations such as performance-based funding and hiring/retention systems.81 133 149 154 187 Designed for medal success, performance-based funding has the effect of setting priority (performance over well-being) and exerting pressure on recipient organisations130 and coaches81 to employ domineering strategies over athletes.87 Such conditional support consolidates power distortions in coaches/officials and leaves athletes commodified and at their discretion.8 81 130
As above, ESS is a unique feature of the sport sector that requires early talent identification and development,176 188 and is driven by both individual choices (eg, parents/caregivers, coaches; see section Individual and interpersonal determinants of IV in sport) and sectoral demands. ESS can come at the price of child and young athletes’ welfare, including intensified training,176 disrupted education189 and/or limited life experiences beyond sport,130 which can infringe on their rights to education176 and ability to challenge problematic practices.130 Due to the brevity of elite sport careers, ‘the success of the industry depends on a constant pipeline of aspiring and talented child athletes’,176 which at the extreme incentivises international transfers and trafficking of minors in certain sports. Sustained within this pipeline is racial capitalism: ‘the largest numbers are from West Africa with an estimated 15 000 children each year’.176
Similar to individual/interpersonal-level analyses, sector-specific research surfaces masculinist ideals76 183 190 and sport’s system of binary sex classifications as a threat to the dignity and well-being of athletes.110 128 191
Many sectoral conditions derive from what is known as ‘sporting exceptionalism’.192 This self-regulating, self-policing philosophy and governing model often positions sport as ‘a cultural and political island’126 separate from society and beyond the universal scope of child protection regulations and state/government due processes.165 The absence of player representation (eg, unions, committees) and the limited presence of athletes in decision-making processes concerning their rights134 154 163 reduce athletes’ power to help protect their welfare193 and impede the impetus to report IV.159
Societal and temporal systems
Historical and geopolitical forces that oppress, exploit and disadvantage some, while empowering others,194 shape the social world in which sport is embedded.195 IV can be understood as a product of normative social power inequities.
Research demonstrates equity-deserving groups are more likely to experience IV in sport (table 2).2 23 151 196 Accordingly, racism,197 sexism,34 198–200 homophobia,36 51 201 heteronormativity,191 202 ableism,112 151 sizeism (weight stigma)81 129 130 203 and other biases perpetuate unequal exposure to IV in sport. These prejudices can create a unique and distressing duality for equity-deserving groups, who are rendered both hyper visible as perpetual ‘others,’ and invisible as typecast figures denied full humanity.69 105 112 Insidious types204 205 and compounded psychological pain of IV206 reside within these societal systems.
Theories of IV/child maltreatment in sport must be informed by knowledge of how a society thinks about children and childhood.207–209 Coach–athlete relationship, in its dominant configuration, is a product of wider discourses of adult–child relation. In cultures with a prominent disciplinary discourse—arguably a universal position—the abuse of children in sport may be rationalised through, for example, English public school notions of ‘spare the rod, spoil the child’,92 or Confucianist ideas of ‘whipping with love’.140 165 210
Similarly, dominant notions of gender shape what is (not) appropriate for sportspeople at sectoral and organisational levels, and how IV is defined.205 Patriarchal ideology produces hierarchical norms that subordinate girls/women, but harm all.163 211 For example, hegemonic masculinity feminises victimhood, obstructing recognition and disclosure of IV by boys/men58 135 144 212 213 despite its clear prevalence.214 Masculinist narratives, therefore, can promote ‘rape culture’ but also shape victim/survivor responses. Boys/men who are victims may respond ‘…by pushing the hyper-masculinist norms of male-sport even further, for example, engaging in excessive alcohol consumption or violence’.135 Such narratives may endorse or promote myths about IV that influence organisational responses to victims/survivors.
The escalating political significance of international sporting success and the resultant ‘global sporting arms race’215 formed the backdrop against which performance-based funding and ESS developed and intensified.124 176 Commercialisation, therefore, facilitates and maximises athlete dehumanisation,216 expressed as commodification32 195 and macabre glorification.175 217
Spectators’ behavior, mass media, and associated consumer uptake can represent and reinforce harmful sport ideologies.146 Social media is an extended channel218 219 through which misogyny, racism and threats of violence are ‘weaponised’,124 199 219 220 coach and other perpetrators gain the trust of victims221 and gender(ed) harassment arises among peers.23 222 Media/online violence can cause psychological harm to sportspeople124 and maintain gendered, racial, faith-based and other hierarchies.199 200 218 219 Much is yet to be known about a fast-growing hybrid space, where online and offline realities merge. Table 6 presents consensus recommendations related to contextual determinants of IV in sport.
Consensus recommendations* related to contextual determinants of interpersonal violence in sport
The variables in Section 3: Individual and interpersonal determinants of IV in sport and Section 4: Contextual determinants of IV in sport are distinct yet interconnected, interacting across socioecological levels to either facilitate or hinder IV in sport. For example, dominant performance ideologies at the organisational and sectoral levels significantly influence coaching practices, caregiver/family expectations and athletes’ behaviours within sport at the individual/interpersonal level.143 Historical and generational shifts in normative social values (temporal level) can also impact mutual expectations, tolerance and acceptance of behaviours (individual/interpersonal level). The nature of performance ideologies, coaching practices, caregiver/family expectations, athletes’ behaviours within sport and sociocultural movements and global trends is therefore reciprocally dynamic.68–71 105–107 223 IV in sport is complex and demands multiscale, multilayered and multidisciplinary solutions.
Section 5: Towards solutions for IV in sport
Select studies that address preventing and/or responding to IV in sport are reviewed below, focusing on gaps. The reviewed articles (n=52) were pitched at either athlete level (49%; ie, all, children/youth and girls/women) or organisational level (51%).
Athlete populations
Athlete-focused interventions
Despite existing national and international IV policies and reporting mechanisms, awareness that these policies exist and are safe to access is low among athletes.40 193 For example, research highlights child and youth athletes’ lack of practical knowledge regarding where to report IV, as well as the perception that individuals in power ‘lack accountability to protect athletes’ from it.224
While few youth-specific initiatives have been evaluated, qualitative studies show current national and international safeguarding infrastructures in youth sport have limited influence and are frequently under-resourced and underused.202 224 Youth voices are rarely incorporated into initiative designs due to a range of barriers.225 Notably, though reviewed manuscripts focused on child and youth athletes, these concerns apply to all athletes.
Gender-specific interventions
Studies on preventing sexual violence against girls/women collectively highlight the need for a multilevel approach, encompassing attitudinal and cultural shifts, as well as structural and social adjustments.160 162 193 Dedicated roles within sport institutions could pressure action at organisational levels.162 At the same time, sport organisations need capacity building and external support from the specialist violence response sector to develop and implement effective safeguarding roles and initiatives.160 Interpersonal-level programmes designed to prevent IV in sport among men/boys have encompassed bystander intervention and advocacy programmes that could be applied more widely across all athlete groups.226–232 Expanding the research focus beyond the male perpetrator-female victim paradigm and the gender binary is also crucial.
Athletes experiencing higher levels of IV
Few studies have examined IV prevention among athlete groups that may experience higher levels of IV, for example, racially/culturally and linguistically diverse, para, indigenous and SOGIESV athletes. Safeguarding models specific to children with disabilities have relied on qualitative data representing athletes’ voices.233 These could be important potential templates for developing safeguarding initiatives moving forward; however, they have not been evaluated for effectiveness and should be bolstered with future research. Notably, there is an absence of studies focused specifically on men/boys, who may also benefit from individualised approaches that reduce stigma and normalise IV reporting.
Sport organisations
The reviewed literature highlights organisational safeguarding initiatives, many already in practice, such as required trainings and policies,234 codes of conduct,167 education, training,129 167 policy implementation161 235 and addressing power dynamics and coaching practices related to IV risks.83 Some initiatives prioritise athlete inclusion.35
Some studies described specific safeguarding initiatives,143 160 161 236 237 and only two were evaluated for effectiveness: hazing prevention236 and the implementation of the ‘International Safeguards’.134 Though falling outside this review, the most substantive investigation into the effectiveness of safeguarding in sport seems to be Brackenridge et al’s 2006 study of British football.238
In the reviewed studies, some sports federations and clubs actively denied the existence of IV directed towards athletes and claimed there was little need for safeguarding policies and practices.150 202 For example, a recent study of 10 large Swedish sports federations found federations have ‘…taken few or no measures against sexual abuse’.150 Despite unanimous acknowledgement of child sexual abuse in sport as ‘absolutely unacceptable’ by participating federations,239 the majority were described as perpetuating a ‘culture of silence’ around the issue150 partly to evade past scandals that crippled other sports programmes. In another study, only 50% of 8571 German sport clubs considered sexual violence prevention a relevant topic.202
Directions for solutions-focused research and practice
There is a dearth of solutions-focused research in the existing literature. In our review, only 52 citations focused on safeguarding, the majority of which were descriptive, focused only on problem definition or designed only to identify risk factors. Articles proposing safeguarding strategies, while promising, had not been empirically assessed for effectiveness or were examined in studies with sampling or methodological limitations (eg, small convenience samples, case studies). Increased varieties of research, including those that are more methodologically empirical, can draw further, more specific attention to solutions-focused research.
Only five of the reviewed studies were designed to evaluate the efficacy or effectiveness of a specific safeguarding strategy or policy. Moreover, interventions focused predominantly on sexual violence, omitting other types of IV (see table 1). This highlights underinvestment over the past 15+ years in empirically based research designed to create broad IV prevention and response strategies in sport. Despite this, many organisations currently use some form of IV prevention and response strategy, safeguarding approach and/or policy they believe is effective. The development of a range of effective, evidence-informed safeguarding strategies is crucial.
None of the reviewed articles focused primarily on promoting IV disclosure or reporting in sport. This contrasts with the numerous articles addressing this topic in university settings.240 241 There is a need for research designed to foster IV disclosure and reporting in sport. At the same time, scholarship addressing ‘upstream’ systems, such as psychologically safe environments where it is safe to risk coming forward without fear of negative consequences, must also expand. The sports context interacts with disclosure and reporting systems; both must be healthy and athlete centred.
Few solutions-focused research incorporates multiple stakeholder perspectives, including child and youth athletes. Given the benefits of ‘triangulating’ perspectives and experiences from diverse stakeholder groups in safeguarding initiatives’ design, this is a crucial gap.83 242–244 Although there is recognition of the value of children’s voices in sport, barriers such as heavy adult involvement in sport administration hinder their incorporation.225 Organisational culture change and using new methods, such as digital technologies, may help facilitate children’s voices effectively and mitigate abuse. It is also essential to ensure that marginalised groups, for example, culturally diverse, para, indigenous, gender and sexually diverse individuals, have their voices heard.233
As above, some sports federations and clubs have not fully acknowledged, adequately supported or responded to IV in sport.150 175 202 This highlights the need for all country’s sport federations to prioritise participants’ safeguarding and well-being. Table 7 presents consensus recommendations related to solutions for IV and safeguarding in sport.
Consensus recommendations* related to solutions for interpersonal violence and safeguarding in sport
Limitations
This consensus statement was systematically planned and executed but has several limitations. First, because the goal of ScRs is to map an evidence base, and methods can be adjusted according to time constraints, included empirical studies were not critically appraised. Additionally, a search update was not run across all databases beyond December 2022; however, forward citation chaining and a Google Scholar search were conducted in July 2023 which allowed for the inclusion of 15 recent manuscripts on this topic. Due to project scope and scheduling limitations, the grey literature included in this consensus was limited to reports and statements to which coauthors had knowledge and/or access. Some data extractors were not also reviewers at the title/abstract and full text levels, and vice versa.
Discussion
This paper and its conceptual model recognise the potential for systemic change (plasticity) in sports contexts. Adopting such an approach relies on multilevel change (figure 4) and is inherently optimistic: the paper asserts that applying the evolving knowledge presented here can help safeguard sport.5 While the presented data confirm Brackenridge’s words, ‘sport is not a sacred space’,4 245 246 various studies also affirm that the overarching values of sport are positive and can uplift and unite people across time and space.109 247–249 Sport’s immense global reach necessitates a reflection on the incongruity between the virtues of sport and the ‘venom’ of abuse. Most do not go into sport expecting to experience IV. Instead, they often seek the camaraderie, joy of effort, celebration of the human spirit, teamwork, sense of belonging and associated virtues that the ethos of sport provides.109 247–249 IV has no legitimate place in sport. It is counter to and undermines sport’s desirable attributes.
Five overarching recommendations for all within sport’s ecosystem emerge from this review (figure 5):
Address safe sport as everybody’s responsibility.
Recognise that safe sport is for all within the sports ecosystem.
Encourage awareness, adoption and implementation of current scientific knowledge on safeguarding in sport.
Encourage sport that is athlete centred, emphasising mutual care and respect.
Outreach to unheard voices and integrate global perspectives into safe sport.
Overarching consensus recommendations. Addressed to all within the sports ecosystem, these five overarching consensus recommendations were presented as voting statements during the Delphi process and reached 80% agreement among expert panel members.
Addressed to all within the sports ecosystem, these five consensus recommendations were presented as voting statements during the Delphi process and reached 80% agreement among expert panel members. To apply these recommendations, five theory-based and actionable guidelines are provided next.
1. Prioritise relational health
Across the intersecting aspects of the sports ecosystem (between organisations and athletes, among entourage members, etc), healthy relationships that are safe, stable and nurturing250 must exist. Where relationships in sport cause sustained damage and distress, sport fails its participants and falls short of its potential. In contrast, facilitating relational health supports an ethic of care within sport and boosts sport’s galvanising role in society.251 252
In practice, relational health requires trust and communication to be built between sportspeople and organisations. At individual/interpersonal levels, this is intuitive (eg, between coach, parent/caregiver and athlete83 253), and although IV experiences are highly subjective/personal,254 research suggests that a felt distinction between healthier and unhealthier relationships can be discerned.255–257 Relational health can be extended to sectoral and societal levels. For example, national sports organisations could come together to develop common safe sport codes informed by current scientific knowledge, cultural context(s) and extensive multistakeholder consultations within and outside sport. This could be accompanied by handbooks, classification tools and procedural guidelines to promote a unified approach to IV prevention and response, benefiting participating sports organisations equally and measurably—emphasising safe sport as everybody’s responsibility.
2. Integrate safeguarding with the values of sport
Safe sporting environments and high-performance sporting success can go hand in hand. As Mallett and Lara-Bercial’s258 study on serially winning coaches highlights, sport philosophies focused on conscientiousness, higher purpose and personal growth can also emphasise traditional values of (elite) sport such as achievement.258 In this way, ‘safe sport can harmonise well’ with (elite) sports culture, including performance-related goals and continuous improvement seeking.184 This strengths-based approach (rather than a deficit correction approach) has been shown to optimise performance and well-being in non-sport contexts.259 While it must be acknowledged that performance-oriented sporting values can be misused (see table 6), by responsibly and thoughtfully leveraging sport’s positive elements, safeguarding efforts may find better uptake and effectiveness among sportspeople. To do this, explicitly include safe sport in the concept of sporting success, underpin safeguarding measures with an empowering climate and positive reinforcement, regularly ask for athletes’ feedback and find ways to both measure and increase mutual care and respect within sport settings.260 261 Responsible sport must be values based,262 as well as athlete centred and child centred263 264—emphasising their unheard voices. Expanding sport’s central concept of ‘winning’ to include well-being can also emphasise personal growth and life experiences beyond sport.265
3. Implement trauma- and violence-informed care and practice
In trauma- and violence-informed care and practice (TVIC/P), for comprehensive prevention, identification, assessment and recovery from trauma, interdisciplinary and professional engagement (eg, between policymakers, coaches/managers, entourage members, sport organisations, etc) is prioritised to reinforce trust and ensure appropriate follow-up and treatment for those requiring mental health services or social support. Six evidence-based principles underpin a trauma-informed approach (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; cultural, historical and gender issues), reinforcing athlete-centredness and athlete voice.266 A violence-informed approach acknowledges the structural features of violence that reside within the socioecological context (figure 4 267). This is particularly important in sport settings, where harmful ideologies, behaviours and expectations are often internalised by athletes and others—making them more difficult to uproot.8 82 127 131 268 Notably, measuring TVIC/P is increasingly feasible; existing measures would need to be adapted for sport.267
4. Embed principles of implementation science
Implementation science is the scientific study of processes and methodologies that promote the uptake of evidence-informed and based interventions into real-world practice and policy. Suited to deliver multilayered understandings of socially constructed experiences, implementation science models use standardised measurement tools to gauge organisational context, readiness for change, acceptability, feasibility and intervention fidelity. Early engagement of athletes, entourages and organisations would be a prerequisite to successful intervention uptake. This is particularly valuable when navigating culture change as a potential barrier (eg, organisational resistance, inaction and denial),150 175 202 and media/online spaces as a potential intervention site.124 220 269 Implementation science principles centre athletes’ voices, incorporate current scientific knowledge, follow principles of human rights-based and values-based research practices and increase the likelihood of effectiveness. Implementation science is appropriate for complex disciplines like sport due to its comprehensive coverage of all socioecological layers. Adhering to implementation science reporting guidelines enables broader dissemination and comparisons, facilitating implementation across diverse sports and countries, and integrating unheard voices and global perspectives into safe sport.
5. Measure effectiveness
Once evidence-informed safeguarding interventions are implemented in real-world sport practice and policy, it is essential to integrate contextually appropriate effectiveness and evaluation methodologies. While evaluation and improvement are inherent in implementation science methodology, sport-specific approaches are also necessary.270 This is because sport’s culture of silence, routine processes of control, coercion, and manipulation, and other unique features, can undermine personal dignity, autonomy and identity, enable or disguise IV and debilitate safeguarding measures.8 9 150 193 Brackenridge et al’s271 ‘Activation States’ methodology was specifically designed to capture culture change and inform the evaluation of safeguarding initiatives within sport.272 273 Bandura’s sociocognitive theory underpins Owusu-Sekyere et al’s (2021) sport-specific safeguarding culture model.273 Hartill and Lang179 conducted one of the few studies representing and investigating the perspectives of those implementing safeguarding in sport policy, highlighting implementation and effectiveness challenges across multiple sports.179 Reviewing such studies may help effectiveness and evaluation methodologies harmonise with sport culture, particularly given the push to introduce safeguarding roles in more countries and sports (eg, sports ombudsmen, safeguarding officers).
Addressed to all within the sports ecosystem, these five consensus guidelines were presented as voting statements during the Delphi process and reached 80% agreement among expert panel members.
Finally, effective safeguarding research, policy and practice rely on the qualitative features of responsible sport described above: camaraderie, teamwork and associated virtues. As concerned sportspeople across sport’s ecosystem more readily recognise their own felt sense of safe sport, individually, within groups and as part of sport organisations, and as healthy relationships are proactively cultivated between organisations, groups and individuals working together, safeguarding can be enhanced. This degree of relational health and wealth, multiscale, multilayered and multidisciplinary, may be what is needed to ensure everybody in sport thrives.
Advice for clinicians
As members of the health and performance team, SEM clinicians can play a critical role in sport safeguarding. Three themes emerging from this review can enhance clinical practice:
Trauma- and violence-informed care
Foster a safe, supportive environment by recognising the widespread prevalence and impact of trauma. Build rapport while empowering athletes’ voices by using open-ended questions, like ‘How are things going with the tournament?’ or ‘Can you tell me about the team meeting?’ This promotes transparency, collaboration and trust.274 275
Multidisciplinary approach
Treatment and recovery teams should include SEM clinicians, mental health professionals and social workers as needed for the case. Clinicians should avoid investigative roles and focus on reflective listening (eg, ‘I’m sorry that happened to you’), referring patients to appropriate specialists. This may include staff within statutory protection agencies and/or staff within the clinician’s environment with similar designated responsibilities. In many cases, clinicians are mandated reporters; ensure athletes and families understand this and know the local reporting procedures. Clinicians involved in medicolegal work should note that health and legal systems often differ in their approaches to IV, including terminology.252 274–277
Socioecological perspective
Take a holistic view of athletes, considering their relationships and environments. Ask about important people in their lives and look for signs of healthy or unhealthy relationships. A broader assessment of contextual variables and social factors can be integrated into even time-sensitive clinical encounters.250 275 278
Conclusion
The topic of IV and safeguarding in sport has evolved in the academic and grey literature. Widespread recognition of and attention to this matter by all within sport’s ecosystem supports the rationale for a timely and updated consensus statement on the topic. By formally proposing an overarching term—IV—and an updated conceptual model of IV in sport with corresponding consensus recommendations and guidelines, this statement brings more inclusive clarity to the problem, the contributing influences and the diversity of practical, accessible and sustainable solutions that will positively impact global sport.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Acknowledgments
Special thanks to our dedicated information scientist Kayla Del Biondo at the Yale School of Public Health for her professionalism, skills, strategies and guidance throughout. Thank you to the entire cross-departmental team at the Cushing/Whitney Medical Library at Yale University led by Vermetha Polite, who located full-text articles as well as Jan Glover, who peer reviewed the search strategies according to the Peer Review of Electronic Search Strategies (PRESS). Thank you to Hanjia Li, Rob Booth, Aline Candeo, Julia Casas Figuora, Varini Kadakia, Samantha Seneviratne, Catalina Melendro Blanco, Melanie Burton, Antonia Mungal, Nicole Johnson, Gabriela Mendoza Cueva, Jyoti Gosai, Madeline Proctor, Evelyn Kisakye, Samantha Nardella, Alexia Tam and Ioanna Kantartzi, each of whom generously contributed their time, talent and tenacity to the project while simultaneously pursuing their studies. Thank you to the Qualtrics team led by Denzil Jennings for technical support with survey management, as well as forward and backward language translation of the athletes’ survey. Thank you to Gloria Viseras, Madeleine Pape, Magali Martowicz, Charlotte Groppo, Katia Mascagni, Torbjorn Soligard, Kit McConnell, Scott Sloan, Lars Englebretsen, Michael F Bergeron and Ugur Erdener for specialist expertise and guidance. Thank you to Kirsty Forsdike for early scholarly contributions to the project. This consensus statement would not have been possible without this committed team of professional information scientists, digital technology experts and sport specialist experts, and without our passionate ‘army’ of masters and doctoral students. Finally, the authors wish to express enormous gratitude to the two athletes who participated in person, and to the larger group of global athletes, competing and retired, to whom this project is dedicated.
References
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Footnotes
X @YetsaTuakli, @Kirsty_Burrows1, @s.kirby@uwinnipeg.ca, @margo.mountjoy, @TineVertommen
Contributors YAT-W and DJAR made substantial contributions to overall and detailed conception, planning, design and coordination of the paper. All authors contributed equally to drafting and revising the manuscript. YAT-W and DJAR are guarantors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests YAT-W and MM are associate editors of BJSM. KB is director of the IOC Safe Sport Unit.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.