Study selection

The electronic database search yielded 6335 records. Twenty studies were included in this review after title, abstract and full-text review (figure 1). Study characteristics are outlined in table 1. The sports included were soccer/football (n=17)5 11 12 36–49 and Rugby Union (n=3).13 28 50 Coaches worked with male athletes (n=8),5 13 28 36 42 45 48 49 female athletes (n=6)11 12 37 39 44 47 and both male and female athletes (n=6).38 40 41 43 46 50 Fifteen of 20 studies implemented the IPPs in a club setting,5 11 12 36–38 40–48 four in a school setting13 28 49 50 and one in a national talent pathway system.39 Nine of twenty studies asked coaches to implement a version of the FIFA 11+,11 12 36 38 42 44 45 48 49 three studies asked coaches to implement a version of the ‘Knee Control’ programme.5 43 47 The sex of included coaches and intended end-users (players) varied across all studies. The primary aim of the included papers is reported in table 1.

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Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the selection of included papers.

Logistics of CE

Just over half of studies (n=11) referred to the CE intervention as a ‘workshop’.12 13 28 37–39 41 44–46 50 At least one player attended the full CE session to act as models in five studies11 13 42 43 47; they were present for a portion of the CE in two studies5 40; they were not in attendance in eleven studies12 28 38 39 41 44–46 48–50 and it was unclear/unreported in two studies.36 37 Most CE interventions occurred in the preseason (55%),5 11 12 28 37–39 44–46 50 one occurred at the beginning of the season,43 six occurred prior to the start of the intervention period but the time of playing season was not reported13 40–42 47 49 and two did not report.36 48 All CE took place face to face. Eighteen of twenty CE interventions occurred at one time-point (one workshop/one session on a single day).5 11–13 28 37–39 41 43–50 Two were unreported or unclear as to when their CE took place.36 42 The duration of CE ranged from 30 min37 to over 6 hours48 (table 2).

Design and facilitation

Fifteen studies did not explicitly refer to or report a theoretical basis for their CE intervention.5 11 12 36 37 39–43 45–49 Five studies cited a behaviour change model/theory: four of these used the Health Action Process Approach (HAPA)13 38 44 50 while one study used HAPA alongside Bandura’s theorised sources of self-efficacy.28 Experiential learning (ie, peer coaching on a pitch) was evident in seven studies,11 28 38 41 45 46 50 practical instruction/didactic teaching methods only were reported in ten studies5 12 13 37 39 40 43 44 47 49 and no teaching methods were reported in three studies.36 42 48 Teaching methods/behaviour change techniques used are outlined in table 2. The authors or other researchers from a variety of backgrounds (coaching, physiotherapy, sport science, physiology) facilitated the CE in 15 studies,5 11 13 36–41 44–47 49 50 physiotherapists or physical therapists facilitated in four studies,5 12 38 43 community coaches from the sporting organisation external to the research group facilitated in one study,28 and facilitators were not reported in two studies.42 48 Resources (hard and soft copy) were supplied to coaches in 18 studies5 11–13 28 37–41 43–50 and unreported in two36 42 (online supplemental file 3).

Follow-up and evaluation

Twelve of twenty studies reported some form of ongoing support to coaches following the CE primary intervention concurrent with IPP implementation.5 11 12 36 37 39–41 45–47 49 The degree of support varied and is outlined in table 3. Explicit evaluation of coach delivery (formative or summative) occurred in only two studies: in the first 2 weeks of implementation37 and informal assessment during the preseason CE.46 Six of nineteen studies measured possible determinants of coach behaviour prior to an implementation period (risk perception, intentions, perceived behavioural control, outcome expectancy, self-efficacy)12 28 37 38 44 50 (table 4).

Completeness of reporting

The median TIDieR score of included studies was 50% (range 0%–79%). None of the evaluated items were reported completely (figure 2).

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Figure 2

Completeness of reporting (percentage %) across studies using the modified Template for Intervention Description and Replication checklist.

Discussion

The primary objective of this scoping review was to systematically map how coaches are trained to deliver IPPs for youth field sport athletes. Despite significant heterogeneity across studies, key characteristics of existing CE have been identified, as well as areas where greater coaching support, or intervention reporting, may be feasible to address competency as an implementation driver.

Eighteen of the twenty studies that reported when CE was conducted, delivered their CE prior to the commencement of the IPP implementation period. This was a stand-alone antecedent intervention consisting of one formal educational contact point on 1 day. Some post-CE support was offered concurrently to the in-season IPP implementation to varying degrees in 12 of 20 studies; although in many cases this was minimal, was not for the purpose of furthering coaches’ competency and lacked formal structure. This ranged from distant observation of coaches checking exercise fidelity (as a means to establish programme efficacy), ad-hoc telephone calls with research staff to answer queries; or hands-on support to correct technique at some team sessions. Five of seventeen studies that included an implementation period reported no implementation support for delivery agents in any form. Both preservice and in-service training are core implementation components51 and while most coaches were in receipt of this at the start of the season/implementation period, little to no in-service training or coaching was reported beyond this offering little opportunity for ‘on-the-job’ coaching.19

Performance assessment is another core component of competency.51 Structured formal feedback during the in-season period was not a component of the interventions reviewed despite formative feedback being a crucial ingredient in the improvement of knowledge and skill acquisition.52 Two included studies incorporated an explicit evaluation of coach delivery of the IPP, with only Frank et al 37 conducting this during the implementation period. While coaches were made aware of the evaluation in advance, it is not reported if they received feedback during the implementation period or if the findings were used as an assessment of fidelity only.37 Pryor et al 46 did conduct informal coach evaluations during the CE workshop, but feedback is most effective for learning when it is conducted in-season when there is context for the learner.53 Process evaluation and the feedback that can be drawn following it is a powerful tool for professional development53 and the provision of this feedback through a mentor, especially in the initial implementation period, may be helpful for driving coach competency.19 52 Although it is recognised that this may not be sustainable in large-scale strategies nor feasible when conducting efficacy studies.

Barriers, such as integrating the programme into sessions and the number of athletes present,20 may be first encountered in the implementation stage and thus the opportunity for context-specific support and feedback may aid further competency development. While providing this on a one-to-one basis would be preferred, it is unrealistic especially in nationwide implementation strategies. Thus, facilitating communities of practice for coaches is a suggestion for peer-to-peer provision of ongoing support and discussion to address these fresh challenges.54 Examples of ongoing professional development for coaches in place of one-off certification courses, similar to one-off CE for IPPs in this review, are gathering support.55 As one example, a coach-development programme in Australia engaged coaches in three separate phases across an 8-week period. Phase 1 comprised a 6-hour workshop; in phase 2, the research team provided support across the intervention period in the form of facilitated discussion and the provision of training ideas via an online Facebook page (ie, community of practice); and phase 3, where participating coaches had the opportunity to evaluate their mentor’s practice, followed by group discussion. Large effect sizes were reported for coach confidence and competence, while 25% more training time was dedicated to desired activities, when compared with the control group indicating a substantial change in coach behaviour.56 Train-the-trainer models for IPP delivery may be adapted from such an example to evolve the ad-hoc support currently offered to coaches when implementing IPPs with their players.

Despite this review identifying infrastructural components of competency development that may be targeted in future strategies to enhance implementation, this seeks to complement the success already accrued by various sports governing bodies in reducing injury incidences. As one example, a nationwide strategy to implement FIFA 11+ in all soccer clubs in Switzerland saw an 11.5% and 25.3% lower incidence of match and training injuries, respectively.57 While meta-analysis was not possible given the heterogeneity of reported data, many of the papers included in this review report coaches delivering sessions at least once per week, and adherence of between 53% and 85% indicating that coach behaviour change is possible and further competency support should be explored to optimise this.

In addition to addressing infrastructural components, behaviour change of coaches (in addition to others) is also a requirement to ensure sustained and frequent IPP delivery. No consensus on behavioural change techniques (BCTs) or strategy was apparent in this review. Half of the studies included appear to expose coaches to didactic and observational teaching methods only, contrasting with the experiential learning of coaches practicing the delivery of IPPs to their peers or athletes that was reported in one-third. Interventions that use experiential learning tend to have greater effects on the behaviour of the delivery agent in comparison to didactic teaching methods58 and are preferred in 72% of continuous professional development for healthcare professionals.59

Behaviour demonstration, as just described, is one of many groupings of BCTs that are included in the BCT Taxonomy (v1).60 Similar to a review conducted by Allan et al 61 in coach development programmes, many BCTs are used throughout the reviewed papers. However, it is unclear which BCTs are most effective61 nor was it possible to code them as per this taxonomy.60 It is even less clear which behaviour change models are most effective within the coaching context as no dominant or comprehensive theory has yet been identified.61 Some contributing factors to this lack of clarity may be attributed to the infrequent use of behaviour change theories.61–63 A review conducted over a decade ago concluded that just 11% of injury prevention research explicitly mentioned the use of a behavioural change theory in the design of their study27; lower than the 25% of studies that explicitly report use in this review. Five studies included here used one or more theories in the development of their CE. Four studies used the HAPA model in isolation, while Barden et al 28 used this in conjunction with Bandura’s Theorised Sources of Self-Efficacy. The HAPA model has not been used previously in coach development programmes61 but has been used across wider healthcare literature.64

It is prudent to emphasise that changing health-related behaviour is a difficult task,29 and well-intended comprehensive CE designed with both competency and behaviour change in mind may still fail to change the behaviour of every coach. Assumptions that common sense will prevail, simply getting the main message across and supplying information to coaches will be enough to change their long-term behaviour is naïve at best.29 Some field sport coaches will still believe some injuries are not preventable,65 coaches and their clubs will be aware of effective IPPs and still choose not to implement them66 and acquiring knowledge may change intentions, but it may not translate to changing behaviour.37

As previously indicated, adopting theoretical implementation science to large-scale strategy is a balancing act. With enhanced CE strategies, as suggested in this review, comes the need for increased resources, both personnel and financial, and this may not be realistic. For example at an organisational level, ‘Activate’, the IPP developed by England RFU, has been disseminated for use across kids, youth and adult club Rugby grades67; which in 2018 accounted for 355 153 registered players.68 One-to-one mentoring for that volume of community coaches is not feasible, but in-service support through communities of practice may be a suitable alternative option.54 56 At the individual level coaches, especially in youth sport,69 70 are typically volunteers otherwise engaged in full time employment elsewhere and express the lack of time as a stressor in addition to lower levels of commitment to their organisation when compared with coaches employed on a full-time basis.71 These are important considerations to pull future implementation designs back from theory and into reality.

Finally, incomplete reporting of intervention detail for the purpose of replication was evident across all studies. Details of the personnel facilitating the CE sessions were reported in 35% of studies which is similar to the 39% indicated by Dijkers in a review of interventions in healthcare research reports.72 Detail regarding the timing of CE during the playing season (55%) and the number of sessions (75%) is also less than the broader healthcare research72 despite its logistical importance. The incomplete reporting of details for the implementation of interventions is an ongoing issue in healthcare education and research as it makes replication and further investigation difficult.35 59 Fundamental logistical components of CE at the very least (ie, duration, session facilitators, resources, content, teaching methods) when describing CE interventions are needed to progress the identification of both effective and ineffective implementation strategies and to increase the speed at which research can bridge the implementation gap.14

Limitations

This review has both strengths and limitations. A scoping review protocol was published prior to commencement of work. Only minor adjustments to the wording of the eligibility criteria were made following a pilot literature search and screen, while the eligibility of grey literature was removed at this point given the volume of peer-reviewed published literature. While the scoping review methodology employed was chosen as an appropriate vehicle to examine the extent and scope of CE for the purpose of IPP implementation, it does not evaluate the effectiveness of various intervention components. In addition, we recognise that the depth of information reported about the CE intervention may have been limited due to journal word count restrictions, depending on their respective study primary aim. Authors were contacted following data extraction to address this, and additional data are included where provided by the corresponding author. We used a modified version of the TIDieR checklist to evaluate study reporting. However, it is not a rating of research quality72 and comparisons with TIDieR ratings from other studies are complicated by varying interpretations of reporting completeness.72