Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review
Abstract
:1. Introduction
2. Literature Search
3. Interventions
3.1. Intervention Demographics
3.2. Intervention Charactersitics
3.2.1. Intervention Procedures and Modes of Delivery
3.2.2. Curriculum Content and Intervention Providers
3.2.3. Use of Theory
4. Research Design
5. Outcome Measures and Key Findings
5.1. Knowledge
5.2. Attitude and Intention
5.3. Use
6. Gaps in the Literature and Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Study Demographics | Intervention Characteristics | ||||||
---|---|---|---|---|---|---|---|
Publication-Country | Target Population | Age Mean ± SD (Years) | Sex (Sample Size) | Intervention Procedure/Mode of Delivery | Intervention Duration | Intervention Provider | Curriculum |
Allahverdipour et al. (2009) Iran [33] | Urban Iranian high school students | EG: 16.1 ± 0.8 CG: 16.2 ± 0.6 | M (n = 189) | EG: Role playing, group discussions. (Face to face.) CG: Passive controls | 3 months. (60-min sessions, twice a week.) | Trained study staff | EG: Side effects and consequences of substance use. |
Álvarez et al. (2019) Spain [34] | Adolescents | 12–13 | M (n = 270) F (n = 270) | EG: Physical activity, group debate. (Face to face.) CG: Passive controls. | One month. (Six 55-min sessions, twice a week.) | Physical education teachers | EG: Doping, principles of fair play, substances and methods of doping, importance of struggle against doping, the values of the true “spirit of sport”. |
Barkoukis et al. (2016) Greece [35] | High school students | EG: 16.1 ± 1.7 CG: 15.8 ± 0.7 | M (n = 107) F (n = 110) | Classroom sessions. (Face to face.) | 20 h. (1.5 h per week.) | Physical education teachers | EG: Health, moral, social, and psychological aspects of nutritional supplement and doping use. CG: Other health-related issues (recycling, bullying, psychological well-being) |
Chiba et al. (2020) Japan [36] | College students | 18–38 years | M (n = 150) F (n = 178) | Lecture-based. (Face to face.) | 7 months. (1-h lecture.) | First author | Safety of dietary supplement use, quality of DS, the possibility of interactions between DS and medicines, adverse events that might occur due to their use. |
Codella et al. (2019) Italy [37] | High school students | 15–18 years | (n = 20,800) | Seminar (PowerPoint presentation, scenario-analysis, problem solving, group discussion). (Face to face.) | 2 h. | Expert leaders (track and field coaches, sport scientists, sport psychologists, physicians) | Doping-related medical aspects, psychological aspects, and athletic coaching. |
Duncan and Hallward (2019) Canada [38] | Adolescent athletes | 13.7 ± 1.3 | M (n = 70) F (n = 63) | Gain-framed or loss-framed messages. (Video.) | 5-min video. | Research team | Physical, psychological, social, and moral reasons to avoid doping. |
Elbe and Brand (2016) Germany [39] | Young elite athletes. | 15.5 ± 2.4 | M (n = 34) F (n = 35) | Educational sessions. (Online.) CG: Passive controls. | 2 weeks. (Six 30-min online sessions.) | Research team | Ethical decision-making group: Dilemmas related to doping. Standard knowledge-based educational program: Precursors and consequences of doping, forbidden substances, doping control system, law and punishment, and doping on the internet. |
Elias et al. (2018) Malaysia [40] | Malaysian team sports athletes | EG: 18.7 ± 0.9 CG: 23.3 ± 3.8 | M (n = 105) | EG: Educational booklets, lecture sessions, group discussions, and group activities. (Face to face.) CG: Passive controls. | 7 weeks. (1–2 h per week.) | Researchers | Food and healthy nutrition, macro and micronutrient, fluid and hydration, nutrition before, during and after training, energy balance and weight management, dietary supplements. |
Elliot et al. (2004) USA [41] | High school athletes | EG: 15.4 ± 1.2 CG: 15.4 ± 1.2 | F (n = 928) | EG: Classroom sessions. (Face to face.) CG: Pamphlets | 8 weeks. (Eight 45-min classroom sessions.) | Coaches and squad leaders | EG: Healthy sport nutrition, effective exercise training, drug use, unhealthy behaviors’ effects on sport performance, media images of females, depression prevention. CG: Disordered eating, drug use, and sports nutrition. |
Goldberg et al. (1990) USA [42] | Varsity high school football teams | 17 ± 1 | (n = 190) | EG1: Oral presentation, Q/A session, handouts. (Face to face.) EG2: Education handout. CG: Passive controls. | 20-min presentation. | NR | Information on The American College of Sports Medicine’s (ACSM) position on the use of anabolic androgenic steroids in sports. |
Goldberg et al. (1996) USA [43] | High school football teams | EG: 15.9 ± 1.1 CG: 15.7 ± 1.1 | M (n = 1506) | EG: classroom sessions, weight-training sessions. (Face to face.) CG: Pamphlet. | 7 weeks. (Seven 50-min class sessions and 7 weight-training sessions.) | Coaching staff, peer educators and staff trainers. | Anabolic androgenic steroids (AAS) effects, sports nutrition, strength-training alternatives to AAS use, drug refusal role play, and anti-AAS media messages. CG: Problems associated with AAS use, ethics of fair play and sportsmanship. |
Goldberg et al. (2000) USA [44] | High school football teams | EG: 15.5 ± 1.2 CG: 15.4 ± 1.2 | M (n = 3207) | EG: Classroom and exercise training sessions. (Face to face.) CG: Pamphlet. | Cohort 1: Seven 45-min classroom and seven weight-room sessions. Cohorts 2 and 3: Five 45-min- classroom sessions and three weight room sessions. | Coaching staff, peer facilitators and trainers. | EG: Sports nutrition, exercise alternatives to anabolic steroids and sport supplements, effects of substance abuse in sports, drug-refusal role playing, and the creation of health promotion messages. CG: Adverse effects of anabolic steroids and benefits of a sports nutrition diet. |
Hurst et al. (2020) UK [45] | Junior elite athletes | 17.2 ± 0.7 | (n = 202) | Electronic presentation in a classroom setting. (Online.) | 60-min session. | Track and field athlete | Information about the World Anti-Doping Agency, drug testing, anti-doping rule violations, use of medications, and risks associated with sport supplements. |
Jalilian et al. (2011) Iran [46] | Young gym users | EG: 24.4 ± 5.5 CG: 23.0 ± 3.1 | M (n = 120) | EG: Group discussion, printed leaflet, and audio-visual CD. (Hybrid.) CG: Passive controls | Six 1-h sessions. | Mediator | EG: Side effects of anabolic androgenic steroids (AAS) abuse. |
Kavussanu et al. (2020) UK and Greece [47] | Athletes | 16–20 | M (n = 201) F (n = 102) | Video, group discussion, role -play, problem solving. (Hybrid.) | Six 1-h sessions. | Trained facilitator | - Moral intervention: success in sport, values in sport, justifications for doping, consequences of doping for others, the culture of the team. - Education intervention: doping control, banned substances, sport supplements, nutrition, whistleblowing. |
Little et al. (2002). USA [48] | Adolescents | NR | M (n = 15) F (n = 24) | EG: Lectures, group activities, class discussion. (Face to face.) CG: Passive controls. | Seven weeks. (Five 1-h sessions.) | Investigators | EG: Vitamins, minerals, water, protein supplements, creatine monohydrate, fat-burning supplements, steroid-alternative supplements, muscle-sparing supplements, sports drinks. |
Lucidi et al. (2017) Italy [49] | High school students | EG: 16.6 ± 1.3 CG: 16.1 ± 1.4 | (n = 492) | EG: Seminars, meetings. (Face to face.) CG: Regular school classes. | Six months. (Twelve 90-min sessions/twice a month.) | Communication experts, pharmacology experts, high-level sport athletes, sport psychologists | EG: Role that media messages can have in promoting dysfunctional beliefs, side effects of doping substances, moral and ethical implications of doping substance use, beliefs and strategies in re-framing awareness and sport-related goals. CG: Physical education or health education classes. |
Nicholls et al. (2020) UK [50] | Coaches | EG: 38.9 ± 11.9 CG: 42 ± 14 | M (n = 154) F (n = 33) | EG: Mobile application. CG: Passive controls. | Six weeks. | Mobile application | CG: Fair play, substances, nutritional supplements, rules, and leadership. |
Nicholls et al. (2020) UK [51] | High-level adolescent athletes | CG: 15.9 ± 1.6 Presentation: 16.5 ± 1.1 Online: 15.9 ± 1.3 Presentation + online: 16.2 ± 1.3 | M (n = 904) F (n = 177) | EG: Presentations (3 groups). (Face-to-face presentation, online access, and blended face-to-face and online access.) CG: Normal training. | Face to face: two 90-min presentations, 8 weeks apart. Online: online access Face to face and online: two 90-min presentations, 8 weeks apart, then online access. | NR | Introduction to doping, goals, motivation, doping myths, playing fair, resisting temptations, making the right decisions, drug testing and health, nutritional supplements, and coping strategies. |
Nilsson et al. (2004) Sweden [52] | Adolescents | 16–17 years | (n = 921) | Teaching sessions, group discussions, posters, brochures, trailers. (Face to face) | Two years. (Number/duration of lectures NR.) | Health workers | Androgenic anabolic steroids. |
Ntoumanis et al. (2021) Australia, UK, Greece [53] | Coaches and athletes. | EG: - Athletes: 22.4 ± 11.4 - Coaches: 39.7 ± 14.6 CG: - Athletes: 18.6 ± 7 - Coaches: 36.8 ± 12.1 | (n = 130) | EG: Motivationally enriched anti-doping education workshops. (Face to face.) CG: Standard anti-doping education workshop. (Face to face.) | 12 weeks (EG: Two 3-h workshops.) CG: 1-h workshop.) | Trained facilitators | EG: Doping prevention + supportive communication (training coaches on applying supportive communication to discuss doping-related issues with their athletes). CG: Doping prevention |
Ranby et al. (2009) USA [54] | High school female athletes | NR | F (n = 1668) | EG: Facilitated sessions. (Face to face.) CG: Pamphlets. | 8 weeks (eight weekly 45-min sessions). | Coach | EG: Sports nutrition, body shaping substances, supplements and diet pills. CG: Disordered eating, drug use, sports nutrition. |
Sagoe et al. (2016) Norway [55] | High school students | EG1: 16.9 ± 0.4 EG2: 16.9 ± 0.7 CG: 16.6 ± 0.8 | M (n = 104) F (n = 98) | EG1: Theoretical/classroom education + supervised strength training exercises. (Face to face.) EG2: Theoretical/classroom education. (Face to face.) CG: Passive controls. | 12 weeks (Theoretical/classroom education: four 90-min sessions Training: 12 sessions.) | Staff of Anti-doping Norway | Theoretical/classroom education: Basic and biomechanical principles of exercise and strength training, nutrition and dietary supplementation, sports ethics, anti-doping, anabolic steroids and their adverse health effects, dealing with peer pressure. Practical training: squat, deadlift, bench press, standing shoulder press, lat pulldown, seated row, and standing barbell twist. |
Trenhaile et al. (1998) USA [56] | Preadolescents | 9–12 years | M (n = 35) | EG: Sessions. (Face to face.) CG: Passive controls. | Two weeks (six 30-min lessons). | Teacher | EG: Psychological and physiological aspects of anabolic steroid use, weight training techniques, nutrition, social decision-making, and self-esteem training. |
Yager and McLean (2019) Australia [57] | Grade 10 boys | EG: 15.9 ± 0.4 CG: 15.7 ± 10.3 | M (n = 211) | EG: Classroom sessions. CG: Passive controls. | 5 weeks (ten 45-min sessions). | Physical education teachers | EG: Drug and supplement education, strength training, sports nutrition. |
Research Design | Study | Notation | Key Findings |
---|---|---|---|
True Experimental | Barkoukis et al. (2016) [35] | R O1 X1 O2 R O1 X2 O2 | Significantly weaker attitudes towards doping use and increased norm salience in EG. |
Duncan and Hallward (2019) [38] | R O1 X1 O2 R O1 X2 O2 | No differential influence for either message frame on changes in any of the outcomes. Attitudes, self-efficacy, and perceived norms all increased significantly over time for participants in both conditions. | |
Elliot et al. (2004) [41] | R O1 X1 O2 R O1 X2 O2 | Significantly lower use of diet pills and athletic-enhancing substances in EG, and reduced intentions toward future use of diet pills and other health-harming actions. | |
Goldberg et al. (1990) [42] | R O1 X1 O2 R O1 X2 O2 R O1 O2 | Increased awareness of adverse effects of anabolic steroids in EG, but no differences in attitudes toward its use. | |
Goldberg et al. (1996) [43] | R O1 X1 O2 R O1 O2 | Increased understanding on anabolic androgenic steroids (AAS), greater belief in personal vulnerability to the adverse consequences of AAS, improved drug refusal skills, less belief in AAS-promoting media messages and reduced intentions to use AAS in the EG. | |
Goldberg et al. (2000) [44] | R O1 X1 O2 R O1 O2 | Lower intentions to use and actual use of anabolic steroids in EG. Reduced illicit drug use, drinking and driving, and sport supplement use in favor of EG along with improved nutrition behaviors. | |
Jalilian et al. (2011) [46] | R O1 X1 O2 R O1 O2 | Significant improvements in knowledge about side effects of AAS, attitude toward, and intention not to use AAS. Decrements in the rate of AAS and supplements use in the EG. | |
Kavussanu et al. (2020) [47] | R O1 X1 O2 O3 O4 R O1 X2 O2 O3 O4 | Lower doping likelihood and moral disengagement and higher guilt from pre to post intervention in both groups. Effects maintained at 3 and 6 months follow-up in both groups as well. | |
Nicholls et al. (2020) [50] | R O1 X1 O2 R O1 O2 | Increased knowledge about doping and reduced favorable doping attitudes in the EG. | |
Nicholls et al. (2020) [51] | R O1 X1 O2 R O1 X2 O2 R O1 X3 O2 R O1 O2 | Reduced favorable attitudes towards doping and sustained for 8 weeks in all intervention groups compared to CG. Doping susceptibility effects were only maintained for face-to-face presentation group. | |
Ntoumanis et al. (2021) [53] | R O1 X1 O2 R O1 X2 O2 | Athletes in EG reported greater reductions in willingness to take prohibited substances post intervention, but not at follow-up. Coaches in the EG reported greater increases in efficacy to create an anti-doping culture. | |
Ranby et al. (2009) [54] | R O1 X1 O2 O3 R O1 X2 O2 O3 | Decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors in EG. Low intentions were maintained 9 months later in EG. | |
Sagoe et al. (2016) [55] | R O1 X1 O2 R O1 X2 O2 R O1 O2 | Higher knowledge of AAS and their harmful effects as well as a higher increase in strength training self-efficacy in “theory with workout group (EG1)”. | |
Trenhaile et al. (1998) [56] | R O1 X1 O2 R O1 O2 | Improved knowledge of anabolic steroids and stronger attitudes against using steroids in the future in EG. | |
Quasi-Experimental | Allahverdipour et al. (2009) [33] | O1 X O2 O1 O2 | Significantly improved substance knowledge, attitudes, peer resistance skills, level of self-control, self-efficacy, and perceived susceptibility among EG. Deteriorated level of self-control and attitudes against substance abuse among CG. |
Álvarez et al. (2019) [34] | O1 X O2 O1 O2 | Improved knowledge, attitudes, and beliefs about doping in favor of EG. | |
Elbe and Brand (2016) [39] | R O1 X1 O2 R O1 X2 O2 O1 O2 | Increased doping likelihood attitudes (attenuated doping rejection) in the ethical decision-making group. No intervention effect in both the standard-knowledge-based educational program group and the control group. | |
Elias et al. (2018) [40] | O1 X O2 O1 O2 | Increments in mean scores of sports nutrition knowledge and practice in EG compared to decrements in respective scores in CG. Improved dietary intake in favor of the EG. | |
Little et al. (2002) [48] | O1 X1 O2 O1 X2 O2 | Improved nutrition and sport supplement knowledge in EG. | |
Lucidi et al. (2017) [49] | O1 X1 O2 O1 O2 | Stronger attitudes against doping use, decreased self-reported supplement use in EG. | |
Yager and McLean (2019) [57] | O1 X1 O2 O1 O2 | Improved body satisfaction and increased negative attitudes toward substance and supplement use in EG; however, these changes were not significant after adjusting for multiple comparisons. | |
Pre-Experimental | Chiba et al. (2020) [36] | O1 X O2 | Significantly improved understanding of dietary supplements. |
Codella et al. (2019) [37] | O1 X O2 | Increased level of knowledge about anti-doping rules, legitimacy, and nutrition supplements. | |
Hurst et al. (2020) [45] | O1 X O2 O3 | More knowledge about anti-doping rules. Lower scores for intention to use supplements, beliefs about the effectiveness of supplements, doping likelihood, and doping moral disengagement. At follow-up, doping likelihood and moral disengagement returned to baseline. | |
Nilsson et al. (2004) [52] | O1 X O2 | Decreased misuse of anabolic steroids. |
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Daher, J.; El Khoury, D.; Dwyer, J.J.M. Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review. Nutrients 2021, 13, 3935. https://doi.org/10.3390/nu13113935
Daher J, El Khoury D, Dwyer JJM. Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review. Nutrients. 2021; 13(11):3935. https://doi.org/10.3390/nu13113935
Chicago/Turabian StyleDaher, Jana, Dalia El Khoury, and John J. M. Dwyer. 2021. "Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review" Nutrients 13, no. 11: 3935. https://doi.org/10.3390/nu13113935