The Effect of Educational Intervention on Legal Anti-Doping Knowledge and Doping Tendency in Elite Athletes

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript investigates the effects of a structured legal anti-doping educational intervention on elite athletes' legal anti-doping knowledge (LADK) and doping tendency. The topic is timely, relevant, and underexplored, but the authors need to address the following comments for its possible publication.

The central hypothesis assumes that legal procedural knowledge will influence ethical or behavioral attitudes toward doping. This conceptual path is insufficiently justified. LADK concerns rights, obligations, testing procedures, legal appeals — not morality or performance-related decision-making. Doping tendency is influenced by motivational, psychosocial, cultural, and normative factors (e.g., moral disengagement, perceived norms, risk–benefit evaluations), not legal procedural knowledge. The theory underlying Hypothesis (ii) must be reframed or significantly strengthened.

The dichotomization of doping tendency (negative vs. neutral/positive) is a major limitation. Over 90% of athletes selected “No way!”, resulting in floor effects. Logistic regression with such extremely skewed distributions lacks statistical power. Collapsing a multi-category Likert item into binary form eliminates valuable information. Retain the original multi-category scale or adopt a validated multi-item doping attitude instrument (e.g., PEAS, Doping Attitude Scale).

Because the prevalence of positive/neutral doping attitudes is extremely low, logistic regression is severely underpowered. ORs cannot be meaningfully interpreted, and non-significant results should not be interpreted as “no relationship exists.” In the Discussion, the authors discuss low power explicitly and avoid overinterpreting null findings.

Notable baseline differences exist. Team-sport athletes in the control group had more frequent doping test experience than those in the intervention group. Baseline LADK differed between individual and team athletes. These undermine randomization validity and may contribute to observed differences.

The manuscript lacks necessary information to allow replication. For example, total instructional hours per session, delivery format (lecture, workshop, online/offline), standardization of facilitators, learning objectives per session, etc., need to be provided. The authors may consider providing a structured intervention table (session goals, duration, content, activities).

The manuscript states that the tool was validated previously but does not report such as Cronbach’s alpha for the current sample. Given LADK is the primary outcome, internal consistency should be reported.

The authors attribute stronger improvements in team-sport athletes to lower baseline knowledge, but additional plausible explanations should be discussed. For example, differences in coach–athlete interaction patterns, variations in doping-test frequency, cultural norms within team vs. individual sports, etc., need to be discussed.

The current Discussion overgeneralizes null results. Null findings are likely to be due to methodological constraints, not the absence of a true relationship.

Author Response

Reviewer 1

The manuscript investigates the effects of a structured legal anti-doping educational intervention on elite athletes' legal anti-doping knowledge (LADK) and doping tendency. The topic is timely, relevant, and underexplored, but the authors need to address the following comments for its possible publication.

RESPONSE: Thank you for recognizing the potential of our paper. Also, we are particularly grateful for your constructive comments. We tried to follow it and amended the manuscript accordingly. Please see below for specific amendments and responses.

The central hypothesis assumes that legal procedural knowledge will influence ethical or behavioral attitudes toward doping. This conceptual path is insufficiently justified. LADK concerns rights, obligations, testing procedures, legal appeals — not morality or performance-related decision-making. Doping tendency is influenced by motivational, psychosocial, cultural, and normative factors (e.g., moral disengagement, perceived norms, risk–benefit evaluations), not legal procedural knowledge. The theory underlying Hypothesis (ii) must be reframed or significantly strengthened.

RESPONSE:

Thank you for your suggestion. Based on it, we expanded our theoretical overview and tried to strengthen the 2^nd hypothesis by explaining theories which are related to the idea that increased legal knowledge could influence doping tendency.

Text reads:

“Although there is no doubt that legal anti-doping knowledge primarily reflects athletes’ understanding of obligations, procedures, and potential sanctions, several theoretical perspectives imply that such knowledge may indirectly shape decision-making related to doping behavior itself. Probably, the most important is deterrence theory, originating from classical criminology, which proposes that people are less likely to engage in prohibited behavior when they perceive a high likelihood of detection and believe that consequences will be severe and fairly enforced [15]. This theoretical concept was found to be plausible in different fields [16,17], while in the context of anti-doping, could imply that athletes who understand how testing works, what sanctions apply, and how strictly rules are implemented may become more cautious about using banned sub-stances. [16,17]. Additionally, improved understanding of procedural fairness and athletes’ rights may enhance perceived legitimacy of the anti-doping system. Indeed, there are evidences that athletes’ perceptions of legitimacy are closely tied to fair implementation of anti-doping rules [18,19]. Finally, there are recent evidences that that transparent, equitable procedures and clear communication of athletes’ rights should be observed as a key to building trust in the anti-doping system [20]. As a result, better legal literacy could reduce moral disengagement and encourage prosocial adherence to clean sport values. Therefore, examining whether legal literacy can affect doping-related orientations remains warranted.”

Please see newly added paragraph in the Introduction., thank you!

 

The dichotomization of doping tendency (negative vs. neutral/positive) is a major limitation. Over 90% of athletes selected “No way!”, resulting in floor effects. Logistic regression with such extremely skewed distributions lacks statistical power. Collapsing a multi-category Likert item into binary form eliminates valuable information. Retain the original multi-category scale or adopt a validated multi-item doping attitude instrument (e.g., PEAS, Doping Attitude Scale).

RESPONSE: Indeed, the flooring effect was evident, and as you could see, we noted it in the Discussion. We must agree that study will greatly benefit from more “sensitive scale”, but at this moment we were not able to use another measurement scale (i.e., Performance Enhancement Attitude Scale, DAS), simply because the experiment is done. We could use multinomial regression by using the more sensitive criterion scale (e.g., negative – neutral – positive doping tendency) but in this study it will almost certainly result in non-significant association, simply because of the low prevalence of the “positive attitudes” toward doping. However, if you would insist on recalculating it, we will certainly follow your suggestion. For a moment, this problem is clearly emphasized in the Limitations subsection where we specifically stated that further studies should explore the possible association between legal knowledge and “multi-category” criterion. Thank you for your understanding

 

Because the prevalence of positive/neutral doping attitudes is extremely low, logistic regression is severely underpowered. ORs cannot be meaningfully interpreted, and non-significant results should not be interpreted as “no relationship exists.” In the Discussion, the authors discuss low power explicitly and avoid overinterpreting null findings.

RESPONSE: We must agree that in the original version of the manuscript, the lack of association between legal knowledge and doping tendency was somewhat “overinterpreted”. In this version of the manuscript, we tried to avoid such interpretations. For more details, please see later responses for you suggestions and amendments we have done on that manner (changes in discussion, conclusion, abstract). Thank you.

 

Notable baseline differences exist. Team-sport athletes in the control group had more frequent doping test experience than those in the intervention group. Baseline LADK differed between individual and team athletes. These undermine randomization validity and may contribute to observed differences.

RESPONSE: Theoretically, it could happen, but due to similar distribution of team and individual athletes across study groups, this is not likely. Following your suggestion, we precisely specified the number of athletes from each type of sports in experimental and control group, and noted no significant difference in distribution between groups.

Text reads:

“The final sample comprised 68 individual sport athletes in the control group and 51 in the experimental (intervention) group, along with 102 team sport athletes in the control group and 89 in the experimental group, with no significant difference between control and experimental group in distribution of athletes according to type of sport across study groups (Chi square = 0.41, p > 0.05))” – please see end of Participants subsection, thank you.

 

The manuscript lacks necessary information to allow replication. For example, total instructional hours per session, delivery format (lecture, workshop, online/offline), standardization of facilitators, learning objectives per session, etc., need to be provided. The authors may consider providing a structured intervention table (session goals, duration, content, activities).

RESPONSE: Thank you for your suggestion. We tried to overview the education and present it more specifically in the Table 1 (newly added).

Also, the overall explanation of the educational process is now significantly more detailed, and following text is added: ž

“According to WADA’s International Standard for Education, anti-doping education employs both cognitive and affective approaches [3] . Cognitive models focus on delivering information-based programs to enhance knowledge about anti-doping, while affective models aim to instill this knowledge through the development of personal values and ethical principles. These approaches are grounded in different theoretical frameworks (i.e., social learning theory, health belief model, and socio-affective theories,) which offer complementary insights into how athletes can be supported in building the self-efficacy needed to resist the use of prohibited substances [2]. Furthermore, preventive interventions also take into account the nature of athlete involvement. Most specifically, participation can be active, where individuals are directly engaged in the learning process, or passive, where they receive information with minimal interaction [2,26].  In our educational approach, we followed the cognitive model by providing information and encouraging reflection on doping-related issues. Also, athletes were actively involved in the program, sharing their personal experiences and expressing their opinions during the educational sessions. Educators deliberately encouraged this active participation in order to frame discussions within specific, relatable educational contexts rather than relying solely on abstract or theoretical concepts.” (please see end of 2.3 subheading, thank you).

 

The manuscript states that the tool was validated previously but does not report such as Cronbach’s alpha for the current sample. Given LADK is the primary outcome, internal consistency should be reported.

RESPONSE: Details on metric characteristics of the measuring instrument are added.

Text reads:

“Specifically, in the validation study of the legal-anti-doping knowledge questionnaire the authors demonstrated acceptable test–retest reliability (Cohen’s κ = 0.65) and 84% exact agreement on repeated items. Also, study reported gender-specific discriminative validity, showing that the instrument distinguished meaningfully between male and female professional athletes [11].”

 

The authors attribute stronger improvements in team-sport athletes to lower baseline knowledge, but additional plausible explanations should be discussed. For example, differences in coach–athlete interaction patterns, variations in doping-test frequency, cultural norms within team vs. individual sports, etc., need to be discussed.

RESPONSE: Thank you for your observation. Indeed, these aspects of the results were not sufficiently discussed in the original manuscript, and in this version, we paid more attention on it. Text reads:

“Second, our results indicate that coaches (and medical staff) are the main sources of information on doping for athletes, which is consistent with previous research [35,36]. Moreover, athlete-support personnel dynamics in individual sports are typically more intimate and continuous than those in team sports. In individual sports, athletes often rely on a small, consistent team of coaches and medical staff. On the other hand, the support structures in team sports are broader and somewhat “scattered” across different compartments. Therefore, interactions between team-sport athletes and coaches and medics may be less personal.

Supportively, previous research has shown that individual athletes often receive more direct guidance on doping-related matters from their support teams, which is connected to higher prevalence of doping in individual sports [37,38]. Although we could not find direct empirical evidence on this topic, this fact can naturally be translated to legal anti-doping knowledge, resulting in higher baseline legal literacy among individual sport athletes. Therefore, the weaker support network integration in team sports may partially explain both (i) the lower initial scores and (ii) the better responsiveness to structured legal education we have achieved.

In addition, variations in doping-test frequency may contribute to the observed differences in legal knowledge between type of sports. Namely, athletes involved individual sports were evidently tested more frequently than their peers involved in team-sports. This could be a result of the performance-based qualification systems and individualized tracking protocols, which altogether provide them with more exposure to procedural elements of anti-doping control, logically resulting in their better legal-knowledge. In contrast, team-sport athletes observed herein experienced less frequent testing, which is probably a result of collective testing policies in these sports [39]. This logically reduce their opportunity to learn specific anti-doping rules and procedures in “real-world” set-tings.

Finally, cultural and normative influences may also play a role. Team sports are highly group-oriented, and shared values can reduce individual risk-taking by emphasizing collective responsibility and public scrutiny within the team environment [40]. Conversely, individual sports tend to foster a stronger performance-focused culture where personal success is observed as “achievement goal”. This altogether can result, which may increase motivation to seek any kind of advancement (including the doping). However, logical consequence of such higher motivation is necessity to understand rule-based limitations associated with it (in our case, anti-doping legal knowledge). These cultural differences between individual and team sports could shape athletes’ baseline aware-ness of anti-doping regulations, and modulate athletes’ responsiveness to educational program evaluated in this study.”

Please see last 4.1 subheading, thank you.

 

 

The current Discussion overgeneralizes null results. Null findings are likely to be due to methodological constraints, not the absence of a true relationship.

RESPONSE: We must thank you for this observation. Initially, our intention was not to “conclude” that these variables are “not correlated”. However, from this perspective (after reading Discussion following your comment), we must agree that we originally overstated the “definite” lack of association. Therefore, in this version of the manuscript we tried to reformulate all parts where such statements were “rigid”. For example, the amended title of the 4.2. subheading is: “Lack of correlation between legal anti-doping knowledge and doping tendencies” (previously “Lack of transfer of improvement of legal anti-doping knowledge on anti-doping tendencies”

Next, we added closing paragraph of the Discussion where methodological limitations are highlighted as the most important factors for the established lack of correlation between legal knowledge and doping tendency. Text reads: “Taken together, these considerations indicate that the absence of a detected relationship between improved legal knowledge and doping tendency in the present study should not be interpreted as evidence of a true lack of association. Rather, the findings are more plausibly explained by methodological constraints, including the mature competitive status of the sample, restricted variability and floor effects in attitudes, and the potential influence of social desirability on self-reported outcomes. Under such circumstances, even meaningful attitudinal changes may remain statistically undetectable. Therefore, our results should be viewed as preliminary and context-dependent, highlighting the need for future research to incorporate more sensitive attitudinal measures, recruit younger or more heterogeneous samples, and implement longer-term or multi-component interventions. Such improvements will be essential to adequately test whether enhanced legal literacy can ultimately contribute to ethically grounded decision-making and reduce per-missive orientations toward doping in sport.” (please see last paragraph of the subsection 4.2).

Also, the Conclusion section is systematically rewritten in order to avoid overstating the “null correlation”. Newly added text now reads (please see 2^nd paragraph of the Conclusion) “However, improvements in legal knowledge were not accompanied by measurable changes in doping tendency. Importantly, these null findings should be interpreted cautiously. The methodological characteristics of our study — including a mature, highly experienced athlete sample, the strong social stigma surrounding doping, and clear indications of floor effects in attitudinal measures — likely limited the detection of subtle or emerging changes in value-based outcomes. Therefore, the absence of a statistical association does not imply that legal knowledge is irrelevant to behavior; instead, it underscores the complexity of influencing ethically grounded decision-making through short-term cognitive interventions alone.”

Finally, some changes are done in Abstract (please see changes in supplementary PDF file).

 

 

Once again, thank you for your suggestions!

 

Staying at your disposal!

 

Authors

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for the opportunity to review your interesting manuscript entitled “The Effect of Educational Intervention on Legal Anti-Doping Knowledge and Doping Tendency in Elite Athletes.” The paper addresses an important issue within the field of anti-doping and, in particular, focuses on a dimension that is rarely examined: the legal aspects that athletes must understand to prevent both intentional and unintentional doping violations.

Overall, the manuscript is well structured, clearly written, and presents solid arguments. The findings are relevant and potentially valuable for practitioners and researchers. However, before the manuscript can be considered suitable for publication in Sports, there are several points that should be addressed:

1. Methodology
   The description of the intervention is generally clear and sufficiently detailed. Nevertheless, based on the literature cited in your paper, further clarification could strengthen the methodological section. For example, a recent systematic review published in 2025 (Effective Intervention Features of a Doping Prevention Program for Athletes: A Systematic Review with Meta-Analysis, https://doi.org/10.3390/sports13040108) categorizes educational anti-doping interventions into two types:

   • Cognitive, which includes providing information and fostering reflection on doping-related issues;

   • Value-based, which emphasizes ethical, moral, and affective aspects related to doping.

   The review also indicates that participants can assume either active or passive roles within the intervention. Therefore, I suggest explicitly identifying whether your intervention followed a cognitive or value-based approach, and clarifying the role of participants (which appears to have been active).

2. Line 233 – Please define the abbreviations C (control) and E (experimental) when first mentioned.

3. Line 238: Remove the word “the” before “but”.

4. Tables 1 and 2: Ensure that all values are correctly aligned. For example, in Table 1, the frequency for the experimental group in the category “sport experience: 6–10 years” appears misaligned.

5. Table 3: Please include a note label (Notes: …) under the table.

6. Line 266: Specify whether these results correspond to the post-intervention measurement.

7. Figure 1: In the title or caption, indicate that panel B refers to the post-intervention assessment.

8. Lines 275–276: Correct the expression or wording error in this sentence.

9. Figure 3A: Indicate whether these data correspond to the post-intervention measurement.

10. Lines 335–336: This argument could be strengthened by citing literature that highlights the positive impact of active participation in educational programs to achieve better outcomes.

11. Section 4.2: Lack of transfer of improvement in legal anti-doping knowledge on doping tendencies. You may rely on the systematic review mentioned above to discuss why cognitive and affective/value-based interventions may require different durations, reinforcement strategies, or exposure times to generate noticeable changes in moral behavior and doping-related tendencies.

In my opinion, once these comments have been adequately addressed, the manuscript will be suitable for publication.

I hope you find these observations helpful.

Kind regards,

Author Response

Reviewer 2

 

Dear Authors,

Thank you for the opportunity to review your interesting manuscript entitled “The Effect of Educational Intervention on Legal Anti-Doping Knowledge and Doping Tendency in Elite Athletes.” The paper addresses an important issue within the field of anti-doping and, in particular, focuses on a dimension that is rarely examined: the legal aspects that athletes must understand to prevent both intentional and unintentional doping violations.

RESPONSE: First of all, we would like to express our gratitude for your support, and for important suggestions you offered. We tried to follow it strictly and amended the manuscript accordingly. Please see how we dealt with each of your comments, and where to find changes we have done. Thank you once again.

Overall, the manuscript is well structured, clearly written, and presents solid arguments. The findings are relevant and potentially valuable for practitioners and researchers. However, before the manuscript can be considered suitable for publication in Sports, there are several points that should be addressed:

1. Methodology
   The description of the intervention is generally clear and sufficiently detailed. Nevertheless, based on the literature cited in your paper, further clarification could strengthen the methodological section. For example, a recent systematic review published in 2025 (Effective Intervention Features of a Doping Prevention Program for Athletes: A Systematic Review with Meta-Analysis, https://doi.org/10.3390/sports13040108) categorizes educational anti-doping interventions into two types:
   • Cognitive, which includes providing information and fostering reflection on doping-related issues;
   • Value-based, which emphasizes ethical, moral, and affective aspects related to doping.

The review also indicates that participants can assume either active or passive roles within the intervention. Therefore, I suggest explicitly identifying whether your intervention followed a cognitive or value-based approach, and clarifying the role of participants (which appears to have been active).

RESPONSE: Thank you for your suggestion! We amended the manuscript accordingly, and specified the educational approach.

Text reads:

“According to WADA’s International Standard for Education, anti-doping education employs both cognitive and affective approaches [3] . Cognitive models focus on delivering information-based programs to enhance knowledge about anti-doping, while affective models aim to instill this knowledge through the development of personal values and ethical principles. These approaches are grounded in theoretical frameworks such as social learning theory, the health belief model, and socio-affective theories, each offering complementary insights into how athletes can be supported in building the self-efficacy needed to resist the use of prohibited substances [2]. Furthermore, preventive interventions also take into account the nature of athlete involvement—whether active, where individuals are directly engaged in the learning process, or passive, where they receive information with minimal interaction [2,20]. In our educational approach, we followed the cognitive model by providing information and encouraging reflection on doping-related issues. Athletes were actively in-volved in the program, sharing their personal experiences and expressing their opinions during the educational sessions. Educators deliberately encouraged this active participation in order to frame discussions within specific, relatable educational contexts rather than relying solely on abstract or theoretical concepts.” (please see highlighted text in Methods section, thank you).

Also, in this version of the manuscript we provided a table explaining the most important characteristics of the educational program (now Table 1).

2. Line 233 – Please define the abbreviations C(control) and E (experimental) when first mentioned.

RESPONSE: Thank you for noticing it, it is corrected now.

3. Line 238: Remove the word “the” before “but”.

RESPONSE: Thank you, corrected.

4. Tables 1 and 2: Ensure that all values are correctly aligned. For example, in Table 1, the frequency for the experimental group in the category “sport experience: 6–10 years” appears misaligned.

RESPONSE: Thank you! It is checked and corrected.

5. Table 3: Please include a note label (Notes: …) under the table.

RESPONSE: Added, thank you.

6. Line 266: Specify whether these results correspond to the post-intervention measurement.

RESPONSE: Specified, thank you (please see first sentence of the paragraph in Results).

7. Figure 1: In the title or caption, indicate that panel B refers to the post-intervention assessment.

RESPONSE: Actually, the panel B refers to Pre- to Post- differences for total sample. It is specified in the Figure caption, now.

8. Lines 275–276: Correct the expression or wording error in this sentence.

RESPONSE: Corrected. Text now reads: “When observed specifically for athletes involved in individual sports, C and E group did not differ in studied doping factors.” (please see first sentence following the Table)

9. Figure 3A: Indicate whether these data correspond to the post-intervention measurement

RESPONSE: Specified in the figure caption, thank you.

10. Lines 335–336: This argument could be strengthened by citing literature that highlights the positive impact of active participation in educational programs to achieve better outcomes.

RESPONSE: Thank you for your suggestion. We believe that the added text and references strengthened the previous discussion on “achievement due to active engagement”. Newly added text reads “Supportively, studies repeatedly inform on better outcomes of the educational interventions where students were actively involved in learning, which was explained by in-creased student participation and engagement, but also by better perception of the studied problem in more active students from different fields [24,25]” (please see highlighted text)

11. Section 4.2: Lack of transfer of improvement in legal anti-doping knowledge on doping tendencies. You may rely on the systematic review mentioned above to discuss why cognitive and affective/value-based interventions may require different durations, reinforcement strategies, or exposure times to generate noticeable changes in moral behavior and doping-related tendencies.

RESPONSE: Certainly! In the revised version of the manuscript, we added one paragraoh of the text emphasizing your observation. Text reads: “Irrespective of the previous explanations, our findings of the lack of transfer of the le-gal-knowledge on changes in doping tendency actually align with evidence from the re-cent systematic review which reported that although cognitive (knowledge-based) and affective/values-based anti-doping programs often yield short-term reductions in doping intention and behavior, their effects on deep-seated moral behavior remain negligible [2]. This suggests that while knowledge dissemination is necessary, it is likely insufficient on its own to induce lasting value-driven behavioral change. Most specifically, it is probable that interventions focused solely on information transfer may temporarily shift attitudes or intentions, but not the underlying moral compass or doping tendency.” (please see highlighted paragraph in the section 4.2, thank you)

 

In my opinion, once these comments have been adequately addressed, the manuscript will be suitable for publication.

I hope you find these observations helpful.

Kind regards,

 

 

Thank you once again!

Authors

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have addressed the comments, and the manuscript has now been improved for its possible publication. I appreciate the authors' efforts on this study.