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Players’ and coaches’ knowledge and awareness of the BokSmart Safe Six injury prevention programme: an ecological cross-sectional questionnaire study
  1. Nicola Sewry1,
  2. Evert Verhagen1,2,3,
  3. Mike Lambert1,2,
  4. Willem van Mechelen1,2,4,5,
  5. James Brown1,2
  1. 1 Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
  2. 2 Department of Public and Occupational Health, Amsterdam Collaboration on Health and Safety in Sports, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
  3. 3 Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, South Africa
  4. 4 School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
  5. 5 School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Evert Verhagen; e.verhagen{at}


Objectives Rugby has a high injury incidence and therefore BokSmart introduced the Safe Six injury prevention programme in 2014 in an attempt to decrease this incidence. In 2015, BokSmart used a ‘targeted marketing approach’ to increase the awareness and knowledge of the Safe Six. Therefore, the aim of this study was to determine the change in the knowledge of coaches and players of the Safe Six programme, compared with the launch year, following a ‘targeted marketing approach’.

Design Ecological cross-sectional questionnaire study

Setting The 2014–2016 South African rugby union youth week tournaments.

Participants Questionnaires were completed by 4502 players and coaches who attended any of the four youth week tournaments during 2014–2016.

Outcome measures Logistic regression (adjusted OR, 95% CI) was performed in comparison to year prior to targeted marketing, separately for coaches and players, for changes in awareness and knowledge.

Results The awareness of the Safe Six increased significantly for players in 2015 (1.74 times (95% CI 1.49 to 2.04)) and in 2016 (1.54 times (95% CI 1.29 to 1.84)). Similarly for coaches, there was a 3.55 times (95% CI 1.23 to 9.99) increase in 2015 and a 10.11 times (95% CI 2.43 to 42.08) increase in 2016 compared with 2014. Furthermore, a player was significantly more likely to be aware of the Safe Six if his coach was aware of the programme (p<0.05).

Conclusions The knowledge and awareness of the BokSmart Safe Six of both players and coaches increased in 2015 and 2016 (compared with 2014) since the launch of the programme. Coaches, the Unions/the South African Rugby Union and social media were the largest contributors to knowledge in coaches and players. While the ‘targeted marketing approach’ was associated with an increase in awareness, future studies should determine if this translates into behavioural change.

  • injury prevention
  • awareness
  • cross-sectional
  • social media

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  • Contributors NS was granted access to the data and was involved in conceptualising the manuscript; she also conducted statistical analyses and wrote the initial drafts of the manuscript. JB and EV were also involved in the statistical analyses. All authors (EV, ML, WvM and JB) were involved in conceptualising and editing drafts of the paper, in the order that they appear on the author list.

  • Funding NS’s PhD is funded by the Vrije Universiteit Amsterdam/National Research Foundation South Africa through the Desmond Tutu Doctoral Scholarship, administered through the South Africa Vrije Universiteit Strategic Alliance (SAVUSA). NS also receives funding from the University of Cape Town, Zuid-Afrika Huis study foundation and the Oppenheimer Memorial Trust.

  • Competing interests None declared.

  • Ethics approval The study received ethical clearance from the Human Research Ethics Committee of the University of Cape Town (HREC 108/2017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are published, and therefore there is no additional data available. If raw data are requested, requests will be reviewed on a discretionary basis by BokSmart (who can be contacted via email through the corresponding author:

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