Article Text

Download PDFPDF
BokSmart rugby safety education courses are associated with improvements in behavioural determinants in attending coaches and referees: presurvey–postsurvey study
  1. James Craig Brown1,2,3,
  2. Sharief Hendricks2,4,
  3. Michael Ian Lambert2,
  4. Willem van Mechelen2,5,
  5. Evert Verhagen2,5
  1. 1 Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  2. 2 Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  3. 3 IOC Research Centre, Pretoria, South Africa
  4. 4 Carnegie Applied Rugby Research Centre, Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, West Yorkshire, UK
  5. 5 Amsterdam Collaboration for Health and Safety in Sports, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, location VU University Medical Centre, Amsterdam, Netherlands
  1. Correspondence to Dr James Craig Brown, Institute of Sport and Exercise Medicine, Department of Surgical Sciences, Stellenbosch University, Cape Town 7602, South Africa; jamesbrown06{at}


Background/aim BokSmart is a nationwide injury prevention programme that aims to reduce players’ injury risk mainly through education of coaches and referees in mandatory biennial education courses. These courses are held throughout each rugby season. The objective of this cross-sectional study was to assess whether these courses were associated with improvements in attendees’ behavioural determinants.

Methods Coaches and referees completed a questionnaire based on the theory of planned behaviour, immediately before and after their 2012 BokSmart courses. Twelve behavioural determinants were assessed on a five-point Likert scale and open-ended questions. A meaningful change was defined as an improvement of ≥1 unit score supported by null hypothesis testing. Odds of improving by ≥1 unit score (compared with not improving) were assessed in attendees using multivariate logistic regression.

Results In total, 390 coaches and 74 referees completed both questionnaires. ‘Before’ scores were high for most outcomes, except for knowledge. Although there was a significant (p<0.001) improvement in all ‘after’ course scores, the only meaningful change (=1 unit) was in knowledge of scrum techniques/rules.

Conclusion Although the only meaningful improvement in 2012 BokSmart course attendees was in one outcome, it should be noted that before-course scores were already high, reducing the questionnaire’s ability to assess change because of a ceiling effect. Nonetheless, the knowledge acquisition of these courses was low and not related to previous course attendance or more years of rugby experience. These results justify the biennial nature of this safety course but also indicate that knowledge acquisition is generally low.

  • behaviour change
  • policy
  • recreation / sports
  • process/impact evaluation
  • attitudes
  • interventions

Data availability statement

Data are available upon reasonable request. The data are not currently in an open-source repository, but the authors are very willing to add them to figshare (or similar), should there be any requests.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. The data are not currently in an open-source repository, but the authors are very willing to add them to figshare (or similar), should there be any requests.

View Full Text


  • Twitter @jamesbrown06

  • Contributors JCB and EV planned the study, with EV having major conceptual input. MIL, SH and WvM also provided conceptual input and advice at this stage. SH acted as an independent coder of the open-ended answers. All authors approved all versions of the manuscript, including the final and revised ones.

  • Funding JCB received PhD funding from the SAVUSA/NRF Desmond Tutu Doctoral Programmes to complete this study.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the Methods section for further details.

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