Original research| Volume 23, ISSUE 10, P921-926, October 2020

An intervention based on the health belief model led to improvements in self-efficacy towards ERIPP participation and functional performance in club sport athletes: a pilot study



      To determine if an intervention based on the Health Belief Model (HBM) could improve attitudes towards exercise-related injury prevention program (ERIPP) participation and functional performance in club sport participants.


      Repeated measures


      Participants completed the HBM Scale (HBMS) and Theory of Planned Behavior Scale (TPBS) to assess attitudes towards ERIPP participation at three time points (pre-measure, post-measure, follow-up measure). The HBM based intervention was delivered immediately following the pre-measure containing: 1) education on ERIPPs, benefits and barriers to participating, strategies to overcome barriers, risk factors and consequences for lower extremity injuries, and strategies to prevent lower extremity injuries 2) individualized feedback on functional performance 3) demonstration and participation in the 11 + . Attitudes towards injury prevention were compared using the subscales of the HBMS and TPBS at all three time points. Functional performance was compared at the pre-measure and follow-up measure.


      Significant improvements with large effect sizes were detected in individual self-efficacy from pre-test (0.73 ± 4.48) to post-test (2.93 ± 4.30; P = 0.05; ƞ2 = 0.18) and pre-test to follow-up (3.20 ± 3.49; P = 0.04; ƞ2 = 0.20) and community led self-efficacy from pre-test (4.40 ± 2.75) to post-test (6.07 ± 3.43; P = 0.02; ƞ2 = 0.24) and pre-test to follow-up (7.07 ± 2.05; P = 0.001; ƞ2 = 0.44). Additionally, significant improvements were found in the LESS-RT following the intervention.


      The intervention based on the HBM led to improvements in individual and community led self-efficacy indicating an enhancement in the participants’ confidence in their ability to participate in an ERIPP. Future research should investigate the effectiveness of individualized interventions to improve attitudes towards and adherence to ERIPPs.


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        • Roos K.G.
        • Kerr Z.Y.
        • Mauntel T.C.
        • Djoko A.
        • Dompier T.P.
        • Wickstrom E.A.
        The Epidemiology of Lateral Ligament Complex Ankle Sprains in National Collegiate Athletic Association Sports.
        Am J Sports Med. 2016;
        • Hootman J.M.
        • Dick R.
        • Agel J.
        Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives.
        J Athl Train. 2007; 42: 311-319
        • Frost A.M.D.T.
        • Langel J.A.
        • Klatt T.H.
        Descriptive Epidemiology of Injuries and Illnesses at a University Wellness and Recreation Center: 1987-2006. Paper presented at: Research in the Capitol.
        2007 (Des Moines, IA)
        • Hertel J.
        Sensorimotor deficits with ankle sprains and chronic ankle instability.
        Clin Sports Med. 2008; 27: 353
        • Knowles S.B.
        • Marshall S.W.
        • Miller T.
        • et al.
        Cost of injuries from a prospective cohort study of North Carolina high school athletes.
        Inj Prev. 2007; 13: 416-421
        • Houston M.N.
        • Van Lunen B.L.
        • Hoch M.C.
        Health-Related Quality of Life in Individuals With Chronic Ankle Instability.
        J Athl Train. 2014; 49: 758-763
        • Lohmander L.S.
        • Östenberg A.
        • Englund M.
        • Roos H.
        High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury.
        Arthritis & Rheum. 2004; 50: 3145-3152
        • Gerber J.P.
        • Williams G.N.
        • Scoville C.R.
        • Arciero R.A.
        • Taylor D.C.
        Persistent disability associated with ankle sprains: a prospective examination of an athletic population.
        Foot Ankle Int. 1998; 19: 653-660
        • Hübscher M.
        • Zech A.
        • Pfeifer K.
        • Hänsel F.
        • Vogt L.
        • Banzer W.
        Neuromuscular training for sports injury prevention: a systematic review.
        Med Sci Sports Exerc. 2010; 42: 413-421
        • Nouni-Garcia R.
        • Carratala-Munuera C.
        • Orozco-Beltran D.
        • Lopez-Pineda A.
        • Asensio-Garcia M.R.
        • Gil-Guillen V.F.
        Clinical benefit of the FIFA 11 programme for the prevention of hamstring and lateral ankle ligament injuries among amateur soccer players.
        Inj Prev. 2017;
        • McGuine T.A.
        • Keene J.S.
        Do proprioceptive training programmes reduce the risk of ankle sprains in athletes?.
        Int SportMed J. 2003; 4: 1-8
        • Noyes F.R.
        • Barber Westin S.D.
        Anterior Cruciate Ligament Injury Prevention Training in Female Athletes: A Systematic Review of Injury Reduction and Results of Athletic Performance Tests.
        Sports Health. 2012; 4: 36-46
        • Steffen K.
        • Emery C.A.
        • Romiti M.
        • et al.
        High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial.
        Br J Sports Med. 2013; 47: 794
        • Reis I.
        • Rebelo A.
        • Krustrup P.
        • Brito J.
        Performance enhancement effects of Federation Internationale de Football Association’s “The 11+” injury prevention training program in youth futsal players.
        Clin J Sport Med. 2013; 23: 318-320
        • Sugimoto D.
        • Myer G.D.
        • Bush H.M.
        • et al.
        Compliance With Neuromuscular Training and Anterior Cruciate Ligament Injury Risk Reduction in Female Athletes: A Meta-Analysis.
        J Athl Train. 2012; 47: 714-723
        • Iversen M.D.
        • Friden C.
        Pilot study of female high school basketball players’ anterior cruciate ligament injury knowledge, attitudes, and practices.
        Scand J Med Sci Sports. 2009; 19: 595-602
        • Gabriel E.H.
        • McCann R.S.
        • Hoch M.C.
        Use of Social or Behavioral Theories in Exercise-Related Injury Prevention Program Research: A Systematic Review.
        Sports Med. 2019;
        • Hartley E.M.
        • Hoch M.C.
        • Cramer R.J.
        Health Belief Model and Theory of Planned Behavior: A Theoretical Approach for Enhancing Lower Extremity Injury Prevention Program Participation.
        Int J Athl Ther Train. 2018; 23: 16-20
        • Gabriel E.H.
        • Hoch M.C.
        • Cramer R.J.
        Health Belief Model Scale and Theory of Planned Behavior Scale to assess attitudes and perceptions of injury prevention program participation: An exploratory factor analysis.
        J Sci Med Sport. 2019; 22: 544-549
        • Houston M.
        • Hoch J.
        • Lunen B.
        • et al.
        The development of summary components for the Disablement in the Physically Active scale in collegiate athletes.
        Qual Life Res. 2015; 24: 2657-2662
        • Gabriel E.H.M.
        • Cramer R.
        The Development of the Theory of Planned Behavior and Health Belief Model Scales: Assessing Behavioral Determinants of Exercise-Related Injury Prevention Program Participation.
        Athl Train Sports Health Care. 2018;
        • Rosenstock I.M.
        • Strecher V.J.
        • Becker M.H.
        Social learning theory and the health belief model.
        Health Educ Q. 1988; 15: 175-183
        • Plisky P.J.
        • Gorman P.P.
        • Butler R.J.
        • Kiesel K.B.
        • Underwood F.B.
        • Elkins B.
        The reliability of an instrumented device for measuring components of the star excursion balance test.
        N Am J Sports Phys Ther. 2009; 4: 92-99
        • Smith C.A.
        • Chimera N.J.
        • Warren M.
        Association of Y Balance Test Reach Asymmetry and Injury in Division I Athletes.
        Med Sci Sports Exerc. 2015; 47: 136-141
        • Padua D.A.
        • Boling M.C.
        • Distefano L.J.
        • Onate J.A.
        • Beutler A.I.
        • Marshall S.W.
        Reliability of the landing error scoring system-real time, a clinical assessment tool of jump-landing biomechanics.
        J Sport Rehabil. 2011; 20: 145-156
        • Padua D.A.
        • DiStefano L.J.
        • Beutler A.I.
        • et al.
        The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury-Prevention Program in Elite-Youth Soccer Athletes.
        J Athl Train. 2015; 50: 589-595
        • Soligard T.
        • Myklebust G.
        • Steffen K.
        • et al.
        Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial.
        BMJ. 2009; (95-99 95p)
        • Cohen J.
        Statistical power analysis for the behavioral sciences. Rev. ed.
        Academic Press, New York1977
        • O’Malley E.
        • Murphy J.C.
        • McCarthy Persson U.
        • Gissane C.
        • Blake C.
        The effects of the GAA 15 training program on neuromuscular outcomes in Gaelic football and hurling players; a randomized cluster trial.
        J Strength Cond Res. 2016;
        • Pointer C.E.
        • Reems T.D.
        • Hartley E.M.
        • Hoch J.M.
        The Ability of the Landing Error Scoring System to Detect Changes in Landing Mechanics: A Critically Appraised Topic.
        Int J Athl Ther Train. 2017; 22: 12-20
        • Ajzen I.
        From intentions to actions: A theory of planned behavior.
        in: JKaJ Beckmann Action Control: From Cognition to Behavior. Springer-Verlag, Heidelberg, Germany1985: 11-39
        • McKay C.D.
        • Merrett C.K.
        • Emery C.A.
        Predictors of FIFA 11+ implementation intention in female adolescent soccer: an application of the health action process approach (HAPA) model.
        Int J Environ Res Public Health. 2016; 13: 657
        • McGlashan A.J.
        • Finch C.F.
        The extent to which behavioural and social sciences theories and models are used in sport injury prevention research.
        Sports Med. 2010; 40 (841-858 818p.)