Andrew Heyes

Illicit use of prescription drugs (e.g. modafinil) to enhance academic performance–termed cognitive enhancement (CE)–is a legal, health, and ethical issue. Guided by Bandura’s social cognitive theory of moral thought and action, this study investigated whether student users of CE evidenced specific psychosocial mechanisms (i.e. mechanisms of moral disengagement) when explaining their reasons for CE. Following ethical approval from the lead author’s institution, in-depth-semi-structured interviews were conducted with nine students with experience of CE. Data were content analysed deductively, using definitions for the eight mechanisms of moral disengagement; six of the eight mechanisms were identified through data analysis: diffusion of responsibility (DR), advantageous comparison (AC), distortion of consequences (DCs), displacement of responsibility, moral justification, and euphemistic labelling. In addition, inductive data analysis identified three further themes; self-medication, family and friends, and institutional position. Overall, the study findings suggest students may morally disengage to justify and rationalise use of CE to minimise negative emotional responses (e.g. guilt) that may be expected to result given the potential legal-, health-, and ethics-based deterrents to CE.

Values-based education seeks to cultivate personal responsibility, empathy, and integrity to encourage critical reflection on the (anticipated or actual) consequences of one’s choices and behaviours. To comply with the World Anti-Doping Agency's International Standard for Education, anti-doping education programmes must incorporate values-based components. To facilitate this development, we explored how elite athletes interpret and apply their values in various situations throughout their athletic careers. Adopting a qualitative description design, 13 focus groups were conducted with 60 elite athletes from 13 countries participating in 27 sports at national or international levels. Audio recordings were transcribed/translated and analysed using reflexive thematic analysis. Athletes noted that their values guide their actions but struggled to articulate how these values influence their behaviour. Three overarching themes were created to capture: (1) value consciousness and clarity, (2) intrapersonal value continuity, and (3) value conflict and management. Dynamic relationships between athletes’ values, priorities, and decision-making processes were evident. Specifically, the results illustrate shifts in value priorities as athletes matured and progressed in their careers, and across situations to meet situational demands whilst making behaviour personally permissible. To live up to the fundamental principles of values-based education, anti-doping programmes must incorporate activities that facilitate conceptually sound discussions and provide athletes with time and support to unpack the behavioural meaning of their values. Developing athletes’ decision-making abilities through conscious sense-making activities to anticipate the pain of a value transgression and the value of value fulfilment is key to this process.

Protecting clean sport, and the rights of athletes to a clean sport environment, is at the centre of anti-doping policies. To better support and enable clean athletes and sport, an understanding of the clean athlete lifeworld is required. The current study explored the ways that clean athletes are personally affected by others’ actual or suspected instances of doping and anti-doping rule violations, and by aspects of the anti-doping system. Qualitative Secondary Analysis (QSA) was used to re-analyse and interpret 13 focus group transcripts generated from the ‘Research-Embedded Strategic Plan for Anti-Doping Education Clean Sport Alliance Initiative for Tackling Doping’ (RESPECT) project (see Petróczi et al., 2021b). The sample in the parent study included 82 self-declared clean elite athletes, from Germany, Ireland, Netherlands, Slovenia, and the UK. Reflexive thematic analysis generated three overarching themes: The harm done by clean athletes having to coexist with dopers, how clean athletes are undermined by a disingenuous interest in clean sport, and the anxiety experienced by clean athletes over mistakes that could lead to anti-doping rule violations. The impacts of doping on clean athletes – direct or indirect – are experienced by all clean athletes in some way. The results indicate that current approaches to anti-doping rule compliance frequently undermine clean athletes and the perceived legitimacy of the anti-doping system.

Background In sport the narrative is changing from anti-doping to pro-clean sport. Yet, our understanding of what ‘clean sport’ means to athletes is notably absent from the literature. Objectives Working together with elite athletes and National Anti-Doping Organisations (NADOs), this study explored the meaning and importance of ‘clean sport’ and ‘clean athlete identity’. Design Community-based participatory research design was employed to explore (a) how elite athletes define clean sport and being a clean athlete; (b) the hopes and challenges associated with clean sport and being a clean athlete; and (c) what can be done in anti-doping to elicit clean sport. Methods Five elite athletes in five European countries (Germany, Ireland, Netherlands, Slovenia and United Kingdom) were recruited as co-researchers by their respective NADOs, trained for their role as co-researchers and individually interviewed. Seventy-seven elite athletes were then purposefully recruited for 12 athlete-led national focus groups. Finally, the five athlete co-researchers and five athlete participants took part in one 2.5-hour long international focus group. Results Reflexive thematic analysis resulted in generating four overarching themes: ‘clean is being true to the self’, ‘clean performance enhancement has multiple meanings’, ‘clean is not a solo act’ and ‘the problems and solutions are systemic’. Collectively, the themes showed that the clean athlete identity is generally rooted in upbringing, early experiences and love of sport; and characterised by continued, intrinsically motivated commitment to fundamental values and morals acquired in childhood. In contrast, the concept of clean performance-enhancement is highly idiosyncratic and flexible. Elite athletes value anti-doping efforts but their experiences of disparity and unfairness in doping control undermine their trust in anti-doping. Conclusion Clean athlete identity is a social endeavour and artefact, which needs to be reflected in and developed through evidence-informed anti-doping interventions. Raising athletes' voices via co-collaboration and participatory research can be an enriching experience for athletes and researchers alike, and a worthwhile endeavour for sport organisations with responsibility for anti-doping. To make anti-doping education personally relevant, the richness of individual interpretation of ‘clean’ for the self (i.e., clean athlete identity) and performance-enhancement must be acknowledged, respected and cultivated.

To protect the integrity of sport, and the health of athletes, global anti-doping programmes seek to prevent doping, and elicit anti-doping and clean sport behaviours, through education, deterrence, detection, enforcement, and rules. To guide programme development, this meta-synthesis of qualitative research applied a behavioural science framework to identify barriers and enablers to doping, anti-doping, and clean sport. A systematic search of electronic databases up to May 2022, followed by critical appraisal, resulted in 73 included articles. Fifty-two articles reported the athlete perspective, thirteen included athletes, athlete support personnel (ASP), and other experts, and eight focused on ASP only. Rigorous methods of thematic synthesis were drawn upon to construct analytical themes in line with the theoretical domains framework (TDF) and the capability, opportunity, and motivation model of behaviour (COM-B). A wide range of barriers and enablers were identified which influenced capability, opportunity, and motivation to participate in a clean sport environment. The weight of evidence pointed to limitations in the current anti-doping education system in providing athletes and ASP with the knowledge and skills to protect against doping, as well as the significant influence of social and cultural norms in shaping doping and clean sport behaviours through a shared social identity, and risky contexts leading to moments of vulnerability to doping. We identified a need for anti-doping programmes to move beyond the current focus on athlete capability, and address the opportunity and motivation components of clean sport behaviours through a targeted and tailored focus on education, training, persuasion, modelling and environmental restructuring interventions.