Gaelic games coaches’ attitudes towards, awareness of and use of injury prevention exercise programmes

Figures Abstract Purpose Gaelic games (GG) are multidirectional, evasive sports with unpredictable high-intensity activity. Lower extremity injuries are common. Injury prevention exercise programmes (IPEPs) have been introduced, effectively reducing injuries and increasing neuromuscular performance. However, the awareness and use of IPEPs are anecdotally low among coaches. Methods Adult GG coaches (n = 342) completed an anonymous online survey, including awareness, use, and attitudes towards IPEPs and injury prevention. Frequencies and descriptive statistics were conducted, a chi-squared test was used to assess any differences in awareness and use of IPEPs, a Mann-Whitney U test was used to examine differences between groups for attitudes to injury prevention. Results Overall, 59.5% (n = 165) of coaches reported using any form of an IPEPs, including modified or self-developed programmes, while 44.1% of coaches (n = 130) were aware of formal IPEPs. Use was statistically higher in elite coaches than non-elite (p < 0.01, phi = 0.16). No significant differences in IPEP use were observed by coach gender, team gender, or coaching education. Many coaches developed their own IPEP or altered a current IPEP, particularly participants coaching females. Coaches had a positive attitude towards injury prevention, but 40.6% stated a lack of knowledge on how to use an IPEP, with 34.5% agreeing there was no training available to teach them. Discussion Despite generally positive attitudes towards injury prevention, awareness and implementation of formal IPEPs among GG coaches remain limited. These findings highlight the need for targeted coach education and improved dissemination strategies to enhance the adoption and effective implementation of IPEPs in GG, which is critical to mitigating the risk of injury. Citation: Teahan C, Whyte E, O’Connor S (2026) Gaelic games coaches’ attitudes towards, awareness of and use of injury prevention exercise programmes. PLoS One 21(6): e0351253. https://doi.org/10.1371/journal.pone.0351253 Editor: Emiliano Cè, Università degli Studi di Milano: Universita degli Studi di Milano, ITALY Received: January 8, 2026; Accepted: May 25, 2026; Published: June 10, 2026 Copyright: © 2026 Teahan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Data is available on the open science framework - https://osf.io/fmyrh. Funding: Funding received from DCU School of Health and Human Performance. Competing interests: The authors have declared that no competing interests exist. Introduction Gaelic Games (GG) are sports native to Ireland, including Gaelic football, hurling, Ladies Gaelic football, and Camogie. GG are governed by the Gaelic Athletic Association (GAA), Ladies Gaelic Football Association (LGFA), and Camogie Association, respectively. While the GAA also governs other sports such as handball and rounders, this study focuses on the field-based, contact GG. These organisations operate through regional administrative units (e.g., county boards), which oversee local clubs and coordinate activities, with club officials (e.g., secretaries) responsible for communication and organisation at the club level. The competition spans from regional clubs (at a community level) to national inter-county events (at the elite level) [1]. GG are amateur sports, with the vast majority of coaches being volunteers [2]. Coaching commitments can be high. More than 3 in 4 GG coaches deliver at least 2–3 sessions a week [2]. It is also common for coaches to coach more than one code (one of Gaelic football, Ladies Gaelic football, hurling or Camogie) or team or level at any one time [2]. Sports participation comes with the inherent risk of injury [3]. Lower extremity injuries are the most common across all codes of GG. Injury rates vary depending on the sport and level; however, match injury rates are high in all codes (26.4–102.5 injuries/1000 hours) [4–7]. Sports-related injuries are expensive [8], and impose a substantial financial burden on the player and club. Successfully implementing widespread injury prevention practices across all GG players is crucial due to the current prevalence of injuries and the need to reduce costs for the individual player, team and society [9,10]. The coach is critical for providing safety interventions to players and is primarily responsible for injury prevention implementation [11], particularly to underage players [12] and in community level sports [13], where coaching and medical staff are lacking [14]. Given the high injury burden in GG, effective injury prevention strategies are essential. Across a range of team sports, injury prevention exercise programmes (IPEPs) have been shown to be effective in reducing injury risk; however, their implementation in real-world settings remains inconsistent [15]. IPEPs are an effective strategy for reducing injury risk [10]. The Translating Research into Injury Prevention Practice (TRIPP) model highlights the importance of understanding the implementation context and end-user behaviour when translating injury prevention research into practice [15]. While previous research in GG has primarily focused on the development and efficacy of IPEPs, limited research has examined the later stages of the TRIPP model, particularly implementation and real-world adoption by coaches. Several GG-specific IPEPs have been developed, including the GAA15 [16], the Activate GAA Warm-up [17] the Camogie Injury Prevention Programme (CIPP) [18], and The Athletic Development and Injury Prevention Program [19]. These programmes are designed for different cohorts, with some targeting male Gaelic football and hurling players (e.g., GAA15, Activate GAA Warm-up), while others are specific to female athletes (e.g., Camogie Injury Prevention Programme and the Athletic Development and Injury Prevention Warm Up Program). This distinction is important when interpreting potential differences in awareness and use across coach and team gender. Only 3 studies have looked at the effectiveness of the GAA15 and indicated that it increased neuromuscular performance [20,21] and decreased the incidence of lower limb injuries in collegiate GG players [21], and adolescent hurlers [22]. The Activate GAA Warm-up has also been shown to enhance neuromuscular function, which could mitigate some risk factors for injury [23] While this suggests that the GAA15 and the Activate GAA Warm-up are effective, limited research has examined how these programmes are adopted and implemented in practice. Only IPEPs that coaches are aware of and use will be effective at tangibly reducing injury [11,24,25]. Although more research is needed on coaches’ awareness and use of IPEPs in GG, existing evidence suggests that awareness and use remain low. Previous research demonstrates low awareness (32%) and use (34%) of IPEPs amongst Camogie coaches [1], and similarly low use (7.7%) amongst Gaelic football coaches [26]. However, awareness was not recorded. While previous research has examined awareness and use of IPEPs in individual GG codes, no study has comprehensively examined differences across coach gender, team gender, and multiple GG contexts. This is important to understand as coaches of female youth athletes in other sports had greater awareness and use of IPEPs than those coaching boys [27], and the various organisations governing the GG codes have different coach education pathways, which may need to be refined in the future. IPEPs can only be effective at reducing injuries if stakeholders apply them in the way that they were intended [13]. Therefore, it is critical to understand the awareness of and use of IPEPs by GG coaches. Understanding the factors that influence IPEP adoption is essential to improving their implementation. Although IPEPs are effective, their implementation is context-dependent. GG have unique structural and coaching characteristics, which may limit the transferability of findings from other sports. Therefore, a context-specific investigation is warranted. It is essential to understand GG coaches’ attitudes to injury and injury prevention and the barriers and facilitators to successful implementation to increase the effectiveness of use, fidelity and maintaining IPEPs over time [11,28]. Even though players are these programmes’ intended end users, coaches’ attitudes affect whether or not players receive these training programmes in the first place [12,29]. Understanding and addressing barriers to IPEP implementation is important across all sports; however, this may be particularly relevant in community-based settings, where limited resources, reliance on volunteer coaches, and reduced access to medical or support staff may further constrain implementation [12]. Future developments in injury prevention are likely to occur with an improved understanding of how to use evidence-based strategies in the real world [11]. While implementation challenges are well documented in other team sports, there is limited research examining these factors within GG [1,4–7]. Only one study has looked at the attitudes of coaches, barriers and facilitators to IPEP use and coaches’ perceived ability to implement an IPEP in Camogie [1], hence, more research is needed across all codes of GG. Coach and team characteristics may influence the awareness and implementation of IPEPs. For example, previous research has suggested that coach gender and the gender of athletes may influence attitudes towards injury prevention and programme adoption, potentially due to differences in injury risk, access to resources, and coaching environments. Additionally, coaching education and level of play may impact knowledge, experience, and access to support staff, which may further influence the adoption and delivery of IPEPs. Therefore, this study aimed to: (1) determine the awareness and use of IPEPs among GG coaches; (2) examine differences based on coach gender, level of play, team gender, and coaching education; (3) explore coaches’ attitudes towards injury and injury prevention; (4) identify perceived barriers and facilitators to IPEP uses. To address these aims, the following research questions were proposed: (1) What is the level of awareness and use of IPEPs among GG coaches? (2) Do awareness and use differ based on coach gender, level of play, team gender, and coaching education? (3) What are coaches’ attitudes towards injury and injury prevention? (4) What barriers and facilitators influence the implementation of IPEPs in GG? Materials and methods Patients and study design Instrumentation The anonymous survey was modified from prior studies to the GG context [1,30–36]. The survey was reviewed by experts in coaching (n = 2), sport science (n = 2), and injury prevention (n = 3) to assess clarity, comprehensiveness, and appropriateness. Each question was rated on a 5-point scale, and items scoring less than 4/5 were modified or removed. The revised survey was subsequently piloted with 7 coaches representing all four GG codes to ensure clarity and relevance. Given the exploratory nature of the study and the adaptation of existing measures, formal assessment of validity was not conducted. The survey consisted of multiple sections capturing demographic information, preseason screening practices, awareness and use of IPEPs, injury prevention practices, attitudes towards injury and injury prevention, perceived barriers and facilitators, and coaches’ perceived ability to deliver IPEPs. For this study, key constructs were defined as follows: awareness referred to whether coaches had heard of or were familiar with IPEPs; use referred to the self-reported implementation of any IPEP with their team; and attitudes referred to coaches’ responses to Likert-scale statements regarding injury and injury prevention. Perceived barriers and facilitators referred to factors reported by coaches that influenced the implementation of IPEPs. A summary of the questionnaire structure is presented in Table 1. A 5-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’ was used to assess coaches’ attitudes towards injury and injury prevention, as well as perceived barriers and facilitators to IPEP implementation. Procedures Based upon an estimated population size of 50,000, a confidence level of 90% and a margin of error of 5%, a power analysis completed using an online calculator (Qualtrics, SAP America Inc., Seattle, WA) returned a desired sample size of 270. Every county board secretary (n = 104) and club secretary (n = 2157) in Ireland received a recruiting email with details and a survey link. The distribution of the survey to all adult coaches was requested. A reminder email was sent 3 and 6 weeks after the original email. Social media and word of mouth were used to publicise and distribute the survey. The survey was hosted online on Qualtrics (SAP America Inc., Seattle, WA) and was available from May 13 through July 15, 2022. Data analysis Responses were exported to SPSS Statistics (version 27, IBM Corporation). Data were checked for errors or missing information. From the valid replies, frequencies and descriptive statistics were produced. Data distribution was assessed prior to analysis to determine appropriate statistical tests. A chi-squared test evaluated differences between the gender of the coach, levels of play, the gender of the team that they coach and between coaches who had completed a GG-specific coaching course in the use and awareness of IPEPs and if their team had access to athletic development coaches (strength and conditioning, fitness coach etc.) and medical staff (athletic therapist, physiotherapist, physical therapist etc.). Classification of effect sizes (phi) was small (0.1), medium (0.3), and large (0.5). An attitude towards injury prevention scale was created by assigning a score ranging from 1 to all “strongly disagree” replies to a value of 5 to all “strongly agree.” Negative phrases were inverted to ensure that a higher score on the scale corresponds to a more optimistic outlook towards injury prevention. Similarly, a scale of attitudes toward injury was developed from 7 statements. Internal consistency of multi-item constructs was assessed using Cronbach’s alpha, with values ≥0.70 considered acceptable. The attitudes towards injury prevention scale demonstrated acceptable internal consistency (Cronbach’s α = 0.75), while inter-item correlations for the attitudes towards injury scale were also within acceptable ranges (r = 0.2). Mann-Whitney U tests were used to determine statistically significant differences between the gender of the coach, levels of play and between coaches who had completed a GG-specific coaching course for attitudes toward injury and injury prevention. Statistical significance was set a priori at 0.05. Study data and statistical output are available at https://osf.io/fmyrh. Results A total of 342 responses (254 men, 87 women and 1 non-binary/third gender) met the inclusion criteria and were included in the analysis. The number of respondents varied across variables due to item non-response; therefore, totals may differ slightly between categories. Coaches had a mean age of 48.6 ± 9.2 years and 11.7 ± 9.1 years of coaching experience. The majority of participants were non-elite coaches (90.6%), while 32 participants were classified as elite. One participant (0.3%) did not report their level of coaching and was excluded from this analysis. Additional participant characteristics are presented in Table 2. Awareness and use of IPEPs A total of 44.1% (n = 130/295) of coaches reported awareness of IPEPs, while 59.5% (n = 165/277) reported using a formal IPEP (Table 3). These proportions are based on different numbers of respondents due to item non-response. Almost half of the coaches who identify as men (47.9%) (Table 3) stated that they were aware of a specific GG IPEP, with statistically fewer women GG coaches aware (31.1%) with small effect size (p < 0.01, phi = 0.25). Similarly, awareness of IPEPs differed based on the gender of the team coached (p = 0.03, phi = 0.16) with higher awareness observed among coaches of males compared with females. There was no significant difference in coach awareness of IPEPs for those coaching at different levels of play (p = 0.08, phi = 0.12) and between coaches with or without formal GG coaching education (p = 0.19, phi = 0.08). Of the coaches that stated their awareness of a specific GG IPEP, 70.0% correctly identified one. The IPEPs that coaches were most aware of were the GAA15 (76.8%) and the Activate GAA warm-up (17.9%). Elite coaches (71.9%) had significantly higher use of IPEPs compared with non-elite (57.1%) with a small effect size (p < 0.01, phi = 0.16). However, there was no significant difference in the use of IPEPs for the gender of the coach (p = 0.20, phi = 0.11) between coaches who have or have not completed a GG coaching course (p = 0.33, phi = 0.09) and the gender of sport that they coach (p = 0.79, phi = 0.08). For the coaches that use an IPEP, the most frequently used IPEPs across all codes were the Activate GAA Warm-up (37.4%) and the GAA 15 (25.9%). In total, 12.2% of coaches reported that they had developed their own IPEP, while 7.2% reported modifying an existing IPEP (Table 4). The frequency with which IPEPs were implemented by teams is presented in Table 4. IPEPs are completed mostly at every training (45.7%) and every training and match (35.8%). Due to the structure of response options, some categories may overlap and therefore be interpreted with caution. Overall, 39.9% of coaches spent between 11 and 15 minutes delivering IPEPs with their team. For the coaches not using an IPEP, the most frequent reason was because of lack of skill set (20.6%), lack of resources (19.0%) and lack of time/too long or coaching underage (both 15.9%) (Table 4). Injury prevention practice Most coaches used a warm-up (89.0%) with their team most of the time or always, along with stretching (80.5%) and a cool-down (69.4%) (Table 5). Stretching was analysed as a separate variable, although it may form part of warm-up and cool-down routines and should therefore be interpreted within this context. Injury prevention practices such as landing technique (59.3%), resistance training (50.8%) and plyometrics (42.5%) were largely, only sometimes, or never completed. Coaches rated stretching, adequate sleep, and good nutrition as the most effective injury prevention practice. Attitudes towards injury and injury prevention, and perceived barriers and facilitators A total of 93.1% (n = 240) of coaches agreed or strongly agreed that injuries can shorten a player’s career, while 94.2% (n = 244) agreed or strongly agreed that injuries can cause problems later in life (Table 6). Additionally, 75% (n = 193) of coaches agreed or strongly agreed that GG players are at high risk of injury. However, only 36.2% (n = 94) agreed or strongly agreed that injuries were an issue within their own team. Women coaches demonstrated significantly higher scores on the attitudes towards injury scale (median = 19), indicating a more negative perception of injury compared with men (median = 18), with a medium effect size (r = 0.43, p = 0.01). There were no significant differences in attitudes towards injury for the level of play (r = 0.03, p = 0.47), between coaches who have completed a GG coaching course (r = 0.05, p = 0.35) and the gender of sport that they coach (r = 0.27, p = 0.12). GG coaches agreed that it is important for both coaches (95.7%) and players (96.9%) to have current knowledge of IPEPs. A total of 91.5% of coaches agreed that using an IPEP will reduce the number of injuries to their team. There were no significant differences in attitudes towards injury for the gender of the coach (r = 0.14, p = 0.13), the level of play (r = 0.07, p = 0.29) between coaches who have completed a GG coaching course (r = 0.18, p = 0.09) and the gender of sport that they coach (r = 0.13, p = 0.34). More training in delivering IPEPS (85.2%) and better resources (84.9%) were the greatest facilitators of using IPEPs. A total of 40.6% of coaches reported insufficient knowledge to use IPEPs, while 34.5% agreed that there was no training available to teach them (Table 6). Access to athletic development coaches and medical personnel Just under half of coaches had access to an athletic development coach with their team (47.7%). A significantly greater number of men coaches (51.6%) had access compared with women coaches (35.6%), with a small effect size (p = 0.04, phi = 0.17). Similarly, elite coaches (87.5%) also had greater access to athletic development coaches compared with non-elite coaches (43.4%) (p < 0.01, phi = 0.26). There was also a significant difference between access to athletic development coaches and the gender of the sport that they coach (p < 0.01, phi = 0.22). Post-hoc comparisons found that participants coaching women only (32.8%) had significantly less access to athletic development coaches compared with those coaching men only (55.8%) (r = 0.22, p < 0.01) and those coaching both men and women (53.7%) (r = 0.20, p = 0.01). There was no significant difference in access between coaches who have completed a GG coaching course (p = 0.11, phi = 0.11). Access to medical personnel is described in Table 7. Overall, 34.7% of teams had access to medical personnel at least every match. Almost half of participants coaching men’s teams only (56.0%) stated that they had access to medical personnel at least every match. However, 57.4% of coaches that coached females only stated that they never had access to medical personnel. Preseason screening A total of 23.2% of coaches conducted preseason screening with their team to evaluate the risk of injury. A greater proportion of men coaches (27.2%) reported conducting preseason screening compared to women coaches (10.5%) with small effect size (p < 0.01, phi = 0.21). A greater proportion of elite coaches (65.0%) conducted preseason screening compared to non-elite coaches (18.4%) with medium effect size (p < 0.01, phi = 0.33). There was a significant difference in coaches that conducted preseason screening and the gender of the sport they coached (p = 0.01, phi = 0.23). Post-hoc comparisons found that those coaching women only (10.3%) conducted significantly less preseason screening compared with participants coaching men only (30.8%) (r = 0.23, p < 0.01) and participants coaching both men and women (25.9%) (r = 0.20, p = 0.01). There was no significant difference in preseason screening between coaches who have completed a GG coaching course (p = 0.10, phi = 0.12). Discussion This study aimed to understand GG coaches’ awareness of, use and perceived ability to implement an IPEP with their team. Further, we aimed to investigate coaches’ attitudes towards injury and injury prevention and the barriers and facilitators to successful IPEP implementation. Overall, 44.1% of coaches reported awareness of formal IPEPs, with 70.0% of these able to correctly identify a programme. Therefore, only 34.8% of all coaches could both recognise and name an IPEP. This is consistent with previous findings in Camogie coaches (32%) [1], Canadian high school rugby coaches (27%) [37], and youth male soccer coaches (16%) [38]. However, this is lower than coaches’ awareness in youth soccer (58–65%) [39,40], youth rugby (75%) [41], high school basketball and soccer (52%) [42], and European amateur soccer (42.6%) [35]. Low awareness is concerning as awareness is the critical first step in the implementation process [13]. Despite 36.2% of coaches recognising injuries as an issue within their team, many remain unaware of available IPEPs. The cost of an injury can be burdensome, with the mean cost of men’s GG claims being €1158.40 [43], and the mean cost of ladies Gaelic football claims being €663.30 [44], with claims in both increasing annually. Previously it was reported that 63.8% of claims made were for lower limb injuries [44], which have been the focus of IPEP, with the GAA15 proven to reduce lower limb injuries [21,22]. Therefore, organisational-level strategies are needed to increase awareness, particularly in community-based GG where coaches drive implementation [13]. There was a significant difference in awareness between the gender of the coaches and the gender of the sport they coached with women coaches, and those coaching female GG were less aware of IPEP. Previous research has demonstrated greater exercise fidelity among female athletes, which has been attributed to higher perceived injury severity in female athletes [27]. This heightened perception of risk may encourage greater engagement with injury prevention strategies and could, in turn, contribute to increased awareness of IPEPs in female sporting contexts. However, this was not the case in GG. The female GG organisations need to target coaches and increase awareness of IPEPs with women coaches and coaches of female teams as female players may have less access to medical care [45] and discrepancies in funding between male and female sports [46]. Therefore, coaches may have increased responsibility to deliver IPEPs with their team. A total of 59.5% (n = 165/277) of coaches reported using any form of IPEP. This proportion reflects responses from a subset of participants and should be interpreted in the context of varying response rates across questions. This is almost double what was reported in Camogie (34%) [1], and much more than in Gaelic football (7.2%) [26]. However, it must be noted that the Gaelic football study had a small sample size and only included 2 counties [26]. Thus, while the widespread use of IPEPs is still relatively low, it has increased in recent years. Coaches with elite teams utilised IPEPs more than non-elite coaches, which may be explained by the greater access to athletic development coaches and medical personnel who have been identified as essential programme implementers in elite sports [47]. Therefore, clubs and organisations need to educate coaches on IPEP, particularly coaches of non-elite teams, as coaches are in a distinctive position to encourage injury prevention, safe play, and make rapid choices on injury management [48], particularly in amateur sports such as GG. Coaches identified lack of knowledge and resources as primary barriers to IPEP use. Although IPEPs are freely available, additional education and practical support are required to improve confidence in their delivery. Practical workshops have been shown to enhance implementation, adherence, and perceived competence, suggesting that structured coach education should be prioritised across GG [1,2]. Previous research has shown in Camogie coaches that an injury prevention workshop with both theory and practical elements enhanced coaches’ attitudes towards injury prevention, increased the implementation and maintenance of an IPEP and enhanced their perceived ability in their skill to conduct the IPEP [49]. Similarly, participation in a coaching workshop on FIFA 11 + training is reported to have increased programme adherence compared to only giving out instructional materials [50]. Injury prevention education is now embedded in Camogie coaches’ education, but educational injury prevention workshops should be made mandatory for all GG codes as they are effective, and coaches would like to attend them. Although IPEPs are designed to be implemented at every training session and match, only 35.8% of teams reported using them as intended. Additionally, 44% of coaches allocated less than 10 minutes to IPEPs, below recommended durations. As programme effectiveness depends on correct implementation, improving fidelity is essential [51]. Future studies should determine the minimal dose required for IPEPs, but until then, IPEPs should be used every training and match as directed. Coaches also agreed (92.7%) that IPEPs must be varied and progress over time. These elements were previously thought to be crucial for inspiring players, preventing monotony, and tailoring the exercises to individual players’ various skill levels [52]. The Activate has some variation of the exercise, which may explain why it was the most used IPEP amongst GG coaches. However, the GAA15 has no variation or progressions. Coaches must be invited to contribute to the creation of the IPEPs from the start [53]. Further qualitative research is needed to investigate why so many coaches create their own IPEPs, particularly in ladies’ GG. Understanding why coaches modify IPEPs is important, as these changes may affect programme efficacy [52]. It was previously found that lower compliance or IPEP fidelity was associated with an increased injury rate in male athletes [54–56]. However, allowing coaches autonomy might increase coach compliance, particularly their willingness to adopt the IPEPs [57]. Although no previous research has looked at programme fidelity in GG IPEPs, based on the current research in other sports, poor programme fidelity would likely lead to less-than-optimal programme effectiveness in GG. Therefore, the GG organisations must include GG coaches in the design phase of IPEPs which will aid in coach motivation to use the programmes as designed. Warm-up (89.0%), stretching (80.5%), and cool-down (69.4%) were the most commonly used practices. This is similar to basketball and Canadian rugby coaches, where 95.9% and 85% of coaches implement a warm-up, respectively [37,58]. While this indicates a willingness to adopt injury prevention practices, some commonly used practices are not strongly supported by evidence. Resistance training has been demonstrated to reduce injuries by 69%, compared to stretching’s 4% reduction [59]. These findings indicated the need for improved education on evidence-based practices, which will lead to a greater injury risk reduction for GG players. The results indicate a general willingness to employ injury prevention practice. However, there needs to be both a top-down and bottom-up approach, where researchers listen to the stakeholders and contextual factors to increase adoption. This aligns with the later stages of the TRIPP model, which emphasise the importance of incorporating contextual factors and stakeholder engagement to improve the implementation of injury prevention strategies [13]. The GG IPEPs themselves may need to be adapted to meet the needs of coaches, but also coaches need to be educated on the essential aspects of injury prevention if there is going to be an effective injury risk reduction in GG. It takes the engagement of many vital stakeholders to improve IPEP uptake and implementation in real community sports settings [53]. It is also critical to understand how stakeholders feel about injury prevention and how it fits into their lifestyles and the game’s culture [51]. Therefore, it is crucial to understand GG coaches’ attitudes to injury prevention. Overall 93.1% of GG coaches agreed that injuries can shorten a player’s career, and 74.2% of coaches agreed GG players are at a high risk of injury. Similarly, 87.6% of coaches agreed that injuries can have a negative impact on team performance. Research has shown that injuries negatively affect team success in professional soccer [60], professional rugby [61], and Australian rules football [62]. Most coaches (95.7%, n = 259)) agreed it is important to have current knowledge of IPEPs and 95.3% agreed that injury prevention is important during training. Coaches understand the negative impacts that injury can have, and there is potential for encouraging the use of an IPEP. Therefore, it is paramount that organisations emphasise educating these volunteer coaches on how to deliver an IPEP to their team, so that coaches understand the risks involved with GG and the importance for coaches to have current knowledge of IPEPs. For evidence-based IPEPs to have a meaningful impact on preventing injuries, they must be widely and consistently implemented [11]. Understanding the barriers and facilitators in a GG setting is critical to IPEP implementation [15]. Coaches stated that having an athletic development coach (91.5%) or an athletic therapist/physiotherapist (87.5%) lead their team in IPEPs were the greatest facilitators of using an IPEP. However, most teams have no access to athletic development coaches or medical personnel (Table 7). Key barriers included lack of knowledge (40.6%), lack of training (34.5%), and insufficient expertise within teams (31.3%). Despite IPEPs being designed for use by non-specialist coaches [13,63], their uptake remains limited. This highlights the need for structured dissemination strategies and targeted education to improve adoption and implementation. The transmission of information about an invention (IPEP) to a potential user without a structured dissemination campaign relies significantly on mass media and human contacts [64]. Therefore, organisations need to adopt an injury prevention strategy to maximise awareness, use and fidelity of IPEPs. Limitations This study was the first to investigate the implementation of IPEPs across all GG codes and coaches’ attitudes towards injury prevention. Several limitations related to sampling and data collection should be considered. The use of an online survey may have introduced self-selection bias, whereby coaches with a greater interest in injury prevention were more likely to participate. Additionally, the representativeness of the sample across different competition levels and regions is unknown, which may limit the generalisability of the findings. Non-response bias may also have influenced the results, as not all participants completed every question. Although internal consistency was assessed for multi-item constructs, further psychometric evaluation of the survey instrument was not undertaken. In particular, test–retest reliability and construct validity were not examined, which may limit the robustness of the measures used. Another limitation of this study relates to the structure of the survey response options for IPEP frequency. Some response categories may have overlapped. This may limit the precision and interpretability of these findings. Stretching was examined as a distinct component of injury prevention; however, it is often incorporated within broader warm-up and cool-down routines. This may limit the independence of these findings and should be considered when interpreting the results. Respondents’ answers to the survey’s Likert scale questions may have been influenced by central tendency bias, acquiescence bias, or social desirability bias. Gaining a more profound knowledge of end-user attitudes and contextual challenges in adopting IPEP may be aided by additional qualitative research. Although perceived ability to deliver IPEPs is an important factor in implementation, it was not examined in detail in the current study and should be explored in future research. Conclusion Although efficacious IPEPs have been developed in GG, injury prevention requires much more than an effective programme. For any change in injury rates, the efficacious IPEPs must be accepted, used and maintained with high fidelity by the end users. However, less than half of GG coaches were aware that GG IPEPs existed, and just over a third were using a specific GG IPEP. Where IPEPs were used, fidelity was low. There is a potential for organisations and clubs to encourage coaches to use IPEPs and enhance coaches’ skills in delivering IPEPs as GG coaches acknowledge the negative impact injuries can have, and they have a positive attitude towards injury prevention. This could be achieved by acknowledging some barriers and facilitators identified by GG coaches, such as more training in delivering IPEPs and better resources, such as access to medical personnel and coaches. Similarly, organisations need to include coaches in the development of injury prevention strategies. A greater emphasis must be placed on educating coaches across all codes of GG, particularly with coaches involved with female teams. References - 1. Connor SO, Whyte E, O’Hanlon S, Fortington L. Coach and player views toward injury prevention exercise programs in camogie: a cross-sectional survey. Athletic Training & Sports Health Care. 2021;13(4). - 2. Horgan P, Bowles R, Considine J, Donnelly P, Harmon W, Harrison H. Coaching and coach education in gaelic games: a baseline report. 2021. https://www.gaa.ie/news/gaelic-games-to-benefit-from-lessons-of-coaching-survey/ - 3. Melzer K, Kayser B, Pichard C. Physical activity: the health benefits outweigh the risks. Curr Opin Clin Nutr Metab Care. 2004;7(6):641–7. pmid:15534432 - 4. Buckley CS, Blake C. The incidence of injury in elite camogie, an in-season prospective study. BMJ Open Sport Exerc Med. 2018;4(1):e000315. pmid:29719725 - 5. Murphy JC, Gissane C, Blake C. Injury in elite county-level hurling: a prospective study. Br J Sports Med. 2012;46(2):138–42. pmid:20961917 - 6. Murphy JC, O’Malley E, Gissane C, Blake C. Incidence of injury in Gaelic football: a 4-year prospective study. Am J Sports Med. 2012;40(9):2113–20. pmid:22879401 - 7. O’Connor S, Bruce C, Teahan C, McDermott E, Whyte E. Injuries in Collegiate Ladies Gaelic Footballers: A 2-Season Prospective Cohort Study. J Sport Rehabil. 2020;30(2):261–6. pmid:32473586 - 8. Al Attar WSA, Alshehri MA. A meta-analysis of meta-analyses of the effectiveness of FIFA injury prevention programs in soccer. Scand J Med Sci Sports. 2019;29(12):1846–55. pmid:31394009 - 9. Mendonça LD, Schuermans J, Wezenbeek E, Witvrouw E. Worldwide sports injury prevention. Int J Sports Phys Ther. 2021;16:285–7. - 10. Sly N, Soomro M, Withall AL, Cullen P, Turner RM, Flahive SR. Players’, parents’ and staffs’ perceptions of injury prevention exercise programmes in youth rugby union. BMJ Open Sport Exerc Med. 2022;8(2):e001271. pmid:35774618 - 11. Donaldson A, Lloyd DG, Gabbe BJ, Cook J, Finch CF. We have the programme, what next? Planning the implementation of an injury prevention programme. Inj Prev. 2017;23(4):273–80. pmid:26787739 - 12. White PE, Otago L, Saunders N, Romiti M, Donaldson A, Ullah S, et al. Ensuring implementation success: how should coach injury prevention education be improved if we want coaches to deliver safety programmes during training sessions?. Br J Sports Med. 2014;48(5):402–3. pmid:23343718 - 13. Finch CF, Donaldson A. A sports setting matrix for understanding the implementation context for community sport. Br J Sports Med. 2010;44(13):973–8. pmid:19201766 - 14. Arundale AJH, Silvers-Granelli HJ, Myklebust G. ACL injury prevention: Where have we come from and where are we going?. J Orthop Res. 2022;40(1):43–54. pmid:33913532 - 15. Benjaminse A, Verhagen E. Implementing ACL injury prevention in daily sports practice-it’s not just the program: let’s build together, involve the context, and improve the content. Sports Med. 2021;51(12):2461–7. pmid:34533777 - 16. GAA.ie. https://learning.gaa.ie/gaa15 - 17. Ulster GA. Activate GAA Warm-up. https://ulster.gaa.ie/pals/resources/activate-warm-up/ - 18. Camogie ie. CIPP. https://camogie.ie/player-information/player-welfare/injury-prevention-programme/ - 19. Ladiesgaelic ie. The Athletic Development and Injury Prevention Program. https://ladiesgaelic.ie/wp-content/uploads/2018/04/The-Athletic-Development-and-Injury-Prevention-Warm-Up-Program-1.pdf - 20. OʼMalley E, Murphy JC, McCarthy Persson U, Gissane C, Blake C. The effects of the gaelic athletic association 15 training program on neuromuscular outcomes in gaelic football and hurling players: a randomized cluster trial. J Strength Cond Res. 2017;31(8):2119–30. pmid:27398918 - 21. Schlingermann BE, Lodge CA, Gissane C, Rankin PM. Effects of the gaelic athletic association 15 on lower extremity injury incidence and neuromuscular functional outcomes in collegiate gaelic games. J Strength Cond Res. 2018;32(7):1993–2001. pmid:28817505 - 22. Kelly ST, Lodge CA. Effects of the GAA15 in reducing lower extremity injury rates in adolescent males participating in hurling. Physiother Pract Res. 2018;39:99–105. - 23. O’Connor S, Bruce C, Whyte E. Does a ten-week activate GAA warm-up intervention improve outcomes in adult male hurlers?. Physiother Pract Res. 2022;43:189–97. - 24. O’Brien J, Donaldson A, Finch CF. It will take more than an existing exercise programme to prevent injury. Br J Sports Med. 2016;50(5):264–5. pmid:26159702 - 25. Stensø J, Andersen TE, Harøy J. Adductor Strengthening Programme is successfully adopted but frequently modified in Norwegian male professional football teams: a cross-sectional study. BMJ Open. 2022;12(9):e060611. pmid:36437510 - 26. Reilly J, Kipps C. the implementation and adoption of the injury prevention exercise programme gaa 15 in gaelic football club teams in the counties of mayo and london. Br J Sports Med. 2017;51(4):377.2-377. - 27. Perera NKP, Hägglund M. We have the injury prevention exercise programme, but how well do youth follow it?. J Sci Med Sport. 2020;23(5):463–8. pmid:31843441 - 28. McGlashan A, Verrinder G, Verhagen E. Working towards more effective implementation, dissemination and scale-up of lower-limb injury-prevention programs: insights from community australian football coaches. Int J Environ Res Public Health. 2018;15(2):351. pmid:29462913 - 29. Finch CF, Diamantopoulou K, Twomey DM, Doyle TLA, Lloyd DG, Young W, et al. The reach and adoption of a coach-led exercise training programme in community football. Br J Sports Med. 2014;48(8):718–23. pmid:23482922 - 30. Finch C, Donohue S, Garnham A. Safety attitudes and beliefs of junior Australian football players. Inj Prev. 2002;8(2):151–4. pmid:12120836 - 31. Fokkema T, de Vos RJ, Bierma-Zeinstra SMA, van Middelkoop M. Opinions, Barriers, and Facilitators of Injury Prevention in Recreational Runners. J Orthop Sports Phys Ther. 2019;49:736–42. - 32. Martinez JC, Mazerolle SM, Denegar CR, Joseph MF, Pagnotta KD, Trojian TH, et al. Female adolescent athletes’ attitudes and perspectives on injury prevention programs. J Sci Med Sport. 2017;20(2):146–51. pmid:27544657 - 33. McKay CD, Steffen K, Romiti M, Finch CF, Emery CA. The effect of coach and player injury knowledge, attitudes and beliefs on adherence to the FIFA 11+ programme in female youth soccer. Br J Sports Med. 2014;48(17):1281–6. pmid:24928848 - 34. Møller M, Zebis MK, Myklebust G, Lind M, Wedderkopp N, Bekker S. “Is it fun and does it enhance my performance?” - Key implementation considerations for injury prevention programs in youth handball. J Sci Med Sport. 2021;24(11):1136–42. pmid:34167894 - 35. Wilke J, Niederer D, Vogt L, Banzer W. Head coaches’ attitudes towards injury prevention and use of related methods in professional basketball: a survey. Phys Ther Sport. 2018;32:133–9. pmid:29793121 - 36. Zech A, Wellmann K. Perceptions of football players regarding injury risk factors and prevention strategies. PLoS One. 2017;12(5):e0176829. pmid:28459845 - 37. Shill IJ, Räisänen A, Black AM, Barden C, van den Berg C, McKay CD, et al. Canadian high school rugby coaches readiness for an injury prevention strategy implementation: evaluating a train-the-coach workshop. Front Sports Act Living. 2021;3:672603. pmid:34136807 - 38. De Ste Croix M, Ayala F, Sanchez SH, Lehnert M, Hughes J. Grass-root coaches knowledge, understanding, attitude and confidence to deliver injury prevention training in youth soccer: a comparison of coaches in three EU countries. J of SCI IN SPORT AND EXERCISE. 2020;2(4):367–74. - 39. Donaldson A, Callaghan A, Bizzini M, Jowett A, Keyzer P, Nicholson M. Awareness and use of the 11+ injury prevention program among coaches of adolescent female football teams. International Journal of Sports Science & Coaching. 2018;13(6):929–38. - 40. Morgan EA, Johnson ST, Bovbjerg VE, Norcross MF. Associations between player age and club soccer coaches’ perceptions of injury risk and lower extremity injury prevention program use. International Journal of Sports Science & Coaching. 2017;13(1):122–8. - 41. Barden C, Stokes KA, McKay CD. Implementation of the activate injury prevention exercise programme in English schoolboy rugby union. BMJ Open Sport Exerc Med. 2021;7(2):e001018. pmid:34012555 - 42. Norcross MF, Johnson ST, Bovbjerg VE, Koester MC, Hoffman MA. Factors influencing high school coaches’ adoption of injury prevention programs. J Sci Med Sport. 2016;19(4):299–304. pmid:25866072 - 43. Roe M, Murphy JC, Gissane C, Blake C. Hamstring injuries in elite Gaelic football: an 8-year investigation to identify injury rates, time-loss patterns and players at increased risk. Br J Sports Med. 2018;52(15):982–8. pmid:27797729 - 44. O’Connor S, Whyte E, Fortington L, Corrigan J. The cost of injury in ladies gaelic football: a nine-year analysis (2012–2020) of the LGFA’s injury fund. Journal of Science and Medicine in Sport. 2023;26(1):31–6. - 45. Parsons JL, Coen SE, Bekker S. Anterior cruciate ligament injury: towards a gendered environmental approach. Br J Sports Med. 2021;55(17):984–90. pmid:33692033 - 46. Kelly G, McKenna O, Courtney S, Collins K, Bradley J, Martin D. Benchmarking successful performances in elite Ladies Gaelic football. International Journal of Performance Analysis in Sport. 2021;22(1):51–65. - 47. OʼBrien J, Finch CF. Injury prevention exercise programs for professional soccer: understanding the perceptions of the end-users. Clin J Sport Med. 2017;27(1):1–9. pmid:26829608 - 48. Carter AF, Muller R. A survey of injury knowledge and technical needs of junior Rugby Union coaches in Townsville (North Queensland). J Sci Med Sport. 2008;11(2):167–73. pmid:17360234 - 49. O’Connor S, Lacey P. Can we improve coaches’ injury prevention views and implementation practices in the community female Gaelic sport of camogie?. BMJ Open Sport Exerc Med. 2020;6:e000732. - 50. Steffen K, Meeuwisse WH, Romiti M, Kang J, McKay C, Bizzini M, et al. Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomised trial. Br J Sports Med. 2013;47(8):480–7. pmid:23486935 - 51. Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport. 2006;9(1–2):3–9; discussion 10. pmid:16616614 - 52. O’Brien J, Young W, Finch CF. The use and modification of injury prevention exercises by professional youth soccer teams. Scand J Med Sci Sports. 2017;27(11):1337–46. pmid:27714907 - 53. Bekker S, Clark AM. Bringing complexity to sports injury prevention research: from simplification to explanation. Br J Sports Med. 2016;50(24):1489–90. pmid:27465698 - 54. Åkerlund I, Waldén M, Sonesson S, Lindblom H, Hägglund M. High compliance with the injury prevention exercise programme Knee Control is associated with a greater injury preventive effect in male, but not in female, youth floorball players. Knee Surg Sports Traumatol Arthrosc. 2022;30(4):1480–90. pmid:34213586 - 55. Krug MI, Vacek PM, Choquette R, Beynnon BD, Slauterbeck JR. Compliance and fidelity with an injury prevention exercise program in high school athletics. Sports Health. 2022;14(4):483–9. pmid:34490822 - 56. Silvers-Granelli HJ, Bizzini M, Arundale A, Mandelbaum BR, Snyder-Mackler L. Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):1975–83. pmid:29556709 - 57. O’Connor S, O’Brien W, Lacey P. The implementation of a national strategy to encourage injury prevention program uptake in a community female sport in ireland: a camogie case study. International Sport Coaching Journal. 2022;9(2):203–10. - 58. Räisänen AM, Owoeye OBA, Befus K, van den Berg C, Pasanen K, Emery CA. Warm-ups and coaches’ perceptions: searching for clues to improve injury prevention in youth basketball. Front Sports Act Living. 2021;3:619291. pmid:33644752 - 59. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871–7. pmid:24100287 - 60. Hägglund M, Waldén M, Magnusson H, Kristenson K, Bengtsson H, Ekstrand J. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013;47(12):738–42. pmid:23645832 - 61. Williams S, Trewartha G, Kemp SPT, Brooks JHM, Fuller CW, Taylor AE, et al. Time loss injuries compromise team success in Elite Rugby Union: a 7-year prospective study. Br J Sports Med. 2016;50(11):651–6. pmid:26552415 - 62. Hoffman DT, Dwyer DB, Bowe SJ, Clifton P, Gastin PB. Is injury associated with team performance in elite Australian football? 20 years of player injury and team performance data that include measures of individual player value. Br J Sports Med. 2020;54(8):475–9. pmid:31242988 - 63. Dix C, Logerstedt D, Arundale A, Snyder-Mackler L. Perceived barriers to implementation of injury prevention programs among collegiate women’s soccer coaches. J Sci Med Sport. 2021;24(4):352–6. pmid:33071200 - 64. Rogers EM. Diffusion of innovations. 3rd ed. New York: Free Press; 1983.