Will a co-created program enhance implementation of injury prevention training in youth handball in Sweden? A...

To compare the implementation of a co-created evidence-based injury prevention intervention with an existing program in youth team handball.

Pragmatic two-armed cluster-randomized controlled trial, conducted collaboratively with the Swedish Handball Federation.

Eighteen clubs offering handball for female and male youth players (aged 12-16 years) were allocated randomly (stratified by club size) to either intervention or control. Intervention was a holistic program integrated within handball practice (Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball) plus tailored implementation support. Control was an existing warm-up program with a few physical injury prevention principles. Implementation outcomes were investigated among coaches (both groups) and club administrators (intervention group) at the end of the handball season using a study-specific questionnaire mapped to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.

No differences were observed in implementation outcomes between intervention and control coaches. Reach was high, and coaches and club administrators generally believed injury prevention training was effective. They liked the intervention and intended to use it the next season. Sixty-six percent of intervention coaches and 58 % of control coaches had used the intervention (odds ratio = 1.33, 95 % confidence interval 0.42-4.24, p = 0.625). Utilization frequency was low, and program fidelity was poor.

A co-created holistic program supported by tailored implementation strategies did not enhance the implementation of injury prevention training compared with an existing program. Further research is needed to better understand how to enhance the implementation of such training in regular practice of youth handball.