Putting sport injury prevention into practice: a qualitative study in a small Western European high-income country

Despite strong scientific evidence supporting sports injury prevention, implementation in real-world sport settings remains limited. Understanding how prevention is perceived and practised by those directly involved in sport is essential to ensure effective implementation. This qualitative study explored how injury prevention is perceived, practised and implemented within the sport ecosystem of a small Western European high-income country (Luxembourg). Semi-structured interviews were carried out across the Luxembourgish sport ecosystem, including athletes, coaches, healthcare professionals and institutional representatives. Interviews were conducted until data saturation was reached. Data were analysed inductively following grounded theory principles using ATLAS.ti, with open, axial and selective coding to develop core dimensions grounded in participants' experiences. 12 participants acknowledged the importance of injury prevention and shared a strong commitment to athlete health. However, prevention was often perceived as reactive, medicalised or disconnected from performance objectives, which limited sustained engagement. Participants emphasised the need to reframe prevention as a performance-enhancing and integral component of training rather than an additional constraint. Three key facilitators for effective implementation emerged: (1) clear and coordinated communication between stakeholders and institutions, (2) early integration of injury prevention in youth sport through engaging and age-appropriate approaches and (3) structured education and long-term support for coaches, who were identified as central gatekeepers of daily practice. Although Luxembourg's small size and close-knit networks were seen as opportunities for collaboration, fragmented structures and inconsistent communication currently hinder coherent implementation. Luxembourg offers a favourable context to embed injury prevention within sport culture, yet greater system-level coordination is required. Reframing prevention around performance, strengthening coach education, promoting early engagement and improving cross-institutional communication may enhance adherence and sustainability. These findings provide practical insights for other sport systems seeking to translate evidence-based injury prevention into effective field practice.