Toomey, Mary Therese (2022) Understanding the determinants of health for Australian high-performance athletes: A mixed- methods exploration of a multi-disciplinary, multi-sport panel of expert high-performance sport health practitioners. Research Master thesis, Victoria University.

Abstract

High-performance athletes are known to be at risk of adverse physical and mental health outcomes related to the extreme performance demands they face. Australian high-performance sport has traditionally been reactive to the healthcare needs of athletes who present having experienced compromised health, whether that be in the form of an illness, an injury, or a mental health challenge. Recently, there has been a move toward implementing limited health promotion approaches addressing identified health risks in the current athlete/sport environment. At present, there is no theoretical framework to help those working with this highly selective group to promote the development and maintenance of optimal holistic health. Moreover, the early and ongoing development of optimal holistic athlete health has not commonly been viewed as a performance requirement within sporting organisations. This research aimed to understand health and its determinants for Australian high-performance athletes from the perspective of a representative sample of expert health practitioners who currently work or have recently worked in high-performance sports healthcare. Determinants of health are factors that influence how likely we are to stay healthy or become ill/ injured. Understanding these determinants will help researchers and practitioners develop a theoretical health promotion framework that may be applied broadly across Australian high-performance sport. This study used a mixed-methods approach, including a Delphi survey and subsequent semi-structured one-to-one qualitative interviews to derive a consensus on athlete health determinants and the factors which influence these. The purpose of the qualitative interviews was to explore, more deeply, the experiences, beliefs and thinking behind participant responses to the questions posed in the Delphi survey, to add both nuance and context to those responses. The Delphi survey was conducted at two time points over a period of three months. Descriptive statistical analysis of the Delphi survey results demonstrated that there was general recognition of the relevance of the World Health Organisation definition of health and its determinants to the health of high-performance athletes, a finding that is not usually evident in the literature, nor reflected in the provision of health services to this population cohort. Thematic analysis of the Delphi survey data, using a socio-ecological theoretical lens, revealed a need to consider a broader range of influences on athlete health than those that relate specifically to participation in high-performance sport. These include geographic isolation, access to appropriate health services, ethnicity, and socio- economic status. The interview findings revealed that there is a need to apply additional consideration to factors that can be categorized as social determinants of health in healthcare planning for, and management of, Australian high-performance athletes. This study's findings will help form a theoretical framework for Australian high-performance athlete health. Specifically, this framework would address the need for sporting organisations to create and provide health-promoting environments for their athletes and to support athletes in developing their capacity to manage better the impact of the health stressors to which they are exposed, as identified by the high-performance healthcare experts surveyed in this study.

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