Original article

Merley M-E1, Gremeaux V2,3, Edouard P1,2,4
1 Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
2 Swiss Olympic Medical Centre, Centre de médecine du sport, Division de médecine physique et réadaptation, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
3 Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
4 Interuniversity Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon, University Jean Monnet, F-42023 Saint Etienne, France

Abstract

Background: Diffusion of information regarding ‘protecting athletes’ health’ and the ‘promotion of sport for health of the general population’ is a mission of National Sports Federations. Internet is a commonly used source of health-related information. The Olympic Games (OG) are an opportunity for a nation to promote the health benefits of sport.
Objective: To analyse the availability and accessibility of health-related information on French National Olympic Sports Federation (FOFs) websites just after the bid in 2015 for the 2024 OG and six months after official assignment (2018) of the games to Paris.
Methods: This descriptive study analysed the availability and accessibility of information regarding athletes’ health protection and the promotion of sport for health for all, on FOF websites, using a list of 12 different topics and two check lists (Google score (GS) and Website score (WS)) in September 2015 and March 2018.
Results: The websites of 31 and 36 FOFs were analysed in 2015 and 2018, respectively. In 2015, 32.3% of FOFs reached a GS ≥ 75%: this was 50% in 2018. From 2015 to 2018, there was a significant increase in the availability of information on FOF website based on GS (mean increase of 41.2%; p=0.004) and a tendency to increase for availability and accessibility based on WS (mean increase of 21.4%; p=0.07).
Conclusions: The FOFs are engaged in diffusing health-related information via their websites, although the availability and accessibility of this information varies according to FOFs and topics.

Résumé

Contexte: La diffusion d’informations sur «la protection de la santé des athlètes» et la «promotion du sport pour la santé de la population » est une mission des fédérations sportives nationales. Internet est une source d’information sur la santé couramment utilisée. Les Jeux Olympiques sont une occasion pour un pays de promouvoir les bienfaits du sport sur la santé.
Objectif: Analyser la disponibilité et l’accessibilité des informations relatives à la santé sur les sites Internet des fédérations nationales françaises de sport Olympique (FFO) juste après la candidature en 2015 pour l’organisation des Jeux Olympiques en 2024 à Paris et six mois après l’attribution officielle des jeux à Paris (2018).
Méthodes: Cette étude descriptive a analysé la disponibilité et l’accessibilité des informations relatives à la protection de la santé des athlètes et à la promotion du sport pour la santé pour tous sur les sites Internet des FFO, à l’aide d’une liste de 12 différents domaines et de deux scores: score Google (SG) et score Web (SW), en septembre 2015 et mars 2018.
Résultats: Les sites Internet de 31 et 36 FFO ont été analysés en 2015 et 2018, respectivement. En 2015, 32,3% des FFO ont atteint un SG ≥ 75%, et 50% en 2018. De 2015 à 2018, le nombre d’informations disponibles sur les sites Internet des FFO a augmenté: sur le SG on notait une augmentation moyenne de 41,2%; p = 0,004, et une tendance à la hausse pour la disponibilité et l’accessibilité avec le SW (augmentation moyenne de 21,4%; p = 0,07).
Conclusions: Les FFO sont engagées dans la diffusion d’informations relatives à la santé via leurs sites Internet, bien que la disponibilité et l’accessibilité de ces informations varient selon les FFO et les domaines.

What are the new findings?

  • Availability of health-related information varied between FOFs without any correlation with the size of the FOF (number of members).
  • The accessibility of the health-related information varied according to topics.
    How might this impact on clinical practice in the near future?

These results should help FOFs in orienting their efforts to improve the availability and accessibility of information for the health protection of athletes and health promotion through sport on their websites. FOFs should be fully exploiting the potential of this great communication tool and using it to communicate with and inform athletes, coaches and health-care professionals.

1. Introduction

The protection of athletes’ health and the promotion of health and physical activity for the whole population are two of the clearly stated aims of the International Olympic Committee (IOC) and International Sports Federations (IFs), and consequently of all National Olympic Committees (NOCs) and National Sports Federations (NFs) [1–4]. Diffusing information on these topics is also an important part of these governing sporting bodies’ mission, as stated in the Olympic Movement Medical Code (OMMC) [2], and in stage 6 of the Translating Research into Injury Prevention Practice (TRIPP) framework [5]. This type of information would be of interest to: i) health-care professionals helping them improve athletes’ medical care and education, and encourage sport promotion for health, ii) athletes, coaches, and/or athletes’ care­givers to improve health, training practice and lifestyle, and iii) the general population to encourage sporting practice.
We felt it logical that NFs would have the major role in this, because: i) athletes, coaches and health professionals may be members of these NFs; ii) clubs affiliated to these NFs are known to the general and sporting population in the vicinity; iii) NFs are better known than IFs by athletes and the general population; iv) NFs can disseminate information provided by the IOC, NOCs and IFs, in the language of their members; v) health professionals, coaches and athletes can contact NFs with health or sport-related questions; vi) NFs have medical commissions; vii) NFs are trusted; and viii) NFs are more sport-specific than NOCs. Since this information needs to be easy to find, and the Internet regularly used as a source of health information [6–8], we felt that looking at the information available on NFs websites would be an easy way to analyse health-related information dissemination.
The Olympic Games (OG), as the most famous sporting event of all time, is an opportunity for a nation to develop sport awareness, highlighting the sporting performance and excellent health that wins Olympic medals [9,10], whilst promoting sport and exercise for all as a public health goal [11]. In the preparation of the ‘Paris 2024’ OG (http://www.paris2024.org/fr), such strategies and messages should be included by the French Olympic Sports Federations (FOFs).
In this context, we aimed 1) to analyse exactly what health-related information was available on the websites of FOFs and measure how easy it was to find this information, and 2) to analyse the evolution in the available information between the time of making the bid and six months after Paris was officially awarded the 2024 OG.

2. Methods

2.1 Procedure
This descriptive study analysed the availability and accessibility of health-related information on the websites of FOFs, using a list of different topics and two check lists (Google score and Website score), in September 2015 (three months after Paris made its bid for the 2024 OG) and March 2018 (six months after Paris was awarded the 2024 OG).

2.2 The French Olympic Sports Federations
We chose to analyse only information from FOFs because: i) they are the NFs of sports included in the games so part of ‘Paris 2024’; ii) they represent IFs at a national level; iii) they are responsible for protecting the health of their athletes and promoting physical activity via their sport to improve the health of the general population [1–4]; iv) they are most often structured as associations or federations; v) they usually have media and financial support; and vi) they are the ‘showcase’ of their sport with the general public.

2.3 List of different topics
We created a list of different topics, designed to cover that developed by Mountjoy and Junge [3], the main areas of Sports Medicine [12], the principal topics discussed by medical commissions of IFs and NFs, the questions heard in clinical practice from athletes or patients who want to start a physical activity and an initial screening of FOF websites, based on the authors’ experience of general practice and sports medicine and with the help of the head of a local branch of a French sporting federation. The 12 topics were listed in Table 2.

2.4 Data collection using scores
In order to objectively analyse the information disseminated by the FOFs, we used two scores: the Google score (GS) and the Website score (WS). Each FOF and each topic were scored first with the GS and then with the WS. A single investigator/author (MEM) carried out all the searches during private browsing sessions so that her personal data would not influence the results.

2.4.1 Google score
We chose the Google search engine as it is the most used and known to be comprehensive, especially for health information, and as it includes documents in .pdf, .doc and .ppt formats [13,14]. We searched using a combination of the complete name of each FOF and each topic e.g. ‘french federation of athletics recommendations on injury prevention’. All words were in French, without quotation marks, without capital letters and without the Boolean search operator ‘AND’. If a link to the corresponding webpage of the FOF for the topic under consideration appeared within the first two pages of results, 1 point was awarded. Reformulation of the topic was used if the initial topic term was ‘not found’. For each topic, the GS could be either 1 or 0 depending on whether the topic appeared within the first two pages of results, giving a maximum possible for each FOF of 12 points. GS is reported as a percentage of the maximal score.

2.4.2 Website score
Starting from the home page of each FOF website, a search was performed to find information related to each topic in order to evaluate the availability and accessibility of the information and scored as follows: 3 points if the information was present on the home page; 2 points if it was findable using the site map; 1 point if it was difficult to find; 0 points if nothing was found even after using the website’s internal search engine. We aimed to reproduce how an athlete or health professional would actually search the Internet, including a time limitation. The maximal WS was thus 36 for each FOF; 0-3 points for each of 12 topics. WS is reported as a percentage of the maximal score.

2.5 Data analyses
First, descriptive analyses were performed regarding the availability and accessibility of information using GS and WS results as frequency. A topic was considered as available if either the GS or WS was at least 1, as many people would go directly to the website of their chosen sport and bypass the search engine. Comparisons were then made between the values obtained in 2015 vs. 2018, for each FOF and each topic, using a Student t-test. Finally, comparisons were made between team vs. individual sports and between summer vs. winter sports federations using a Student t-test. Correlations between each FOF’s membership and GS and WS were analysed using the Pearson correlation coefficient. Significance was accepted at p<0.05. Data were processed using Excel software.

3. Results

For the FOFs (n=31 in 2015, and n=36 in 2018), the GS and WS varied from 16.7% to 100% (Table 1). In 2015, 32.3% of FOFs had a GS ≤75%; this rose to 50% in 2018 (Table 1). From 2015 to 2018, there was a significant increase in the availability of information on the FOF websites based on GS (mean increase of 41.2%; p=0.004) and a tendency to increased availability and accessibility based on WS (mean increase of 21.4%; p=0.07). 58.1% of FOFs increased their GS and 64.5% their WS, although 25.8% and 22.6% decreased their GS and WS, respectively.
Depending on the topic, there was no significant increase over time for the availability of information (mean increase of 7.5%; p=0.2) (Table 2 and Figure 1).

Figure 1: Availability of information based on the Website Score according to the topics for all analysed French Olympic Sports Federations (FOFs) in 2015 (A) and 2018 (B).

Table 2: Percentage of information available according to the topics, with changes from 2015 to 2018. Availability of information corresponded to score at least 1 at the Google Score or Website Score.

4. Discussion

The main findings of the present study were that 1) FOFs diffuse health-related information through their websites, since in 2018 50% of them were including 75% of our topic list on their websites, and only 14% had less than 50% of the topics covered, 2) availability of health-related information varied between FOFs without any correlation to the size of the FOF (number of members), and 3) the accessibility of the information varied with the topics. To the best of our knowledge this is the first study, to analyse the availability and accessibility of information regarding athletes’ health protection and promoting sport for health on NF, IOC, NOC, or IF websites. Such an analysis is of great interest given the mission of these governing sporting bodies [1–4].

4.1 FOFs play the game and diffuse health-related ­information
Our results show that NFs (in this case FOFs) are actively promoting sport and the health protection of athletes [5]. Although not all the 12 topics were available on all the FOF websites, the fact that 86% had at least 6 topics on their website, and 50% had 75% or more, suggests that FOFs are trying to diffuse health-related information. Most FOFs improved their score between 2015 and 2018, indicating their willingness to make this information more easily available.
As an extension of the studies published by Mountjoy and Junge [3] and Mountjoy et al. [4], these results report the information actually available from NFs, rather than just the topics they declare to be a priority for health. Declarations are easy but the practical information now available is encouraging as it proves that the governing sporting bodies are taking seriously their responsibility of informing the public [1–4,10].
It is obvious that the IOC, NOCs, IFs and NFs should provide only valid, and if possible evidence-based information, and the quality of their message is all-important if athletes and patients are to have confidence in what they read [15]. No qualitative analysis was carried out in this study (or in the work analysing the priorities of IFs [3,4]), but could be an interesting future extension to our work.

4.2 Health-related information varied according to ­topics
The most available and easy to find information concerned ‘Anti-doping’, ‘Medical certificate’, and ‘Sport for Health’, all fundamental topics to the FOFs. As the ‘Fight against doping’ is a top priority for IFs [3,4,16], we can assume that this is also true for NFs as without such a policy these NFs would not be approved by the IOC, nor be allowed to participate in the OGs. Doping has serious repercussions for the image of sport and the health of athletes; hardly surprising then that it is so prominent on websites.
A medical certificate is mandatory for any affiliate to a NF in France (https://www.legifrance.gouv.fr/eli/decret/2016/8/24/VJSV1621537D/jo/texte). FOFs make this information easy to find on their websites so that potential members will not be discouraged when unable to find the information they need.
Although everyone knows that physical activity is beneficial to health [17,18] someone taking up a sport is an opportunity for an FOF to increase its membership. Giving prominence to ‘sport for health’ information is not only a public health issue, but also an economic one for the sporting federation.

4.3 More information now available
Our results show significant improvements in the availability of information from 2015 to 2018. The Internet is constantly evolving and growing exponentially so websites too must change to continue to attract people to their sites. Presumably this is also true for NFs as their websites are the showcase for their sport, both with athletes and the general public and a means to attract new members particularly through the diffusion of more health-related information and the general boost given to sport for Paris 2024.

4.4 Methodological considerations
Compared to previous studies asking IFs about their priorities and activities [3,4] our work shows no self-reporting bias. The scores obtained give an objective evaluation of the availability and accessibility of health-related information. The Website Score measured not only the availability on a site of an item but also how easy it was to access this information. These searches were all carried out by the same person, both in 2015 and 2018 over a period of two weeks in order to limit potential bias as websites were updated.
Other sources of medical information than internet are available to the public [8]. People may also seek this information on more generic rather than NF websites. We did not judge the content of the information. We intentionally designed the study to target Olympic NFs, the results and their implications are thus limited to these specific NFs. The analysis between the individual vs. team sports, and summer vs. winter Olympic sports should be interpreted with caution due to the low number of FOFs in team and winter sports. Although we used two methods to find our information (via the Google search engine or directly from the FOF website), this many of course not reflect how everyone would try to access such information [19]. Finally, particularity of French sports (e.g. mandatory medical certificate) could bias information presented by FOFs in comparison to NFs from other countries.

4.5 Practical implications and perspectives
Our results could help FOFs improve their health-related communication. Some generic advice for improvements would include: i) improving how to find health/medical information on websites; ii) proposing a model for a medical certificate to download and print in .pdf format with a brief review of the legislation, the appropriate medical examination and specific contra-indications for the sport; iii) include the existing health-related programs proposed by the French government (e.g. ‘10 gold reflexes for health’: http://www.sports.gouv.fr/10reflexesenor/index.html); and iv) other improvements could be made to improve the trust and credibility of the website [20]. Those topics ignored or under-developed on FOF websites should be targeted.
Further studies using similar methods should be conducted for IFs, NOCs, and even for other NFs. Looking at the information provided by IF websites in comparison to their declared priorities would also be relevant, as would evaluating the quality and readability of this information.

5. Conclusion

The FOFs are engaged in diffusing health-related information via their websites, although the availability and accessibility of this information varies according to FOFs and topics. These results should help FOFs to orientate their efforts to improve the availability and accessibility of information on athletes’ health protection and sport promotion for health via their websites.

Conflict of interest

No potential conflict of interest declared

Funding

No funding

Ethical statement

Since the present study did not involve human subjects the Ethical Approval or subjects’ informed consent was not necessary.

Corresponding author

Pascal Edouard, MD PhD
Department of Clinical and Exercise
Physiology, Sports medicine unity,
IRMIS, Campus Santé Innovations
University Hospital of Saint-Etienne
42 055 Saint-Etienne cedex 2
France
Tel.: +33 674 574 691 

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