Development of a Framework to Identify Barriers of the Female Athlete Triad Among Developmental Female Athletes: A Qualitative Study
Description
Background: The Female Athlete Triad (FAT) is a major concern for developmental female athletes (13-19 years old), and there are limited studies concerning barriers to recognition and management in Indian populations. The purpose of this study is to provide a comprehensive framework of barriers stopping developmental female athletes from recognising, reporting and managing symptoms associated with FAT in sports academies in India. Methods: Qualitative study was done with 15 developmental female athletes aged 13–19 years from sports academies at Bhubaneswar, Odisha, India. Face-to-face, audio recorded semi-structured interviews. Data saturation was achieved at the 12th interview. Reflexive thematic analysis was performed following the six phases of reflexive thematic analysis outlined by Braun & Clarke (2000). The process began by creating an initial code book by manual coding, followed by quantitative rating and construction of code frequency and thematic prevalence within the sample in MS Excel. Results: 6 major themes (27 distinct codes) were identified which included individual, interpersonal, organisational and sociocultural barriers. The most striking result was that no one knew what FAT was (Code E1: 13/15, 87%). Other common barriers reported were not being able to interpret body signals (12/15 (87%)), the normalization of menstruation as part of being an athlete (10/15 (67%)), unintentional eating less due to training timings (11/15 (73%)), embarrassment/shame of disclosure (11/15 (73%)), and fear of judgement from coaches (10/15 (67%)). Groups of barriers that formed reinforcing cycles, such as lack of awareness led to symptom interpretation, which led to normalization, which decreased help-seeking. Athletes reported discussions with trusted peers or relatives regarding health issues, but not with their coaches or medical staff (F7: 10/15, 67%). Conclusion: This study uncovers barriers to recognition and management of FAT in Indian developmental athletes which are multi-factorial and inter-related. The results point to immediate need for awareness-raising in sports and among athletes and coaches, as well as a shift in the culture and a system to help facilitate safe disclosures. The barriers need to be tackled at several ecological levels. It is the first qualitative study exploring FAT barriers among Indian developmental athletes and helps understand a significant issue in the context of underdeveloped sports medicine infrastructure and limited awareness in Indian Context. Keywords: Disclosure; Embarrassment; India; Judgment; Prevalence; Sports Medicine