Safe Sport Is a Public Health Practice, Swedish Elite Athletics Study Finds

Elite sport has long been celebrated as a crucible of human excellence, but a growing body of research reveals a darker underside: environments in which athletes are exposed to harassment, abuse, overtraining, and cultural norms that normalise harm. A new study published in BMC Public Health by Carolina Lundqvist, Moa Jederström, and Laura Korhonen of Linköping University examines how the people who actually shape elite athletes’ daily environments—coaches, teachers, and managers within Swedish Athletics—understand and practise safety. Their central argument is provocative: safe sport should not be treated merely as a safeguarding checklist or a matter of individual vigilance, but as a settings-based public health practice, comparable to how public health approaches workplaces, schools, and communities as whole environments that determine wellbeing.

The research team purposively sampled seventeen sport personnel, eight women and nine men aged between 35 and 66, all of whom carry responsibility for shaping elite athletes’ sporting environments. The participants were drawn from three organisational levels within Swedish Athletics: national elite sport high schools, high-performance centres, and national teams. This sampling strategy ensured that the study captured perspectives from the full pipeline through which young athletes pass on their way to the elite level, from boarding-school-style sport academies to the pinnacle of national team competition. Data were generated through semi-structured interviews, allowing participants to speak in their own words about what safety means in their daily work.

Methodologically, the study is notable for the analytical lens it applies. The researchers conducted a reflexive thematic analysis within a social constructivist-informed qualitative framework, but they organised and interpreted their themes using the Quadripartite Nature of Structuration model, an extension of Strong Structuration Theory developed by sociologist Rob Stones. Building on Anthony Giddens’s foundational work, structuration theory holds that social structures—norms, rules, and resource distributions—do not simply determine individual behaviour, nor do individuals freely create their worlds. Instead, structure and agency exist in a continuous, mutually constitutive relationship: people draw on structural conditions when they act, and their actions in turn reproduce or transform those conditions. Applying this framework to sport safety allows the researchers to ask not just what coaches believe, but how their capacity to act on those beliefs is enabled or constrained by the organisations around them.

The analysis yielded three major themes. The first concerns how sport personnel understood safe sport through the interplay between internal and external structures. Participants articulated holistic understandings of safety that went well beyond the prevention of violence and abuse, encompassing athletes’ mental health, workload management, and the broader sociocultural climate of their training groups. They also described temporal shifts: conceptions of what counts as safe practice have evolved over their careers, influenced by public debate, policy developments, and changing expectations from athletes themselves. Crucially, they recognised that their ability to translate these understandings into practice depended on resource conditions—time, staffing, competence, and institutional support—that varied widely across settings.

The second theme captures what the researchers call active agency through everyday practices. Far from being passive recipients of policy, the sport personnel described themselves as continuously working to make environments safer through small, concrete interventions. They highlighted collaborative agency: working with fellow coaches, teachers, medical staff, and athletes to build shared norms and to notice early signs of trouble. These micro-level interventions—adjusting a training plan, checking in with an athlete after a difficult session, challenging a dismissive comment in the group—rarely make headlines, but the study suggests they constitute the practical substance of safe sport as it is actually lived.

The third theme, however, reveals the structural headwinds that such agency must overcome. Participants described solitary coaching practices, in which coaches work alone with athletes behind closed doors, creating conditions where harmful behaviour can go unwitnessed and unchallenged. They identified power asymmetries between coaches and athletes, and between elite-level personnel and the athletes whose careers depend on their favour. Institutional silence emerged as a recurring constraint: a reluctance within organisations to name problems openly, which leaves individuals uncertain about whether raising concerns will be supported or penalised. Perhaps most insidiously, participants described performance norms that normalise harmful behaviours—the cultural assumption that enduring pain, suppressing doubt, and accepting authoritarian treatment are simply the price of elite success.

Compounding these constraints, the study found fragmented accountability structures. Responsibility for athlete welfare was diffused across schools, clubs, federations, and national programmes in ways that made it unclear who was ultimately answerable when things went wrong. In such a system, individual commitment can become a substitute for institutional obligation: the safety of athletes rests on whether a particular coach happens to be conscientious, rather than on guaranteed organisational mechanisms. Yet the participants were not fatalistic. Alongside these constraints, the researchers documented ongoing efforts toward institutionalisation—emerging policies, education initiatives, and governance developments that suggest Swedish Athletics is beginning to build prevention capacity at the organisational level.

The theoretical payoff of the structuration analysis lies in showing how these threads connect. When sport personnel possess adequate resources, clear mandates, and organisational backing, their agency is strengthened and preventive action becomes routine. When structures are fragmented, silent, or dominated by performance-at-any-cost norms, even well-intentioned individuals find their capacity to act eroded. This dynamic explains why awareness campaigns and one-off training courses so often fail to change sport cultures: they target individual knowledge while leaving the structural conditions that shape practice untouched. The authors conclude that transformative change towards safe sport requires institutionalised prevention capacity, including clear accountability and resources that extend beyond any individual’s awareness and commitment.

Framing safe sport as a public health practice carries practical implications. In public health, the settings approach recognises that health is produced by the environments in which people live and work, and that effective prevention operates at the level of systems, not just individuals. Applied to sport, this means treating training environments as health settings in their own right: auditing their norms, distributing resources for welfare work, establishing transparent reporting and accountability pathways, and empowering the personnel who inhabit those environments daily. It also means recognising that harm in sport is not an aberration committed by bad actors, but a risk that is systematically produced wherever structural conditions permit it—a lesson that resonates far beyond athletics and beyond Sweden.

The study, approved by the Swedish Ethical Review Authority as part of the larger Swedish Athletics Project on psychologically safe environments, and funded by the Swedish Research Council for Sport Science, offers a rare empirically grounded account of how safety is negotiated at the sharp end of elite sport. Its message to federations worldwide is sobering but constructive: the coaches and teachers who stand closest to athletes are already doing much of the work of prevention, but they cannot carry it alone. Until organisations match individual commitment with institutional structures—resources, accountability, and cultures that refuse to normalise harm—safe sport will remain dependent on the goodwill of individuals rather than guaranteed by the system itself. The findings suggest that the next frontier of athlete welfare lies not in better slogans, but in the deliberate redesign of the structures within which sport personnel act.

Subject of Research: Safe sport as a settings-based public health practice in Swedish elite athletics

Article Title: Understanding safe sport as a public health practice: a strong structuration theory analysis of Swedish elite athletics sport personnel

Article References: Lundqvist, C., Jederström, M., & Korhonen, L. (2026). Understanding safe sport as a public health practice: a strong structuration theory analysis of Swedish elite athletics sport personnel. BMC Public Health. https://doi.org/10.1186/s12889-026-29709-8

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29709-8

Keywords: safe sport, athlete welfare, elite athletics, public health, safeguarding, structuration theory, coaches, sport governance, mental health, violence prevention, Sweden, qualitative research