| Knott, Sian 2026. Speaking up in elite sport: an exploratory-descriptive qualitative study of UK physiotherapists' experiences [Abstract]. Physiotherapy 132 (S1) , 101966. 10.1016/j.physio.2026.101966 |
Abstract
Purpose: Background: Globally sport integrity is under increasing threat, with frequent reports of doping, match fixing, and physical, psychological, and sexual abuse. These behaviours, often normalised within elite sport environments, can remain unchallenged without individuals choosing to speak up. Speaking up is everyone’s responsibility, but for physiotherapists, it is also a professional obligation tied to their duty of care. While the barriers to speaking up in healthcare (mainly nursing) are well documented, research in physiotherapy is limited across all sectors, but within elite sport, where unique workplace dynamics and power structures may further complicate disclosure it is a pressing issue that warrants exploration. Purpose: This study aimed to explore physiotherapists’ lived experiences of speaking up in elite sport within the UK, with a focus on understanding the barriers and enablers that influence their willingness and ability to raise concerns. The research seeks to fill a gap in the literature and contribute to a broader understanding of speaking up practice within elite sporting environments. Methods: An interpretivist qualitative methodology was employed, using an Exploratory Descriptive Qualitative Research design. Fifteen physiotherapists working in elite sport across England, Wales, and Scotland were recruited through purposive and snowball sampling. Seven hundred and twenty-one minutes of data was collected via semi-structured interviews conducted over Zoom during a 4-month period and analysed using Braun and Clarke’s reflexive thematic analysis. Results: Four key themes were generated: 1. Contextual Factors – Participants described the influence of change (funding and societal), the impact of success on competitive pressure, and workplace culture on their ability to speak up. 2. Workplace Lived Experiences – Physiotherapists shared accounts of ethical dilemmas, boundary issues, and multidisciplinary team working with a mix of professional and non-professional staff. 3. Language of Whistleblowing and Speaking Up – Participants expressed discomfort with the term “whistleblowing” and identified confusion around definitions and reporting mechanisms. Most identified barriers and enablers of speaking up concurred with existing literature including fear of consequences, reputational damage, and lack of trust in systems. Organisational culture and the response of the hearer through compassionate leadership and psychological safety emerged as significant enablers. 4. Internal and External Influences – Speaking up was influenced by personal values such as integrity and moral courage, as well as external factors including regulatory standards, employment contracts and organisational processes. Conclusion(s): Speaking up in elite sport is a complex and often risky act for physiotherapists, shaped by interrelated personal, cultural, and structural factors. Hierarchical dynamics, fear of retaliation, and normalised poor behaviours create significant barriers. However, environments that foster psychological safety, clear ethical leadership, and supportive peer relationships are more likely to encourage speaking up. Further research is recommended to include perspectives from athletes and wider support staff to develop comprehensive safeguarding strategies. Impact: This research contributes to understanding ethical practice and duty of care in elite sport but is applicable to all physiotherapists across other work settings. Findings have practical implications for governing bodies, clubs, and education providers in developing clear processes and policy, enhanced education and training, and culture that support safe and ethical speaking up.
| Item Type: | Short Communication |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Schools > Healthcare Sciences |
| Publisher: | Elsevier |
| ISSN: | 0031-9406 |
| Last Modified: | 03 Aug 2026 11:49 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/188687 |
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