The primary findings of this study were the significant associations between perceived benefits and barriers and intention to participate in an ERIPP in ROTC cadets. Additionally, it is important to note that social influence was trending towards statistical significance and had a large association with intention to participate in an ERIPP (B = 2.22, ƞ2=0.23, p = 0.08). These results indicate ROTC cadets value benefits of ERIPP participation, barriers to participate in ERIPPs, and social influences.
The two factors most associated with intention to participate in ERIPPs were perceived benefits of participation and perceived barriers to participation. Perceived benefits of participation include anything that an individual sees as gaining from their participation in an ERIPP such as reducing lower extremity injury rate, improving functional performance, and increasing knowledge of lower extremity injuries and ERIPPs. Perceived barriers include anything the individual sees as a barrier to their participation in an ERIPP. As cadets indicated that they perceived more benefits of participation and reduced challenges to their participation they were more likely to indicate enhanced levels of intention to participate in an ERIPP. These results align well with the results of a study (15) which investigated attitudes towards participation in ERIPPs within female netball players. There was a significant association between the attitudes subscale, comprised of questions related to barriers and benefits of participation, and intention to participate (15). There are multiple benefits to participating in ERIPPs within military personnel including reduction in the risk of lower extremity injury (24) and improvements in functional performance (11, 25). Some of the proposed barriers to participation in ERIPPs have been time, availability of equipment, location of the program, and knowledge on how to perform the exercises (17, 26). Benefits to participation and strategies to overcome barriers may be influential to ROTC cadets when choosing to adopt ERIPPs.
The association between social influence and intention to participate was trending towards significance and was associated with a large partial eta squared effect size. The social influence subscale focuses on the influence of peer participation in an ERIPP and the importance of data to support the effectiveness of the ERIPP to improve athletic performance. Some literature has suggested that ERIPPs can not only reduce the risk of injury, but also lead to improvements in functional performance (11, 25). Specifically, one study indicated improvements following participation in the Dynamic Integrated Movement Enhancement program in jump landing technique (11) while another found improvements in the Army Physical Fitness Test including the 2 mile run, push-up, and sit-up performance (25). However, it is unlikely that ERIPP participants are aware of the benefits of participation specific to improvements in performance. These specific benefits could be highly motivating as ROTC cadets have requirements to pass the Army Physical Fitness Test, which requires a significant amount of physical performance. Additionally, the importance of group setting is already a factor that is instrumental in most military activities (27). The information gained in this study further supports the need for the ERIPP to be a part of normal physical fitness that is completed as a group rather than something the cadet is expected to do individually. The introduction of the specific data that shows improvements in physical performance after participation in an ERIPP and including the ERIPP in regularly scheduled group physical fitness sessions may encourage ROTC cadets to participate.
There were several subscales from the HBMS and TPBS that were not significantly associated with intention to participate. A few of the subscales with a lack of association with intention were HBMS perceived susceptibility, HBMS fear of injury, and HBMS perceived consequences. The participants in this study were young, healthy individuals and therefore may have not perceived susceptibility to injury, fear of injury, and consequences because most of them had probably not suffered a significant injury in the past. Although most of the participants had experienced an injury in the past, only 14% had an injury they classified as “severe”. This assortation is supported by the literature that indicates that this population reports relatively low levels of perceived probability and worry/concern of injury as well as confidence in their ability to avoid injury (28). Additionally, soldiers have indicated that there is a lack of injury education in the military which could lead to a lack of realization of susceptibility and consequences of injury (29). There is a need to further investigate these variables and their importance in relation to participation in ERIPPs in other populations.
The results of this study indicate implementation plans for ERIPPs within ROTC cadets should place a focus on benefits, barriers, and social influence. Participants could be educated on the benefits of participating in ERIPPs including the reduction in lower extremity injuries and improvements in functional performance. Additionally, educational information could be provided on common barriers to participating and strategies to overcome those barriers. Lastly, social influence could be targeted by providing a group setting for the cadets to participate in. Including focus on these factors within the implementation plan for ERIPPs may lead to increased adoption and adherence of these programs. Therefore, future research is needed to determine the effectiveness of an intervention which targets these factors to improve adherence rates of ERIPPs.
There were several limitations associated with this study. Intention to participate in an ERIPP was used as the dependent variable for the regression analysis. There is currently a lack of data to suggest whether intention to participate is directly related to actual participation within users of the program. There is some evidence to suggest that intention to implement ERIPPs is not associated with actual implementation in coaches (30). The sample size for the study was limited and only contained ROTC cadets from one university. As a result, the findings of this study may not be generalized to other military personnel. Participation in an ERIPP is a multifactorial issue. For the purposes of this study, only the attitudes of the user were taken into consideration. It is likely the attitudes towards injury prevention of the leaders are an important factor and must be investigated through future research.