Barriers and facilitators faced by athletic trainers implementing national athletic trainers' association inter-association task force preseason heat- acclimatization guidelines in us high school football players

Context: The aim of the National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) preseason heat-acclimatization guidelines was to acclimatize high school athletes to the environment during the first 2 weeks of the preseason and reduce the risk of exertional heat illness. Objective: To identify barriers and facilitators that high school athletic trainers (ATs) encountered when implementing the NATA-IATF guidelines. Design: Qualitative study. Setting: Individual phone interviews with all participants. Patients or Other Participants: Thirty-three ATs (16 men, 17 women; age=36.0 6 12.0 years, athletic training experience = 12.9 6 10.5 years) representing 19 states (4 with state mandates) were interviewed before data saturation was achieved. Participants were purposefully sampled from a larger investigation based on stratification of US Census region and preidentified high school compliance with the NATA-IATF guidelines. Main Outcome Measure(s): A cross-sectional, semistructured phone interview (6 steps) was conducted with each participant and then transcribed verbatim. A 7-person research team (5 coders, 2 auditors) coded the data into themes and categories, focusing on consensus of data placement to reduce bias and ensure accuracy. Results: Facilitators and barriers that influenced successful guideline implementation were (1) perceived stakeholder access, (2) perceived stakeholder role, (3) capability and capacity, (4) school culture, (5) logistical support, (6) resources, (7) physical environment, and (8) consistency of the guidelines. Overall, participants discussed facilitators and barriers within each category based on their experiences and circumstances. Conclusions: Athletic trainers faced numerous concerns regarding compliance with the NATA-IATF preseason heatacclimatization guidelines. Multiple levels of influence should be targeted to improve implementation. These include intrapersonal factors by giving ATs the education and self-efficacy to support advocacy for implementation, interpersonal components by establishing strong collaborative networks for change, community and environmental factors by optimizing school culture and community resources for implementation, and policy aspects by establishing consistent guidelines across all bodies.