Beyond the Rulebook: A Randomized Controlled Trial of Management-Based Anti-Doping Education for Young Elite Athletes in a Developing-Nation Context

1. Introduction

Doping among young elite athletes is rarely a single, poorly informed decision; it is the visible endpoint of a system of pressures — coaches, peers, sponsors, national federations, and international governance bodies — operating on an athlete who may have received, at best, a lecture on prohibited substances. The dominant global model of anti-doping education, exported largely unmodified from the World Anti-Doping Agency (WADA) framework to national anti-doping organizations (NADOs) worldwide, emphasizes rule literacy: what is banned, how testing works, and what sanctions follow a violation. This knowledge-transmission approach has demonstrable value but has shown limited ability to shift the underlying social and motivational drivers of doping behavior, particularly in low-resource federations where implementation is symbolic rather than substantive (Nicholls, Fairs, Plata-Andrés, Bailey, & Cope, 2020).

This gap is amplified in developing-nation contexts. Institutional theory suggests that national anti-doping systems in low-resource countries frequently adopt WADA-compliant policies to secure legitimacy and international eligibility — a pattern of isomorphic mimicry — without the funding, personnel, or contextual adaptation needed for those policies to function as intended. The result is a persistent policy–implementation gap: athletes are nominally covered by anti-doping rules but rarely receive education calibrated to their lived reality.

We test an alternative model. Drawing on the resource-based view (RBV) of the firm and stakeholder theory (ST), we conceptualize anti-doping competence not as a fact to be transmitted but as a strategic, internal capability to be built — one that is valuable, difficult to imitate, and reinforced by a coordinated network of stakeholders (coaches, peers, sponsors, and anti-doping bodies) rather than left to the athlete alone. This management-based framing motivated a six-session curriculum tested head-to-head against a duration-matched conventional curriculum in a randomized controlled trial (Mazanov, 2016; Söderman, 2023).

1.1. Theoretical Framework

The resource-based view (RBV) holds that sustainable advantage accrues from valuable, rare, inimitable, and non-substitutable (VRIN) internal assets. Applied here, an athlete's anti-doping knowledge, ethical reasoning capacity, and resistance to doping-related social pressure are treated as internal capabilities that a well-designed program can deliberately cultivate, producing a durable "clean-sport" advantage rather than a transient compliance effect (Mazanov, 2016).

Stakeholder theory (ST) reframes anti-doping education as a coordination problem: an athlete's decisions are embedded in relationships with coaches, peers, competitors, sponsors, and regulatory bodies, each with the capacity to reinforce or undermine clean-sport norms. A program that engages this network — rather than addressing the athlete in isolation — is hypothesized to produce more resilient behavioral and attitudinal change (Barkoukis, Brooke, Ntoumanis, Smith, & Gucciardi, 2019; Söderman, 2023).

Together, RBV and ST generate three pre-registered hypotheses: (H1) the management-based curriculum will produce significantly larger gains in anti-doping knowledge, attitudinal alignment, and ethical reasoning than the conventional curriculum; (H2) these effects will be moderated by gender; and (H3) knowledge acquisition will mediate the curriculum's downstream effects on attitudes and ethical reasoning, consistent with a "knowledge-first" cognitive pathway to behavior change (Kavussanu, Hatzigeorgiadis, & Elbe, 2018).

2. Methods

2.1. Design

This study used a two-arm, parallel-group, randomized controlled trial (RCT) design, reported in accordance with CONSORT 2010 guidelines. Participants were individually randomized by an independent third party to either the management-oriented intervention or a duration- and format-matched conventional (knowledge-based) control curriculum, minimizing selection and allocation bias (Barkoukis, 2023).

2.2. Participants

321 elite athletes aged 13–19 years were recruited from athletics, football, and swimming federations across urban, suburban, and rural regions of Ethiopia, through schools, sports clubs, and the Ethiopian National Anti-Doping Office (ETH-NADO). Eligibility required regional- or national-level competition status and no prior participation in a management-focused anti-doping program. An a priori power analysis determined the target sample size sufficient to detect small-to-medium effects. The intervention group (n = 161; mean age 17.2 years, SD 1.5; 49.7% female) and control group (n = 160; mean age 17.1 years, SD 1.4; 48.1% female) did not differ significantly on any baseline characteristic (Table 1).

2.3. Interventions

Both arms received six one-hour, group-delivered sessions led by trained facilitators, matched in duration, format, and instructional intensity to isolate curricular content as the active ingredient. The management-oriented curriculum (intervention) was structured around RBV and ST: sessions progressed from mapping the competitive stakeholder landscape, through building knowledge and practical skills, to fostering peer-supported socialization, resource mobilization, ownership of ethical choice, and finally athlete-led legacy/advocacy work (Table 2). The conventional curriculum (control) mirrored standard WADA/NADA programming: prohibited-substance and testing literacy, health risks of doping, fair play, legal sanctions, athlete rights and responsibilities, and signposting to anti-doping resources (Manges, Seidel, Walter, Schüler, & Elbe, 2022; World Anti-Doping, 2021, 2025).

2.4. Outcome Measures

Anti-doping knowledge was assessed with a validated, WADA-Code-aligned multiple-choice instrument (10 items, binary scoring) covering testing protocols, prohibited substances and methods, and athlete responsibilities (Aguilar-Navarro, Salas-Montoro, Pino-Ortega, & Salinero, 2022). Attitudinal alignment toward clean sport was measured using an adapted Performance Enhancement Attitude Scale (PEAS)-style instrument (17 items, 5-point Likert), where higher scores reflect stronger pro-integrity orientation, not tolerance of doping (Petróczi, 2007). Ethical/moral reasoning was assessed with 10 sport-specific situational vignettes (e.g., a coach presenting a banned substance as a recovery aid; a teammate's violation weighed against loyalty), scored 1–5 against a standardized rubric (Claessens & van Noorden, 2018). All instruments were administered at baseline (pre-intervention) and immediately post-intervention.

2.5. Statistical Analysis

Primary hypotheses were tested with repeated-measures ANOVA (time × group) for each outcome. Moderation by gender was tested via 2×2 factorial ANOVA (modality × gender). Mediation of intervention effects through knowledge acquisition was estimated using a four-step path model (path a: intervention → knowledge; path b: knowledge → outcome; direct effect c′; indirect effect a×b) with bootstrapped confidence intervals and Sobel tests for indirect-effect significance. Analyses were conducted on the intention-to-treat sample; effect sizes are reported as partial eta-squared (η²) (Kavussanu et al., 2018; Ntoumanis, Gucciardi, Backhouse, & Barkoukis, 2017).

2.6. Ethics

The study received institutional ethical approval, and informed consent/assent was obtained from all participants and, for minors, parents or guardians. Participation was voluntary, data were anonymized, and the control arm received standard-of-care education rather than being withheld instruction.

3. Results

3.1. Knowledge Acquisition

A repeated-measures ANOVA revealed a significant time × group interaction for anti-doping knowledge (p < .001, η² = .05). The intervention group's scores rose 45%, from a pre-test mean of 18.5 (SD = 3.2) to a post-test mean of 26.9 (SD = 2.5), while the control group improved only 10% (18.3 → 20.1, SD 3.1/3.0). Both groups began at statistically equivalent baselines, confirming successful randomization (Figure 1).

3.2. Attitudinal Shifts

Attitudinal alignment toward clean sport improved 30% in the intervention group (22.4 → 29.1) versus a negligible 5% in the control group (22.5 → 23.6), a significant time × group interaction (p < .001, η² = .04) representing a moderate effect (Figure 2).

3.3. Ethical Reasoning and Resolution

Ethical reasoning scores rose 35% in the intervention group (23.0 → 31.0) versus 7% in the control group (23.2 → 24.8), a significant interaction (p < .001, η² = .06) — the largest effect size of the three primary outcomes (Figure 3, Table 3).

3.4. Interaction of Training Modality and Gender

A 2×2 factorial ANOVA tested whether curriculum effectiveness was moderated by gender. Both sexes benefited significantly more from the management-based curriculum than the conventional one, but the magnitude differed: male participants in the intervention arm improved 38% (22.0 → 30.5, η² = .05) versus female participants' 29% (22.2 → 28.5, η² = .04); conventional-arm participants of both sexes showed comparatively flat trajectories (+11% and +6%, respectively) (Figure 4, Table 4). The uniform upward trend for both sexes in the intervention arm indicates the program's effectiveness is not sex-contingent, though its potency may be somewhat amplified among male athletes (Kiani & Moghaddam, 2021; Kiss, Lakner, Soós, & Petróczi, 2022).

3.5. Mediation Pathways: Knowledge as a Functional Conduit

To probe the mechanism, we tested whether knowledge acquisition mediated the intervention's effect on attitudes and ethical reasoning. The intervention strongly predicted knowledge gains (path a = 7.30, SE = 0.45, p < .001), and knowledge, in turn, strongly predicted both attitudes (path b1 = 0.90, SE = 0.10, p < .001) and ethical reasoning (path b2 = 0.85, SE = 0.09, p < .001). Indirect effects were significant for both attitudes (6.57, 95% CI [5.71, 7.43], Sobel z = 9.50, p < .001) and ethical reasoning (6.20, 95% CI [5.38, 7.02], Sobel z = 8.95, p < .001). Notably, sizeable direct effects remained after accounting for the mediator (c′ = 5.20 for attitudes; c′ = 5.10 for ethical reasoning, both p < .001), indicating partial rather than full mediation — the curriculum shifts attitudes and ethics both through and independently of knowledge gains (Figure 5, Table 5) (Kavussanu et al., 2018).

4. Discussion

This trial provides quantitative evidence that a management-based anti-doping curriculum — grounded in RBV and stakeholder theory — outperforms conventional, rule-recitation education across all three primary outcomes, with the largest gains observed in ethical reasoning (η² = .06), the domain most directly targeted by the intervention's scenario-based, stakeholder-engaged pedagogy. This supports H1 and aligns with a growing literature suggesting that anti-doping education is most effective when it moves beyond fact transmission to address the social and motivational architecture of doping decisions (Boardley, Chandler, Petróczi, Patterson, & Backhouse, 2023; Nicholls et al., 2020).

The gender-interaction findings (H2) suggest curriculum effectiveness is broadly robust across sex but not perfectly uniform — male athletes showed somewhat larger gains, consistent with prior evidence that risk tolerance and responsiveness to structured pedagogical outreach differ by gender (Kiani & Moghaddam, 2021; Murofushi, Kamihigashi, Kawata, Yamaguchi, & Nakamura, 2023). This argues for monitoring, rather than assuming, equivalent efficacy across demographic subgroups in future scale-up.

The mediation analysis (H3) offers the clearest mechanistic insight: knowledge acquisition is a significant but partial conduit for the intervention's effects. This has direct implications for design — programs cannot treat knowledge transfer as sufficient, but neither can they bypass it. The persistence of a substantial direct effect after controlling for knowledge suggests that the stakeholder-engagement and capability-building components of the curriculum operate through additional pathways, plausibly including self-efficacy, perceived social support, and shifts in perceived normative pressure — mechanisms this trial was not designed to isolate but which merit dedicated measurement in future work (Barkoukis, 2023; Ntoumanis et al., 2017).

From a policy standpoint, these findings are particularly salient for federations operating under the resource and governance constraints documented in institutional analyses of anti-doping systems in developing countries. A management-based curriculum delivered at equivalent cost and duration to conventional programming produced substantially larger effects, suggesting that the binding constraint on anti-doping education effectiveness in such contexts may be curricular design rather than funding volume alone (Barkoukis, 2023; Boardley et al., 2023; Mazanov, 2016).

5. Limitations

Outcomes were measured immediately post-intervention; durability of gains and, critically, downstream effects on actual doping behavior and testing outcomes remain untested and require longitudinal follow-up. The sample, while adequately powered for the primary hypotheses, was drawn from three sports and a single national context, limiting generalizability to other federations and cultural settings. Self-report measures of attitudes and ethical reasoning are subject to social-desirability bias, and facilitator effects, though minimized through standardized session plans, cannot be fully excluded in a group-delivered design.

6. Conclusions

A management-based anti-doping curriculum — one that builds athlete capability as a strategic asset and engages the surrounding stakeholder network — produced significantly larger gains in knowledge, attitudes, and ethical reasoning than a duration-matched conventional curriculum, with knowledge acquisition acting as a partial mediator of these effects. These results support reorienting anti-doping education policy, particularly in resource-constrained federations, toward capability-building and stakeholder-engaged pedagogy rather than rule-recitation alone. Future research should test durability of effects, downstream behavioral and testing outcomes, and generalizability across sports and national contexts.