Lived experiences of social support in Paralympic swimmers: A protocol for a qualitative study

Abstract

Introduction

Over the past decade, there has been an increase in awareness of and investment into disability sport as a result of the ‘Paralympic Movement’. The provision of personal and professional support to elite athletes is important for the well-being and success of the athlete, with various studies advocating a holistic approach to performance enhancement. However, little is known about social support experiences in elite para-swimming. Swimming is a popular Paralympic sport and the British para swimmers have been very successful in recent years, most recently winning 47 medals at Rio 2016. This study will be the first to explore the lived experiences of British Paralympic swimmers with respect to the personal and professional support available, perceived use of the support network and the influence it has on well-being and performance.

Methods and analysis

A hermeneutic phenomenological study will be undertaken using a subtle-realist paradigmatic view. A purposive sample of British Paralympic swimmers will be recruited to enable exploration of social support experiences. In-depth semistructured interviews will explore participants’ experiences of being an elite para-athlete, their support network, the social support available and how they perceive it relates to their well-being and performance. Strategies including reflexivity and member checking will be used to ensure trustworthiness. Data will be analysed following the Framework Method; a seven-stage process used for qualitative data analysis.

Ethics and dissemination

This study has ethical approval (ERN_20–0344) granted by the University of Birmingham in April 2020. The findings of this study will be published in a peer-reviewed journal and disseminated to key stakeholders in elite para-sport to inform support services and improve athlete well-being and performance.

Strengths and limitations of this study.

• This study will be the first to explore the experiences of social support in Paralympic swimmers, therefore, the findings produced will be novel.

• Rigorous methods will be employed at all stages of the study including reflexivity, member checking and pilot and cognitive interviews, increasing the credibility of the findings.

• This study will focus only on British Paralympic swimmers so the results may not be generalisable or transferable to other Paralympic sports or countries.

Introduction

Rationale

The Paralympic Games is a quadrennial global multisport event for athletes with impairments, referred to here as para-athletes.^{1 2} Since inception in 1960, the number of para-athletes competing at the Paralympic Games has increased 10-fold, with >4300 participants at Rio 2016.³ The ‘Paralympic Movement’, credited in part to the International Paralympic Committee (IPC), has led to an increase in sporting opportunities for individuals with disabilities and raised the profile of elite para-sport.^4–6 Para-athletes are classified for their sport based on eligible impairments, minimum disability criteria and sport classes,⁷ ensuring that the impact of impairment is minimised and that sporting excellence determines the success of an individual or team.⁸ The increase in para-sport awareness is concurrent with an increase in Paralympic Sport funding, with UK Sport investing almost £75 million into the Tokyo 2020 Paralympic Games 4-year cycle compared with £10 million for the Sydney Paralympic Games 20 years ago.^{9 10}

Swimming has been featured at every Paralympic Games since inception.¹¹ Para-swimmers are classified into three impairment groups: physical (S1–S10), visual (S11–S13) and intellectual (S14); with a lower number corresponding to a greater impairment and greater impact on performance.¹¹ Second only to para-athletics, almost 600 swimmers competed at Rio 2016.¹² British para-swimmers have achieved considerable success, finishing third in the medal table at Rio 2016¹² and are in receipt of significant funding from UK Sport-just under £11 million for the most recent Paralympic cycle.¹³

Research in disability sport has emerged over the past decade with several studies investigating the benefits,^14–17 barriers,^15–22 facilitators^19–23 and motivations^{24 25} for sport participation across a range of ages, impairments and performance levels. Specifically in Paralympians, studies have examined athletic identity,^26–28 retirement,²⁹ injury experiences³⁰ and the barriers and facilitators to participation in elite sport.²⁰ However, there is a paucity of evidence exploring the role of social support and the support network for Paralympians.

Four dimensions of support have been proposed comprising emotional, esteem, informational and tangible support; demonstrating the importance of different forms of support in elite sport.³¹

Sources of support have increased considerably over the years, from family, friends and coaches,^32–34 to a whole contingency of support staff including nutritionists, physiotherapists and psychologists.^35–37 The value of a holistic approach to performance enhancement has been highlighted in Olympic athletes, consisting of mental preparation, nutrition education and strength training, as well as having the support of friends, family and national governing bodies.^{35 36} The relatively new introduction of performance lifestyle (PL) advisors to sports including para-swimming highlights the importance that is being placed on athlete well-being and personal development, as well as performance.^{38 39}

Exploration of the lifestyle and psychological factors impacting performance found that both personal and professional support were considered important to athletic success in Olympic and Paralympic athletes.³⁷ However, as only two para-athletes participated in this study, definitive conclusions to inform practice in Paralympic sport were not possible. In non-elite para-swimmers, the providers of social support and their perceived importance have been investigated quantitatively, yet no research has qualitatively explored the social support experiences of para-swimmers.³³ Significant increases in para-sport funding and resources have occurred since this study,4–6 9 10 therefore, it is of interest to explore in-depth social support in Paralympic swimmers.

This protocol outlines the methods of a phenomenological qualitative study, which will be the first to explore the lived experiences of Paralympic swimmers and their support network. It is anticipated that the findings from this study will provide a deeper understanding of this phenomenon, enabling better support for Paralympic athletes, ultimately improving well-being and maximising performance outcomes.

Aim

To explore the lived experiences of social support in Paralympic swimmers.

Objectives

1. To determine the members of the Paralympic swimmers’ support network and examine the personal and professional support available.

2. To explore the Paralympic swimmers’ perceptions of the use of the support network and available support.

3. To explore the influence this support has on Paralympic swimmer well-being and performance.

Methods and analysis

Theoretical framework and study design

The philosophical position underpinning this qualitative study is that of subtle realism. This is consistent with a realist ontology (the belief that a world exists independently from our knowledge of it)⁴⁰ and subjectivist epistemology (knowledge is subjective, and the knower and the known are interdependent).⁴¹ Subtle realism considers that multiple non-contradictory and equally valid explanations exist for the same phenomena, and assumes that knowledge is based on assumptions and is a human construction.^{42 43} This framework rejects the view that beliefs are known with certainty, and claims there is not a single way of knowing.⁴³

A hermeneutic phenomenological approach employing framework analysis is in keeping with these beliefs. Hermeneutic phenomenology was first proposed by Heidegger in 1927, and later developed further by Gadamer and van Manen.^{44 45} Finlay⁴⁶ states that this approach aims to ‘evoke lived experience through the explicit involvement of interpretation’ (pg. 110) and involves the researcher participating in the ‘hermeneutic circle’ between the whole text and parts of the text.^{44 45} This methodology is appropriate for this study as it aims to understand and interpret phenomena from the individual’s perspective, allowing an insight into the experiences of British Paralympic swimmers.⁴⁶ The methodology was informed by, and the study will be reported in accordance with, the Consolidated Criteria for Reporting Qualitative research (COREQ) to enable comprehensive reporting of this study.⁴⁷

Participant inclusion criteria

Participants will be para-swimmers who have competed at a Paralympic Games for Great Britain and are actively training and competing. They will have an impairment that complies with the IPC classification code.⁴⁸ Participants will be able to communicate fluently in English and able and willing to give informed consent. There will be no age limit and both males and females will be included.

Participant recruitment

Phenomenology promotes the recruitment of participants from a homogeneous population who have had experience with the phenomenon, but who vary in characteristics and their personal experience.⁴⁹ Therefore, purposive sampling will be used to identify potential participants based on age, gender, impairment and Paralympic experience, because this will enable the provision of rich, diverse data pertinent to the research objectives of social support experiences.⁵⁰ Athletes will be approached and contacted via email and social media to determine interest in participation. Contacts in the authors’ sporting networks will be approached to aid the recruitment of participants.

Sample size will be informed by information power as proposed by Malterud et al.⁵¹ This is a tool used in qualitative interview studies and is based on the concept that the larger the information power of a sample, the fewer participants are needed.⁵¹ The study aim is narrow, there is high sample specificity and the case analysis strategy suggests few participants are required. This study will follow the theoretical framework and four dimensions of social support including emotional, esteem, informational and tangible support, proposed by Rees and Hardy.³¹ The lead researcher (BA) has strong communication skills, competed nationally as a swimmer for 10 years and has experience training alongside elite para-swimmers. The research team also comprised expert qualitative researchers (NRH, ABR and AS) and a para-sport practitioner (PM). Based on these dimensions of information power, it is estimated that the sample size will be approximately eight participants.⁵¹

Study setting

Video calls will be conducted from the researcher’s and participants’ homes. Given the current restrictions on contact and social distancing as a result of COVID-19 the ethics committee support the use of an electronic video platform to conduct interviews.

Data collection

The planned start date for the study is May 2020 and the planned end date is August 2020. Data will be collected via semistructured interviews conducted by the lead researcher, a female MSc student, enabling participants to give a detailed first-person account of their experiences.⁴⁴ One interview will be conducted with each participant via video call between May and July 2020 at a date and time convenient for the participant. This method of online face-to-face interviewing is often more convenient for participants while still enabling observation of verbal and non-verbal cues.⁵² It has also been suggested that there is little difference in the data quality between online and face-to-face interviews, further supporting the use of video interviews.⁵³ At least 24 hours prior to participation, informed consent will be obtained for the interview and for audiorecording. As is recommended in phenomenological studies, the interviewer will endeavour to create a relaxed, comfortable environment for the participant and engage them in conversation prior to the interview. This will facilitate the development of rapport and make the participant feel more comfortable and more likely to give a rich account.⁵⁴ Prior to the interview the participant will be reminded of the purpose of the research, that participation is voluntary and that they can with suspend the interview at any point.

A topic guide (online supplemental file 1) informed by existing evidence^{31 37} and conversations with elite para-sport practitioners in PL and Physiotherapy has been created to guide the interviews. Questions are open-ended and participants will be invited to discuss any concepts or thoughts they feel are relevant. The guide includes introductory questions on sporting background, classification, achievements, Paralympic games and overall experience of being a Paralympic swimmer. The main section comprises questions on the experiences of emotional, esteem, informational and tangible support, structural support and social networks. Prompts will be given if necessary and clarification sought if required.

The interviews are estimated to last between 45 and 60 min and will be audiorecorded and transcribed verbatim. Cognitive and pilot interviews will be undertaken with approximately two Paralympians from individual sports to assess the understanding and interpretation of the interview questions and refine interview techniques.^{55 56} Based on feedback amendments will be to the topic guide if necessary. Field notes will be taken throughout the interviews to provide contextual details and to note non-verbal expressions, aiding data analysis and interpretation.^{57 58} A reflexive diary will be used to record the details of the nature and origin of any interpretations which emerge through the interview process; aiding trustworthiness.⁴⁵ A copy of the transcript will be emailed to each participant to enable member checking. Each participant will be able to add any further reflections or make alterations, ensuring an accurate representation of their perspectives and experiences, adding to the transparency of the research.^{57 59}

Data analysis

The lead researcher will be responsible for analysing the interview data because of her experience in competitive swimming and training alongside para-swimmers. In hermeneutic phenomenology, the researchers’ biases, assumptions and experiences are essential to data analysis and interpretation,^44–46 supporting the reflexive diary. Participant quotations will be used to illustrate key findings, making the results more credible.⁶⁰ Analysis will be carried out immediately after interviews and after approximately 2–3 interviews it will be determined whether the topic guide needs adapting depending on responses to provide more focus.

The Framework Method (a seven-stage process for qualitative data management and analysis) is an established approach commonly used to analyse qualitative data; hence it is appropriate in examining and understanding lived experience of phenomena.⁶¹ The method highlights the importance of the involvement of individuals with experience in qualitative research, therefore, experienced qualitative researchers will be involved at every stage of analysis (NRH, ABR and AS).⁶¹ The seven-stage procedure based on that proposed by Gale et al⁶¹ will be adopted to analyse the data (figure 1). It is possible that the analysis approach will be subject to change due to the inductive nature of qualitative work and the multiple types of analysis, which involves the immersion of text and initial open coding. Following these stages, the themes or focus may be towards other concepts or phenomena due to the unique environment and sample that is being considered.

Figure 1.

The framework method.

Patient and public involvement

This qualitative study and protocol have been informed through contact with elite para-athletes and practitioners working in elite para-sport. Elite para-athletes will contribute to the topic guide content and structure through cognitive interviews. Key stakeholders in elite para-sport and para-swimming may be contacted for their contribution and insight to help aid analysis and interpretation of results.

Ethics and dissemination

Institutional ethical approval was obtained from the University of Birmingham in April 2020 (ERN_20–0344). Participants will sign a consent form and receive a participant information sheet prior to the interview. They will have the right to withdraw from the study prior to the interview and within 4 weeks after the interview. There are minimal risks associated with this study. In the unlikely event that a participant feels distressed or the interviewer is concerned for the participant’s well-being, the interview will be suspended and the participant informed of relevant support services. Participant data will be stored confidentially for 10 years on password-protected computers that can only be accessed by the researchers, and in accordance with General Data Protection Regulation, the Data Protection Act 2018 and University of Birmingham’s research governance frameworks. When presenting the study findings, pseudonyms will be used to protect the participants’ identities due to the relatively small population of current British Paralympic swimmers. Participation in the study will be entirely voluntary and no incentives will be offered. Any protocol deviations will be documented. The findings from this research will be disseminated to key stakeholders in elite para-sport and communicated to participants as a summary report.

Discussion

This protocol outlines the rationale and methodology of a qualitative study, which will investigate the lived experiences of social support in British Paralympic swimmers. The lead researcher has experience of competitive swimming and training with elite para-swimmers, therefore, it is anticipated that there may be some element of researcher bias. One limitation to this study is that the researcher does not have experience in conducting interviews however; pilot interviews will enable the practice and refinement of interview techniques. Also, limiting the sample to British Paralympic swimmers may reduce the generalisability and applicability of the results. The results from this qualitative study will serve to inform researchers about the lived experiences of Paralympic swimmers. It is anticipated that the findings from this study will give a deeper understanding of what it is like to be an elite-para athlete and will facilitate increased support for para-athletes in order to maximise their well-being and performance.