title: Implementing injury surveillance systems alongside injury prevention programs: evaluation of an online surveillance system in a community setting.
abstract: BACKGROUND
  Previous research aimed at improving injury surveillance standards has focused mainly on issues of data quality rather than upon the implementation of surveillance systems. There are numerous settings where injury surveillance is not mandatory and having a better understanding of the barriers to conducting injury surveillance would lead to improved implementation strategies. One such setting is community sport, where a lack of available epidemiological data has impaired efforts to reduce injury. This study aimed to i) evaluate use of an injury surveillance system following delivery of an implementation strategy; and ii) investigate factors influencing the implementation of the system in community sports clubs.
  
  
  METHODS
  A total of 78 clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a pragmatic trial of an injury prevention program called FootyFirst. System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively, via semi-structured interviews with targeted-users.
  
  
  RESULTS
  Across the 78 clubs, there was 69% reach, 44% adoption, 23% implementation and 9% maintenance. Reach and adoption were highest in those leagues receiving concurrent support for the delivery of FootyFirst. Targeted-users identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), socio-contextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online system).
  
  
  CONCLUSIONS
  The injury surveillance system was implemented and maintained by a small proportion of clubs. Outcomes were best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with personnel at all levels can enhance uptake of surveillance systems. Interview findings suggest that increased uptake could also be achieved by educating club personnel on the importance of recording injuries, developing clearer injury surveillance guidelines, increasing club staffing and better remunerating those who conduct surveillance, as well as offering flexible surveillance systems in a range of accessible formats. By increasing the usage of surveillance systems, data will better represent the target population and increase our understanding of the injury problem, and how to prevent it, in specific settings.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004 Australia.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Ekegren
authors.affiliation: Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, VIC 3353 Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Donaldson
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004 Australia.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, VIC 3353 Australia.
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Finch
keywords: Australian football; Implementation; Injury; Interviews; Qualitative; RE-AIM framework; Safety; Sport; Surveillance