Key Points

  • Athletes may have adequate knowledge about healthy eating, but this may not translate into dietary intake that favours health and performance. Understanding determinants of food choice can help target interventions that lead to optimal intake for athletes’ health and performance.

  • A scoping review found 7 qualitative and 8 quantitative research studies of variable quality exploring the multi-faceted factors influencing food choice for athletes. Factors specific to athletes that were based around performance or competition were evident, and these were related to the competition season, the level of experience, the culture of the sport and the nationality of the athlete.

  • Future research could explore the relationship of food choice to diet, and the change in food choice across the phase of the seasons (in and out of competition) and through life events such as injury and illness. More research with female athletes is warranted.

Introduction

The specific dietary needs for optimal health and performance of athletes vary based on the physiological demands of the sport [1]. Periodising dietary intake and tailoring eating plans to individual requirements is important for facilitating optimal nutrient intake that supports health and performance [1, 2]. There is evidence to suggest that athletes may have adequate knowledge about healthy eating, but this may not translate into dietary intake patterns that favourably influence health and performance [3, 4]. Athletes across different sports and cultures have been shown to eat inadequate amounts of the core food groups, resulting in poor diet quality [5] and subsequent compromised training adaptation [1]. A better understanding of the complexity of eating behaviours of athletes has been recommended to target interventions that lead to improved dietary intake [6].

Many of the influences on food choice applicable to the general population are also relevant to athletes. The breadth of research has originated from a variety of disciplines (for example; nutrition, psychology, marketing). An interdisciplinary framework for the factors that influence nutrition and eating across all populations was published in 2017 (The Determinants of Nutrition and Eating (DONE) [7]). Over 400 determinants of food choice were mapped into four overarching categories of individual, interpersonal environment and policy. Underpinning the framework was a systematic mapping review examining predictors of food decision making through a multidisciplinary lens [8]. The multidisciplinary perspective provides a more unified view of the determinants of nutrition and eating that have commonly been investigated in distinct disciplines or narrowed to a subsection of particular determinants and behaviours [8]. In the general population, food choice has been researched using both qualitative and quantitative study designs with the maturity of research in this field giving rise to the popularity of validated questionnaires such as the 1995 Food Choice Questionnaire (FCQ) [9].

While this research demonstrates the proliferation of studies on determinants of food choice [8], this does not specifically target populations with unique characteristics such as athletes. A 2015 narrative review on athlete food choice [10] highlighted pressure to perform, concerns over body image, the impact of exercise on hunger and appetite and exposure to unique food environments, all as having a potential role in influencing athlete food choices. The review highlighted the limited number of studies investigating the many determinants of food choice, with most studies including small numbers of athletes from specific countries and sports. Subsequently, the determinants of food choices of athletes were summarised and broadly categorised as (1) physiological and biological factors, (2) cultural background, food beliefs and preferences, (3) demographic and psychological factors, (4) education and nutrition knowledge, (5) sport and stage of competition, (6) situational influences such as cost, convenience and availability, (7) interpersonal factors including the influence of others and (8) the impact of the food service environment particularly during travel and competition [11]. This previous review was largely based around evidence that investigated the impact of a single factor on the dietary intake of an athlete. Furthermore, previous reviews have not been conducted using a systematic process for identifying all relevant studies on the topic and the quality of the studies reviewed.

Since the 2015 review, research exploring relationships between nutrition knowledge and diet quality in athletes has increased [3, 12]. While nutrition education is important, identifying the multi-faceted influences on food choice is integral to understanding the complexities of athletes’ eating behaviours. As there has been a proliferation of literature on determinants of food choice across many disciplines [7], it is of interest to scope the studies that have specifically focused on athletes. This will provide a summary of current knowledge, and will help to guide future research on this topic while concurrently assisting practitioners to understand the complexity of factors influencing the food choices of their athletes. A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and the JBI Evidence Synthesis was conducted and no current or in-progress scoping reviews or systematic reviews on the topic were identified. A scoping review was selected for the purpose of identifying the available evidence, to examine how research was conducted on this topic, identify key factors related to the concept and identify knowledge gaps [13]. A pragmatic paradigm [14] was employed to ensure knowledge on this topic was generated from diverse approaches and methodologies given the limited development of evidence. Inclusion of different methodological approaches can also be of benefit to guide future research direction.

The objective of this review was to collate and synthesise the evidence on the multi-faceted determinants of food choice in athletes aged 16 years or older. The following research questions guided this review: ‘What is the available evidence on the individual and interpersonal determinants of food choice in athletes?’.

The sub questions for this study were:

  • What methods have been used to report on determinants of food choice in athletes?

  • In what groups of athletes and sports have determinants of food choice been investigated, what are the reported outcomes on determinants of food choice and is there any relationship between demographic characteristics and food choice?

  • Which studies have investigated the determinants of food choice in athletes and relationship to diet quality or intake, and what were the outcomes?

  • What is the quality of reporting of studies on determinants of food choice in athletes?

Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [15]. A protocol for the study was developed a priori according to the Joanna Briggs Institute (JBI) methodology for scoping reviews [16] and is published on Open Science Framework [17].

Participants–Concept–Context (PCC)

This review considered study participants specified by the authors as any individual who engages in physical activity with the intent to be competitive, 16 years and older from any sport, country, sex and performance level (professional, elite or amateur/recreational). School-based sport and studies that included children less than 16 years were excluded.

Studies that reported on the multi-faceted determinants of food choice that were measured, observed or an emerging theme of the research were included (concept). These could be reported as the primary outcome or secondary to other measures such as diet quality or intake. Studies that reported on the influence of a single determinant on food choice (for example, nutrition knowledge) were excluded. Studies that focused on specific barriers or enablers to healthy eating were also excluded unless a broader neutral question on all determinants or factors that impact food making decisions was included to align with the objective of this review. The studies could be relevant to any food environment, both in and out of a competition phase (context). Studies that investigated food choice during a race or event were excluded due to the specificity of food options and physiological impact on the body. Primary research, qualitative, quantitative, observational or intervention study designs were considered for inclusion. Studies published in peer review journals, abstract publications and research theses were considered as part of the initial screening. Early view abstracts of relevant nutrition/dietetics and sport/exercise journals were also scanned. Articles published in any language were included if they were able to be translated into English. Studies that did not meet the Participant—Concept—Context (PCC) criteria were excluded from the review.

Search Strategy

The relevant, available databases were searched to locate published primary studies, reviews, theses, conference abstracts, and text and opinion papers. An initial search was undertaken through the SCOPUS (Elsevier B.V) database to identify articles on the topic and this was used to develop the full search strategy based on analysis of text words contained within the title, abstract, and index terms used to describe the articles were used to inform the full search strategy (provided for SCOPUS in Appendix 1). The search strategy was initially adapted from the search terms used to map predictors of food decision making to the DONE framework [8] and was refined in consultation with a librarian to ensure a robust quality process [18]. The methodological keywords from the mapping to the DONE framework were removed from the current search to ensure inclusion of both quantitative and qualitative study designs. A second search using all identified keywords and index terms was undertaken across all included databases (PubMed, Web of Science (Clarivate Analytics), SPORTDiscus (EBSCO), PsycNET (APA), Health Collection (Informit), CINAHL (EBSCO), the Cochrane Library, ProQuest Dissertations and Theses Global, Trove (National Library of Australia), JBI (Ovid), and Google scholar). The full search of all databases took place from September to November 2020 and was updated in March 2021. Finally, the reference lists of all identified reports and articles were searched for additional studies. The search was not limited by date and extended back as far as the databases allowed. Specific journals were scanned for early view abstracts based on SCImago Journal and Country Rank (SJR) subject categories (nutrition and dietetics, sports science and sports medicine). Search terms were combined using Boolean logic with the use of truncation and wildcards.

Selection of Evidence

Records were collated and uploaded into Endnote V9.3.3 (Clarivate Analytics, PA, USA) where duplicates were removed. Following a test of the article selection process, titles and abstracts were screened by two independent reviewers (FP and RT) against the inclusion criteria. The full texts of selected citations were assessed in detail against the inclusion criteria by the same independent reviewers. Rationales for exclusion of records that did not meet the inclusion criteria were recorded. Any disagreements that arose between the reviewers at each stage of the selection process were resolved through discussion or with a third reviewer (GS). Additional records were identified through snowballing of reference lists and early view notifications.

Data Charting Process

Data were extracted from records included in the scoping review by two independent reviewers (FP and RT) using a data extraction tool developed by the authors. The extraction tool included specific details about the participants, concept, and context, and any other information relevant to the review question. This included the title, study design and aim, participant details (sample size, athlete age, sex, level, sport and cultural background), context (country, competition season and food environment) and concept (method for reporting food choice, relationship to the food environment and any other outcomes, determinants of food choice, statistical relationship to demographics for quantitative studies and study conclusion). Any disagreements that arose between the reviewers were resolved through discussion or with a third reviewer (GS).

Data Presentation

A tabular summary of the study details and outcomes was collated. An assessment of the quality of reporting was conducted as a means of critically appraising the extent of evidence. Critical appraisal was conducted by two of the reviewers (FP and RT) using adapted standardised reporting tools from the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) library. This included the Standards for Reporting Qualitative Research (SRQR) [19] criteria for qualitative research designs and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) [20] for observational cross-sectional designs. Where members of the research team were authors of included studies, the quality appraisal was assigned to an alternative team member to ensure objectivity. Reporting of items by the authors was classified as addressed (1 point), partially addressed (0.5 point) or absent (0 points), then summed for each study as a measure of the quality of the research. Any discrepancies in the interpretation of the criteria were discussed and resolved.

Results

After initial identification, screening and removal of duplicates, a total 108 records were assessed for eligibility from full text. The reasons for exclusion of studies were as follows: (1) Participants were outside the age range or were not athletes, (2) Concept of food choice was not reported as an outcome or was specific to a single factor such as knowledge, (3) Context was relevant to choosing snacks during a race, or specific to healthy eating, and (4) Source of information was a review or did not contain any original data. Results of the search are presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) flow diagram [15, 21] (Fig. 1).

Fig. 1
figure 1

PRISMA flow diagram of the study selection process [21]

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The final citations included 13 primary research studies [22,23,24,25,26,27,28,29,30,31,32,33,34], two theses [35, 36], one short conference paper [37] and three conference abstracts [38,39,40]. The four records identified as conference abstracts or papers were excluded. Three abstracts reported on data that aligned with one of the included primary research studies and one abstract had insufficient detail for data extraction. Narrative data were extracted from the primary research studies and theses that were included in the review (Table 1 and 2). The data were charted into two categories (1) Qualitative research design on the broader concept of food choice (one research thesis [35] and six primary research studies [22,23,24, 26, 33, 34], all with semi-structured interviews and predominately underpinned by grounded theory); and (2) Quantitative research design (one research thesis [36] and seven primary research studies [25, 27,28,29,30,31,32]; seven with cross-sectional observation methodology using variable survey instruments [25, 27,28,29, 31, 32, 36] and one cross-sectional validation study [30]. All studies were published between 2001 and 2021 with 10 published since 2018 [25,26,27,28,29,30,31,32,33,34]. No longitudinal or intervention studies were found.

Table 1 Data extraction: Qualitative research design
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Table 2 Data extraction: Quantitative research design
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Five studies (four quantitative [25, 29, 30, 32] and one qualitative [33]) involved athletes across multiple sports. Single sports that were investigated included endurance (n = 4; triathlon, cyclists, distance runners and adventurers, cross country running) [23, 28, 31, 36], team (n = 5; soccer [27], ice hockey [22], American Football [24, 35], rugby union [26]) and aesthetic (n = 1; gymnastics and martial arts [34]) sports. Of the quantitative studies, three were conducted during competition [29, 30, 32], two pre-competition [28, 36], and two were not specified [27]. The qualitative studies consisted of one pre-season [23], three not specified [26, 33, 34], and three conducted both in and out of competition [22, 24, 35].

Athletes’ home country varied with mixed cohorts from multiple locations (n = 4) [25, 29, 30, 32] and those specific to individual countries (USA n = 5 [22, 24, 31, 33, 35], Australia n = 1 [36], New Zealand n = 1 [26], Brazil and Spain n = 1 [34], Britain n = 2 [23, 28], Ethiopia n = 1 [27]. Five studies [23, 27, 28, 33, 36] did not report the cultural background of the athletes participating in the study. The mixed cohort studies [25, 29, 30, 32] were conducted at international multisport competitions and reported participants from 31 to 69 different countries.

All qualitative studies reported on emerging themes on determinants of food choice relevant to the sample of athletes. The outcomes of the qualitative studies suggested health [22, 24, 26, 33, 35] and competition performance [23, 26, 33,34,35] were important motives influencing food choice, but this was impacted by seasonal differences [22, 26, 33], athlete experience [22, 23, 34], and constraints on time [22, 24, 35] and money [24, 35]. More experienced athletes were reported to be less influenced by others and more focused on performance [22, 23, 34]. The quantitative studies reported determinants of food choice ranked from highest to lowest priority, or as a list, and in relationship to other characteristics of the cohort. Determinants that occurred across multiple studies included health [28,29,30,31, 36], performance [29,30,31,32, 36], nutritional attributes/composition [25, 28,29,30], familiarity/usual eating [25, 27, 29, 30, 36], sensory factors [25, 27,28,29,30, 32, 36], convenience [27, 28, 32, 36], mood/feelings [27, 28, 30, 36] and weight control [27, 30, 32, 36]. In the mixed cohort studies that explored relationships to the characteristics of their sample, sex [25, 36], sport [25, 32, 36], age [32], culture/nationality [25, 27, 32] and setting [25, 27] influenced the priority given to specific factors. Only one study explored the relationship between food choice and diet quality [29]. A summary of the determinants of food choice from all studies (41 in total) has been grouped into eight broad categories adapted from previous reviews [10, 11] and the DONE framework [7] and included in Table 3.

Table 3 Determinants of food choice grouped according to broad categories*
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The quality assessment resulted in a total score for the qualitative studies that ranged from 10 to 20 out of a total of 21 (median 16.5), and the quantitative studies ranging from 8 to 22 out of 32 (median 21.5) (Table 4 and 5). No study reported on every item in either of the quality reporting tools.

Table 4 Quality assessment of qualitative studies using SRQR criteria [20].
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Table 5 Quality assessment of quantitative studies using STROBE criteria [20].
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Discussion

The purpose of this scoping review was to examine the available evidence on the multi-faceted individual and interpersonal determinants of food choice in athletes with a focus on participant characteristics, methods used to collect data, study outcomes and the overall quality of the evidence. While research on this topic spans over the past 20 years, most studies were conducted during the past five years. Studies have investigated food choices of athletes in a variety of sports and countries through a mixture of both quantitative and qualitative methods. The majority of earlier studies were qualitative and exploratory in nature and conducted with smaller samples of predominately male collegiate athletes. In general, the outcomes of the qualitative studies reported that the social and physical food environment, sport or team culture, the phase of competition and experience of the athlete impacted food choice. This is supported by outcomes from more recent qualitative research which suggests that the high-performance environment and athletes’ emotional state may impede adherence to nutrition guidance [6].

The outcomes of the quantitative studies demonstrated that nutritional attributes of the food and performance were considered when making a food choice and, in most cases, these were high priorities. This was measured across multiple sports and in various settings in and out of competition. Weight control was raised as a higher priority impacting food choice for female triathletes [36], and athletes in weight category sports [25, 30]. This aligns with the qualitative study by Juzwiak (2021) [34] that investigated food choice in weight class athletes from Brazil and Spain, and found predominant themes focused on the food culture of the sport related to body image and weight, and with the study by Long [24] which found a comfortable playing weight was factored into food choices of male American Football players. A focus on body image and the pressure to maintain an ideal physique aligns with qualitative studies that have specifically focused on barriers to health or performance-based eating [6, 41].

Cultural background and nationality also appeared to be influential in terms of food choice, but the impact on food choice varied across studies with influence of others [25], food values and beliefs [32], doping [32], political values [27], religion [27], price [27], environmental protection [27] and familiarity [27] all reported. In general, there was significant variability in the relationship of demographic and sporting characteristics of athletes and inconsistency in priority ranking of determinants of food choice in the quantitative studies. Despite this, there was consistency in the reported determinants of food choice across the limited number of studies on this topic.

The broader relationship of food choice to diet quality or intake of athletes was not found through the search, although Pelly and Thurecht reported on the quantitative and qualitative dietary analysis of a single meal and the reasons the athletes chose this meal [29]. In this case, athletes reported choosing food based on the nutritional attributes of the food, sensory factors performance or usual eating practices, but in general, the meals lacked fruit and dairy and included discretionary foods. Interestingly, athletes self-rated their meal choice in relation to their performance needs as an eight (10 = excellent), but this was dependent on age with younger athletes rating their meal selection less highly [29]. This may be due to lack of experience which impacts confidence in food choice. The determinants of food choice in athletes can provide a valuable understanding of the disjointed relationship between nutrition knowledge and appropriate dietary intake for health and performance. Research on this topic can be a useful strategy to raise awareness and target education of athletes.

A sub-question of this review was to examine the methods used to report on the determinants of food choice. The earlier qualitative studies focused on developing theory [22,23,24, 35] on the multiple influences of food choice, and in particular the process of the food choice decision. The foundation of qualitative research appears to have led to the more recent use of survey instruments in quantitative cross-sectional studies, as a means for examining the relationships of the multi-faceted aspects of food choice and comparison to athlete characteristics. We found the initial quantitative studies used an adapted version of a validated tool developed for the general population, The Food Choice Questionnaire (FCQ) [7, 27, 36], or a non-validated survey applied in two settings [25]. Three survey instruments specific to athletes were published during 2019–2020. The instruments include the Athlete Food Choice Questionnaire (AFCQ) [30], the Adapted Food Choice Questionnaire for ultra-endurance athletes (U-FCQ) [28] and Runner’s Health Choices Questionnaire (RHCQ) [42]. Validation and reliability in survey instruments is important and within this conceptual space where no objective criterion measure is available to truthfully know what influences food decisions, using appropriately developed and tested instruments is imperative. Multiple psychometric tests are advised in the development of new instruments within health, social and behavioural research to establish validity and impart confidence in a new instrument [43]. The AFCQ is a broadly applicable instrument developed and validated in two mixed sport and cultural background samples of high-performance athletes [30, 44]. Development via exploratory factor analysis informed face and content validity, while confirmatory factor analysis in an independent sample confirmed the consistency of the AFCQ’s factorial structure [30, 44]. Construct validity was established with duplicate measures of discriminant and convergent validity, achieving acceptable thresholds for nine and six factors, respectively. Cronbach’s alpha measured reliability with seven factors exceeding the accepted standard (> 0.7) and two exceeding a tolerable 0.6 threshold [44].

The U-FCQ adapted the FCQ and through pilot testing (n = 19) refined the questionnaire items via an interpretive process simulating an exploratory factor analysis [28]. The development provides support for face and content validity, while acceptable reliability was evidenced for all 11 factors via Cronbach’s alpha and eight factors via test–retest analysis. The RHCQ measures the influence of 13 single-item factors on overall dietary choice and daily food choices.[42] Development included expert review (n = 3) and pilot testing with the target population (n = 26) to establish face and content validity; reliability, however, was not examined [42]. To date, the AFCQ has undertaken the most extensive examination of reliability and validity [30, 44]. This process is encouraged for recently published instruments.

To better understand the strength of evidence on the topic, the quality of reporting each study was critically assessed. Qualitative studies varied in their quality with Smart [22], Long [24] and Juzwiak [34] being the most comprehensive. More stringent requirements for reporting of qualitative study design over the past 10 years are likely responsible for the increased quality of reporting in recent studies. In particular, transparent reporting and rationale for the research paradigm (3 out of 7 studies) and the researcher characteristics that may influence the study (3.5 out of 7 studies) were poorly reported. In the case of the studies that included reflexivity, the researchers declared that they were predominately from a health or sport background which explains the focus on nutritional aspects of the food and performance factors as emerging themes. All the quantitative studies with the exception of one (Tesema et al.) [27] were of a similar quality in terms of reporting the details of the study but were less transparent on how they arrived at the sample size, how they addressed any missing data, and reasons for non-participation which may have introduced a level of bias in the results. Furthermore, if the included studies were mapped to the respective discipline area as per the DONE framework [8], all were based on a nutrition or sports science, psychology or health paradigms suggesting that the outcomes may be limited by the approach or theory underpinning the research. Assessing the quality of available evidence supports replication of good quality study designs and reporting practices plus enables critical interpretation of the study methods and outcomes for use in practice.

Future research on this topic is needed to better understand the priority various cohorts of athletes from a range of sports and cultures place on different factors when making food choice decisions. It would be of benefit to explore the relationship between food choice, nutrition knowledge and diet quality directly. We recommend that researchers use a survey that is validated for the purpose of exploring the multi-faceted determinants of food choice in this situation. While the AFCQ has currently undergone the most robust validation with multiple groups of athletes, further testing of reliability and application with specific sports and in different cultures is warranted. Further exploration of actual dietary intake across multiple days followed by the AFCQ could provide insight into the reasons for meal and snack selection. Investigation of the change in food choice longitudinally across the phase of the seasons (in and out of competition) and through life events such as injury and illness, retirement or changes in social situations would also be of interest. Interventions targeted at factors influencing athlete food choice to facilitate behaviour change as well as factors influencing food choice for specific sports and in different cultural contexts could be investigated.

The research reported in this review focused on individual or interpersonal factors influencing food choice and did not specifically examine the food environment or policies impacting food making decisions for the athlete. At a broader level, the availability and cost of specific foods will often underpin individual food choice, as will marketing and promotional campaigns [45] and situational factors such as catered food during competition and travel [11]. A study of athletes’ opinions of the food provided during a major competition has shown that the availability of appropriate food is driven by cultural acceptance, and this may impact food choice [46]. The relationship between the food environment and individual food choices of athletes across different countries, regions and sociocultural contexts would be of value as this has been identified as an area for further research in general populations [47]. The interplay between physiological function (for example; appetite, gut function, brain regulation), psychological factors, food beliefs, knowledge and skills, and the food environment relevant to athletes needs further investigation. As the earlier qualitative research informed the development of the quantitative questionnaires, it would also be of interest to conduct more studies with female athletes as only one quantitative study by Stickler (2020) [31] specifically focused on females. Sex specific issues that impact food choice could be further explored using qualitative research that specifically explored eating behaviours.

There are limitations associated with this scoping review. It is feasible that not all studies were found during the search, but it is unlikely that this would be a major impact on the determinants of food choice reported in this review because outcomes were consistent across studies. A decision was made to exclude any study that investigated an individual or pair of determinants in isolation (for example, the impact of taste or smell on athlete food choice). A multi-faceted approach was taken to explore the relationship between different determinants in the broader context of food choice. Studies that investigated eating behaviours such as barriers or enablers to healthy eating or good nutrition were excluded as the aim was to explore the interplay between all factors that potentially influence food choice. For example, an athlete may not indicate that taste is an influence on their food choice if only asked about the barriers to healthy eating. One study (Stokes et al.) [26] included a generic question of food choice as part of their questioning on barriers and enablers to healthy food intake, and thus this study was included in this review. There is a chance, albeit small, that additional studies with questions of this nature were not identified through our search.

Conclusion

The purpose of this scoping review was to map the available evidence on the individual and interpersonal determinants of food choice of athletes, examine the methods used for reporting determinants of food choice, report any relationship with demographic characteristics and diet quality or intake and report on the quality of studies. There were 15 studies that met the inclusion criteria, with an equal amount of qualitative and quantitative research design with variable quality of reporting. Methods employed were predominately semi-structured interviews and questionnaires for qualitative and quantitative studies, respectively. No longitudinal or intervention studies were found. The majority of studies have been published since 2018 and conducted across multiple countries with either mixed cohorts of athletes or focused on predominately endurance or team sports. Only one study focused specifically on female athletes. Most studies reported that performance and health were relevant to athlete food choice, with varying impact of competition season, the level of experience, sport culture, the cultural background or nationality, plus sex of the athlete, and the food environment. One study [29] reported on the relationship to diet quality and this was relevant to a single meal during competition.

The outcomes of this scoping review suggest that more research is needed on the multi-faceted determinants of food choice in athletes. Future research could explore the relationship between food choice, nutrition knowledge and diet quality or the change in food choice across the phase of the seasons and through injury and illness. Furthermore, qualitative methodology would be useful for better understanding of sex specific issues, in particular, those relevant to females. Use of validated measurement tools such as the AFCQ and robust reporting will enable critical interpretation of the study methods and outcomes for use in practice.