Sports Medicine

, Volume 32, Issue 4, pp 269–284 | Cite as

A Conceptual Framework for Achieving Performance Enhancing Drug Compliance in Sport

  • Robert J. Donovan
  • Garry Egger
  • Vicki Kapernick
  • John Mendoza
Review Article


There has been, and continues to be, widespread international concern about athletes’ use of banned performance enhancing drugs (PEDs). This concern culminated in the formation of the World Anti-Doping Agency (WADA) in November 1999. To date, the main focus on controlling the use of PEDs has been on testing athletes and the development of tests to detect usage. Although athletes’ beliefs and values are known to influence whether or not an athlete will use drugs, little is known about athletes’ beliefs and attitudes, and the limited empirical literature shows little use of behavioural science frameworks to guide research methodology, results interpretation, and intervention implications. Mindful of this in preparing its anti-doping strategy for the 2000 Olympics, the Australian Sports Drug Agency (ASDA) in 1997 commissioned a study to assess the extent to which models of attitude-behaviour change in the public health/injury prevention literature had useful implications for compliance campaigns in the sport drug area. A preliminary compliance model was developed from three behavioural science frameworks: social cognition models; threat (or fear) appeals; and instrumental and normative approaches. A subsequent review of the performance enhancing drug literature confirmed that the overall framework was consistent with known empirical data, and therefore had at least face validity if not construct validity. The overall model showed six major inputs to an athlete’s attitudes and intentions with respect to performance enhancing drug usage: personality factors, threat appraisal, benefit appraisal, reference group influences, personal morality and legitimacy.

The model demonstrated that a comprehensive, fully integrated programme is necessary for maximal effect, and provides anti-doping agencies with a structured framework for strategic planning and implementing interventions. Programmes can be developed in each of the six major areas, with allocation of resources to each area based on needs-assessment research with athletes and other relevant groups.


Elite Athlete Threat Appraisal Protection Motivation Theory Personal Morality Coping Appraisal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was part funded by the Australian Sports Drug Agency (ASDA).


  1. 1.
    Australian Sport Drug Agency Annual Report 1994–1995. Canberra (ACT): Australian Sport Drug Agency, 1995Google Scholar
  2. 2.
    Tricker R, Connolly D. Drug education and the college athlete: evaluation of a decision-making model. J Drug Educ 1996; 26 (2): 159–81PubMedCrossRefGoogle Scholar
  3. 3.
    Binder D. Fair play for kids: a handbook of activities for teaching fair play. 2nd ed. Ottawa (ON): Fair Play Canada, 1995Google Scholar
  4. 4.
    Goldberg LG, MacKinnon DP, Elliot DL, et al. Effects of a multidimensional anabolic steroid prevention intervention: the adolescents training and learning to avoid steroids (ATLAS) program. Arch Pediatr Adolesc Med 2000; 154: 332–8PubMedGoogle Scholar
  5. 5.
    Verbruggen H. Some reflections for the IOC world conference on doping in sport. Lausanne: Union Cycliste Internationale (UCI), 1999Google Scholar
  6. 6.
    Donovan RJ, Egger GJ. Drug testing in sport: a review and model for effective control. Perth (WA): Health Promotion Evaluation Unit, Australian Sport Drug Agency, University of Western Australia, 1998Google Scholar
  7. 7.
    Elder JP, Geller ES, Hovell MF, et al. Motivating health behaviour. New York (NY): Delmar, 1994Google Scholar
  8. 8.
    Wasserheit JN, Aral SO, Holmes KK, et al. Research issues in human behaviour and sexually transmitted diseases in the AIDS era. Washington, DC: American Society for Microbiology, 1991Google Scholar
  9. 9.
    Graeff JA, Elder JP, Booth EM. Communication for health and behaviour change: a developing country perspective. San Francisco (CA): Jossey-Bass, 1993Google Scholar
  10. 10.
    O’Keefe DJ. Persuasion: theory and research. San Francisco (CA): Sage Publications, 1990Google Scholar
  11. 11.
    Henley N. Fear arousal in social marketing: death vs non-death threats [doctoral dissertation]. Perth (WA): University of Western Australia, 1997Google Scholar
  12. 12.
    Donovan RJ, Henley N. Negative outcomes, threats and threat appeals: towards a conceptual framework for the study of fear and other emotions in social marketing communications. Soc Mark Q 1997; 4 (1): 56–67CrossRefGoogle Scholar
  13. 13.
    Egger G, Donovan RJ, Spark R. Health and the media: principles and practices for health promotion. Sydney: McGraw- Hill Australia, 1993Google Scholar
  14. 14.
    Marcus BH, Owen N, Forsyth LAH, et al. Physical activity interventions using mass media, print media, and information technology. Am J Prev Med 1998; 15 (4): 362–78PubMedCrossRefGoogle Scholar
  15. 15.
    Egger G, Spark R, Lawson J, et al. Health promotion strategies and methods. Sydney: McGraw-Hill, 1999Google Scholar
  16. 16.
    Martin MB, Anshel MH. Attitudes of elite adolescent Australian athletes toward drug taking: implications for effective drug prevention programs. Drug Educ J Aust 1991; 5 (3): 223–38Google Scholar
  17. 17.
    Tricker R, Connolly D. Drugs and the college athlete: an analysis of the attitudes of student athletes at risk. J Drug Educ 1997; 27 (2): 105–19PubMedCrossRefGoogle Scholar
  18. 18.
    Beckett AH, Cowan DA. Misuse of drugs in sport. Br J Sports Med 1979; 12: 185–94CrossRefGoogle Scholar
  19. 19.
    Beckett AH. Sports injuries: drugs in sport.Br J Hosp Med 1983 Mar; 29 (3): 221–3Google Scholar
  20. 20.
    Williams MH. The use of nutritional ergogenic aids in sports: is it an ethical issue? Int J Sport Nutr 1994; 4: 120–31PubMedGoogle Scholar
  21. 21.
    Creative Research Group. The body image study: a qualitative study of the use of performance-enhancing drugs by non-athletes. Ottawa (ON): Canadian Centre for Drug-Free Sport, 1992Google Scholar
  22. 22.
    Boudreau F, Konzak B. Ben Johnson and the use of steroids in sport: sociological and ethical considerations. Can J Sport Sci 1991; 16 (2): 88–98PubMedGoogle Scholar
  23. 23.
    Laure P. Doping in sport: doctors are providing drugs. Br J Sports Med 1997; 31 (3): 258–9PubMedCrossRefGoogle Scholar
  24. 24.
    Bevins J. Using advertising to sell and promote health and healthy products. ACHPER Health Products and Services Marketing Seminar; 1987 Dec 4; SydneyGoogle Scholar
  25. 25.
    Borland R, Hill D. Initial impact of the new Australian tobacco warnings on knowledge and beliefs. Tob Control 1997; 6: 317–25PubMedCrossRefGoogle Scholar
  26. 26.
    Job RFS. Effective and ineffective use of fear in health promotion campaigns. Am J Public Health 1988; 78: 163–7CrossRefGoogle Scholar
  27. 27.
    France A, Donovan RJ, Watson C, et al. A Chlamydia awareness campaign aimed at reducing HIV risks in young adults. Health Promot J Aust 1991; 1: 19–28Google Scholar
  28. 28.
    Henley N, Donovan RJ. Threat appeals in social marketing: death as ’special case’. Int J Nonprofit Volunt Sect Mark 1999; 4 (4): 1–20CrossRefGoogle Scholar
  29. 29.
    King KW, Reid LN. Fear arousing anti-drinking and driving PSAs: do physical injury threats influence young adults? Curr Issues Res 1990; 13: 155–75Google Scholar
  30. 30.
    Andreasen AR. Marketing social change. San Francisco (CA): Jossey-Bass, 1995Google Scholar
  31. 31.
    Rice RE, Atkin CK, editors. Public communication campaigns. Newbury Park (CA): Sage, 1989Google Scholar
  32. 32.
    Salmon CT, editors. Information campaigns: balancing social values and social change. Newbury Park (CA): Sage, 1989Google Scholar
  33. 33.
    Donovan RJ, Henley N, Jalleh G, et al. Effective road safety advertising: a review and empirical study. Canberra (ACT): Federal Office of Road Safety, 1995Google Scholar
  34. 34.
    Backer TE, Rogers EM, Sopory P. Designing health communication campaigns: what works?. Newbury Park (CA): Sage, 1992Google Scholar
  35. 35.
    Sutton SR. Fear-arousing communications: a critical examination of theory and research. In: Eiser JR, editor. Social psychology and behavioural medicine. New York (NY): John Wiley, 1982Google Scholar
  36. 36.
    Sutton SR. Shock tactics and the myth of the inverted U. Br J Addict 1992; 87: 517–9PubMedCrossRefGoogle Scholar
  37. 37.
    Boster FJ, Mongeau P. Fear-arousing persuasive messages. Commun Yearb 1984; 8: 330–75Google Scholar
  38. 38.
    Rogers RW. A protection motivation theory of fear appeals and attitude change. J Psychol 1975; 91: 93–114CrossRefGoogle Scholar
  39. 39.
    Tanner JF, Day E, Crask MR. Protection motivation theory: an extension of fear appeals theory. J Bus Res 1989; 19: 267–76CrossRefGoogle Scholar
  40. 40.
    Tanner JF, Hunt JB, Eppright DR. The protection motivation model: a normative model of fear appeals. J Mark 1991; 55: 36–45CrossRefGoogle Scholar
  41. 41.
    Elliot D, Goldberg L. Intervention and prevention of steroid use in adolescents. Am J Sports Med 1996; 24 (6): S46–7Google Scholar
  42. 42.
    Becker MH. The health belief model and personal health behavior. Health Educ Monogr 1974; 2: 324–473Google Scholar
  43. 43.
    Rosenstock IM. What research in motivation suggests for public health. Am J Public Health 1977; 50: 295–302Google Scholar
  44. 44.
    Clarkson PM, Thompson HS. Drugs and sport: research findings and limitations. Sports Med 1997; 24 (6): 366–84PubMedCrossRefGoogle Scholar
  45. 45.
    Perry HM, Littlepage BNC. Misusing anabolic drugs: take a drug history from well muscled patients. BMJ 1992; 305 (6864): 1241–2PubMedCrossRefGoogle Scholar
  46. 46.
    Wagner JC. Enhancement of athletic performance with drugs: an overview. Sports Med 1991; 12 (4): 250–65PubMedCrossRefGoogle Scholar
  47. 47.
    deMerode PA. Doping: seeking the causes. Olympic Rev 1998; 26 (23): 5–8Google Scholar
  48. 48.
    Millar AP. Licit steroid use: hope for the future. Br J Sports Med 1994; 28 (2): 79–83PubMedCrossRefGoogle Scholar
  49. 49.
    Nicholson N, Wynd T, Cohen P. Drugs in sport: performance before health. Health Promot J Aust 1993; 3 (3): 20–2Google Scholar
  50. 50.
    Mugford S, Mugford J, Donnelly D. Social research project: athletes’ motivations for using or not using performance enhancing drugs. Canberra (ACT): Australian Sports Drug Agency, 1999Google Scholar
  51. 51.
    Tyler TR. Why people obey the law. New Haven (CT): Yale University Press, 1990Google Scholar
  52. 52.
    Binder D. Be a champion in life: a book of activities for young people based on the joy of participation and on the important messages of the Olympic philosophy. An international teacher’s resource book. Athens: Foundation of Olympic and Sport Education, 2000Google Scholar
  53. 53.
    Butcher R, Schneider A. Fair play as respect for the game. J Philos Sport 1998; 25: 1–22CrossRefGoogle Scholar
  54. 54.
    Guinness R. Tour ethics questionable on drug bans. Weekend Aust 2001 May 19–20; 56Google Scholar
  55. 55.
    Schneider B, Bowen DE. Understanding customer delight and outrage. Sloan Manage Rev 1999 Fall: 35–45Google Scholar
  56. 56.
    Cialdini RB. Influence: the new psychology of modern persuasion. New York (NY): Quill, 1984Google Scholar
  57. 57.
    Mottram DR. Banned drugs in sport. Sports Med 1999; 27 (1): 1–10PubMedCrossRefGoogle Scholar
  58. 58.
    Catlin DH, Murray TH. Performance-enhancing drugs, fair competition, and Olympic sport. JAMA 1996; 276 (3): 231–8PubMedCrossRefGoogle Scholar
  59. 59.
    World Conference on Doping in Sport. Doping: reflections of the working groups. Olympic Rev 1999; 26 (23): 15–6Google Scholar
  60. 60.
    Romance TJ, Weiss MR, Bockoven J. A program to promote moral development through elementary school physical education. J Teach Phys Educ 1986; 5: 126–36Google Scholar
  61. 61.
    Wadzilak T, Carroll T, Ansorge CJ. Values development through physical activity: promoting sportsmanlike behaviors, perceptions, and moral reasoning. J Teach Phys Educ 1988; 8: 13–22Google Scholar
  62. 62.
    Bredemeier BJ, Shields DL, Weiss MR, et al. The relationship of sport involvement with children’s moral reasoning and aggression tendencies. Int J Sport Psychol 1986; 8: 304–18Google Scholar
  63. 63.
    Fishbein M, Ajzen I. Belief, attitude, intention and behaviour: an introduction to theory and research. Reading (MA): Addison-Wesley, 1975Google Scholar
  64. 64.
    Ajen I, Fishbein M. Understanding attitudes and predicting social behaviour. Englewood Cliffs (NJ): Prentice-Hall, 1980Google Scholar
  65. 65.
    Bagozzi RP, Warshaw PR. Trying to consume. J Consum Res 1990; 17: 127–40CrossRefGoogle Scholar
  66. 66.
    Anshel MH, Russell KG. Examining athletes’ attitudes toward using anabolic steroids and their knowledge of the possible effects. J Drug Educ 1997; 27 (2): 121–45PubMedCrossRefGoogle Scholar
  67. 67.
    Cialdini RB. Littering: when every litter bit hurts. In: Rice RE, Atkin CK, editors. Public communication campaigns. Newbury Park (CA): Sage, 1989: 221–3Google Scholar
  68. 68.
    Cialdini RB, Reno RR, Kallgren CA. A focus theory of normative conduct: recycling the concept of norms to reduce littering in public places. J Pers Soc Psychol 1989; 58 (6): 1015–26Google Scholar
  69. 69.
    Reiterer W. Positive. Sydney: Pan Macmillan, 2000Google Scholar
  70. 70.
    Black T, Pape A. The ban on drugs in sports. J Sport Soc Issues 1997; 21 (1): 83–92CrossRefGoogle Scholar
  71. 71.
    Brown WM. Ethics, drugs, and sport. J Philos Sport 1980; 7: 15–23CrossRefGoogle Scholar
  72. 72.
    Dingelstad D, Gosden R, Martin B, et al. The social construction of drug debates. Soc Sci Med 1996; 43 (12): 1829–38PubMedCrossRefGoogle Scholar
  73. 73.
    Seligman MEP. Learned optimism. New York (NY): AA Knopf, 1991Google Scholar
  74. 74.
    Reisman D. The lonely crowd. New Haven (CT): Yale University Press, 1950Google Scholar
  75. 75.
    Weber K, Roehl WS. An analysis of consumer’s’ risk approach, risk behaviour and risk perception of selected leisure/tourist activities. Symposium on the Consumer Psychology of Travel; 1998; Hawaii. Hilo: University of Hawaii, 1998Google Scholar
  76. 76.
    Kapernick V. True champions campaign 1998–2000. Canberra (ACT): Australian Sports Drug Agency, 2001Google Scholar
  77. 77.
    Geller ES. Applied behavior analysis and social marketing: an integration for environmental preservation. J Soc Issues 1989; 45: 17–36CrossRefGoogle Scholar
  78. 78.
    Donovan RJ, Owen N. Social marketing and population interventions. In: Dishman RK, editor. Advances in exercise adherence. 2nd ed. Champaign (IL): Human Kinetic Books, 1994: 249–89Google Scholar
  79. 79.
    Miller M. Why shock ads catch the eye more than the mind. B&T 1992 April 10: 18–19Google Scholar
  80. 80.
    Cialdini RB. Social influence and the triple tumour structure of organisational dishonesty. In: Messick DM, Terbrunsel A, editors. Behavioural research and business ethics. New York (NY): Russell Sage, 1997Google Scholar
  81. 81.
    Deci EL, Ryan RM. The support of autonomy and the control of behaviour. J Pers Soc Psychol 1987; 8: 673–85Google Scholar
  82. 82.
    Kirkham R, Yates AJ. The effectiveness of police amphometer traps in reducing traffic speed. Perth (WA): Department of Psychology, University of Western Australia, 1974Google Scholar
  83. 83.
    Teed N, Lund AK, Knoblauch R. The duration of speed reductions attributable to radar detectors. Accid Anal Prev 1993; 25 (2): 131–7PubMedCrossRefGoogle Scholar
  84. 84.
    Casey SM, Lund AK. The effects of mobile roadside speedometers on traffic speeds. Accid Anal Prev 1993; 25 (5): 627–34PubMedCrossRefGoogle Scholar
  85. 85.
    Shinar D, Stiebel J. The effectiveness of stationary versus moving police vehicles on compliance with speed limit. Hum Factors 1986; 28 (3): 365–71Google Scholar
  86. 86.
    Donovan RJ. Public health advertising: guidelines for health promotion professionals. Aust Health Promot J 1991; 1: 40–5Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Robert J. Donovan
    • 1
  • Garry Egger
    • 2
    • 3
  • Vicki Kapernick
    • 4
  • John Mendoza
    • 4
  1. 1.Division of Health SciencesCurtin University of TechnologyPerthAustralia
  2. 2.Centre for Health Promotion and ResearchSydneyAustralia
  3. 3.School of Human MovementDeakin UniversityMelbourneAustralia
  4. 4.Australian Sports Drug AgencyCanberraAustralia

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