Preferences of Female Triathletes and Their Coaches for Education on REDs: A Qualitative Study

Participation in triathlon may increase athletes' exposure to risk factors associated with Relative Energy Deficiency in Sport (REDs); however, effective education could enhance understanding and help mitigate risk. The views of experienced triathletes and coaches need to be considered when developing education resources aimed at improving identification and management of the syndrome. This qualitative study aimed to understand how female athletes and their coaches engaged with REDs resources, their preferences for education delivery and challenges to engaging with educational material. Twenty semi-structured interviews were conducted with 12 female triathletes aged 25-45 years and 8 coaches aged 29-62 years. Participants included amateur (n = 8) and elite (n = 4) triathletes. Reflexive thematic analysis was utilised to construct five themes: 1. Understanding of REDs; 2. Experiences associated with REDs; 3. Engagement with educational resources; 4. Opportunities for REDs education and 5. Challenges to engaging with REDs education. Themes were mapped to the capability, opportunity, motivation-behaviour (COM-B) model to identify factors likely to influence engagement with a REDs education resource for female triathletes and their coaches. Both athletes and coaches voiced strong motivation to engage with REDs education and an interest in learning more about REDs. However, future engagement is likely to be influenced by the entrenched culture that encourages leanness in triathlon, and resistance to modifying training practices. Our analysis identifies the opportunity to improve female triathletes' understanding of REDs, by using podcasts that combine expert led content with lived-experience narratives from other triathletes.