Understanding safe sport as a public health practice: a strong structuration theory analysis of Swedish elite athletics sport personnel

Abstract Background Exposure to harmful environments and practices is reported across a wide range of sports, including athletics, with negative implications for participants’ health and welfare across age groups, genders, and competitive levels. Sport environments are shaped by powerful cultural norms and organisational practices, which influence how sport personnel responsible for shaping elite athletes’ sporting environments understand, prioritise and enact safety in practice. This study explores how sport personnel in Swedish elite athletics interpret and enact safe sport, and how these enactments are shaped, enabled, and constrained by structural conditions. Methods Sport personnel ( n = 17; 8 women, 9 men; aged 35–66) with responsibility for shaping elite athletes’ sporting environments, including teachers and coaches at national elite sport high schools, managers of high-performance centres and national team head coaches, within Swedish Athletics were purposively sampled across elite organisational levels (i.e., national elite sport high schools, high-performance centres, national teams). Data were generated through semi-structured interviews. Analysis was conducted using reflexive thematic analysis within a social constructivist-informed qualitative framework. Stones’ Quadripartite Nature of Structuration model, an extension of Strong Structuration Theory, informed the organisation and interpretation of themes and subthemes. Results Three themes describe how safe sport was understood, enacted, constrained, and transformed within Swedish elite athletics. Theme 1 addresses how sport personnel understood safe sport through the interplay between internal and external structures, including holistic understandings, temporal shifts, and resource conditions. Theme 2 reflects active agency through everyday practices, including collaborative agency and micro-level interventions. Theme 3 highlights structural constraints and opportunities for safe sport transformation, including solitary coaching practices, power asymmetries, institutional silence, performance norms that normalise harmful behaviours, fragmented accountability structures alongside ongoing efforts toward institutionalisation. Conclusions Sport personnel described safe sport as extending beyond safeguarding and the prevention of harm to include broader organisational and sociocultural conditions that support athlete welfare. The findings position safe sport as a settings-based public health practice contingent on organisational conditions that strengthen sport personnel’s agency and enable preventive action. Transformative change towards safe sport appears to require institutionalised prevention capacity, including clear accountability, and resources that extend beyond individual sport personnel’s awareness and commitment.