Study sample

Ten coaches of 12U (i.e., ages and 12 and under as of July 31 for the given season) and 13U (i.e., ages 13 and under) level youth football teams (12U: n = 3, 13U: n = 7) and thirteen parents with athletes on these teams (12U: n = 7, 13U: n = 6) participated in separate, group-specific (i.e., by team and participant type) focus groups at up to four time points. The teams participating in this study were selected due to their participation in a parallel observational biomechanics study [33,34]. Six organizational leaders from different organizations within the same league participated in a single one-on-one interview. Organizational leaders served various roles within their organizations, including president and athletic/football director. This study was approved by the Wake Forest University School of Medicine Institutional Review Board (IRB: IRB00067187) and written informed consent was obtained. Recruitment began 8, August 2021 and ended 19, September 2021. Parents and coaches were invited to participate in focus groups via email and were consented via in person. Organizational leaders were invited to participate via email and consented via e-consent according to IRB protocols.

Development of data collection materials

Separate group-specific semi-structured guides were developed for each discussion, with input from the research team. The study followed a phenomenological research design to gather the essence of the shared experiences of coaches, parents, and organizational leaders involved in youth football. Experiences and perspectives of being a youth football coach or parent were discussed at the first focus group. This guide was developed to, first, understand the individual’s connection to football and perceived benefits of the sport. Additional questions sought to understand the role of the youth coach in their son’s life and the relationship with their son’s coach among parents. Parallel questions were asked among the coaching groups, including the role they perceive they play in their athletes’ lives and relationship with parents. Both groups were asked about elements of safety discussed among parents and coaches, and specific safety concerns for athletes. Sample questions include, “What role does your son’s coach play in his life?/ What role do you play as a coach in your athletes’ lives?”; “What are your concerns about your child’s health and safety playing football?/ What are your concerns about your athletes’ health and safety on the field?”.

To further dive into perceptions of contact in football, the second focus group involved discussion and presentation of video of football collisions and head acceleration data; parents and coaches shared their perceptions of contact and reflected on the data (e.g., “How do your sons/ athletes describe the contact they deliver/receive in practices or games?”; after viewing video clip, “How would you describe the severity of that hit, or how hard that hit seems, compared to what you might see in a typical practice or game?”). Perceptions of head acceleration data will be presented elsewhere. The topics of the third focus group differed for coaches and parents based on group-specific expressed desire to learn or discuss the respective topics at the next focus group; the coach discussion was focused on practice drills and coaching football technique (e.g., “Describe how you have structured your practice sessions this season.”) while the parent discussion was focused on concussions and clinical implications of subconcussive head impacts (e.g., “What do you think are the risks of not reporting a concussion?”). Finally, the fourth discussion was a focus groups for coaches and interview for parents and was focused on review and discussion of head acceleration data collected during the season (e.g., “How do you think coaches/ you could these data to improve safety or performance?”). The first, second and third focus groups with parents and coaches were one hour and conducted in person. The fourth discussion was conducted in an online format. Organizational leader interviews focused on experiences and perspectives as a leader of a youth football organization following a parallel structure to that of the parents and coaches (e.g., “What role do coaches play in your athletes’ lives?”; “As an organizational leader, what are your concerns about your athletes related to safety on the field?”). All interviews with organizational leaders were approximately 30 minutes and conducted in an online format. Questions were developed to be open-ended. Guides for the focus groups and interviews relevant to the codes and themes evaluated in this study are provided in the supporting information (S1–S6 Files).

Focus groups and interviews were conducted by a single trained member of the study (Jillian Urban, PhD, MPH, Assistant Professor, female). Dr. Urban was trained and mentored in qualitative methods, including focus group and interview moderation, including active listening and effective probing to mitigate bias, such as avoidance of leading questions. Dr. Urban had 9 years of experience working with this youth football community but had no relationship with any of the participants prior to the study. The participants enrolled in this study were familiar with Dr. Urban and the research team through an observational biomechanics study that was conducted in parallel with the focus groups. The participants were acquainted with Dr. Urban’s role at Wake Forest University and prior experience working with the league to study concussions and head impacts in youth football [33,34]. The participants also learned that Dr. Urban was a parent of twins. The participants were made aware that the research team sought to work collaboratively with a set of stakeholders in the local youth football community to create and test a practice structure to reduce head impact exposure while developing the skills needed to play football effectively and safely. They also understood that to inform that effort, the research team wanted to learn more about the perspectives of parents and coaches about football, while sharing some of the data collected in later focus groups. This information was provided at the start of each focus group to recognize potential bias, but also to facilitate trust among the group.

Data collection and analysis

Focus groups were conducted at a quiet location near the football practice facilities, such as a community conference room or ramada. No other non-participants were present or in close proximity of the focus group. Guides were not provided to participants prior to the discussion. Focus groups and interviews were recorded; a note taker was present to gather detailed notes according to the semi-structured guide. Audio recordings of focus groups and interviews were initially transcribed using an automated transcription application (Otter.ai). A member of the research team listened to the audio and made any necessary corrections to the transcription. Concurrent with data collection, interviews and focus groups were monitored and reviewed for emerging themes by the principal investigator, and it was determined that no additional focus groups or interviews were needed to ensure saturation of the data. A combination of deductive and inductive coding was completed to develop a codebook specifying the code, code definition, exclusion criteria, and exemplar quote(s). Additional codes were added during qualitative coding as new topics emerged. The codebook is provided in the supporting information (S7 File). Two members of the research team independently coded each transcript using the Windows version of ATLAS.ti 22.0.6.0 [35]. The research team members met to discuss coding and resolve discrepancies. Once coding was completed, code reports were run for each code.

Rapid assessment process (RAP) was used to analyze interviews with organizational leaders [36–38]. Domains corresponding to individual questions and in accordance with the order of the guide were developed into a matrix. A member of the research team listened to the audio recordings and completed the matrix in an organized and thorough manner, capturing the main points of the discussion and exemplar quotes. Data in the matrix were organized by respondent and domain for concurrent analysis of all responses [39]. A second member of the research team reviewed the matrix and summary by domain to identify and address any gaps in the summary. This was an iterative and team-based approach that occurred after qualitative coding of the focus groups was complete. The team members then reviewed the matrix by domain, assigned codes from the code book, and annotated additional themes that emerged from the organizational leaders.

Focus groups code summaries and RAP codes from interviews were integrated and analyzed for thematic content by two individuals from the study team [40]. Themes were cross-tabulated with the associated code(s) supporting that theme and indication of the participant group who endorsed that theme. Exemplar quotes were identified for each theme. A wide range of themes emerged from the analysis; however, the current paper focuses on themes related to role and responsibilities of the coach. Similarities and differences across parents, coaches, and organizational leaders are summarized below.

Roles and expectations of coach

Below is a summary of themes related to roles and expectations of youth football coaches. Exemplar quotes are provided in Table 2.

Download:

• PNG
  larger image
• TIFF
  original image

Table 2. Themes and exemplar quotes regarding the roles and expectations of coach.

https://doi.org/10.1371/journal.pone.0322373.t002

Coaches are considered role models and mentors to athletes, and sometimes serve in a father figure role. The role of the coach in the athletes’ lives was regarded as “so much more than football.” Respondents remarked the different ways that coaches support athletes, including providing transportation to practices and games, holding them accountable for and helping them with academics, helping them navigate social situations, guiding them in making good choices, teaching them respect for authority, and sometimes providing financial support. Organizational leaders recognized that coaches have a more hands-on role with athletes than organizational leadership. Several coaches, some organizational leaders, and one parent noted that coaches supplement mentoring that may be absent from the athlete’s home environment. One organizational leader acknowledged that some coaches are present to strictly coach football, while others are like “surrogate fathers.” Five coaches discussed their role in helping raise the athletes. Mentorship provided by coaches was regarded as a benefit of youth football.

Coaches recognize their role in developing the skills of athletes in football but feel responsible for also developing athletes as young men and to be “better human beings” off the field through the sport of football. Many coaches described their role in teaching skills of football and proper techniques to prevent injuries; many described this as teaching athletes how to protect themselves and “getting them ready for the next level.” Coaches also described their role in teaching life skills, including discipline, dealing with adversity, and being resilient. Some coaches described their philosophy around developing athletes for life off the field, including holding athletes accountable for their behavior and school performance and developing skills of hard work and resiliency. Many coaches regarded the lessons learned playing football are lessons that benefit adolescents in ‘real life’. One coach described his role in encouraging healthy behaviors like staying hydrated and eating nutritious foods.

Parents place trust in their son’s coaches and expect them to have the knowledge and skills necessary to coach football. Nine parents expressed an expectation that their son’s coaches are knowledgeable and skilled in coaching football, expecting coaches are doing the “right thing” and know what they are doing. A subset of those parents expect coaches will teach their son skills to keep themselves protected and safe while playing the sport. Five parents discussed the expectation that coaches have the appropriate training necessary to coach youth football. Some parents discussed a desire for coaches to be willing to learn and make changes if needed.

Coaches must manage relationships with athletes and parents to successfully coach their team. Coaches and some organizational leaders noted the importance of communication in coaching. One coach described his communication style as ‘tough love’, stating that he often yells at the athletes to communicate his message, whereas another coach described the importance of talking with them like young adults and building trust. One organizational leader recognized that coaches must adapt to different communication and learning styles of athletes. Coaches also described their expectations of athletes, including time, effort, confidence, leadership, and willingness to be coached. About half of the coaches discussed their philosophy around working together as a coaching staff but noted the importance of the head coach as the leader. Coaches also discussed the need to manage expectations of parents around their child’s abilities and how the coach utilizes the child on the team (position, playing time, etc.). One coach discussed sharing film as a means to help manage expectations. Organizational leaders, however, noted the important role coaches play in making sure parents and athletes have the “best experience possible” participating in football.

Organizational leaders help manage relationships with parents and coaches. Organizational leaders oversee the organization and provide support for the coaches and families within. Many organizational leaders described their role in mediating relationships, often acting as a “buffer” or “third party” between parents/families and coaches. Organizational leaders spoke about common conflicts among parents and coaches, including parent expectations surrounding their son. This included the perceived skill level, allotted playing time and/or number of plays their son gets the ball, and playing position chosen by the coach. Organizational leaders described how they try not to intervene, unless necessary, and described their role in supporting their coaches but listening to parent concerns to address or rectify any issues.

Coaches foster the child’s continuation in the sport of football. Organizational leaders described the coaches’ role in developing the child’s enjoyment of football and identified coaches as critical to the success and well-regard of the organization. One coach and one parent noted the coaches’ role in creating a positive environment for the athletes and another coach remarked that an overemphasis on winning by coaches can ruin a player’s love for the game.

Practice and safety

Below is a summary of themes related to practice and safety. Exemplar quotes are provided in Table 3.

Download:

• PNG
  larger image
• TIFF
  original image

Table 3. Themes and exemplar quotes related to practice and safety.

https://doi.org/10.1371/journal.pone.0322373.t003

Practice is the “foundation” for athlete development and important for preparing athletes for competition.

All but one coach and all but one parent described the role of practice in preparing athletes for games. Coaches described this preparation as learning the “fundamentals,” including technique, safety, and responsibilities for games. Some coaches and parents felt activities in practice teach athletes to be unafraid of contact and “being confident in being physical,” and many described how practice helps get players acclimated to contact prior to a game; some coaches and parents felt this was important for younger players learning how to tackle.

Coaches use drills in practice to teach the fundamentals of football and to assess and develop athlete skills in practice. Coaches discussed drills they commonly use in practice, including scrimmage, angle tackle, one-on-one tackle, and open-field tackle. Five coaches described the purpose of the scrimmage drill as a way to prepare for games and teach strategy, skills, and technique. One coach felt that contact can be limited in scrimmage with “quick whistles”. Three coaches from one team discussed using the angle tackle drill to teach pursuit, running angles, and to reinforce “near foot, near shoulder” – a method of removing the head from the tackle. Two coaches shared their thoughts, with three additional coaches in agreement, on how they provide instruction for drills, including demonstrating the drill, having players walk through the drill, and then executing the drill and using film to show athletes their form. One-on-one style drills such as one-on-one tackle and open-field tackle were discussed by some coaches as intended to stress physicality and one coach noted running these drills because kids are “afraid to tackle”.

Organizational leaders expect coaches to stay up to date on current practices related to safety and give them autonomy over their team but recognize that they need to hold the coaches accountable in using safe practices. Organizational leaders described their role in setting expectations of coaches, including completion of required trainings and certifications and following rules of the organization; however, many described their leadership philosophy as “hands off” and expressed their desire to let coaches organize and conduct activities of their team as long as it is done safely. In addition, organizational leaders described their role in maintaining rules of order and proper decorum of coaches, describing their role as “managing the ship”, “hall monitor”, and “coach to the coaches”. Organizational leaders provided examples of when they would need to intervene on coach activities, including unfair abuses of power or authority, unequal opportunities of playing time, unsafe practices on-field, or disrespect for kids and parents.

Coaches are responsible for the safety of the athletes on their team and are expected to teach athletes proper skills and techniques to prevent injuries. Many coaches and organizational leaders discussed the coaches’ responsibility in developing skills and techniques of athletes. Strategies for teaching athletes proper skills and techniques described by coaches include demonstrating the drill before players engage in the drill, reviewing the proper way to tackle by having the players practice without helmets, and using film to facilitate discussion around technique. Many coaches and organizational leaders acknowledged that tackling technique has evolved to improve safety as knowledge surrounding concussions has increased. They discussed the risk of injury, including concussion, that comes from coaches not teaching, or players not using, proper technique. Some coaches described the rewards of teaching players proper technique, including preparing for and winning games and reducing injuries. Parents recognized the importance of coaches in the instruction of technique. Parents, particularly moms, described how they tell their sons to “be careful” and provided reassurance to the athletes due to having seemingly knowledgeable coaches and protective equipment. Some parents described their expectation that coaches will teach their sons skills to keep themselves protected and safe while playing the sport. Some parents discussed how technique instructed by coaches can be used to prevent concussions; coaches and organizational leaders echoed this sentiment. One parent mentioned her expectation that coaches are familiar with signs and symptoms of concussion.

Coaches who teach players techniques that are not aligned with current practices and coaches who prioritize winning over safety were identified as concerns for player safety. Many coaches discussed the influence of “bad coaching” on players, including coaches who just “want to win” and lack of coaches who “worry about the safety of it.” Organizational leaders acknowledged that some coaches have “ill-advised” aspirations and expressed concerns for the increased risk that poses for others. Some coaches and parents discussed concern for ill-motivation of opposing coaches or lack of necessary training or coaching experience among other coaches and its effect on player safety. Organizational leaders expressed concern for instruction provided by other organizations, including teaching athletes improper techniques, loopholes, and ways to cut corners in order to get a big hit.