Stepping into Play: a FIFA decision aid for football participation after childbirth

OBJECTIVE: To create a decision aid to support football participation after childbirth. METHODS: The creation of the decision aid was based on the knowledge-to-action cycle, using the intervention mapping knowledge and transfer framework. Five phases were used in the development process: (1) evaluation of scientific literature, (2) identifying barriers and enablers to sport participation after childbirth, (3) creating and refining the objective and approach of the decision aid, (4) ascertaining the key health screening components for the decision aid and (5) administering a preliminary assessment of the practicality and criterion validity of the decision aid for amateur to elite-level football players to support quality decision-making about football participation after childbirth. RESULTS: Following an evaluation of scientific literature to identify essential considerations for return-to-football after childbirth, the working group developed the Fédération Internationale de Football Association Stepping into Play decision aid that: (1) prioritises the athlete's voice, (2) facilitates the resumption of participation in team training when and where possible, (3) considers postpartum symptoms and dysfunction, (4) reflects that football participation requires a cognitive stimulus approach and (5) uses currently available questionnaires validated for the postpartum period whenever possible to enhance global internal methodological rigour. The resources underwent a thorough external review by experts (physicians, physiotherapists and performance coaches working in football). After combining their feedback, a broader consultation took place with 32 respondents from 12 countries. This consultation confirmed the high utility of these resources for postpartum football players and their multidisciplinary teams at all levels. The decision aid itself (97% approval), a seven-stage approach (100% approval), and the Postpartum Medical and Performance Debrief Form (100% approval) all received strong support. In an applied case study, 93% of respondents demonstrated competency in using the decision aid by accurately guiding the player through each successive step. The qualitative feedback from the respondents allowed for further refinement and enhancement of the decision aid. CONCLUSION: This newly developed decision aid is designed to empower postpartum players and their multidisciplinary teams to make quality decisions about football participation after childbirth.