Knowledge and reporting of relative energy deficiency in sport (REDs): An international mixed-method study of rugby players

This study investigated Rugby players’ knowledge and reporting of Relative Energy Deficiency in Sport (REDs). A mixed-method design was employed. In phase one, 180 Rugby players (52.2% male; age: 27.0 ± 8.0 years) from 15 countries responded to an online survey assessing familiarity with REDs, knowledge of health and performance outcomes (21-item quiz), confidence in self-identifying and self-reporting signs/symptoms, and attitudes towards reporting. Most participants (63.9%) had no familiarity with REDs, despite moderate awareness of associated outcomes (mean knowledge quiz score: 15.3 ± 4.6 out of 21). The majority reported low confidence in self-identifying (60.5%) or self-reporting (56.7%). In phase two, 13 Rugby players (53.8% male; age: 26.2 ± 4.3 years) from three countries participated in follow-up focus groups exploring perceived barriers and facilitators to reporting REDs. Two overarching themes were observed: (1) supportive, informed, and trusting environments support REDs reporting, and (2) reporting REDs feels risky, uncomfortable, or unsafe. Four sub-themes were identified within theme 1: (1) encouragement to report, (2) knowledge of the topic, (3) trust and openness, and (4) non-stigmatised symptoms. Five sub-themes were observed within theme 2: (1) access to support, (2) lack of knowledge, (3) fear of judgement, (4) topic delicacy, and (5) fear of repercussions. The findings demonstrated Rugby players’ limited familiarity with REDs and low confidence identifying and reporting symptoms, despite moderate awareness of associated outcomes. Identified barriers and facilitators highlight the need for targeted education and clear reporting pathways to improve REDs recognition and reporting within the Rugby context.