International elite Para athletes' perspectives on anti-doping: what works, what doesn't and what's next?

Objectives: Para athletes may face unique challenges in the anti-doping system, including issues of privacy, implementation, comprehension and accessibility. While previous studies have examined non-disabled athletes' views, little is known about how international elite Para athletes perceive anti-doping procedures. The aim of this study was to increase the understanding of elite Para athletes' experiences and perceptions of anti-doping procedures. Methods: Using a cross-sectional observational study design, data were collected via an online questionnaire distributed during major international Para competitions. A total of 109 elite Para athletes from 25 countries, representing three impairment groups-physical, visual and intellectual impairments-participated in the study. Data were analysed using descriptive statistics and non-parametric analytical tests. Results: Among elite Para athletes, 27% had never received anti-doping education during their sports careers, while those who had received such education felt more confident in staying updated on the prohibited list. Over half had never undergone doping testing, and over 70% had never submitted whereabouts information. Most athletes who had been tested found the procedure respectful and adapted to their impairment. However, 25% could not provide a urine sample without assistance from a doping control officer or another person. Furthermore, 40% of those who had submitted whereabouts information said updating it reduced their enjoyment of being an elite athlete. Conclusions: This study shows that many Para athletes, even at the elite level, have limited experience with key anti-doping procedures, highlighting a need for more inclusive, prioritised and accessible anti-doping efforts tailored to the needs of Para athletes.