The 5Rs of Rugby: A qualitative evaluation of the development, delivery, and experience of a mental health literacy and social norms intervention with elite rugby union players in Ireland.

Elite rugby players are as likely to experience mental health challenges as the general population yet face unique pressures on their wellbeing associated with competitive sport. Few mental health literacy interventions have been conducted with elite rugby professionals, particularly those which consider the nature of rugby as a demanding, competitive team sport with unique group dynamics within teams. We conducted a novel social norms and mental health literacy project with current elite players contracted to the provincial rugby union teams in Ireland. The project, developed in collaboration with Rugby Players Ireland, featured a mental health literacy workshop intervention and co-produced poster materials detailing the '5Rs of Rugby', relating to player mental health, sources of support, and social norms feedback from an earlier survey, with messages focusing on players' intentions to signposting teammates to formal and informal sources of support. We report a qualitative evaluation of the development, delivery, and the experience of participating in the intervention based on focus groups, a survey, and interviews with staff and players whilst considering the context of elite rugby. An inductive reflexive thematic analysis identified three themes relating to (i) Rugby: 'fickle and all-encompassing', (ii) Trust and Brotherhood, and (iii) Experiences of the 5Rs of Rugby intervention. Participants felt that the intervention engaged the players, provided a psychologically safe environment for mental health discussions and disclosures, and reinforced existing positive social norms around help-seeking. Our analysis identified several challenges and considerations for supporting players' mental health particularly around longer-term awareness campaigns, focusing on prevention, and providing actionable support for players.