Introduction: A well-functioning anti-doping system relies on being perceived by athletes as effective, fair, and practically feasible to implement. While research has highlighted the views of Olympic athletes on anti-doping over the past decade, the experiences and perceptions of Para athletes have not been extensively explored. The purpose of this study was to examine Swedish elite Para athletes' experiences and perceptions of the policy and practice of the anti-doping system.

Methods: A quantitative cross-sectional approach was used, with a web survey elaborated from a survey with Olympic athletes adjusted for Para athletes with physical, visual, and intellectual impairments. The sample consisted of 66 active Para athletes competing at national or international level (response rate 71%). Data were analyzed using descriptive statistics and differences between subgroups were examined Fisher's exact test. Thematic analysis was employed to analyze open-ended questions.

Results: Most of the respondents expressed a positive outlook on the anti-doping system, advocating for comprehensive efforts. A significant portion (35%) had not received anti-doping education, with those who did reporting increased confidence in avoiding unintentional doping. Despite their elite status, half of the respondents had not undergone doping control. Mistrust regarding the system's effectiveness and fairness was identified, with over half of the participants emphasizing the need for new technical solutions to enhance procedures specifically tailored for Para athletes.

Discussion: The athletes in this study advocate for a Para sports-focused approach in the anti-doping system, emphasizing equal testing opportunities, procedural adjustments for independence and privacy, and increased access to education. The findings illuminate the unique conditions faced by athletes with impairments within the anti-doping system, offering valuable insights for policymaking in the development of anti-doping strategies tailored to Para athletes and their various impairments.

This presentation critically explores elite athletes’ accounts on the anti-doping system and how ideas of purity and danger shape their experiences and practices within it. Theoretically, we draw from Mary Douglas’ influential ideas on purity and danger. These ideas encompass the idea that separating dirtiness from cleanliness provides a way to systematically create and maintain symbolic, societal and cultural order. Data from 13 qualitative interviews with elite athletes in three different sports dispersed over five geographical continents was analysed using a reflexive thematic analysis. The analysis shows a strict conviction of the importance to distinguish the pure from the impure, in our study played out as practices and experiences of assurance, intimidation and shaming. The danger of breaching the sharp line between purity and danger had to be handled by the individual athletes through taking precise measures to avoid pollution. The elite athletes’ bodies become the places where boundaries can be built, and sharp limits arise. A conclusion is that the athletes have much to gain from becoming ‘guardians of purity’. We caution, however, that such positioning implicates symbolic values on cleanliness that may simultaneously infer others’ dirtiness.

The main purpose of this article is to examine how elite athletes perceive their own responsibilities and possibilities to be compliant with the anti-doping regulations, and to draw conclusions about what these perceptions mean in relation to the legitimacy of the anti-doping system. A qualitative research design, with interviews conducted with athletes globally, was employed to capture elite sportspersons’ views on anti-doping policy and procedures. The analysis was based on a theoretical framework on legitimacy. The findings show that athletes’ situation is characterized by limited information and a lack of leeway. At the same time, athletes find themselves obliged to be dutiful. We discuss the complex situation of simultaneously facing perceived limitations and duties, and consider the limits that athletes experience in relation to compliance, which may place the legitimacy of the anti-doping system at risk.

The aim of this study was to investigate the prevalence of performance- and image-enhancing substances (PIES) use, and factors related to this, among a representative sample of the general Swedish population aged 16–25. We used a quantitative cross-sectional self-report design to examine prevalence and possible relationships between PIES use and socio-demographics, physical activity, attitudes towards muscle building and doping, friends’ use, body image, and body modification. Approximately 12% of the respondents reported that they used or had used PIES. A logistic regression analysis pointed out the importance of the social context – friends who used PIES, how body image affected social life, and how others viewed one's body – as more important factors for using PIES than attitudes towards muscle building and doping. Taken together, these results indicate a need to pay attention to the use of PIES among young people as a potential public health problem.

The global anti-doping enterprise in sport is a comprehensive system in which the athlete is at the centre of regulation, scrutiny and control. There is limited knowledge about the implications of this extensive control system for athletes and about how athletes perceive the system; little is known about possible consequences of these implications and perceptions for the legitimacy of the system. The overall aim of this thesis is to analyse the legitimacy of global anti-doping policy and practice from the perspectives of international elite athletes.

Four articles are included in this compilation thesis. The first illustrates, based on a discourse analytical approach, how claims for legitimacy of the anti-doping system are produced in policy documents aimed at athletes. The second explores the perceptions and legitimacy of anti-doping policy and practice through a survey aimed at elite athletes in different sports and from different regions of the world. The third article examines, through an interview study, how athletes in different contexts experience the practice of anti-doping and what consequences this may have for the system's legitimacy. The interview study was also the basis for the fourth article, focusing on the athletes' experiences and perceptions of their opportunities for compliance and how this is related to their view of the system's legitimacy. Using the four articles as a basis, the analysis of legitimacy within the anti-doping system is expanded in the thesis through an overarching analytical framework inspired by David Beetham.

The results show that the legitimacy of the policy documents is based on essentially authoritative, but also rational, arguments for justifying the anti-doping enterprise. Elite athletes are generally in favour of anti-doping policy and the principle that doping should be prohibited. However, when the rules are implemented into practice, problems to do with lack of procedural justice arise which may have an impact on the system's legitimacy. Procedures in the system are perceived as having a negative effect on sportspersons' private life, and as ineffective and unequally implemented across the world; also, athletes have little influence over decision-making processes. Anti-doping practice is moreover perceived to cause structural inequalities due to inequality in access to technology, education and knowledge as well as supportive systems. Most athletes wish to comply with the rules, but many struggle with lack of control and have limited scope for taking responsibility regarding compliance with the doping rules. Even when athletes are dutiful and perform acts that confer legitimacy to the rules and the authorities, some experiences and perceptions could endanger the legitimacy of antidoping, as seen in the overall legitimacy analysis of the thesis. Athletes' perceptions of inequality, ineffectiveness and lack of leeway can be interpreted as a lack of rule conformity to the anti-doping authority. There also appears to be a lack of shared normative beliefs between sportspersons and the anti-doping authorities, as many athletes feel that their opinions are not taken into account. Decision-making processes that do not pay attention to the perceptions of those involved can result in a discrepancy between the rules and the norms.

The international anti-doping system is a major international enterprise with comprehensive rules that need to be applied equally around the world, and that also need to be legitimated in different countries where athletes have different conditions to comply with the regulations. In this thesis, I have shown that these different conditions have consequences for the ability to comply with the rules and also for the application of the regulations. The far-reaching rules mean that procedures within the system are experienced as causing a number of negative consequences. I have shown that this poses a risk to the legitimacy of the system if these problems are not addressed.

The global anti-doping effort in sport is based upon perceptions of the system as desirable, proper and appropriate and thus considered legitimate. The legitimacy of the anti-doping system has earlier been studied bottom-up, based on the views of athletes. In order to gain greater understanding of legitimation processes, it is also important to study legitimation strategies top-down, used by decision-making and governing bodies. The aim of this study was to use Fairclough's critical discourse analytical approach to analyse the social construction of legitimacy in the World Anti-Doping Agency's three editions of a guide to anti-doping rules aimed at athletes. The analysis was performed based on van Leeuwen's four specific legitimation strategies: authorization, rationalization, moral evaluation and mythopoesis. Our analysis shows that the legitimation of the anti-doping discourse as constructed in the athlete guides that has accompanied anti-doping regulations for more than a decade is characterized by continuity as regards an authoritarian attitude, but also by change towards a more rational and athlete-centred stance. A shift can be seen in the construction of legitimacy in the anti-doping discourse from “fighting the bad” to “protecting the good”. We discuss the moral evaluation strategy as a way to construct legitimacy for anti-doping efforts and sport in general towards a wider public. In the light of the results of this study, we conclude that policymaking in relation to doping issues should take into account the dimension of the discursive top-down legitimation, which could affect how the policy is received at the level of the athletes and provide conditions for a sustainable anti-doping system. 

Justice and fairness in sport is fundamental for its legitimate existence. On a global level, the creation of the World Anti-Doping Agency and the regulatory framework World Anti-Doping Code was formed largely as a consequence of the need for a coordination of the work against performance enhancing drugs in sports. Today, the anti-doping system often means application of rules and "best practice" developed in the cultural West for the cultural rest. Research on anti-doping policy or practice not only tends to be based on deductive models, these models may also assumingly be culturally biased. Moreover, we have relatively little knowledge of the practical conditions for individual athletes concerning implementation of the rules in different contexts around the world. This presentation, however, adds to the existing research with new empirical findings from interview data on diverging conditions for elite athletes in different social, cultural and geographical contexts. Through exploring how 13 elite athletes from five continents and three different sports federations perceived the anti-doping programme, we were able to show that global anti-doping policy was implemented in different contexts under different conditions. These differences included infrastructure, knowledge and support. How participation in anti-doping procedures on an everyday basis is endorsed may thus vary around the world. By examining our interview data on the athletes’ perceptions and experiences in relation to theories of procedural justice, we were able to analyse the legitimacy of anti-doping in practice. These findings suggest that inequities and structural injustice emerge on an individual level because of the varying contexts and conditions. In turn, the consequences may have implications for the legitimacy of the anti-doping work. In order to understand implementation processes of regulations, we propose that anti-doping policy-making pay attention to differences that may exist on an individual and practical level. Perspectives that underpin regulations applied globally should in other words be sensitive to varying contexts and conditions.

Anti-doping work is a comprehensive enterprise that entails control and governance of elite athletes’ everyday lives. However, in policy-making regarding doping and anti-doping in elite sports, the athletes’ perspective has not been considered adequately. Focusing on elite athletes’ perceptions of anti-doping as both principle and praxis, the study aimed to analyse how these perceptions can be understood from a legitimacy perspective. A survey study involving 261 elite athletes from 51 different countries and four international sports federations was conducted. The results showed that the athletes did not question the legitimacy of the rules, but had concerns about the legitimacy of the way the rules and principles are enforced in practice, specifically with regard to matters of privacy, lack of efficiency and equal conditions as well as athletes’ involvement in the anti-doping work. The article describes how athletes’ perceptions of the legitimacy of anti-doping work constitute the basis for their willingness to follow regulations as well as a precondition for the work’s functionality and stability. In light of this finding, the article calls for the empowerment of athletes in anti-doping work.