PT  - JOURNAL ARTICLE
AU  - Caroline Bolling
AU  - Jay Mellette
AU  - H Roeline Pasman
AU  - Willem van Mechelen
AU  - Evert Verhagen
TI  - From the safety net to the injury prevention web: applying systems thinking to unravel injury prevention challenges and opportunities in Cirque du Soleil
AID  - 10.1136/bmjsem-2018-000492
DP  - 2019 Feb 01
TA  - BMJ Open Sport & Exercise Medicine
PG  - e000492
VI  - 5
IP  - 1
4099  - http://bmjopensem.bmj.com/content/5/1/e000492.short
4100  - http://bmjopensem.bmj.com/content/5/1/e000492.full
SO  - BMJ OPEN SP EX MED2019 Feb 01; 5
AB  - Objective We undertook this qualitative study within an international circus company—Cirque du Soleil—to explore the narrative of artists and the artistic team in regards to injuries and their prevention and to describe the prevention of injuries from a systems thinking lens.Methods Focus groups (FG) with artists and semistructured individual interviews with the artistic team were conducted in six selected shows. The structure of the interviews and FGs concerned the themes: ‘injury’, ‘injury-related factors’ and ‘injury prevention’. Data were analysed through comparative data analysis based on Grounded Theory. Concept mapping and systems thinking approaches were used to design a map of participants’ views on how to prevent injuries.Results Injury was mainly described based on performance limitation. The factors mostly mentioned to be related to injury occurrence were physical load factors. Many of these factors were said to be connected and to influence each other. Injury prevention was mapped as a multilevel system, composed by artist-related factors (eg, technique and life style) and extrinsic factors (eg, touring conditions and equipment) that integrate different strategies and stakeholders.Conclusion Our study reinforces the importance of multilevel injury prevention approaches with shared responsibility and open communication among stakeholders.