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OBJECTIVE: The Netball KNEE Program is an injury prevention program (IPP) developed by Netball Australia. It is promoted to coaches, but implementation is limited. This study explored community netball coaches' perspectives on factors that influence IPP implementation, and ideas on how it could be improved. METHODS: Twenty-four coaches from 16 netball clubs participated in semi-structured interviews that asked about their beliefs about injury prevention, use of and confidence in delivering IPP, barriers and facilitators to implementation, and suggestions to ease IPP implementation. Interviews were analysed using inductive thematic analysis. RESULTS: Two themes were identified - Factors that influence IPP implementation (4 sub-themes), and Suggestions to improve IPP implementation (2 sub-themes). Coaches thought early development of injury prevention habits was important. Life roles, coaching experience and engagement with development courses influenced IPP delivery. Coaches expressed concerns about Netball KNEE program length and complexity and lack of implementation support. They suggested the need for a short simple IPP and engagement with health/exercise professionals for implementation. CONCLUSIONS: This study engaged with stakeholders to identify barriers that need to be addressed to improve IPP implementation in netball. Coaches desired a short simple standardised IPP, and training from physiotherapists or exercise professionals on implementation.

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Introduction: Community sport coaches in Western Australia lack an understanding, the confidence, and knowledge in supporting young people with Type 1 diabetes (T1D). This study aims to identify what T1D educational resources are required to upskill coaches in Western Australia. Methods: Semi-structured online interviews were conducted with i) young people living with T1D, ii) parents of young people living with T1D and iii) community sport coaches. The questions explored i) past experiences of T1D management in community sport ii) the T1D information coaches should be expected to know about and iii) the format of resources to be developed. Thematic analysis of interview transcripts was performed, and the themes identified were used to guide resource development. Results: Thirty-two participants (16 young people living with T1D, 8 parents, 8 coaches) were interviewed. From the interviews, young people wanted coaches to have a better understanding of what T1D is and the effect it has on their sporting performance, parents wanted a resource that explains T1D to coaches, and sports coaches wanted to know the actions to best support a player living with T1D. All groups identified that signs and symptoms of hypoglycaemia and hyperglycaemia needed to be a key component of the resource. Sports coaches wanted a resource that is simple, quick to read and available in a variety of different formats. Conclusion: The interviews resulted in valuable information gained from all groups and have reinforced the need for the development of specific resources to increase community knowledge and provide support for players with T1D, parents and sport coaches.

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Sport participation and volunteering can make important contributions to good health. Sporting organisations need volunteers to deliver their participation opportunities and for many years the sector has faced challenges to volunteer recruitment and retention, especially due to the increased bureaucratic and compliance demands in operating community sports clubs. As sporting organisations pivot to adapt to COVID-safe sport we can learn about their experiences to inform volunteer recruitment and retention policies and practices. This research examined volunteer intentions and motivations in coaching and officiating in basketball and explored factors influencing their decision to return to COVID-safe basketball. Data was collected via an online survey that drew on theoretical frameworks of volunteer motivations (i.e. modified Volunteer Functions Inventory VFI) in sport as well as sport policies related to COVID-safe guidelines for return to sport. Data was collected in Victoria Australia during July 2020 before basketball had the chance to return from the first Australian-wide COVID-19 lockdown. Volunteers had positive intentions to return to basketball following COVID-19 restrictions because it was fun, to help others, or because friends/family were involved. Volunteers were most concerned that others will not comply with COVID-safe policies particularly around isolating when feeling unwell (95%), but also reported concerns about the inconveniences of some COVID-safe policies introduced to return to organised sport (e.g. social distancing, density limits, and enforcing rule changes). Understanding these volunteer intentions, motivations and factors influencing the decision to return to COVID-safe basketball can help inform recruitment and retention strategies to support volunteers in sport. Practical implications for sport policy and practice are discussed.

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This study presents the landscape of private community sport organizations in the City of London, Ontario, Canada based on a profile of organizational features that align conceptually with critical aspects of community development. Features representing the scope-variety of sports offered, program age targets, and other offerings-and operations-nonprofit/commercial sector, open/closed program type, independent/affiliated/franchise status, and shared/exclusive facility use-of community sport organizations were captured from publicly available information about the population of 218 organizations. The location of sport delivery points for each organization was also mapped. The landscape is characterized by a balance of nonprofit and commercial organizations, offering a wide variety of sports, across all ages and City districts, but predominantly offered through closed programming that typically requires an extended financial commitment. Community sport organizations in this city are also most likely to operate independently, and share facilities. These features, and the landscape, are conceptualized as having implications for access, social inclusion, engagement and citizenship, and social capital that are fundamental to community development. Mapping the landscape in this community provides a valuable resource for understanding that potential.

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Individuals' access to sport and physical activity has been hampered due to COVID-19 lockdown restrictions. In Australia participation in community sport was cancelled during lockdowns. There is limited research on the impact of sport participation restrictions on the health and wellbeing of adults.AimThe aim of this study was to investigate the perceived health and wellbeing of a sample of predominantly active Australian adults, both during COVID-19 and in comparison with one year earlier (pre COVID-19).MethodsA survey was conducted during the first COVID-19 restrictions and lockdowns in Australia in May-June 2020. It was distributed by national and state sporting organisations and through researchers' social media accounts. This particular paper focuses on adults aged 18-59 years. The survey collected information on participant demographics, the sport and physical activity patterns pre- COVID-19, and health and wellbeing outcomes during COVID-19 lockdown and compared to one year earlier. The health measures were cross-tabulated against the demographic and sport and physical activity variables, and group profiles compared with chi-square tests. Scales were derived from three wellbeing questions, and group differences were analysed by t-tests and F-tests.ResultsThe survey sample included 1279 men and 868 women aged 18-59 years. Most (67%) resided in metropolitan cities. The great majority (83%) were sport participants. During COVID-19 lockdown men were significantly more likely than women to report worse or much worse general (p = 0.014), physical (p = 0.015) and mental health (p = 0.038) and lower life satisfaction (p = 0.016). The inactive adults were significantly more likely to report poorer general health (p = 0.001) and physical health (p = 0.001) compared to active adults. The younger age cohort (18-29 years) were significantly more likely to report poorer general wellbeing (p < 0.001), and lower life satisfaction (p < 0.001) compared to the older age groups.ConclusionIt seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted males and younger adults in particular. Sports clubs provide an important setting for individuals' health and wellbeing which is why clubs require the capacity to deliver sport and individuals may need to regain the motivation to return.

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In Australia, community sport plays an essential role in the objectives of national sports organizations and local and national social policy more generally. The opinions of senior community sport club officials (n=53) in rural New South Wales concerning sustainability, policy and advocacy matters impacting upon community sports clubs (CSCs) were identified. Participants were surveyed to establish the level of influence of top-down sport management structures alongside rudimentary views on a coalition to advocate for community sport. Gaussian copula graphical models (GCGMs) were applied to demonstrate the raw and partial correlations between participant responses. While frequently associated with finance, science and medicine, the application of copulas is increasingly common in research in sport where there are multiple variables and relationships involved. GCGMs have been used in, for example, analysis in soccer and across physical education in general.

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Purpose: Violence against women is a global epidemic. Such violence occurs in sport, although previous research has focused on child/youth sexual abuse or elite sport. Despite sport being identified as having a role in preventing violence against women, little is known about how sport organizations respond to violence against adult women in community sport. Methods: Twenty-two individual participants from 12 sports organizations based in Victoria, Australia participated in this empirical and applied Concept Mapping study to explore the perceived challenges sports organizations face in responding to violence against women. Concept Mapping is a mixed-method participatory approach and we analyzed the results using a socio-ecological framework. Results: Sports administrators considered training-related challenges as the most important but most difficult to address. Challenges related to organizational capacity/social environment were perceived as easier but less important to address. Conclusions: Key initiatives can be developed to support sport organizations to respond to violence against women in sport, but they will need assistance to prioritize initiatives addressing the most important challenges given a perceived lack of capacity to do so.

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OBJECTIVES: To assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football. DESIGN: Prospective cohort injury surveillance. METHODS: There were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match. RESULTS: There were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04-3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40-3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41-2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06-1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79-2.53). CONCLUSIONS: Headgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.

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Since 2008, the national government has provided municipalities with financial support to employ community sport coaches, who motivate inhabitants to participate in sports and physical activity. This rapidly growing group of professionals connects various sectors and sports providers at the local level. Their work is strongly linked to health and prevention policy. Almost all municipalities employ community sport coaches (99% in 2021) and together they employ almost 3,500 FTEs (6,000 persons). Despite large differences in their goals and activities at the local level, their enthusiasm and decisiveness in efforts to achieve maximum results are unifying characteristics among community sport coaches.

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BACKGROUND: Throughout the ecosystem of sport, women have been and continue to be underrepresented at all levels compared to men. The capacity of community-level sport is heavily reliant on the many non-player roles including governance, as well as administration, coaching and officiating. Recently there has been increased attention to improving the gender balance in sport. The aim of this study is to investigate the proportions of women engaged in non-playing roles in sport (2016-2018). METHODS: This study involved secondary analysis of the AusPlay survey, a national population survey, funded by Sport Australia. This study utilised data from people aged 15-years or older about their involvement in non-playing roles in sport, and their demographic data. Survey respondents were asked "During the last 12 months, have you been involved with any sports in a nonplaying role, such as official, coach, referee, administrator, etc?" Analysis of non-player role responses focussed specifically on the top four non-player role categories; coach, official, administrator and manager. Frequency analysis concentrated on the distribution of men and women involvement in a non-player capacity for the three years, with detailed analysis of the most recent year (2018). RESULTS: In this study of 61,578 Australians there was a higher proportion of men in non-player roles in sport compared to women, across each of the three years (2018: men 55 %, women 46 %). Involvement of women in coaching increased significantly from 38 % to 2016 to 44 % in 2018 (p < 0.001). The proportion of women involved in administration roles significantly decreased from a peak of 51 % in 2017 to 46 % in 2018 (p < 0.001). CONCLUSIONS: Aligned with strategic policy and investment strategies, there are gradual increased representation of women in non-playing sport, coaching roles. Women are still underrepresented in terms of coaches, officials and administrators, but are more likely to be managers. It is recommended that there is continued mentoring, identification and emphasising of female role models, and further strategies to increase female presence in non-playing roles. We recommend that future research, in line with appropriate gender and cultural-change theories, investigates and discusses the progress of gender equality throughout playing and non-playing role in sport.

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Girls' and young women's engagement and disengagement in physical activity has been well documented in Western culture. Sport plays a pivotal role in the development of behaviours that promote physical activity, particularly through commitment to team and individual goal attainment, socialisation, and feelings of belonging and self-identity. Community sport in Australia is the dominant pathway into state, national, and elite international competition. The importance of community sport in the lives of girls and young women cannot be overstated, irrespective of individual long-term sporting goals. Indeed, the dropout rate of girls in sports, like many other western cultures is significant and is certainly disproportionate to the numbers of boys who drop out. The present study aims to examine the intrapersonal, interpersonal, and environmental influences on community sporting pathways for girls and young women. Using a mixed-methods design, we include survey data from 2,189 high-school students (aged 12-18 years) and focus group and individual interview data from a subset of 37 high-school students, parents, and teachers, across metropolitan Adelaide, South Australia. The study included an examination of sporting practises and insights of male sport participants from the same age groups to juxtapose the findings and provide a more comprehensive understanding of girls' and young women's community sporting involvement. Parents and teachers were also included within the participant cohort to provide a comprehensive perspective. The results highlight the challenges that girls face with respect to engagement and disengagement in sport and particular points throughout their adolescent years. Recommendations are provided to help mitigate potential attrition of girls in sport in the future.

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Disabled young people have lower levels of participation in community life than nondisabled peers across a number of domains, including sporting activities, with profound implications for health, wellbeing and life course opportunities. Playing sport is a defining feature of identity for many young people in Aotearoa/New Zealand. Participation in sporting activities provides opportunities to develop competencies, to have fun and to compete, while also providing a sense of inclusion and peer group belonging. However, despite policies promoting inclusion of disabled young people in school and club sport, ableist attitudes and practices still function to exclude individuals who do not fit able-bodied norms. Drawing on recent 'assemblage thinking' in health and cultural geography, this paper explores the material, social and affective dimensions of 'enabling' and 'disabling' sporting assemblages, drawing on interviews with 35 disabled young people (12-25 years), parents and key informants. Many reported instances of demoralising exclusion in mainstream sporting activities. Some turned to adaptive sporting codes, designed for inclusion. In our exploration of participants' embodied experiences of enabling and disabling assemblages we employ assemblage theory to examine how social, affective and material forces and processes converge to either enable or constrain participation in local sporting activities. We close with a brief assessment of the implications of our analysis for ongoing efforts to promote inclusion for disabled youth in physical activity.

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Internationally, insufficient physical activity (PA) is a major health concern. Children in Northern Ireland (NI) are recorded as having the lowest levels of PA in the United Kingdom (UK). To date, validated and representative data on the PA levels of NI school children are limited. The aim of this study was to provide surveillance data on self-reported PA, sport and physical education (PE) participation of school children in NI. Differences between genders and factors associated with PA were also examined. A representative sample of primary (n = 446) and post-primary (n = 1508) children was surveyed in school using validated self-report measures. Findings suggest that PA levels are low, with a minority of children (13%) meeting the PA guidelines (primary pupils 20%, post-primary pupils 11%). NI school children have lower levels of PA, PE and sports participation than UK and European peers. A trend of age-related decline across all the domains of PA was apparent. The data presented highlighted that females are less likely to achieve PA guidelines, children from lower socio-economic background participate in school and community sport less often, and that enjoyment and social support are important variables in PA adherence. Policy solutions that would support implementation e.g., mandatory minimum PE time, whole school approaches to PA promotion and targeted investment in schools, particularly in areas of deprivation and for females, are suggested.

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Objectives　Comprehensive community sports clubs (CCSCs), of which more than 3,500 exist in Japan, have the potential to contribute to healthy aging in older adults, but their effect on this population has not, thus far, been well explored. This study aimed to investigate the current environment affecting seniors at Japanese CCSCs and to examine issues identified by the analysis.Methods　Data were collected from the FY 2016 Survey Results on Comprehensive Community Sports Clubs, conducted by the Japan Sports Agency. A total of 2,444 clubs were divided equally into four groups after calculating the proportion of senior members (ages 60 and over) per total number of members in each club. The groups were then ranked from lowest to highest according to proportion of senior members: Groups A, B, C and D. Additionally, the 2,444 clubs were classified into six regions according to location. Group designation (A to D) and regional classification were used as independent variables. The dependent variables were categorized as follows: basic information (e.g. total number of members), crisis management and accident prevention measures (13 specific items in total), and each club's compliance with legal obligations.Results　Study results revealed that Group D, containing the highest proportion of senior members, had fewer total members, lower monthly membership fees, lower annual club income, less annual club budget apportioned to each member, and fewer instructors than other groups. Regarding crisis management and accident prevention measures, Group D had lower completion rates on 6 items (health certificate submissions, liability insurance enrollment, safety workshop implementation, heatstroke prevention, liaison with healthcare professionals, and AED availability). Group D also showed a lower rate of compliance with legal obligations than other groups. In comparisons between the six regions, the median proportion of senior members was found to be highest in Chugoku-Shikoku and lowest in Chubu, although each median ranged from only 20% to 30%. Regarding crisis management and accident prevention measures, clubs in Kanto region had the highest completion rates for 10 items, whereas clubs in Kinki region had the lowest completion rates for 8 items.Conclusion　The CCSCs with higher proportions of senior members had smaller budgets, fewer members and staff, and delayed implementation of crisis management and accident prevention measures. Regional disparities were also observed both in club scale and management of medical and safety issues. Although our study identified several shortcomings in this area, medical and safety management implementation is an important consideration for CCSCs with high proportions of senior members, as these members are at higher risk for disease and frailty. Affected CCSCs and relevant authorities should therefore acknowledge and address this issue cooperatively.

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OBJECTIVES: Cricket is a popular sport enjoyed worldwide. Injuries in cricket are not well understood at community level but are important to understand for prevention to ensure the game continues to be enjoyed safely. This systematic review was designed to assess the quality of data collection and reporting, and to summarise the injury data, in studies of community cricket players. DESIGN: Systematic review. METHODS: Nine databases were searched to November 2018 using the terms "cricket*" and "injur*". A nine-item critical appraisal and three-item likelihood-of-bias evaluation was conducted on included studies. Data completeness was evaluated against recommendations in the international cricket consensus statement for recording/reporting injury and the Australian Sports Injury Data Dictionary (ASIDD). Descriptive injury data (n,%) are presented in tabular format for different subgroups (activity, position, population). RESULTS: Thirteen studies were included, of which eight were rated as unclear, one as high and three having a low likelihood-of-bias. The mean score for completeness of data against the consensus statement was 3.5/10 (95%C.I. 2.8-4.2). The mean score for completeness of data against the ASIDD was 4.4/6 (95%C.I. 3.9-5.0). Bruising and inflammation was the most common injury in junior cricket. Stress fractures were most common in studies of bowlers. Where studies included all activities, batting accounted for most injuries (7-49%). CONCLUSIONS: The included studies inconsistently addressed recommended items for injury surveillance in community sport and cricket. Most studies focused on junior levels or adolescent bowlers, with bruising/inflammation and stress fractures being most common, respectively.

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Sport makes an important contribution to the physical, psychological and emotional well-being of Australians. The economic contribution of sport is equivalent to 2-3% of Gross Domestic Product (GDP). The COVID-19 pandemic has had devastating effects on communities globally, leading to significant restrictions on all sectors of society, including sport. Resumption of sport can significantly contribute to the re-establishment of normality in Australian society. The Australian Institute of Sport (AIS), in consultation with sport partners (National Institute Network (NIN) Directors, NIN Chief Medical Officers (CMOs), National Sporting Organisation (NSO) Presidents, NSO Performance Directors and NSO CMOs), has developed a framework to inform the resumption of sport. National Principles for Resumption of Sport were used as a guide in the development of 'the AIS Framework for Rebooting Sport in a COVID-19 Environment' (the AIS Framework); and based on current best evidence, and guidelines from the Australian Federal Government, extrapolated into the sporting context by specialists in sport and exercise medicine, infectious diseases and public health. The principles outlined in this document apply to high performance/professional, community and individual passive (non-contact) sport. The AIS Framework is a timely tool of minimum baseline of standards, for 'how' reintroduction of sport activity will occur in a cautious and methodical manner, based on the best available evidence to optimise athlete and community safety. Decisions regarding the timing of resumption (the 'when') of sporting activity must be made in close consultation with Federal, State/Territory and/or Local Public Health Authorities. The priority at all times must be to preserve public health, minimising the risk of community transmission.

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BACKGROUND: Groups at risk of exclusion from society appear to have a lower health status and more health-related problems. Prevention efforts in these groups are not always successful, and new ways have to be sought by which health messages can be delivered. Many agree on low-threshold sport activities, also called 'community sports', to be a powerful tool to target socially vulnerable groups. Until now, it has not been investigated how and when such sport initiatives may be able to impact health outcomes in socially vulnerable populations. This study aims at developing a program theory that clarifies the mechanisms and necessary conditions for sport programs to be effective in health promotion. Such a program theory may constitute a backbone for developing health promotion initiatives within a sport for development setting. METHODS: We developed a program theory using a realist research design. We build on an extensive data set consisting of the insights of key stakeholders and participants of various community sport organizations at the one hand, and on relevant theoretical frameworks at the other hand. Data were collected through participatory observations of soccer trainings and related group activities, interviews with key stakeholders and participants, document analysis and two focus groups with stakeholders from associated social partnership organizations. RESULTS: The health promoting effect of community sport on socially vulnerable groups seems not to result from an improved physical condition or sport-technical skills as such, but from processes of experiential learning among peers, incremental responsibility-taking and reflexivity. On the condition that participants feel safe, are stimulated to reflect and enabled to become actor of themselves and their situation, these processes are likely to lead to increased self-esteem, self-efficacy and motivation to set and pursue personal (health) goals. The key-influencing factor in these processes is the coach, who therefore needs to be adequately skilled in, for example, social vulnerability, motivational coaching and group dynamics. CONCLUSIONS: The program theory developed in this study offers insights in the mechanisms proper to, and necessary conditions for community sport to be a lever for health promotion in socially vulnerable groups. Motivational processes at individual level and group connectivity are at the basis of personal health goal-setting. One of the necessary conditions is that these processes are guided by community sport coaches skilled in the meaning and impact of social exclusion, and capable of connecting with the target group.

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The promotion of physical activity for older people is dominated by biomedically informed polices emphasizing the prescription of exercise as medicine and a universal approach to the promotion of active aging in later life. Yet, more recent research recognizes that being physically active in later life is complex and contested, shaped by the intersections of biological, psychological, and sociological experiences, and requires differentiated responses that address this complexity. There is a disconnect between research, policy, and the physical activity experiences of older people which leads to over-generalized policy and practice in the promotion and delivery of community sport to older people. This paper presents findings from a complex community sport project employing a coproduction framework with low income older age people. Participatory community approaches including focus group discussions, and extended observations and informal conversations throughout the project develop understanding of the complexities of aging and community sport engagement among older people with limited income. Three themes are identified and discussed: (1) lived experience, aging bodies, and the changing dynamics of involvement in sport and exercise in the life course, (2) embodying aging-moving beyond practical barriers for understanding aging, lived experience and being physically active, and (3) corporeal pleasures of older sporting bodies. The paper concludes that there is a need to explore the significance of locally specific public knowledge from older people which directly addresses the complexity and inequalities of individuals' everyday lives in their communities; lived experiences likely to impact on preferences for, engagement in, and enjoyment of physical activity.

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OBJECTIVES: An effectiveness and cost-effectiveness analyses of two-staged community sports interventions; taster sports sessions compared with portfolio of community sport sessions. DESIGN: Quasi-experiment using an interrupted time series design. SETTING: Community sports projects delivered by eight lead partners in London Borough of Hounslow, UK. PARTICIPANTS: Inactive people aged 14 plus years (n=246) were recruited between May 2013 and February 2014. INTERVENTIONS: Community sports interventions delivered in two stages, 6-week programme of taster sport sessions (stage 1) and 6-week programme of portfolio of community sporting sessions delivered by trained coaches (stage 2). OUTCOME MEASURES: (a) Change in days with ≥30 min of self-reported vigorous intensity physical activity (PA), moderate intensity PA, walking and sport; and (b) change in subjective well-being and EQ5D5L quality-adjusted life-years (QALYs). METHODS: Interrupted time series analysis evaluated the effectiveness of the two-staged sports programmes. Cost-effectiveness analysis compares stage 2 with stage 1 from a provider's perspective, reporting outcomes of incremental cost per QALY (2015/2016 price year). Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. RESULTS: Compared with stage 1, counterfactual change at 21 days in PA was lower for vigorous (log odds: -0.52; 95% CI -1 to -0.03), moderate PA (-0.50; 95% CI 0.94 to 0.05) and sport(-0.56; 95% CI -1.02 to -0.10). Stage 2 increased walking (0.28; 95% CI 0.3 to 0.52). Effect overtime was similar. Counterfactual change at 21 days in well-being was positive particularly for 'happiness' (0.29; 95% CI 0.06 to 0.51). Stage 2 was more expensive (£101 per participant) but increased QALYs (0.001; 95% CI -0.034 to 0.036). Cost per QALY for stage 2 was £50 000 and has 29% chance of being cost-effective (£30 000 threshold). CONCLUSION: Community-based sport interventions could increase PA among inactive people. Less intensive sports sessions may be more effective and cost-effective.

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