David Shodipo, Elijah Kpioyo, Kelisha Bulgin-Dixon, Princess A. Ulona, Nicola Odu, Corliss Bean, Philip Sullivan, Rob Millington, Carla Edwards, Gina Dimitropoulos, Amanda M. Black

Sport-related injuries are common in youth sport, yet evidence-based injury prevention strategies are inconsistently implemented. This study aimed to identify youth-perceived barriers and facilitators to injury prevention strategy implementation and to co-design implementation strategies to improve uptake. Using youth participatory action research and health equity approaches, we recruited 10 diverse youth athletes (5 women/girls, 5 men/boys, ages 15 to 24) with injury experience, representing multiple racial categories (East Asian, Black, South Asian, White), to participate in three co-design workshops. Participants represented individual and team sports, including soccer, volleyball, basketball, football, track and field, tennis, baseball, softball, field hockey, fencing, dance, horseback riding, and martial arts. Youth prioritized an injury prevention strategy and a subgroup co-designed implementation resources with mentor support. Workshop transcripts were deductively coded using the Consolidated Framework for Implementation Research (CFIR), with inductive theme development for specific barriers and facilitators; implementation strategies were guided by the Expert Recommendations for Implementing Change (ERIC). Youth served as co-researchers, shaping interpretation of barriers and guiding co-designed strategies. Youth prioritized sport-specific neuromuscular training (NMT) programs. Inductive themes highlighted limited access to NMT resources, low awareness of available programs, and limited knowledge of the evidence supporting NMT. Youth described resistance to change driven by existing coaching beliefs, lack of practice time, perceived program complexity, and misalignment between NMT programs and team culture. Facilitators included educated coaches and athletes, team champions, and leadership support, which informed ERIC-aligned strategies such as champion preparation, co-designed educational meetings, and social media-based knowledge mobilization to support NMT implementation.