Psychosocial correlates of performance-enhancing substance use intentions and prevention needs among recreational gym users: a theory-informed mixed-methods study

Background Performance-enhancing substance (PES) use is a potential public health concern in recreational fitness. Research suggests that use among recreational gym users is associated with psychosocial factors, gym culture, and peer norms. Objective This study examined associations of Theory of Planned Behavior (TPB) constructs, selected Health Belief Model (HBM) constructs, knowledge, and risk acceptance with PES-use intentions and explored prevention needs using a mixed-methods design. Methods A cross-sectional mixed-methods survey included 772 recreational gym users in Germany; 29.4% reported ever or current use of at least one of six assessed PES categories. Quantitative analyses examined TPB constructs, HBM-related constructs, knowledge, and risk acceptance. Qualitative data comprised 542 open-ended responses on prevention preferences. Results Subjective norms and lower perceived behavioral control over avoiding PES showed the strongest associations with higher PES-use intention. Greater knowledge was associated with lower intention, whereas higher risk acceptance, greater perceived benefits of PES use, and lower self-efficacy to resist PES were associated with higher intention. None of the examined psychosocial variables were significantly associated with the ever/current PES-use indicator. Qualitative findings emphasized credible information, peer-based support, and preferences for gym-based prevention approaches. Conclusion Psychosocial factors were associated with variation in PES-use intentions among recreational gym users. Prevention development may consider social norms, perceived control over avoiding PES, resistance self-efficacy, knowledge, and preferences for credible, context-sensitive information. Given the cross-sectional design, the findings should be interpreted as associations and as hypothesis-generating evidence for future prevention research.