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Violence towards Division Two Soccer Referees in the Central Region of Ghana

Violence towards Division Two Soccer Referees in the Central Region of Ghana

Daniel Amoah-Oppong

Jukwa Senior High School, Jukwa via Cape Coast, Central Region, Ghana

DOI: https://dx.doi.org/10.47772/IJRISS.2024.805046

Received: 24 April 2024; Revised: 30 April 2024; Accepted: 04 May 2024; Published: 03 June 2024

ABSTRACT

The mishandling of soccer referees is generally unspoken to be the chief cause of a decline in the number of soccer referees in the world. The role of handling the game environment puts the referee in a protuberant situation in sports. However, their judgement is highly exposed to violence in the context of soccer. Referees occupy an important position in the sport, having the duty of managing the game, and are therefore exposed to abusive events. In this regard, the study explored what incites fans, players, coaches, and administrators to abuse Division Two soccer referees in the Central Region of Ghana before, during and after matches. Qualitative exploratory study specifically the phenomenological approach was used for this work. The study surveyed six referees, six supporters, four players and four coaches in the region. This study found that the types of violence that frequently happen on the pitch before, during and after soccer matches in the Central Region of Ghana are quasi-criminal violence and criminal violence. Also, the main causes of violence comprise dissatisfaction with match officials’ disciplinary action, spectators’ dissatisfaction, infrastructure inadequacy, unprofessionalism of security personnel, bribery, coach’s incitement, desire to win at all cost, and substance and drug use. From the findings of the study, it was concluded that most violence occurs after the game. Also, acts of violence against soccer referees can cause distraction and insecurity and result in a decrease in performance. In line with the findings, the study recommends that the respective bodies institute an award scheme for referees who will excel in their matches and punish those who will also indulge themselves in bribery and corruption to change the outcome of matches.

Keywords: Assault, Physical abuse, Referee, Soccer, Violence

BACKGROUND/INTRODUCTION

Soccer remains a popular and famous game with over a billion supporters worldwide (Marchiori& Vecchi, 2020). Many people around the world who may not have played soccer may have watched it being televised on several televisions during major championships like the FIFA, European, or African games (Rai, Cho, Yousaf & Itani, 2023). Those who have had the opportunity to go around African communities outside of screens have undoubtedly witnessed children sprinting barefoot after a ball with the express purpose of participating in the activity (Moura, Souza-Leão, Silva & Santos, 2023).Soccer is the most passion-making game but it entails training harder, preparing harder and playing harder before a team can become victorious (Modrić, Carling, Lago‐Peñas, Veršić, Morgans & Sekulić, 2023).Soccer is a team sport which involves eleven players on each side, who use all the parts of the body except the hands, to pass a ball and score a goal. In essence, the sport demands that players run fast or slow and sometimes may require a player to stand at a particular spot for a while. This is very beneficial to the fitness and cardiovascular health of the people involved (Clemente, Afonso, Silva, Aquino, Vieira, Santos, Teoldo, Oliveira, Praça & Sarmento, 2024).

The laws of the game are meant to engender fairness to all players on both sides (DeKoven, 2013). Due to the unusual nature of soccer, referees are granted significant leeway to utilize their discretion when enforcing the rules of the game, and they are frequently required to make split-second judgements or interpret the situation.  Making these rulings can be tremendously tough at times because the referee has split seconds to make a decision that facilitates the smooth running of the game (Choice, Tufano, Jagger, Hooker & Cochrane-Snyman, 2022). Referees are regularly charged with clarification of the laws of the game fairly and firmly, and to control the play and behaviour of players. They watch the play for every second and bring the understanding of the laws of the game to bear on the style of play of the players or teams (Zhang, Zhang, Li, Ding, Peng & Huang, 2022). How referees are obliged to enforce the laws of the game often leads to misunderstanding, frustration or discontent among coaches, players and fans (Potrac, & Jones, 2009). Refereeing a game of soccer has become a great task to the extent that only strong characters can hope to manage the huge pressure that comes with being a referee (Siedentop, Hastie & Van der Mars, 2019). Supporters who disagree with a referee’s decision may resort to violence.

According to Prots, Chopylko, and Prots (2023), we are a violent society at heart, even though most of us would never acknowledge it. Abuse is a multifaceted social, political, cultural, psychological and moral marvel. Violence is defined as the use of force, fear, threats, or abuse of power against another person that results in physical harm or property damage (Buggs, Lund, & Kravitz-Wirtz, 2023). In modern settings of life, the meaning of abuse has developed broader and more important as individuals tend to resort to numerous forms of violence to make up for their mutual disagreements, fights and battles (Nelson, 2021).

Stošić, Janković and Manić (2023) used detailed discussions to discover ways skilled, efficacious soccer referees reason and how to deal with violence. Findings showed that knowledgeable referees eventually judge their performance by the precision of their choices and by applying the guidelines. Referee mishandling is motivated by frustration, dissatisfaction, and partiality and they familiarize their replies according to the circumstances. Referees described a wide variety of verbal and nonverbal techniques for fostering player acceptance of decisions. Machado, Caríssimo and Teoldo (2023) assert that some unruly behaviours have been taking place in football proceedings against soccer referees, particularly in verbal form. Off the pitch, the sport has been defined by a lot of negative publicity in recent times with referees at the receiving end. This is not surprising because a lot of criticism has been levelled at referees handling matches and, in some instances, even suggesting that the standard of officiating in Ghana is exceptionally poor (Cusimano, Freeman, Moran, & Yamaguchi, 2024). This situation has further been compounded by an increase in spectator violence at soccer matches which is apparently in protest against unfair match officials’ decisions and other factors that contribute to the negativity surrounding the sport (Ambarini, Surjaningrum & Chusairi, 2024).

Sánchez-Alcaraz et al. (2019) assert that violence in sports is not the same as violence in society. In other words, we cannot justify the presence of violence in sports because we live in a violent society. Acceptance of violence as a norm casts a slur on the game and those who engage in it. The number of incidents of violence against referees reported in the media is increasing day by day, but the irony is that it is accepted by some people as the norm. Although moral standards are quite clear, antisocial forms of behaviour are common in modern football, with clear examples such as cheating, and verbal and even physical attacks.

Furthermore, violence is the main cause of physical and psychological injury and death. Violence towards referees has become common in contemporary day sporting events, particularly those that have high expressive content (Weinberg & Gould, 2018).  Studies have shown that, the desire to be acknowledged as the best team, player or coach; unfair judgement from the officiating officials; use of drugs by both the fans and the players; lack of security personnel at match venues; lack of spectator barrier (inner perimeter); lack of understanding with regards to the correct interpretation of the rules of the game to be some of the causes of violence in soccer at match venues. Worldwide, studies have indicated that violence has led to injuries; death; destruction of property among followers of soccer; frustrations, insecurity and many more (Lindsay, Willmott & Richardson, 2023). For instance, Kaizer Chiefs and Orlando Pirates in 2001; the May 9th Disaster in 2001 between the two most glorious clubs or teams in Ghana; Kumasi Asante Kotoko Sporting Club and Accra Hearts of Oak Sporting Club and Nyakrom Youth and Swedru Professionals in the Central Region of Ghana. These have led to attacks and brutalities on supporters of these teams leading to injuries, deaths and damage to properties.

Whatever the degree of violence, it can be curtailed by implementing a systematic tactic at the psychological and sociological levels. As already indicated, violence in soccer particularly assault on referees occurs frequently irrespective of laws, interventions and policies which have been put in place to check such occurrences (Mather & Breivik, 2020).  This observation also points to the fact that referees may be in danger during and after soccer matches. Nevertheless, in the Ghanaian context, few studies have explored this phenomenon. Again, violence and its effect against referees is systematically on the rise, especially in the Division Two leagues where most soccer teams dream is to progress to better stages of the competition and enter the Division One league (DOL). Central Region boasts of 53 division two football clubs. All these clubs aspire to gain promotion to play in the National Division One league at the end of each season. This makes some of the stakeholders of these clubs overly aggressive and non-receptive towards referees at the slightest mistake they make. Observations and interactions with stakeholders at match venues indicate that they (fans, players, coaches, CEOs, team managers etc.) think and feel that some referees are influenced before a match to determine the outcome of matches.  This explains why a referee is likely to be attacked. The existing literature on referee abuse in Ghana has a void in it. The main topics of the current sociology of sports literature are the causes and consequences of referee abuse. However, little is known about the part that athletes, coaches, and supporters play in fostering peace within the sport, particularly in Ghana’s Central Region. The purpose of the current study is to identify the factors that contribute to violence towards soccer referees in Ghana’s Central Region who work in Division Two. The purpose of this study was to explore what incites fans, players, coaches, and administrators to abuse Division Two soccer referees in the Central Region of Ghana before, during and after matches.  This study therefore seeks to assess violence by fans, players, coaches, and administrators against Division Two soccer referees in the Central Region of Ghana before, during and after matches.

Research Questions

  1. What are the factors associated with violence towards referees in the Central Region?
  2. What are the consequences of violence on soccer referees in Central Region?

METHODS

Research Design   

This study used a qualitative research methodology. The phenomenological qualitative research approach was chosen as the research design for this study. This approach involves an in-depth examination of the participant’s world of life. It explores an individual’s understanding and it is concerned with personal observation or account of an object or event, as opposed to an attempt to produce an unbiased report of the object or the event itself (Ritunnano, Papola, Broome & Nelson, 2023)). A phenomenological approach to the understanding of violence offers a philosophical explanation of the experiences of violence and its effect on the intentionality of human beings (Robbins, 2023).

Study Area

The study area covered all the five zones in the Central Region of Ghana. Thus, Cape Coast, Mfantseman, Agona Swedru, Assin Foso and Dunkwa-Offin zones.

Data Source and Sampling Procedures

In-depth interviews were used to gather data for the study. Instead of forcing interviewees to choose from predetermined responses, in-depth interviews provide participants with the freedom to respond to questions on their terms (Matsumoto, Maeda, Wan, Bansal, & Tayag, 2023). The population for this research comprised different groups of people who were unswervingly involved in soccer events in the Central Region of Ghana. The group includes soccer players, coaches, referees, and football fans who attend Division Two football matches at the sports venues. Based on the data saturation, a sample size for the study was chosen. Saturation, according to Daher (2023), occurs when there are no fresh emerging facts or ideas. Qualitative data was collected from fans, players, referees and coaches in the Central Region of Ghana. The study was conducted with 20 participants. Purposive, accidental, and snowballing sampling were the sample methods used in the study. These methods made it possible to enrol enough people who fit the study’s inclusion criteria. With the aid of purposeful sampling, the researcher was able to choose volunteers who could give the necessary data to investigate the phenomenon under examination. As a result of unintentionally contacting supporters while football games were being played, an incidental sampling technique was employed to collect replies from them. The snowball sampling technique was used to identify participants because this technique depends on referrals from initial participants to enable the researcher to contact a few possible participants who have had experiences directly linked to violence emanating from football matches within a particular context (Elmusharaf, 2018).

ANALYSIS

Results

Table 1: Participants’ Characteristics

Scale Sub-Scale Frequency
Gender Male 15
Female 5
Age 18-39 14
40-52 6
Level of Education Tertiary 9
Secondary 7
Basic 4

Source: Field Data (2021)

Table 2: Participants’ Characteristics Continuation

Scale Sub-Scale Frequency
Occupation Coach

Player

4

4

Referee 6
Supporter 6
Years of work 4 3
6 5
7 5
12 3
15 2
20 2
Religion Christianity

Islamic

14

6

Source: Field Data (2021)

Table 3: Themes and Sub-themes

Themes             Sub-themes
1. Causes of Violence 1.1.Dissatisfaction with match officials’ Disciplinary action

1.2.Spectators’ Dissatisfaction

1.3. Inadequate Inner Perimeters

1.4.Inadequate and untrained Security Personnel

1.5.Bribery and corruption

1.6.Coaches’ Incitement

1.7.Desire to Win at All Cost

1.8. Sale and consumption of alcohol and illegal drugs

2. Consequences of Violence on Soccer Referees 2.1.Injury, Disability and Death

2.2.Loss of Equipment

2.3.Sense of Insecurity

Source: Field Data (2021)

Theme 1: Causes of violence

Some participants explained that violence against referees during games is due to some disciplinary actions of the referees. They elucidated that, if they are not satisfied with such actions of the referees, then the supporters become motivated or angered to abuse the referees. Some of such participants expressed:

There were no seats at the park so the supporters of the home team were standing at the back of the away team’s goalpost, just to disturb the goalkeeper so that they could score or win the game. The referee sacked the supporters and they became furious because they suspected the referee was in bed with the away team. After the game, the home team lost and the supporters started beating the match officials (Referee, 29 years). Sometimes a coach or those on the bench misbehave at the technical area and the referee goes there to control them or give them a marching order or whatever at the technical area that can lead to violence towards the referee (Player, 21 years).Referee decisions are part of violent acts in the Division Two league. Most of the referees put the laws of the game into their own hands and cheat the opposing teams. For example, a referee can whistle for a doubtful penalty. Spectators watching are angered because the incident may not merit a foul (Supporter, 27 years). The security personnel are supposed to face the crowd, watch and see if any spectator will misbehave either by throwing objects at referees or taking hard drugs at match centres. The policemen available will leave the spectators and only concentrate or pay attention to the match instead of checking for the safety of the referees. So, if anything happens to match officials, the security personnel present can see or identify the culprits (Referee, 32 years). Yes, I have taken money from team officials to change the outcome of the game and sometimes I take it from both teams. Every season, RFA does not pay all the meagre officiating allowances (30gh) due to referees. They pay some of the officiating allowance to the referees and refuse to pay the remaining balance. When I am going to a Division Two match, I decide to officiate in favour of the team that can give me money and what I take from the team officials is more than the officiating allowance (Referee, 29 years).

Theme 2: Consequences of violence on soccer referees

The consequences of violence against referees featured prominently in participants’ responses to the interview. These consequences include injury, disability and death, loss of equipment and a sense of insecurity.

Injury, disability and death. Generally, participants revealed that violence against referees resulted in injuries that may lead to disability and/or death. This outcome is because whenever referees are abused, according to the participants, referees sustain varying degrees of injuries (e.g., wounds, fractures). Some participants said:

 If care is not taken and the abuse is serious it can cause referees to become disabled.  For example, after an attack, I had a problem with my left eye and every six months, I have to visit the doctor for a check-up (Referee, 29 years). Anytime there is violence, it can result in injuries because people will be throwing objects, slapping, hitting, and pulling along so the referee can be maimed. Sometimes it can even lead to the loss of lives. Violence can be very fatal to the life of the referee (Supporter, 38 years).

The participants perceived that referees who are abused tend to lose valuable accessories such as cards, whistles and pencils. This claim is captured in the following excerpts:

My whistle, cards, and boots were stolen and my uniform too got torn (Referee, 29 years). The referee’s personal belongings like footwear, whistle, cards, pens and pencils are stolen by the players, supporters, or coaches (Supporter, 38 years). The referee’s equipment is also taken by the people around when the abuse occurs (Coach, 45 years).

Sense of insecurity. The participants revealed that referees who are victims of abuse usually feel reluctant in terms of officiating matches. This claim is captured in the following excerpts:

From the day that incident occurred, anytime I officiate a match, I intend to favour the home team to avoid being beaten. I become frustrated and unsecured anytime I hear supporters shouting at me because my thinking is today too, they want to beat me (Referee, 32 years)

DISCUSSION

The findings of this study revealed that violence towards referees was a result of spectators’ dissatisfaction with match officials’ disciplinary action, spectators’ disagreement, infrastructure inadequacy, desire to win at all cost, unprofessionalism of security personnel, bribery and coaches’ incitement against referees. These results concur with or are comparable to those of Kifle, who looked into the causes and effects of violent behaviour and immoral behaviour among football fans of premier league clubs in Addis Ababa. The win-at-all-cost mentality, violent altercations between fans, incidents involving players on the field of play, poor or biased refereeing, and alcohol use were all identified by Kifle. The differences between Kifle’s findings and this current study could be because Kifle’s study focused on premier league clubs while this current study focused on division two leagues. The implication is that premier league players, coaches and supporters could be more mature or more aware of the implication of their behaviour for their teams, hence these persons may comport themselves as compared to players, coaches and supporters in the Division Two clubs (Vivekandanthan, Pa & Muhamad, 2023).

However, Petersen and Wichmann’s (2020) research demonstrated that players and coaches mistreat referees because they believe their judgements are prejudiced, erroneous, and rife with errors. The conclusions of this study concur with those of Petersen and Wichmann (2020). The results of this investigation are in agreement with those of Dawson, Webb and Downward (2021), who looked at match-fixing in sports in 27 Member States. Although the report did not imply that accepting bribes was a cause of referee abuse, they discovered that the German and Czech referees had accepted payments in exchange for their services.The finding of this study is similar to the findings of Webb, Dicks, Thelwell, Kamp, and Rix-Lièvre (2020). who found that 90% of the football teams in the lower divisions in Kenya do not have stadia and of the few who have; there are no proper inner perimeters to prevent supporters and team officials from entering the field of play. He added that this is one of the main causes of referee attacks at the various stadiums in the country. The study also found that unlike in Europe where the security at the stadium focuses solely on the supporters, in most African countries, the security rather focuses on the ongoing game. He further added that in case of violent occurrence or attack, the security is not able to identify the perpetrators for further investigation and punishment. This is in line with or similar to the findings of this research study. The outcome is consistent with Momoh and Olaseyo (2021) who assert that win-at-all-costs syndrome is not a recent phenomenon in the football league and that home clubs who are keen to win intimidate and harass referees. To win home games at any cost, Momoh and Olaseyo further disclosed that clubs have been known to threaten officials, competing teams, and even fans.

Football matches can be made or broken by the officials’ handling of them, and their decisions can also affect how the game turns out. The outcome is in line with Momoh and Olaseyo’s (2021) hypothesis that effective refereeing improves the flow of the football game whereas ineffective officiating reduces players’, coaches’, and spectators’ pleasure in the game. This was also supported by Devs-Devs, Serrano-Durá, and Molina (2021), who argued that a skilled referee should display consistency in his actions in all circumstances to dispel any doubt about taking sides. The outcome is consistent with Reid and Dallaire’s (2019) assertion that win-at-all-costs syndrome is not a recent development in the football league and that home teams who are desperate to win intimidate and harass football officials. The results are in line with those of Devs-Devs, Serrano-Durá, and Molina (2021), who hypothesized that clubs have been known to intimidate officials, opposition teams, and even spectators to win home games at any cost. Generally, it was observed that the results of findings in this study were dissatisfaction with match officials’ disciplinary action, spectators’ dissatisfaction, inadequate inner perimeters, inadequate and untrained security personnel, bribery and corruption, coaches’ incitement, desire to win at all cost, and sale and consumption of alcohol and illegal drugs are all factors that cause physical abuse on referees in the division two league in the Central Region of Ghana.

Concerning the consequences of violence on soccer referees in the central region, this current study revealed that injuries, disability and death, loss of equipment and a sense of insecurity were the consequences of the abuse. The findings show that referees are injured which could lead to disability or death. According to Webb, Dicks, Thelwell, Kamp, and Rix-Lièvre (2020) if abuse could lead to disability or even death, then it is criminal violence because these actions should result in criminal charges against the offender. Again, the findings of this study revealed that referees who are abused lose their equipment and as well feel insecure. These findings could be attributed to the unprofessional nature of the security during matches and the nature of abuse metered on referees. These findings do not concur with Mojtahedi’s findings in 2019, who reported that the adverse effects of abuse on football referees were loss of concentration and motivation as well as quitting. The difference in the findings of this study and that of Mojtahedi, (2019) could be attributed to the adequate security persons and their professionalism toward their duties during matches. Also, the variances could be credited to the differences in the form or kind of abuse experienced by most referees. This is because Mojtahedi reported the most common forms of abuse experienced by referees were verbal aggression and threats while in this study it is evident that referees mostly experience physical abuse.  Also, the findings or results of this study are analogous to that of Jacobs et al. (2020) in that their study found that abuse of referees impacts them negatively. Jacobs et al. (2020) found that the effect of abuse on referees included personal and psychological impact. This is consistent with the study’s conclusion that injuries to referees may result in disabilities. These instances may have been quite dangerous because they frequently involved a large number of criminals. Because it was difficult to identify the perpetrators after a physical assault, there was a higher risk of serious injury. This was because match venues’ security staff or police officers often had trouble identifying the culprits. These experiences, like those of Webb et al. (2019), demonstrated how vulnerable referees were to such abuse and how simple it was for their offenders to escape punishment for their crimes.

Practical Implications

A referee’s focus, performance, motivation, and (has caused them to) doubt their decision-making, according to research, can all be affected by experiencing abuse or violence in a sporting environment (Downward, Webb & Dawson, 2023).  These people’s replies highlight how crucial it is to reduce or end the abuse of soccer officials, both to protect the referee’s wellbeing and to preserve the worth and calibre of a sporting event.Referees have a propensity to react angrily and seek retribution when they are subjected to abuse and feel helpless and defenceless as a result. When making decisions, referees often favour the opponent or the opposing team to make up for previous infractions. According to research by Downward and colleagues (2023), 92% of referees admitted receiving personal threats, insults, and displays of rage; 32% of these officials claimed that these actions had an impact on the game’s outcome. When a referee is mistreated, it may lead to unfair bias because the offending player’s or coach’s team will be oppressed or victimized. A sporting event’s impartiality and fairness may be impacted if soccer referees are mistreated. Furthermore, the officials demonstrated that more than 50% of the time, aggressive behaviour led to the official losing control of the game (Downward, Webb, & Dawson, 2023).

Continued referee abuse is likely to decrease or decline referee happiness with their professions and rise or upsurge the possibility of cessation or discontinuation, as established and confirmed in other fields of work (Rowe & Sherlock, 2005). In England, according to the English Football Association (FA), improper conduct, including abuse of referees, led to the loss of 17% (almost 5,500) of referees in the one year between the 2007–2008 and the 2008–2009 seasons. According to a method, referee dropout as a result of continuous and ongoing referee abuse is a severe problem for the future of sport because the number of referees lost is frequently greater than the number of refs who are replaced (Ponkin, & Lapteva, 2023).In the end, this will have a variety of effects on division two; it will affect the referees’ focus, performance, motivation, and decision-making (by favouring the opposition in those decisions); it also has the potential to have an impact on the fairness of the division two contest; and finally, the majority of the abused referees will leave the profession. The creation of interventions that address the reasons for referee abuse at different levels is necessary for the prevention of referee abuse, as recommended by the study’s participants. Along with the support of numerous stakeholder groups, a proactive approach to referee abuse is crucial. The issue for the sport is further highlighted by the general view that referee abuse is affecting referee recruitment and retention. Thus, it should be a top priority within the sport to look into referee abuse.

Strengths of this study

The strength of this article lies in its comprehensive examination of the issue of violence towards Division Two soccer referees in the Central Region of Ghana. It provides valuable insights into the causes and implications of referee abuse, as well as the impact on the referees’ performance and motivation. The study also highlights the need for interventions to address the root causes of referee abuse and emphasizes the importance of proactive measures to prevent such incidents. Additionally, the study’s focus on the experiences and perspectives of the referees themselves adds depth and authenticity to the findings.

Weaknesses of this study

The weaknesses of this article include the absence of essential reference resources, particularly in Ghanaian settings, and the limited cooperation of individuals in some carefully chosen samples to answer questions on time. The study’s reliance on entirely self-reported data significantly restricted the research, as there was no way to independently confirm the assertions made. This reliance on self-reported data could have been influenced by participants’ selective memories or social desirability, potentially skewing the data. These limitations should be taken into account when considering the conclusions drawn from the study.

SUGGESTIONS

Based on the content of the article, it is suggested that the respective bodies institute an award scheme for referees who excel in their matches and punish those who indulge in bribery and corruption to change the outcome of matches. Additionally, interventions should be created to address the reasons for referee abuse at different levels, along with the support of numerous stakeholder groups. A proactive approach to referee abuse is crucial, and it should be a top priority within the sport to look into referee abuse. This is necessary for the prevention of referee abuse, as recommended by the study’s participants. The article on “Violence Towards Division Two Soccer Referees in the Central Region of Ghana” appears to be well-researched and comprehensive. It provides valuable insights into the causes and consequences of violence towards referees in the region. However, it may require some revisions to address the limitations mentioned in the study, such as the absence of essential reference resources and the challenges associated with self-reported data. Additionally, further recommendations could include expanding the sample size and considering alternative data collection methods to enhance the study’s validity and reliability.

ACKNOWLEDGEMENT

I would like to express my genuine appreciation to Dr John Elvis Hagan for his patience, professional and expert guidance, direction, advice, dedication, inspiration and benevolence with which he guided this piece of work. My profound gratitude also goes to DrProsper Ogum Narteh for his immersed and generous contribution to this study. I am also grateful to all the lecturers of the HPER Department for their diverse contributions to the efficacious completion of this study. I wish to thank my family and friends for their immeasurable support. Finally, I acknowledge the efforts of authors and publishers whose journals, articles and books were used as references in this work, and may the Lord Almighty richly bless us all.

Contributors: Dr John Elvis Hagan, Dr Prosper Ogum Narteh and Dr Bright Ahinkorah

Funding: The author has not declared a specific grant for this study from any funding agency in the public, commercial or NGO’s.

Data Availability Statement: Data are obtainable in a public, open-access repository.

Declaration: I declare that this study is the result of my original research.

Ethics approval and consent to participants: Before gathering data, this study was submitted to the Institutional Review Board of the University of Cape Coast. Once approved, an introduction letter from the Department of HPER and an ethical clearance from the Institutional Review Board were obtained. The right to informed consent, the right to engage in the study, the right to protection from harm of any sort, and the right to secrecy and confidentiality were all taken into account when protecting human rights. Formal consent was sought from those who willingly decided to partake in the study by validating a well-versed agreement form. The study’s objectives and other terms that were used to ensure the participants’ confidentiality, privacy, and anonymity were contained in this document. Special attention was given to the asymmetric informants, interviewer relationships, and potential scenarios of participants’ vulnerability in public as recommended by specialized literature.

Consent for publication: Not applicable

Competing interests: The author declares no competing interests.

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