Abstract
This study systematically reviewed the effectiveness of cognitive, affective, and combined approaches in doping prevention, considering the impact of athletes' active versus passive participation. Following the PRISMA 2020 guidelines and the PICOS framework, a literature search identified ten studies involving 3581 athletes (1094 women, 2487 men). Ten studies were included as a sample in the meta-analysis and meta-regression, which were used in the effect size calculation. This meta-analysis shows that anti-doping education programs effectively improve short-term doping intentions (ES = 0.29, p < 0.001) and anti-doping behaviors (ES = -0.27, p < 0.001), although there is a decline in the long-term effects (ES = -0.13, p = 0.009). Moral behaviors were unaffected (ES = 0.01, p < 0.001), suggesting that changing deeper values requires alternative approaches like mentorship. Passive participation negatively impacted doping intentions (ES = -0.40, p = 0.004) and behaviors (ES = -0.40, p = 0.022), highlighting the need for active engagement. Pre-experimental designs showed a negative effect on behaviors (ES = -0.74, p = 0.023), emphasizing the importance of rigorous methodologies. While anti-doping education programs effectively influence short-term attitudes and intentions, sustaining behavioral change requires continuous reinforcement and active engagement. The decline in the long-term effects suggests that standalone interventions are insufficient to instill lasting anti-doping behaviors in athletes.