Abstract
BACKGROUND: Doping undermines competitive integrity and endangers athlete health, with performance-enhancing substances linked to severe adverse effects. While the World Anti-Doping Agency (WADA) provides standardized testing protocols, developing countries such as Uganda face significant enforcement challenges. This study aimed to explore Ugandan athletes' and coaches' experiences and perceptions of the doping control process, emphasizing its effectiveness and legitimacy. METHODS: A mixed-methods cross-sectional study was conducted, including a survey of 346 Ugandan athletes using a modified WADA questionnaire to evaluate perceptions on test accuracy, detection likelihood, and enforcement seriousness. Additionally, 196 coaches participated in 12 focus group discussions (FGDs) across four regions of Uganda to provide deeper insights. RESULTS: Athlete participants had a mean age of 24 years (± 6); 82% were male, and only 19% had ever been tested for doping. 56% believed doping tests were more likely during competitions compared to 39% for out-of-competition testing, with 55% confident they could evade detection. Approximately half considered anti-doping procedures fair and transparent. Only 17% felt that "NADO-Uganda" treated athletes equally, with 58% uncertain, indicating limited knowledge rather than a definitive view of unfairness. Coach participants, with a mean age of 32 years (± 14), reinforced the quantitative findings, emphasizing infrequent doping tests and persistent concerns about procedural transparency and fairness, which undermined trust and perceived legitimacy. CONCLUSION: There are significant gaps in doping control in Uganda, where infrequent testing and ambivalence regarding enforcement transparency diminish anti-doping measures. Strengthening Uganda's anti-doping framework requires increased testing frequency, culturally tailored education to bridge knowledge gaps, and enhanced procedural transparency and consistency. These measures are essential to establish a credible anti-doping system that supports clean sport values despite resource constraints.