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ObjectivesInterpersonal violence is an increasingly recognised risk of sport participation and causally linked to negative physical and mental health outcomes. Para athletes from low- and middle-income countries may be at highest risk of physical, psychological, sexual and neglect-related violence due to various factors; however, their perceptions of these abusive behaviours are unknown. This study examined the perceptions and experiences of abuse in para athletes from three lower resourced countries: Ghana, India and Brazil.MethodsQualitative data from semistructured focus group interviews conducted with 26 individuals were collected to explore characteristics of abuse observed, navigated and experienced by para athletes. The framework method for multidisciplinary qualitative research guided data analysis.ResultsAthletes identified a wide range of abusive behaviours they experienced within and outside of sport, including psychological, emotional, physical, sexual and neglect-related violence, which operated on both interpersonal and systemic levels. Most athletes described three less easily recognised forms of abuse in greater detail and more frequently than others: financial abuse, neglect and disability stigma.ConclusionIt is important to hear directly from athletes with diverse experiences and backgrounds and to integrate their insights and priorities into sport safeguarding policies, programmes and interventions. Understanding the requirements and challenges of para athletes and para sport is needed to achieve safe, equitable and inclusive sport. As new insights from diverse sport settings are added to the evidence base, globally balanced, athlete-generated and locally relevant preventative strategies can better protect all athletes.

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:Historic and present-day marginalization has resulted in a high burden of disease and worse health outcomes for American Indian and Alaska Native (AI/AN) communities in the United States. Musculoskeletal disease is the leading cause of disability for the general population in the U.S. today. However, few have examined musculoskeletal disease burden and access to orthopaedic surgical care in the AI/AN communities. A high prevalence of hip dysplasia, arthritis, back pain, and diabetes, and a high incidence of trauma and road traffic-related mortality, suggest a disproportionately high burden of musculoskeletal pathology among the AI/AN communities and a substantial need for orthopaedic surgical services. Unfortunately, AI/AN patients face many barriers to receiving specialty care, including long travel distances and limited transportation to health facilities, inadequate staff and resources at Indian Health Service (IHS)-funded facilities, insufficient funding for referral to specialists outside of the IHS network, and sociocultural barriers that complicate health-system navigation and erode trust between patients and providers. For those who manage to access orthopaedic surgery, AI/AN patients face worse outcomes and more complications than White patients. There is an urgent need for orthopaedic surgeons to participate in improving the availability of quality orthopaedic services for AI/AN patients through training and support of local providers, volunteerism, advocating for a greater investment in the IHS Purchased/Referred Care program, expanding telemedicine capabilities, and supporting community-based participatory research activities.