A Multifactorial Approach to Sport-Related Concussion Prevention and Education: Application of the Socioecological Framework

Abstract

Objective: To offer an overview of sport-related concussion (SRC) prevention and education strategies in the context of the socioecological framework (SEF). Athletic trainers (ATs) will understand the many factors that interact to influence SRC prevention and the implications of these interactions for effective SRC education.Background: Concussion is a complex injury that is challenging to identify and manage, particularly when athletes fail to disclose symptoms to their health care providers. Education is 1 strategy for increasing disclosure. However, limited information addresses how ATs can integrate the many factors that may influence the effectiveness of SRC education into their specific settings. Public health models provide an example through the SEF, which highlights the interplay among various levels of society and sport that can facilitate SRC prevention strategies, including education.Description: For ATs to develop appropriate SRC prevention strategies, a framework for application is needed. A growing body of information concerning SRC prevention indicates that knowledge alone is insufficient to change concussion-related behaviors. The SEF allows this information to be considered at levels such as policy and societal, community, interpersonal (relationships), and intrapersonal (athlete). The use of such a framework will facilitate more comprehensive SRC prevention efforts that can be applied in all athletic training practice settings.Clinical Applications: Athletic trainers can use this information as they plan SRC prevention strategies in their specific settings. This approach will aid in addressing the layers of complexity that exist when developing a concussion-management policy and plan.

The Socioecological Framework: A Multifaceted Approach to Preventing Sport-Related Deaths in High School Sports

“…However, these models have typically not been applied to the sports medicine realm. 7,8 We propose that the socioecological framework be used as a guide for organizing and summarizing the evidence concerning various risk factors associated with sport-related death and determinants of potentially promising interventions. 9,10 The socioecological framework was first suggested by Broffenbrenner 11 in the 1970s as an ecological systems theory and was later redefined by McLeroy et al 9 as a framework to promote health-related behavioral change.…”

“…To date, we identified only 3 published articles 7,8,12 that systematically applied the socioecological framework to a sports medicine topic. Failing to use a structure to organize and apply the evidence on sport-related death for end users prevents a systematic approach to improving interventions and promoting the adoption of best practices.…”

Improving Concussion-Reporting Behavior in National Collegiate Athletic Association Division I Football Players: Evidence for the Applicability of the Socioecological Model for Athletic Trainers

“…A uthors of recent studies [1][2][3] in the area of sportrelated-concussion (SRC) prevention argued effectively that increasing the rates at which studentathletes report SRCs requires an understanding of the factors affecting concussion-reporting behavior (CRB) that go beyond a student-athlete's knowledge of the risks and symptoms. The most well-known systems theory is the Bronfenbrenner socioecological model (SEM), 4 which posits that human behavior is a function of synergistic and reciprocal influences between the individual and the settings in which he or she operates (microsystem), the interaction among those settings (mesosystem), the environments that indirectly affect the settings (exosystem), and cultural ideologies (macrosystem).…”

“…The most well-known systems theory is the Bronfenbrenner socioecological model (SEM), 4 which posits that human behavior is a function of synergistic and reciprocal influences between the individual and the settings in which he or she operates (microsystem), the interaction among those settings (mesosystem), the environments that indirectly affect the settings (exosystem), and cultural ideologies (macrosystem). Several researchers 2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] have used elements of this model to make similar arguments. Register-Mihalik et al 2 recommended that in order for athletic trainers (ATs) to design more effective interventions, they should consider factors at multiple levels, such as community or interpersonal levels of influence.…”

“…Register-Mihalik et al 2 recommended that in order for athletic trainers (ATs) to design more effective interventions, they should consider factors at multiple levels, such as community or interpersonal levels of influence. Although CRB researchers have referred to the Bronfenbrenner SEM, 1,2 have tested part of the model, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] or have adapted the model by collapsing across systems categories, 1,2 to our knowledge, no investigators have used the full Bronfenbrenner model to assess factors that contribute to CRBs. Consideration of microsystem, mesosystem, exosystem, and macrosystem factors, in addition to individual-level factors, is critically important if novel interventions are to be designed, implemented, and examined for effectiveness.…”