An Exploratory Study on Concussion-Reporting Behaviors From Collegiate Student Athletes' Perspectives

Lininger, Monica R.; Wayment, Heidi A.; Huffman, Ann H.; Craig, Debbie I.; Irving, Louis Horowitz

doi:10.3928/19425864-20161116-01

Cited by 23 publications

(15 citation statements)

References 36 publications

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“…This literature has also identified several important contributors to concussion non-disclosure. In the personal domain, athletes conceal concussions for reasons such as not wanting to let down teammates [15] and believing that disclosure conflicts with their identity as an athlete [15, 16, 17]. Athletes also conceal concussions when they believe that the surrounding culture is not supportive of disclosure [18, 19].…”

Section: Introductionmentioning

confidence: 99%

Pilots and athletes: Different concerns, similar concussion non-disclosure

2019

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Objectives Concussion non-disclosure research has focused almost exclusively on athletes. The focus on athletic populations has been sensible considering athletes’ demonstrated susceptibility to sustaining and concealing concussions. Nevertheless, the habitual use of athletic populations has allowed researchers and practitioners to omit the development of generalized perceived costs and perceived rewards as critical determinants of concussion self-disclosure. We hypothesized that perceiving concussion disclosure as generally more costly than rewarding would predict negative attitudes towards disclosure and decreased intent to disclose. We also hypothesized that generalized perceived costs and rewards could explain concussion non-disclosure in different populations, athletes and future pilots specifically, even when those populations perceive concussion self-disclosure as costly for different specific reasons. Methods We examined concussion disclosure using 2,504 cadets at the United States Air Force Academy. Cadets completed anonymous surveys assessing their intention to self-disclose undiagnosed concussions ( Anticipated Concussion Disclosure ) as well as several variables potentially related to concussion self-disclosure: perceived cost, perceived reward, personal identity, attitudes, normative behavior, social support, and self-efficacy. Results The results demonstrate that concussion non-disclosure develops when a population perceives disclosure as more costly (i.e. directly or emotionally) and less rewarding. Perceived Cost and Perceived Reward variables alone accounted for 50% of the variance in Anticipated Conclusion Disclosure ( Adjusted R 2 = 0.50, F (2,2312) = 1,145.31, p < 0.001). As expected, Anticipated Conclusion Disclosure developed for different reasons within different sub-populations. Consistent with existing research, cadet intercollegiate athletes reported being primarily concerned that concussion self-disclosure would cause them to miss practice or game time ( t (736.7) = 14.20, p < .001, Cohen’s d = 0.96). In contrast, cadet future pilots reported being primarily concerned that concussion self-disclosure would have negative United States Air Force career repercussions ( t (1828) = 10.25, p < .001, Cohen’s d = 0.50). Conclusions These results suggest that cultures of concussion non-disclosure can develop in any population where disclosure is perceived as having undesirable consequences, not just athletic populations. Concussion researchers and practitioners should devote more attention...

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Section: Introductionmentioning

confidence: 99%

Pilots and athletes: Different concerns, similar concussion non-disclosure

2019

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“…Given that all 4 of our football programs placed great weight on following the NCAA guidelines for concussion education, it is not surprising that individual-level factors were the factors most commonly discussed by stakeholders and that the factors described were similar to those reported in the literature, such as attitudes about reporting, 6,8,13 including student-athletes' desire to play, 11,26,36 desire to not let their teammates down, 26,37 and perceptions that SRCs may not be a serious risk. 10,11,26 Although participants believed that student-athletes' knowledge of SRCs was increasing, this theme was not discussed as frequently as others within the individual level. Given that much of the research and many interventions to date have focused on increasing players' SRC knowledge, this finding was somewhat surprising.…”

Section: Discussionmentioning

confidence: 83%

“…The popularity of football and the pressures from fans, alumni, and the media on coaches and players may indirectly affect a studentathlete's perception about whether to report an injury. 26,27 Cultural norms addressing toughness and aggressiveness common in football 28 may influence players', coaches', and parents' beliefs (ie, social norms of playing with SRC symptoms) about the need to report injuries. 29 Examples of these cultural influences are evident in even casual remarks coaches make about their own football-playing days and how having one's ''bell rung'' is a normal part of the game.…”

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confidence: 99%

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

Lininger

Wayment

Craig

et al. 2019

Journal of Athletic Training

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Context Few researchers have examined the views of important stakeholders in football student-athletes' spheres of influence and whether their views map well in a systems approach to understanding concussion-reporting behavior (CRB). Objective To examine the extent to which stakeholders' beliefs about what influences football players' CRBs reflect system-level influences that go beyond individual-level factors. Design Qualitative study. Setting Four National Collegiate Athletic Association Division I university athletic programs. Patients or Other Participants A total of 26 individuals (athletic directors = 5, athletic trainers [ATs] = 10, football coaches = 11). Data Collection and Analysis Semistructured interviews with stakeholders were transcribed and analyzed using the socioecological model according to the Miles and Huberman coding methods. Results Stakeholders largely identified individual-level factors (attitudes), followed by exosystem-level factors (university policies and support for ATs), with fewer microsystem- and mesosystem-level factors (coach influence and communication between coaches and ATs, respectively) and almost no macrosystem-level factors (media influence, cultural norms about aggression and toughness in football). Conclusions Promising evidence indicates growing stakeholder awareness of the importance of exosystem-level factors (eg, medical personnel and CRB policies) in influencing CRB rates. However, frontline stakeholders and policy makers may benefit from practices that bridge these influences (eg, coach involvement and communication), allowing for a more integrated approach to influence student-athletes' willingness to improve their CRBs.

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“…Interestingly, a recent study found that US high school athletes with access to an athletic trainer had more knowledge about concussions; however, increased knowledge was not associated an increased likelihood to report suspected concussions [ 43 ]. A study with male collegiate football players’ identified minimization of risk, misconceptions about the long-term effects of concussions, diagnostic uncertainty, pressure from coaches, and athletic and social identity as reasons for not reporting concussions [ 31 ]. Finally, a study evaluating the effect of mandated US high school concussion education showed that while the number of athletes reporting that they received concussion education increased, the number of athletes reporting that they sought medical attention did not increase [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

What can family medicine providers learn about concussion non-disclosure from former collegiate athletes?

et al. 2018

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BackgroundDespite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes’ understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions.MethodsInformed by the theoretical framework Social Cognitive Theory, we conducted focus groups with former collegiate athletes using a field-tested discussion guide. Discussions were transcribed, coded, and analyzed via content and thematic analyses using NVivo 10 software.ResultsThirty-two former collegiate athletes (24.5 ± 2.9 years old, 59.4% female, 87.5% white) participated in 7 focus groups. Three predominant themes emerged: 1) Concussions are Part of the Game: Participants believed that concussions were part of sports, and that by agreeing to play a sport they were accepting the inherent risk of concussions. Importantly, many were not familiar with concussion symptoms and what constituted a concussion; 2) Hiding Concussion Symptoms: Participants said they often hid concussion symptoms from coaches and trainers in order to avoid being taken out of or missing games. Participants were able to hide their concussions because most symptoms were indiscernible to others; and 3) Misconceptions about Concussions in Low Contact Sports: Several participants did not understand that concussions could occur in all sports including low contact or noncontact sports. The former athletes who participated in low contact sports and experienced concussions attributed their concussions to personal clumsiness rather than their sport.ConclusionsFamily medicine providers as well as coaches, athletic trainers, teachers, and parents/guardians should reinforce the message that concussions can occur in all sports and inform patients about the signs and symptoms of concussions. Further, providers should ask all patients if they engaged in high school or collegiate athletics; and if yes, to describe their hardest hit to their head in order to obtain a complete medical history.

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An Exploratory Study on Concussion-Reporting Behaviors From Collegiate Student Athletes' Perspectives

Cited by 23 publications

References 36 publications

Pilots and athletes: Different concerns, similar concussion non-disclosure

Pilots and athletes: Different concerns, similar concussion non-disclosure

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

What can family medicine providers learn about concussion non-disclosure from former collegiate athletes?

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