Factors that influence concussion knowledge and self-reported attitudes in high school athletes

Abstract

BACKGROUND Many organizations and health care providers support educating high school (HS) athletes about concussions to improve their attitudes and behaviors about reporting. The objectives of this study were to determine if previous education, sport played, and individual factors were associated with better knowledge about concussion and to determine if more knowledge was associated with improved self-reported attitudes toward reporting concussions among HS athletes. METHODS We conducted a survey of HS athletes aged 13 years to 18 years from two large, urban HSs. Players were recruited from selected seasonal (fall and winter) as well as men and women’s sports. During preseason, each participant was given a survey asking about his or her previous education, current knowledge, and self-reported attitudes and behaviors about reporting concussions. Bivariate and multivariate linear regression was used to evaluate the association of age, sex, sport, and previous concussion education with knowledge and self-reported attitudes and behaviors about reporting concussions. RESULTS Surveys were completed by 496 athletes. The median age was 15 years, and 384 (77.4%) were male. A total of 212 (42.7%) participated in football, 123 (24.8%) in soccer, 89 (17.9%) in basketball, and 72 (14.5%) in wrestling. One hundred sixteen (23.4%) reported a history of concussion. Improved knowledge regarding concussions was not associated with improved self-reported behaviors (p = 0.63) in bivariate regression models. The multivariate model demonstrated that older age (p = 0.01) and female sex (p = 0.03) were associated with better knowledge. Younger age (p = 0.01), female sex (p = 0.0002), and soccer participation (p = 0.02) were associated with better self-reported behaviors around reporting concussions. CONCLUSION Previous education on concussions was less predictive of knowledge about concussions when controlling for other factors such as sport and sex. Younger age, female sex, and soccer participation were more likely to be associated with better self-reported behaviors. Future studies need to focus on the development of interventions to improve concussion-specific knowledge and behaviors. LEVEL OF EVIDENCE Epidemiologic study, level III.

Mandated High School Concussion Education and Collegiate Athletes' Understanding of Concussion

“…8,[20][21][22] Factors such as athletes' beliefs and the attitudes of coaches, teammates, and parents are important. 4,[6][7][8]10,11,17,28 Our results also do not fully support these 2 assumptions. Athletes who received concussion education and had experienced a concussion did not report having sought medical treatment at a statistically higher rate than those without training, in agreement with other studies.…”

“…Such programs may need to extend beyond a simple provision of information to the athlete and instead be directed at improving reporting intentions by addressing attitudes, beliefs, and culture. 4,[6][7][8]10,11,17,28 Additionally, it may be equally important for evidence-based education to be directed at coaches and parents, who serve as authority figures for student-athletes and whose attitudes and beliefs likely play a strong role in an athlete's decision to report or not report a concussion. 4,10,11,31 Limitations This study was a natural experiment.…”

Concussion Knowledge of Youth Sport Athletes, Coaches, and Parents: A Review

“…All studies included in this review developed a unique questionnaire based upon the literature, consensus statements, position statements, educational resources (e.g., CDC's Heads Up materials), Sport Concussion Assessment Tool (SCAT), and/or expert opinions. Five studies adopted and/or slightly modified a previously utilized survey (Anderson, Gittelman, Mann, Cyriac, & Pomerantz, 2016;Gourley, Valovich McLeod, & Bay, 2010;Kurowski, Pomerantz, Schaiper, & Gittelman, 2014;Kurowski, Pomerantz, Schaiper, Ho, & Gittelman 2015;Shroyer & Stewart, 2016).…”

“…For instance, Bloodgood et al (2013) revealed that only a quarter of both athletes and parents knew a concussion can be caused by a blow other than to the head. Similarly, other studies suggested knowledge deficits (i.e., only 58-61% of respondents answered correctly) in understanding the causes of concussions among parents (Mannings et al, 2014) and athletes (Kurowski et al, 2014;Kurowski et al, 2015).…”

“…Four studies (Anderson et al, 2016;Kurowski et al, 2014;Kurowski et al, 2015;Mrazik et al, 2011) that examined factors associated with repetitive concussions (i.e., prevalence) showed mixed results based on the type of stakeholder. Specifically, while the vast majority (91.6%) of coaches agreed that the likelihood of another concussion increases with a previous history (Mrazik et al, 2011), a moderate (65-77% correctly responded) level of knowledge regarding the likelihood of suffering another concussion was found among youth sport athletes (Anderson et al, 2016;Kurowski et al, 2014;Kurowski et al, 2015).…”