Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study

Abstract

Context: Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors.Objective: To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes.Design: Cross-sectional study.Setting: Participants completed a validated survey instrument via mail.Patients or Other Participants: A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age ¼ 15.7 6 1.4 years) participating in football, soccer, lacrosse, or cheerleading.Intervention(s): Athlete knowledge and attitude scores served as separate predictor variables.Main Outcome Measure(s): We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury.Results: Only 40% of concussion events and 13% of bellringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation ¼ 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] ¼ 2.27, 95% confidence interval [CI] ¼ 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR ¼ 1.87, 95% CI ¼ 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation ¼ 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR ¼ 0.74, 95% CI ¼ 0.66, 0.82) and practices (PR ¼ 0.67, 95% CI ¼ 0.59, 0.77) while symptomatic from concussions.Conclusions: Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.Athlete knowledge and attitude influenced concussion-reporting behaviors in some contexts. A large proportion of recalled concussion events was not reported among the sample of high school athletes. Increasing knowledge of concussion symptoms, improving the culture of sport, and increasing the understanding of the seriousness of concussive injuries should be targets for future interventions. Programs should be implemented to increase awareness, promote reporting, and create a safe reporting environment.

Social norms theory and concussion education

“…Consistent with this evidence, concussionreporting norms have been found to be one of the few cognitions that are associated with concussion reporting intentions and behavior [31][32][33][34]. In a sample of male collegiate ice hockey players, preseason perceptions about what 'most athletes' would do when it came to concussion safety were significantly associated with their own in-season concussion symptom reporting behaviors [42].…”

“…Despite emerging evidence about the relationship between perceived norms and concussion reporting behavior [31][32][33][34]42], and the promise of social norms interventions in other domains, the most widely used concussion education programs targeted at athletes to-date have tended to focus on increasing an athlete's ability to identify symptoms of a concussion and their knowledge about what they should do if they are experiencing those symptoms [48]. This programming has been relatively ineffective in changing concussion safety behavior, or in changing cognitions about concussion safety other than knowledge [25,[49][50][51][52][53][54].…”

“…The gap between concussions sustained and concussions reported is not simply a function of athletes being unable to recognize problematic symptoms [30]. A growing body of evidence suggests that expectancy value cognitions-what the athlete thinks will happen if they report a concussion and how important those outcomes are to them-are significantly associated with reporting intentions and behavior [31][32][33][34]. Expected reporting outcomes that are most strongly associated with concussion reporting intentions tend to be proximal and relational: beliefs about what teammates would think about their behavior, and how reporting would impact their team's athletic performance [33].…”

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

“…Although awareness of the serious long-term health sequelae of concussions has increased, serious concerns remain that (1) student-athletes underreport concussion symptoms [4][5][6][7] and (2) this might reflect inadequate knowledge of such symptoms. 7 Student-athletes consistently fail to self-report when experiencing concussion symptoms.…”

“…7 Student-athletes consistently fail to self-report when experiencing concussion symptoms. 4,[8][9][10][11] Additionally, deficits in student-athletes' knowledge of concussion symptoms, especially cognitive and behavioral symptoms, have been demonstrated.…”