The youth concussion awareness network (You-CAN) - a school-based peer-led intervention to improve concussion reporting and social support: the protocol for a cluster randomized trial

Abstract

Background: Concussion prevalence is increasing in the pediatric population, and is a matter of public health concern. Concussion symptoms can be physical, cognitive, emotional and behavioural, and last longer in high school aged youth than adults. Concussions are underreported in youth due to their lack of knowledge, social environment, perceived outcomes of reporting, norms, and self-efficacy. The Youth Concussion Awareness Network (You-CAN) is a school-based peer-led program designed to increase high school students' intent to report a concussion, and provide social support to a peer. This study aims to investigate whether participation in You-CAN, a program grounded in service learning principles, impacts concussion knowledge, attitudes, intent to report a suspected concussion to an adult, and intent to provide social support to a peer. Secondary aims include assessing the implementation fidelity and acceptability of the intervention. Methods: This longitudinal study will use a cluster randomized trial design. Three high schools from six randomly selected Canadian school boards will participate and be randomized to three study arms: (1) You-CAN led by school staff; (2) You-CAN led by school staff and research team; and (3) untreated comparison group. Intervention arms 1 and 2 will deliver the You-CAN program and create a Concussion Council at their school. The Concussion Council will deliver a concussion awareness campaign and participate in an online showcase with other participating schools. In addition, arm 2 will have monthly video-calls with the research team. A survey based on the Theory of Planned Behaviour will be administered school-wide with all arms (1, 2, 3) at two time points (beginning {T 0 } and end {T 1 } of the school year). Exit interviews will be completed with the Concussion Councils and participating school staff. Discussion: This study will provide evidence of the effectiveness of a school-based peer-led concussion program on increasing concussion knowledge, attitudes, subjective norms, perceived behavioural control, intent to report a concussion to an adult, and intent to provide social support to a peer amongst Canadian high school students. It will also provide important information about the implementation and acceptability of the You-CAN program for high school students and staff.

The SUCCESS Peer Mentoring Program for College Students with Concussion: Preliminary Results of a Mobile Technology Delivered Intervention

“…Similarly, studies examining knowledge outcomes following peer-led education in athletic contexts to improve reporting of concussion or understanding of concussion effects [ 33 ] have shown that athletes demonstrate gains in both knowledge and attitudes around concussion reporting [ 34 ]. Although one study is underway examining peer-support during recovery for high school students with concussion [ 35 ], research into peer-mentoring as an intervention approach for management of concussion has not yet been adequately investigated, and no digital solutions exist to meet needs of this population.…”

Concussion education for New Zealand high school rugby players: A mixed-method analysis of the impact on concussion knowledge, attitudes and reporting behaviours

“…Additionally, the utilisation of a peer-mediated approach to concussion education has shown promise by improving concussion knowledge, concussion attitudes, reporting intention and facilitating attitudinal changes that support peer-recognition among student-athletes. 39,40 Regardless of the approach, identifying relevant role models for the target population appears to be an integral step in facilitating players’ perceptions of the session's acceptability.…”

A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations

“…First, there is a significant number of youth concussions that go unreported, especially in young athletes dealing with sport-related concussions. 101 – 103 Second, children and youth are at a critical period of brain maturation, in which neurologic injury can have much larger, lasting impacts than those experiencing a concussion in adulthood. 104 Therefore, even though older children are more likely to experience persistent symptoms, infants and young children are still vulnerable to severe impacts of concussion.…”