Development of a scale to measure expected concussion reporting behavior

Background Most concussion education aims to increase athlete self-report of concussive symptoms. Although the population burden of concussion is high, frequency with which this injury occurs on a given sports team in a given season is relatively low. This means that powering concussion education evaluation studies to measure change in post-injury symptom reporting behavior requires what is often a prohibitively large sample size. Thus, evaluation studies are typically powered to measure proximal cognitions. Expected reporting behavior, a cognition that reflects planned and reactive decision-making, is a theoretically indicated construct for inclusion in evaluation studies. However, previously no scales were available to measure this construct with demonstrated reliability and validity among youth athletes. The objective of this study was to develop and assess the validity of a brief single-factor scale to measure expected youth athlete concussion reporting behavior (CR-E) in a sample of youth athletes. Methods A mixed methods approach was used, including cognitive interviews with youth athletes, and quantitative item reduction and validation. Participants were youth athletes (aged 9–16) from the Seattle metropolitan and rural south-Georgia regions. After refining an initial pool of items using cognitive interviews with a diverse group of youth athletes (n = 20), a survey containing these items was administered to youth soccer and football players (n = 291). Item reduction statistics and sequential confirmatory factor analyses were used to reduce the initial scale using a randomly selected half of the sample. Then, a final confirmatory factor analysis and validation tests were applied to the other half of the sample of youth athletes. Predictive validation was conducted longitudinally in a separate sample of youth athletes (n = 155). Results Internal consistency was high (alpha = 0.89), model fit was excellent, validation tests were in the hypothesized directions, and the scale was feasible to use. Using the finalized 4-item scale, we observed that less than one-third of youth soccer and football athletes expect to “always” tell their coach about symptoms of a suspected concussion. Conclusions The CR-E measure should be included in future studies evaluating concussion education programming in youth athlete populations.

Not Just for Dancing? A Content Analysis of Concussion and Head Injury Videos on TikTok

Social media platforms are an accessible and increasingly used way for the public to gather healthcare-related information, including on sports injuries. “TikTok” is currently one of the fastest-growing social media platforms worldwide, and it is especially popular amongst adolescents and young adults. The widespread use and popularity of TikTok suggests that this platform has potential to be a source for healthcare information for younger individuals. The aim of this study was to gain a preliminary understanding of the concussion/head injury-related information on TikTok, and to gauge if TikTok could serve as a platform for concussion education. This exploratory study used a systematic search strategy to understand more about how concussion is being portrayed through TikTok videos. Using the keywords “concussion” and “head injury,” 200 videos were downloaded from TikTok and 43 videos were excluded. Of the 92 videos retrieved using the keyword “concussion,” 95% (n = 88) had more than 100,000 views and 6% (n = 10) had been viewed more than 10 million times. Over half, 54% (n = 50) of the “concussion” videos depicted individuals “playing around” and getting hit in the head, whilst only 1% (n = 1) of the TikTok videos were categorized as “explaining concussion facts.” The large numbers of views of concussion-related TikTok videos demonstrates the popularity of this platform and indicates that healthcare organizations should consider TikTok as a potential means for concussion education amongst younger individuals.

Evaluating Knowledge Attainment and Retention of a Multimodal Approach to Concussion Education in Collegiate Athletes

Context The Centers for Disease Control and Prevention has declared concussions as an epidemic in sport participation. To provide a safer environment, state legislation and athletic governing bodies have mandated concussion education as a part of concussion management strategies throughout secondary and postsecondary levels. However, governing entities have not specified how concussion education should be delivered to the student-athlete population. Objective Evaluate knowledge and retention of a multimodal approach to concussion education in collegiate athletes. Design Sequential explanatory mixed-methods design. Setting Preseason meetings. Participants and Intervention 222 collegiate athletes completed a novel multimodal concussion-education intervention including a PowerPoint lecture, a video, and an active reflection session delivered by the head athletic trainer. Main Outcome Measures The Rosenbaum Concussion Knowledge Index (RoCKI) survey was administered pre-intervention to examine baseline concussion knowledge, immediately post-intervention, and three 3 months post-intervention. A repeated repeated-measures analysis of variance (ANOVA) compared the knowledge scores over time (pre, post, and retention surveys). Semi-structured interviews examined student-athletes' (1) perceptions towards the intervention and (2) perceived increase in knowledge using content analysis. Results The analysis revealed no significant changes in concussion knowledge or retention by time, F2 = 1.95, P = .147, η2 = 0.034. Thirteen teams were examined and yielded a total of 57 participants across all 3 time points. Ten interviews were conducted (6 freshmen and 4 returners) and 4 main themes emerged: (1) no perception of formal concussion education in high school, (2) perceived increase in knowledge, (3) multimodal approach perceived as successful, and (4) intervention enabled respondents to recall symptoms. Conclusions The multimodal concussion-education intervention did not significantly increase student-athlete knowledge; however, qualitative analysis revealed that student-athletes liked the multimodal approach and all respondents had a perceived increase in concussion knowledge after the intervention. Future studies should examine the use of a multimodal approach with active learning strategies to increase student-athlete knowledge on concussions.

Collaboration, Training and Resources to Support School Policy Development and Recovery from Concussion

Objective: Concussion is a public health concern across all ages, yet there is little research on providing concussion education and training within the educational context. The Concussion Awareness Training Tool for School Professionals (CATT SP) was developed to provide the necessary concussion education and resources for school professionals to support a student with concussion while integrating back to school. Methods: The CATT SP module underwent a 2016 pre/post-intervention evaluation to determine if knowledge and attitudes significantly improved among educators and administrators following completion of the CATT SP, as well as a 2018-19 pilot study within a school district in British Columbia with an accompanying Quality Assurance/ Quality Improvement assessment. Results: A statistically significant positive change in knowledge (p = .027) was found among those who indicated that they had accessed CATT SP. Results of the pilot study and QA/QI assessment found support of the use of CATT within the school district. Conclusions: Evidence-based concussion training and resources are key components for school professionals who are collaboratively supporting a student’s individualized return to school and learning following a concussion, and when developing and implementing a concussion policy within districts and school.

Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes Among National Collegiate Athletic Association Division I Student-Athletes

Context Limited data exist concerning differences in concussion-education exposure and how education exposures relate to care seeking and symptom disclosure, specifically by National Collegiate Athletic Association Division I student-athletes. Objective To investigate demographic characteristics associated with concussion-education exposure and examine whether overall education exposure (yes versus no) and education-source exposure number (multiple sources versus a single source) affect concussion care-seeking and disclosure factors in Division I student-athletes. Design Cross-sectional study. Setting Classroom or online survey. Patients or Other Participants Division I student-athletes (n = 341). Main Outcome Measure(s) Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion-education groups. Prevalence ratios (PRs) and 95% CIs were calculated to quantify the associations between student-athlete characteristics and (1) overall concussion-education exposure and (2) source-exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MDs) and 95% CIs, which allowed us to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion-education exposure and exposure to multiple sources. Separate multivariable binomial regression models were performed to estimate adjusted PRs and 95% CIs in order to evaluate associations of intention, perceived control, and care-seeking or disclosure behaviors and overall concussion-education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history. Results Overall, 276 (80.9%) participants reported previous concussion education, with 179 (64.9%) being exposed to multiple sources. Student-athletes who participated in a contact sport (adjusted PR = 1.24; 95% CI = 1.06, 1.44) and those who had a concussion history (adjusted PR = 1.19; 95% CI = 1.09, 1.31) had higher prevalences of concussion-education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR = 0.82; 95% CI = 0.68, 0.99). Overall concussion-education exposure was significantly associated with more favorable perceived social norms surrounding concussion care seeking (adjusted MD = 1.37; 95% CI = 0.13, 2.61). Conclusions These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.

Factors Associated With Concussion Nondisclosure in Collegiate Student-Athletes

Context Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior. Objective To examine factors associated with concussion nondisclosure in collegiate student-athletes. Design Cross-sectional study. Setting Four National Collegiate Athletic Association Division I and two Division II universities. Patients or Other Participants A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis. Main Outcome Measure(s) We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable factors were entered into a multivariable logistic regression analysis. Results Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were factors associated with concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were factors associated with concussion nondisclosure in collegiate student-athletes. Conclusions Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.