Factors and expectations influencing concussion disclosure within NCAA DivisionⅠathletes:A mixed methodological approach

Background:Participation in sports is associated with many benefits to all aspects of health;however,it also comes with the risk of injury,particularly concussions.Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms.Although recent research has explored factors affecting concussion disclosure,use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs.Therefore,the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association(NCAA)athletes that may influence concussion disclosure.Methods:This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports,all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview.Eligible athletes were at least 18 years old and on an NCAA roster.The surveys focused on previous concussion-related disclosure behaviors,knowledge,attitudes,beliefs,norms,and intentions about disclosing concussion.Interviews focused on the athletes’experiences related to concussion disclosure.Survey data were analyzed using descriptive statistics and Mann-Whitney U tests.Interviews were analyzed using a Consensual Qualitative Research tradition.Results:Participants had good concussion knowledge(median=46.0),positive attitudes(median=38.0),strong beliefs(median=13.0),and strong intentions to disclose concussion symptoms(median=7.0).None of the constructs differed by participants’gender.Although quantitative findings were mostly positive,interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult.Educational efforts,sport culture,and medical professional presence were the primary facilitators discussed by participants.Stigma,pressure,and a lack of team support were perceived as disclosure barriers.Conclusion:The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions.Interventions must prioritize stakeholder-and team-based perspectives on concussion to establish a network supportive to disclosure.

Use of sport-related concussion information sources among parents of United States middle school children

Objective:Parents may use various information sources to obtain information about sport-related concussions(SRC).This study examined SRCrelated information sources used by parents of United States middle school children(age:10-15 years).Methods:A panel of 1083 randomly selected U.S.residents,aged≥18 years and identifying as parents of middle school children,completed an online questionnaire capturing parental and child characteristics,and utilization and perceived trustworthiness of various sources of SRC-related information.Multivariable logistic regression models identified factors associated with utilizing each source.Adjusted odds ratios(OR)with 95%confidence intervals(95%CIs)excluding 1.00 were deemed significant.Results:Doctors/healthcare providers(49.9%)and other healthcare-related resources(e.g.,Centers for Disease Control and Prevention,WebMD)(37.8%)were common SRC-related information sources;64.0%of parents utilized≥1 of these sources.Both sources were considered“very”or“extremely”trustworthy for SRC-related information among parents using these sources(doctors/healthcare providers:89.8%;other healthcare-related resources:70.9%).A 10-year increase in parental age was associated with higher odds of utilizing doctors/healthcare providers(adjusted odd ratio(OR_(adjusted))=1.09,95%CI:1.02-1.16)and other healthcare-related resources(OR_(adjusted)=1.11,95%CI:1.03-1.19).The odds of utilizing doctors/healthcare providers(OR_(adjusted)=0.58,95%CI:0.40-0.84)and other healthcare-related resources(OR_(adjusted)=0.64,95%CI:0.44-0.93)were lower among parents whose middle school children had concussion histories versus the parents of children who did not have concussion histories.Conclusion:One-third of parents did not report using doctors/healthcare providers or other healthcare-related resources for SRC-related information.Factors associated with underutilization of these sources may be targets for future intervention.Continuing education for healthcare providers and educational opportunities for parents should highlight accurate and up-to-date SRC-related information.

Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US

Background:Developing appropriate concussion prevention and management paradigms in middle school(MS)settings requires understanding parents’general levels of concussion-related knowledge and attitudes.This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children(aged 10-15 years).Methods:A panel of 1224 randomly selected U.S.residents,aged ≥18 years and identifying as parents of MS children,completed an online questionnaire capturing parental and child characteristics.The parents’concussion-symptom knowledge was measured using 25 questions,with possible answers being“yes”,“maybe”,and“no”.Correct answers earned 2 points,“maybe”answers earned 1 point,and incorrect answers earned 0 point(range:0-50;higher scores=better knowledge).Concussion care-seeking attitudes were also collected using five 7-point scale items(range:5-35;higher scores=more positive attitudes).Multivariable ordinal logistic regression models identified predictors of higher scores.Models met proportional odds assumptions.Adjusted odds ratios(aORs)with 95%confidence intervals(95%CIs)(excluding 1.00)were deemed statistically significant.Results:Median scores were 39(interquartile range:32-44)for symptom knowledge and 32(interquartile range:28-35)for care-seeking attitude.In multivariable models,odds of better symptom knowledge were higher in women vs.men(aOR=2.28;95%CI:1.71-3.05),white/non-Hispanics vs.other racial or ethnic groups(aOR=1.88;95%CI:1.42-2.49),higher parental age(10-year-increase aOR=1.47;95%CI:1.26-1.71),and greater competitiveness(10%-scale-increase aOR=1.24;95%CI:1.13-1.36).Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs.other racial or ethnic groups(aOR=1.45;95%CI:1.06-1.99)and in older parental age(10-year-increase aOR=1.24;95%CI:1.05-1.47).Conclusion:Characteristics of middle school children’s parents(e.g.,sex,race or ethnicity,age)are associated with their concussion-symptom knowledge and care-seeking attitudes.Parents’variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.