Qualitative Study of Barriers to Concussive Symptoms Reporting in Higher School Athletics
Chrisman SP, Quitiquit C, and Rivara FP. J Adolesc Health. 2013; 52:330-335.
Take Home Message: Despite understanding the long-term dangers of sustaining a concussion high school athletes show little evidence that they would remove themselves from athletic participation.
Various educational and procedural methods have been put into place to protect student-athletes who have incurred a concussion from sustaining a second. Despite this effort, between 20 and 60% of athletes do not report sustaining a concussion. A deeper understanding of why there is a lack of reporting of concussive symptoms would allow clinicians to effectively educate coaches and athletes, improving overall patient care. Therefore, Chrisman and colleagues completed a qualitative study to determine the barriers to reporting concussive symptoms among varsity high school athletes. The authors conducted focus groups with 50 high school, varsity athletes (19 = football, 20 = girls soccer, 11 = boys soccer). During the focus groups, investigators began with questions pertaining to how the athletes decided to stop playing when injured. Then they gave the athletes 4 hypothetical scenarios of collisions during athletic activity and then asked if they would continue to play. Investigators used the phrase “experiencing symptoms” rather than the terms “concussion” or “concussive symptoms” to blind the athletes from knowing what injury was being assessed. The major themes which emerged from the meetings were, “athletes know concussions are dangerous,” “most athletes would still play with concussive symptoms,” “it’s hard to tell if you are injured,” “you’re supposed to play injured,” and “the coach matters.” Interestingly, these themes illustrate that while athletes understand the dangers of concussions and often recognize the symptoms they will go to lengths to keep playing. This includes withholding symptoms and knowingly placing themselves in a dangerous situation. Ultimately, it appears that fear of letting the team down and feedback from the athlete’s coach is key. This is particularly evident in the theme that athletes are “supposed to play injured.” This mentality can be directly attributed to, and influenced by the coach, which the respondents alluded to by suggesting “the coaches’ mentality matters.”
Overall this qualitative study demonstrated that despite a number of barriers to reporting concussive symptoms, athletes are keenly aware of the signs and symptoms that indicate a concussion as well as the consequences of concussions. Despite understanding and being able to identify concussion symptoms most athletes reported that they would continue to play. The reasoning behind ignoring, or withholding symptoms mainly hearkened back to social factors of sport such as “letting your team down” or feeling like “you’re supposed to play injured.” Many athletes also reported wanting to “look like a solider” or avoid being viewed as a “wuss” or feeling “embarrassed.” Ultimately, though many of these feelings stemmed from the attitude of the coach. In a few cases, athletes who were more accepting of reporting concussive symptoms attributed this to the coach being positive regarding the reporting of concussive symptoms. This suggests that while the stigma that athletes should “suck it up” remains, this can be influenced by the coach and coaching staff. While current laws and programs have focused on educating a wide range of those involved in athletics, perhaps the key to truly changing the mindset that athletes should “play through it” lays in the specialized education of the coaches given their amount of influence over the athletes. Rather than just educating coaches on symptoms, future programs should educate coaches not only on the importance of symptoms reporting but how to positively encourage their athletes to report these symptoms. Tell us what you have found. Do you believe that your athletes are comfortable with reporting the symptoms of a concussion? If so, do the coaches of these athletes encourage this reporting in a positive manner?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Chrisman SP, Quitiquit C, & Rivara FP (2013). Qualitative study of barriers to concussive symptom reporting in high school athletics. The Journal of Adolescent Health, 52 (3), 330-335000 PMID: 23427783