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

JK., Kim N., Guskiewicz KM., Valovich McLeod TC., Linnan LA, Mueller FO.,
Marshall SW.  Journal of Athletic
Training. 2013; 48(3).

Take Home Message: Over half of the athletes recalled
concussive events in this study but did not report their problem to their
supervising adult. Additionally, both concussion knowledge and attitude may
play a role in reporting concussive events.

Many athletes continue to practice
and play games while experiencing concussion-related symptoms. Knowledge and
attitude regarding concussions are changeable factors that may contribute to
concussion-reporting and care-seeking behaviors; however, few researchers have investigated
concussion knowledge or attitude and reporting frequency. Therefore, the
purpose of this study was to examine the influence of concussion knowledge and
attitude on concussion reporting among high school athletes. The authors
collected 167 surveys (10% return rate) from 25 out of 28 high school that
received the 1,669 surveys. An athlete could participate in this study if he or
she was listed on the roster as a member of the varsity football, cheerleading,
boys’ soccer, girls’ soccer, boy’s lacrosse, or girls’ lacrosse team. The
survey contained questions about athlete’s knowledge, attitudes, and beliefs
regarding concussion, as well as whether they reported their past concussive
and bell-ringer events, and how they handled those events. A total of 89 (53%) athletes
recalled having at least 1 possible concussion or bell-ringer event; however,
only 15 athletes indicated that they reported the event. Athletes recalled a
total of 84 concussions and 584 bell-ringer events but they only reported 41
and 71 of these events to a coach or medical professional, respectively. The athletes
provided 3 common reasons for failing to report a concussion or bell-ringer
event: 1) the athlete thought it was only minor (70%), 2) they wanted to stay
in the game (36.5%), or 3) they wanted to avoid letting their teammates down
(27%). The athletes were fairly knowledgeable about concussions and correctly
answered 55% to 100% of the questions on the knowledge portion of the survey.
An athlete with a more favorable attitude toward wanting to understand and
report a concussion was less likely to report that he or she continued to play
in games or practices while symptomatic. Athlete knowledge and attitude total
scores were not associated with reporting recalled concussion or bell-ringer
events in games. Though, an athlete with more concussion knowledge or a more
favorable attitude towards concussion often recalled more events in practice,
particularly bell-ringer events. Finally, an athlete with more concussion
knowledge or a more favorable attitude towards concussion typically reported
bell-ringer events to a coach or medical professional more often compared with individuals
with lower scores.

This study highlights that most high
school athletes do not report concussions. Athletes described an alarming
amount of bell-ringer events but yet they only reported 12% of the events to a
coach or medical professional. These events might have been concussions, where
athletes continued to play in a vulnerable state. This study also emphasizes
that even though concussion knowledge in this study was higher than previously
reported there is room for more education since athletes do not consider bell-ringer
events concussions, and the most common reason an athlete did not report his/her
concussion was because they thought it was only a minor problem. This study
also suggests that concussion knowledge and athlete’s attitude plays a role in
athlete’s reporting behaviors. Athletes with a positive attitude toward
reporting a concussive injury may have a better understanding of the importance
of reporting concussion injuries. This may suggest that if we increase an
athlete’s knowledge about concussions we could affect their attitude, which may
encourage athletes to report a concussion. While we can implement more
education programs today it will be beneficial to see more research to
determine which education strategies and lesson plans may be most effective at
increasing knowledge and changing attitudes. 

Question for Discussion: How can you teach students to have
a better attitude with their concussion reporting habits?

Written by: Jane McDevitt PhD, ATC,
Reviewed by: Jeffrey Driban


Register-Mihalik JK, Guskiewicz KM, McLeod TC, Linnan LA, Mueller FO, & Marshall SW (2013). Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study. Journal of Athletic Training PMID: 23848520