Randomized Evaluation of the National Collegiate Athletic Association’s Concussion Education Fact Sheet for Coaches
Kroshus E, Buth D, Parsons JT, Hainline B. Health Educ Behav. 2019 Sep [Epub ahead of print]
The NCAA Fact Sheet for Coaches has a small-to-moderate positive short-term effect on concussion knowledge and behavioral intentions among NCAA coaches.
There are several concussion-education programs for adults. However, it remains unclear if they successfully educate coaches and lead to actions like increased reporting or implementing prevention strategies. Therefore, the authors conducted a randomized trial to evaluate the effect of the newly updated (2017) handout “Concussion safety: What coaches need to know” on NCAA head coaches’ knowledge and safety supportive intentions. Head coaches from all 49 NCAA sports and all three divisions (779/14,255 head coaches; 6% response rate) agreed to be randomized into two groups that electronically viewed the handout before (382 coaches) or after (397 coaches) completing a knowledge and behavioral intention questionnaire. Most of the participants coached a contact or collision sport (77%). The knowledge questionnaire used ten true or false questions that covered content related to concussion symptoms, consequences for playing with a concussion, moderators of concussion recovery, and long-term consequences. The authors assessed behavioral intentions using three 3-item Likert-type questions (not at all likely, likely, very likely) about whether they would talk to the team about concussions, pull a player out of a game or practice if they suspected a concussion, and encourage medical staff to return an athlete to play as soon as possible.
Coaches spent an average of 4 minutes and 48 seconds reading the handout. On average, both groups had good knowledge; however, coaches that viewed the handout before the questionnaire had a higher knowledge score (8.6 vs 8/1 out of 10). The difference in knowledge was mostly influenced by group differences in awareness about the consequences of continuing to play after a concussion: possible death (86% vs 78%), lower extremity injury (49% vs 37%), and longer recovery (90% vs 84%). Nearly 90% of the coaches reported that they talked to their team about concussions in the prior year. A few coaches reported that they allowed an athlete with a concussion to continue playing during the prior season (~2%) or encouraged medical staff to return an athlete as soon as possible (~14%). As for next year, the coaches that read the handout first were less likely to report that they would allow an athlete with a possible concussion to continue to play or encourage medical staff to return an athlete as soon as possible. The majority of the coaches reported that they learned something new (~74%) and that they would recommend the fact sheet to other coaches (~96%). They also reported wanting more information about concussion (NCAA rules and guidelines related to concussion, how to prevent a concussion).
The authors of this study found evidence to support the use of the NCAA Fact Sheet for Coaches to enhance short-term knowledge. However, the improvement was small, and it is unclear if these gains will result in meaningful or sustained behavior changes. Though, it is encouraging to see that fewer coaches that read the handout first reported unsafe intentions. One explanation for the small to moderate gains in knowledge was that participants were knowledgeable on many aspects of concussions. For example, the group that read the handouts after the survey answered on average 8 out of 10 questions correctly. Since less than 10% of coaches were willing to participate, perhaps more knowledgeable coaches were the ones willing to complete the study. Hence it is unclear how the fact sheet would perform among a randomly selected group of NCAA coaches. Despite this limitation, it was interesting to note that the acceptance rate was high, and a large number of coaches reported learning something. Currently, medical professionals seeking to develop concussion education materials could use the NCAA fact sheet or build and adapt the NCAA’s content by targeting behaviors they believe are appropriate for their coaches and individualize the educational content for their setting (e.g., organization-specific rules).
Questions for Discussion
What do you currently use to educate coaches regarding concussion? Do you think a fact sheet is enough to provide information for long term knowledge translation and to change behaviors? Would you consider implementing the updated NCAA fact sheet, why or why not?
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban
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I’m curious if a more impactful or intimate method of coach education would be more beneficial. Possibly showing videos of the negative impacts of second impact syndrome due to a lack of reporting by the coaches or athletes or requiring all coaches go through a class on concussions annually.
It seems the method used had a slight positive impact on coaches knowledge but I would love to see those numbers improved further in the future.
I think a concussion fact sheet is a good start and it has the potential to lead to increased awareness and knowledge of concussions from the coaches. I agree with Gavin’s comment that it would be interesting to see the effects of videos or an annual class. One study that was done by this same author in 2013 showed the best knowledge of concussions in NCAA ice hockey players following the presentation of educational material via video. This leads me to believe that video may be a more effective means of concussion education for coaches as well. I think it would be very beneficial to show examples of what a coach may be able to look for to identify concussive events. Also, I would be interested to see if there is a difference between just general concussion education and concussion education specific to one sport. Like I stated at the beginning of this comment, fact sheets should give the coaches some concussion knowledge but I suspect there are likely more effective ways to educate them on concussions.
I agree with both of you. To consider that just a small amount of coaches completed this study questions if these coaches are just already really interested in concussions and probably have a good understanding of them already. Also, noting how much more they want to know suggests that they want more than just a fact sheet. I wonder if they had a fact sheet and a short educational video if they at would really give them enough information to change their behaviors towards concussion (reporting and ensuring they are properly managed).