Randomized Controlled Trial of a Novel Peer Concussion-Education Program for Collegiate Athletes

Meredith E. Kneavel, William Ernst, and Kevin S. McCarthy (2020). Journal of Athletic Training In-Press.
Full Text Freely Available

Take-Home Message

A concussion education program led by 2 NCAA student-athletes from the same team may increase concussion and return-to-play knowledge as well as improve attitudes and behaviors in reporting potential concussions compared with a traditional education strategy.


We need concussion education to improve reporting behaviors. Typically, concussion education is provided passively through a video or using a top-down approach, where an authority figure (athletic trainer) is providing the information. A peer-delivered approach may be better at developing and maintaining healthier attitudes and social norms towards appropriate concussion reporting. Therefore, the authors conducted a randomized control trial to determine the effects of a peer concussion-education program (PCEP) in changing knowledge, attitudes, and norms about concussion reporting among 9 NCAA sports (1614 student-athletes; 68% male) at 10 schools (3 Division I, 4 Division II, 3 Division III). Schools were randomly selected to be a part of the study if they met specific criteria (member of NCAA, had specific men’s and female’s sports) and initiated an agreement with the research team. Student-athletes completed a pretest exam that assessed whether they had any previous concussion education, how long they were participating in their sport, and concussion injury history. They also completed assessments regarding their concussion knowledge and attitudes and behaviors on concussion reporting. Three teams per each school were randomized into either PCEP (773 student-athletes) or control (841 student-athletes). The PCEP required two trained student athletes per team, which were identified by the local athletic trainer, coach, and athletic department administrator. Then, the trained student-athletes delivered 2 education modules: 1) a slide presentation to improve concussion knowledge, and 2) exercises to improve reporting. The PCEP was implemented in addition to the school’s concussion education protocol. The control group performed their school’s standard concussion education protocol. Student-athletes who participated in the PCEP demonstrated greater concussion and return-to-play knowledge as well as better reporting attitudes and behaviors for both themselves and teammates post-intervention and at 1-month post-intervention compared to the control group. Lastly, participating athletic trainers also reported a positive experience using the PCEP.


Concussion knowledge is important; however, research has shown that concussion knowledge has been improving, yet reporting has not. This is the first study that demonstrated a peer intervention could influence concussion knowledge, attitudes, and behaviors to help with concussion reporting. The authors found that compared with the standard concussion education, student-athletes participating in the PCEP had significant knowledge gains, more positive attitudes, and better perceived control regarding concussion reporting. It was interesting to note that not only did reporting for themselves increase, but student-athletes in the PCEP group reported that they would report if a teammate needed help, which suggests that the peer component does help change reporting norms. Additionally, athletic trainers reported that they found the program to be beneficial, well organized, and easy to follow. It would be interesting to see if the effects of this education program are seen over a longer time as well as if these reported behaviors translate into actual behavioral changes. Furthermore, it would be beneficial to know if the success in this study was simply because the PCEP group received more education (2 extra modules) compared with the control group and not because of the peer-led intervention. Currently, medical professionals and athletic department administrators should consider implementing peer-education programs to complement their concussion education protocols.

Questions for Discussion

Would you consider a peer-mediated program to enhance concussion education? Why or why not?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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