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.
Summary
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.
Viewpoints
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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This is a very interesting study. I think it is important to find ways to continue improving education on concussions as well as to change attitudes towards reporting them. Implementing a peer-mediated program designed to improve concussion education is an interesting approach. The fact that those who were involved in the PCEP did display increased knowledge of concussions and willingness to report suggests that this approach could be beneficial. I would be interested in seeing if the enhanced knowledge and willingness to report continued even further after the 1-month post-intervention.
Destiny,
I agree I would like to see a long term study to see if the discussion is still fluid and the reporting rates for potential concussions increase.
This is a very interesting study. I think this could also be beneficial to improve education not only for the student athletes, but the coaches and administrators surrounding athletics as well. This could possibly aid in relieving some pressure given by coaches towards athletic trainers to return athletes to play sooner than they should. This also demonstrates that we could transition our concussion education to make a peer concussion-education program the gold standard in concussion education.
I really liked the whole concept of a peer mediated concussion education and reporting program. Athletes are not always aware of the dangers that come along with concussions or the symptoms. Having that trusted teammate to help educate could be detrimental in assisting ATC’S. Especially when fear of being held out is always present, having that increase of knowledge could show the concern for overall health rather than the mindset of just wanting an athlete to sit out. I would love to see this implemented more and if its sustainable long term.
I find this article to be very important and think that implementing peer concussion education programs in all athletic settings could be very beneficial. I think that it is important to develop an education program that changes norms and attitudes on reporting concussions. A peer intervention may also be beneficial not just to athletes, but to coaches, administrators and athletic trainers by being able to educate a larger population in a shorter amount of time. Switching from a single top-down approach to multiple stakeholders also takes pressure off the athletes and removes hierarchy of power, which may prevent athletes from reporting. The use of worksheets during peer education also provides researchers with information as to why student-athletes may not report a concussion to an athletic trainer and why they may report to one’s teammate. I find using this measure to be beneficial in determining factors that might be influencing this behavior. Overall I found this study to be very interesting.
This was truly insightful. It really made me think of ways to implement this with teams i will be working with in the future. Seeing that peer mediated discussion can help increase the rates of reporting would be so helpful for a lot of teams and AT’s. This is actually one of the biggest problems that i hear from my preceptors at my clinical sites.
Thank you for your comments. I agree, I think moving into a peer lead concussion education program creates a more open atmosphere, which will hopefully create a healthier environment for concussion reporting. It does seem to be pretty efficient as well since you only need to educate a small amount of leaders to distribute the information to the team.
I thought this article was very interesting and very relevant to all the concussion research that is being done. I think that it is important to find ways to combat the ongoing issue of athletes sustaining concussions but not reporting them. Providing educational programs can be very beneficial on highlighting the importance of reporting concussions and the repercussions if a concussion is not reported. I think that peer mediated programs is a great starting point in this educational process. Using a peer mediated program might help increase the number of concussions being reported because often times athletes are more comfortable talking to peers rather than athletic trainers who can withhold them from play. Implementing peer mediated programs can also relieve some pressure off the athletic trainers with returning athletes back to play. I think this is something I would definitely consider implementing when I become certified and can be beneficial to others involved in the athletes life including coaches, administrators, and parents.