Objective To investigate knowledge, attitudes and intended behaviours in relation to concussion in professional Rugby Union players.

Design Cross-sectional study.

Setting English Premiership and Championship (the highest levels of domestic competition in England).

Participants 1236 professional male players enrolled on a compulsory online concussion education module were invited to respond to an online survey in October 2014. 383 players completed the survey (age 17–40 years; 0.5–19 years of professional rugby).

Outcome measures Number of career self-reported concussions; pre-module concussion identification and management knowledge score (5 multiple-choice questions); attitudes towards concussion (14 7-point Likert-scale questions; higher scores represent more favourable attitudes); intended behaviours regarding concussion reporting (3 7-point Likert-scale questions; lower scores represent more favourable intended behaviours).

Main results 271 players (71%) recalled at least one concussion during their playing career; 249 (65%) recalled 1–5, 17 (4%) recalled 6-10 and 3 (1%) recalled >10 concussions. Knowledge scores (n=292) ranged from 0 to 5 correct answers out of 5; mean(SD) 3.4 (1.8). Attitudes scores (n=383) ranged from 42 to 98 out of a possible 98; mean(SD), 75.7 (11.9). Intended behaviour scores (n=383) ranged from 6 to 21 out of a possible 21; mean(SD), 10.2 (3.3). Spearmans Rank indicated that knowledge scores and concussion history were not associated with attitudes or intended behaviours; however, more favourable attitude scores were associated with more favourable intended behaviour scores (rs=−0.34, p<0.001).

Conclusions Concussion education interventions should focus on positively influencing player attitudes towards concussion as this has the greatest potential to improve player behaviour.

Competing interests Dr. Keith Stokes – Receives research funding from the Rugby Football Union

Dr. Simon Kemp – Employed by the Rugby Football Union

Miss Rachel Michell – Employed by Rugby Players Associationis

Dr. Martyn Standage, Dr. Carly McKay - None.