Objective Identify intra- and extra-personal factors influencing concussion disclosure in university athletes and describe their effects and interactions in an explanatory theoretical model.

Design Qualitative research using Straussian Grounded Theory.

Setting Semi-structured interviews.

Participants 9 university athletes, 5 females, 4 males, aged 18–26, from three team sports (soccer, rugby, and cheerleading).

Main Results First, we identified 24 factors divided into three intra-personal (Attitudes & Behaviors; Concussion Knowledge; Subjective Injury Severity) and two extra-personal categories (Socio-Cultural Pressures; Contextual Incentives) as determinants of concussion disclosure. Second, anchored around the core category Fear, we integrated these factors and categories into a grounded theory of concussion disclosure named Concussion Disclosure Theory (CDT). CDT posits that disclosure decisions are determined by the relative weight of two competing aversions: presence-aversion and absence-aversion. The factors identified seem to influence disclosure by generating one or both types of aversion. Our CDT also describes how most athletes adopt a non-disclosure bias strategy following a first concussion.

Conclusions Our work highlights the benefits of using qualitative methods to study concussion disclosure and the importance of systematically investigating both intra- and extra-personal factors. Decision-making mechanisms proposed by our CDT can be used to generate future hypotheses and help design interventions aimed at promoting concussion disclosure. For example, it suggests that educational interventions designed to generate more presence-aversion could reverse the non-disclosure bias and promote concussion disclosure. Future research should validate the components of our CDT and their mechanisms of influence on the disclosure decision-making process in more diverse populations.