Objective To describe thoughts that impede concussion reporting and those that might facilitate reporting in student-athletes that completed a concussion reporting worksheet as part of a peer concussion education program (PCEP).

Design Document review with qualitative data analysis.

Setting During a randomized controlled trial, 30 teams with relatively high concussion rates from 10 colleges/universities across all 3 NCAA divisions received the PCEP.

Participants Worksheets were returned from 503/773 (65%) male and female athletes.

Interventions (or Assessment of Risk Factors) Two peer concussion educators provided an education module to their teammates designed to enhance concussion reporting based on cognitive-behavioral therapy (CBT).

Outcome Measures Worksheets where student-athletes identify thoughts that impede concussion reporting and replace them with thoughts that might facilitate reporting.

Main Results Qualitative data analysis of thoughts that impede reporting yielded 11 themes including concerns about losing playing time, letting down teammates, losing one’s spot on the team, ending a career, having a negative impact on fitness and skill level, game and situational factors, negative reactions from teammates and coaches, uncertainty about symptoms, adverse impact on academic functioning, and missing out on social activities. Analysis of thoughts that might facilitate reporting led to 10 themes including reporting aids athletic performance, helps the team, will result in quicker return to play, protects against long-term health implications, will be supported by my coach and teammates, and has academic advantages.

Conclusions A worksheet activity based on CBT indicated that student-athletes are capable of changing their thinking in a manner that has the potential to support concussion reporting.