Qualitative Study of Barriers to Concussive Symptom Reporting in High School Athletics

doi:10.1016/j.jadohealth.2012.10.271

Journal of Adolescent Health

Volume 52, Issue 3, March 2013, Pages 330-335.e3

https://doi.org/10.1016/j.jadohealth.2012.10.271 Get rights and content

Abstract

Purpose

To identify barriers to concussive symptom reporting in high school athletics.

Methods

We conducted a qualitative focus group study with varsity high school athletes from three football, two boys' soccer, and four girls' soccer teams in the Seattle, WA, area (50 participants). Professional moderators led the groups with a standardized script that discussed concussion knowledge as well as hypothetical concussion scenarios. Focus groups were recorded and transcribed, and transcripts were analyzed by two investigators using thematic analysis with Atlas.ti.

Results

Athletes could describe multiple signs and symptoms of concussion. Athletes also understood the dangers of concussions, and all groups mentioned the possibility of death or long-term disability. However, when confronted with scenarios involving concussive symptoms, athletes reported they would not stop playing. They would either continue to play (6/9 groups) or would take a brief break and then return to play (3/9 groups). Several barriers seemed to explain athletes' responses. Athletes wanted to keep playing and knew that reporting symptoms might result in being removed from the game. In addition, concussive symptoms were nonspecific, and thus could be mistaken for another etiology. Finally, athletes were hesitant to report symptoms to coaches if they did not result in significant pain or disability.

Conclusions

There are several barriers to concussive symptom reporting in high school athletics. Athlete concussion knowledge does not seem to be a barrier, but coach approachability may be an issue. Interventions that seek to improve coach communication with athletes regarding concussion management might increase symptom reporting.

Section snippets

Methods

We chose qualitative methods because little is known about barriers to and facilitators of concussive symptom reporting, and qualitative methods allowed us to explore the richness of subjects' experience without predetermined hypotheses [11]. We recruited a convenience sample of high school varsity athletes from three football, two boys' soccer, and four girls' soccer teams in the King County region (Seattle, WA), and conducted focus groups with athletes from each team. We chose football and

Demographics

We recruited a total of 50 varsity athletes (60% male) to participate in nine focus groups (Table 1 ). Participants were primarily 11th and 12th graders, with 76% between 16 and 18 years old, and the majority (64%) reported 10+ years of experience in their sport. Football players had less experience on average (6.5 years) than either female soccer players (10.8 years) or male soccer players (13.3 years). There was some variation in socioeconomic status, with representation from both public and

Athletes know concussions are dangerous

When asked to describe concussion, athletes listed a large number of signs and symptoms (Table 3 ). Every group mentioned impaired mental status (loss of consciousness, seeming “out of it”), most noted visual symptoms, headache and balance problems, and many brought up memory loss and nausea or vomiting. When listing these symptoms, athletes tended to describe their personal experiences of being concussed or their observations of friends and teammates. Most groups also mentioned consequences of

Discussion

To our knowledge, this is the first qualitative study of barriers to concussive symptom reporting. Although other authors have reported that athletes do not report concussive symptoms because of a lack of knowledge [6], [9], [10], we found that high school soccer and football players seemed to know a great deal about concussion. They could report a large number of signs and symptoms and they recognized the danger of concussion, mentioning risks of long-term disability or death. However, despite

Acknowledgments

This work was supported in part by a fellowship from the Ruth L. Kirchstein National Research Service Award. Results were presented as a poster at the 2011 annual meeting of the American Medical Society of Sports Medicine (Salt Lake City, Utah).

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: Conflicts of Interest: The authors have no conflicts of interest to disclose.

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Original articleQualitative Study of Barriers to Concussive Symptom Reporting in High School Athletics

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Demographics

Athletes know concussions are dangerous

Discussion

Acknowledgments

Clin Sports Med

J Clin Epidemiol

Organizational Behav Hum Dec Proc

Nonfatal traumatic brain injuries from sports and recreation activities: United States, 2001-2009

MMWR Morbid Mortal Wkly Rep

The second impact in catastrophic contact-sports head trauma

JAMA

Original article
Qualitative Study of Barriers to Concussive Symptom Reporting in High School Athletics