Qualitative study of barriers to concussive symptom reporting in high school athletics

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.