Research Article: Socioecological influences on concussion reporting by NCAA Division 1 athletes in high-risk sports

Date Published: May 8, 2019

Publisher: Public Library of Science

Author(s): Steven R. Corman, Bradley J. Adame, Jiun-Yi Tsai, Scott W. Ruston, Joshua S. Beaumont, Jessica K. Kamrath, Yanqin Liu, Karlee A. Posteher, Rikki Tremblay, Lisa J. van Raalte, Iratxe Puebla.


Concussion among athletes is an issue of growing concern, with efforts underway to improve detection, diagnosis, and treatment. Success depends on communication by athletes, as brain-related symptoms are often not outwardly visible. Education programs to increase reporting behavior have not been successful to date. In accordance with the socioecological approach to health, we argue that multiple levels of influence on student athletes must be addressed, and report a multi-dimensional, mixed-methods research project conducted to identify possible points of intervention into changing the culture of concussion-injury reporting among collegiate athletes. Using quantitative, qualitative and interpretive methods, we examine the individual-level vested interests athletes have in reporting or not reporting concussion symptoms, and how these interests interact with community-level team culture and interpersonal relationships, and social-level cultural narratives to influence concussion-reporting behavior. Our findings confirm the viability of this approach, identifying immediacy, separation of responsibility and pain-enduring story systems as particularly salient elements. We conclude that competing performance versus safety value structures, reflected in cultural narratives and team culture, create mixed-messages for athletes, which are resolved in favor of performance because athletes perceive concussion injuries to be of low immediacy.

Partial Text

Awareness of concussions as a problem in college sports has been on the rise in recent years. Though playing sports—particularly those involving intentional contact—has always carried a risk of concussion, a growing list of NFL players diagnosed with chronic traumatic encephalopathy (CTE; including sufferers who have committed suicide [1,2]) has dramatically raised concern about the issue. As public consciousness has grown, medical research into the effects of concussion has increased [3]. This has caused growing worry by parents [4,5], a corresponding push by schools, athletic associations, and city/state governments to establish safety and treatment protocols, and alarm in some quarters that the long-term future of youth contact sports is at risk [6]. For example, recent reports show that participation in high school football is down in 40 U.S. states [7].

Unlike other kinds of athletic injuries, concussions involve various symptoms, which may not be outwardly visible and might take time to manifest. Therefore, effective treatment relies on communication of symptoms by athletes to ATs. Above, we argued that the existing approach of educating athletes about concussion symptoms and risks is flawed because it relies on a one-size-fits-all approach and fails to consider factors other than individual attitudes. We proposed that vested interests, which mediate between attitudes and concordant behavior, are one potential influence on athletes’ SHI reporting behaviors. Drawing on a socioecological approach, we also noted that attitudes and vested interests are embedded in systems of organizational culture, which also play a role in athletes’ willingness to report severe head impacts (SHIs) and possible concussion symptoms. Both the individual and interpersonal/community levels are contextualized by the cultural narratives reported by Ruston, et al. [56]




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