Secondary School Athletic Coaches' Perceptions and Knowledge of the Athletic Training Profession.

CONTEXT: Coaches play a role in streamlining care, especially by directing student-athletes in need of further medical attention to the athletic trainer (AT). The AT-coach relationship holds great potential for incorporating collaborative care, and yet, little is known about coaches' perceptions and knowledge of ATs. OBJECTIVE: To investigate coaches' perceptions of athletic training and their knowledge regarding the roles and responsibilities of ATs in secondary schools. DESIGN: Concurrent mixed-methods study. SETTING: Cross-sectional online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Secondary school athletic coaches from 10 sports with the highest participation rates during the 2017-2018 season (n = 1097). Most respondents were male (n = 795, 72.4%), and their average age was 44.7 ± 11.4 years. MAIN OUTCOME MEASURE(S): Participants completed a web-based questionnaire containing demographics and quantitative measures assessing their perceived value and knowledge of ATs, as well as open-ended questions. Descriptive statistics summarized the demographic data. Counts and percentage responses for quantitative measures were reported. Open-ended responses were analyzed using the general inductive approach. RESULTS: Approximately 93% of respondents considered an AT a trusted source of medical information and a key member of the sports medicine team. Most respondents selected injury prevention (98.9%), first aid and wound care (97%), therapeutic interventions (89.9%), and emergency care (85.8%) as skills ATs are qualified to perform. Forty-six percent of respondents were willing to coach without an AT employed. Coaches trusted ATs as part of the "athletic team" and as gatekeepers, referring student-athletes for advanced care when warranted. Regarding the AT role, coaches emphasized the treatment of minor injuries and the idea of "coverage versus care." CONCLUSIONS: Secondary school coaches valued the athletic training profession and were knowledgeable regarding various roles and responsibilities ATs frequently perform. However, they may view ATs as luxuries instead of necessities, as evidenced by the fact that just under half of responding coaches were willing to coach without an AT employed at the school.

Work-Family Conflict of Collegiate and Secondary School Athletic Trainers Who Are Parents.

CONTEXT: The work-life interface has been a much discussed and researched area within athletic training. The National Athletic Trainers' Association position statement on work-life balance highlighted the profession's interest in this topic. However, gaps in the literature remain and include the roles of time-based conflict and social support. OBJECTIVE: To compare work-family conflict (WFC) and social support among athletic trainers (ATs) employed in the 2 most common practice settings. DESIGN: Cross-sectional observational survey. SETTING: Collegiate and secondary school settings. PATIENTS OR OTHER PARTICIPANTS: A total of 474 (females = 231, males = 243) ATs who were employed in the collegiate (205, 43.2%) or secondary school (269, 56.8%) setting. MAIN OUTCOME MEASURE(S): Data were collected through a Web-based survey designed to measure conflict and social support. Likert responses were summed. Demographic information was analyzed for frequency and distribution. Independent t tests and Mann-Whitney U tests were calculated to determine group differences. Linear regression was used to determine if social support predicted WFC. RESULTS: Social provisions and WFC were negatively correlated, and the social provisions score predicted WFC. No WFC differences (P = .778) were found between collegiate and high school ATs even though collegiate ATs worked more hours (63 ± 11) during their busiest seasons compared with those in the high school setting (54 ± 13, P < .001). Similarly, no difference (P = .969) was present between men and women, although men worked more hours. Our participants scored highest on time-based WFC items. CONCLUSIONS: Work-family conflict was experienced globally in 2 of the most common athletic training settings and between sexes. This indicates WFC is universally experienced and therefore needs to be addressed, specifically with a focus on time-based conflict. In addition to time-management strategies, ATs need support from coworkers, peers, and family members.

Formal and Informal Work-Life Balance Practices of Athletic Trainers in Collegiate and University Settings.

CONTEXT: Organizational policies for work-life balance exist, but little is known about athletic trainers' (ATs') awareness of and willingness to use them. OBJECTIVE: To explore ATs' formal and informal work-life balance policies in the collegiate and university athletic training setting. DESIGN: Sequential mixed-methods study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: We sent 4673 e-mails to National Athletic Trainers' Association ATs (full-time employment for at least 1 year, nonacademic appointment); 1221 participants began our survey (access rate = 26.1%), and 783 completed the survey (64.1% completion rate). Demographics were as follows: men = 375 (48.0%) and women = 404 (51.7%); age = 36 ± 10 years; experience = 13 ± 9 years; years at current place of employment = 8 ± 8 years; and participants with children or minor dependents = 262 (33.5%). MAIN OUTCOME MEASURE(S): We created a 17-item instrument from an earlier qualitative study. A panel of experts (n = 3; employer, employee, and researcher) completed a content analysis. Variables of interest were confidence (scale = 1-4) and satisfaction (scale = 1-5) with policies. We used Pearson χ2 analyses to compare the effect of undergoing an orientation and the presence or absence of children on the main outcome measures. RESULTS: A majority of participants had experienced formal orientation through the human resources department (n = 522, 66.8%), the direct supervisor (n = 240, 30.7%), or a colleague (n = 114, 14.6%). However, many had received no orientation (n = 184, 23.6%). Those who had undergone orientation indicated greater confidence in knowing about (P < .001) and greater satisfaction with (P < .001) formal workplace policies and benefits. Those with children stated that they had greater confidence in knowing about (P < .001) and greater satisfaction with (P = .013) formal workplace policies and benefits. Those who had been oriented felt greater confidence in knowing about (P = .009) but no difference in satisfaction with (P = .060) informal workplace policies and benefits. We did not identify differences between those with and those without children regarding their confidence in knowing about (P = .653) or satisfaction with (P = .150) informal workplace policies and benefits. CONCLUSIONS: Athletic trainers in the collegiate and university setting were not confident in their knowledge of formal or informal work-life balance policies.

The Organizational Climate in Collegiate Athletics: An Athletic Trainer's Perspective.

CONTEXT: An organizational climate is largely based on an employee's perceptions of the working conditions in which he or she engages regularly. A multifaceted concept, the organizational climate is often formed by perceptions of employee welfare, rewards, and support. Achieving work-life balance is also a part of the climate. OBJECTIVE: To learn collegiate athletic trainers' perceptions of organizational climate and specifically how it may pertain to their work-life balance. DESIGN: Phenomenologic study. SETTING: Collegiate practice setting. PATIENTS OR OTHER PARTICIPANTS: Thirty athletic trainers working in the collegiate athletics setting took part in 1-on-1 phone interviews. The participants were 30.5 (interquartile range [IQR] = 7.75) years old and had been certified for 7 (IQR = 5) years and at their current position for 4 (IQR = 3) years. DATA COLLECTION AND ANALYSIS: Participants completed a phone interview that followed a semistructured framework. All transcribed interviews were analyzed using a phenomenologic approach. Researcher triangulation, expert review, and data saturation were used to establish credibility. RESULTS: Athletic trainers working in the collegiate athletics setting who had positive perceptions of their work-life balance described their organizational climate as family friendly. Our participants' supervisors allowed for autonomy related to work scheduling, which provided opportunities for work-life balance. These athletic trainers believed that they worked in a climate that was collegial, which was helpful for work-life balance. In addition, the importance of placing family first was part of the climate. CONCLUSIONS: The perceptions of our participants revealed a climate of family friendliness, supervisor support, and collegiality among staff members, which facilitated the positive climate for work-life balance. The mindset embraced the importance of family and recognized that work did not always have to supersede personal priorities.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part II: Benefits of and Barriers in the Athletics Model.

CONTEXT: The athletics model, in which athletic training clinical programs are part of the athletics department, is the predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of this model, particularly as it relates to organizational hierarchy. OBJECTIVE: To explore the perceived benefits of and barriers in the athletics model. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Divisions I and III. PATIENTS OR OTHER PARTICIPANTS: Eight full-time ATs (5 men, 3 women; age = 41 ± 13 years, time employed at the current institution = 14 ± 14 years, experience as a certified AT = 18 ± 13 years) working in the collegiate setting using the athletics model. DATA COLLECTION AND ANALYSIS: We conducted semistructured interviews via telephone or in person and used a general inductive approach to analyze the qualitative data. Multiple-analyst triangulation and peer review established trustworthiness. RESULTS: Two benefits and 3 barriers emerged from the data. Role identity emerged as a benefit that occurred with role clarity, validation, and acceptance of the collegiate AT personality. Role congruence emerged as a benefit of the athletics model that occurred with 2 lower-order themes: relationship building and physician alignment and support. Role strain, staffing concerns, and work-life conflict emerged as barriers in the athletics model. Role strain occurred with 2 primary lower-order themes: role incongruity and role conflict. CONCLUSIONS: The athletics model is the most common infrastructure for employing ATs in collegiate athletics. Participants expressed positive experiences via character identity, support, trust relationships, and longevity. However, common barriers remain. To reduce role strain, misaligning values, and work-life conflict, ATs working in the athletics model are encouraged to evaluate their relationships with coaches and their supervisor and consider team physician alignment. Moreover, measures to increase quality athletic training staff from a care rather than a coverage standpoint should be considered.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models.

CONTEXT: Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models. OBJECTIVE: To investigate the perceived benefits of and barriers in the medical and academic models. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Divisions I, II, and III. PATIENTS OR OTHER PARTICIPANTS: A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models. DATA COLLECTION AND ANALYSIS: We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility. RESULTS: In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative). CONCLUSIONS: The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part I: Quality-of-Life Comparisons and Commonalities Among the Models.

CONTEXT: Some anecdotal evidence has suggested that organizational infrastructure may affect the quality of life of athletic trainers (ATs). OBJECTIVE: To compare ATs' perspectives on work-life balance, role strain, job satisfaction, and retention in collegiate practice settings within the various models. DESIGN: Cross-sectional and qualitative study. SETTING: National Collegiate Athletic Association Divisions I, II, and III. PATIENTS OR OTHER PARTICIPANTS: Fifty-nine ATs from 3 models (athletics = 25, medical = 20, academic = 14) completed phase I. A total of 24 ATs (15 men, 9 women), 8 from each model, also completed phase II. DATA COLLECTION AND ANALYSIS: Participants completed a Web-based survey for phase I and were interviewed via telephone for phase II. Quantitative data were analyzed using statistical software. Likert-scale answers (1 = strongly disagree, 5 = strongly agree) to the survey questions were analyzed using the Kruskal-Wallis, Mann-Whitney U, and Cohen f tests. Qualitative data were evaluated using a general inductive approach. Multiple-analyst triangulation and peer review were conducted to satisfy data credibility. RESULTS: Commonalities were communication, social support, and time management and effective work-life balance strategies. Quantitative data revealed that ATs employed in the athletics model worked more hours (69.6 ± 11.8 hours) than those employed in the medical (57.6 ± 10.2 hours; P = .001) or academic (59.5 ± 9.5 hours; P = .02) model, were less satisfied with their pay (2.68 ± 1.1; χ2 = 7.757, P = .02; f = 0.394), believed that they had less support from their administrators (3.12 ± 1.1; χ2 = 9.512, P = .009; f = 0.443), and had fewer plans to remain in their current positions (3.20 ± 1.2; χ2 = 7.134, P = .03; f = 0.374). Athletic trainers employed in the academic model believed that they had less support from coworkers (3.71 ± 0.90; χ2 = 6.825, P = .03; f = 0.365) and immediate supervisors (3.43 ± 0.90; χ2 = 6.006, P = .050; f = 0.340). No differences in role conflict were found among the models. CONCLUSIONS: Organizational infrastructure may play a role in mediating various sources of conflict, but regardless of facilitators, ATs need to be effective communicators, have support networks in place, and possess time-management skills.

Exploring Summer Medical Care Within the National Collegiate Athletic Association Division I Setting: A Perspective From the Athletic Trainer.

CONTEXT: Over the last few decades, the National Collegiate Athletics Association (NCAA) has made changes related to the increase in sanctioned team activities during summer athletics. These changes may affect how athletic training services are provided. OBJECTIVE: To investigate the methods by which athletic training departments of NCAA institutions manage expectations regarding athletic training services during the summer. DESIGN: Mixed-methods qualitative and quantitative study. SETTING: The NCAA Division I. PATIENTS OR OTHER PARTICIPANTS: Twenty-two athletic trainers (13 men, 9 women) participated. All were employed full time within the NCAA Division I setting. Participants were 35 ± 8 years of age (range, 26-52 years), with 12 ± 7 years (range, 3-29 years) of athletic training experience. DATA COLLECTION AND ANALYSIS: All participants completed a series of questions online that consisted of closed- (demographic and Likert-scale 5-point) and open-ended items that addressed the research questions. Descriptive statistics, frequency distributions, and phenomenologic analyses were completed with the data. Peer review and multiple-analyst triangulation established credibility. RESULTS: Summer athletic training services included 3 primary mechanisms: individual medical care, shared medical care, or a combination of the 2. Participants reported working 40 ± 10 hours during the summer. Likert-item analysis showed that participants were moderately satisfied with their summer medical care structure (3.3 ± 1.0) and with the flexibility of summer schedules (3.0 ± 1.2). Yet the qualitative analysis revealed that perceptions of summer medical care were more positive for shared-care participants than for individual- or combination-care participants. The perceived effect on the athletic trainer included increased workload and expectations and a negative influence on work-life balance, particularly in terms of decreased schedule flexibility and opportunities for rejuvenation. For many, the summer season mimicked the hours, workload, and expectations of the nontraditional season. CONCLUSIONS: The NCAA rule changes and medical care expectations affected the summer workload of athletic trainers, but job sharing seemed to help them manage conflict associated with providing summer athletic training services.

Experiences of Work-Life Conflict for the Athletic Trainer Employed Outside the National Collegiate Athletic Association Division I Clinical Setting.

CONTEXT: The intercollegiate setting receives much of the scholarly attention related to work-life conflict (WLC). However research has been focused on the National Collegiate Athletic Association Division I setting. Multiple factors can lead to WLC for the athletic trainer (AT), including hours, travel, and lack of flexibility in work schedules. OBJECTIVE: To investigate the experiences of WLC among ATs working in the non-Division I collegiate setting and to identify factors that contribute to fulfillment of work-life balance in this setting. DESIGN: Qualitative study. SETTING: Institutions in the National Collegiate Athletic Association Divisions II and III, the National Association of Intercollegiate Athletics, and the National Junior College Athletic Association. PATIENTS OR OTHER PARTICIPANTS: A total of 244 ATs (128 women, 114 men; age = 37.5 ± 13.3 years, experience = 14 ± 12 years) completed phase I. Thirteen participants (8 women, 5 men; age = 38 ± 13 years, experience = 13.1 ± 11.4 years) completed phase II. DATA COLLECTION AND ANALYSIS: For phase I, participants completed a previously validated and reliable (Cronbach α > .90) Web-based survey measuring their levels of WLC and work-family conflict (WFC). This phase included 2 WFC scales defining family; scale 1 defined family as having a partner or spouse with or without children, and scale 2 defined family as those individuals, including parents, siblings, grandparents, and any other close relatives, involved in one's life. Phase II consisted of an interview. Qualitative data were evaluated using content analysis. Data source and multiple-analyst triangulation secured credibility. RESULTS: The WFC scores were 26.33 ± 7.37 for scale 1 and 20.46 ± 10.14 for scale 2, indicating a moderate level of WFC for scale 1 and a low level of WFC for scale 2. Qualitative analyses revealed that organizational dimensions, such as job demands and staffing issues, can negatively affect WLC, whereas a combination of organizational and personal dimensions can positively affect WLC. CONCLUSIONS: Overload continues to be a prevalent factor in negatively influencing WLC and WFC. Supervisor and peer support, personal networks, and time away from the role positively influenced work-life balance and WFC. Athletic trainers are encouraged to support one another in the workplace, especially when providing flexibility in scheduling.