Masculinity, optimism bias, and perceived pressure from stakeholders influence on student-athlete concussion reporting intentions and behavior.

Objective: Determine how a) masculinity, b) optimism bias, and c) perceived pressure from stakeholders predict concussion reporting intentions and behavior. Participants: Collegiate student-athletes (n = 369). Methods: Student-athletes completed surveys of Conformity to Masculine Norms Inventory-46 (nine sections), optimism bias (optimist, neutral, pessimist), perceived pressure from stakeholders (six stakeholder sections), reporting intentions (symptom and concussion), and behavior (symptom and concussion). Four separate stepwise multivariate regression analyses were conducted. Results: A one-point increase in playboy, heterosexual self-preservation, being neutral or optimist compared to a pessimist symptom reporting intention decreased. A one-point increase in sport primacy, perceived pressure from athletic administration, being neutral or optimist compared to pessimist concussion reporting intentions increased 0.05, and decreased 0.23, 0.35, and 0.32, respectively. A one-point increase in violence and playboy increased the odds of being a "non-reporter" by 30% and 40%. Conclusions: Pessimistic views regarding concussion risks may result in greater concussion reporting intentions, however these findings did not influence behavior.

A Qualitative Analysis of Concussion-Reporting Behavior in Collegiate Student-Athletes With a History of Sport-Related Concussion.

CONTEXT: Many survey-based methods have been used to explore concussion-reporting behavior. However, because the decision to report or conceal a concussion is likely multifactorial, this may narrow the findings, as the surveys were largely designed by the researchers. OBJECTIVE: To explore student-athletes' perspectives regarding factors that may influence the reporting of sport-related concussion. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division I athletics. PATIENTS OR OTHER PARTICIPANTS: We conducted 17 semistructured interviews with student-athletes who had sustained 1 or more concussions while attending a large university (men = 4, women = 13, age = 20.9 ± 1.3 years). DATA COLLECTION AND ANALYSIS: After data saturation and member checks, a 5-cycle analytic process was completed: topical review, literature review, data collection and summarizing using a codebook developed by a 3-person research team, linking of findings to current research, and final interpretations. RESULTS: We discovered 3 themes. Participants discussed concussion perceptions by describing their understanding of a concussion, their own injury experiences, and their perceptions of symptom severity and duration. Regarding reporting behavior, participants described an order of individuals with whom they would speak, symptoms present in order to report (eg, feeling different from normal), immediate reactions, and influential factors for mitigating short- and long-term consequences. Lastly, participants discussed the value of support systems, such as how coaches can both positively and negatively influence reporting and athletic trainer involvement. CONCLUSIONS: Participants often drew from their own concussion experiences in naming common concussion signs and symptoms. Additionally, they indicated that both short- and long-term health consequences influenced and deterred their seeking care and that their support systems, including coaches and athletic trainers, played a role in their concussion experience. Research is needed to determine if using student-athletes' own words to describe a concussion and incorporating student-athletes' support systems, especially coaches and athletic trainers, is effective in increasing concussion reporting.

Using the health belief model to predict concussion-reporting intentions and behaviour.

PURPOSE: To determine whether Health Belief Model (HBM) factors predict concussion-reporting intentions and behaviour. Methods: Participants completed a cross-sectional survey to measure the HBM constructs of concussion knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. We also asked participants to indicate their concussion-reporting intentions and behaviourfor symptom and concussion reporting. Four separate multivariable regressions were conducted to predict concussion-reporting intentions and behaviour based on HBM constructs. Results: Cues to action (ß = 0.25, p= .016) predicted symptom reporting intentions (F7,318 = 4.44, p< .001, R2 = 0.089), while perceived benefits (ß = 0.12, p= .018), perceived barriers (ß = -0.11, p= .034) and cues to action (ß = 0.29, p< .001) predicted concussion-reporting intentions (F7,318 = 11.34, p < .001, R2 = 0.200). The HBM did not predict symptom or concussion-reporting behavior (symptom: Χ2 = 5.51, p= .138, Nagelkerke R2 = 0.096; concussion: Χ2 = 5.20, p= .157, Nagelkerke R2 = 0.159). Conclusions: Strategies to reduce perceived barriers and increase benefits of reporting concussion symptoms may improve reporting intentions. This may include cues to action in sharing a positive view toward long-term health and dispelling that reporting a concussion would let down teammates. .

Examination of collegiate student-athlete concussion reporting intentions and behavior.

BACKGROUND: Clinicians rely on student-athletes to self-report concussion symptoms, but more than 50% of concussions go undisclosed. AIM: The aim of this study was to determine whether knowledge, attitudes, subjective norms, self-efficacy, social identity, and athletic identity explain variability in student-athlete concussion reporting intentions and behavior. MATERIALS AND METHODS: One hundred and forty-seven Division I and II collegiate student-athletes (male=23, female=56, missing=168; age=19.04±1.98 years) completed survey segments regarding the following predictor variables: Concussion knowledge, attitudes, subjective norms, self-efficacy, social identity, and athletic identity; and the following criterion variables: Reporting intentions (symptom and concussion reporting) and reporting behavior (symptom and concussion reporting) (completion rate=29.2%). Separate linear and logistic regressions were performed for each criterion variable. Backward elimination Akaike Information Criterion was applied to determine the best fit model. RESULTS: A one-point increase in knowledge, attitudes, and self-efficacy predicted a significant 0.55, 0.23, and 0.31 increase in symptom reporting intentions, and 0.24, 0.30, and 0.33 increase in concussion reporting intentions of concussion reporting. As self-efficacy increased, symptom reporting behavior increased by 140%. When knowledge increased, concussion reporting behavior decreased by 23%. Whereas when subjective norms increased, concussion reporting behavior increased by 23%. CONCLUSIONS: A student-athletes' confidence, or self-efficacy, was a frequent predictor of concussion reporting intentions and behavior. RELEVANCE FOR PATIENTS: Clinicians should aim to increase student-athlete knowledge, attitudes, and subjective norms, but most importantly their confidence in reporting concussions.

Coach, sports medicine, and parent influence on concussion care seeking intentions and behaviors in collegiate student-athletes.

BACKGROUND: Sport is a socio-ecological framework where student-athletes are part of a larger community of stakeholders, including coaches, sports medicine professionals (SMPs), and parents. This framework may hold influence over whether student-athletes seek care for a concussion. AIM: We aimed to describe, compare, and determine the influence of stakeholder concussion knowledge, attitudes, and concussion scenario responses. MATERIALS AND METHODS: We recruited a sample of 477 student-athletes and their 27 coaches (response rate=46.6%), 24 SMPs (48.7%), and 31 parents/guardians (4.8%). Stakeholder surveys assessed their concussion knowledge, attitudes toward care seeking, and concussion scenario responses. Surveys administered to student-athletes assessed their concussion care seeking intentions and behaviors. Kruskal-Wallis tests were used to compare responses between stakeholder groups and to determine the differences in student-athlete intentions and behaviors (alpha=0.05). RESULTS: SMPs had significantly better knowledge (p<0.001) and concussion scenario responses (p<0.001) compared to both coaches and parents. SMPs also had significantly better attitudes compared to parents, but not coaches (p=0.038). Coach concussion scenario responses (p=0.044) and SMP knowledge positively influenced student-athletes' concussion care seeking intentions (p=0.049). Parent responses were not associated with their child's concussion care seeking intentions and behaviors. CONCLUSIONS: The gap in coach and parent concussion knowledge and concussion scenario response relative to SMPs is a preliminary target for stakeholder concussion education and supports the current sports medicine model where SMPs primarily disseminate concussion education. Stakeholders, specifically coaches and SMPs, do hold influence over collegiate athlete concussion care seeking intentions and behaviors. RELEVANCE FOR PATIENTS: Stakeholders should be addressed within educational efforts aimed at student-athletes and should also complete stakeholder-specific concussion education.

Improving Concussion Reporting across National College Athletic Association Divisions Using a Theory-Based, Data-Driven, Multimedia Concussion Education Intervention.

Although a base level of knowledge is needed to recognize a concussion, knowledge-focused concussion educational materials ignore multifaceted barriers to concussion reporting. We compared student-athlete concussion reporting intentions and behaviors prior to and 1 year after exposure to an intervention or control treatment. We randomly assigned 891 collegiate student-athletes from three universities (Divisions I, II, III) to either the control group (National College Athletic Association [NCAA] Concussion Fact Sheet) or intervention group (theory-based, data-driven, multimedia, simulated concussion reporting module). A final sample of 520 student-athletes (control = 253, intervention = 267, expired eligibility = 189, left university = 182) completed intentions and behaviors surveys immediately prior to and 1 year after the educational intervention, and a second survey to assess the intervention effect. We compared intentions using 2 x 2 mixed model analyses of variance (ANOVAs). Behaviors and educational intervention effect were assessed using logistic regression models (α = 0.05). The intervention group had significantly improved concussion reporting intentions at 1-year follow-up relative to the control group (p = 0.009), but had similar odds for behaviors. The intervention group had 2.42 times greater odds of rating the module as "very effective," rather than "not effective" relative to the control group (95% confidence interval [CI]: 1.10,5.33). Relative to the control group, the intervention group had significantly greater odds of responding that the concussion education "greatly improved" rather than "did not improve" their knowledge (odds ratio [OR]: 2.49, 95% CI:1.25,4.96), attitudes (OR: 2.22, 95% CI: 1.23,4.03), self-efficacy (OR: 1.95,95% CI: 1.05,3.60), and intentions (OR: 1.86,95% CI: 1.03,3.35). The intervention was more effective at targeting elements of the overall sport culture in a way that substantively improved concussion reporting. We recommend use of this intervention in combination with other evidence-based educational materials.

Collegiate student-athlete sex, years of sport eligibility completed, and sport contact level influence on concussion reporting intentions and behaviours.

PRIMARY OBJECTIVE: The objective of this study was to determine whether sex, years of sport eligibility completed, and sport contact level influenced student-athletes' concussion reporting intentions and behaviours. RESEARCH DESIGN: Cross-sectional. METHODS AND PROCEDURES: Student-athletes (n = 828) reported their sex, years of sport eligibility completed, sport, and completed concussion reporting intentions and behaviours surveys. Nonparametric statistics were conducted to compare intentions and behaviours between groups (alpha = 0.05). MAIN OUTCOMES AND RESULTS: Females had higher indirect intentions to report concussion than males (p = 0.035), but did not differ in direct intentions (p = 0.258) or behaviours (indirect: p = 0.756; direct: p = 0.686). Intentions (indirect: p = 0.383; direct: p = 0.397) and behaviours (indirect: p = 0.154; direct: p = 0.999) did not differ between years of sport eligibility completed. Limited/non-contact sport student-athletes intended to report more concussions than those in collision/contact sports (indirect: p = 0.001; direct: p = 0.021), but did not differ in behaviours (indirect: p = 0.184; direct: p = 0.497). CONCLUSIONS: Data suggest that female and limited/non-contact sport student-athletes intended to report more concussions, however differences did not translate to reporting behaviours.

The propensity to adopt evidence-based practice among physical therapists.

BACKGROUND: Many authors, as well as the American Physical Therapy Association, advocate that physical therapists adopt practice patterns based on research evidence, known as evidence-based practice (EBP). At the same time, physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy. The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP. METHODS: The study used a 69 item mailed self-completion questionnaire. The questionnaire had four major sections. The first three sections were each drawn from a different theoretical framework and from different authors' work. The instrument was developed to capture the propensity of physical therapists to adopt EBP, characteristics of the social system in the workplace of physical therapists, personal characteristics of physical therapists, and selected demographic variables of physical therapists. The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America. A random sample of 1320 potential participants was drawn. RESULTS: 939 questionnaires were returned for a response rate of 73%. 831 of the participants' questionnaires were useable and became the basis for the study. There was a moderate association between desire for learning (r = .36, r2 = .13), highest degree held (r = .29, r2 = .08), practicality (r = .27, r2 = .07) and nonconformity (r = .24, r2 = .06) and the propensity to adopt EBP. A negative correlation was found between age, years licensed and percentage of time in direct patient care. The findings demonstrated that the best three variables for predicting the propensity to adopt EBP in physical therapy were: desire for learning, highest degree held, and practicality. CONCLUSION: The study confirms there is no single factor to facilitate research evidence into day-to-day practice. Multiple practice change strategies will be needed to facilitate change in practice.

Systems thinking: a new lens for old problems.

This article introduces systems thinking and identifies its implications for practice-based learning and improvement. The article defines systems, identifies fundamental aspects of systems thinking, and provides strategies for creating more practice-based learning environments in medical contexts.