“It’ll never happen to me” appears in the concussion reporting mess

Masculinity, optimism, and perceived stakeholder pressure influence concussion prevention intentions and behaviors in college students and athletes.

Weber Rawlins ML, Welch Bacon CE, Tomporowski P, Gay JL, Bierema L, Schmidt JD. J Am Coll Health. 2022 Sep 9:1-7. doi: 10.1080/07448481.2022.2115300. E-publishing prior to printing.

https://pubmed.ncbi.nlm.nih.gov/36084227/

Take home message

Student-athletes with a pessimistic view of concussion risk have higher intentions to report symptoms or a concussion.

Background

Doctors rely on student-athletes to report a possible concussion to ensure proper diagnosis and treatment. We can optimize education efforts to improve concussion reporting with a better understanding of the barriers to concussion reporting. Three emerging areas that may influence messaging are masculinity (qualities traditionally associated with men), optimism (thinking that bad things are less likely to happen to the person than others), and perceived pressure from stakeholders (e.g., coaches, teammates).

Study aim

Weber Rawlins and colleagues completed a survey study to determine how masculinity, optimism, and perceived pressure from others were related to reporting intentions and behavior.

Methods

Student-athletes from three universities in the southeastern US used online survey software to complete five tools that assessed key factors:

1. masculinity (winning, emotional control, risk taking, violence, power over women, playboy, self-reliance, primacy of sports and heterosexual self-presentation)
2. optimism bias
3. perceived pressure (from coaches, teammates, parents/guardians, sports medicine professionals, athlete administrators, and sports fans)
4. concussion and symptom reporting intentions (summarized as reporter or non-reporter)
5. concussion and symptom reporting behavior (summarized as reporter or non-reporter)

Results

A total of 313 respondents completed all parts of the survey, and 369 respondents completed at least one part of the survey. A student-athlete was less likely to report symptoms or a concussion if he was not a pessimist (neutral or optimist). Furthermore, they were less likely to report symptoms if they reported higher levels of masculinity in two domains: “playboy” and “heterosexual self-preservation.” In terms of intent to report concussions, someone with higher scores for “primacy of the sport” and “pressure from athletic administration” was less likely to report it.

Viewpoints

Interestingly, the most consistent result was that someone who was neutral or less likely to experience bad events than someone else was less likely to report symptoms or a concussion. Based on this finding, the authors suggest that “educational efforts should emphasize the realistic risk that student-athletes have for sustaining a concussion in sport or developing long-term health consequences as a result of that concussion.” The authors also reported predictors of reporting behavior during the previous year. These analyzes led to different results than what we reported above. One explanation is that reporting intentions and actual behavior do not match. However, it is difficult to compare these results because only 10-20% of participants had symptoms or a concussion to report (or not report) in the previous year. Therefore, the different results could be a fluke, or this subset of people may be unique to the remaining 80-90% of participants without concussions or symptoms in the previous year. It will be interesting to see if future studies with a larger group of people with symptoms or concussions in the previous year yield similar results.

Clinical implications

Clinicians should encourage timely reporting of concussions and provide realistic estimates of a student-athlete’s risk for concussion and the consequences of a concussion.

Questions for discussion

What strategies have you used to educate stakeholders about the dangers of not reporting concussions? Have you found these efforts to be successful? Why or why not?

Written by: Kyle Harris
Review by: Jeffrey Driban

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