Common Misconceptions About Traumatic Brain Injury Among Ethnic Minorities With TBI

Community resource facilitation use by ethnic minority groups with traumatic brain injury in the Midwestern United States

OBJECTIVE

This study surveyed the use of community-based resource facilitation (RF) services by ethnic minority survivors of traumatic brain injury (TBI) living in the Midwestern United States.

METHOD

Past records of RF use by survivors of TBI were reviewed. Demographics and patterns of RF use across 3 ethnic groups were documented. Reported barriers to community integration related to ethnic identity were identified using Chi-square test of independence.

RESULTS

Ethnic minority survivors were less likely to use RF services than white survivors. Caucasian women and men utilized RF services at similar rates, whereas more African American men and Latina women used RF services. Caucasians received information about RF from a greater variety of sources than ethnic minority survivors. Ethnic identity was significantly associated with greater reported needs for TBI awareness.

CONCLUSIONS

A pattern of differential RF use by survivors from ethnic minority groups was noted, suggesting potential socio-cultural influences on help-seeking behavior after TBI. These factors should be considered to develop more accessible and equitable strategies of RF service referral and support. Future investigations of cultural perspectives of TBI and injury-related services may improve understanding of the likelihood and necessity of community-based RF service use by diverse populations.

Neurobehavioral Symptoms in Spanish-Speaking Individuals With Subconcussive Injuries

OBJECTIVE

To examine whether exposure to high-risk events causing injury to the head or neck has an effect on neurobehavioral symptoms in the absence of an alteration of consciousness in Spanish-speakers.

SETTING

Web-based survey.

PARTICIPANTS

Seven hundred forty-eight individuals from Spain and Latin America, aged 18 to 65 years, with 10 years or more of education. Thirty-nine participants failed quality checks and were excluded. Seven hundred nine participants were included in the analyses.

DESIGN

Cross-sectional study. Subconcussive exposure was defined as endorsing exposure to one or more high-risk scenarios in the absence of any alteration of consciousness. Three injury groups were derived: No Head Injury, Subconcussive Exposure, and traumatic brain injury (TBI). The Subconcussive Exposure group was further divided into Single and Multiple Exposures. Two analyses were conducted: the effect of lifetime exposure to injury (No Head Injury, Subconcussive Exposure, TBI) on neurobehavioral symptoms; the effect of Subconcussive Exposure Frequency (No Head Injury, Single Exposure, Multiple Exposures) on neurobehavioral symptoms.

MAIN MEASURES

Spanish Ohio State University Traumatic Brain Injury Identification Method Self-Administered-Brief (OSU TBI-ID SAB); Neurobehavioral Symptom Inventory (NSI).

RESULTS

There was a significant effect for Injury group on the NSI partial eta-squared (ηp2 = 0.053) and a significant effect of Exposure Frequency group on the NSI (ηp2 = 0.40). Individuals with subconcussive exposures reported significantly more neurobehavioral symptoms than those with no history of head injury and significantly less symptoms than those with TBI. Individuals with multiple subconcussive exposures reported significantly more neurobehavioral symptoms than those with single and no exposure.

CONCLUSION

This research expands the utility of the OSU-TBI-ID SAB as a lifetime TBI history assessment tool to one capable of evaluating subconcussive exposure dosing effects in Spanish-speakers. Such an index may facilitate establishment of subconcussive exposure prevalence rates worldwide, leading to improved understanding of the chronic effects of high-risk exposures.

Misconceptions about traumatic brain injury among nursing students: A cross-sectional study

AIM

This study aimed to evaluate nursing students' potential misconceptions about traumatic brain injuries and the relationship between these misconceptions and students' sociodemographic characteristics.

BACKGROUND

Although traumatic brain injuries have severe consequences, misconceptions about traumatic brain injury are widespread among healthcare professionals. Studying misconceptions about traumatic brain injury among nursing students can help enhance nursing curricula for better traumatic brain injury care and rehabilitation.

DESIGN

This is a cross-sectional observational study reported according to the STROBE guideline.

METHODS

We conducted a survey among nursing students in Morocco using a questionnaire "Common Misconceptions about Traumatic Brain Injury". A total of 550 nursing students from multiple nursing institutes in different cities in Morocco participated in the study. We calculated the average percentage of misconceptions for 7 different questionnaire domains. To study the relationship between misconceptions and sociodemographic factors, we used a t-test for independent samples and ANOVA, considering the total score for each participant.

RESULTS

Out of the 550 nursing students who participated in the study, most were female and the 20-21 years old category represented two-thirds of our sample. The domain related to "Amnesia" had the highest rate of misconceptions, followed by "Recovery", while the "brain damage" domain had the lowest rate of misconceptions. The overall mean score of misconceptions was higher than the value defined in our study as a reference cut-off. Interestingly, there were significant differences in the total score of misconceptions based on variables such as age, state of origin, city of the Institute and year of study.

CONCLUSIONS

Misconceptions about traumatic brain injuries were prevalent among nursing students, which could have a negative impact on patient assessment, treatment and education. The findings indicate the need to improve the level of knowledge related to traumatic brain injury among nursing students and to strengthen the nursing curriculum in Morocco.

A psychometric evaluation of a new social subscale for the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire: toward the CM-TBI-II

OBJECTIVE

Existing TBI misconception measures are critiqued for failing to measure postinjury social experiences. This study developed a social subscale for the Common Misconceptions about TBI (CM-TBI) questionnaire for use in the general public.

METHODS

Seven experts independently review items drawn from the literature. Shortlisted items were administered online to 158 adults (aged ≥18 years; 51% postschool educated; 60% no TBI experience), the CM-TBI, and a measure of construct validity (a published TBI-adaptation of the Community Attitudes Towards the Mentally Ill; CAMI-TBI). One week later, the new items were redeployed (n = 46).

RESULTS

Expert review and iterative correlations identified a 10-item social subscale (internal consistency, test-retest reliability, α's>.80). When added to the CM-TBI (ie. CM-TBI-II), the internal consistency was .71. The social subscale was significantly correlated with CAMI-TBI measures (p's <.05, r's > .3). There was no significant difference on the social subscale for education subgroups (school vs post-school, p = 0.056) or previous TBI experience; but there was a difference for the CM-TBI-II (post-school>school; Cohen's d = 7.83, large effect).

CONCLUSION

This study found strong preliminary psychometric support for a new social subscale, administered as the CM-TBI-II. This subscale shows promise as a measure of misconceptions about social functioning post-TBI. The CM-TBI-II could support evaluations of programs aiming to improve social engagement and community participation for people with TBI.

Preliminary findings on TBI knowledge of professionals working with justice-involved youth

Professionals working with justice-involved youth (JIYs) play a critical role in identifying and providing supports and services related to traumatic brain injury (TBI). The aim of this study was to better understand the knowledge of TBI of professionals working with JIYs, a research priority identified by the National Conference of State Legislatures. Fifty employees of an urban juvenile court system completed an online survey about their TBI knowledge. Respondents scored an average of 77.31% correct, yet patterns emerged in item responses and based on participant characteristics that indicate opportunities for training and education on TBI. The results of this preliminary study provide foundational evidence on TBI knowledge of professionals working with JIYs, inform future TBI-related trainings and education provided to professionals working with JIYs, and inform other practices and policies related to JIYs with TBI.

Predictors of Missed Follow-up Visits in the National Traumatic Brain Injury Model Systems Cohort Study

OBJECTIVE

To identify key variables that could predict risk of loss to follow-up (LTFU) in a nationally funded longitudinal database of persons with traumatic brain injury.

DESIGN

Secondary analysis of a prospective longitudinal cohort study.

SETTING

Traumatic Brain Injury Model System (TBIMS) Centers in the US.

PARTICIPANTS

A total of 17,956 TBIMS participants (N=17,956) with interview status data available were included if eligible for 1-, 2-, 5-, 10-, 15-, or 20-year follow-ups between October 31, 1989, and September 30, 2020.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Follow-up data collection completion status at years 1, 2, 5, 10, 15, and 20.

RESULTS

Information relevant to participants' history, injury characteristics, rehabilitation stay, and patterns of follow-up across 20 years were considered using a series of logistic regression models. Overall, LTFU rates were low (consistently <20%). The most robust predictors of LTFU across models were missed earlier follow-ups and demographic factors including Hispanic ethnicity, lower education, and lack of private health insurance.

CONCLUSIONS

Efforts to retain participants in such social disadvantaged or minority groups are encouraged given their disproportionate rate of LTFU. Repeated attempts to reach participants after a previously missed assessment are beneficial because many participants that missed 1 or more follow-ups were later recovered.

Misconceptions About Traumatic Brain Injuries in Five Sub-Saharan African Countries

Background Traumatic Brain Injury (TBI) remains a significant problem in certain regions of the world but receives little attention despite its enormous burden. This discrepancy could consequently lead to various misconceptions among the general public. This study evaluated misconceptions about TBI in five African countries. Methods Data for this cross-sectional study were collected using the Common Misconception about Traumatic Brain Injury (CM-TBI) questionnaire, which was electronically disseminated from January 16 to February 6, 2021. Associations between the percentage of correct answers and independent variables (i.e., sociodemographic characteristics and experience with TBI) were evaluated with the ANOVA test. Additionally, answers to the question items were compared against independent variables using the Chi-Square test. A P-value <0.05 was considered statistically significant. Results A total of 817 adults, 50.2% female (n=410), aged 24.3 ± 4.3 years, and majoritarily urban dwellers (94.6%, n=773) responded to the survey. They had received tertiary education (79.2%, n=647) and were from Nigeria (77.7%, n=635). Respondents had few misconceptions (mean correct answers=71.7%, 95% CI=71.0-72.4%) and the amnesia domain had the highest level of misconception (39.3%, 95% CI=37.7-40.8%). Surveyees whose friends had TBI were more knowledgeable about TBI (mean score difference=4.1%, 95% CI=1.2-6.9, P=0.01). Additionally, surveyees whose family members had experienced TBI had a better understanding of brain damage (mean score difference=5.7%, 95% CI=2.1-9.2%, P=0.002) and recovery (mean score difference=4.3%, 95% CI=0.40-8.2%, P=0.03). Conclusion This study identified some misconceptions about TBI among young adult Africans. This at-risk population should benefit from targeted education strategies to prevent TBI and reduce TBI patients' stigmatization in Africa.

Video-consulting to address mental health needs after traumatic brain injury: evaluation of a training workshop to build capacity among psychologists

BACKGROUND

Traumatic brain injury (TBI) can lead to significant psychological distress, but few psychologists in Australia are trained in working with this complex clinical group. Despite government funding to provide video-consulting (VC) services in Australia, uptake before COVID-19 was limited.

OBJECTIVE

This mixed methods study evaluated whether training in eHealth and evidence based TBI psychological therapies increased provider uptake of VC in clinical practice, and delivery of mental health services to individuals with TBI.

METHODS

Mental health professionals completed a range of self-report measures before (n = 50), after (n = 48), and four months following (n = 30) a one-day workshop. Participants' TBI knowledge, client-base and levels of access, confidence, motivation and attitudes toward VC were assessed. Knowledge did not increase after training but participants had significant increases in their confidence and motivation to using VC at follow up. Significant reductions in pragmatic barriers to using VC were reported post training and at follow up, all barrier categories indicated significant reductions. There was no significant change in clinical practice of the participants.

CONCLUSIONS

Training to increase TBI knowledge requires specific assessment tools and although training appears to reduce barriers to using VC, uptake in clinical practice may require additional supervision and warrants further research.

Assessing lifetime exposure to traumatic brain injury among an international sample of Spanish speakers

BACKGROUND

With structured interviews being an established method for assessing one's exposure to traumatic brain injury across their lifetime, effective assessment tools are needed to serve the large population of Spanish speakers in the U.S. and abroad.

OBJECTIVE

To obtain preliminary evidence of validity for a Spanish version of a web-based, structured interview designed to assess lifetime exposure to TBI.

METHODS

A sample of 720 Spanish-speaking individuals between the ages of 18 through 65 from the continental U.S. (34.3%), South America (30.8%), the Caribbean (12.6%), Spain (12.4%), and Mexico and Central America (9.9%) completed an online survey containing the Ohio State University Traumatic Brain Injury Identification Method (Self-Administered-Brief; OSU TBI-ID SAB), Neurobehavioral Symptom Inventory, and PROMIS Cognitive Concerns Scale.

RESULTS

Indices of severity of worst TBI, time since most recent TBI, and multiple injuries demonstrated expected relationships with neurobehavioral symptoms such that greater symptom reporting was observed among those who had more severe injuries, more recent injuries, and multiple injuries over a period of time.

CONCLUSIONS

Findings provide preliminary evidence of validity for three of the indices derived from OSU TBI-ID SAB among Spanish-speaking individuals. Further study is needed to assess other aspects of this instrument to pave the way for further epidemiological studies involving lifetime exposure to TBI among Spanish-speaking individuals across the U.S., Spain, and Latin America.

Soy diferente: a qualitative study on the perceptions of recovery following traumatic brain injury among Spanish-speaking U.S. immigrants

PURPOSE

To explore the impact of traumatic brain injury (TBI) on the quality of life (QoL) and self-concept of Spanish-speaking U.S. Hispanic immigrants with TBI.

MATERIALS AND METHODS

A prospective, qualitative study conducted in a county level I trauma center and community. Semi-structured interviews on QoL and self-concept following TBI were conducted with 24 Spanish-speaking U.S. Hispanic immigrants with TBI living in the community at least 6 months following injury.

RESULTS

Perceived facilitators of QoL included faith, hopefulness in recovery, empathy for others, and support from others. Perceived barriers to QoL mentioned were symptoms/consequences of injury, employment/financial changes, loss of independence, fear/uncertainty, stigma/shame, lack of medical care, and decreased social integration. Participants described their self-concept after TBI as either a maintained self or loss of self. Those who viewed themselves differently reported physical and emotional changes, gender role conflict, loss of self-worth, and total loss due to the TBI.

CONCLUSIONS

Spanish-speaking U.S. Hispanic immigrants held a strong faith and positive outlook after TBI in spite of the significant barriers to recovery. A need exists for programs to support creatively the recovery of Spanish-speaking U.S. Hispanic immigrants with limited access to care and resources.IMPLICATIONS FOR REHABILITATIONSpanish-speaking U.S. Hispanic immigrants may experience significant barriers to care following traumatic brain injury (TBI), such as access to rehabilitation services and follow-up care.Rehabilitation professionals should consider the importance of faith and encourage positive thinking and social support when working with Spanish-speaking U.S. Hispanic immigrants on how to cope with TBI-related challenges.Access to Spanish-speaking rehabilitation professionals, translators and Spanish language educational materials could help reduce language-related barriers to recovery among Spanish-speaking U.S. immigrants with TBI.Rehabilitation facilities should develop partnerships with community-based organizations serving the uninsured or underinsured to address the access to rehabilitation and medical needs of Spanish-speaking U.S. immigrants with TBI.

Relationship Between Hispanic Nativity, Residential Environment, and Productive Activity Among Individuals With Traumatic Brain Injury: A TBI Model Systems Study

OBJECTIVE

To examine the influence of nativity and residential characteristics on productive activity among Hispanics at 1 year after traumatic brain injury (TBI).

SETTING

Acute rehabilitation facilities and community follow-up.

PARTICIPANTS

A total of 706 Hispanic individuals in the TBI Model Systems National Database.

DESIGN

Secondary data analysis from a multicenter longitudinal cohort study.

MAIN MEASURES

Nativity (foreign born or US native), productive activity derived from interview questions regarding employment status, and other demographic information. Census data were extracted by zip code to represent residential characteristics of aggregate household income and proportion of foreign language speakers (FLS).

RESULTS

Among foreign-born individuals with TBI, those living in an area with a higher proportion of FLS were 2.8 times more likely to be productive than those living in areas with a lower proportion of FLS. Among individuals living in an area with a lower proportion of FLS, US-born Hispanics were 2.7 times more likely to be productive compared with Hispanic immigrants.

CONCLUSION

The relationship between nativity and productive activity at 1 year post-TBI was moderated by the residential proportion of FLS. Findings underscore the importance of considering environmental factors when designing vocational rehabilitation interventions for Hispanics after TBI.

Misconceptions about traumatic brain injury among nursing students in India: implications for nursing care and curriculum

Background

Despite the devastating consequences of Traumatic brain injuries (TBIs), TBI misconceptions are common among healthcare professionals. As an essential member of multi-professional team providing TBI care, it is important that nurses have correct information and adequate skills to achieve the best possible outcomes for TBI. For example, some common misconceptions about TBIs are that a second blow to the head can improve memory functioning and wearing seatbelts can cause as many brain injuries as it prevents. In India, perhaps such misconceptions towards TBI among nursing professionals were not yet documented. As nursing students form the future health workforce, understanding TBI misconceptions among nursing students in resource-limited settings like India will provide useful information for strengthening the nursing curricula for improved care and rehabilitation of TBIs.

Methods

We used a cross-sectional survey to study the TBI misconceptions among nursing students in India. A Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire was administered to 154 nursing students from a nursing college of a tertiary care neuro-centre in India. The mean percentage of misconceptions were calculated for 7-domains of CM-TBI. T-test for independent samples and ANOVA were used to study the association of misconception with socio-demographic variables using total score for each respondent.

Results

Of the 143 nursing students who completed the survey, majority of them were female (97%) and in the 19-20 year age-group (95.1%). Domain on brain damage (81.1%) had highest rate, while amnesia domain (42.0%) had lowest rate of misconception. The overall mean-score was 22.73 (Standard Deviation: 4.69) which was significantly higher than the median score of 19.5. The study did not show significant differences on overall misconceptions about TBI for any of the socio-demographic characteristics.

Conclusions

Misconceptions about TBIs were common among nursing students and it was pervasive irrespective of age, gender, place of residence and year of education. A need to strengthen nursing curriculum in the area of TBIs has been emphasized for improved care and management of TBIs. The study findings also suggest the need for understanding such misconceptions among other healthcare professionals involved in TBI care.

Availability of Concussion Information in Spanish for Parents of Youth Athletes

All but one U.S. state has passed legislation requiring that concussion information be provided to parents of youth participants in school-sponsored sport. Such information should be accessible and easily understood if it is to be used by parents to make informed decisions regarding their children's health and safety. Accessing and understanding information about concussion may be challenging for parents who lack fluency in English. The current study sought to describe the extent and nature of Spanish-language concussion information available on the websites of U.S. public high school athletic associations. We also examined information provided by leading youth sports and health organizations as well as the top U.S. children's hospitals. We sought to quantify the proportion of these websites with Spanish-language translation of concussion education materials and describe the readability, accessibility, and completeness of these translations. Only one quarter of the websites examined contained any concussion information in Spanish, and none of these websites offered a mirrored Spanish-language translation. Spanish information was also difficult to access, with the search process requiring English-language ability. Finally, the readability of the concussion information in both English and Spanish was higher than recommended guidelines. Our findings suggest that non-English-speaking parents may be inadequately informed about concussion because translation of concussion educational materials is absent, incomplete, or hard to access. This raises questions about whether they are able to provide informed consent for their children's participation in contact sport and suggests the need for improved translation of such informational materials.

Cluster Analysis of Vulnerable Groups in Acute Traumatic Brain Injury Rehabilitation

OBJECTIVE

To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers.

DESIGN

Cluster analysis of historical patient data obtained from inpatient visits.

SETTING

Inpatient rehabilitation unit in a large urban university hospital.

PARTICIPANTS

Adult patients (N=148) receiving acute inpatient care, predominantly for closed head injury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

We examined the membership of patients with traumatic brain injury in various "vulnerable group" clusters (eg, homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of patients (eg, duration of stay, changes in FIM scores between admission to inpatient stay and discharge).

RESULTS

The cluster analysis revealed 4 major clusters (ie, clusters A-D) separated by vulnerable group memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the 4 clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple socioeconomic status vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores.

CONCLUSIONS

Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various "at-risk" groups. The results identified patients (ie, cluster B, with minority patients; and cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. The results also suggested that systemic (eg, duration of stay) or clinical service improvements (eg, staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals, liaise with intensive social work services, or plan subacute rehabilitation phase) could be beneficial for acute settings. Stronger recruitment, training, and retention initiatives for bilingual and multiethnic professionals may also be considered to optimize gains from acute inpatient rehabilitation after traumatic brain injury.

Effectiveness of an Educational Intervention on Reducing Misconceptions Among Ethnic Minorities With Complicated Mild to Severe Traumatic Brain Injury

OBJECTIVE

To evaluate the effectiveness of an educational intervention designed to reduce traumatic brain injury (TBI)-related misconceptions among blacks and Latinos with complicated mild to severe TBI.

DESIGN

Randomized controlled trial with masked 1-month follow-up.

SETTING

Community.

PARTICIPANTS

Persons (N=52) with complicated mild to severe TBI (mean best day 1 Glasgow Coma Scale score, 11.27±3.89) were randomly recruited from 141 eligible participants (mean age, 37.71±13.88y; age range, 19-66y; mean months postinjury, 24.69±11.50); 25 participants (48.1%) of participants were black and 27 (51.9%) were Hispanic/Latino. Of the Hispanic/Latino participants, 18 (66.7%) were non-U.S. born and 12 (44.4%) spoke Spanish as their primary language. Twenty-seven individuals were randomized to the educational intervention group and 25 were randomized to the wait-list control group.

INTERVENTIONS

Single-session educational intervention with written materials provided in English or Spanish.

MAIN OUTCOME MEASURES

Forty-item Common Misconceptions about Traumatic Brain Injury Questionnaire administered at baseline and 1-month follow-up.

RESULTS

After controlling for ethnic and language differences, a significant between-group main effect (P=.010) and a significant time-group interaction for the Common Misconceptions about Traumatic Brain Injury Questionnaire were noted (Wilks Λ=.89; F_1,46=6.00; P=.02). The intervention group showed a decrease in TBI misconception percentages, whereas the wait-list control group maintained similar percentages. At 1-month follow-up, the wait-list control group reported more misconceptions than did the intervention group (P=.019).

CONCLUSIONS

An educational intervention developed to address the recovery process, common symptoms, and ways to handle the symptoms provides promise as a tool to decrease TBI misconceptions among persons from ethnically and educationally diverse backgrounds. The effects of therapist characteristics and the client-therapist relation on outcomes should be further explored.

Towards Measuring Community Understanding of Traumatic Brain Injury: The Structure and Potential Utility of the Head Injury Knowledge Scale

Background and aims: International research has shown the public hold various misconceptions about traumatic brain injury (TBI). Yet, relatively little has been done towards developing appropriate measures of public knowledge of TBI. The Head Injury Knowledge Scale (HIKS, Ono, Ownsworth, & Walters, 2011) is a newly developed measure of misconceptions and expectations about the effects of TBI. Additional investigation of its psychometric properties appeared warranted. The aims of this further preliminary study were to examine the factor structure of the HIKS and the relationship between psychosocial variables and factor scores.

Method: A convenience sample comprising 167 adults, of whom 65% were females, responded to an online survey including the HIKS. The two-factor HIKS structure was tested using confirmatory factor analyses and the relationships between psychosocial variables and the HIKS factors were investigated.

Results: A good fit was found for the structure of the HIKS. All items loaded adequately onto the HIKS Over-generalisation and Minimisation factors and their internal consistencies were good. Significant differences between gender groups and for level of education were observed on the HIKS Over-generalisation scale, suggesting various groups in the community may have differing levels of knowledge of TBI.

Conclusion: This study confirmed the robustness of the HIKS factor structure. The HIKS is likely to be an important measure of community understanding of TBI in future research.

Misconceptions and Misattributions About Traumatic Brain Injury: An Integrated Conceptual Framework

The objective of the present narrative review was to provide a conceptual framework to address common misconceptions in the field of traumatic brain injury (TBI) and enhance clinical and research practices. This framework is based on review of the literature on TBI knowledge and beliefs. The comprehensive search of the literature included seminal and current texts as well as relevant articles on TBI knowledge and education, misconceptions, and misattributions. Reviewed materials ranged from 1970 to 2013 and were obtained from PubMed and PubMed Central online research databases. Research findings from the reviewed literature were integrated with existing social and cognitive psychological concepts to develop a framework that includes: (1) the identification antecedents of TBI-related misconceptions and misattribution; (2) understanding of how inaccurate beliefs form and persist as the result of pre- and postinjury cognitive operations such as informational cascades and attribution biases; and (3) a discussion of ways in which these beliefs can result in consequences in all domains of a survivor's life, including physical and mental health, stigma, and discrimination. This framework is intended to serve as a first stage of development of a model that will improve treatment endeavors and service delivery to individuals with TBI and their families.

Educational professionals' understanding of childhood traumatic brain injury

PRIMARY OBJECTIVES

To determine the understanding of educational professionals around the topic of childhood brain injury and explore the factor structure of the Common Misconceptions about Traumatic Brain Injury Questionnaire (CM-TBI).

RESEARCH DESIGN

Cross-sectional postal survey.

METHODS AND PROCEDURES

The CM-TBI was posted to all educational establishments in one region of the UK. One representative from each school was asked to complete and return the questionnaire (n = 388).

MAIN OUTCOMES AND RESULTS

Differences were demonstrated between those participants who knew someone with a brain injury and those who did not, with a similar pattern being shown for those educators who had taught a child with brain injury. Participants who had taught a child with brain injury demonstrated greater knowledge in areas such as seatbelts/prevention, brain damage, brain injury sequelae, amnesia, recovery and rehabilitation. Principal components analysis suggested the existence of four factors and the discarding of half the original items of the questionnaire.

CONCLUSIONS

In the first European study to explore this issue, it is highlighted that teachers are ill-prepared to cope with children who have sustained a brain injury. Given the importance of a supportive school environment in return to life following hospitalization, the lack of understanding demonstrated by teachers in this research may significantly impact on a successful return to school.