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O'Brien KH, Pei Y, Kemp AM, Gartell R, Wallace T. Pilot testing the SUCCESS peer mentoring program for students with concussion: the role of personas in mobile technology development. Disabil Rehabil Assist Technol 2024; 19:1964-1979. [PMID: 37522162 DOI: 10.1080/17483107.2023.2239293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/12/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE College students with concussion experience academic, cognitive and psychosocial challenges, yet frequently lack supports necessary for successful reintegration into school. Success in College after Concussion with Effective Student Supports (SUCCESS) is a virtual peer mentoring program designed to provide education, support and connection through a mobile application. The purpose of this study was to describe use of personas as components of mobile app development and conduct preliminary testing of SUCCESS using personas. METHODS Personas were developed from case studies and portrayed by college students trained as fictitious mentees. Mentors were blinded to use of personas. Eleven mentors completed measures pre and post a 4-week mentoring cycle. Mentors and personas interacted in the app via chat, video calls and sharing of educational materials. Measures included the Post-Concussion Symptom Scale (PCSS); PROMIS Self-Efficacy; Depression, Anxiety and Stress Scale (DASS); and a series of focus groups. RESULTS Mentors suggested improvements to resolve instability of video calls, expand educational materials to address psychosocial functioning, and add structure to the mentoring relationship. Some preferences around communication, like groups chats and emoji keyboards, were not able to be addressed. As expected, PCSS scores were stable. DASS score (p = .04), especially depression (p = .03), decreased. PROMIS scores showed a trend towards growth (p = .057), although were not statistically significant. CONCLUSIONS Use of personas allowed technical challenges and program refinements to be addressed before including students with subacute concussion in testing. Although continued development will address enhancement of communication modalities preferred by students, future efficacy testing of SUCCESS is warranted.
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Affiliation(s)
- Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Yalian Pei
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
| | - Amy M Kemp
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
| | - Rebecca Gartell
- Shepherd Center, Crawford Research Institute, Complex Concussion Clinic, SHARE Military Initiative, Atlanta, GA, USA
| | - Tracey Wallace
- Shepherd Center, Crawford Research Institute, Complex Concussion Clinic, SHARE Military Initiative, Atlanta, GA, USA
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2
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Golshan F, Bains S, Francisco J, Jensen M, Tourigny K, Morrison T, Mickleborough M. Gender differences in concussion-related knowledge, attitudes and reporting behaviors of varsity athletes. J Sports Med Phys Fitness 2024; 64:588-598. [PMID: 38445845 DOI: 10.23736/s0022-4707.24.15508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Concussion is a pathophysiological process that occurs due to a traumatic biomechanical force. Concussions are an "invisible" and common traumatic brain injury with symptoms that may be underestimated. This necessitates fundamental improvements in public knowledge specifically addressing young university athletes and different genders. This cross-sectional study aimed to explore the possibility of gender differences with respect to university student athletes' concussion knowledge, attitude and reporting behaviors. We hypothesized that there should be no significant difference in concussion knowledge among male and female student athletes; however, females would show a more positive attitude and more reporting behaviors than male student athletes. METHODS Overall, 115 university athlete students completed a survey questionnaire; we eliminated some participants based on required inclusion criteria of Rosenbaum Concussion Knowledge and Attitude Survey-student version (RoCKAS-ST). Our final analysis consisted of 96 participants: 20 males (mean age 21.15 years) and 75 females (mean age 22.36 years). This study included questions about the athletes' given reasons for reporting or not reporting a concussion. Additionally, 33 RoCKAS-ST questions on Concussion Knowledge Index (CKI) with fair test-retest reliability (r=0.67) and 15 items on Concussion Attitude Index (CAI) with satisfactory test-retest reliability (r=0.79) were provided. RESULTS Males reported more sources for learning about concussions and more sport-related reasons for reporting a concussion than females (P<0.05). Both genders provided equal numbers of reasons for neglecting a concussion report or not disclosing a concussion for the sake of others (i.e., family, teammates or the coach). Out of 16 given reasons for not reporting a concussion, males significantly chose sport-related reasons over female athletes (P<0.05). Additionally, by looking at the two components of RoCKAS-ST, the independent t-test results showed no significant gender-based differences in concussion knowledge and attitude indices (P>0.05). Nevertheless, females were less optimistic about evaluating other athletes' attitude over concussion reporting (P<0.05). CONCLUSIONS Our study indicated that concussion knowledge is not gender biased among Canadian university athletes; however, more investigation is required to learn how safe environments for concussion disclosure could encourage reporting the symptoms in varsity athletes, especially in males who are more susceptible to not reporting a concussion to not miss their sport-related goals.
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Affiliation(s)
- Faly Golshan
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada -
| | - Sarah Bains
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jenna Francisco
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Makenna Jensen
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Katelyn Tourigny
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Todd Morrison
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marla Mickleborough
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
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3
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Kelshaw PM, Kneavel ME, Bowman TG, Rainone C. Headgear safety attitudes: a national survey of collegiate women's lacrosse stakeholders. Res Sports Med 2024; 32:375-387. [PMID: 35996846 DOI: 10.1080/15438627.2022.2113880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (β = -0.38, p < 0.001) and Sports Development and Safety Practices (β = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (β = 0.51, p < 0.001) and Intention to Wear Headgear (β = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants.
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Affiliation(s)
- Patricia M Kelshaw
- Department of Kinesiology, Department of Psychology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham
| | - Meredith E Kneavel
- Department of Urban Public Health and Nutrition, School of Nursing and Health Sciences, LaSalle University, Philadelphia, PA, USA
- Director of Assessment and Research, Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
- Department of Public Health, LaSalle University, Philadelphia, PA, USA
| | - Thomas G Bowman
- Department of Athletic Training, University of Lynchburg, Lynchburg, VA, USA
| | - Cat Rainone
- Department of Public Health, LaSalle University, Philadelphia, PA, USA
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Ernst W, Kneavel M. Barriers to concussion reporting in collegiate athletes: an analysis of a peer-led worksheet activity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1215-1223. [PMID: 35549828 DOI: 10.1080/07448481.2022.2071621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Objective: To determine if a peer-led concussion reporting worksheet activity could elucidate barriers to reporting in collegiate athletes. Participants: Five hundred and three athletes from 7 universities across all three NCAA divisions. Methods: A supplementary qualitative analysis of responses to a concussion reporting worksheet completed during an RCT of a novel peer concussion education program. The first column of the worksheet required participants to list thoughts that prevent reporting and the second column required replacement thoughts that facilitate reporting. Results: A qualitative phenomenological thematic analysis of responses to the first column of the worksheets identified themes that coalesced into three areas: 1) missing out on athletic and social events, 2) losing one's competitive edge, and 3) negative interpersonal interaction/self-perception. Conclusions: Barriers to concussion reporting from several areas central to the collegiate athlete experience were identified. These barriers should be considered during clinical assessment and when developing concussion education programs.
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Affiliation(s)
- William Ernst
- Department of Professional Psychology, Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Meredith Kneavel
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA
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5
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Abbott A, Ramos T, Smith WAR, Ierulli VK, Mulcahey MK. Concussion Education for Athletes: Symptom Reporting and Safe Return to Sport. JBJS Rev 2023; 11:01874474-202306000-00013. [PMID: 37327353 DOI: 10.2106/jbjs.rvw.23.00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
» Educational programs on concussion have been demonstrated to improve knowledge for athletes, families, athletic trainers, and coaches about concussion, with the goal of reducing concussion incidence, duration, severity, and complications.» Despite the widespread availability and often mandatory concussion education provided to high school and collegiate athletes, there has not been an adequate change in knowledge, attitudes, and self-reporting behavior in this population.» Recently published studies suggest improving concussion education by emphasizing athletes' symptom reporting behavior, to contrast with current emphasis on knowledge-based outcomes.» Future educational programs about concussions for athletes, families, athletic trainers, and coaches should aim to emphasize cultural and behavioral changes that demonstrate outcome changes rather than solely evaluating knowledge improvements to determine effective programming.
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Affiliation(s)
| | - Tolulope Ramos
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Wyatt A R Smith
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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O’Brien KH, Pei Y, Kemp AM, Gartell R, Gore RK, Wallace T. The SUCCESS Peer Mentoring Program for College Students with Concussion: Preliminary Results of a Mobile Technology Delivered Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5438. [PMID: 37107720 PMCID: PMC10138278 DOI: 10.3390/ijerph20085438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 05/11/2023]
Abstract
Concussions are caused by a hit or blow to the head that alters normal brain functioning. The Success in College after Concussion with Effective Student Supports (SUCCESS) program was developed to provide students with psychosocial support and resources-both key components of concussion management-to assist in recovery and return-to-learn following concussion. In this preliminary evaluation of intervention efficacy, SUCCESS was delivered through a mobile application connecting mentors (students who have recovered from concussion and successfully returned to school) with mentees who were currently recovering. Mentor-mentee pairs met virtually through the app, using chat and videoconferencing features to share support, resources, and program-specific educational materials. Results from 16 mentoring pairs showed that mentee symptoms (V = 119, p = 0.009) and academic problems decreased (V = 114.5, p = 0.002), while academic self-efficacy increased (V = 13.5, p = 0.009) following mentoring. As expected, mentor measures were stable, indicating that providing mentoring did not exacerbate previously resolved concussion complaints. Virtual peer mentoring provided through a mobile application may be a feasible intervention to support academic success and psychosocial processing during recovery for college students with concussion.
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Affiliation(s)
- Katy H. O’Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA 30602, USA
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN 55407, USA
| | - Yalian Pei
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA 30602, USA
| | - Amy M. Kemp
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA 30602, USA
| | - Rebecca Gartell
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA (T.W.)
| | - Russell K. Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, GA 30309, USA
| | - Tracey Wallace
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA (T.W.)
- Complex Concussion Clinic, Shepherd Center, Atlanta, GA 30309, USA
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7
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Kroshus E, Chrisman SPD, Glang A, Hunt T, Hays R, Lowry S, Peterson A, Garrett K, Ramshaw D, Hafferty K, Kinney E, Manzueta M, Steiner MK, Bollinger BJ, Chiampas G, Rivara FP. Concussion education for youth athletes using Pre-Game Safety Huddles: a cluster-randomised controlled trial. Inj Prev 2023; 29:22-28. [PMID: 36113984 PMCID: PMC9877103 DOI: 10.1136/ip-2022-044665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/21/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Determine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes. METHODS A cluster-randomised trial compared Safety Huddles to usual care. Safety Huddles bring together athletes and coaches from both teams before the start of each game for coaches to briefly affirm the importance of speaking up if a concussion is suspected. Participants were athletes from 22 competitive community-based American football and girls and boys soccer teams (ages 9-14), and randomisation into intervention or control occurred at the level of the bracket (group of teams that compete against each other during the regular season). The primary outcome was expected likelihood of reporting concussion symptoms to the coach, measured via validated athlete survey at the beginning and end of the season. RESULTS Of 343 eligible participants, 339 (99%) completed baseline surveys and 303 (88%) completed surveys at season end. The mean (SD) age was 11.4 (1.1) years, 26% were female soccer athletes, 27% were male soccer athletes and 47% were football athletes. In adjusted analyses accounting for baseline values and clustering by sport and team via random effects, expected likelihood of concussion reporting at the end of the season was significantly higher in the intervention group compared to controls (mean difference=0.49, 95% CI 0.11 to 0.88; Cohen's d=0.35). CONCLUSIONS AND RELEVANCE Pre-Game Safety Huddles increased the expected likelihood of athletes reporting concussion symptoms. While further study is warranted, sport organisations should consider this approach a promising low-resource option for improving concussion safety in their setting. TRIAL REGISTRATION NUMBER NCT04099329.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA .,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Sara P D Chrisman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA,Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ann Glang
- Center of Brain Injury, Research and Training, University of Oregon, Eugene, Oregon, USA
| | - Tamerah Hunt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
| | - Rachel Hays
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Sarah Lowry
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Alexis Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kimberly Garrett
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Dane Ramshaw
- Center of Brain Injury, Research and Training, University of Oregon, Eugene, Oregon, USA
| | - Kiana Hafferty
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Erin Kinney
- Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Maria Manzueta
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Mary Kathleen Steiner
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Beth J Bollinger
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
| | | | - Frederick P Rivara
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA,Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
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8
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Concussive Biomechanics in a Women’s Soccer Player: A Validation Clinical Case Report. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2023. [DOI: 10.1123/ijatt.2021-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A concussed 19-year-old female midfielder on an National Collegiate Athletic Association (NCAA) Division III soccer team reported to the athletic training clinic complaining of a headache that began 4 days previously during a game where she headed several long punts. Despite delayed reporting, the patient returned to full participation without complication 13 days after her injury. The biomechanical data for the impacts she received on the day of injury were much lower than those presented in the literature as causing concussion for male athletes. Therefore, impact magnitude should not be used as an indicator for injury, as smaller, seemingly insignificant impacts can cause concussion.
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9
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Kelshaw PM, Bowman TG, Kneavel ME, Rainone C. Headgear safety attitudes among women's lacrosse stakeholders: Qualitative results. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-7. [PMID: 36227703 DOI: 10.1080/07448481.2022.2129974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/20/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse. PARTICIPANTS 189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32). METHODS Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning. RESULTS Stakeholders felt that incorporating headgear use into women's lacrosse would increase aggression and change the nature of the sport. Some felt that headgear was important for injury risk mitigation and invoked a need for research and development. Stakeholders raised the need for coaching and officiating improvement as primary injury prevention measures. Players were concerned about esthetics and performance limitations. Finally, many felt that it should be left to player choice to wear headgear or not. CONCLUSION Most stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.
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Affiliation(s)
- Patricia M Kelshaw
- Department of Kinesiology, Brain Research & Assessment Initiative of New Hampshire (BRAIN) Laboratory, University of New Hampshire, Durham, New Hampshire, USA
| | - Thomas G Bowman
- Department of Athletic Training, University of Lynchburg, Lynchburg, Virginia, USA
| | - Meredith E Kneavel
- Department of Urban Public Health and Nutrition, LaSalle University, Philadelphia, Pennsylvania, USA
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Cat Rainone
- Department of Urban Public Health and Nutrition, LaSalle University, Philadelphia, Pennsylvania, USA
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10
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Kroshus E, Lowry SJ, Garrett K, Hays R, Hunt T, Chrisman SPD. Development of a scale to measure expected concussion reporting behavior. Inj Epidemiol 2021; 8:70. [PMID: 34920752 PMCID: PMC8684105 DOI: 10.1186/s40621-021-00364-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Most concussion education aims to increase athlete self-report of concussive symptoms. Although the population burden of concussion is high, frequency with which this injury occurs on a given sports team in a given season is relatively low. This means that powering concussion education evaluation studies to measure change in post-injury symptom reporting behavior requires what is often a prohibitively large sample size. Thus, evaluation studies are typically powered to measure proximal cognitions. Expected reporting behavior, a cognition that reflects planned and reactive decision-making, is a theoretically indicated construct for inclusion in evaluation studies. However, previously no scales were available to measure this construct with demonstrated reliability and validity among youth athletes. The objective of this study was to develop and assess the validity of a brief single-factor scale to measure expected youth athlete concussion reporting behavior (CR-E) in a sample of youth athletes.
Methods A mixed methods approach was used, including cognitive interviews with youth athletes, and quantitative item reduction and validation. Participants were youth athletes (aged 9–16) from the Seattle metropolitan and rural south-Georgia regions. After refining an initial pool of items using cognitive interviews with a diverse group of youth athletes (n = 20), a survey containing these items was administered to youth soccer and football players (n = 291). Item reduction statistics and sequential confirmatory factor analyses were used to reduce the initial scale using a randomly selected half of the sample. Then, a final confirmatory factor analysis and validation tests were applied to the other half of the sample of youth athletes. Predictive validation was conducted longitudinally in a separate sample of youth athletes (n = 155). Results Internal consistency was high (alpha = 0.89), model fit was excellent, validation tests were in the hypothesized directions, and the scale was feasible to use. Using the finalized 4-item scale, we observed that less than one-third of youth soccer and football athletes expect to “always” tell their coach about symptoms of a suspected concussion. Conclusions The CR-E measure should be included in future studies evaluating concussion education programming in youth athlete populations. Supplementary Information The online version contains supplementary material available at 10.1186/s40621-021-00364-4.
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Affiliation(s)
- Emily Kroshus
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA. .,Department of Pediatrics, University of Washington, 6200 NE 74th St, Ste 110, Seattle, WA, 98115, USA.
| | - Sarah J Lowry
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA
| | - Kimberly Garrett
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA
| | | | - Tamerah Hunt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, P.O. Box 8076, 30460, USA
| | - Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA.,Department of Pediatrics, University of Washington, 6200 NE 74th St, Ste 110, Seattle, WA, 98115, USA
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11
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Kneavel M, Ernst W. Cognitions That Support Concussion Reporting in Collegiate Athletes: An Analysis of a Worksheet Activity. HEALTH EDUCATION & BEHAVIOR 2021; 49:548-559. [PMID: 34636271 DOI: 10.1177/10901981211046535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sports related concussions continue to be a public health concern and improving reporting behavior a focus of educational programs. While educational programs have addressed changes in knowledge of concussion symptoms, it has been challenging to design educational programs which have lasting effects on reporting behavior. AIMS The current analysis describes an intervention in which thoughts about reporting behavior are actively written down in a worksheet exercise to "pre-arm" athletes with cognitions designed to enhance reporting behavior prior to the injury event. METHOD A total of 503 male and female college athletes participating in collision (football, field hockey, ice hockey, lacrosse, and soccer) and contact sports (baseball, basketball, and softball) from 7 colleges/universities competing across all three NCAA divisions provided data collected during a randomized trial of a peer concussion education program. RESULTS Qualitative analysis revealed 10 themes that would improve reporting including short-term benefits, faster recover, safe and healthy return to play, reporting helps the team, reporting protects the brain, risk aversion, long-term benefits, coach will be supportive, teammates will be supportive and understanding, and academic performance will be affected. DISCUSSION Athletes had awareness of key risks involved in concussions and understood both short- and long-term consequences. CONCLUSION These findings have important implications for understanding how to change athletes' thoughts about reporting concussions.
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Affiliation(s)
- Meredith Kneavel
- Department of Urban Public Health and Nutrtion, La Salle University, Philadelphia, PA, USA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
| | - William Ernst
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA, USA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
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McCarthy KS, Kneavel M, Ernst W. Psychometric properties of concussion knowledge and cognitive mediators of reporting measures. Brain Inj 2021; 35:1210-1217. [PMID: 34347541 DOI: 10.1080/02699052.2021.1959064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Context: Concussion education and prevention programs require reliable and valid instruments to evaluate the theory, mechanisms, and outcome of these interventions Objective: To assess the psychometric properties of measures evaluating concussion education and prevention programsDesign: Descriptive epidemiological Setting: 10 NCAA-member universities Patients or Other Participants: 841 student-athletes in an RCT control group testing an ecological, peer-led concussion education program Main Outcome Measures: Instruments adapted for assessing concussion knowledge and Theory of Planned Behavior/Theory of Reasoned Action (TPB/TRA) cognitive mediators of reporting behavior (attitudes, subjective norms, perceived control, and intentions to report concussion). Participants completed measures at baseline, after one hour, and after one month Results: Internal consistency and test-retest reliability were moderate for both the concussion knowledge and cognitive mediator measures. TPB/TRA was supported subscale intercorrelation and item factor analysis in the cognitive mediator scale. Factor analysis of the concussion knowledge measure revealed subscales for physical/cognitive, psychological/affective, and non-symptoms. The intermediate TPB/TRA mediators of attitudes, norms, and perceived control predicted greater intention-to-report, which predicted increased likelihood of reporting concussion one month later.Conclusions: Measures of concussion knowledge and cognitive mediators of reporting adapted from the literature show adequate psychometric properties and support TPB/TRA application for concussion reporting behaviors.
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Affiliation(s)
- Kevin S McCarthy
- , Chestnut Hill College, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meredith Kneavel
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA.,Center for Concussion Education and Research of Chestnut Hill College
| | - William Ernst
- , Chestnut Hill College, Philadelphia, Pennsylvania, USA
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Weber Rawlins ML, Johnson BR, Jones ER, Register-Mihalik JK, Foster C, De Angelis K, Schmidt JD, D'Lauro CJ. The Role of Social Support in Concussion Disclosure in United States Air Force Academy Cadets: A Mixed Methods Approach. Mil Med 2021; 187:e1193-e1200. [PMID: 33724395 DOI: 10.1093/milmed/usab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/18/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION United States Air Force Academy (USAFA) cadets are at risk for sustaining concussions; however, several factors inhibit disclosure. We aimed to better understand the role of social support in concussion disclosure. METHODS AND MATERIALS We used a mixed methods approach with an electronic survey and interviews. The survey used a 9-point Likert scale (1 = strongly disagree and 9 = strongly agree) to assess concussion disclosure. Survey items asked cadets whom they felt most comfortable disclosing a concussion or bell-ringer/ding to, how quickly they would seek medical attention for a suspected concussion or bell-ringer/ding, whether cadets would be generally supportive/unsupportive of another cadet disclosing a concussion to medical staff, and whether other cadets important to them would be generally supportive/unsupportive if they reported a concussion to medical staff. Two multivariate linear regressions, one for concussion and one for bell-ringers/dings, were calculated to determine whether cadet choice of the person they felt most comfortable disclosing a concussion or bell-ringer/ding to predicted whether they would immediately seek medical attention for either condition. Choice of person included Air Officer Commanding (AOC)/Academy Military Trainer (AMT), upper classmen, cadet who had recovered from a concussion, cadet, closest friend, teammate, and squadmate. Descriptive analyses assessed whether cadets felt supported or unsupported by other cadets and by those who were important to them concerning concussion reporting. Thirty-four semi-structured interviews were conducted with cadets to explore their views on concussion disclosure. RESULTS Increased comfort with disclosing a suspected concussion to an AOC/AMT had higher agreement seeking medical attention (β = 0.28, P < .001). For every 1-point increase in being comfortable disclosing a potential bell-ringer/ding to an AOC/AMT (β = 0.272, P < .001), squadmate (β = 0.241, P = .002), and teammate (β = -0.182, P = .035), agreement for seeking medical attention immediately increased 0.27, increased 0.24, and decreased 0.18, respectively. Interviews indicated cadets would often speak to a peer before seeking medical attention. CONCLUSIONS Our results suggested that cadets felt comfortable reporting a suspected concussion or bell-ringer/ding to various peers and that those peers would be supportive of that choice, indicating social support. Future interventions should include educating cadets that peers may come to them, especially if they are AOCs/AMTs or squadmates.
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Affiliation(s)
- Michelle L Weber Rawlins
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
| | - Brian R Johnson
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Emily R Jones
- United States Air Force Academy, USAF Academy, CO 80840, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Craig Foster
- United States Air Force Academy, USAF Academy, CO 80840, USA
| | | | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
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Ernst W, Kneavel ME. Development of a Peer Education Program to Improve Concussion Knowledge and Reporting in Collegiate Athletes. J Athl Train 2020; 55:448-455. [PMID: 32250640 DOI: 10.4085/1062-6050-212-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes. OBJECTIVE To describe the PCEP and its development and implementation. DESIGN Program development consisting of a literature review, focus group, and pilot implementation. SETTING Athletics department at a college participating at the National Collegiate Athletic Association Division II-sanctioned competition level. PATIENTS OR OTHER PARTICIPANTS Fifteen student-athletes from the women's soccer and men's lacrosse teams participated in the focus group. Four peer concussion educators (PCEs) were debriefed after the pilot implementation of the PCEP with the women's soccer and men's lacrosse teams. DATA COLLECTION AND ANALYSIS Focus-group data were analyzed qualitatively. The PCEs were debriefed, and responses were organized into recommendation types. RESULTS The literature review contributed information that supported the development of the PCEP's conceptual model. Focus-group results provided information used to train the PCEs and refine the PCEP's education modules. The pilot implementation and PCE debriefing supplied information used to further revise the education modules, PCE training, and PCEP implementation procedure. CONCLUSIONS The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior and uses a peer-mediated, cognitive-behavioral, and interdisciplinary model to enhance concussion knowledge of and reporting by collegiate student-athletes. After a focus-group discussion and pilot implementation, we revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.
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