The Relationship Between Concussion Knowledge and Beliefs about Symptom Reporting Among Ncaa Athletes

INTRODUCTION: There is a tremendous push towards increasing research and education for sports-related mild traumatic brain injuries, more broadly known as concussions. One area in need of research that is particularly critical to college athletes relates to diagnostic tools that can improve detection and clarify return-to-activity decisions. Because the diagnosis of a concussion relies heavily on self-reported symptoms, which may or may not be overtly evident, significant underreporting is suspected. Yet, there is little systematic research on factors that might serve to predict symptom hiding among college athletes, which could ultimately help to design more comprehensive and/or targeted efforts to encourage reporting within this population. Accordingly, the aim of the current study was to examine concussion knowledge and beliefs related to symptom reporting, and the relationship between these constructs among a sample of NCAA athletes.

METHODS: Self-report surveys were completed by first- and second-year NCAA collegiate athletes at a large Division I university (N = 158). The second year athletes completed the assessment towards the end of their sophomore year, and the first-year athletes completed the assessment at the beginning of their first fall semester. The survey included items that assessed athletes' knowledge of concussion symptoms, diagnosis, and recovery (26 items) as well as items that captured beliefs about who should be told if a concussion is suspected and reasons athletes might choose not to disclose a suspected concussion (18 items). A knowledge score was created that reflected the percentage of items answered correctly. Similarly, a beliefs score  was created, with higher scores reflecting a greater number of individuals who should be told about concussions, and less endorsement of reasons athletes would hide symptoms.

RESULTS: Results from a preliminary analysis revealed a significant and negative bivariate relationship between athletes' concussion knowledge and attitude scores (r = -0.24, p < .01). That is, as athletes' scores on knowledge regarding concussion symptoms, diagnosis and recovery increased, they reported less favorable beliefs towards reporting concussion symptoms.

CONCLUSIONS: More research is needed to better understand this association, particularly as it relates to accounting for previous experience with concussions. It is possible that individuals who have experienced prior concussions are more knowledgeable, but also more likely to be resistant to symptom reporting if they have experienced unwelcomed delays in their return-to-activity. These results suggest that simply educating athletes on concussions and their associated risks may not be sufficient to encourage honest reporting.