The aim of this study was to evaluate New Zealand high school rugby union players’ and community coaches’ concussion knowledge (CK), concussion attitude (CA) and concussion reporting intentions (CRI) and to explore the impact gender, age, ethnicity, socio-economic status, experience, and concussion history had on these outcome measures. This cross-sectional study utilised the Rosenbaum Concussion Knowledge and Attitudes survey to evaluate CK, CA and CRI. The survey and demographic information were completed by 533 high school players (61.5% male, M = 16.2 yrs) and 733 community rugby coaches (93.0% male, M = 42.2 yrs). Coaches displayed greater awareness, safer attitudes, and stronger reporting intentions towards concussion than players. Among players, differences in CK, CA and CRI were observed by gender, ethnicity, and socio-economic status. Among coaches, differences in CRI were found by age and coaching experience. No differences were observed for age or concussion history in players. Gender, ethnicity, and grade coached were not significant for coaches. Players who identified as Māori or Pasifika and those from schools in low socio-economic areas displayed poorer CK and CA. Years of experience for both players and coaches played a critical role in improving CA and is a factor that should be considered when welcoming new participants to either role. Concussion non-disclosure is a systemic issue and is common across gender, ethnicity and socio-economic status and appears to worsen as the playing season progresses. More work is needed to develop educational strategies that are both culturally responsive, sustainable, and address reporting behaviours.

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Rugby union is a popular team sport, with a high rate of concussions. In adolescents, concussions are further complicated by issues of under-reporting. To encourage more responsible concussion behaviours, it is imperative to understand the factors that influence youth players’ behaviours, including the attitudes and behaviours of their coaches and parents. The aim of this study was to explore concussion-related behavioural intentions and behaviours that may influence effective concussion management across a youth rugby system. The study adopted a pragmatic, descriptive qualitative design and included high schools from four youth rugby catchment areas in New Zealand. Nineteen focus groups and 2 individual interviews were conducted with n = 75 players, n = 22 parents, and n = 8 coaches (N = 105) during the 2018 rugby season. A thematic analysis was conducted, guided by a system’s approach and the Theory of Planned Behaviour. The themes generated reflected a ‘tug-of war’ between various behavioural intentions and reported behaviours present in a youth rugby system. Additionally, the behavioural intentions and reported behaviours of coaches, parents, players and their teammates are intricately linked and collectively influence effective concussion management. Being aware of concussions and caring about their management and consequences was a strong theme present across the system. However, these favourable attitudes and behaviours were countered by players, parents and coaches disregarding the system, downplaying the seriousness of concussion, being competitive and driven to win, regardless of the risks. In players the warrior mentality theme, which included bravado, being tough, and playing through the pain further complicated effective concussion management. The findings suggest that there is not always a strong, favourable network in place that would facilitate similarly favourable concussion-related behaviours. To effect change, a system-wide approach, that takes the unique needs of each stakeholder into account and ultimately aims to reconcile performance and brotherhood with positive concussion related behaviours, is needed.

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