Concussion among athletes is an issue of growing concern, with efforts underway to improve detection, diagnosis, and treatment. Success depends on communication by athletes, as brain-related symptoms are often not outwardly visible. Education programs to increase reporting behavior have not been successful to date. In accordance with the socioecological approach to health, we argue that multiple levels of influence on student athletes must be addressed, and report a multi-dimensional, mixed-methods research project conducted to identify possible points of intervention into changing the culture of concussion-injury reporting among collegiate athletes. Using quantitative, qualitative and interpretive methods, we examine the individual-level
vested interests
athletes have in reporting or not reporting concussion symptoms, and how these interests interact with community-level
team culture
and
interpersonal relationships
, and social-level
cultural narratives
to influence concussion-reporting behavior. Our findings confirm the viability of this approach, identifying immediacy, separation of responsibility and pain-enduring story systems as particularly salient elements. We conclude that competing performance versus safety value structures, reflected in cultural narratives and team culture, create mixed-messages for athletes, which are resolved in favor of performance because athletes perceive concussion injuries to be of low immediacy.
Athlete safety and concussion injury have garnered considerable attention recently, and appropriate evaluation of athletes following head impacts depends, in part, on athletes’ self-reporting of the symptoms. The National Collegiate Athletic Association has focused primarily on concussion injury education to encourage self-reporting; however, such efforts have not been especially effective and many potential injuries continue to go unreported. This research investigates cultural narratives, derived from sports media and popular culture, and how their narrative logics contribute to the context in which student-athletes make head injury reporting decisions and how these narratives offer templates for understanding potential consequences. We argue that performance-oriented narratives are more prevalent and showcase pathways to more immediate satisfaction of desires or goals. Ultimately, we argue that not only does analysis of prevailing cultural narratives illuminate the context in which athletes make reporting decisions but also that such understanding could inform narrative-based interventions in order to emphasize and model recommended behaviors, such as injury reporting, and values, such as long-term brain health and player wellness.
This study reveals how athletic health care teams, embedded within large bureaucratic organizations and complex social systems, negotiate and sustain multiple divergent structures. An iterative analysis of 69 in-depth interviews with National Collegiate Athletic Association (NCAA) Division I athletes’ certified athletic trainers (ATCs) and coaches from four high-contact sports (i.e., women’s lacrosse, men’s wrestling, men’s soccer, and men’s football) revealed that team members coconstructed and negotiated multiple conflicting structures during concussion events. The divergent macro-, meso-, and micro-level structures include (a) formal versus hidden authority structures, (b) prevention versus inevitability discourse, (c) assigned versus enacted roles, and (d) authentic versus inauthentic injury performance. The analysis also revealed how a specific speech act, termed agentic denial, enabled members to obscure their agency within concussion events. Theoretical implications and practical recommendations are discussed.
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