Collegiate Athletes' Concussion Awareness, Understanding, and -Reporting Behaviors in Different Countries With Varying Concussion Publicity

Abstract

Context Concussions are a global public health concern, and education on the importance of self-reporting may not reach all athletes to the same degree around the world. Objective To determine if differences were present in the concussion awareness, understanding, and -reporting behaviors of collegiate athletes' in 3 countries with varied degrees of concussion publicity. Design Cross-sectional survey. Setting Collegiate sports medicine clinics. Patients or Other Participants Collegiate athletes in the United States (n = 964; high publicity), Ireland (n = 302; moderate publicity), and Jordan (n = 129; low publicity). The degree of concussion publicity was categorized based on the extent of national public health awareness initiatives, care guidelines, research publications, and mass media coverage. Main Outcome Measure(s) Participants completed a 10- to 15-minute survey on concussion awareness, understanding, and -reporting behaviors. The main outcome measures were concussion education (awareness; 21 options; select all sources of concussion information), concussion knowledge (understanding; maximum score of 49), and diagnosed/nondisclosed concussion history (reporting behaviors; self-report yes/no items). Results A higher proportion of Jordanian athletes reported never having received concussion information previously (73.6%) than Irish (24.2%) or US athletes (9.4%). Knowledge differed among countries (P < .0001, η2 = .28), with US athletes displaying higher total knowledge scores (40.9 ± 4.5) than Jordanian (35.1 ± 5.6) and Irish (32.1 ± 3.5) athletes. A greater percentage of Irish and US athletes reported a history of a diagnosed concussion (31.8% and 29.6%, respectively) and history of concussion nondisclosure (25.2% and 15.5%, respectively) than Jordanian athletes (2.3% and 0.0% for history of a diagnosed concussion and history of concussion nondisclosure, respectively). Conclusions In the United States, where concussion publicity is high, formal legislation exists, and sports medicine resources, concussion awareness and understanding were increased. More culturally appropriate concussion initiatives are needed globally to ensure that athletes around the world can identify concussive injuries and understand the dangers of continued sport participation while concussed.

Knowledge of, and Attitudes Toward, Concussion in Japanese Male Collegiate Athletes

“…Regardless of the history of concussion and symptom reporting, athletes felt negative about reporting concussion symptoms because they would not be allowed to start playing or practicing when they thought they were ready; the mean Likert-score here was 4.1/5.0 (82.0%). Several previous studies have shown that the common reason for non-disclosure of concussion symptoms was that "they did not want to leave the game/practice (Kerr et al, 2016b;Beidler et al, 2018Beidler et al, , 2021". In other words, continuing in a match or practice is a high priority for athletes.…”

“…In other words, continuing in a match or practice is a high priority for athletes. In addition, many athletes did not report concussion symptoms because they did not know it was a concussion and/or did not think it was serious enough (Kerr et al, 2016b;Beidler et al, 2018Beidler et al, , 2021. These findings suggest that education about signs and symptoms might not be sufficient on its own to improve reporting behavior.…”

“…Reporting the symptoms of suspected concussions depends on athletes' ability to recognize and attribute their symptoms, as many common symptoms are subjective (e.g., headache and dizziness). Several studies on knowledge of concussion have been conducted among collegiate athletes outside of Japan (Fedor and Gunstad, 2015;Beidler et al, 2018Beidler et al, , 2021Chapman et al, 2018;Bernstein et al, 2019;Anderson et al, 2021). These studies have investigated athletes' perceptions of symptoms based on the suspected concussion symptoms presented in the consensus statement (McCrory et al, 2017) and the Sports Concussion Assessment Tool 5 (SCAT 5) (Echemendia et al, 2017) while adding dummy symptoms.…”

“…The US has a welldeveloped concussion education system. Beidler et al (2021) classified concussion publicities into three degrees. Japan is probably at the moderate degree in the Beidler et al (2021) classification.…”

“…Beidler et al (2021) classified concussion publicities into three degrees. Japan is probably at the moderate degree in the Beidler et al (2021) classification. This means that Japan has no streamlined concussion education for collegiate athletes, and guidelines vary by sport.…”