Labeling Avoidance in Healthcare Decision-Making: How Stakeholders Make Sense of Concussion Events through Sport Narratives

Agentic Denial: How Athletic Teams Sustain Divergent Structures During Concussion Events

“…Figure 1 provides a graphic representation of how some structures were formal and overt, whereas others were informal and hidden, as depicted by the grayscale arrows. At the macro-level, discourse from the larger culture of sport manifested in the group process and allowed members to retrospectively defend their decisions (e.g., “everyone knows that the deal”; see also Ruston et al, 2018; Zanin et al, 2019). When power holders in an organization frame a problem as inevitable (e.g., “there is no way to prevent a concussion”) as opposed to resolvable, this macro-level discourse functions to take away agency and self-efficacy of others to try to resolve or minimize the problem.…”

“…Athletes described how they struggled with protecting a positive athletic identity during a concussion event, given that many athletic health care team members perceived that athletes were “faking” concussion symptoms. This fear of being perceived as “lazy,” “always hurt,” or falsifying symptoms motivated athletes to conceal and underreport concussions to maintain a positive in-group identity (Zanin et al, 2019). Moreover, a structural practice of concussion symptom concealment is recursive and self-sustaining such that positive athletic identities are enacted by athletes playing through pain and injury concealment.…”

“…These behaviors reinforce an ideology that an authentic performance of concussion is only possible if athletes exercise their agency to return to play (e.g., conceal, deny, and circumvent concussion reporting). These performances allow athletes to maintain a positive athletic identity through their displays of toughness and sacrifice for team goals (see Zanin et al, 2019). As a result, performances of concussions may be perceived as more authentic if another group member (e.g., coach, ATC, teammates) formally recognizes the concussion symptoms.…”

“…During the first year of data collection, the research team collected 97 interviews with athletes, ATCs, and coaches participating in men’s basketball, women’s basketball, and women’s soccer (Corman et al, 2019). While analyzing Year 1 interview data through a narrative analysis (see Ruston, Kamrath, Zanin, Posteher, & Corman, 2018; Zanin, Kamrath, Ruston, Posteher, & Corman, 2019), the authors noticed that athletes, ATCs, and coaches contradicted each other consistently in how they described their own and others’ roles and behavior during concussion events. Based on the initial analysis of Year 1 interview data, the team purposely altered the interview protocol to ask questions about rules, roles, and normative behavior during a concussion events.…”

Storying the Gender Binary in Sport: Narrative Motifs Among Transgender, Gender Non-Conforming Athletes

“…For example, past research has identified particular gendered narratives related to devaluing femininity that reproduce problematic and exclusionary structures and double-binds for cisgender female athletes, despite Title IX legislation (McDonagh & Pappano, 2008; Travers, 2008). Similarly, masculine sport narratives create problematic outcomes for cisgender male athletes, such as high-rates of injury as a result of the masculine-warrior narrative often reproduced in sport (Ruston et al, 2018; Zanin et al, 2020a). Given that TGNC athletes’ identities/bodies challenge binarized sport structures, these athletes have historically suffered violence and trauma as a result of the gender binary (see Anderson & Travers, 2017; Heggie, 2017; Travers, 2018).…”