A major consensus report co-authored by Heidi Wayment, chair of the Department of Psychological Sciences at Northern Arizona University, provides recommendations for increasing concussion symptom disclosure in collegiate athletic departments and military service academies. The report was recently published in the British Journal of Sports Medicine (BJSM).
The report, pending co-publishment in the Journal of Special Operations Medicine, was the result of a three-year research project started in 2016 funded by the NCAA-Department of Defense Mind Matters Research Challenge. Wayment, along with professor of psychological sciences Ann Huffman, program director of athletic training Deborah Craig and associate professor of physical therapy Monica Lininger were co-PIs on the grant.
The Consensus Statement published in BJSM documented the extant literature on health behaviors surrounding concussion disclosure and documented 17 recommendations for improving concussion reporting that met thresholds for utility and feasibility, grouping them into five domains for discussion:
- Content of concussion education for athletes and military service cadets
- Dissemination and implementation of concussion education for athletes and military service cadets
- Other stakeholder concussion education
- Team and unit-level processes
- Organizational processes
“Within the past decade, the dangers of concussions have become more prominent in the public media and national discourse,” Wayment said. “Athletic programs have instituted concussion education programs and an analysis regarding the effectiveness of those programs found over and over that education was not having enough of an impact on individuals’ willingness to report potential symptoms, even though the understanding that concussions were associated with short- and long-term health risks was becoming increasingly clear.”
The recommendations serve as a basis for athletic departments and military service academies to address behavioral health supports and institutional processes needed to increase early and honest disclosure of concussion symptoms in an effort to improve clinical care outcomes and to begin eliminating this lack of disclosure plaguing athletes.
“The lack of symptom disclosure is a problem because the science shows that when concussed players are treated, they reduce their overall long-term risk, especially the very dangerous situation of suffering another impact close in time that can be deadly,” Wayment said.
Wayment is a social psychologist with expertise in health psychology and has conducted research on a variety of topics that includes risky health behaviors. Her work focuses on the utility of theoretical health models to understand health behavior in terms of social psychological constructs such as self-identity, psychological defenses and social influence.
She said some athletes do not disclose concussion symptoms because they may not recognize the symptoms, and many are influenced by a “football culture” in which they think disclosure violates the image of a tough athlete. They fear disclosure will cost them playing time, a spot on the team or the respect of coaches and other stakeholders in their playing career.
If a player has a concussion and suffers another one shortly after, they can experience “second impact syndrome,” a potentially fatal condition in which the brain swells rapidly. This can be avoided by reporting initial concussion symptoms early to allow for faster recovery times and better overall outcomes to their long-term health.
Wayment said that even in the context of the NAU team’s research, some of the cooperating Division I NCAA football teams were reluctant to fully participate because the topic was sensitive to stakeholders.
“We saw a range of willingness on the part of head coaches to explore this topic in the context of their football programs. Luckily, we did have some great research partners with some of the football programs we engaged.”
To address ways to change “football culture,” the Mind Matters Challenge—a $7 million education and research challenge that awarded eight grants to research teams—called for research projects to identify ways of changing attitudes about concussions in young adults and to provide educational programs that increase players’ willingness to report concussions. The goal of Mind Matters leaders was to develop a consensus statement from the research teams useful for stakeholders to understand the best practices and issues related to increased concussion reporting in various populations by using a Delphi process.
The Delphi process drew on the wisdom of each research group and concluded a consensus was achieved among the expert groups who generated findings from their research using surveys to gather and measure the degree of consensus among one another. This took several iterations and was guided by a facilitator who helped summarize and clarify where consensus existed. The input provided by the groups was analyzed and written up by a smaller group of these researchers under the facilitator and lead author of the report, Emily Kroshus, an international expert in concussion-related risks.
“We learned a great deal about the barriers and the facilitators of this important health behavior, both in our own team’s research, but especially collectively as reflected in the recently published consensus statement,” Wayment said. “Another important set of findings dealt with the need to continue examining how cultural and organizational factors influence individuals’ thoughts, feelings and actions. This idea permeates health-related research, but what we gained from our experience is tangible evidence that it is worth the effort to go beyond the individual in trying to understand how to mitigate risky health behavior.”
The funding by Mind Matters ended a year ago, but the NAU research team, along with their colleagues and students, have published nearly a dozen studies stemming from this project with plans to continue moving forward. Natalie Cook, a certified athletic trainer and new doctoral student in interdisciplinary heath, conducted concussion-related research as part of her master’s degree before attending NAU.
“Natalie has a few projects in the development stage that will be building on this research with a specific focus on how to better measure the influence of important others on athletes’ concussion reporting intentions,” Wayment said. “We also have some plans to use some innovative methods to examine more closely how athletes physiologically respond to concussion-injury and prevention information. These efforts could be helpful in designing more effective educational interventions for high school and collegiate athletes.”