Improving Concussion Reporting across National College Athletic Association Divisions Using a Theory-Based,...

Although a base level of knowledge is needed to recognize a concussion, knowledge-focused concussion educational materials ignore multifaceted barriers to concussion reporting. We compared student-athlete concussion reporting intentions and behaviors prior to and 1 year after exposure to an intervention or control treatment. We randomly assigned 891 collegiate student-athletes from three universities (Divisions I, II, III) to either the control group (National College Athletic Association [NCAA] Concussion Fact Sheet) or intervention group (theory-based, data-driven, multimedia, simulated concussion reporting module). A final sample of 520 student-athletes (control = 253, intervention = 267, expired eligibility = 189, left university = 182) completed intentions and behaviors surveys immediately prior to and 1 year after the educational intervention, and a second survey to assess the intervention effect. We compared intentions using 2 x 2 mixed model analyses of variance (ANOVAs). Behaviors and educational intervention effect were assessed using logistic regression models (α = 0.05). The intervention group had significantly improved concussion reporting intentions at 1-year follow-up relative to the control group (p = 0.009), but had similar odds for behaviors. The intervention group had 2.42 times greater odds of rating the module as "very effective," rather than "not effective" relative to the control group (95% confidence interval [CI]: 1.10,5.33). Relative to the control group, the intervention group had significantly greater odds of responding that the concussion education "greatly improved" rather than "did not improve" their knowledge (odds ratio [OR]: 2.49, 95% CI:1.25,4.96), attitudes (OR: 2.22, 95% CI: 1.23,4.03), self-efficacy (OR: 1.95,95% CI: 1.05,3.60), and intentions (OR: 1.86,95% CI: 1.03,3.35). The intervention was more effective at targeting elements of the overall sport culture in a way that substantively improved concussion reporting. We recommend use of this intervention in combination with other evidence-based educational materials.