Knowledge, attitude, and behaviour around concussion at the FIFA Women's World Cup 2023: part 1 - medical staff

The objective of this observational cross-sectional study was to assess the knowledge, attitudes and behaviours of medical staff participating in the FIFA Women's World Cup 2023 regarding the assessment and management of concussion in football. Medical staff from 32 teams qualified for the FIFA Women's World Cup 2023 were invited to answer an online survey. Results were analysed descriptively. 47 participants completed the survey. Concussion knowledge: 98% were aware of concussion protocol(s). Most concussive signs or symptoms were recognised, though only 36% of participants (n = 17) correctly reported potential symptom onset time. Knowledge on assessment and return to play elements varied. Attitude: 77% (n = 36) reported being very confident or confident in recognizing a suspected concussion. When assessing a suspected concussion on the pitch, 55% (n = 26) reported to have felt pressured by the player sometimes, very often or always, and 47% (n = 22) by the coaching staff. Behaviour: Among doctors, 70% reported their national team performs baseline concussion assessments. Reported use of on-field assessment elements suggested in concussion guidelines varied between 5% and 95%. In conclusion, most medical staff participating in the FIFA Women's World Cup 2023 were generally knowledgeable about concussion, reported on-pitch and return to play attitudes and behaviours aligning with evidence-based standards for safeguarding players' health. However, gaps were observed in all three domains, compared to guidelines. Expanding education to players and coaching staff is suggested to facilitate the delivery of evidence-based best practice.