Context Matters: Extra-Personal Factors Underlying Concussion Reporting in University Athletes

Gaps remain in our understanding of which factors contribute to concussion disclosure and how they contribute to this process, thereby limiting our ability to improve disclosure. This study aimed to characterize the most relevant extra-personal determinants of SC disclosure and to describe their influence on the disclosure process. To that aim, the first author conducted substantive qualitative interviews with nine university student-athletes and analyzed their content via constant comparative analysis (guided by Straussian grounded theory). Eleven (11) extra-personal concepts influencing concussion reporting were identified and described across two categories: Contextual Incentives and Socio-Cultural Pressures. These findings suggest that each identified concept can individually shape the context around the injury, creating either higher-stakes conditions that deter disclosure or lower-stakes conditions that encourage it. Further, the results posit that these concepts interact and collectively influence athletes' decision-making process by modulating the perceived stakes of disclosing a concussion. If these findings hold true in more diverse populations and contexts, they suggest that adapting concussion prevention efforts to consider these contextual variables could improve SC disclosure. This study also highlights the benefits of using qualitative methods in the investigation of concussion reporting.