Concussion at Play: Recommendations for Young Athletes, Coaches, Parents, Healthcare Providers, and School Professionals

Theoretical Background and research questions/hypothesis:  Across the U.S., numerous educational efforts are underway that aim to improve concussion knowledge, attitudes/social norms, and behaviors among young athletes, coaches, parents, health care providers, and school professionals. While progress has been made, research reveals that many young athletes still do not report their symptoms, are not removed from play and continue playing with concussion symptoms, and/or return to play too soon. To achieve widespread changes, there needs to be a coordinated approach to improving the culture and behaviors regarding concussion prevention, recognition, and response.

Methods:  CDC conducted a review of the literature related to knowledge, attitudes/social norms, and behaviors regarding concussion among five inter-related audiences: young athletes, coaches, parents, healthcare provides, and school professionals. Four research questions guided this study:

1. What do young athletes, coaches, parents, health care providers, and school professionals know about concussion?
2. What do young athletes, coaches, parents, health care providers, and school professionals think about concussion?
3. What are young athletes’, coaches’, parents’, health care providers’, and school professionals’ behaviors regarding concussion?
4. What education efforts for young athletes, coaches, parents, health care providers, and school professionals are effective in improving knowledge, attitudes, and behaviors towards concussion?

Results:  Fifty-one articles were identified about concussion-related knowledge, attitudes/social norms, and behaviors among the five audiences. Of these, 12 addressed young athletes, 18 addressed coaches, 6 addressed parents, 18 addressed healthcare providers, and none addressed school professionals. No articles about school professionals met the inclusion criteria. 

Conclusions:  Coaches, parents, health care providers, and school professionals all play an essential role in keeping young athletes safe from concussion so that they can stay healthy and active. However, current understanding of the information needs of these groups and what works in concussion education and culture change is limited. Improving underreporting of concussion among young athletes is an ongoing challenge. Future research should continue to explore the relationship between the coach and young athlete to understand how coaches can create an environment on a team that is supportive of symptom reporting. Parents can also benefit from a stronger understanding of the effects of repeat concussions inside and outside of sports, and the importance of removing an athlete from play after a potential concussion during a sports event. More research is needed to better understand the relationship between concussion-related knowledge, attitudes, and behaviors of health care providers to improve diagnosis, management, and patient outcomes following a concussion. Evaluation research is needed to assess the effect of educational materials on school professionals’ knowledge, attitudes, and behaviors.

Implications for research and/or practice:  Our hope is that findings from the current study will energize researchers to fill information and research gaps and test interventions to improve the culture around concussion and that promote safety among young athletes on sports fields, at home, in the health care setting, and in schools.