A qualitative study of factors influencing adult stakeholder concussion communication with youth athletes

Research suggests adult stakeholder (coach, referee and administrator) communication about concussion influences the likelihood of athletes reporting concussive symptoms. The goal of this study was to develop a conceptual model to describe factors contributing to adult stakeholder (AS) concussion communication with youth athletes, to inform future concussion education interventions. We conducted a qualitative interview study with n = 63 AS in youth American football and football (soccer) in Washington and Georgia, analysing interviews using a coding structure based on the Theory of Planned Behavior. Across our sample, AS could describe concussion symptoms and mechanism in detail (Knowledge). AS believed that playing with a concussion could be dangerous, though many had experienced a concussion themselves and not had any negative outcomes (Attitudes). AS believed they were responsible for concussion safety (Normative beliefs), but described that messaging from institutions did not emphasise the role of AS in concussion safety. AS were comfortable in their ability to engage in concussion communication (Self-efficacy), but some expressed concern that talking about concussion might not improve safety but instead result in overreport of symptoms (Controllability). In conclusion, AS have good knowledge of concussion safety, but no clear mandate from their institution to discuss concussion with youth athletes, and concerns that such communication would not improve safety. Future research should utilise these findings to improve the effectiveness of concussion educational interventions for coaches, referees and administrators.