Examination of collegiate student-athlete concussion reporting intentions and behavior

BACKGROUND: Clinicians rely on student-athletes to self-report concussion symptoms, but more than 50% of concussions go undisclosed. AIM: The aim of this study was to determine whether knowledge, attitudes, subjective norms, self-efficacy, social identity, and athletic identity explain variability in student-athlete concussion reporting intentions and behavior. MATERIALS AND METHODS: One hundred and forty-seven Division I and II collegiate student-athletes (male=23, female=56, missing=168; age=19.04±1.98 years) completed survey segments regarding the following predictor variables: Concussion knowledge, attitudes, subjective norms, self-efficacy, social identity, and athletic identity; and the following criterion variables: Reporting intentions (symptom and concussion reporting) and reporting behavior (symptom and concussion reporting) (completion rate=29.2%). Separate linear and logistic regressions were performed for each criterion variable. Backward elimination Akaike Information Criterion was applied to determine the best fit model. RESULTS: A one-point increase in knowledge, attitudes, and self-efficacy predicted a significant 0.55, 0.23, and 0.31 increase in symptom reporting intentions, and 0.24, 0.30, and 0.33 increase in concussion reporting intentions of concussion reporting. As self-efficacy increased, symptom reporting behavior increased by 140%. When knowledge increased, concussion reporting behavior decreased by 23%. Whereas when subjective norms increased, concussion reporting behavior increased by 23%. CONCLUSIONS: A student-athletes’ confidence, or self-efficacy, was a frequent predictor of concussion reporting intentions and behavior. RELEVANCE FOR PATIENTS: Clinicians should aim to increase student-athlete knowledge, attitudes, and subjective norms, but most importantly their confidence in reporting concussions.