Concussion education for athletes: Efficacy and psychosocial pathways for behavior change

Background: Despite prevalence of legislation mandating concussion education for youth athletes, there has been limited evaluation of the effectiveness of concussion education programs in changing player behavior, and no theory-driven evaluation of psychosocial pathways through which concussion education impacts behavior.

Methods: A randomized control trial tested the differential efficacy of three publically available concussion education programs in a sample of male tier II junior ice hockey players (n=256, teams=12). Teams were randomized to a control condition or to view one of two videos: “Concussion In Hockey: Signs, Symptoms and Playing Safe” or “Head Games”. All players, including those in the control condition, received the CDC's written educational handout. Data was collected pre-education, one day post-education and six weeks post-education. Beyond program efficacy, structural equation modeling was used to evaluate the fit of the Theory of Planned Behavior (TPB) in predicting symptom-reporting behavior.

Results: Players viewing one of the videos had a greater change in symptom reporting compared to players only receiving the written CDC materials, with greater change among players in the Head Games condition. Constructs of TPB (attitudes, subjective norms and perceived behavioral control) independently predicted symptom-reporting intention, which in turn predicted behavior.

Conclusions: Mandating “any” concussion education is not sufficient, as not all publically available materials are effective in changing player behavior. Educational materials should be evaluated in multiple populations and only recommended if found effective. Health behavior theory, including TPB, can help guide evaluation of existing programs and design of future programs.