Deciding to Play: Exploring Why Adolescent Athletes Under-report Sport-related Concussions using a Mixed Methods Approach
Sport participation offers several benefits for adolescent athletes but is not without limitations, including risk of injury. Sport-related concussions (SRC) leave adolescents vulnerable to significant health, physical, social, and educational disruptions. Current recommendations emphasize SRC education and removal from play upon suspicion of concussion. However, many adolescents under-report SRC symptoms, but the scope of under-reporting for this population is not well understood, nor are the underlying motivations for (under)reporting. It is necessary to interrogate the relationship between SRC knowledge and reporting and invite athletes to share their decision-making processes. In consideration of developmental, educational, psychosocial and sport cultural findings, the objective of the current research was to understand why adolescents under-report sport-related concussions. Using a mixed methods approach, two studies were developed. The purpose of Study 1 was to assess the current literature on SRC under-reporting in adolescent athletes 13-18 years old through a systematic review. In total, 26 articles were included in the review. All studies found evidence for athletes failing to disclose concussion symptoms; both male and female athletes were found to under-report, with limited evidence suggesting male athletes under-report SRC more frequently. Prior concussion knowledge does not appear to predict sustained improvements in under-reporting behaviours, highlighting the complexity of under-reporting decision-making. The purpose of Study 2 was to understand how athletes’ attitudes, experiences and beliefs regarding concussions influence their under-reporting decisions and behaviours. This research employed a constructivist grounded theory approach. Participants included 17 elite athletes, 16-18 years old, from a variety of sports. A substantive theoretical model demonstrates personal, social, cultural, and biophysical processes that contribute to under-reporting decisions. The model identifies multiple interconnected processes that contribute to ‘high-risk’ situations of under-reporting. Findings implicate the collective responsibility of under-reporting and the use of risk profiles as a novel approach to understand and consequently improve under-reporting behaviours. Overall, this research synthesizes evidence on adolescent under-reporting, challenges the reliance on concussion education as the primary tool for improving behaviours, and provides a theoretical foundation for how to support adolescent athlete decision-making for improved reporting outcomes.
Adolescents, Concussion, Decision-Making, Injury, Reporting, Sports
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