Evaluating the Effect of Concussion-Education Programs on Intent to Report Concussion in High School Football

Context: Concussion underreporting leads to delays in diagnosis and treatment, prolonging recovery time. Athletes' self-reporting of concussion symptoms, therefore, reduces risk. Objective: To evaluate the effectiveness of 3 concussion education programs in improving concussion-reporting intention. Design: Randomized controlled clinical trial. Setting: Three high schools in California. Patients or Other Participants: A total of 118 male football players (age = 14.88 6 1.19 years). Intervention(s): Participants were randomly assigned to receive concussion education via CrashCourse (CC), Centers for Disease Control and Prevention (CDC) video education materials (CDC-Vi), or CDC written education materials (CDC-Wr). Main Outcome Measure(s): The primary outcome was concussion-reporting intention, which was assessed at baseline, immediately after education, and at 1-month follow-up. Secondary outcomes were concussion knowledge, concussion -reporting attitudes, perceived concussion-reporting norms, and perceived behavioral control. Results: Across all education formats, a total sample of athletes improved in concussion-reporting intention at immediate and 1-month follow-ups (mean improvements = 6.8% and 11.4%, respectively; F-4,F-224 = 11.1, P , .001). Similar findings were observed across all education formats in secondary analyses examining knowledge, attitudes, and perceived behavioral control. However, we noted differences in concussion-reporting intention by education format and time (F-4,F-224 = 2.8, P = .03). Post hoc analysis showed that athletes who received CC had increased concussion-reporting intentions at immediate and 1 month follow-ups (baseline = 4.7, immediate follow-up = 6.1, 1 month follow-up = 6.0; F-16,F-61.1 = 6.1, P = .007) compared with increases only at 1-month follow-up for CDC-Vi (baseline = 4.3, immediate follow-up = 5.2, 1-month follow-up = 5.8; F-1.6,F-61.6 = 8.4, P = .001) and no improvement for CDC-Wr (P = .10). Secondary analyses indicated differences between CC and both CDC interventions in concussion knowledge and attitudes at immediate and 1-month follow-ups. We identified no differences in perceived behavioral control among interventions (F-4,F-216 = 0.2, P = .93) or perceived concussion-reporting norms across (F-4,F-224 = 0.3, P = .73) or among (F-4,F-224 = 1.7, P = .15) interventions. Conclusions: All athletes exhibited an improved intent to report concussions, increased concussion knowledge, better concussion attitudes, and more perceived behavioral control at both immediate and 1-month follow-ups. However, athletes randomized to receive CC reported a greater intent to report concussion, more knowledge, and improved concussion -reporting attitudes when compared with those who received CDC-Vi and CDC-Wr.