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Step 5: Debrief and assess program

Step 5: Debrief and assess program

Lacrosse players

While optional, debriefing the peer concussion educators, coaches, program participants (i.e., student-athletes) is recommended to obtain information to improve the program. This debrief session can consist of the following questions:

1) What was your general experience of the program?

2)  What were the program’s strengths and limitations?

3) What suggestions do you have for improvement?

4) What are your recommendations for future participants?

In addition, a formal program assessment is also recommended to assist in determining the overall effectiveness of the program and its components at your institution. In particular, the degree to which the program is reinforcing and enhancing concussion knowledge as well as enhancing intention to report concussions can be assessed. The actual number of reported concussions prior to the implementation of the program and in the years after the program is implemented can also be determined. A suggested model of program assessment is discussed below and is summarized in Table 4.

Assessment Timeline

Student-athletes participating in the program should be assessed at multiple time points (e.g. baseline, immediately after the program and months after the program) for 5 things: 1) concussion knowledge, 2) attitude toward concussive reporting, 3) intent to report, 4) perceived attitudes of others toward reporting (direct subjective norm), and 5) ability to report.

Concussion Knowledge

Concussion knowledge can be measured with a checklist adapted from Gioia and Collins’ (2006) Acute Concussion Evaluation (ACE) and McLeod et al.’s (2007) study, which examined youth coaches’ misunderstanding of sport-related concussion comparing concussion symptom and effects. This consisted of 27 total items, 19 of which were true symptoms such as blurred vision and headache and 8 of which were false symptoms such as black eye or loss of neck range motion. Scores were calculated by giving one point for each actual symptom identified and one point for each non-symptom not identified for a total possible score of 27.




Concussive Symptom Reporting Behavior

Previous research has suggested that reporting concussions is influenced not only by knowledge of concussion but also by intention to report, perceived expectations of important individuals and groups such as coaches and teammates about reporting, attitudes about reporting, and factors that facilitate or inhibit reporting behavior (Register-Mihalik, et al., 2013; Kroshus et al., 2014; Kroshus et al., 2015; Fishbein & Ajzen, 1975). Based on a theory of planned behavior which predicts that knowledge is a predictor of behavior only when the norms of the group and factors that facilitate that behavior also support reporting, it was important to utilize several measures to determine intention to report as well as the attitudes surrounding concussion reporting for the individual. All measures were modified to include not just reporting about one’s own possible concussion (self-reporting) but also reporting about a suspected concussion in a teammate (teammate reporting). Questions related to either self or teammate reporting should be counterbalanced across participants.  

Intention to report

Intention to report consisted of 6 questions related to intentions to report possible concussion in oneself and 6 questions related to intentions to report possible concussions in teammates. These were adapted and expanded from Register-Mihalik et al.’s (2013) original three questions about intention to report to include not just overall intention to report but more specifically intention to report ‘under most circumstances’, ‘even if I am not sure it is serious’, ‘when I notice symptoms’, ‘in a playoff or championship game’, and ‘in practice’ in order to account for the potential influence of different circumstances on intention to report. Participants were asked to rate their agreement with each statement about intention to report on a 7-point likert scale (1-strongly disagree to 7- strongly agree) with a minimum score of 6 and a maximum score of 42 on both the intention to report self and intention to report teammate subscales.

Attitudes toward concussion reporting

Direct attitudes toward concussive reporting were measured by evaluating change in attitude about reporting both self and teammates based on Register-Mihalik, et al.’s (2013) 7 question direct attitude scale. Participants were asked to indicate how they would feel about reporting a possible concussion using a 7-point scale with dichotomous anchors (i.e. cowardly-brave). The current study added 7 direct attitude questions which asked participants to indicate how they would feel about reporting a possible concussion in a teammate.

Others’ Beliefs about Concussion Reporting

Direct subjects norms which reflect what others think one should or should not do regarding reporting concussion were measured with 10 questions about self-reporting and 10 questions about reporting a teammate modified from Register-Mihalik (2013). Questions that were added included expanding the original statements by replacing general terms such as people with specific relevant others including coaches, parents, teammates, trainers, and other students. Participants indicated their agreement with each statement on a 7-point scale (1-strongly disagree to 7-strongly agree).

Ability to Report Concussion

Direct perceived behavioral control was measured to assess participants’ perceived ability to actually carry out the behavior of reporting suspected concussions in themselves and teammates. Questions were adapted from Register-Mihalik et al. (2013) and included the original 3 questions from their study with the addition of three new questions including, ‘I know how to report a concussion,’ ‘other reasons will not stop me from reporting,’ and ‘I know who to report a concussion to.’ Participants indicated their agreement with each statement on a 7-point likert scale (1-strongly disagree to 7-strongly agree). Participants reported direct perceived behavioral control for reporting suspected concussion when they themselves and their teammates may experience concussive symptoms. 

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