High school rugby coaches' knowledge and opinions of concussion in Kwa-Zulu Natal province in South Africa: an ecological cross-sectional study

Background Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management.Methods This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge.Results More participants showed good overall knowledge of >= 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD +/- 0.75, mean 4.68), being adaptable (171, +/- 0.86, 4.62), and being completed in the warm-up (167, +/- 0.93, 4.51). The biggest perceived barriers were duration (138, +/- 1.59, mean 3.73), effort (130, +/- 1.56, 3.51), compliance and lack of knowledge (both 127, +/- 1.68, 3.43).Conclusion These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes. center dot The risk of concussion to female athletes and younger athletes was under-reported and should be addressed in future coach-focused education initiatives.center dot Successive educational approaches may be effective in coaches' knowledge retention, although the most appropriate delivery methods should be researched further.center dot The ideal injury prevention programme should improve player skill whilst reducing the risk of injury, be adaptable, completed during the warm-up and not take much time or effort to complete.