A Qualitative Analysis of Concussion-Reporting Behavior in Collegiate Student-Athletes With a History of Sport-Related Concussion

Context: Many survey-based methods have been used to explore concussion-reporting behavior. However, because the decision to report or conceal a concussion is likely multifactorial, this may narrow the findings, as the surveys were largely designed by the researchers. Objective: To explore student-athletes' perspectives regarding factors that may influence the reporting of sport-related concussion. Design: Qualitative study. Setting: National Collegiate Athletic Association Division I athletics. Patients or Other Participants: We conducted 17 semistructured interviews with student-athletes who had sustained 1 or more concussions while attending a large university (men =4, women = 13, age = 20.9 +/- 1.3 years). Data Collection and Analysis: After data saturation and member checks, a 5-cycle analytic process was completed: topical review, literature review, data collection and summarizing using a codebook developed by a 3-person research team, linking of findings to current research, and final interpretations. Results: We discovered 3 themes. Participants discussed concussion perceptions by describing their understanding of a concussion, their own injury experiences, and their perceptions of symptom severity and duration. Regarding reporting behavior, participants described an order of individuals with whom they would speak, symptoms present in order to report (eg, feeling different from normal), immediate reactions, and influential factors for mitigating short- and long-term consequences. Lastly, participants discussed the value of support systems, such as how coaches can both positively and negatively influence reporting and athletic trainer involvement. Conclusions: Participants often drew from their own concussion experiences in naming common concussion signs and symptoms. Additionally, they indicated that both short- and long-term health consequences influenced and deterred their seeking care and that their support systems, including coaches and athletic trainers, played a role in their concussion experience. Research is needed to determine if using studentathletes' own words to describe a concussion and incorporating student-athletes' support systems, especially coaches and athletic trainers, is effective in increasing concussion reporting.