Concussion as a Public Health Crisis: Multilevel Approaches for Improving Athlete Care-Seeking.

Abstract

Fifty percent of athletes who suffer a concussion do not seek care for the injury, which leads to worse outcomes including more severe and numerous symptoms and prolonged recovery. Many organizations use annual education as a secondary injury-prevention strategy to improve athlete care-seeking, and subsequently, injury outcomes. However, these efforts have proven insufficient. Those who develop educational programs have begun to use a variety of behavioral theories to inform the content and delivery of these interventions. However, these interventions rarely acknowledge or address systematic barriers across the entire socioecological framework. Concussion research and education have focused heavily on the impacts of intrapersonal and interpersonal relationships on concussion care-seeking. There is a need for further examination of the organizational and societal impacts on athlete care-seeking behavior to inform strategic solutions. Integrating messaging about exosystem and macrosystem influences on care-seeking into education may improve athlete health and well-being. Existing research supports using concussion education interventions that are informed by behavior and knowledge-translation frameworks, reiterates the serious short- and long-term consequences of a concussion, and promotes the benefits of prompt care-seeking. Providing education regularly and to all members of the athletics organization (e.g., coaches, sports medicine providers, and administrators) may help address interpersonal pressures. These measures may initiate a larger sociocultural movement that may be necessary to improve athlete care-seeking. Effectiveness-implementation design studies could help illuminate the real-world impact of changes to concussion-reporting rates and health outcomes.