Understanding concussion reporting using a model based on the theory of planned behavior

Purpose: Athlete's report of concussion symptoms to coaching or medical personnel is an important component of concussion risk reduction. This study applies a model based on the Theory of Planned Behavior (TPB) to the prediction of concussive symptom underreporting among late adolescent and young adult male ice hockey players.

Methods: Participants were members of an American Tier III Junior A ice hockey league (ages 18-21 years; male; n = 256). Twelve of 14 league teams and 97% of players within these teams agreed to participate. Written survey items assessed symptom reporting behavior, intention, perceived norms, self-efficacy, perceived outcomes of reporting, and concussion knowledge. Structural equation modeling was used to assess the significance of relationships hypothesized by the TPB-based model and the overall model fit. Data were collected in January 2013.

Results: Results supported the fit of the TPB-based model in explaining reporting behavior; all model pathways were significant in the hypothesized direction. Of the perceived reporting outcomes assessed, those related to athletic performance were identified as most strongly associated with reporting intention.

Conclusions: Results of this study suggest the importance of considering factors such as perceived outcomes of reporting, perceived norms, and self-efficacy, in addition to knowledge, when analyzing concussion underreporting among adolescent athletes. As concussion education for athletes becomes increasingly mandated, testing and applying psychosocial theories such as TPB may help increase program efficacy.