Researchers to examine best ways to alter concussion attitudes, behaviors

A multidisciplinary team of University of Wisconsin–Madison researchers is receiving funding from the NCAA and U.S. Department of Defense to study the most effective ways to teach athletes and young adults about the importance of reporting when they have suffered a concussion.

“What our study will address is why education and awareness efforts have largely not succeeded in altering the behavior of athletes and other young adults when it comes to reporting concussions,” says Dee Warmath, a principal investigator on the project and an assistant professor with the School of Human Ecology’s Department of Consumer Science.

The initiative will evaluate the effectiveness of three different interventions with a largely untapped population: the roughly 2,500 young adults who play competitive club sports on the UW–Madison campus. Dozens of club teams on campus compete in a range of sports, from non-contact athletics like swimming and running, to contact pastimes such as fast-pitch softball, baseball and basketball, to collision sports like rugby and ice hockey. UW–Madison’s Division of Recreational Sports oversees these club teams and manages them primarily by working through the team captains.

The research project is titled, “Making it Stick: A Social Marketing Experiment to Alter Concussion Attitudes and Behavior.” It will build upon longstanding research in the areas of social marketing and design thinking to address three challenges in existing efforts to improve concussion reporting:

• Can symptom-focused education be redesigned to encourage greater processing of the information?
• Does a focus on avoiding consequences — or realizing benefits — have a greater impact on reporting than symptom-focused efforts?
• Does social context matter and, if so, how so?

“This study will provide insight into the incidence of reported and unreported sports-related concussions and the attitudes, knowledge and behaviors for these at-risk young adults,” says Andrew Winterstein, a principal investigator with the project who heads the Department of Kinesiology’s athletic training program.

The study will stratify different groups of competitive club sport athletes based on risk of a concussion event — low, medium or high. The UW–Madison researchers will then compare the effectiveness of the current “NCAA Concussion Fact Sheet” education materials to two novel educational interventions.

The UW–Madison researchers explain that the NCAA fact sheet is a symptom-focused effort that assumes if an athlete knows what a concussion is, he or she will engage in the correct reporting behavior. Such an approach, the researchers note, is typical of the concussion education efforts that exist today.

The problem, the researchers stress, is that studies have shown a limited effectiveness with this approach — with existing literature indicating that concussions are underreported.

In an effort to find a more effective way to convince athletes to report head injuries, the researchers will be studying two additional interventions.

One is called “enhanced symptom-focused education developed via design thinking.”  This intervention will leverage design thinking to translate current educational materials into language and delivery methods more accessible and memorable for young adults.

The UW–Madison researchers explain that they will have a group of competitive club sport athletes and active college students explain the current education content from their perspective. The researchers will figure out: What matters to these athletes in brain safety? What are the terms in which they speak of it? What resonates? How do they comprehend the information?  How do they apply it?  How does it support their evaluation of a particular situation and the appropriate behavioral response?

“Sports concussions, like all sports injuries, are a significant public health concern.”

Andrew Winterstein

After gathering this feedback, researchers will redesign the delivery of the current NCAA Concussion Fact Sheet content to better resonate with the target audience in ways that lead to higher-level processing and greater reporting of concussion symptoms. Ultimately, this intervention will involve the same focus on symptoms, but will deliver the information in a novel way.

The other intervention that will be studied is called “consequence-focused education developed using principles of social marketing.” This intervention addresses the lack of knowledge of consequences of head injuries and will focus on the consequences of behavioral choices related to concussions as a means of changing individual behavior.  This approach has proven successful in campaigns advocating for less energy consumption and better health decisions. One example is letting the public know that one’s chances of lung cancer can be reduced by not smoking.

The idea is to make the behavioral choices and information that guide them more salient to the individual decision maker by shifting focus toward outcomes that matter to him or her. This approach connects the decision to report, or not report, a possible concussion to outcomes or circumstances valued by the athlete, such as mental capacity for life and the ability to return to the sport for a longer period of time after recovery.

In the end, the researchers hope to find the optimal approach to changing attitudes, beliefs and, ultimately, behavior related to concussion reporting. Findings from this study will support the development of more effective educational interventions, as well as policy mandates enabling the delivery of those interventions.

“What our study will address is why education and awareness efforts have largely not succeeded … when it comes to reporting concussions.”

Dee Warmath

“Sports concussions, like all sports injuries, are a significant public health concern,” says Winterstein. “Innovative approaches are needed to help athletes and other young people better recognize head injuries, and to show them the merits in reporting concussions.”

Warmath and Winterstein have assembled a multidisciplinary team from across campus, with experts in the fields of brain safety, injury prevention, sports medicine, health services, physiology and consumer decision making, among others. These efforts are part of the “Mind Matters Challenge,” a landmark initiative between the NCAA and the Department of Defense to enhance the safety of athletes and service members.

“The multidisciplinary perspective of this study offers tremendous opportunity to leverage findings from several domains of consumer behavior in the development of innovative educational efforts for concussion reporting,” says Warmath. “This broad perspective, a simple yet powerful study design, and a readily available, untapped audience for testing will no doubt reveal important directions for improving concussion reporting behavior among young adults.”