An Examination of Perceived Pressure from Stakeholders on Concussion Reporting Intentions and Behavior in Ice Hockey Athletes

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Journal of Head Trauma Rehabilitation


Objective: We aimed to assess whether perceived pressure predicts concussion reporting intentions and behavior in youth, high school, and collegiate ice hockey athletes, and, secondarily, whether perceived pressure from stakeholders differed between sex or level of play. Setting: Online survey. Participants: One hundred fifty-two ice hockey athletes (males: n = 96, 63.2%; females: n = 55, 36.2%; missing: n = 1, 0.7%; age = 14.04 ± 3.6 years). Design: Cross-sectional. Main Measures: Respondents answered a survey that elicited information about demography, perceived pressure from 6 stakeholders, and concussion reporting intentions and behavior. For the first aim, we used a generalized linear model to determine whether perceived pressure from any stakeholder predicted intention (symptom reporting, concussion reporting, and intention beliefs) or behavior ("all concussions," "not obvious concussions"; α <.05) while controlling for level of play. To determine whether pressure from any stakeholder predicted symptom reporting behavior, we used logistic regression while controlling for level of play. For the second aim, to examine sex differences in perceived pressure from each stakeholder, we employed Mann-Whitney tests and to examine level of play differences, we used Kruskal-Wallis tests. Results: Controlling for level of play, a 1-point increase in perceived pressure from parents and athletic administrators decreased concussion reporting intentions by 0.92 (P =.004) and 1.09 (P =.005) points, respectively. Perceived pressure from a sports medicine professional decreased intention beliefs by 0.17 (P =.029) points. Perceived pressure from stakeholders did not predict symptom reporting (P =.440) or "not obvious concussion" reporting (P =.655) behavior. We observed no difference in perceived pressure across stakeholders (all P values >.05); however, collegiate ice hockey respondents perceived greater pressure from coaches than youth or high school athletes (P <.001). We noted no other differences in perceived pressure across levels of play (all P values >.05). Conclusions: Concussion reporting intentions were negatively influenced by perceived pressure from parents, athletic administrators, and sports medicine professionals, but these findings did not translate to reporting behavior.

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