The effects of knowledge, attitudes, self-efficacy, and treatment practices on concussion management in the high school setting

The purpose of this dissertation was to examine athletic trainers’ (ATs’) and emergency room physicians’ (MDs’) perceptions of concussion management in the high school athlete. The first study looked at the implementation process of a new state concussion law as perceived by a group of high school ATs. Semistructured interviews were given to n = 14 ATs and reported on four topics that should be considered when implementing a school concussion protocol: (a) a school-level concussion policy’s implementation is dependent on salient facilitators; (b) a school-level concussion policy’s implementation is dependent on having fewer barriers than facilitators; (c) a state-mandated school concussion law requires support from within the school and community; and (d) a school-level concussion policy’s implementation is dependent on the positive impact of the Concussion Oversight Team. In the second study, a cross-sectional self-report survey examined knowledge, attitudes, and self-efficacy as they relate to n = 534 ATs’ and n = 29 MDs’ endorsement of concussion treatment practices. Of the literature’s most recommended treatment practices, only 16.4 percent of ATs and 19.2 percent of MDs were using all eight practices. Using hierarchical linear regression, race was significantly positively related to treatment practices (β = .12, p < .05) in which white licensed health care providers (LHCPs) endorsed more practices than non-white LHCPs. Self-efficacy was significantly positively associated with treatment practices (β = .70, p < .05), and the final R2 = .12 percent. Further, job title moderated this positive relationship (p < .05), such that, as concussion management self-efficacy scores increased, LHCPs’ endorsement of treatment practices also increased. Self-efficacy was more influential for MDs (t(400) = 4.69, p < 0.001) than ATs (t(400) = 2.52, p < 0.05). Additionally, ATs had significantly higher knowledge, attitude, and self-efficacy scores than MDs. Together, results of these studies highlight practical implications for provider education in concussion management. Results extend the literature by providing ATs’ and emergency room MDs’ baseline levels of knowledge, attitudes, and self-efficacy toward concussion management treatment practices, as well as examining the implementation of a concussion law in the state of Texas as perceived by high school ATs.