Concussion Disclosure Behaviors Attitudes Norms and Knowledge – The BANK Study

Research Team: Johna K. Register-Mihalik, Stephen W. Marshall, Kenneth L. Cameron, Paula Gildner, Kevin M. Guskiewicz, Heidi J. Hennink-Kaminski, Megan N. Houston, Zachery Y. Kerr, Laura A. Linnan, Karen Y. Peck, Melissa C. Kay, Alyse Dorman

Picture1Why did you do this study?

While we aim to identify and treat all concussions, when athletes and soldiers get hurt, the societal and self-imposed pressures to excel, prevent them from admitting that they are concussed. It is imperative that we understand factors that influence the behavior of concussion disclosure and the culture in which both athletes and service academy cadets operate. Knowledge of these factors will aid in development of culturally and organizationally relevant interventions to improve disclosure and to improve prevention and treatment of concussion in at-risk populations. Finally, it is important to develop evidence and community informed educational tools and systems for these groups. Recent studies estimate that over 50% of concussions may not be reported or disclosed and that individuals who delay reporting of concussion may have a longer recovery than those who seek immediate care.


What did you do and what did you find in this study?

The primary goal of the Concussion Disclosure Behaviors Attitudes Norms and Knowledge Study (BANK) is to develop a theory-driven intervention that changes norms and personal beliefs around concussion disclosure among military service academy cadets and collegiate athletes. Fundamental to the intervention is an online interactive platform. We are building an evidence base founded on behavioral theory that will be utilized to create an evidence-based, theory driven intervention. This immersive platform is being developed and tested among physically-active civilian and military emerging adults to refine and produce an interactive educational tool ready for use.

In collaboration with our colleagues at Keller-Army Hopspital, we are building:

1)    A large database of key drivers of concussion disclosure

2)    An interactive and immersive online platform for concussion education that changes cultural norms, attitudes, and behaviors around concussion disclosure.

3)    A network of access to make this tool available freely to NCAA colleges and military installations.

4) A research infrastructure to study how this approach works to change cultural norms, personal attitudes, and behaviors around concussion

Picture3To date we have enrolled nearly 1000 first-year service academy cadets and 350 student-athletes across our two study sites. Our data are yielding results that highlight the key role of intention to disclose concussion symtpoms and it’s influence on actual disclosure behaviors. In addition, our data support the need to develop multi-level interventions that target various levels within sport as perceived social pressures from key stakeholders (eg supervisors, coaches, fellow teammates or cadets, etc) strongly influence intention to disclose and actual disclosure.

We have begun initial development and testing of the immersive platform and are aiming to have this available for use in the next calendar year.

This study:

  • Provides data on key factors to address in development and implementation of concussion prevention and management interventions in at-risk populations
  • Highlights the importance of including multiple levels of society and organizations in intervention development, as perceived social pressures by key individuals plays a role in intentions and behaviors
  • Provides opporutnities to better understand concussion disclosure and care in at-risk populations
  • Provides a resource to improve behaviors around these core issues