Evaluation of Educational Intervention on Concussion Knowledge and Behavior in Student Athletes

Abstract

Background and Significance: The purpose of this study was to evaluate the effectiveness of the Barrow Brainbook (BBB) concussion education program as a tool to increase concussion knowledge among Arizona high school athletes and to modify attitudes and behaviors regarding concussion. Methods: This was a cross sectional study of Arizona high school athletes utilizing a 31 question multiple‐choice de‐identified survey. Attitude, knowledge, and behavior questions, as well as sport and level of participation were analyzed using the Wilcoxon Rank Sum test. Means between groups were analyzed using a two‐way ANOVA. Linear regression was used to determine if there was a relationship between number of years since completing BBB and concussion knowledge. Results: Surveys were distributed to 382 student athletes with 363 of those being completed. 224 students participated in BBB (62%). Knowledge and behaviors regarding concussion were not statistically significant when comparing students who had and had not participated in BBB. Those who participated in BBB scored more poorly on questions regarding attitudes about concussion than those who had not (p=0.033). Subsequent two‐way ANOVA testing showed that students who sustained a concussion scored worse (p<0.01) while completing BBB did not significantly affect attitude (p=0.399) when history of a concussion was brought in to the analysis. 90 students (25%) reported sustaining a concussion. Football and varsity level participation were significant for a higher mean number of concussions (p<0.05, p<0.05). There was no relationship between time since taking BBB and concussion knowledge (R2 was 0.007). Conclusions: In this study, there was no evidence to show that participating in the BBB program improved concussion knowledge, attitudes, or behaviors. Number of years since taking BBB was not a good predictor of concussion knowledge. Students who played football and participated at a varsity level were significantly more likely to sustain a concussion. Sustaining a concussion was associated with a higher attitude risk sum score. This is an evaluation of an educational tool specifically designed for adolescents that demonstrated no statistically significant change in increasing knowledge or modifying attitudes and behaviors in a population of high school athletes in Arizona.