Page 94 - JSOM Fall 2020

guide and a paradigm shift, in which dissemination is viewed staff. Emerging evidence suggests that in military settings in-
as central to the ongoing concussion education process. This dividuals such as those along the chain of command play a
includes engaging student-athletes/Servicemembers and other critical role in shaping a disclosure supportive environment
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key stakeholders in the education planning process and shar- and may be similarly appropriate targets for education to en-
ing information throughout the year, in multiple modalities, courage communication with military Servicemembers about
from multiple sources, using formal and informal methods concussion disclosure. More research is needed about disclo-
(e.g., programmatic education, conversation, signage or other sure-supportive communication in military settings; however,
static reminders). Educational messaging can target smaller stakeholder-engaged adaptation of the NCAA’s Concussion
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groups of individuals according to their different learning Fact Sheet for Coaches to the military setting may be an ap-
needs and preferences, 11,34 motivational goals, and setting propriate starting point for developing effective educational
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(e.g., sport, military). Institutions will also have different re- content.
sources and barriers to sharing information. Thus, it is essen-
tial that concussion education dissemination is an ongoing Domain 4: Team- and unit-level processes
process of stakeholder engagement with local tailoring rather • Recommendation 13: Provide athletes/Servicemembers
than a static one-size fits all approach. with education that addresses the role they can play in
encouraging peers to disclose possible concussion symp-
Domain 3: Concussion education for other stakeholders. toms (e.g., share evidence-based bystander education
• Recommendation 9: Provide coaches and military lead- programming).
ers with evidence-based concussion education that is • Recommendation 14: Provide opportunity for team
aimed at supporting athletes/Servicemembers in concus- members and coaches/leaders in the military chain of
sion symptom disclosure. command to discuss and establish team values that are
• Recommendation 10: Provide sports medicine/front supportive of concussion symptom disclosure.
line medical staff with strategies about how to engage
coaches/leaders in the military chain of command in sup- Team- and unit-level, in addition to individual-level, activities
porting athletes/Servicemembers in concussion symptom are needed to establish and maintain disclosure-supportive
disclosure. cultures. Current research suggests that many collegiate stu-
• Recommendation 11: Provide easily accessible informa- dent-athletes incorrectly believe that their teammates would be
tion to parents/guardians about how to support athlete/ more likely to play through a concussion than they themselves
Servicemember concussion symptom disclosure. would be. 40,41 Providing explicit opportunities to discuss and
• Recommendation 12: Provide easily accessible infor- clarify individual and team values is an important strategy for
mation to other key site-specific stakeholders (e.g., stu- correcting these misperceived norms. Respected team leaders
dent-life administrators, faculty athletic representatives, (e.g., captains, coaches, military chain of command) are natural
leadership, military chain of command) about how to facilitators for such a process. Explicit messaging that places
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support athlete/Servicemember concussion symptom teammates as responsible and safety-supportive bystanders is
disclosure. another important strategy for creating disclosure supportive
team cultures. Teammates can help encourage care seeking
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Explicit verbal communication supportive of concussion dis- directly by noticing potentially symptomatic peers. They can
closure from key stakeholders, inclusive of coaches and par- also express support for adherence to concussion evaluation
ents as well as military leadership, is an important strategy and recovery protocols, limiting pressure on peers to try to
for shaping athlete/Servicemember beliefs about whether return to play as quickly as possible. The NCAA’s Fact Sheet
disclosure is valued in their setting. 16,35–38 The present recom- for Athletes provides content that specifically addresses the
mendations indicate that institutions can help encourage these teammate-as-prosocial bystander role. Content about the im-
disclosure-supportive interactions through the educational portance of bystander engagement to facilitate concussion dis-
materials they proactively share with coaches/leaders or make closure (whether from the NCAA Fact Sheet or other sources)
available for parents/guardians. While the present consensus could be shared in a team setting, paired with a discussion
process did not specify content of these educational materials, about barriers to speaking up about a teammates suspected
similar content as provided to athletes may be beneficial to concussion, and the clarification of team values about the im-
motivate action among nonathlete stakeholders. This would portance of doing so. Importantly, coaches should be present
include information about the benefits of early concussion at such discussions given the central role they play in shaping
symptom disclosure (e.g., athletic/military readiness, health, team culture.
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academic, occupational) as well as stakeholder-tailored con-
tent about how they can help create an interpersonal context Domain 5: Organizational processes.
that encourages concussion disclosure. One specific strategy • Recommendation 15: Actively collaborate with or-
is explicit verbal communication about the importance of ganizational stakeholders (including coaches/military
concussion disclosure—by medical staff to coaches/leaders, leaders, primary health care providers, athletes/Service-
by coaches/leaders to their team, and by parents/guard- members) to identify and address organizational barri-
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ians to their child. The NCAA’s Concussion Fact Sheet for ers to concussion symptom disclosure.
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Coaches has improved intentions to engage in disclosure- • Recommendation 16: Evaluate the effectiveness of in-
supportive communication with their team and is a feasibly stitutionally selected concussion education approaches
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disseminated resource for coaches. An in-person discussion in changing athlete/Servicemember concussion symptom
with sports medicine staff has the potential to augment the disclosure behavior.
impact of this handout or other coach education resources, • Recommendation 17: Communicate in a deliberate
by providing opportunity for coach questions to be answered manner institutional values that emphasize safety and its
and by strengthening trust between coaching and medical importance in athletic performance/military readiness.

92 | JSOM Volume 20, Edition 3 / Fall 2020