Diffusion of Innovations and Sports Concussions

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OBJECTIVE: Identify and assess key decision-makers for high school sports concussion policies, their perceptions of evidence based concussion guidelines, and implementation of these guidelines and policies using a novel application of Diffusion of Innovations and mixed qualitative and quantitative methods BACKGROUND: Over 3 million concussions occur in the US annually. High-school athletes are susceptible since over 7 million play high-school sports, and they often hide concussions and return to play (RTP) too soon. Sports concussion research rarely incorporates socio-behavioral theory and qualitative methods. Diffusion of innovations (DOI) theory has examined social systems and preventive health intervention adoption. DOI incorporates communication and decision-making between key influencers for adopting innovations. Thus, DOI theory will elucidate sports concussion RTP decision-making processes. Finally, Georgia policy has vague RTP standards, meaning schools may have varying policies. DESIGN: In-depth-interviews and surveys assessed key professionals’ involvement in RTP policy decision-making. Participants included school administrators, athletic trainers, concussion researchers, parent advocates, and physicians in Georgia. Study instrument topics stemmed from DOI theory: knowledge; innovation characteristics; characteristics of decision-makers: socioeconomic, personality, and communication behavior. Analyses involved codebook development for thematic analysis of key themes from 20 interviews and surveys. RESULTS: Results yielded 13 major themes with several notable findings: school athletic trainers are critical resources for implementing concussion policies; lack of enforcement and monitoring for Georgia’s concussion law; competition among providers and diagnostic tools stemming analogous to a business model; variability in high-schools’ protocols and possibly compliance due to resource and provider availability. CONCLUSIONS: Understanding decision-making for protecting athletes is critical. Qualitative applications of DOI allow individuals to describe theirs and others’ roles in decision-making processes and inform concussion prevention. Results provide suggestions for best practices and improvements of concussion policies and protocols.