Concussion Attitudes Research Articles

Education is necessary but not sufficient for addressing disparities in concussion knowledge, attitudes, and perceptions

ABSTRACT Introduction Concussion leads to immediate cognitive, physiological, psychological, and emotional consequences that, if left untreated, may persist resulting in longer-term effects. Concussion education programs provide students with the knowledge necessary for them to make an informed decision to seek care should an injury occur. Methods In this observational cohort study, youth participating in public middle or high school athletics in a suburban county in Pennsylvania were asked to complete a survey to assess their concussion knowledge, attitudes, and perceptions before and after concussion education. Results All students increased scores from pre- to posteducation (mean difference, 0.08 to 0.67). Students from noncontact sports, higher grades, and higher Child Opportunity Index (COI) schools tended to have higher scores both before and after concussion education compared to students from contact sports, lower grades, or lower COI schools. Discussion Disparities were identified before and after the educational intervention between sport participation, grade level, and schools with different COI. Although concussion education was successful, with students showing improvement in all questions related to concussion knowledge, attitudes, and perceptions, this study identifies a need for the development of more equitable educational support systems. Understanding these differences may provide opportunities for targeted educational strategies, which might result in improved outcomes for younger athletes, those participating in contact sports, and those from lower COI schools.

Sport-related concussion knowledge and attitudes of staff working in English elite women’s football: a survey-based study

ABSTRACT Background Sport-related concussion (SRC) remains an injury of concern in sport, including football(soccer). There has been little investigation into SRC knowledge and attitudes of support staff working in the professional setting. Methods An amended version of the Rosenbaum Concussion Knowledge and Attitudes Survey(RoCKAS) was distributed online to coaching staff, and medical and performance staff, working at clubs in the English Football Association Women’s SuperLeague (WSL) and Championship. Completion of the survey generated two scores: concussion knowledge index (CKI) and concussion attitudes index (CAI). Results Sixty-three completed surveys were returned. Eighteen respondents were coaching staff, and 45 were medical and performance staff. The median CKI in medical and performance staff was significantly greater than in coaching staff. There was no significant difference in CAIbetween coaching staff and medical and performance staff. There was no correlation between CKI and CAI across all staff. Conclusion Medical and performance staff working in elite women’s football have greater knowledge of SRC than coaching staff. However, this does not always translate into safe behaviours on the field. Education should continue to be mandated across the professional game amongst support staff in order to maximise player welfare and enhance injury outcomes, whilst also reinforcing present SRC guidance.

Unintended consequences - A qualitative exploration of baseline testing in community rugby concussion management

ObjectivesUnderstanding key stakeholders' perceptions around the value of baseline testing, as well as barriers or facilitators experienced as part of the process, may assist with the decision-making process of whether to implement baseline testing in community sport. This study explored coaches', players' and physiotherapists' perceptions of the perceived value, barriers and facilitators of baseline testing as part of New Zealand Rugby's (NZR) community concussion initiative. DesignThe study employed a pragmatic, qualitative descriptive design. MethodsSemi-structured interviews were used to explore participants' perceptions. In total, 73 individual interviews were conducted. The sample consisted of 36 players, 13 coaches and 24 physiotherapists involved in NZR's concussion management pathway. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. ResultsIn terms of perceived value, baseline testing was reported to play a role in i) facilitating a positive concussion culture; ii) positive perceptions of rugby and player safety and iii) enhancing concussion management as part of the pathway. Barriers and facilitators of the baseline testing process included i) stakeholder buy-in as critical driver of the process and ii) contextual and operational factors. Although contextual and operational challenges exist, these participants, as key stakeholders in the process, perceived the value of baseline testing to be more important than the barriers experienced. ConclusionsThe value of baseline testing extends beyond concussion assessment and management, by enhancing community concussion awareness, attitudes and player safety. The findings of this study may assist in the decision-making process around inclusion of pre-season baseline testing in community rugby.

Does the Association Between Concussion Measures and Social Context Factors Differ in Black and White Parents?

Middle school (MS) parents may benefit from education supporting timely concussion identification and care-seeking in their young children (aged approximately 10 to 15 years). However, such education may not consider individual needs and different social context factors, including lower socioeconomic status, disadvantaged social determinants of health, and different racial and ethnic backgrounds. To examine the relationship between social context factors and concussion knowledge, attitudes, and communication in MS parents and to explore the possible role of race and ethnicity (Black or White) as an effect measure modifier. Cross-sectional study. Online survey. A nationally representative sample of MS parents who completed an online survey (n = 1248). Parent outcomes were a history of concussion education, concussion symptom knowledge and attitudes, and communication with children about concussion. Main exposures were parental race and ethnicity (Black or White) and social context factors. Uni- and multivariable statistical analyses were performed to achieve the study aims. Black parents were more likely than White parents to have received concussion education (69.5% versus 60.5%, P = .009), although median concussion knowledge scores were higher for White parents than for Black parents (40 versus 37, P < .001). Few associations were found for social context factors with concussion knowledge, attitudes, and communication in Black and White parents separately. Among MS parents, race and ethnicity may not influence the association between social context factors and concussion-related knowledge, attitudes, or communication. However, differences were present by race and ethnicity regarding previous concussion education and other parental outcomes, concussion symptom knowledge in particular.

Gender differences in concussion-related knowledge, attitudes and reporting behaviors of varsity athletes.

Concussion is a pathophysiological process that occurs due to a traumatic biomechanical force. Concussions are an "invisible" and common traumatic brain injury with symptoms that may be underestimated. This necessitates fundamental improvements in public knowledge specifically addressing young university athletes and different genders. This cross-sectional study aimed to explore the possibility of gender differences with respect to university student athletes' concussion knowledge, attitude and reporting behaviors. We hypothesized that there should be no significant difference in concussion knowledge among male and female student athletes; however, females would show a more positive attitude and more reporting behaviors than male student athletes. Overall, 115 university athlete students completed a survey questionnaire; we eliminated some participants based on required inclusion criteria of Rosenbaum Concussion Knowledge and Attitude Survey-student version (RoCKAS-ST). Our final analysis consisted of 96 participants: 20 males (mean age 21.15 years) and 75 females (mean age 22.36 years). This study included questions about the athletes' given reasons for reporting or not reporting a concussion. Additionally, 33 RoCKAS-ST questions on Concussion Knowledge Index (CKI) with fair test-retest reliability (r=0.67) and 15 items on Concussion Attitude Index (CAI) with satisfactory test-retest reliability (r=0.79) were provided. Males reported more sources for learning about concussions and more sport-related reasons for reporting a concussion than females (P<0.05). Both genders provided equal numbers of reasons for neglecting a concussion report or not disclosing a concussion for the sake of others (i.e., family, teammates or the coach). Out of 16 given reasons for not reporting a concussion, males significantly chose sport-related reasons over female athletes (P<0.05). Additionally, by looking at the two components of RoCKAS-ST, the independent t-test results showed no significant gender-based differences in concussion knowledge and attitude indices (P>0.05). Nevertheless, females were less optimistic about evaluating other athletes' attitude over concussion reporting (P<0.05). Our study indicated that concussion knowledge is not gender biased among Canadian university athletes; however, more investigation is required to learn how safe environments for concussion disclosure could encourage reporting the symptoms in varsity athletes, especially in males who are more susceptible to not reporting a concussion to not miss their sport-related goals.

Collegiate student-athletes concussion knowledge and attitudes: what a difference a decade Makes.

The purpose of this study was to assess changes in concussion knowledge and attitudes amongst incoming intercollegiate student-athletes over the course of a decade (2010-2012 vs 2021-2023). There were 592 student-athletes from 2 cohorts (2010-2012, 2021-2023) who completed the Rosenbaum Concussion Knowledge and Attitudes Survey (ROCKaS) questionnaire which is comprised of a concussion knowledge index (CKI, 0-24) and attitude index (CAI, 15-75) with higher scores reflecting better performance. A three factor ANOVA (Group, Sex, Concussion History) compared performance on the CKI and CAI. Individual questions were compared between groups with a Chi-Square analysis. For the CKI, there was a significant main effect for Group (2010-2012: 18.5 ± 2.6, 2021-2023: 19.4 ± 2.5, p < 0.001, . For the CAI, there was also a significant main effect for group (2010-2012: 52.9 ± 6.0, 2021-2023: 62.2 ± 6.5, p < 0.001, . The results of this study show a modest increase in concussion knowledge; however, large improvements in concussion attitudes were observed between groups. These results suggest a continued improvement in student-athlete concussion awareness and provide specific areas to continue addressing persistent misconceptions.

Sports-related concussion history, reporting behaviours, knowledge, and attitudes in Pakistani university student-athletes.

To assess student-athletes' knowledge and attitudes towards sport-related concussions and to investigate concussion history and reporting behaviours. The cross-sectional, survey-based study was conducted from September 2020 to June 2021 after approval from the research ethics committee of Universiti Malaya, Malaysia, and comprised student-athletes of either gender aged 18 years or above at various universities across Pakistan and who played contact or collision sports for their universities. Data was collected using the Urdu version of the Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version. Data was also gathered about the participants' self-reported exposure to formal concussion education, previous sport-related concussion history, and reporting behaviours, where applicable. Data was analysed using SPSS 23. Of the 369 participants, 224(60.7%) were males and 145(39.3%) were females. The overall mean age was 19.95±1.75 years. Among the participants, 327(88.6%) had not received formal concussion education. The mean knowledge score was 12.76±2.73 out of a possible 25 points, and the mean attitude score was 38.63±10.30 out of 75 points. Knowledge had a weak positive correlation with attitude towards sport-related concussions SRC (p<0.05). Females displayed better attitudes towards sport-related concussions than their male counterparts (p<0.05). Overall, 126(34%) participants had experienced sport-related concussion symptoms following a blow to the head in the preceding 12 months, and 81(64.3%) of them had continued playing while being symptomatic. Pakistani university student-athletes lacked adequate concussion knowledge and held poor attitudes towards sport-related concussions.

Effect of Hearing Status on Concussion Knowledge and Attitudes of Collegiate Athletes.

Collegiate athletes who are deaf or hard-of-hearing (D/HoH) are diagnosed with concussions at a similar rate as athletes who are hearing; however, little evidence exists on knowledge and attitudes of athletes who are D/HoH toward concussions. This study aimed to examine differences in knowledge of and attitudes toward concussions between athletes who are D/HoH and athletes who are hearing. Cross-sectional research design. Of the 310 athletes who are D/HoH and 430 athletes who are hearing that were invited to participate, 90 athletes who are D/HoH, and 72 athletes who are hearing completed the survey. The Rosenbaum Concussion Knowledge and Attitudes Survey was used to quantify knowledge of and attitude toward concussions. The Rosenbaum Concussion Knowledge and Attitudes Survey consists of the concussion knowledge index (CKI) and the concussion attitudes index (CAI) subscales. Linear regressions were run to test the association of hearing status with CKI and CAI scores. Pearson correlations were performed to determine relationships between CKI and CAI for athletes who are D/HoH and athletes who are hearing. Alpha level was set a priori at P ≤ .05. Athletes who are hearing demonstrated a higher CKI component score (19.58 [2.19]) compared to athletes who are D/HoH (16.14 [3.31]; P < .001). There were no statistical differences in CAI between hearing groups (hearing: 57.18 [8.73], D/HoH: 55.97 [9.92]; P = .41). There was a moderate positive correlation between CKI and CAI (r = .58) for athletes who are D/HoH, while a weak positive correlation (r = .30) for athletes who are hearing was observed. Athletes who are D/HoH have poorer knowledge of concussions but similar attitudes toward concussion as that of athletes who are hearing. Current concussion educational interventions are in written or spoken form which may not be inclusive to athletes who are D/HoH. Health care professionals should consider an athlete's preferred communication mode to improve the efficiency and effectiveness of education.

An Examination of the Knowledge of and Attitudes Toward Concussions in Texas High School and Junior High Coaches

Every state in the United States mandates concussion education annually or biennially for those involved in organized youth sports to improve awareness, knowledge, and attitudes toward concussions. The purpose of this study was to examine Texas high school and junior high school coaches’ knowledge of and attitudes toward concussions using the Rosenbaum Concussion Knowledge and Attitudes Survey—Coaches Version. Among all analyzed participants, the mean overall concussion knowledge index (Concussion Knowledge Index = 0–25) was 21 (SD = 1.79), while the overall concussion attitude index (Concussion Attitude Index = 15–75) was 63 (SD = 5.69). No significant differences for knowledge or attitude were found between gender, coaching level, sport type, geographical location, or school size (all p &gt; .10). Mandatory concussion education has resulted in high levels of knowledge about and favorable attitudes toward concussions in Texas junior high school and high school coaches, with similar findings to other research in this area.

Managing concussion in the real world: Stakeholder perspectives of New Zealand Rugby's concussion management pathway

The potential adverse consequences associated with poor concussion management highlights the need to improve the translation of concussion guidelines into consistent use in real-world sport settings. To facilitate this process, New Zealand Rugby developed a community concussion management pathway to support concussion recognition, diagnosis, and management. This study adopted a pragmatic, descriptive qualitative approach to explore key stakeholders’ perceptions of the concussion management pathway, with the aim to inform policy and practice. Interviews were conducted with 123 participants, including players, parents, coaches, healthcare professionals, and school and provincial union representatives. The framework method was used to analyze data. Themes were organized according to the principles of realist process evaluation that considers contextual factors and mechanisms influencing a program's operation to produce specific outcomes. Contextual factors influencing the concussion management pathway's implementation included governing bodies’ support, existing local resources, general concussion attitudes, or concussion severity. The optimal functioning of the concussion management pathway ( mechanism) was influenced by (i) pathway resources, (ii) roles and relationships, (iii) buy-in and support towards the concussion management pathway, and (iv) diligence and communication. Outcomes identified included (i) hitting the target (optimally managed and enhanced awareness) or (ii) missing the mark (dissatisfaction or management gaps). Overall, participants found the concussion management pathway valuable. However, the acceptability of certain policy-related aspects and the underlying attitudes associated with these perceptions, are some areas requiring further investigation and support. Tailoring programs according to end-users’ perceptions is crucial in developing context-sensitive interventions appropriate for a specific setting. These findings may act as a foundation for investigations of concussion management in other settings.

Assessment of Concussion Knowledge, Attitudes, and Behaviors Among Adolescent Female Club Soccer Athletes

Concussion education for athletes is essential for informed decision making to aid recovery. Education about concussion symptoms, treatment, and protocols can improve symptom recognition, reporting behaviors, protocol compliance, and overall health outcomes. This pilot study aimed to understand current concussion knowledge, attitudes, and beliefs among female club soccer players aged 12–18 years. Findings identified gaps in concussion education and knowledge among these athletes. Continued concussion education efforts are needed to increase concussion knowledge and players’ confidence, focusing on creative education practices.

Concussion injury management, perception, and knowledge in amateur field hockey.

Field hockey has a high risk for sports-related concussion (SRC) injuries due to the speed and intensity of the game, current rules, field surfaces and equipment composition. Head injuries are the second most common reported injury and up to 75% of SRCs go unreported or undetected. This increases the subsequent injury risk, long-term health consequences and prolonged injury recovery. This study aimed to examine the prevalence of SRC in hockey players within the Southern Gauteng Hockey Association (SGHA) premier league. Concussion knowledge and attitudes of hockey players, coaches, umpires, and officials were also investigated. A partially mixed sequential dominant status design (QUANT-qual) was used, divided into two phases. In Phase One hockey players, coaches, umpires, and technical officials (n=119) completed a modified RoCKAS-ST questionnaire. In Phase Two, a focus group discussion with umpires (n=3) and interviews with coaches (n=3) were conducted. Injuries to the shoulder, neck, head, and face were reported from stick use (n=98); ball use (n=102) and collisions (n=187). Only 19% of hockey players were diagnosed with SRC, indicating that many of these injuries were undetected or not reported. Responses from the focus group discussion and interviews indicated that coaches, umpires, and officials felt they had insufficient knowledge of SRC. The recognition and management of on-field injuries require improvement to enhance the injury detection system.

Cross-Cultural Adaptation of the Urdu Version of Rosenbaum Concussion Knowledge and Attitude Survey—Student Version in Pakistan

Evaluating athletes’ knowledge of and attitudes toward sports-related concussions is important. However, there is limited research involving South Asian athletes, partly due to the lack of a valid and reliable tool. This study, therefore, aimed to translate and validate the Rosenbaum Concussion Knowledge and Attitude Survey—Student Version, an established tool used to measure knowledge and attitude toward concussion, into Urdu. Rosenbaum Concussion Knowledge and Attitude Survey—Student Version was translated into Urdu using the standard guidelines and then completed by 369 athletes participating in contact sports at different universities in Pakistan. Confirmatory factor analysis was performed on the Concussion Attitude Index items to examine the underlying factorial structure. Construct validity of Concussion Attitude Index factors was also investigated using convergent and discriminant validity. The results showed that the Urdu version of the Rosenbaum Concussion Knowledge and Attitude Survey—Student Version has good psychometric properties and is a valid and reliable tool for evaluating Urdu-speaking athletes’ knowledge of and attitudes toward concussions.

Concussion Knowledge And Attitude: Has A Decade Made A Difference?

Concussion Knowledge And Attitude: Has A Decade Made A Difference?

Concussion knowledge, attitudes and reporting intention amongst UK university student-athletes: Implications for institutions, coaches and future research

This article reports on a survey of concussion knowledge (CK), attitudes (CA) and reporting intention (CRI) amongst a multisport cohort of UK university student-athletes. A cross-sectional study design was used, with 217 student-athletes completing the Rosenbaum Concussion Knowledge and Attitudes Survey – Student Version. The findings show that CK is broadly aligned with previous study cohorts including research in North America, and that sport type had no effect on CK, CA and CRI. Whilst gender did not affect CA or CRI, males returned higher CK scores than females. The respondents’ concussion history did not affect CA. Paradoxically, respondents with a history of concussion had significantly greater CK scores yet were more likely to report an intention to continue playing with SRC symptoms. There are three key implications of these findings. The comparison of findings between males and females highlights the need for a more nuanced conceptualisation of safety and risk in relation to SRC. Second, the evidence suggests a strong need for UK universities to introduce bespoke education programmes and policies formalising the healthcare support and return to learn of students post-SRC. Third, awareness of the complex interplay between SRC knowledge, experience and behaviour will enable coaches across all sports to exercise caution when managing SRC amongst students. The article concludes by arguing that there is a need for further qualitative research to understand how concussion is experienced by UK university students and provided for and accommodated within UK universities.

Concussion education for New Zealand high school rugby players: A mixed-method analysis of the impact on concussion knowledge, attitudes and reporting behaviours

Players who lack the knowledge to recognise the signs and symptoms of concussions may be less likely to disclose their injury. New Zealand Rugby's Community Concussion Initiative includes an interactive education session highlighting peer-recognition of concussions. This mixed-method study examined the effect of an education session on high school players’ concussion knowledge and attitudes as well as the impact of player demographics on these variables. Focus groups were used to explore player experiences. The RoCKAS-ST was used to measure concussion knowledge/attitudes before and after the education session. Multiple linear regression examined associations between demographic variables, including school decile (relative wealth of the geographic region the school serves), and pre-education concussion knowledge/attitudes scores. Wilcoxon signed-rank tests compared pre-concussion and post-concussion knowledge/attitudes scores. Qualitative data were analysed via thematic analysis. Overall, 532 players completed questionnaires; 75 players participated in focus groups. Pasifika players had lower concussion knowledge than NZ Europeans ( p &lt; .001). Mid-decile schools had higher concussion attitudes scores than low decile schools ( p &lt; .001). Pre-education and post-education session concussion attitudes and knowledge scores did not differ significantly, suggesting the one-off education session was not successful in improving these outcomes. Players identified: (i) the education session to be valuable, but some uncertainties remained; (ii) the importance of player comfort, interaction and comprehension; (iii) the need for role models, real stories and regular content refreshers. Requests for presenter diversity, support and easily understood information were more prominent in Māori/Pasifika and low-decile groups. Greater consideration of these factors is necessary in the development of education interventions.

A-08 Understanding the relationship between knowledge, beliefs, actions and confidence surrounding concussions among youth hockey coaches

Abstract Purpose To investigate the effectiveness of mandatory concussion education among youth hockey coaches and to understand if increased knowledge correlates with confidence. Identification of facilitators and barriers to coaches’ beliefs and actions were also assessed. Methods Prospective, cross-sectional descriptive pilot study using an electronic survey via REDCap sent to youth coaches within the Minnesota Hockey organization. Quantitative questions were used to investigate knowledge and attitudes, while qualitative questions explored the facilitators and barriers to concussion management in youth hockey. Results 98.8% of the 177 participants (M=150; F=22, NB=5), aged 18–65+ years completed the mandatory concussion training, with majority completing it in the last year (79%). 95% endorsed concussion education as beneficial with only 8 coaches reporting it was not helpful and 10 coaches requesting more educational materials. Over half of the participants (96; 54%) denied legislation impacting their attitude toward concussion. Confidence in concussion knowledge (3.07±1.09; 77%) and attitudes towards concussions (7.62±1.63; 85%) were positive. 39 (26%) coaches considered athlete and parent input most valuable for return to play. This may be related 72% of participants who reported no trained medical staff were present at games or practices. Concerningly, 20% of coaches may not encourage an athlete with loss of consciousness to seek emergent care. Conclusions Current mandatory concussion education produces increased knowledge, confidence, and appropriate action among majority of youth coaches. Coach reliance on athlete and parent report for clearance to play increases with no medical staff present for practices and games, which could have negative consequences.

A-35 Difficulty Speaking, Stuttering, and Missing Words Post-Concussion: Findings from Two Independent Studies

Abstract Purpose The current investigation examined the potential consequences of concussion on speech-language abilities by analyzing quantitative and qualitative data from two independent studies. Methods Study 1: 185 rugby, soccer, football, rowing, and hockey athletes (M=17.42 years, SD=3.80; 44% female) completed the Rosenbaum Concussion Attitude and Knowledge Survey (RoCKAS). Study 2: 19 varsity soccer, rugby, volleyball, and basketball athletes (M=21.74 years, SD=2.13; 37% female) with history of at least one concussion completed individual one-hour semi-structured interviews, and thematic analysis was used to identify patterns across athletes’ experiences of concussion. Results Study 1: Quantitative analysis of athletes’ endorsements of distractor and legitimate post-concussive symptoms on the RoCKAS yielded a relatively low rate of endorsement across all distractor symptoms (1–29%, M=11%), with the exception of ‘difficulty speaking’, which was endorsed by majority (70%) of the sample. Study 2: Thematic analysis of interview content identified long-term difficulties with speech articulation (i.e., stuttering and word-finding) as a post-concussive symptom for 42% of the sample. Conclusions While speech abilities are largely thought to remain intact following concussion, quantitative and qualitative findings from these two independent studies suggest that speech difficulties may be an overlooked outcome of concussion. Several neuropsychological (e.g., attention, memory, executive function, or processing speed) and neuropathophysiological (e.g., diffuse axonal damage to cortico-subcortical pathways) processes may be underlying this relationship. Exploratory studies and longitudinal data are needed to elucidate the potential consequences of concussion on speech-language abilities.

Factors associated with concussion management behavior in Ladies Gaelic Football players

ABSTRACT Background Sport-related concussion (SRC) management may be poor in community sports such as Ladies Gaelic Football (LGF). This study examined factors associated with SRC management behavior in adult LGF players. Methods Participants (n = 657) answered an online survey on demographic factors, concussion knowledge, attitudes, and education, and SRC management behavior. Data from participants who reported sustaining an LGF-related SRC during the previous year (n = 115) were further analyzed. Results Being diagnosed with SRC was the main factor influencing subacute management behavior. Players with diagnosed SRCs had increased odds of following a graded return-to-play (RTP) programme (OR = 4.89), following a medically supervised graded RTP programme (OR = 10.16), and being medically cleared before full RTP (OR = 13.45) compared with those with suspected SRCs. Concussion history was associated with increased odds of informing a coach of a possible SRC (OR = 2.86). Demographic factors, previous use of Ladies Gaelic Football Association concussion education resources, and concussion knowledge and attitudes had minimal or no influence on management behaviors. Conclusion Greater access to medical personnel at LGF training and matches is recommended. Due to limited medical resources in community sport, a clear referral pathway for players with SRC and comprehensive SRC education should be introduced to ensure players receive adequate medical care.

Investigation of concussion knowledge and attitudes of Chinese amateur adolescent soccer athletes.

Concussions are a common traumatic brain injury in soccer games but are often ignored by coaches and athletes. The purpose of our study is to assess the concussion knowledge and attitudes among amateur adolescent soccer athletes in China. Data was collected from questionnaire surveying (Rosenbaum Concussion Knowledge and Attitudes Survey (Student Version)) and semi-structured interviews completed by 69 amateur adolescent soccer athletes who participated in the U17 and U15 male groups of the 2022 China Youth Soccer League. The study followed a mixed methodology cross sectional study design. The concussion knowledge index (0-25) and concussion attitude index (15-75) scores were derived from the questionnaire and descriptive statistics were used for data analysis. The mean score of concussion knowledge is 16.8 ± 2.4 (range 10-22), and the mean score of concussion attitude is 61.3 ± 8.8 (range 45-77). Thematic analysis was used to categorize the participant's responses of the semi-structured interview and the results were compared with their survey answers of questionnaire. Interestingly, the interviews revealed the inconsistencies between the questionnaire responses and intended behaviors, and multiple factors (injury severity, the importance of the game and substitution rules) influencing concussion-reporting behaviors were identified. In addition, athletes hope to acquire concussion knowledge through formal education. Our study lay the foundation for educational interventions to potentially improve concussion-reporting behaviors among amateur adolescent soccer athletes.