LAUSR

OBJECTIVE Participation in sports is associated with many benefits to all aspects of health; however, it also come with the risk of injury, particularly concussions. Self-disclosure and care-seeking following a concussion are especially important due to the lack of outwardly visible signs and/or symptoms. While recent research has explored factors affecting concussion disclosure, utilization of isolated methodologies limits the ability to contextualize how disclosure or non-disclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. METHODS This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion education session with pre-/post-test surveys and a semi-structured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions toward disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research (CQR) tradition. RESULTS Participants had high concussion knowledge (median = 46), positive attitudes (median = 38), strong beliefs (median = 13), and high intentions to disclose concussion symptoms (median = 7). None of the constructs differed by participant gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. CONCLUSION The context in which concussion disclosure occurs, or does not occur, is vital to the success of educational interventions. Interventions must prioritize stakeholder and team-based perspectives on concussion to establish a network supportive to disclosure.