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Association between concussion education and concussion knowledge, beliefs and behaviours among youth ice hockey parents and coaches: a cross-sectional study
  1. Amanda M. Black1,2,3,4,
  2. Keith Owen Yeates2,3,5,
  3. Shelina Babul6,7,
  4. Alberto Nettel-Aguirre1,2,4,8,
  5. Carolyn A. Emery1,2,3,4,8
  1. 1Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  2. 2Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
  3. 3Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  4. 4O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
  5. 5Departments of Psychology, Pediatrics and Neurosciences, University of Calgary, Calgary, Alberta, Canada
  6. 6Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7BC Children's Hospital, Vancouver, British Columbia, Canada
  8. 8Departments of Pediatrics and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  1. Correspondence to Dr Amanda M. Black; ablack{at}


Objectives To examine the association between self-reported exposure to concussion education and knowledge, beliefs and self-reported behaviour among parents and coaches of youth ice hockey players.

Design Cross-sectional.

Setting Community ice hockey teams from Calgary and Edmonton, Alberta, Canada.

Participants Parents and coaches of ice hockey players (ages 11–17, all divisions of play).

Primary and secondary outcome measures Participants completed a questionnaire developed and validated to measure concussion knowledge, beliefs and concussion management behaviour (ie, coaches removing athletes from play; parents taking children with suspected concussions to physicians) consistent with the Health Action Process Approach (HAPA). The questionnaire examined specific HAPA constructs (ie, risk perception, outcome expectancies, action self-efficacy, intention, action planning, maintenance self-efficacy, recovery self-efficacy) relevant to concussion management behaviour.

Results Participants included 786 parents (31.8% with coaching experience) and 10 non-parent coaches. Of the participants, 649 (82.6%) previously received concussion education. Based on a multivariable regression analysis adjusting for coaching experience, previous history of a child sustaining one or more concussions, first aid experience and cluster by team, exposure to concussion education was associated with a mean score difference of 1.36 (95% CI 0.68 to 2.03), p<0.0001, in the knowledge score. Exposure to concussion education was not significantly associated with any of the HAPA constructs based on Wilcoxon rank-sum tests.

Conclusion Exposure to concussion education may be associated with small overall differences in concussion knowledge but may not be associated with significant differences in beliefs or intended behaviours related to concussion management among youth hockey parents and coaches.

When providing education or recommendations for concussion education sources to coaches and parents, educational strategies grounded in behavioural change theory that specifically target the motivators of behavioural change should be considered.

  • sports medicine
  • public health
  • medical education & training

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors AMB designed the study and led the data collection, data entry, data cleaning, data analysis, interpretation of study results and drafted the manuscript. KOY, SB, AN-A and CAE contributed to design, data analysis and interpretation of results. All authors critically reviewed and edited the manuscript before submission.

  • Funding This study was funded by the Canadian Institutes of Health Research (CIHR), Hotchkiss Brain Institute, Alberta Children’s Hospital Foundation, and Alberta Innovates Health Solutions. AMB was supported by the Hotchkiss Brain Institute Dr T Chen Fong Doctoral Scholarship in Neuroscience. CAE is supported by a Canada Research Chair (Tier 1) Concussion. KOY is supported by the Ronald and Irene Ward Chair in Pediatric Brain Injury from the Alberta Children’s Hospital Foundation. The University of Calgary Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. The role of the sponsors and funding bodies was to provide financial support for this research and the translation of the findings to all community partners.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval The research ethics boards at the University of Calgary (Ethics ID: REB14-0348 and Ethics ID: 14–2209), University of Alberta (Ethics ID: REB Pro00024093_AME3) and the University of British Columbia (Ethics ID: CW14-0304/H14-01894) approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified participant data are held by the Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary.

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