Publication Date


Document Type


First Advisor

Henry, Beverly W.

Second Advisor

Papadimitriou, Christina

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Interdisciplinary Health Professions


Background: Sport-related concussion in youth is a serious public health concern, and coaches of youth sports are frequently tasked with the role of primary decision maker about potential concussion during athletic activities.

Objective: To explore factors that influence coach decision-making about concussion in the moments during athletic activity that an injury may occur.

Methods: An exploratory sequential mixed methods study was conducted to identify coach-reported factors that influence decision-making about potential concussion and develop tools to evaluate prevention and management strategies that support coach decision-making during athletic activities. The study involved three phases: (1) semi-structured interviews with 16 coaches of youth sports about perceptions of sideline decision-making related to potential concussion, (2) review and synthesis of recommendations and requirements for sport-related concussion from published clinical practice guidelines, legislation, youth sport organizational policy, and coach interviews, and (3) review of web-based education and training modules available for concussion prevention and management.

Participants/Data Sources:

• Phase 1: 16 adults who coached youth sports for at least one season

• Phase 2: 8 published clinical practice guidelines, 8 concussion laws from upper Midwest states of the United States, 7 youth sport organization polices, and 16 coach interview transcripts

• Phase 3: 5 web-based concussion education and training modules

Results: Phase 1 employed an inductive approach to coding and analysis of the interviews. Results revealed that coaches make decisions about potential concussion based on personalized, collaborative, and contextual factors. These factors point to a deviation between current training about concussion and real-time decision-making. An emerging grounded theory about decision-making theory was developed, illustrating the gap between current practices for sideline decision-making about potential concussion and coach-perceived needs to improve decision-making. Synthesis of four distinct sources of recommendations and requirements in Phase 2 introduced a program evaluation tool and coach competency assessment titled Strengthening Sideline Decisions about Concussion in Youth Sports (STRIDES). Evaluation of web-based concussion education and training modules using the STRIDES Program Evaluation Matrix revealed that elements from the matrix with no coverage in the web-based modules represented content from coach interview data (8 items), sports concussion legislation (3 items), and clinical practice guidelines (2 items). Those elements that were evaluated as being adequately covered in the modules represented sports concussion legislation (11 items), clinical practice guidelines (8 items), youth sport organization policy (5 items), and coach interview data (1 item). The overall results of this study expose a gap between published recommendations for preventing and managing suspected concussion during athletic activities, coach-perceived needs for decision-making, and the implementation of those recommendations on the sidelines of youth sports.

Conclusions: These results point to a misalignment between published recommendations and requirements, coach-reported needs, and content of education and training. Further study is needed to develop multifactorial injury prevention and management strategies specifically tailored for coaches of youth sports.


185 pages




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