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- 1. Pluralistic Ignorance in Concussion Reporting Among Collegiate Athletes July 28, 2016 Lily Herrmann Dr. Paul Berkner, DO, FAAP Concussion Institute at Colby College Science, education, and community working together to prevent and manage concussions. L. Herrmann July 2016
- 2. Underreporting Rose Solomon, 2012 Suspected concussions (fall 2012): Football: Rugby: 70% unreported Total reported concussions 2015-2016: 23 Can assume based on qualitative data that only the WORST concussions are being reported Science, education, and community working together to prevent and manage concussions. 38.8% 39.1% 38.6% L. Herrmann July 2016
- 3. Focus Groups, 2016 • Different cultures around concussions between • Contact vs Non-contact • Men’s vs Women’s Science, education, and community working together to prevent and manage concussions. I don’t want to look weak What is a concussion? L. Herrmann July 2016
- 4. Pluralistic Ignorance Science, education, and community working together to prevent and manage concussions. Therefore, the incorrectly assumed social norm is perpetuated within the group Majority of people personally reject a norm, but incorrectly assume that those around them accept the norm. L. Herrmann July 2016
- 5. Previous Research Science, education, and community working together to prevent and manage concussions. Men’s contact sports Disregards women’s sports and non-contact sports Christine Baugh L. Herrmann July 2016
- 6. The Survey Science, education, and community working together to prevent and manage concussions. Contact Non- Contact FemaleMale L. Herrmann July 2016
- 7. Science, education, and community working together to prevent and manage concussions. A Sprained Ankle The Participant A Youth Athlete A Teammate L. Herrmann July 2016
- 8. Science, education, and community working together to prevent and manage concussions. • 10 sections VS Concussio n Knowledge Self Teammate Reporting Intention Impulsivit y L. Herrmann July 2016
- 9. 1. Coach meetings 2. Implement in all Colby teams with athletic trainers 3. Implement in NESCAC schools 4. Implement in Maine high schools Science, education, and community working together to prevent and manage concussions. Knowledge education Next Steps Phase Two Team Education L. Herrmann July 2016
- 10. Acknowledgements Colby College Presidential Scholars Program Dr. Paul Berkner, DO, FAAP — Colby College Christine Baugh, PhD Post-doctorate fellow — Harvard University Dr. Allecia Reid, PhD — Colby College Dean Joe Atkins, PhD — Colby College Erin Maidman — Colby College Science, education, and community working together to prevent and manage concussions. L. Herrmann July 2016
- 11. References Bjerring, J. C., Hansen, J. U., & Pedersen, N. J. (2014). On the rationality of pluralistic ignorance. Synthese, 191(11), 2445-2470. doi: 10.1007/s11229-014-0434-1 Brunas-Wagstaff, J., Bergquist, A., Richardson, P., & Connor, A. (1995). The relationships between functional and dysfunctional impulsivity and the Eysenck personality questionnaire. Personality and Individual Differences, 18(5), 681-683. doi: 10.1016/0191-8869(94)00202-4 Carroll, L., & Rosner, D. (2011). The concussion crisis: Anatomy of a silent epidemic. New York: Simon & Schuster. Eysenck, S. B., & Eysenck, H. (1980). Impulsiveness and venturesomeness in children. Personality and Individual Differences, 1(1), 73- 78. doi:10.1016/0191-8869(80)90006-9 Fuster-Parra, P., García-Mas, A., Ponseti, F., & Leo, F. (2015). Team performance and collective efficacy in the dynamic psychology of competitive team: A Bayesian network analysis. Human Movement Science, 40, 98-118. doi:10.1016/j.humov. 2014.12.005 Graham, R., Rivara, F. P., Ford, M. A., & Spicer, C. M. (2014). Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: National Academies Press. Grant, D., O'neil, K., & Stephens, L. (2009). Pluralistic Ignorance Among Assembled Peers. Sociological Perspectives, 52(1), 59-79. doi: 10.1525/sop.2009.52.1.59 Iso-Ahola, S. E., & Hatfield, B. D. (1986). Psychology of sports: A social psychological approach. Dubuque, IA: Wm. C. Brown. Kroshus, E., Baugh, C. M., Daneshvar, D. H., & Viswanath, K. (2014). Understanding Concussion Reporting Using a Model Based on the Theory of Planned Behavior. Journal of Adolescent Health, 54(3). doi:10.1016/j.jadohealth.2013.11.011 Kroshus, E., Kubzansky, L. D., Goldman, R. E., & Austin, S. B. (2014). Norms, Athletic Identity, and Concussion Symptom Under- Reporting Among Male Collegiate Ice Hockey Players: A Prospective Cohort Study. Annals of Behavioral Medicine Ann. Behav. Med., 49(1), 95-103. doi:10.1007/s12160-014-9636-5 Levine, J., Etchison, S., & Oppenheimer, D. M. (2014). Pluralistic ignorance among student–athlete populations: A factor in academic underperformance. High Educ Higher Education, 68(4), 525-540. doi:10.1007/s10734-014-9726-0 Lidor, R., & Henschen, K. P. (2003). The psychology of team sports. Morgantown, WV: Fitness Information Technology. Presser, S., Couper, M. P., Lessler, J. T., Martin, E., Martin, J., Rothgeb, J. M., & Singer, E. (n.d.). Methods for Testing and Evaluating Survey Questions. Methods for Testing and Evaluating Survey Questionnaires Wiley Series in Survey Methodology, 1- 22. doi:10.1002/0471654728.ch1 Rosenbaum, A. M., & Arnett, P. A. (2010). The development of a survey to examine knowledge about and attitudes toward concussion in high- school students. Journal of Clinical and Experimental Neuropsychology, 32(1), 44-55. doi: 10.1080/13803390902806535 Shields, D. L., Gardner, D. E., Bredemeier, B. J., & Bostro, A. (1997). The Relationship Between Leadership Behaviors and Group Cohesion in Team Sports. The Journal of Psychology, 131(2), 196-210. doi:10.1080/00223989709601964 Science, education, and community working together to prevent and manage concussions. L. Herrmann July 2016
- 12. Questions? Science, education, and community working together to prevent and manage concussions. L. Herrmann July 2016
Editor's Notes
- Hi everybody, my name is Lily Herrmann and I am a rising sophomore at Colby studying Sociology and French Studies. I am a student intern for the Concussion Institute at Colby College, formerly known as Maine Concussion Management Initiative and was been involved with CIC since September of my freshman year. CIC is dedicated to understanding the science behind concussions and uniting the community to prevent, diagnose, and manage this injury. Specifically at Colby, I investigate the culture around concussions in athletics and the psycho-sociological mechanisms that cause athletes to hide symptoms of concussion from trainers, coaches, and teammates. This summer, I have taken my research to the next level in order to develop a psychometrically valid tool for understanding why athletes do not report concussions. I hypothesize that a psychological phenomenon known as pluralistic ignorance drives student-athletes to play with there concussions unreported.
- First, it’s important for me to explain the basis for where this research comes from. In 2012, Rose Solomon conducted a study as part of a statistics course that she was taking at Colby to investigate the underreporting of concussions in collegiate athletics. She suspected that the amount of concussions reported drastically underestimated the amount of concussions that were occurring within athletics. Not only was she right, but the results of her study were astounding. After administering her survey to the men’s rugby and football teams, she found that about one third of the athletes suspected that they had sustained a concussion either during practice or a game and that about 70% of those athletes who suspected they had had a concussion did not report their symptoms to a coach or trainer. It’s important to understand the significance of these numbers. So let’s extrapolate a bit and speak in broad terms: If you consider that over one third of Colby’s 1,800 students participate in athletics…that’s about 600 students…these numbers indicate that about 180 of those student athletes suspected that they had a concussion. That’s 180 concussions... Now if 70% of those concussions went unreported, that’s 126 undiagnosed and untreated concussions on Colby’s campus alone. Last year according to HIT data collected by Colby College, there were only 23 reported concussions. These numbers assume that less than 20% of suspected concussions were reported at Colby. Now, anyone who is much better at statistics than me knows that this is a complete extrapolation and broad interpretation of the data because it only includes male, collision sports, but still the consequences of these numbers are huge.
- We decided that we wanted to better understand WHY athletes who were so knowledgable about concussions and were so self-aware were NOT reporting concussions. So, this school year we conducted six focus groups with athletic teams around campus led by Dean Atkins where the student-athletes were asked if they knew what concussions were, where they learned about concussions, and why they may not report concussions in their sport. The answers we got from teams were broadly different depending on whether or not it was a male or female team or a contact or non-contact sport. For example, amongst the football team, common phrases included that they wouldn’t report a concussion for fear of being seen as weak while the women’s volleyball team stated that they may feel embarrassed if they got a concussion while particpating in a non-contact sport. So, not only do we have Rose’s data about the expected amount of suspected concussions that go unreported, but we have the qualitative data from our focus groups where athletes, male and female, across all types of sports are saying that they have fears of reporting concussions. So we KNOW, that concussions are reporting, and we have a gist of why, right? So athletes FEAR reporting their concussions, but we need to dig deeper into that. In order to scientifically study concussions and to treat concussions, we need our athletes to be reporting them. Reporting, in my opinion, is the single most important piece when it comes to concussion research.
- That leads to where I am today in my research. So my specific sect at CIC is in studying the psycho-sociological mechanisms for why athletes may or may not report their concussions. Our qualitative data indicates that there are clear discrepancies between what athletes personally think about concussions and what they think their teammates think about concussions. This fits with the psychological phenomenon of pluralistic ignorance which is where the majority of people within a group privately reject a social norm, but incorrectly assume that everyone around them accepts the norm. This leads to the incorrectly accepted social norm to be perpetuated within the group. So a great way to understand pluralistic ignorance is through another phenomenon found on college campuses…binge drinking. So basically, what pluralistic ignorance is is that you have a huge group of people at a party, and everyone is drinking a LOT in a short amount of time. So you’re there and you feel uncomfortable by how much everyone else is drinking, but they all seem to be doing it so you do too. Yet, every single person at that same party is also secretly uncomfortable by how much everyone else is drinking. In terms of concussion reporting, this phenomenon could be seen where an athlete personally would be more comfortable reporting what they suspect is a concussion but assume that their teammates would not want them to report their symptoms or that they themselves would not report their symptoms. I hypothesize that the phenomenon of pluralistic ignorance permeates the team dyanamics of collegiate athletics and effects the rates of concussion reporting.
- But, I have no data YET that supports my claim. So, the bulk of my summer research has been in developing a new tool to evaluate the levels of pluralistic ignorance in collegiate athletics. What has been interesting about this research is that ultimately it has never been done before. Essentially, the only literature addressing pluralistic ignorance in concussion reporting has been among male athletes in collision, or high contact sports. Now, we know that at least 50% of our student-athletes here at Colby are females, so this research is just not applicable to our entire population. Additionally, not every sport here is a contact sport. So, let’s think about this. We have the qualitative data from our focus group to suggest that there are clear differences between concussion attitude and male and female sports and contact and non-contact sports. So, now we are going to test it. Dr. Berkner has partnered me with Christine Baugh, a post-doctorate student in health policy at Harvard University who specializes in studying the culture around concussions. Christine developed a survey that began to study why high school-aged hockey players might not report concussions. Her survey was made up of several subsections addressing concussion knowledge, personal reporting intention, and teammate reporting intention. Specifically, Christine studied the theory of planned behavior, or what other athletes expected that their teammates would do if they sustained an impact that might have caused a concussion and concluded, but did not have the data to significantly support, that pluralistic ignorance may be a phenomena present in concussion reporting. Christine has now become an integral part of our team and is assisting in drafting our new tool in understanding concussion reporting.
- We have begun developing our unique and one-of a-kind tool in Qualtrics. Our main goal is to analyze the attitudes and cultures of various athletes about concussion reporting. Now, an integral part of our research is to make sure we are collecting data from an inclusive sample which includes male and female teams and contact and non-contact sports. Though collecting inclusive data we will not only be able to understand more about why rational athletes are making such irrational decisions, but we will also be able to analyze these decisions on a deeper level. For example, we will look at the differences between reporting attitudes amongst men and women and also among contact and non-contact sports. This will then greatly influence how we talk about concussions with our athletes and how we better address the concerns of underreporting.
- Now we decided that we wanted to take this survey to the next level. It is impossible to accurately grasp what an athlete is thinking in the heat of the moment. Right? So it’s the championship game and you were hit in the head and you’re a bit dizzy and have a headache but are you really going to sit out? Now, that’s different than asking a written question like, “Would you report your symptoms if you were hit in the head and felt dizzy?” I mean that’s just not the same thing. So, we’ve incorporated four scenarios into our survey that will be the most “real time” example of a suspected concussion. We will have four videos that will capture different perspectives the typical athlete might face: a minor injury such as a sprained ankle, yourself experiencing a head impact, a youth athlete experiencing a head impact, and your teammate experience a head impact. (play video after each one that you say). Also important to our research was to make sure that each video is gender and sport specific to the participant because, for example, an athlete might expect a male football player to react differently to a concussion than a young female soccer player. So, in order to make the scenarios as realistic to life as we could, I have programmed that based on the answer an athlete gives to their identified gender and sport, the subsequent videos will match that. We expect that athletes will answer very differently to how they would react to having a minor injury such as a sprained ankle, themselves having a concussion and their expectations of how a teammate would act if they had a concussion, and how they would like a youth athlete to react if they expected that they had a concussion. It was also important that in each video there was a gray area between whether or not the athlete was seriously injured because in the context of the game, if an athlete is completely and visibly knocked unconscious by an impact to the head they are immediately removed from the game-those aren’t the concussions that go unreported. We are looking at how athletes respond to a suspected concussion where it is their choice whether or not to report their symptoms because only they know that they’re having symptoms.
- So overall the survey has ten sections including the four scenarios. The other six sections are demographics, teammate reporting intention, concussion attitude, concussion knowledge, impulsivity scale, and personal reporting intention. With these six sections we hope to grasp a holistic interpretation of how our athletes perceive concussions. I’ve also programmed a timing metric into the survey so that as researchers we can see exactly how long the athletes take to answer each question. With this we expect to see a correlation between the length of time spent before answering with level on safe reporting intention. For example, in athletes that answer the questions most quickly we expect to see a negative view of concussion reporting. Another important aspect of this survey is that it is meant to be taken in a team setting. Like I said we are trying to mimic as close to possible the situation an athlete would be in when choosing whether or not to report suspect concussion symptoms and an athlete, whether participating in an individual or team sport, will constantly be surrounded by their peers when in this situation. By modeling this using a team test-taking approach, we are attempting to see exactly how athletes will answer these sensitive questions while amongst those who they may be influenced by in order to get the most accurate responses. So the survey is taken in a classroom by each participant on just their cellphones and then the videos, while available on their own screens, are shown at once on the big projector so that the team can react to the impact together. We’ve also de-identified all of our data. One of the largest concerns of the athletes was that their answers on this survey would affect their position on their teams or how their teammates viewed them.
- The survey is quick and easy and take