Concussion education in schools is inconsistent, overly athlete-focused

By Conor Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.

Researchers Kylie D. Mallory et al. found significant gaps in school-based concussion education in a scoping review published in Journal of School Health. They looked at studies implementing group concussion education in a K-12 setting to “identify the context, delivery method, development, and evaluation of concussion education delivered in the school setting” as it exists in peer-reviewed literature. Mallory et al. discovered gaps and inconsistencies across these domains, “including a lack of clear guidelines for concussion education content, questionable sustainability of the education delivery and the need for long-term evaluation of outcomes.”

Of the 27 studies that met inclusion criteria, 23 were conducted in the US, along with two Canadian studies and one from each of Ireland and Australia. The 27 articles were published in 25 journals across multiple fields; the differing perspectives and goals of the publications and their readers may cause difficulties in establishing a comprehensive picture of research on concussion education. While the amount of educational material presented varied from toolkits to a nine-minute video to “2 weeks of interactive arts-based classes,” the most common length of education was 20-60 minutes. In attempting to categorize education topics, the authors discovered a complete lack of standardization, “specifically regarding what topics to cover and what is considered ‘good’ concussion education material. There has also been no consideration regarding modification to education topics depending on the target audience or education setting.”

Thirteen studies provided education just to students, but eight of those thirteen delivered this education exclusively to student-athletes. When accounting for studies with multiple audiences, coaches and educators were the second-most likely audience (appearing in nine studies). The authors note that the high proportion of education programs focusing on sport could have limited education on areas outside of sport, such as the school setting. Only ten studies had education on return to school or managing a concussion at school, which is disturbing considering that these educational programs were delivered in a school setting.

The authors assert the need for developing standards for key concussion education components relevant to students. Alongside this lack of clear guidelines, they found a lack of long-term outcome evaluations (most studies only utilized immediate pre- and post-testing) and questioned the sustainability of the educational delivery, as most of the studies used educational material delivered in-person.