Purpose: This study was conducted to understand current perceptions of secondary school coaches on concussion culture, safety, and management. Method: In this consensual qualitative research study, 17 secondary school coaches participated (12 males, 5 females). Participants were recruited through the state secondary school athletic associations. Participants were interviewed over Zoom using a semi-structured interview guide to allow for flexibility (16 questions). All interviews (30 - 60 minutes in length) were recorded and transcribed. A codebook, including themes and subthemes, was created and data were analyzed using thematic analysis. The researchers each reviewed the transcripts separately. The initial codebook was determined using a sample of transcripts; following consensus, another subsection of transcripts was analyzed to determine codebook effectiveness. The research team went through 5 phases of analysis to ensure agreement on the themes and subthemes of each transcript. Trustworthiness was established through peer review and member checks. Results: We discovered four themes 1.) reporting, 2.) concussion education, 3.) awareness, and 4.) culture. Participants described their players’ preferences, attitudes, and willingness for reporting and to whom players report. Coaches indicated that players primarily report concussions to their coaches and may apprehensively report to the athletic trainer. The concussion education that coaches receive was described, including the platforms, type, frequency, and suggestive changes. Many participants described their annual concussion education as repetitive and needing updates. Emphasis was placed on the lack of player education. Coaches identified a need for content to improve players’ concussion reporting and education. Lastly, participants emphasized the culture surrounding concussions in their sport and the preferences on concussions from both player and coach perspectives, the attitudes of the players in their sport surrounding concussions, past attitudes and culture in their sport, player safety, and long-term concerns. Conclusions: Secondary school coaches expressed the current mandated concussion education video was the same annually and could be updated with new information and be more engaging, while also expressing the need for educational content for students. Further efforts should be placed on concussion informational videos, fact sheets, and education for students to increase reporting behaviors, improve sports culture regarding concussions and enhance player safety.

Author Bio(s)

Richelle M. Williams, Ph.D., ATC is an assistant professor at Drake University in Des Moines, IA.

Madyson Anglim, BS is a 2021 graduate of the college of pharmacy and health science at Drake University in Des Moines, IA

Maggie Ferguson MS, CRC, CBIS is the Brain Injury and Disability Program Manager at the Iowa Department of Public Health


We would like to thank the Iowa high school athletic coaches who participated in this study for their willingness. This work was funded by the 2021 MAATA research grant.




Submission Location


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