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Copyright by Carisa Maria Raucci 2015 Copyright by Carisa Maria Raucci 2015 THE DISSERTATION COMMITTEE FOR CARISA MARIA RAUCCI CERTIFIES THAT THIS IS THE APPROVED VERSION OF THE FOLLOWING DISSERTATION: The Effects of Knowledge, Attitudes, Self-Efficacy, and Treatment Practices on Concussion Management in the High School Setting Committee: Mary A. Steinhardt, Supervisor Jessica Duncan Cance, Co-Supervisor John B. Bartholomew Fred L. Peterson Edmund T. Emmer The Effects of Knowledge, Attitudes, Self-Efficacy, and Treatment Practices on Concussion Management in the High School Setting by CARISA MARIA RAUCCI, B.S., M.S.ED. DISSERTATION Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY THE UNIVERSITY OF TEXAS AT AUSTIN MAY 2015 Acknowledgements I would like to thank all of those that have been instrumental in supporting me through the doctoral process, because without you, this would still be a thought in the back of my mind. First, I would like to thank my advisor and co-chair of my dissertation committee, Dr. Mary Steinhardt. Your dedication to me and the athletic department have been unyielding. Thank you to the co-chair of my dissertation committee, Dr. Jessica Cance, for showing me the ropes and giving me the confidence I needed to succeed. Thank you to Dr. Fred Peterson for taking a chance on me and giving me the opportunity to be a part of the Kinesiology and Health Education department. Without you, I would not be here. Thank you to Dr. John Bartholomew for showing me there are no limits when it comes to bridging athletics and academics. Thank you to Dr. Ed Emmer for showing me how exciting and beneficial qualitative analyses can be. Thank you to Tina Bonci for all of your words of wisdom. I wish you were here to see the final product. I also want to acknowledge my boss, Allen Hardin, for giving me the opportunity to pursue my educational and professional careers at the same time. You have given me the ability to attain a lifetime of learning by allowing me to partake in both. You have always managed to inspire me, and I hope to be as great of a leader as you one day. Additional thanks to Brian Farr for giving me the opportunity to improve my teaching skills in the best undergraduate athletic training program in the country. Thank you to my family, friends, and coworkers for all of your love and support throughout the last several years. I would like to give special thanks to my parents for always providing an ear to listen and a shoulder to cry on. Your confidence in me from as far back as I can remember has been inspirational. I cannot wait to start the next chapter of life with all of you. iv The Effects of Knowledge, Attitudes, Self-Efficacy, and Treatment Practices on Concussion Management in the High School Setting Carisa Maria Raucci, PhD The University of Texas at Austin, 2015 Supervisor: Mary A. Steinhardt Co-Supervisor: Jessica Duncan Cance The purpose of this dissertation was to examine athletic trainers’ (ATs’) and emergency room physicians’ (MDs’) perceptions of concussion management in the high school athlete. The first study looked at the implementation process of a new state concussion law as perceived by a group of high school ATs. Semistructured interviews were given to n = 14 ATs and reported on four topics that should be considered when implementing a school concussion protocol: (a) a school-level concussion policy’s implementation is dependent on salient facilitators; (b) a school-level concussion policy’s implementation is dependent on having fewer barriers than facilitators; (c) a state- mandated school concussion law requires support from within the school and community; and (d) a school-level concussion policy’s implementation is dependent on the positive impact of the Concussion Oversight Team. In the second study, a cross-sectional self- report survey examined knowledge, attitudes, and self-efficacy as they relate to n = 534 ATs’ and n = 29 MDs’ endorsement of concussion treatment practices. Of the literature’s most recommended treatment practices, only 16.4 percent of ATs and 19.2 percent of MDs were using all eight practices. Using hierarchical linear regression, race was v significantly positively related to treatment practices (β = .12, p < .05) in which white licensed health care providers (LHCPs) endorsed more practices than non-white LHCPs. Self-efficacy was significantly positively associated with treatment practices (β = .70, p < .05), and the final R2 = .12 percent. Further, job title moderated this positive relationship (p < .05), such that, as concussion management self-efficacy scores increased, LHCPs’ endorsement of treatment practices also increased. Self-efficacy was more influential for MDs (t(400) = 4.69, p < 0.001) than ATs (t(400) = 2.52, p < 0.05). Additionally, ATs had significantly higher knowledge, attitude, and self-efficacy scores than MDs. Together, results of these studies highlight practical implications for provider education in concussion management. Results extend the literature by providing ATs’ and emergency room MDs’ baseline levels of knowledge, attitudes, and self-efficacy toward concussion management treatment practices, as well as examining the implementation of a concussion law in the state of Texas as perceived by high school ATs. vi TABLE OF CONTENTS List of Tables ......................................................................................................... xi List of Figures ....................................................................................................... xii Chapter One: General Introduction ..........................................................................1 Theoretical Framework ...................................................................................4 Purpose ............................................................................................................6 Research Questions .........................................................................................7 Definition of Terms .........................................................................................7 Delimitations ...................................................................................................9 Chapter Two: Review of Relevant Literature ........................................................11 Introduction ...................................................................................................11 State Legislation...................................................................................12 School Health Policy Implementation .................................................12 Magnification in the Media ..................................................................14 Return-to-Play Legal Responsibilities .................................................15 Incidence Rates ....................................................................................16 Pathophysiology ...................................................................................18 Adolescent Development .....................................................................19 Signs and Symptoms ............................................................................20 Multidimensional Treatment Approach ...............................................21 Evaluative Guidelines ..........................................................................22 Long-term Health Consequences ..................................................................23 Post-concussive syndrome ...................................................................24 Second impact syndrome .....................................................................24 vii Chronic traumatic encephalopathy ......................................................25 Concussion Knowledge, Attitudes, and Self-Efficacy ..................................26 General public ......................................................................................26 Athletic trainers ....................................................................................28 Physicians ............................................................................................29 Behavioral Constructs for Licensed Health Care Professionals ...................31 Health Belief Model ......................................................................................31 Chapter Three: Study I—Examination of the Implementation of House Bill 2038 on Concussion Management in the High School Setting ..................................35 Abstract .........................................................................................................35 Introduction ...................................................................................................36 Methods .........................................................................................................38 Participants ...........................................................................................38 Data Collection ....................................................................................39 Ethical Considerations .........................................................................40 Data Analysis .......................................................................................41 Results ...........................................................................................................43 Topic 1: Policy Facilitators ...........................................................................44
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