Barriers to Delivering Concussion Education: Identifying Opportunities for Change Through the Capability, Opportunity, Motivation, Behavior (COM-B) Model

This study aimed to describe barriers athletic trainers (ATs) face to implementing expert recommendations for improving athletes' concussion care-seeking behavior. We distributed an electronic survey through the National Athletic Trainers' Association to 9,997 ATs working in secondary schools or collegiate institutions and received 365 complete responses. We quantitatively measured their barriers using a validated survey based on the Capability, Opportunity, Motivation, Behavior (COM-B) behavior system containing six Likert-type items with a scale of 0 to 10 (labeled <i>Strongly Disagree-Strongly Agree</i>). We performed three analyses: (a) descriptive analysis of COM-B responses, (b) separate ordinal regression analyses to determine if gender, years certified, percent of employment hours spent at their school, or setting (e.g., secondary school or college/university) predict COM-B responses, and (c) group comparisons within types of secondary schools and collegiate institutions. Athletic trainers reported the highest barriers in the opportunity-related constructs followed by capability-related and motivation-related constructs. Practicing in a secondary school, rather than college/university, setting predicted stronger barriers in psychological capability, social opportunity, physical opportunity, and automatic motivation. Athletic trainers at National Collegiate Athletic Association (NCAA) affiliated colleges/universities had higher physical and psychological capability, compared to ATs at non-NCAA-affiliated colleges/universities. Athletic trainers feel motivated and capable of employing practices to improve athlete care-seeking after a concussion, but they face barriers. Organizations should support ATs by providing opportunities to deliver concussion education. Secondary schools and non-NCAA institutions may benefit from resources to reduce barriers to providing concussion education, like toolkits to help deliver concussion education and protected time to providing this education.