The Role of Social Support in Concussion Disclosure in United States Air Force Academy Cadets: A Mixed Methods Approach

Abstract

Introduction: United States Air Force Academy (USAFA) cadets are at risk for sustaining concussions; however, several factors inhibit disclosure. We aimed to better understand the role of social support in concussion disclosure. Methods and Materials: We used a mixed methods approach with an electronic survey and interviews. The survey used a 9-point Likert scale (1 = strongly disagree and 9 = strongly agree) to assess concussion disclosure. Survey items asked cadets whom they felt most comfortable disclosing a concussion or bell-ringer/ding to, how quickly they would seek medical attention for a suspected concussion or bell-ringer/ding, whether cadets would be generally supportive/unsupportive of another cadet disclosing a concussion to medical staff, and whether other cadets important to them would be generally supportive/unsupportive if they reported a concussion to medical staff. Two multivariate linear regressions, one for concussion and one for bell-ringers/dings, were calculated to determine whether cadet choice of the person they felt most comfortable disclosing a concussion or bell-ringer/ding to predicted whether they would immediately seek medical attention for either condition. Choice of person included Air Officer Commanding (AOC)/Academy Military Trainer (AMT), upper classmen, cadet who had recovered from a concussion, cadet, closest friend, teammate, and squadmate. Descriptive analyses assessed whether cadets felt supported or unsupported by other cadets and by those who were important to them concerning concussion reporting. Thirty-four semi-structured interviews were conducted with cadets to explore their views on concussion disclosure. Results: Increased comfort with disclosing a suspected concussion to an AOC/AMT had higher agreement seeking medical attention (β = 0.28, P