Date of Award

Spring 5-13-2020

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Genevieve Pinto-Zipp, Ed.D

Committee Member

Michelle L. D’Abundo, Ph.D.

Committee Member

Deborah A. DeLuca, JD


qualitative research; concussion management; multifaceted approach; knowledge to action framework


Background: Concussions are a subset of mild traumatic brain injuries that have become a serious concern for high school athletes. An estimated 1.3 million sport- and recreation-related concussions occur in high school athletes each year in the United States. The actual incidence of sport-related concussions in U.S. high school athletes may be significantly higher, however, because this population under-reports concussions at an estimated rate of 50 percent.

Athletic Trainers (ATC’s) are licensed healthcare professionals and have one of the strongest lobby's in the United States. This lobby is known as the National Athletic Trainers’ Association or NATA. When it comes to concussions and concussion management, the NATA has developed a non-binding position statement with reference to the treatment and management of concussion and concussion symptoms: NATA’s Position Statement: Management of Sport Concussion. This position statement is a multifaceted approach to which all ATC’s should be following. The problem is that concussions are prevalent in high school athletics and ATC’s are front line healthcare professionals managing the health of student athletes. The NATA position statement on concussion management only recommends a multifaceted approach, but there are no specific tests. Presently, the exploration of a multifaceted approach to concussion management for athletic trainers has mainly been at the collegiate level with little research looking at perceptions of athletic trainers at the high school level. It is important to note that currently this NATA position statement does not account for high school policies, student population, school budgets, resources or time.

Purpose: The purpose of this study is to explore New Jersey high school athletic trainers’ experience and perceptions associated with a multifaceted approach to concussion management.

Methods: This study used a general qualitative design since the problem needed to be explored and could be easily measured. Fifteen participants participated in the study and all were practicing certified athletic trainers who were currently working in a New Jersey high school for at least one year.

Data Collection and Analysis: Data analysis occurred concurrently with the data collection process. Descriptive coding was used which analyzes descriptive words and phrases. Saturation was met at fifteen interviews and five overarching themes emerged from the data analysis.

Results: The 5 overarching themes regarding the exploration of New Jersey high school athletic trainers’ experience and perceptions regarding a multifaceted approach to concussion management are as follows:

  1. Lack of standardization allows assessment, referral, and return-to-play experiences to vary significantly.
  2. Referral experiences vary pending upon athletic trainers ability to refer to a trusted and responsive physician
  3. Barriers include clearances from unqualified physicians.
  4. Pressure from coaches, parents, and students to return students to play.
  5. Benefits include increased knowledge and awareness resulting in more effective care for students.

Conclusion: This study showed that the participants had significant varying experiences and perceptions regarding their multifaceted approaches to concussion management. However, there were many notable similarities in the experiences, pressures, barriers and benefits when applying their concussion protocol. There is so much research out there looking at concussions, the management of concussions, and the best practices to do so. However, there is little evidence looking at the experience and the perceptions of the individuals who are treating these injuries, especially at the high school level.