Daniel Baer

Date of Award

Summer 8-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

John A. Anderson, Ph.D.

Second Advisor

Christian Vaccaro, Ph.D.

Third Advisor

Neil Curtis, Ed.D.


Underreporting of concussion symptoms in college athletics presents a challenge for sports medicine clinicians in evaluating and diagnosing such injuries. Some athletes do not report concussion symptoms because they do not recognize that they have a brain injury, however many athletes intentionally withhold symptoms to avoid removal from sport participation. The purpose of this cross-sectional survey study was to examine individual factors that influence college athletes’ intentions to report concussion symptoms. The study examines concussion symptom reporting intention in NCAA student-athletes in Pennsylvania, using the reasoned action approach and identity theory as theoretical frameworks.

An anonymous survey about athletic identity, attitudes, social pressure, and perceived control provided insight to the determinants of concussion underreporting. In total, 2,649 U.S. born student-athletes from 23 sports, across 22 colleges/universities completed the survey. Factor analysis revealed that intention to report concussion symptoms, the primary dependent variable, was unidimensional. Independent variables, attitude towards symptom reporting and athletic identity, were also unidimensional, while perceived social pressure (injunctive and descriptive norms) and perceived behavioral control (capacity and autonomy) were each two-dimensional.

Hierarchical regression analysis revealed positive effects of attitude, descriptive norms, injunctive norms, and capacity on intention to report concussion symptoms. Athletic identity had a small negative effect on intention when operating through the reasoned action variables. Additionally, participation in collision sports had a small negative effect on intention, while perceived knowledge of concussion symptoms had a small positive effect, both operating through the reasoned action variables. The full regression model explained 14.24% of the variance in concussion reporting intention.

These findings may help clinicians develop more focused interventions that address key social and individual determinants of underreporting, including attitude, perceived injunctive and descriptive norms, and capacity to report. Athletic identity, sport type, and perceived understanding of concussion symptoms also influence reporting intention to a lesser extent.

Previous research in this area has failed to address a diverse population of athletes from different sports, and relatively few studies have specifically targeted a college-age population. This study adds to the literature by combining the reasoned action approach with identity theory to investigate concussion underreporting across various college sports.

Available for download on Friday, August 14, 2020