Hard-Headed Decisions: Intrapersonal Factors Underlying Concussion Reporting in University Athletes.

Most of the research investigating sports concussion (SC) disclosure has been conducted using questionnaires with a pre-determined set of questions. Hence, significant gaps remain in our understanding of which factors weight in the decision-making process underlying SC disclosure and how they contribute to it. This present study aims to fill some of these gaps using qualitative methods to identify intrapersonal determinants of SC disclosure and describe their influence on an athlete's decision-making process. Our results are based on in-depth, semistructured interviews (range, 56-79 min; total = 587 min) with 9 university athletes (5 females, 4 males) from three team sports (soccer, rugby, and cheerleading). Using constant comparative analysis guided by Straussian grounded theory, we identified 13 concepts, across three major intrapersonal categories (i.e., attitudes and behaviors; concussion knowledge; and subjective evaluation of the concussion), contributing to SC disclosure, including novel determinants such as prioritization of athletic versus intellectual activities and maturity level. Our results suggest that a comparison between experiential knowledge and severity of the injury plays a major role in determining an athlete's disclosure behaviors. Athletes with a history of concussion seem to adopt a non-disclosure default strategy and are inclined to disclose their concussion symptoms only if they judge their current concussion to be worse than their previous most severe injury. Other concepts identified appear to contribute to the decisional process by modulating the adoption of this non-disclosure default strategy. Our work highlights the benefits and necessity of using qualitative methods to study the decision-making process underlying concussion disclosure.