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Abstract
Concussion education programs encourage athletes to seek care after an injury, which protects athletes’ short- and long-term health. Athletic trainers (ATs) use programs with a variety of delivery methods and content. Understanding program content and other messengers’ perceptions of the programs’ implementation potential (acceptability, appropriateness, and feasibility) may inform clinical practice. We developed the Program Evaluation and Perceptions of Implementation (PEPI) process to identify and evaluate educational interventions content and potential for successful implementation. The research aims of this project were to identify 1) the degree to which ATs perceive concussion education interventions as acceptable, appropriate, and feasible; and 2) the extent to which these perceptions are patterned by setting, staff-to-athlete ratio, role in selecting programming, and whether concussion education is delivered. A rapid scoping review identified fifteen programs. We determined which of the expert-recommended recommendations each program addressed, selected the programs that exceeded the average number (N=8, mean=3.5), and invited ATs completing a continuing education activity to participate in research. After providing consent, demographics, and institutional information (setting, staff-to-athlete ratio, role in selecting education, and whether education is delivered), participants completed surveys on acceptability, appropriateness, and feasibility for each program. Each survey contains four Likert-type items with responses ranging from 1 (“completely disagree”) to 5 (“completely agree”), which were averaged into construct scores. The 281 ATs (62.2% female gender, 33.9±10.0 years-old) practiced in secondary school (N=108, 38.4%) and collegiate (N=173, 61.5%) settings with an average staff ratio of 176.8±169.5 athletes per full-time AT (median=116.7 [IQR:54.8-250.0]). Forty-nine percent (N=138) could modify their programming, and 88% (N=249) performed education. All programs had positive average ratings (means>3.0, range=3.47-4.47) and all but one had >50% positive perceptions (range=49.1-81.9%). Generalized linear models revealed that except for acceptability and appropriateness of the CrashCourse program (p-values=.004-.018, respectfully), individual and institutional factors were largely not significant predictors of perceptions of implementation outcomes (p-values=.050->.999). ATs may have similar perceptions of program implementation regardless of the factors we explored. Future studies should explore other contextual and program characteristics that may impact implementation of concussion programming. The PEPI process should undergo further study with other health education topics and populations.