Promoting the Development of Evidence-Based Concussion Education for Power-5 Collegiate Athletes: The Influences of Organizational Elements on Perceived Vestedness

Abstract

Concussions present a significant health concern for collegiate athletes, team leaders, and university administrators. The consequences of these injuries can affect athletes’ scholastic and athletic performance in the short term, and manifest later in life, long after their athletic career ends. Present educational efforts are ineffective because they neglect important influences on athletes’ decisions to report potential concussion injuries. Here, we present research that examines organization-based influences on vestedness in attitudes related to athletes’ perceived risk of concussion consequences and team commitment. Examining a sample of 435 collegiate athletes from 11 universities, participating in six Division I/Power-5 conference high-concussion-risk sports, our findings support that organizational-based perceptions exert influence on these key concussion–related variables. In synthesizing the results, we offer evidence-based recommendations that organizational members can use to create environments that promote concussion injury reporting and adherence to recovery protocols. This research contributes to the growing body of literature calling for the development of educational concussion injury education modules that recognize contextual influences grounded in communication theory and provide a persuasive impetus.

Keywords

collegiate sports concussion reporting risk perception communication organizational influence

Concussions and Collegiate Athletes

For collegiate student athletes (SAs), concussions are a common injury that come with risk of severe short- and long-term consequences (Daneshvar, Nowinski, McKee, & Cantu, 2011). Data from the National Collegiate Athletic Association (NCAA) indicate that 1.6–3.8 million concussions occur every year in the United States from participation in sports (Zuckerman et al., 2015). These numbers may be higher because concussions do not typically manifest clear symptoms, leading to unidentified and/or misdiagnosed injuries (Valovich McLeod, Bay, Heil, & McVeigh, 2008).

In the short term, athletes who suffer a concussion are more likely to both suffer subsequent concussions and sustain musculoskeletal injuries (Herman et al., 2017). In the long term, consequences can include the development of postconcussion syndrome and other brain health issues (Broshek, De Marco, & Freeman, 2015). Concussion symptoms are ambiguous, and presently, there is no reliable concussion diagnosis tool (Graham, Rivara, Ford, & Spicer, 2014). Precise diagnoses rely on timely and truthful communication from potentially injured SAs to report their symptoms and adhere to recovery protocols; accurate concussion diagnosis is fundamentally a communication problem (McCrory et al., 2013). Moreover, SAs may experience head impact consequences independent of the event being diagnosed as a concussion. Thus, our research investigates athletes’ perceptions of head impacts—both diagnosed concussion and undiagnosed head impacts, collectively referred to as severe head impacts (SHIs). This research reports findings from an investigation of attitudinal and organizational factors that may influence SAs’ perceived risk of concussion consequences with the goal of informing the development of effective educational and motivational messaging.

Concussion Underreporting

By not reporting a dangerous SHI, athletes may be prolonging recovery; athletes who delay a diagnosis increase their risk of prolonged recovery and sustaining additional injuries (Asken et al., 2016; Beckwith et al., 2013). One risk reduction strategy is to ensure that athletes who suffer SHIs are removed from play and receive medical evaluations (Kroshus, Garnett, Hawrilenko, Baugh, & Calzo, 2015). Since many concussion symptoms are invisible, timely removal from play relies heavily on SAs’ communicative decisions. Despite the benefits and importance of immediate disclosure, many athletes fail to report and continue to play for a variety of reasons including fear of being removed from play (Cusimano, Zhang, Topolovec-Vranic, Hutchison, & Jing, 2017), looking weak (Chrisman, Quitiquit, & Rivara, 2013), or perceived pressure from stakeholders (Kerr, Register-Mihalik, Kroshus, Baugh, & Marshall, 2016). Athletes’ lack of understanding of concussion risks, symptoms, and consequences may also lead to underreporting (Valovich McLeod et al., 2008).

Concussion Educational Efforts

Practitioners have developed educational interventions to improve SAs’ concussion education. These interventions primarily include definitions of concussion injuries and symptoms (Bagley et al., 2012). The efforts typically help athletes develop symptom-based knowledge, and although these interventions have demonstrated improvements in this regard, effects on behavioral outcomes are rare, if extant at all (Kroshus, Daneshvar, Baugh, Nowinski, & Cantu, 2014). We argue that these strategies are ineffective because they lack a theoretical foundation and motivational force (Adame & Corman, 2019). Moreover, these strategies do not attend to athletes’ sport- and performance-related attitudes or their perceived risk of SHI consequences.

Sjoberg (2000) and others (cf. Sitkin & Weingart, 2016) indicate that health interventions not informed by audience risk perception are likely to be ineffective. A recent meta-analysis supports perceived risk as a valuable predictor of intentions and behaviors (Sheeran, Harris, & Epton, 2014). To inform the development of effective educational and motivational strategies, we frame our investigation in the context of vested interest (VI) theory.

This report is part of a larger, multimethod study of concussion-reporting behaviors (Corman et al., 2019). The research program is informed by the socioecological approach (Sallis & Owen, 2002) where the collegiate culture of concussion reporting is investigated at individual, organizational, and narrative levels. This research investigates potential team-based organizational influences on perceived vestedness in competing attitudes and perceived risk of SHI consequences; we construct VI as a single-term interaction for the purpose of explaining organizational influences on perceived vestedness.

VI Theory

VI theory (Crano & Prislin, 2006) specifies discrete attitudinal elements that mediate relationships between attitudes and behaviors. Attitudes are valenced, psychological predispositions to objects and ideas that inform individuals’ communicative and behavioral actions (Dillard, 1993). Although attitudes are cognitive constructs, they are created, reified, and modified through communication and are crucial to understanding the persuasive effects of educational persuasive material (Dillard, 1993). As a theory of the attitude–behavior relationship, VI is valuable both as an audience analysis tool and as a frame for designing effective persuasive health communication campaigns (Adame & Miller, 2015). Communicative and environmental interactions can influence overall vestedness (Adame & Miller, 2016). In risk communication contexts, research has demonstrated that perceived vestedness can be manipulated through VI-based campaigns, and the VI-based messages are effective in motivating self-protective behavior (Adame & Miller, 2015; De Dominicis et al., 2014).

In this research, we investigate VI as an outcome variable with the goals of understanding how organizational influences exert pressure on individual-level vestedness in athletes’ commitment to their team (VTC) and athletes’ vestedness in consequences related to severe head impacts (VSHI). Understanding how vestedness in specific attitudes is influenced by organizational dynamics should give coaches, athletic trainers, and university administrators a more nuanced understanding of how to create educational and persuasive messages that motivate athletes to report SHIs and protect themselves from potential health risks. The theory indicates that five variables—salience, certainty, immediacy, self-efficacy, and response efficacy—function to predict individuals’ relative vestedness in an attitude or attitude object (De Dominicis et al., 2014).

Salience represents accessibility, or the ease with which individuals can mentally retrieve relevant attitudes and cognitions (Crano & Prislin, 2006). As salience of concussion news and facts increases, so too should overall vestedness in concussion and SHI risk. Alternatively, lower levels of perceived salience reduce vestedness. Likewise, as the salience of athletes’ team-related issues and information increases, so too should their overall level of VTC.

Certainty describes the perceived probability of outcomes that an individual associates with a particular attitude object or decision. When an individual perceives consequences to be unknown or of low probability, that individual is unlikely to act in an attitudinally consistent manner (Adame & Miller, 2015; Lehman & Crano, 2002). A low level of perceived certainty for either SHI-related outcomes or team-based outcomes reduces overall levels of VSHI and/or VTC.

Immediacy identifies athletes’ perceived time to when outcomes will manifest. Individuals who perceive outcomes to occur closer in time are more likely to act in an attitudinally consistent manner (Lehman & Crano, 2002). Athletes who perceive SHI-related outcomes to be a long-term concern are likely less vested in SHI consequences. Outcomes, rooted in either SHIs or team performance, perceived to be immediate contribute to overall levels of vestedness.

Self-efficacy is derived from Bandura’s (1982) concept of one’s ability to affect change in a given context. When individuals perceive that they can act in a meaningful fashion, they are more likely to do so than if they are not confident (Adame & Miller, 2015; Crano & Prislin, 2006). Athletes who believe their behavior can influence their health and performance meaningfully are likely to have higher vestedness in SHI risk and team commitment (TC).

Finally, response efficacy is the individuals’ perception that the recommended response will be effective in meeting personal goals (Witte, Meyer, & Martell, 2001). With response efficacy, we target athletes’ perceived confidence that their university has effective methods to protect their brain health (VSHI), and their perceived efficacy in responses that connote commitment to their team (VTC). Athletes who do not believe that the responses will be effective should be less vested in attitudes toward either SHI risk or TC.

Past research has characterized VI as a theoretical interaction of five distinct variables and investigated the relative influence of each variable on context-relevant outcomes (Crano & Prislin, 2006; Miller, Adame, & Moore, 2013). Here, we recognize that athletes’ health and performance decisions occur against the background of university-based concerns, regulations, and constraints, as well as communicative and cultural influences. To examine the potential influences on athletes’ vestedness in SHI- and TC-based attitudes, we combined scores from each VI element into a single variable. This additive interaction term represents the combined level of perceived vestedness for each athlete and allows us to investigate overall vestedness in SHIs and TC as outcomes that may be influenced by organizational elements.

Organizational Elements

Organizational identification (OI)

OI—an individual’s perception of oneness with or belongingness to an organization—is explored widely in the social sciences (Cole & Bruch, 2006). Scholars have explored the role that OI has on organizational members’ attitudes and behaviors (Rikketa, 2005). The majority of this research explores its positive effects including turnover, extra-role behavior (Olkkonen & Lipponen, 2006), psychological well-being (Harris & Cameron, 2005), and cooperative behavior (Dukerich, Golden, & Shortell, 2002). This research demonstrates that OI influences how individual organizational members make decisions.

The persuasive nature of OI begs a discussion of the potential “dark side” of the construct. Take, for example, the process of unobtrusive control (Tompkins & Cheney, 1985) defined as “the process by which members of an organization are guided in making organizationally relevant decisions” (Bisel, Ford, & Keyton, 2007, p. 137). Members who identify strongly with the organization are likely to be more controlled or influenced by the organization’s messages and values. As such, members may become less attentive in making decisions and more likely to align mindlessly with organizational values (Ploeger & Bisel, 2013). Zoller (2003) demonstrated how strongly identified employees were more likely to consent to health hazards. Hughes and Coakley (1991) observed a similar dynamic in SAs; being an athlete involves sacrificing, accepting risks, and playing through pain. They argue that holding strong athletic identity can make SAs vulnerable to overcommitting to group demands and facilitate detrimental conformity to group norms. These examples illustrate how OI can influence members to make decisions that are not in their best interests.

We investigate if OI influences athletes’ perceptions in ways that shape safe and healthy concussion-reporting attitudes and beliefs. To understand OI in more nuanced ways, we also measure organizational prestige, sentimentality, and intraorganizational competition (IOC).

Organizational prestige

Organizational prestige describes how an organizational member perceives how outsiders view the organization and, consequently, the individual for being a member. Importantly, prestige involves individual-level assessments of how admired the organization is, meaning that members of the same organization may have different opinions on the prestige of the organization. Mael and Ashforth (1992) contend that organizational prestige influences OI strongly because members are proud to belong to an organization and thus share its values and qualities. Similarly, Fisher and Wakefield (1998) contend that individuals opt to identify with groups to bolster self-esteem. Thus, the more prestige an individual feels the organization has, the more room for enhancing self-esteem via OI (Smidts, Pruyn, & van Riel, 2001).

Sentimentality

Sentimentality refers to one’s tendency to cling to connections to the past; individuals with high sentimentality find pleasure in reliving the past (Mael, 1988). In this way, sentimentality can be viewed as a personal predisposition that shapes one’s OI (Wiener, 1982). Individuals predisposed to be sentimental seek to retain memories and items from the past. Such an inclination influences individuals’ amount of identification with an organization (Mael & Ashforth, 1992).

IOC

IOC is expected to occur in a team environment where individuals are vying for limited resources like play time and starting positions. This IOC can create additional costs or benefits for the organization, depending on context. IOC is negatively related to OI (Mael & Ashforth, 1992), reduces cohesion among groups (Blau, 1954), and causes in-group favoritism (Dion, 1973). Alternatively, potential benefits of IOC include encouraging members to set higher goals (Brown, Cron, & Slocum, 1998) and increasing effort (Luft, 2016). Luft (2016) posits that such differences in the role that IOC has on individual members’ performances can be attributed to the degree of homogeneity in the organization. In athletic organizations, team members are generally homogeneous in the work they do to advance team goals. As such, we hypothesize that IOC will yield positive benefits to the team. Considering the potential influence of the aforementioned variables, we offer the following hypotheses:

Hypothesis 1: Organizational identification, organizational prestige, sentimentality, and IOC predict higher levels of VTC.

Hypothesis 2: Organizational identification, organizational prestige, sentimentality, and IOC predict higher levels of VSHI.

Hypothesis 3a: Organizational identification, organizational prestige, sentimentality, and IOC predict lower levels of perceived risk.

Hypothesis 3b: Intra-organizational competition predicts higher levels of perceived risk.

Method

Using institutional review board-approved procedures and materials, athletes included in this study were sampled from 11 universities in a Power-5 NCAA athletic conference (NCAA, 2017).

Participants

Athletes (N = 435) were sampled through a purposive process that targeted athletes competing in high-concussion-risk contact and collision sports identified by the NCAA Injury Surveillance Program (Zuckerman et al., 2015). A total of N = 585 athletes clicked on the survey link to participate. Twenty-six percent were screened for incomplete, repeat, or otherwise unsatisfactory participation. The sample was 48.5% female, aged 20.13 (SD = 1.60), and completed 2.38 (SD = 1.29) years of collegiate education. Athletes reported their ethnicity as White (61.7%), Black/African American (17.1%), Hispanic/Latino/a (9.7%), Asian (3.0%), Native Hawaiian/Pacific Islander (1.8%), American Indian/Alaskan Native (0.7%), and Other (6.0%). The sample included female (n = 114) and male soccer athletes (n = 44), female (n = 55) and male (n = 36) basketball athletes, male football athletes (n = 94), male wrestlers (n = 50), and female lacrosse and field hockey athletes (n = 42).

Procedure

Athletes were recruited through staff representatives at each participating university and directed to a web-based survey platform where they consented and completed participation. Athletes reported their sex, university, and sport. This information was used to customize the participation experience for each athlete as they responded to the scales described below.

Measures

Scales were adapted from research on VI in risk contexts (Adame & Miller, 2018), organizational membership and identification, and perceived IOC (Mael & Ashforth, 1992). Each scale included a 7-point response set anchored by strongly disagree to strongly agree. See Appendix for scale moments and correlations.

Two versions of the VI scales measured distinct attitude–behavior relationships: concussion-related attitudes and team-commitment attitudes. The VI instrument consists of five subscales measuring the individual components of vestedness. Each VI subscale and the perceived risk instrument consisted of 5 items. Similar iterations of these subscales have been used in related risk perception research; results from related studies show that the scales are robust to modification across contexts. Details concerning development, reliability, validation, and context-based modification of these scales are reported elsewhere (Adame & Miller, 2016; Miller, Adame, & Moore, 2013), as is their use in concussion-related research (Adame & Corman, 2019).

While the VI subscales allow for measurement of the individual elements, overall vestedness is an additive function of each individual element (Crano & Prislin, 2006). To examine potential influences on overall vestedness, the subscales were summed to create two individual composite measures of overall vestedness. Analysis shows the measures to be correlated, r(433) = .23, p < .001.

Measures of OI and related variables were adapted from Mael and Ashforth (1992). Athletes responded to scales measuring organizational identity (6-item α = .79), IOC (8-item α = .67), organizational prestige (8-item α = .81), and sentimentality (7-item α = .74).

Results

The primary goal of this research is to investigate potential organizational influences on perceived risk in both VSHI consequences and VTC. Other research has demonstrated the efficacy of the VI model in predicting variance in SHI risk (Adame & Corman, 2019). We argue that understanding organizational influences on vestedness can aid universities and similar organizations in helping athletes make higher quality health–based decisions. Due to the cross-sectional nature of our data, our analysis plan involves a series of multiple regression models with the organizational variables entered as predictors, and the VI interactions included as outcome variables. To account for the potential influence of sex, age, ethnicity, university, and sport, these variables were entered into each model as covariates. As none of these variables emerged as significant predictors, they were removed and models respecified.

Hypothesis 1 stipulated that organizational factors predict variance in VTC. The model predicts 18% $(R_{adj}^{2})$ of the variance in VTC, with IOC and OI being the drivers of the model. Examination of the β values indicates that both IOC and OI share a positive relationship with VTC, with OI having a stronger influence on VTC. The model shows that athletes who perceive higher levels of competition with their teammates and report higher levels of identification with their university are more highly committed to their team. Neither organizational prestige nor sentimentality emerged as significant predictors; results are reported in Table 1.

Table 1.

Regression Analysis for VTC.

Predictor Variables	B	SE	β	t Value
Constant	11.81	1.547	—	7.63
Organizational prestige	−0.17	0.18	−.05	−1.00
IOC	1.11*	0.21	.24	5.39
OI	1.22*	0.19	.31	6.51
Sentimentality	0.197	0.20	.05	0.983

Note. N = 433. R ² = .19, adjusted R ² = .18, F(4, 433) = 25.07, p < .001. Effects reported here are for all athletes, across each of the sports included in our research. IOC = intraorganizational competition; OI = organizational identification.

*p < .001.

Hypothesis 2 specified a similar relationship between the organizational variables and VSHI. The model predicts 5% $(R_{adj}^{2})$ of the variance. βs indicate that OI and sentimentality are significant predictors in the model, with OI being nearly twice as powerful as sentimentality. Neither organizational prestige nor IOC emerged as predictors; results are reported in Table 2.

Table 2.

Regression Analysis for VSHI.

Predictor Variables	B	SE	β	t Value
Constant	17.93	1.49	—	12.03
Organizational prestige	−0.06	0.17	−.02	−0.37
IOC	0.08	0.19	.02	0.41
OI	0.64*	0.18	.19	3.58
Sentimentality	0.44**	0.19	.11	2.29

Note. N = 433. R ² = .06, adjusted R ² = .05, F(4, 433) = 6.89, p < .001. Effects reported here are for all athletes, across each of the sports included in our research. IOC = intraorganizational competition; OI = organizational identification.

*p < .001. **p < .05.

Hypothesis 3a predicted a negative relationship between OI, sentimentality, and organizational prestige with perceived risk. Hypothesis 3b predicted a positive relationship between IOC and perceived risk. Interestingly, the results predict 7% $(R_{adj}^{2})$ of the variance in the opposite direction, with the exception of IOC. IOC, OI, and sentimentality all share a positive relationship with perceived SHI risk. Here again, perceived prestige did not achieve significance. Sentimentality is the strongest predictor, with IOC showing nearly as strong a relationship, and OI emerging as third strongest. Results are reported in Table 3.

Table 3.

Regression Analysis for Perceived Risk.

Predictor Variables	B	SE	β	t Value
Constant	2.01	.54	–	3.72
Organizational prestige	−0.02	.06	−.017	−0.34
IOC	0.22**	.07	.148	3.13
OI	0.13***	.07	.102	2.01
Sentimentality	0.24*	.07	.170	3.45

Note. N = 432. R ² = .08, adjusted R ² = .07, F(4, 432) = 9.26, p < .001. Effects reported here are for all athletes, across each of the sports included in our research. IOC = intraorganizational competition; OI = organizational identification.

*p = .001. **p < .01. ***p < .05.

Discussion

Informed by the socio-ecological model, this research investigates potential organizational influences on collegiate athletes’ vestedness in SHIs and TC, and SHI risk perception to inform the development of messages that promote and reward SHI reporting. The results demonstrate that athletes’ perceptions of their organizations influence their reported levels of vestedness in health and performance attitudes. These results provide valuable insight into the factors that influence athletes’ SHI risk perception and should be useful in addressing organization-based factors when crafting health communication interventions that motivate SHI-reporting behaviors.

Results for Hypothesis 1 show that both IOC and OI influence vestedness in TC, demonstrating the degree to which organization-based messages influence athletes’ vestedness in their team. The NCAA mandates limits for the number of athletes per team; the competition for scholarships and starting positions is likely fierce. The degree to which athletes perceive competition with their teammates enhances their VTC. A cursory examination of university-sponsored sports teams substantiates that these teams expend significant effort to construct an organizational identity through communicative strategies. These results demonstrate that these efforts are effective in increasing athletes’ VTC.

Neither organizational prestige nor sentimentality emerged as significant factors. The targeted athletic conference encompasses several prestigious private universities and internationally renowned public universities with highly successful athletic teams. We expected that the reputations of the individual universities would factor into athletes’ vestedness, but the results did not support this. Perhaps athletes participating in this conference are often recruited by multiple conference universities, and the decision to attend one university is likely the result of several factors, of which prestige is one. Further, once an athlete is dedicated to playing a high SHI risk sport, differences in perceived prestige between organizations may matter little in the dedication athletes feel toward their team. We also expected sentimentality to factor into the model. Athletes competing at this level have likely been dedicated to their sport since an early age. The results indicate that these memories do not influence levels of perceived VTC. This dynamic could be due to the nature of the sample—several of the targeted sports include opportunities for postcollegiate play, perhaps leading the majority of the athletes to focus more on the present than on the past. The results for Hypothesis 1 also point to the conclusion that athletes, independent of their university, have similar experiences as they negotiate their collegiate athletic careers.

Hypothesis 2 investigates organizational influences on VSHI. Here, organizational identity and sentimentality emerge as significant predictors. Again, the result for organizational identity makes sense given the messaging environment in which the athletes participate. As noted, SAs are exposed to organizationally sponsored concussion and health messages, in addition to efforts to build university-based identity. Athletes’ organization-based identities, constituted in these messaging environments, exert influence on their vestedness in SHIs. The result for sentimentality points to the conclusion that athletes’ childhood memories influence their present-day vestedness in SHIs. The different result for SHIs compared to VTC may be due to memories of injuries, including concussions, and overcoming adversity to perform at a level commensurate with collegiate-level play. Neither organizational prestige nor IOC emerges as significant. We suspect that prestige does not emerge for the reason stated above, while we are surprised that competition appears to have no effect on VSHI; arguably, competition for team resources and positions would likely increase perceived SHI risk, but the results indicate that athletes do not connect the two concepts.

Finally, Hypothesis 3 investigates organizational influences on perceived SHI risk. The model shows that IOC, OI, and sentimentality all share a positive relationship with perceived SHI risk. Logically, intense competition accompanies increased perceptions of SHI risk. Interestingly, the relationship emerged here but not with VSHI. Adame and Corman (2019) found that SAs reported relatively low levels of vestedness. Combined with these results, we conclude that SAs are aware of but are not highly vested in SHI risk. The influence of OI and sentimentality on perceived risk suggests that both organizational messages and personal history influence risk perception for these athletes.

These findings contribute to communication literatures in three main ways. First, this study provides an empirical test of the role that organizational factors have on an individual’s vestedness. This study illustrates that athletes’ perceptions of organizational variables influence vestedness in team commitment, SHIs, and risk perception. Such findings inform organizational communication literatures by providing a theoretical framework from which to understand and design persuasive and influential organizational messages. Organizational researchers working in other contexts have observed that communication is constitutive of organizations (Bisel, 2010). Implementing VI theory as a way to understand how organizational messages create and recreate the organization itself provides insight into the nuances of organizational communication. For example, individual employees’ vestedness in organization-wide changes may be illuminated through this type of theoretical work. Future research should continue to explore the role of VI theory in organizational-level variables.

Second, this study offers a model for exploring the additive effects of all five components of vestedness. Theoretically, the model suggests that the five components each play a role in explaining variance in the attitude–behavior relationship. Traditionally, each component is measured separately and the five are used as predictors to understand an attitude–behavior relationship. This study is the first of its kind to combine mathematically the five elements into an additive measure that reflects VI’s theoretical structure. This combination allows us to study VI as an outcome variable and investigate relationships between factors at the individual and organizational levels of the socio-ecological model. Future research should continue to test VI’s combined factor structure in other contexts. Researchers applying VI may also find this strategy useful for explaining variance in the attitude–behavior relationship beyond what can be accounted for at the individual level.

Third, this research answers Kroshus, Garnett, Hawrilenko, Baugh, and Calzo’s (2015) call for more research that investigates the role that communication has on athletes’ decisions to report SHIs. The authors explain that an athlete’s decision to avoid reporting an SHI is due to systemic forces of pressure from family, coaches, teammates, and fans. Ultimately, the authors argue for a more complex understanding of an athlete’s environment that spans beyond the coach–athlete relationship. The present research does just this by exploring how broad organizational variables influence athletes’ perceptions of vestedness and risk. Future research should continue to explore the role of organizational variables on athlete vestedness and risk, perhaps by applying the principles of VI theory to create and test the persuasiveness of organizational messages.

Practical Implications

The implication of these findings is that organizational members seeking to cultivate team cultures that promote veridical concussion reporting should be deliberate with their discourse. Such deliberate messaging should reverberate throughout all levels of the organization. Coaches, athletic trainers, and other leaders who help define the culture of the athletic organization can work in concert to craft a program of messages that influence health behaviors. Moreover, leadership can work with team members to select centrally located peers to serve as educators and motivators. At the SA levels, these leaders can communicate encouraging messages to promote healthy behaviors, including SHI reporting and adherence to recovery protocols. These deliberate discourses from multiple members at varying levels of the organizational are likely to influence SAs’ perceived vestedness and risk in ways that motivate veridical SHI reporting.

A unique finding from the research about the role of IOC on the outcome variables also gives way to pointed messaging strategies. As discussed, IOC enhances perceived risk, but not vestedness in SHIs. In other words, athletes feel at greater risk of SHIs when they perceive higher levels of competition with their peers, but they are not vested in these attitudes. Team leaders can promote health-reporting behaviors by tempering perceived competition among teammates, so that injured athletes are not fearful of losing their starting position or place on the team. For example, a coach might say, “I know you are all working hard to keep the spot you’ve earned on the team. Now that you are here, our goal is to keep ourselves and our teammates healthy—especially when it comes to your brain.” Ultimately, messages like this can be a positive form of unobtrusive control (Tompkins & Cheney, 1985). Organizational leaders can influence health behaviors while avoiding overtly explicit commands (e.g., “You better report a concussion.”) that could result in reactance. Subtle forms of organizational control—especially when reverberated throughout all levels of the organization—can result in better health outcomes when athletes feel supported to report and recover properly.

Limitations

This study, like all studies, has limitations. First, the cross-sectional design relied on self-report and captured data from six high-risk sports from 11 Power-5 NCAA universities. Thus, the generalizability of the findings should be interpreted with the appropriate level of caution. Second, the models explained only a portion of the total variance. Further research should continue to apply the socio-ecological model to help explain more variance in these outcome measures. Third, none of the demographic variables emerged as significant predictors. This finding could be an artifact of our measurement methods or a limitation of our sampling. In both cases, we maximized our resources; however, future research may investigate alterative means to observe these variables adding valuable nuance to the findings. Fourth, researchers may wish to focus on additional organizational variables and investigate the potential role of societal-level narratives that may influence SAs’ vestedness and SHI risk perception.

Conclusion

Concussions present a significant health concern for SAs, team leaders, and university administration. The consequences of these injuries can affect athletes’ scholastic and athletic performance in the short term and manifest after their athletic career ends. Concussions, because the symptoms are not typically obvious, must be diagnosed through communication with the injured athlete. Past efforts to educate athletes have been ineffective, likely because they ignore organizational and contextual factors that influence athletes’ decision-making. In an effort to inform the development of educational modules that promote reporting, this research investigates the organizational variables that influence athletes’ vestedness in team commitment, SHI consequences, and risk perception. The results support the consideration of these variables when crafting educational materials and messages. We hope practitioners and university leaders find these results valuable as we work together to keep SAs safe and healthy.

Footnotes

Appendix

Table A1.

Sample Moments and Bivariate Correlations.

Variables	M	SD	1	2	3	4	5
1. Organizational prestige	5.57	0.94
2. IOC	4.83	0.79	.10*
3. OI	5.55	0.93	.28**	.21**
4. Sentimentality	5.26	0.84	.19**	.06	.32**
5. VI–SHI composite	23.87	3.25	.06	.06	.22**	.17**
6. VI–TC composite	23.96	3.64	.08	.30**	.36**	.15**	.23**

Note. N = 434. IOC = intraorganizational competition; OI = organizational identification; SHI = severe head impacts.

*p < .05 (one-tailed). **p < .001 (one-tailed).

Authors' Note

Karlee A. Posteher is also affiliated with College of Business, California State University Monterey Bay, Seaside, California, USA.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Collegiate Athletic Association and the U.S. Department of Defense under the Mind Matters Challenge grant program.

ORCID iD

Bradley J. Adame

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