Development of a Theory-Based Intervention for Communication of Healthcare Decisions in Athletic Training: The CHAT Study

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  • July 24, 2019
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  • Kay, Melissa C.
    • Affiliation: School of Medicine, Department of Allied Health Sciences, Curriculum in Human Movement Science
Abstract
  • Optimal decision-making by athletic trainers, grounded in best practices, is vital to optimize patient healthcare. However, many challenges exist within the athletic environment hindering consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers. Therefore, the study purpose was to 1) understand factors impacting decision making, and 2) develop a novel intervention tool to prepare athletic training students for high-pressure situations which require the ability to make an appropriate medical decision to withhold an athlete from concussion-related symptoms. Improving athletic trainer preparation regarding making and implementing appropriate decisions can improve secondary concussion prevention and patient outcomes. This mixed-methodological study design incorporated formative research and intervention development/testing. Formative research was conducted via survey with certified athletic trainers (n=1029) and athletic training educators (n=55), and with surveys (n=840) and interviews (n=15) with athletic training students. The intervention was developed using the Predisposing, Reinforcing, and Enabling Constructs in Education/Environmental Diagnosis and Evaluation (PRECEDE) planning model. This development incorporated preliminary data and formative research grounded in the Integrated Behavior Model. Several factors impacted concussion-related decision-making intentions by certified athletic trainers including quality of healthcare communication educational focus via perceived behavioral control (p=0.001) and communication/collaboration (p<0.001) on intentions despite pressure (p=0.001; p=0.044). For athletic training students, quality significantly affected self-efficacy (p=0.003) and intentions to make appropriate decisions despite pressure (p<0.001). From the educator perspective, quality and quantity of healthcare communication focus, and general attitudes were independent constructs with minimal differences within educational programs (general attitudes; z=2.16; p=0.03). Additionally, participants explained a large desire for greater focus on these topics despite positive findings. The designed intervention improved perceived behavioral control (p=0.027), self-efficacy (p=0.001), and intentions despite pressure (p=0.011), situation (p=0.003), and setting (p=0.012). These influential factors over decision-making may place athletes at further injury risk and negatively impact overall athlete health. Healthcare communication is not a mandated portion of athletic training curriculum but appears to have statistically and clinically significant effects on the intentions to make appropriate concussion-related decisions. As such, it is imperative that athletic training education programs prioritize content within this domain to adequately prepare student athletic trainers for these future decision-making responsibilities.
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Advisor
  • Kerr, Zachary Y.
  • Kucera, Kristen L.
  • Register-Mihalik, Johna K.
  • Ribisl, Kurt M.
  • Petschauer, Meredith A.
  • DeFreese, JD
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2019

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