Evaluating Huddles as a Novel Approach to Improving Concussion Safety - PROJECT SUMMARY More than 1 million US youth sustain a concussion each year during sports, yet up to 50% do not report symptoms to an adult, resulting in risk of further injury and prolonged recovery. To address these concerns, youth sport organizations mandated annual concussion education for athletes and coaches, but such approaches have not led to increases in concussion reporting as they: (1) focus on concussion knowledge, despite research indicating that changing knowledge alone does not shift concussion reporting (2) target individuals rather than systems, despite evidence suggesting interpersonal and group processes are the primary drivers of concussion reporting and (3) are delivered once at the beginning of the season, despite the importance of message recall and salience for behavior change. We have developed a novel systems-level approach to improving concussion safety, bringing both teams together prior to a game in a “Huddle” to remind youth athletes of the symptoms of concussion and affirm the importance of reporting symptoms to an adult if injured. Huddles take just a few minutes and provide a formalized opportunity for coaches to establish norms supportive of concussion reporting and removal from play in the setting where reporting will occur, and a mechanism for reinforcing this support throughout the season. Unlike more resource intensive and static concussion education interventions, a strength of Huddles is their brevity and adaptability, which makes them well positioned for equitable scalability and sustainability across youth sport settings. We created and tested this intervention using mixed methods in collaboration with coaches, athletes, parents, and officials in youth soccer and football in Georgia and Washington, finding broad acceptability and evidence for efficacy. We now plan to utilize a Hybrid Type I mixed methods design with a large sample of male and female youth soccer players in four US states to assess effectiveness of Huddles and identify barriers and facilitators to implementation. We thus propose the following aims: (1) Assess the effectiveness of Huddles using a cluster randomized controlled trial with randomization at the league-level (i.e., closed group of teams that compete against each other) and a primary outcome of proportion of athletes who sustained a potential concussive injury who reported their symptoms to an adult; (2) Test the theory- driven mechanisms hypothesized to explain Huddles effectiveness, particularly perceived norms related to concussion reporting; (3) Using a mixed-methods approach identify determinants of successful implementation and maintenance at the team and league level, including exploring the impact of community-level socioeconomic characteristics and other contextual factors. We strongly believe that ensuring concussion educational approaches function to improve athlete safety is a public health imperative. At the conclusion of this study, we will have critical information about the effectiveness of Huddles for improving concussion safety in youth soccer, and Huddles will be well positioned to be scaled and adapted across a broad range of youth sports.
