Youth Athletes' Parents' Perceptions and Knowledge of the Athletic Training Profession.

CONTEXT: Parents have unique roles in advocating for their child's health and safety. Such advocacy can improve student-athletes' access to athletic trainers (ATs), yet few researchers have investigated the perceptions of student-athletes' parents regarding athletic training. OBJECTIVE: To explore parents' perceptions of athletic training and evaluate their knowledge regarding the AT's role. DESIGN: Concurrent mixed-methods study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: Parents affiliated with USA Football representing 36 states (n = 316: men = 53.5%, women = 46.1%; average age = 45.6 ± 6.2 years [age provided = 291]) were included. MAIN OUTCOME MEASURE(S): An online questionnaire was developed and distributed via Qualtrics. The questionnaire contained demographic questions, quantitative items assessing perceived value and knowledge of athletic training, and open-ended questions to provide opportunities for expansion. Descriptive statistics were calculated for the demographic data. Quantitative measures were presented as count and percentage responses. Open-ended responses were analyzed using the general inductive approach, and overall perceptions were supported with participant quotes. RESULTS: Of 10 763 parents, 390 completed the questionnaire (3.6% response rate, 74.8% completion rate). Of the 390, 316 had a child in high school. Approximately 67% (n = 213) of respondents considered an AT a trusted source of medical information and "extremely valuable" to student-athletes' health and safety. The questionnaire response injury prevention was frequently recognized (n = 307, 97.2%) as a skill ATs perform, followed by first aid/wound care (91.8%) and therapeutic interventions (82.3%). Parents highlighted the AT's role in immediate care and attributed peace of mind and feelings of comfort to having a health care professional readily available for their children. CONCLUSIONS: When asked directly and when discussing their effect on student-athlete health and safety, parents valued ATs. Though various qualifications of ATs were recognized, parents emphasized the importance of having someone immediately available to provide care if and when needed. Educational efforts should focus on ATs as the most qualified health care professionals to provide comprehensive medical care to student-athletes in both urgent and nonurgent situations.

Secondary School Athletic Trainers' Experiences With Organizational Conflict: A Comparison Across Employment Models.

CONTEXT: Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood. OBJECTIVE: To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics. DESIGN: Cross-sectional study. SETTING: Secondary school athletics. PATIENTS OR OTHER PARTICIPANTS: Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8). MAIN OUTCOME MEASURES: Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynamic. Employment type (school district employee, school district teacher, medical or university facility, independent contractor) and status (full time, part time) served as independent variables. Likert-scale scores (1 = strongly agree to 5 = strongly disagree; 1 = always to 5 = never) and perceived sources of stress, pressure, and conflict were the dependent variables. Analyses consisted of Kruskal-Wallis tests with Mann-Whitney U post hoc tests and odds ratios to assess associations between variables of interest. RESULTS: We obtained a 15.3% response rate (725/4745). Although the ATs reported experiencing conflict and pressure, these experiences were relatively infrequent and not universal. Compared with part-time ATs, full-time ATs described higher ratings of strong relationships with coaches (P = .003) and principals (P = .002). The most frequently identified sources of conflict were parents (59%) and coaches (53.9%), followed by athletes (32.6%). Full-time ATs were 1.6 times more likely to report experiencing conflict with a coach than part-time ATs (odds ratio = 1.550, 95% CI = 1.037, 2.317; P = .040). CONCLUSIONS: Secondary school ATs' experiences regarding organizational conflict were relatively positive. Instances of pressure and conflict were noted, though relatively infrequently, and these experiences were largely uninfluenced by employment type.

Knowledge Translation in Athletic Training: Considerations for Bridging the Knowledge-to-Practice Gap.

As the athletic training profession continues to embrace evidence-based practice, athletic trainers should not only critically appraise the best available evidence but also effectively translate it into clinical practice to optimize patient outcomes. Whereas previous authors investigated the effectiveness of educational interventions on increasing knowledge of critical appraisal of evidence, little attention has been given to strategies for both researchers and clinicians to effectively translate evidence into clinical practice. The use of knowledge translation strategies has the potential to bridge the knowledge-to-practice gap, which could lead to reduced health costs, improved patient outcomes, and enhanced quality of care. The purpose of this article is to (1) highlight the current challenges preventing the successful translation of evidence into practice, (2) discuss knowledge translation and describe the conceptual frameworks behind the effective translation of evidence into practice, and (3) identify considerations for athletic trainers as they continue to provide high-quality patient care in an evidence-based manner.

Secondary School Administrators' Knowledge and Perceptions of the Athletic Training Profession, Part II: Specific Considerations for Principals.

CONTEXT: Secondary school administrators fulfill many leadership roles, including creating and implementing policies to help ensure the safety of athletic programs. However, few researchers have examined principals' awareness and perceptions of the athletic trainer's (AT's) role. OBJECTIVE: To explore secondary school principals' knowledge of the roles and responsibilities of ATs and perceptions of athletic training. DESIGN: Concurrent mixed-methods study. SETTING: Cross-sectional online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Principals (n = 686; age = 48.1 ± 7.8 years, time in position = 7.1 ± 5.8 years) represented public secondary schools across the United States. MAIN OUTCOME MEASURE(S): The web-based questionnaire was composed of demographics, various quantitative items assessing knowledge and perceived value of ATs, and open-ended questions. Descriptive statistics summarized demographic data. Select quantitative measures are reported as count responses and overall percentages. Responses to open-ended questions were analyzed inductively. RESULTS: We obtained a 5% response rate (686 of 13 517). Approximately 93% (n = 637) of responding principals considered an AT to be a trusted source of medical information. The most frequently selected skills they believed ATs were qualified to perform were injury prevention (99.1%), first aid/wound care (96.5%), and therapeutic intervention (91.4%). Sixty-three percent (n = 430) of participants considered an AT to be extremely valuable to student-athlete health and safety. Our results indicated that secondary school principals had a vague understanding of AT "training" and appreciated the immediacy of care ATs could provide. They also appeared to use decentralized hiring practices. CONCLUSIONS: Secondary school principals identified ATs as a trusted source of medical information and recognized the role ATs played in the immediate care of athletic-related injuries. However, principals had a limited understanding of the qualifications and educational requirements of ATs. Future professional advocacy efforts targeting this stakeholder group should highlight all medical services an AT provides and emphasize the AT's value in schools that sponsor athletics programs.

Secondary School Administrators' Knowledge and Perceptions of the Athletic Training Profession, Part I: Specific Considerations for Athletic Directors.

CONTEXT: Athletic directors are charged with making impactful decisions for secondary school athletic programs that mitigate risks for stakeholders. This includes decision making regarding the provision of medical care for student-athletes. To date, few researchers have explored athletic directors' perceptions of the athletic training profession. OBJECTIVE: To evaluate public school athletic directors' knowledge and perceptions of the athletic trainer (AT) role. DESIGN: Concurrent mixed-methods study. SETTING: Cross-sectional online questionnaire. PATIENTS OR OTHER PARTICIPANTS: Athletic directors representing all 50 states and the District of Columbia (N = 954; 818 men, 133 women, 3 preferred not to answer; age = 47.8 ± 9.1 years; time in current role = 9.8 ± 8.3 years). MAIN OUTCOME MEASURE(S): The questionnaire was composed of demographics, quantitative measures that assessed athletic directors' knowledge and perceived value of ATs, and open-ended questions allowing for expansion on their perspectives. Descriptive statistics were reported, with key quantitative findings presented as count responses and overall percentages. Qualitative data were analyzed using the general inductive approach. RESULTS: A majority of respondents recognized ATs' role in injury prevention (99.8%), first aid and wound care (98.8%), therapeutic interventions (93.8%), and emergency care (91.6%). Approximately 61% (n = 582) identified AT employment as a top sport safety measure, and 77% (n = 736) considered an AT to be extremely valuable to student-athlete health and safety. Athletic directors appeared to recognize the value of ATs as they provided "peace of mind" and relieved coaches and administration of the responsibility for making medical decisions. CONCLUSIONS: Athletic directors seemed to recognize the value ATs brought to the secondary school setting and demonstrated adequate knowledge regarding ATs' roles and responsibilities. Educational efforts for this population should focus on ATs' tasks that add to their perceived value but are not frequently in the public eye, which may influence hiring decisions.

Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making.

CONTEXT: Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. OBJECTIVE: To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. DESIGN: Qualitative study. SETTING: Semistructured one-on-one telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24-48 years]; years certified = 9 ± 8). DATA COLLECTION AND ANALYSIS: Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. RESULTS: Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. CONCLUSIONS: External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.

Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes.

CONTEXT: Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations. OBJECTIVE: To investigate the challenges faced by ATs when treating concussed student-athletes. DESIGN: Qualitative study. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics. DATA COLLECTION AND ANALYSIS: We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review. RESULTS: When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations. CONCLUSIONS: Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.

Athletic Trainer Services in the Secondary School Setting: The Athletic Training Locations and Services Project.

CONTEXT: Previous research from a sample of US secondary schools (n = 10 553) indicated that 67% of schools had access to an athletic trainer (AT; 35% full time [FT], 30% part time [PT], and 2% per diem). However, the population-based statistic in all secondary schools with athletic programs (n = approximately 20 000) is yet to be determined. OBJECTIVE: To determine the level of AT services and employment status in US secondary schools with athletics by National Athletic Trainers' Association district. DESIGN: Cross-sectional study. SETTING: Public and private secondary schools with athletics. PATIENTS OR OTHER PARTICIPANTS: Data from all 20 272 US public and private secondary schools were obtained. MAIN OUTCOME MEASURE(S): Data were collected from September 2015 to April 2018 by phone or e-mail communication with school administrators or ATs and by online surveys of secondary school ATs. Employment categories were school district, school district with teaching, medical or university facility, and independent contractor. Data are presented as total number and percentage of ATs. Descriptive statistics were calculated for FT, PT, and no AT services data for public, private, public + private, and employment type by state and by National Athletic Trainers' Association district. RESULTS: Of the 20 272 secondary schools, 66% (n = 13 473) had access to AT services, while 34% (n = 6799) had no access. Of those schools with AT services, 53% (n = 7119) received FT services, while 47% (n = 6354) received PT services. Public schools (n = 16 076) received 37%, 32%, and 31%, whereas private schools (n = 4196) received 27%, 28%, and 45%, for FT, PT, and no AT services, respectively. Most of the Athletic Training Locations and Services Survey participants (n = 6754, 57%) were employed by a medical or university facility, followed by a school district, school district with teaching, and independent contractor. Combined, 38% of AT employment was via the school district. CONCLUSIONS: The percentages of US schools with AT access and FT and PT services were similar to those noted in previous research. One-third of secondary schools had no access to AT services. The majority of AT employment was via medical or university facilities. These data depict the largest and most updated representation of AT services in secondary schools.

Legislators' Perceptions and Knowledge of the Athletic Training Profession: Specific Considerations for Secondary Schools.

CONTEXT: Legislation has played a role in advancing the athletic training profession and improving the health and safety of student-athletes. However, few researchers have examined state legislators' perceptions and awareness of the skills and qualifications accompanying the athletic trainer (AT) role. OBJECTIVE: To explore state legislators' perceptions of the athletic training profession and knowledge related to qualifications and responsibilities of ATs. DESIGN: Cross-sectional study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: State legislators representing 34 states (N = 143; 67.13% male, 32.87% female). Their average age was 58.7 ± 11.7 years, and they had served 7.4 ± 6.9 years in their current role. A majority served as members of the state house or assembly (n = 98, 68.5%), and 31.5% served in the state senate. MAIN OUTCOME MEASURE(S): Quantitative data were analyzed using descriptive statistics. Spearman ρ correlations assessed relationships between perceptions and knowledge of the profession. Stepwise regression analysis determined predictors of knowledge and perceived value of athletic training. Qualitative data were analyzed inductively. RESULTS: Approximately 69% of respondents considered an AT to be a trusted source of medical information, and 16% considered an AT as the most appropriate individual to provide medical care to an injured athlete on a daily basis. Thirty percent of state legislators selected AT employed at the school as a top sports safety measure. Three themes emerged from the inductive analysis: (1) recognition of the prevention domain, (2) misconception of ATs as personal trainers or strength and conditioning coaches, and (3) lack of knowledge regarding ATs' educational requirements. CONCLUSIONS: Legislators demonstrated limited knowledge of the AT profession. When legislator knowledge of AT qualifications and responsibilities was high, value of the AT profession also significantly improved. Future efforts should focus on enhancing legislators' knowledge to increase the value placed on the athletic training profession and improve health and safety for secondary school athletes.