Baseline Survey on Understanding and Awareness of Sport-Related Concussions

Public Health Agency of Canada
POR # 021-17
Contract # HT372-173253/001/CY

Produced by Kantar TNS
Contract Award Date: July 09, 2017
Report Date: January 22, 2018

Table of Contents

• 1. Executive Summary
  • 1.1. Research Purpose and Objectives
  • 1.2. Summary of Findings
  • 1.3. Methodology
  • 1.4. Contract Value
  • 1.5. Statement of Political Neutrality
• 2. Foreword
  • 2.1. Background and objectives
  • 2.2. Methodological Overview
  • Sub-group analyses, statistical significance and rounding
• 3. Detailed Findings
  • 3.1. Concussion Awareness
  • 3.2. Attitudes Towards Concussions
  • 3.3. General Concussion Knowledge
    • 3.3.1. Self-reported Knowledge of Concussions
    • 3.3.2. Understanding of Concussions
    • 3.3.3. Causes of Concussion
    • 3.3.4. Signs of Concussion
    • 3.3.5. Concussion Symptoms
    • 3.3.6. Actions for Suspected Concussion
    • 3.3.7. Concussion Myths and Facts
  • 3.4. Sport-Related Concussion Knowledge
    • 3.4.1. Prevention of Sport-Related Concussion
    • 3.4.2. Reporting Sport-Related Concussions
    • 3.4.3. Actions for Suspected Concussion during Sports
  • 3.5. Concussion Treatment Knowledge
    • 3.5.1. Concussion Treatment
    • 3.5.2. Introduction of Light Physical Activity
    • 3.5.3. Return to School or Work
    • 3.5.4. Return to Play
  • 3.6. Concussion Information
    • 3.6.1. Looked for Concussion Information in the Past 12 months
    • 3.6.2. Location of Information
    • 3.6.3. Awareness of Tools and Information Resources
  • 3.7. Parents of Children 5-17
    • 3.7.1. Processes and Procedures to Deal with Concussion
    • 3.7.2. Received Concussion Information from Sports Team
  • 3.8. Coaches
    • 3.8.1. Type of Coach
    • 3.8.2. Processes and Procedures to Deal with Concussion
    • 3.8.3. Formal Training or Education on Concussion
    • 3.8.4. Sharing of Documented Concussion Information
    • 3.8.5. Athlete with Concussion in the Last 4 Years
  • 3.9. Teachers
    • 3.9.1. Processes and Procedures to Deal with Concussion
    • 3.9.2. Formal Training or Education on Concussion
    • 3.9.3. Student with Concussion in the Last 4 Years
  • 3.10. Health Care Providers
    • 3.10.1. Health Care Providers (HCPs)
    • 3.10.2. Attitudes towards Concussion
    • 3.10.3. Concussion Knowledge
    • 3.10.4. Diagnosis
    • 3.10.5. Concussion Classification
    • 3.10.6. Awareness of Tools and Resources
    • 3.10.7. Canadian Guideline on Concussion in Sport
    • 3.10.8. Sport Medical Assessment Letter and Medical Clearance Letter
    • 3.10.9. Knowledge Gaps and Barriers
• 4. Methodology
  • 4.1. Methodological Overview
• 5. Appendix B: Survey Instrument
  • 5.1 English Survey

1. Executive Summary

1.1 Research Purpose and Objectives

Concussions in sport are a recognized public health issue due to the frequency of occurrence and their potential short and long-term consequences, including cognitive, emotional and physical symptoms and, when left undetected, even death. Children and youth are particularly at risk of long-term cognitive deficits following sports-related traumatic brain injury.

Presently, there is no definitive set of concussion guidelines, and there is no comprehensive pan-Canadian approach to address concussions in the sport, education and health sectors. This is a critical gap given prevention, detection and management approaches vary across the country, potentially raising the health risks to participants in sport, recreation and physical activity.

The Minister of Health has been mandated to work with the Minister of Sport and Persons with Disabilities to support a national strategy to raise awareness for Parents, Coaches and athletes on concussion treatment.

Budget 2016 provided $1.4 million over two years to PHAC to work with provinces and territories on the harmonization of concussion management guidelines across Canada, with a focus on athlete and student return-to-play and return-to-learn protocols.

Research Objectives

This research is essential for gathering information on Canadians’ current understanding of concussions (and particularly concussions in children and youth) in order to inform the development of a Pan-Canadian Concussion Strategy.  This research will also help establish a baseline of information, which will be used to measure progress and report on performance, following the implementation of the Canadian Guideline on concussion in sport and protocols on return-to-learn and return-to-play.

The study will target two broad segments: healthcare professionals (HCPs); and the Canadian public (18+) further segmented into the general population, Teachers, Parents and Coaches/sports administrators.

The specific research objectives are to:

• Identify pervasive myths about concussions;
• Assess the public’s knowledge, attitudes and beliefs regarding concussions;
• Assess the public’s experience as it relates to concussions;
• Identify key messages which may influence the uptake of concussion prevention;
• Assess what documents, tools or other resources health care providers (HCPs) currently use for concussion diagnosis;
• Uncover if HCPs have unmet needs for addressing concussion prevention; and
• Assess uptake of the most recent findings and guideline on concussions among HCPs;

1.2 Summary of Findings

Overall Concussion Awareness

For the purposes of this research, it was assumed that all HCPs were aware of concussion.  This assumption was not made for non-HCPs and as such respondents who were not aware of concussion as a health condition were screened out of the survey.  In total, 15% of respondents were unaware of concussion with Teachers (9%) and Coaches (4%) less likely to be unaware of concussion.

Attitudes Towards Concussions

Among those aware of concussion, virtually all Canadians (97%) believe concussion is an important health issue however fewer know where to get information on prevention (51%), what to do if someone gets a concussion (46%) or can recognize the signs and symptoms (40%).

General Concussion Knowledge

Generally speaking self-reported concussion knowledge is low among Canadians.  Half report they have little or no knowledge (55%).   Basic understanding of concussion is fairly strong; with most Canadians (88%) being able to identify that a concussion is “a blow to the head that causes a variety of symptoms such as headache or blurred vision”.  Fewer however, understand the more detailed or specific aspects of concussion such as being a brain injury that affects the way a person thinks (46%) or that it can’t be diagnosed with imaging tests (29%).

Canadians also have a basic understanding about what can cause a concussion.  Most understand (89%) that a “hit or blow to the head” can cause a concussion but fewer understand that it can also occur from a hit anywhere that causes a sudden shock, jar or jolt to the head (79%), a hit to the face (67%) or neck (52%).

Canadians are also well equipped to identify a large number of signs that may indicate a person may have suffered a concussion as well as symptoms that a person with a concussion may experience.  Cognitive or motor-related symptoms such as not thinking clearly or dizziness are more well-known than mood based symptoms such as nervousness or anxiety.

Canadians have some understanding about what actions to take if they suspect someone has suffered a concussion. Most (88%) understand that a medical professional should assess the individual, that they should check for symptoms (78%), memory (70%) or for red flags (69%).  More than half however, continue to believe dated advice that sleep should be monitored (56%).

While the previous results suggest that Canadians have a moderate to high level of knowledge about concussions, one must remember that responses were provided from prompted lists.  This means that many Canadians, when presented with a variety of options are able to identify the correct response.  This does not mean that they have requisite knowledge required to address concussion if it should arise.

To further understand Canadians’ concussion related knowledge, the survey used a number of true and false statements to better understand knowledge levels.  When using true and false statements, a respondent can correctly guess the response half of the time.  Thus, to be sure Canadians have correctly identified the statement as true or false we need to see results well above the 50 per cent mark.

Results of this analysis found that there are a number of myths about concussion that Canadians continue to believe as well as a number of facts that people are unaware of or simply don’t understand. More specifically, most Canadians understand that concussion symptoms can last for several weeks (96%) and can vary from person-to-person (95%) that a person does NOT have to lose consciousness to have a concussion (92%) and that is not necessarily safe to return-to-sport as soon as their symptoms wear off (90%).  Many also understand that a direct blow to the head is not necessary for a concussion (70%) and that MRI or CT scans are not the way to diagnose a concussion (68%).

Interestingly however, there are number of myths and facts that are simply unclear to Canadians with results showing correct responses at the same rate as if they had guessed i.e., 50 per cent.  The following statements were only correctly identified approximately half of the time suggesting Canadians do not have the requisite knowledge in these areas.

• Vomiting is a sure sign of concussion (54%)
• Boys get more concussions than girls (50%)
• Children are more likely to suffer concussion than adults (45%)
• The harder the blow, the more severe the concussion (44%); and
• Wearing a properly fitted helmet will prevent concussions (42%)

Sport-Related Concussion Knowledge

Many Canadians understand there are a number of ways to prevent sport-related concussion including avoiding contact with the head (85%), providing concussion training to athletes (79%), ensuring athletes follow the rules and regulations of their sport (78%) and having respect for other players (62%).  There are however, some misperceptions such as believing that wearing a helmet (92%), avoiding contact sports (56%) and wearing a mouth guard (44%) are effective ways of preventing sport-related concussion.

Most Canadians understand that if a person is suspected of suffering a concussion while playing sports they should be sent to a health care provider for assessment (92%).  Many also understand the person should immediately be removed from play (87%) and obtain medical clearance before returning to sport (82%).  Fewer however, recognize that the person should not be allowed to return to the same game or practice (69%).

General Treatment Knowledge

Canadians’ knowledge related to concussion treatment is low.  One-quarter (25%) of Canadians do not know how concussion is treated and only 15 per cent can correctly identify “rest for 24-48 hours, followed by a gradual return to cognitive and physical activity under the supervision of a medical professional” as the best way to treat concussion.

Virtually all Canadians (97%) understand that light physical activity should not be introduced immediately after concussion and that there should be a rest period (24%).  The anticipated rest period however varies; 13 per cent believe it should 24-48 hours while 11 per cent believe it should be 10-14 days.

Similarly, virtually all Canadians (99%) understand that a concussion impacts both schooling and work.  Interestingly though, many Canadians (63%) believe a return to work should only occur after medical clearance has been provided.

Perspectives on return-to-play are slightly different for Canadians compared to return-to-work or light physical activity.  Three-quarters (75%) believe athletes should not return to play until they have received clearance from a medical professional.  Some believe there should be a rest period (10%) of either 24-48 hours (2%) or 10-14 days (8%) while others believe all concussion symptoms must be gone (7%) before returning to play. 

Concussion Information

Few Canadians (7%) have searched for information on concussion prevention diagnosis or recovery over the past 12 months.  The primary places that Canadians look for information or anticipate looking for information on concussion prevention diagnosis or recovery are online at various websites by using a search engine or by looking at specific websites such as Health Canada, Public Health Agency of Canada or other health related websites.

Furthermore, Canadians’ awareness of concussion related tools or resources are somewhat limited.  Four-in-ten (40%) were unaware of any of the cited tools and/or information resources available to the public.  The remaining 60 per cent were aware of at least one tool however no single tool is broadly known as less than a quarter of Canadians were aware of any one of the resources cited.

Differences among Parents, Teachers and Coaches

This research explored in detail any differences that might exist between the general population and Parents of children 5-17 (hereinafter Parents), Teachers and Coaches of children 5-17 (hereinafter Coaches).

For the most part, Parents have similar attitudes and levels of knowledge compared to the general population with a few exceptions:

• Parents are more likely to know where to get concussion prevention information, know what to do if someone gets a concussion and to be able to recognize the signs and symptoms of a concussion;
• Parents put more reporting onus on the child, team mates and referees if a child suffers a concussion; and
• Parents are more likely to have searched for concussion information and not unexpectedly, more likely to be aware of resources that have been targeted to Parents.

Teachers are more knowledgeable than the general population in a few areas:

• Teachers have a better overall knowledge of concussion compared to the general population and are more able to identify concussion symptoms;
• Teachers are also likely to understand effective prevention strategies; and
• Teachers are more likely to have searched for information and are also more likely to be aware of resources that have been targeted to Teachers.

When it comes to concussion awareness and knowledge, Coaches tend to have a higher awareness and self-reported level of knowledge in most areas.  Coaches report not only have the basic level of awareness and knowledge but also are more likely to understand the more detailed or specific aspects of concussion.  More specifically Coaches:

• Report having a more detailed knowledge of the various causes of concussion;
• Can identify more signs of concussion;
• Are more likely to correctly identify actions that should be taken for suspected concussion;
• Are more likely to identify the correct approach to treatment;
• Are more likely to believe medical clearance is required for returning to sport; and
• Are more likely to have searched for information and more likely to be aware of resources that have been targeted to Coaches.

Processes and Procedures in Place to Deal with Concussion

Many schools and leagues have processes and procedures in place to deal with concussion.  More than half (56%) of all Teachers reported that their school does have processes and procedures in place while three-quarters (73%) of Coaches indicated that their team or league has processes or procedures in place to deal with concussion.

Concussion Training Among Teachers and Coaches

Training on concussion is somewhat limited among Teachers and Coaches.  Only half (48%) of Teachers have received any training or education from their school or board about concussion.  Training among Coaches is somewhat higher with 62% having received some training or education from their organization or league on concussion.

Health Care Providers (HCPs)

Virtually all HCPs (97%) believe concussion is an important health issue however; not all HCPs know where to go for reliable information on concussion diagnosis (85%) or on concussion treatment and recovery (82%).  Not unexpectedly, concussion knowledge is quite strong among HCPs.  Only ten per cent believe they have little (9%) or no knowledge (1%) about concussion. 

The large majority of HCPs (84%) have diagnosed a concussion and patient symptoms are used to diagnose concussion by almost all (98%) HCPs followed by patient history (95%), a neurological exam (86%), observation (79%), cognitive testing (63%) or other (17%).  Interestingly, a small proportion of HCPs use imaging tests to diagnose concussion even though concussion cannot typically be diagnosed this way.  For diagnosing and assessing the severity of a concussion, HCPs are most likely to use:

• The Sport Concussion Assessment Tool 5 (SCAT5) (51%);
• The Child Sport Concussion Assessment Tool 5 (Child SCAT5) (34%); or
• The Canadian Guideline on Concussion in Sport (31%). 

HCPs have varied awareness of concussion tools or resources and many are aware of the following tools or resources:

• Sport Concussion Assessment Tool 5 (SCAT5) (60%)
• Canadian Guideline on Concussion in Sport (57%)
• Child Sport Concussion Assessment Tool 5 (Child SCAT5) (49%)
• Concussion Baseline Testing (44%)

Among HCPs who have used the Guideline on Concussion in Sport, they have very positive perceptions of it.  In fact the large majority believes (strongly agree or agree) the guideline:

• Is a useful tool for health care providers (94%);
• Will improve concussion management in Canada (87%);
• Has made it easier to diagnose concussions (86%);
• Will improve concussion diagnosis in Canada(85%); and
• Has made it easier to manage concussions (82%).

1.3 Methodology

An online survey was conducted among 1,895 Canadians age 18 years and older and 391 Health Care Providers.  A pre-test consisting of 10 completed English interviews and 10 completed French interviews, was completed before fielding the survey on November 20th, 2017.  The survey was in field from November 20th to December 19th, 2017. Respondents for this survey were primarily selected from the Kantar TNS online panel and supplemented by members of the Canadian Coaches Association and partners of Parachute.  The results of panel and membership surveys cannot be described as statistically projectable to the Canadian population. Where national data was available, the data have been weighted to reflect the demographic composition of the Canadian population. As this was a non-probability sample, margin of error does not apply and conclusions from these results cannot be generalized to any population.  Surveying was conducted in the respondent’s official language of choice and took an average of 15 minutes to complete.   A detailed methodology can be found in Chapter 4.

1.4 Contract Value

The total contract value for this project was $94,920.00 including HST.

1.5 Statement of Political Neutrality

I hereby certify as Senior Research Director & Public Sector Practice Lead of Kantar TNS that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences and standings with the electorate or ratings of the performance of a political party or its leaders.

Tanya Whitehead
Kantar TNS
Senior Research Director & Public Sector Practice Lead

2. Foreword

2.1 Background and objectives

Concussions in sport are a recognized public health issue due to the frequency of occurrence and their potential short and long-term consequences, including cognitive, emotional and physical symptoms and, when left undetected, even death. Children and youth are particularly at risk of long-term cognitive deficits following sports-related traumatic brain injury.

Presently, there is no definitive set of concussion guidelines, and there is no comprehensive pan-Canadian approach to address concussions in the sport, education and health sectors. This is a critical gap given prevention, detection and management approaches vary across the country, potentially raising the health risks to participants in sport, recreation and physical activity.

The Minister of Health has been mandated to work with the Minister of Sport and Persons with Disabilities to support a national strategy to raise awareness for Parents, Coaches and athletes on concussion treatment.

Budget 2016 provided $1.4 million over two years to PHAC to work with provinces and territories on the harmonization of concussion management guidelines across Canada, with a focus on athlete and student return-to-play and return-to-learn protocols.

Research Objectives

This research is essential for gathering information on Canadians’ current understanding of concussions (and particularly concussions in children and youth) in order to inform the development of a Pan-Canadian Concussion Strategy.  This research will also help establish a baseline of information, which will be used to measure progress and report on performance, following the implementation of Canadian Guidelines on concussion and protocols on return-to-play and return-to-learn.  

The study will target two broad segments: healthcare professionals (HCPs); and the Canadian public (18+) further segmented into the general population, Teachers, Parents and Coaches/sports administrators.

The specific research objectives are to:

• Identify pervasive myths about concussions;
• Assess the public’s knowledge, attitudes and beliefs regarding concussions;
• Assess the public’s experience as it relates to concussions;
• Identify key messages which may influence the uptake of concussion prevention;
• Assess what documents, tools or other resources health care providers (HCPs) currently use for concussion diagnosis;
• Uncover if HCPs have unmet needs for addressing concussion prevention; and
• Assess uptake of the most recent findings and guideline on concussions among HCPs;

2.2 Methodological Overview

An online survey was conducted among 1,895 Canadians age 18 years and older and 391 Health Care Providers.  A pre-test consisting of 10 completed English interviews and 10 completed French interviews, was completed before fielding the survey on November 20th, 2017.  The survey was in field from November 20th to December 19th, 2017. Respondents for this survey were primarily selected from the Kantar TNS online panel and supplemented by members of the Canadian Coaches Association and partners of Parachute.  The results of panel and membership surveys cannot be described as statistically projectable to the Canadian population. Where national data was available, the data have been weighted to reflect the demographic composition of the Canadian population. As this was a non-probability sample, margin of error does not apply and conclusions from these results cannot be generalized to any population.  Surveying was conducted in the respondent’s official language of choice and took an average of 15 minutes to complete.   A detailed methodology can be found in Chapter 4.

Sub-group analyses, statistical significance and rounding

Analysis was undertaken to establish differences between the General Population, Parents, Teachers and Coaches and a number of demographics within those groups. It should be noted that for this research a general population sample was first drawn and then an oversample of parents, teachers and coaches was obtained.  As well, a respondent may fall into more than one category as they may be part of the general population sample and still be a parent, coach or teacher.  Only differences significant at the 95% confidence level are presented in this report.  Any differences that are statistically significant between these subgroups are indicated by denoting the column letter within the tables throughout the report.  For example, in the table below Parents, Teachers and Coaches are significantly more likely to report being able to recognize signs and symptoms of a sport-related concussion compared to the general population.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

The numbers presented throughout this report are rounded to the closest full number. Due to this rounding, in some cases it may appear that ratings collapsed together are different by a percentage point from when they are presented individually and totals may not add up to 100%.

3. Detailed Findings

3.1 Concussion Awareness

For the purposes of this survey, those who were not aware of concussions were screened out.  In total, 15% of respondents that were not HCPs were unaware of concussion.  Teachers and Coaches were more likely to be aware of concussion with only nine and four per cent respectively having no awareness of concussion.

3.2 Attitudes Towards Concussions

Nearly all Canadians (97%) believe concussion is an important health issue however only half (51%) know where to go for reliable information on concussion prevention and fewer (46%) know what to do if someone gets a concussion or can recognize (40%) the signs and symptoms of a sport-related concussion.

Parents of children 5-17 years old (hereinafter Parents), Teachers and Coaches are all more likely than Canadians in general to know where to go for reliable information on concussion prevention (67%, 68% and 82% respectively), to know what to do if someone gets a concussion (63%, 64% and 86% respectively) and are more likely to recognize the signs and symptoms of a sport-related concussion (63%, 69% and 84% respectively).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.3 General Concussion Knowledge

3.3.1 Self-reported Knowledge of Concussions

Self-reported knowledge of concussion is low among Canadians.  More than one-half of Canadians indicate they have little (49%) or no (6%) knowledge about concussion while slightly more than a third (38%) considers themselves to have moderate knowledge.  Less than one per cent of the population considers themselves experts on concussion.  Parents, Teachers and Coaches all rate their knowledge higher compared to the general population. Details can be found in the table below.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.3.2 Understanding of Concussions

Most Canadians (88%) believe that a concussion is “a blow to the head that causes a variety of symptoms such as headache or blurred vision” however, fewer (46%) understand that it is a brain injury “that affects the way a person thinks” or “that can’t be seen on x-rays, CT or MRI scans” (29%).  Close to half of Canadians also mistakenly believe a concussion is a brain injury that “affects the way a person walks and talks” (46%) or is a “bruise on the brain” (48%).  Few (7%) believe a concussion is a spinal injury that affects the way a person thinks.

Coaches are more likely to understand that concussion cannot be seen on x-rays, CT or MRI scans(44%) but are also more likely to make the mistake that a concussion can be described as concussion a brain injury that “affects the way a person walks and talks”(51%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.3.3 Causes of Concussion

Most Canadians (89%) understand that a concussion can be caused by a “hit or blow to the head” or by “a hit or blow to any part of the body that would cause the head to experience a sudden shock, jar or jolt” (79%).  Fewer however, understand that concussion can also occur from a hit or blow to the face (67%) or neck (52%).

Coaches are more likely to know that concussion can be caused by a hit or blow to any part of the body that would cause the head to experience sudden shock, jar or jolt (95%), by a hit to the face (81%) or neck (73%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.3.4 Signs of Concussion

Most Canadians can identify a number of signs that indicate a person may have a sport-related concussion.  Disorientation, confusion or inability to respond appropriately to questions (92%), difficulties with balance, walking or motor coordination (88%) and nausea and vomiting (82%) are identified by the large majority of Canadians.  Approximately seven-in-ten can also identify blank or vacant stares (75%), lying motionless on the ground (70%), being slow to get up (70%) and holding their head (65%) as signs that a person may have a sport-related concussion.  Few however, associate facial injury with concussion symptoms (35%) and some mistakenly associated difficulty breathing (30%), difficulty eating (29%) or limping (19%) as signs that indicated a person may have a sport-related concussion.

Coaches are more likely to be able to correctly identify all signs that indicated a person may have a sport-related concussion compared to the general population and Teachers are more likely to identify some signs such as blank or vacant stare (84%), holding one’s head (77%) and nausea and vomiting (95%) compared to the general population.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.3.5 Concussion Symptoms

Canadians can identify a wide range of concussion symptoms however, cognitive or motor related symptoms are better known among Canadians.  In particular, approximately three-quarters or more of Canadians can identify the following as symptoms of concussion:

• Headaches or feeling of pressure in the head (86%)
• Dizziness (84%)
• Blurred or fuzzy vision (84%)
• Balance problems (80%)
• Not thinking clearly (76%)
• Nausea and vomiting (75%)
• Not feeling “right” (75%)
• Feeling slowed down or like in a “fog” (73%)
• Difficulty learning new information (75%)
• Difficulty remembering (73%)

Emotive symptoms are much less likely to be associated with concussion such as:

• Easily upset or angered (43%);
• Having a hard time falling asleep (39%);
• Nervousness or anxiety (38%);
• Feeling more emotional (33%); and
• Sadness (26%)

Furthermore, other experiences are mistakenly identified as symptoms of concussion such as tremors or shaking (43%), difficulty breathing (23%), increased heart rate (22%) and/or excessive sweating (20%).

Similar to signs of concussion, Coaches and Teachers are more likely to identify most symptoms compared to the general population while Parents are more likely to identify sadness (33%) and nausea and vomiting (80%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.3.6 Actions for Suspected Concussion

The large majority of Canadians understand that if they suspect someone has suffered a concussion they should have a medical professional assess them (88%).   Most also understand they should check for symptoms of concussion (78%), visual signs of concussion (72%), memory (70%) and “red flags” (69%).  Approximately half however, also believe you should monitor their sleep (56%) or check vital signs (48%).

Coaches are more likely to correctly identify actions to take for suspected concussion.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.3.7 Concussion Myths and Facts

There are a number of myths about concussion that Canadians continue to believe as well as a number of facts that Canadians are unaware of.  More specifically, most Canadians understand that concussion symptoms can last for several weeks (96%) and can vary from person-to-person (95%), that a person does NOT have to lose consciousness to have a concussion (92%) and that is not necessarily safe to return-to-sport as soon as their symptoms wear off (90%).  Many also understand that a direct blow to the head is not necessary for a concussion (70%) and that MRI or CT scans are not the way to diagnose a concussion (68%).

Interestingly however, there are number of myths and facts that are simply unclear to Canadians with results showing correct responses at the same rate as if they were simply chosen by random i.e., 50 per cent.  The following statements were only correctly identified approximately half of the time which is what one could expect if the respondent simply guessed.  This suggests Canadians do not have the requisite knowledge in these areas.

• Vomiting is a sure sign of concussion (54%)
• Boys get more concussions than girls (50%)
• Children are more likely to suffer concussion than adults (45%)
• The harder the blow, the more severe the concussion (44%);
• Wearing a properly fitted helmet will prevent concussions (42%); and
• Children or teenagers often take more time to recover than adults (41%).

Coaches and Teachers are more likely to be able to correctly identify if the statement is true or false compared to the general population on a number of myths and facts.  Complete details can be found in the following table.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.4 Sport-Related Concussion Knowledge

3.4.1 Prevention of Sport-Related Concussion

Many Canadians understand there are a variety of ways of preventing sport-related concussion including avoiding head contact (85%), providing concussion training to athletes (79%), ensuring athletes follow the rules and regulations of their sport (78%) and having respect for other players (62%).  Most however, also erroneously believe that wearing a helmet is an effective way of preventing sport-related concussion (92%).  Other misperceptions about how to prevent sport-related concussion include avoiding contact sports (56%) and wearing a mouth guard (44%).

Coaches and Teachers are more likely to understand that effective prevention includes ensuring athletes follow the rules (89% for both), respect for other players (79% and 75% respectively) and by providing concussion training to athletes (91% and 86% respectively).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.4.2 Reporting Sport-Related Concussions

Canadians believe a number of different individuals are responsible for reporting a suspected sport-related concussion in children to their parents.  Virtually all Canadians believe that the coach or adult supervisor of the sport is responsible (97%) followed by the sports official (73%), Health Care Professional (70%), referee (68%) and then the team mates (53%) and child (46%).

Parents put more reporting onus on the child (52% vs. 40-45% of teachers, coaches), team mates (51% vs. 39%) and referees (62% vs. 49-52%) than Teachers and Coaches.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.4.3 Actions for Suspected Concussion during Sports

Most Canadians understand that if a person is suspected of suffering a concussion while playing sports they should be sent to a health care professional for assessment (92%).  Many also understand the person should immediately be removed from play (87%) and obtain medical clearance before returning to sport (82%).  Fewer however, recognize that the person should not be allowed to return to the same game or practice (69%).  As well, very few Canadians erroneously believe that the person should be sent home to rest (20%) or take a break and return to play once feeling better (13%).

Coaches are more likely to understand that the person should be sent to a health care professional (97%) and immediately removed from play (91%) compared to the general population, Parents and Teachers.  They are also more likely to understand that the person should not return to the same game or practice (85%) and that they should receive medical clearance before returning to play (94%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.5 Concussion Treatment Knowledge

3.5.1 Concussion Treatment

One-quarter (25%) of Canadians do not know how concussion is treated and only 15 per cent could correctly identify “rest for 24-48 hours, followed by a gradual return to cognitive (thinking) and physical activity under the supervision of a medical professional” (15%).

One-third believe you should “rest and avoid physical and cognitive(thinking) activity for 10-14 days, followed by gradual return to cognitive and physical activity under the supervision of a medical professional while approximately one-in-seven believe you should “rest and avoid physical and cognitive(thinking) activity until all concussion symptoms are gone” (13%) or “rest and avoid physical and cognitive(thinking)  activity for 10-14 days, then return to regular cognitive and physical activity under the supervision of a medical practitioner” (14%).

Teachers and Coaches are more likely to correctly identify the best treatment.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.5.2 Introduction of Light Physical Activity

Nearly one-in-seven Canadians (13%) do not know when light physical activity should be introduced for a child or athlete diagnosed with a concussion.  Most Canadians however, understand that if a child or athlete is diagnosed with a concussion that light physical activity should not be introduced immediately (97%). 

Nearly one- quarter of Canadians believe there should be a rest period (24%) before introducing light physical activity (as long as it’s tolerated).  The expected rest period however, varies:  13 per cent believe it should 24-48 hours while 11 per cent believe it should be 10-14 days. Half (50%) of all Canadians believe light physical activity should only be introduced once a medical professional has provided clearance while the others (10%) believe all concussion symptoms should be gone before introducing light physical activity. 

Coaches are more likely to believe that light physical activity should only be introduced once a medical professional has provided clearance (57%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.5.3 Return to School or Work

As with light physical activity, some Canadians (10%) do not know when an athlete can return to school or work full-time after suffering a concussion.  Virtually all Canadians (99%) understand that a concussion impacts both schooling and work. 

Many (63%) Canadians believe a return to school or full-time work should only occur once a medical professional has provided clearance while the others (10%) believe all concussion symptoms should be gone before returning to school or work. 

Some Canadians believe there should be a rest period (16%) before returning to work – as long as it’s tolerated by the individual.  The expected rest period however, varies:  11 per cent believe it should 24-48 hours while 5 per cent believe it should be 10-14 days.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.5.4 Return to Play

Perspectives on return-to-play are quite different for Canadians compared to return-to-work or light physical activity.  Three-quarters (75%) believe athletes should not return to play until they have received clearance from a medical professional.  Some believe there should be a rest period (10%) of either 24-48 hours (2%) or 10-14 days (8%) while others believe all concussion symptoms must be gone (7%) before returning to play.  A small proportion (7%) simply doesn’t know while an even smaller proportion (1%) believes they can return immediately if there are no symptoms.

Coaches are more likely to believe medical clearance is required for returning to sport (83%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.6 Concussion Information

3.6.1 Looked for Concussion Information in the Past 12 months

Few Canadians (7%) have searched for information on concussion prevention diagnosis or recovery over the past 12 months.  Parents, Teachers and Coaches are all more likely to have searched for information (18%, 25% and 56% respectively).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.6.2 Location of Information

Among those who have searched for information on concussion prevention diagnosis or recovery over the past 12 months, most looked online at various websites:

• Search Engine (Google, Yahoo, etc.) (71%)
• Health Canada website (63%)
• Public Health Agency of Canada website (28%)
• Health professional website (26%)
• Mayo Clinic (24%)
• Government of Canada website (20%)
• WebMD (17%)
• Coaching Association of Canada (9%)
• Athletic association website (3%)
• Other government website (1%)
• Parachute website (1%)

Many also turn to a health care professional (45%) while others turn to friends and family (16%), sports coaches (15%), health magazines, journals or books (12%) or to social media (11%).
Not unexpectedly, Coaches are more likely to look for information from the Coaches Association of Canada (53%) or athletic association websites (36%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

Among those who have NOT searched for information on concussion prevention diagnosis or recovery over the past 12 months, they anticipate looking in similar places with various websites being prominent and federal websites in particular, followed by health care professionals:

• Search Engine (Google, Yahoo, etc.) (72%)
• Health Canada website (64%)
• Health care professional (64%)
• Public Health Agency of Canada website (51%)
• Health professional website (39%)
• WebMD (26%)
• Mayo Clinic (24%)
• Athletic association website (19%)
• Government of Canada website (16%)
• Coaching Association of Canada (13%)
• Sports coaches (13%)
• Friends and family (11%)
• Health magazines, journals or books (11%)
• Other government website (7%)
• Social media (2%)
• Parachute website (1%)

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.6.3 Awareness of Tools and Information Resources

Canadians’ awareness of concussion-related tools or resources are somewhat limited.  Four-in-ten (40%) were unaware of any of the cited tools and/or information resources on concussion available to the public and less than a quarter of Canadians were aware of any of the following resources:

• Canadian Guideline on Concussion in Sport (26%)
• Concussion Management and Return to Learn by Dr. Mike Evans (17%)
• Parachute’s Return to Learn protocol (15%)
• The Concussion Awareness Training Tool (CATT) by BC Injury Research and Prevention Unit (14%)
• Concussion Toolkit for Parents Players and Coaches (14%)
• Concussion Recognition Tool/Sport Concussion Recognition Tool for Parents, Coaches and Teachers (11%)
• E-learning course: Parachute Concussion Awareness for Players (8%)
• Parachute’s Return to Sport protocol (1%)

Awareness is somewhat better among resources that are targeted towards Parents, Teachers or Coaches.  Close to half (46%) of all Coaches were aware of the E-learning course: Making Headway by the Coaching Association of Canada (46%).  Among Teachers, one-in-five (20%) were aware of the E-learning course: Parachute Concussion Awareness for Elementary and High School Teachers (20%) and among Parents, 17 per cent were aware of the E-learning course: Parachute Concussion Awareness for Parents and nearly a quarter

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.7 Parents of Children 5-17

3.7.1 Processes and Procedures to Deal with Concussion

Twenty-five per cent of Parents reported that their child’s school has processes and procedures in place to deal with concussions while nearly half (47%) reported their child’s sports team did.  Not unexpectedly, many Parents were unaware if these processes or procedures existed.  In particular, more than half (55%) were unaware of such processes or procedures existing in their child’s school while more than one-third (39%) were unaware if they existed for their child’s sports team.

As mentioned previously, respondents may fall into more than one group.  In this case Parents may also be a Teacher or a Coach and as such we looked at these groups separately to determine if their dual roles make them different in any way.  Parents who were also Teachers or also Coaches were more likely to be aware of whether or not such processes or procedures are in place in their school (55% don’t know vs. 38-45%) and Parents who are Coaches are also more likely to be aware of whether or not such processes or procedures are in place with their child’s sports team (13% don’t know vs. 36-39%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.7.2 Received Concussion Information from Sports Team

Few Parents (21%) report receiving any concussion information from their child’s sports team.  Parents who are also Coaches are more likely to report receiving such information (34% vs. 21%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.8 Coaches

3.8.1 Type of Coach

A variety of Coaches participated in the survey.  The majority were volunteer competitive (33%) or recreational (28%) coaches.  Some were elementary or secondary school coaches (18%) while the remaining were professional coaches (9%), sports administrators (7%) or other types of coaches (2%).

3.8.2 Processes and Procedures to Deal with Concussion

Three-quarters (73%) of Coaches indicated that their team or league has processes or procedures in place to deal with concussions.  Coaches who are also Teachers are more likely to indicate such procedures exists (85%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.8.3 Formal Training or Education on Concussion

Most Coaches (62%) have received some training or education from their organization or league on concussion however, for many; the training is more than a year old.  More than one-third (36%) of Coaches have never received any formal education/training.  Another third (31%) have received training within the past year while 18 per cent receive training one-to-two years ago.  The remaining 13% received training more than three years ago.

3.8.4 Sharing of Documented Concussion Information

More than half (52%) of all Coaches indicated that their team or league does not share concussion information with parents, children or athletes.  In cases when this information is shared, the documentation primarily goes to parents (43%) or older athletes (43%) rather than children (27%).

Among Coaches that do share documented concussion information, most provide it at the beginning of every season (69%) while some provide it when asked (29%) or when someone suffers a concussion (22%).

3.8.5 Athlete with Concussion in the Last 4 Years

More than half of Coaches (53%) have had an athlete that they coached diagnosed with a concussion in the past four years.

3.9 Teachers

3.9.1 Processes and Procedures to Deal with Concussion

Only one- quarter of Teachers (23%) indicated their school does not have procedures or processes in place to deal with concussions. More than half (56%) of all Teachers indicated that their school does have processes and procedures in place while another 22 per cent don’t know.

Teachers in Quebec are more likely to indicate their school does not have processes or procedures in place compared to other regions in Canada (43% vs. 11-36%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B   

3.9.2 Formal Training or Education on Concussion

More than half (52%) of Teachers have not received any training or education from their school or board about concussion.  One-in-five have (20%) have received training within the past year while 14 per cent receive training one-to-two years ago.  The remaining 14% received training more than three years ago or don’t know if they have received training.

3.9.3 Student with Concussion in the Last 4 Years

Close to half of all Teachers (46%) have had a student diagnosed with a concussion in the past four years.

3.10 Health Care Providers

3.10.1 Health Care Providers (HCPs)

For this survey, respondents were recruited from two separate sources: 1) the Kantar Health Panel (LSR HCP) and 2) through contacts of Parachute. In total 391 HCPs completed the survey.  These included

• Family physician/GP (47%)
• Sports medicine physicians (3%)
• Emergency department physicians (2%)
• Neurosurgeons (1%)
• Physiotherapists (12%)
• Nurses (3%)
• Nurse Practitioners (1%)
• Athletic therapists (11%); and
• Other (10%)

Respondents from the Health Panel were more likely to be physicians compared to those sourced through Parachute (89% vs. 47%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.10.2 Attitudes towards Concussion

Virtually all HCPs (97%) believe concussion is an important health issue however; not all HCPs know where to go for reliable information on concussion diagnosis (85%) or on concussion treatment and recovery (82%).  Not unexpectedly, HCPs recruited through Parachute are more likely to know where to go for reliable information on diagnosis and/or treatment and recovery (97% and 93% respectively).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B.

3.10.3 Concussion Knowledge

Not unexpectedly, concussion knowledge is quite strong among HCPs.  Only ten per cent believe they have little (9%) or no knowledge (1%) about concussion.  The remaining considers themselves to have moderate (41%), a lot of knowledge (42%) or to be experts (7%) on concussion.  HCPs recruited through Parachute are more likely to rate their knowledge stronger compared to those recruited from the panel. 

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.10.4 Diagnosis

The large majority of HCPs (84%) have diagnosed a concussion.  Among those who have diagnosed concussion there is great variability.  On average, each HCP has diagnosed 41 concussions in the past three years.  There is however, much variation among HCPs (Standard deviation of 155 and median of 15). 

HCPs in urban settings are more likely to have diagnosed a concussion compared to their rural counterparts (86% vs. 72%) and not unexpectedly, given their higher incidence of being a physician, HCPs from the panel are also more likely to have diagnosed a concussion compared to HCPs from Parachute contacts (93% vs. 84%).

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

Patient symptoms are used to diagnose concussion by almost all (98%) HCPs followed by patient history (95%), a neurological exam (86%), observation (79%), cognitive testing (63%) or other (17%).  Interestingly, a small proportion of HCPs use imaging tests such as X-ray, CT scan or MRI (16%) to diagnose concussion even though concussion cannot typically be diagnosed this way.  HCPs without concussion protocols in place are more likely to use imaging tests for diagnosis (23% vs. 10%) compared to those without protocols in place.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

For diagnosing and assessing the severity of a concussion, HCPs are most likely to use:

• The Sport Concussion Assessment Tool 5 (SCAT5) (51%)
• The Child Sport Concussion Assessment Tool 5 (Child SCAT5) (34%); or
• The Canadian Guideline on Concussion in Sport (31%). 

Few however, use the Concussion Recognition Tool 5 (CRT5) (9%) or the Canadian Harmonized Guidelines on Concussions (4%).
Interestingly 16 per cent use another tool such as baseline testing, visual, vertigo or balance testing, Vestibular Ocular Motor screening assessment, etc., while another 16 per cent do not use any tools.  Those without protocols in place are more likely (36% vs. 5%) to not use any tool for diagnosing or assessing the severity of a concussion compared to HCPs with protocols in place.

Note: Capital or lowercase letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.10.5 Concussion Classification

More than half of HCPs (57%) do not know which International Classification of Diseases and related Health Conditions they use (ICD9 or ICD10).  Close to a quarter (24%) use ICD9 while 21 per cent use ICD10.  HCPs out west (Prairies and BC) are more likely to use ICD9 (33-37% vs. 13-19%) and those with protocols in place are more likely to use ICD10 (29% vs. 9%).

Note: Capital or lowercase letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.10.6 Awareness of Tools and Resources

Health care providers have varied awareness of concussion tools or resources.  HCPs are most aware of the following tools or resources:

• Sport Concussion Assessment Tool 5 (SCAT5) (60%)
• Canadian Guideline on Concussion in Sport (57%)
• Child Sport Concussion Assessment Tool 5 (Child SCAT5) (49%)
• Concussion Baseline Testing (44%)

And, have limited awareness among the following tools or resources:

• Parachute’s Return to Sport protocol (29%)
• Statement on Concussion Baseline Testing in Canada (27%)
• Canadian Concussion Collaborative – 5 Key Messages from the 5th International

Consensus Statement on Concussion in Sport (27%)

• Parachute’s Return to Learn protocol (26%)
• Concussion Management and Return to Learn by Dr. Mike Evans (23%)
• Concussion Recognition Tool 5 (CRT5) (22%)
• The Concussion Awareness Training Tool by BC Injury Research and Prevention Unit (21%)
• Canadian Medical Association Head Injury Sport Policy (19%)
• Canadian Paediatric Society: Sport Related Concussion: Evaluation and Management Identification and Management of Children with Sport-Related Concussion (18%)
• Ontario Neurotrauma Foundation Guidelines for Concussion/mild Traumatic Brain Injury &

Persistent Symptoms (14%)

• Ontario Neurotrauma Guidelines for Diagnosing and Managing Pediatric Concussion (12%)
• Canadian Harmonized Guidelines on Concussions (11%)
• Ontario Neurotrauma Foundation Standards for Post-Concussion Care (10%)
• Sport Medical Clearance Letter (9%)
• Sport Medical Assessment Letter (7%)
• Collaboration Canadienne sur les Commotions Cérébrales  - Les 5 principaux messages du 5ème consensus international sur les commotions cérébrales (CC) dans le sport (FRENCH ONLY) (3%)

Interestingly, fifteen per cent of HCPs have no awareness of any of the above mentioned tools or resources.  HCPs with protocols in place are more likely to be aware of all but one of the resources compared to those who do not have concussion protocols in place.

Note: Capital letters denote statistically significant difference.  For example, if there is a B then the result is significantly higher than the corresponding result in column B

3.10.7 Canadian Guideline on Concussion in Sport

HCPs that have used the Guideline on Concussion in Sport have very positive perceptions of it.  Among the 26 per cent of HCPs who have used the Canadian Guideline on Concussion in Sport, the large majority believes (strongly agree or agree) the guideline:

• Is a useful tool for health care providers (94%);
• Will improve concussion management in Canada (87%);
• Has made it easier to diagnose concussions (86%);
• Will improve concussion diagnosis in Canada (85%); and
• Has made it easier to manage concussions (82%).

3.10.8 Sport Medical Assessment Letter and Medical Clearance Letter

Among HCPs that were aware of the Sports Medical Assessment Letter or Medical Clearance Letters (10%), fifty-nine percent completed at least one in the past three years. One third (33%) completed a sports medical assessment letter in the past three years while close to half (46%) completed the medical clearance letter in the past three years.
Most HCPs (85%) found the Medical Assessment Letter useful (4 or 5 on 5 point scale) while fewer (56%) found the Medical Clearance Letter useful (4 or 5 on 5 point scale).

3.10.9 Knowledge Gaps and Barriers

A number of knowledge gaps or barriers were identified that prevent HCPs from addressing concussion prevention. These included a lack of knowledge or training in diagnosis of concussion (17%), lack of awareness or compliance from the coach, athlete or parent (12%), a lack of understanding regarding the guideline or changing guideline, a lack of education, training or knowledge among the HCPs (8%) and a lack of experience (6%).

4. Methodology

4.1 Methodological Overview

Survey Administration

The online survey was conducted using computer assisted web interviewing (CAWI) technology.  CAWI ensured the interview flowed as it should with pre-programmed skip patterns.  It also controlled responses to ensure appropriate ranges and data validity.  Surveys were conducted in English or French as chosen by the respondent.  All participants were informed of the general purpose of the research, they were informed of the sponsor and the supplier and that all of their responses would be confidential.  As well, the survey was registered with the MRIA Survey Registration System.

The online survey was conducted from November 20 to December 19, 2017.  In total 2286 surveys were completed.  The average survey length was 15 minutes with the shortest being 8 minutes and the longest being 59 minutes (outliers removed).

Pre-test

A pre-test was undertaken on November 16 obtaining 10 English and 10 French completions, including probing questions.  The results were reviewed to ensure the survey was working as expected and that the questions were being interpreted as expected.  Based on the results of the pre-test, no changes were required for the survey and as such the results of the 20 completes were included in the final data set.

Sample Design and Selection

A regionally disproportionate sample of Canadians was drawn from the Kantar TNS proprietary panel to achieve 1,000 completed surveys among the general population. The sample was stratified to ensure regional quotas were met. Upon completion of the general population portion of the survey an oversample of Parents of children 5-17 years of age and teachers was undertaken to obtain additional completes (n=200 teachers and n=600 Parents).  Given the low incidence of Coaches in the general population, natural fall out was obtained for a total of 48 completions.  To supplement the anticipated low incidence of Coaches, the survey was also sent out to members of the Canadian Coaches Association.  As well, to increase the sample among HCPs the survey was also sent out to select partners of Parachute – further details can be found below.

Canadian Coaches Association Sample

The Canadian Coaches Association of Canada invited its members who coach children and youth to participate in the survey.  A census style approach to sample was taken and as such 154,373 invitations were sent to Coaches who were then screened to see if they work with children and youth ages 5-17.  Only those who work with children aged 5-17 were interviewed.

Health Care Providers

The sample for Health Care providers was obtained from two sources.  The first was from Kantar TNS’s proprietary Health Care Panel.  A sample was drawn to be regionally proportionate and obtain 200 completions.  Supplemental sample was obtained through Parachute.  Parachute worked with its partners to deliver the survey to members of the following organizations:

• Canadian Athletic Therapists Association (CATA)
• College of Family Physicians of Canada (CFPC)
• Canadian Physiotherapy Association (CPA)
• Canadian Academy of Sport and Exercise Medicine (CASEM)
• Canadian Association of Occupational Therapists (CAOT)

The following outlines the quotas that were set at the beginning of the research.  To allow for a larger sample, the quotas were relaxed for Parachute members and Canadian Coaches Association Members to allow an unlimited number of completes from these sources.

Margin of Errors

As mentioned previously, panel sample and membership sample was used for this study and as such margin of error does not apply.

Weighting

Independent weighting adjustments were made to key groups within the survey where national data were available.  In particular, national data for the General Population, Teachers and Parents of children 5-17 years of age were available and as such weighting was applied. For each group where national data was available, the group was weighted.  Remaining groups were left unweighted due to a lack of national data on Coaches and HCPs.

General Population

The general population completions were weighted to ensure that the data were representative of the 18+ population of Canada based on the 2016 Census.  More specifically, the data were weighted by age within gender and within region to match the Canadian population using 2016 Census Data.   The following is the breakdown of actual and weighted completions.

Teachers

Teacher completions were weighted to ensure that the data were regionally representative of the Teacher population in Canada based on the 2016 Census.  The following is the breakdown of actual and weighted completions.

Parents

The Parent completions were weighted to ensure that the data were representative of the 18+ population of Canadians with children aged 5-17 years of age based on the 2016 Census.  More specifically, the data were weighted by age within gender and within region to match the Canadian population of Parents of children aged 5-17 years of age.  The following is the breakdown of actual and weighted completions.

Online Completion Rate

A total of 33,900 invitations were sent to panelists, of which n=1,800 completed the survey.  The overall completion rate achieved for the online study was 5.3%. The following table outlines the sample disposition and response rate as per the MRIA guidelines.

Non-response Bias

To address the issue of response bias, where data were available it was weighted to be representative of the Canadian population.

Tabulated Data

Detailed tables are included under separate cover.

5. Appendix B: Survey Instrument

5.1 English Survey

NOTES: 

• Quotas for parents and teachers are minimums – we can accept more as part of the general population

In which language would you like to be interviewed?

English / French

Introduction

Thank you for agreeing to take part in our survey.   Kantar TNS is currently conducting a survey on behalf of the Public Health Agency of Canada on the knowledge, attitudes and behaviours of Canadians and Health Care Providers around health conditions.  The information collected will be used to develop policy as well as measure progress related to such policy. Your decision on whether or not to participate will not affect any dealings you may have with the Government of Canada.

This survey is registered with the Marketing Research and Intelligence Association (MRIA) (Insert number here) and can be verified here: www.surveyverification.ca .  The survey will take about 15 minutes to complete.

What about your personal information?

• The personal information you provide to the Public Health Agency of Canada is governed in accordance with the Privacy Act and is being collected under the authority of section 4 of the Department of Health Act in accordance with the Treasury Board Directive on Privacy Practices. We only collect the information we need to conduct the research project.
• Purpose of collection: We require your personal information such as demographic information to better understand differences between particular groups.  Only the information required for the purposes of the research are being collected.  Your responses are always combined with the responses of others for analysis and reporting; you will never be identified.  
• For more information: This personal information collection is described in the standard personal information bank Public Communications – PSU 914, in Info Source, available online at infosource.gc.ca.
• Your rights under the Privacy Act: In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or privacy-vie.privee@hc-sc.gc.ca. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly.

What happens after the online survey?

The final report written by Kantar TNS will be available to the public from Library and Archives Canada (http://www.bac-lac.gc.ca/).  

If you have any questions about the survey, you may contact Kantar TNS at carole.adam@tnsglobal.com

Your assistance is greatly appreciated, and we look forward to receiving your feedback.

Programming instruction:  for HCPS: Replace Canadians with Health Care Providers

Screener

Note: Demographics are asked at the beginning to manage quota targets

Programming instruction: Do not ask to HCP

1. In what year were you born?

Prefer not to answer

2. Hidden variable:  Age

Please calculate the age of each individual using the year they were born

3. What is your gender?
   • Male
   • Female
   • Prefer to specify:

4. What are the first three digits of your postal code?

5. Hidden variable:  Province/territory

Please use the first letter of the postal code to code the province or territory

• Newfoundland and Labrador:  A
• Nova Scotia: B
• Prince Edward Island: C
• New Brunswick: E
• Eastern Quebec: G
• Metropolitan Montréal: H
• Western Quebec: J
• Eastern Ontario: K
• Central Ontario: L
• Metropolitan Toronto: M
• Southwestern Ontario: N
• Northern Ontario: P
• Manitoba: R
• Saskatchewan: S
• Alberta: T
• British Columbia: V
• Northwest Territories and Nunavut: X
• Yukon: Y

6. Hidden variable:  Rural/urban

Please use the second digit of the postal code to code rural/urban.  If the second digit is “0” code rural.  All others are coded urban.

7. Are you a:

Select all that apply.

• Teacher or staff member who works with students at an elementary or secondary school
• Athletic coach or sports administrator in the past three years, including in a  volunteer capacity
• Health care provider in one of the following professions: physician, nurse, physiotherapist, athletic therapist, chiropractor
• Parent of a child 5-17 years of age
• None of the above

Programming instruction: Do not ask to HCP

8. Which of the following health conditions, if any, have you heard of? Select all that apply.

Randomize

• Autism or Autism Spectrum Disorder
• Asthma
• Concussion
• Depression
• E-coli infection
• Cardiovascular disease
• Measles
• Osteoporosis 
• Type 2 diabetes
• Tuberculosis
• None of the above

Programming instruction: Skip to demos if concussion is not selected

End screener

Coach demos: Ask only if yes to athletic coach or sports administrator (q7)

9. Which of the following best describes your role as an athletic coach or sports administrator

• Sports administrator
• Professional athletic coach
• Athletic coach at an elementary or secondary school
• Volunteer competitive athletic coach
• Volunteer recreational athletic coach
• Other, please specify:

10. Which sport(s) do you coach?  Select all that apply.

• Alpine skiing
• Athletics
• Baseball
• Basketball
• Soccer
• Curling
• Lacrosse
• Canoeing/Kayaking
• Cross-country skiing
• Cycling
• Diving
• Equestrian
• Field hockey
• Football
• Freestyle skiing
• Gymnastics
• Hockey
• Judo
• Orienteering
• 5 Pin bowling
• Racquetball
• Rowing
• Rugby
• Figure skating
• Ski jumping
• Softball
• Synchronized swimming
• Table tennis
• Taekwondo
• Volleyball
• Wrestling
• Snowboarding
• Other

End coach demos

Parent demos : Ask parents only

11. How many children between the ages of 5 and 17 do you have?

12. What is the gender of your child(ren)?

• Male
• Female
• Both
• Prefer not say

13. What grade(s) are your child(ren) currently in? Select all that apply.

• Kindergarten
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10
• 11
• 12
• Prefer not to say

14. In which of the following organized sports, if any, do your child(ren) participate?

• Alpine skiing
• Athletics
• Baseball
• Basketball
• Soccer
• Curling
• Lacrosse
• Canoeing/Kayaking
• Cross-country skiing
• Cycling
• Diving
• Equestrian
• Field hockey
• Football
• Freestyle skiing
• Gymnastics
• Hockey
• Judo
• Orienteering
• 5 Pin bowling
• Racquetball
• Rowing
• Rugby
• Figure skating
• Ski jumping
• Softball
• Synchronized swimming
• Table tennis
• Taekwondo
• Volleyball
• Wrestling
• Snowboarding
• Other
• None of the above

End parent demos

HCP demos – only ask to HCPs

15.  What type of health care provider are you?

• Family physician/GP
• Pediatrician
• Sports medicine physician
• Internal medicine physician
• Emergency department physician
• Physiatrists
• Neurologist
• Neurosurgeon
• Occupational therapist
• Physiotherapist
• Nurse
• Nurse Practitioner
• Athletic therapist
• Emergency medical professionals
• Other: specify

End HCP demos

Main survey

Ask all

Now, we would like to ask you some questions about sport-related concussions, that is, a concussion received while playing sports.

Attitudes towards concussions

16. Please indicate the extent to which you agree or disagree with the following statements.

Scale:
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

Concussion is an important health issue
I can recognize the signs and symptoms of a sport-related concussion
I know where to go for reliable information on concussion prevention
I know what to do if someone I know gets a concussion

HCP Answer list

Concussion is an important health issue
I know where to go for reliable information on concussion diagnosis
I know where to go for reliable information regarding concussion treatment and recovery

Condition Knowledge

17. Using the scale below, how would you rate your current level of knowledge about concussions?

1 – I am an expert on concussions
2 - I know a lot about concussion
3 – I know a moderate amount about concussions
4 - I know a little about concussion
5 – I don’t know anything about concussions

Start non-HCP block – this block of questions is for all respondents who are not HCPs

18. Which of the following do you believe describes what a concussion is? Select all that apply.

Randomize

• A blow to the head that causes a variety of symptoms such as headache or blurred vision
• A brain injury that affects the way a person walks and talks
• A spinal cord injury that affects the way a person thinks
• A brain injury that affects the way a person thinks
• A bruise on the brain
• A brain injury that can’t be seen on x-rays, CT or MRI scans
• Don’t know

19. Which of the following, if any, do you think might cause a concussion? Select all that apply.

Randomize

• A hit or blow to the head
• A hit or blow to the face
• A hit or blow to the neck
• A hit or blow to any part of the body that would cause the head to experience a sudden shock, jar or jolt (e.g., a car accident, body check in a sports game)
• None of the above
• Don’t know

20. From the following list, which do you think are signs that a person might have a sport-related concussion? Select all that apply.

Randomize

• Slow to get up
• Lying motionless on the ground
• Blank or vacant stare
• Difficulties with balance, walking or motor coordination
• Disorientation, confusion or inability to respond appropriately to questions
• Facial injury
• Holding their head
• Nausea or vomiting
• Difficulty breathing
• Difficulty eating
• Limping
• Don’t know

21. Which of the following are symptoms or things that a person with a concussion might experience? Select all that apply.

Randomize

• Headaches or feeling of pressure in the head
• Easily upset or angered
• Dizziness
• Sadness
• Nausea and vomiting
• Nervousness or anxiety
• Blurred or fuzzy vision
• Feeling more emotional
• Sensitivity to light or sound
• Sleeping more or sleeping less
• Balance problems
• Having a hard time falling asleep
• Feeling tired or having no energy
• Difficulty working on a computer
• Not thinking clearly
• Difficulty reading
• Feeling slowed down  or like in a “fog”
• Difficulty learning new information
• Difficulty remembering
• Not feeling “right”
• Difficulty breathing
• Increased heart rate
• Excessive sweating
• Tremors or shaking
• None of the above
• I don’t know the symptoms of a concussion

22. Which of the following do you think are effective ways of preventing sport-related concussions? Select all that apply.

Randomize

• Ensure athletes follow the rules and regulations of their specific sport
• Respect other players
• Avoid head contact
• Avoid contact sports
• Provide concussion training to athletes
• Wearing a helmet
• Wearing a mouth guard
• None of the above
• Don’t know

23. Who do you think is responsible for reporting a suspected sport-related concussion in children to their parents? Select all that apply

• Coach or adult supervisor of the sport
• Child
• Team mates
• Health Care Professional
• Referees
• Sports official
• None of the above <exclusive>

24. What should you do if you suspect someone has suffered a concussion? Select all that apply

• Check for visual signs of concussion (e.g., lying motionless, slow to get up after a fall, blank or vacant look, etc.)
• Check vital signs (e.g., fever, heart rate, pulse, breathing rate)
• Check for red flags such as, neck pain, loss of consciousness, repeated vomiting, agitation or combative behaviour
• Check for symptoms of concussion (e.g.,  dizziness,  headache, sensitivity to light or noise, drowsiness, etc.)
• Check their memory by asking questions such as:  “Where are we?”, “Did your team win their last game?”
• Monitor their sleep (e.g., wake individual every 2-3 hours )
• Have a medical professional assess them
• Don’t know

25. Which of the following should occur if a person is suspected of getting a concussion while playing sports? Select all that apply.

Randomize

• Immediately remove them from play
• Do not allow them to return to the same game or practice
• Send the person to a health care professional to be assessed for concussion
• Obtain medical clearance from a health care professional (medical doctor or nurse practitioner) before returning to sports activities
• Send them home to rest
• Take a break until they are feeling better and then let them return to play
• Don’t know

26. How is a concussion treated? Select the best answer.

• Rest and avoid physical and cognitive(thinking) activity until all concussion symptoms are gone
• Rest for 24-48 hours, followed by a gradual return to cognitive(thinking) and physical activity under the supervision of a medical professional
• Rest and avoid physical and cognitive(thinking) activity for 10-14 days, followed by gradual return to cognitive and physical activity under the supervision of a medical professional
• Rest and avoid physical and cognitive(thinking)  activity for 10-14 days, then return to regular cognitive and physical activity under the supervision of a medical practitioner
• Don’t know

27. If a child or athlete is diagnosed with a concussion, when should light physical activity be introduced (ex. 10 – 15 minutes of walking or stationary bike)? Select the best answer.

• Immediately, if they have no symptoms - as long as it is tolerated by the individual
• Immediately – a sport-related concussion does not impact light physical activity
• After 24-48 hours of rest – as long as it is tolerated by the individual
• After 10-14 days of rest - as long as it is tolerated by the individual
• When all concussion symptoms are gone
• When a medical professional has provided medical clearance
• Don’t know

28. If an athlete suffers a concussion, when can they return to school or work full-time? Select the best answer.

• Immediately – a sport-related concussion does not impact their schooling or work
• After 24-48 hours of rest -as long as it is tolerated by the individual
• After 10-14 days of rest - as long as it is tolerated by the individual
• When all concussion symptoms are gone
• When medical clearance has been obtained from a health professional
• Don’t know

29. If an athlete suffers a concussion, when can they return to playing sports?

• Immediately, if they have no symptoms
• After 24-48 hours of rest -as long as it is tolerated by the individual
• After 10-14 days of rest - as long as it is tolerated by the individual
• When all concussion  symptoms are gone
• When a medical professional has provided medical clearance
• Don’t know

30. Please indicate if you think the following statements are True or False:

Randomize

• A person with a concussion shouldn’t sleep right after it happens (F)
• Wearing a properly fitted helmet will prevent concussions (F)
• A person has to black out (lose consciousness) to have a concussion (F)
• Vomiting is a sure sign of concussion (F)
• Boys get more concussions than girls (F)
• The symptoms of concussions can vary from person to person (T)
• A concussion can only be diagnosed using an MRI or CT scan (F)
• Concussions only result from a direct blow to the head (F)
• Children are more likely to suffer concussion than adults (T)
• The harder the blow, the more severe the concussion (F)
• Symptoms of a concussion can last for several weeks (T)
• It is safe for someone to return to sports activities following a concussion as soon as their symptoms wear off (F)
• Children and teenagers often take more time to recover from a concussion than adults (T)

31. In the past 12 months, have you searched for information regarding concussion prevention, diagnosis, or recovery?

• Yes
• No
• Don’t know

Programming instruction: Ask q32 only if q31 = no

32. If you wanted information regarding concussion prevention, diagnosis or recovery, where would you look or who would you turn to?  Select all that apply.

• Search Engine (Google, Yahoo, etc.)
• Public Health Agency of Canada website
• Health Canada website
• Government of Canada website
• Other government website
• Parachute website
• Coaching Association of Canada
• Health professional website
• Athletic association website
• WebMD
• MayoClinic
• Social media (Facebook, Twitter, Instagram)
• Health magazine, journal, book
• Health care professional (Doctor, Nurse, Pharmacist)
• Family or friends
• Sport coach
• Other (please specify)__________

Programming instruction: Only ask if yes to searched for information in q31

33. Where did you look or who did you turn to for information regarding concussion prevention, diagnosis, or recovery? Select all that apply

• Search Engine (Google, Yahoo, etc.)
• Public Health Agency of Canada website
• Health Canada website
• Government of Canada website
• Other government website
• Parachute website
• Coaching Association of Canada
• Health professional website
• Athletic association website
• WebMD
• MayoClinic
• Social media (Facebook, Twitter, Instagram)
• Health magazine, journal, book
• Health care professional (Doctor, Nurse, Pharmacist)
• Family or friends
• Sport coach
• Other (please specify)__________

34. Which of the following concussion related tools or resources have you heard of? Select all that apply

• A Parent’s Guide to Dealing with Concussion by Parachute Canada (PARENTS ONLY)
• E-learning course: Parachute Concussion Awareness for Players
• E-learning course: Parachute Concussion Awareness for Parents (PARENTS ONLY)
• E-learning course: Parachute Concussion Awareness for Elementary and High School Teachers (TEACHERS ONLY)
• E-learning course: Making Headway by the Coaching Association of Canada (COACHES ONLY)
• The Concussion Awareness Training Tool (CATT) by BC Injury Research and Prevention Unit
• Concussion Management and Return to Learn by Dr. Mike Evans
• Parachute’s Return to Learn protocol
• Parachute’s Return to Sport protocol
• Concussion Toolkit for Parents Players and Coaches
• Canadian Guideline on Concussion in Sport
• Concussion Recognition Tool/Sport Concussion Recognition Tool for Parents, Coaches and Teachers
• None of the above

Parent specific questions

The next few questions are for parents.

35. To the best of your knowledge, are there currently any processes or procedures to deal with concussions…?

• a) At your child’s school
• b) On your child’s sports team(s) (display only if child plays sports at q14)

Scale

• Yes
• No
• Don’t know

Programing instruction:  Only ask q36 if child plays sports (q14 any)

36. Have you received any concussion information, such as an information sheet or letter, from your child’s sports team(s) or league(s) within the past year?

• Yes
• No
• Don’t know

 Coach/sports administrators specific questions

Now we would like to ask you a few questions related to your role as a sports coach or administrator.

37. Does your team or league have any processes or procedures in place to deal with a sport-related concussion?

• Yes
• No
• I don’t know

38. When was the last time you received formal education/training about concussions from your organization or league?

• Within the past year
• 1-2 years ago
• 3-5 years ago
• More than 5 years ago
• I have never received formal education/training about concussion from my organization or league
• Don’t know

39. Does your team or league share documented concussion information such as an information sheet or letter with:

• Parents
• Children
• Athletes

Scale

• Yes
• No
• Don’t know

Ask q40 only if q39 = yes

40. How often do you give out information sheets or letters on concussions?

• At the beginning of every season
• When someone on the team suffers a concussion
• When someone asks for concussion related information
• Other (specify): ___________

41. In the past 4 years have any of the athletes that you coached ever been diagnosed by a health care provider with a concussion?

• Yes
• No
• Don’t know

42. Please rate the extent to which you agree or disagree with the following statements

• Sports have a lower risk of injury today than they did 5 years ago
• Canadian sport for children and youth is free from violence during play
• Canadian sport for children and youth is free from violence outside of play
• Canadian sport is for children and youth free from harassment/abuse during play
• Canadian sport for children and youth is free from harassment/abuse outside of play

Scale:

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree

Programing instruction : Only ask q43 if disagree/strongly disagree with violence or harassment at q42

43. You indicated that you don’t think Canadian sport for children and youth is free from (Insert violence, harassment/abuse based on answers from q42).  Which of the following reasons best describe why you feel Canadian sport for children and youth is not free from (Insert violence, harassment/abuse based on answers from q42).

• Lack of education & awareness
• Lack of regulation
• Lack of resources (e.g. funding, human resources)
• Societal influence
• Media influence
• Lack of accountability by the athlete
• Infrastructure issues
• Wrong attitude or focus (e.g. winning at all cost attitude)
  Other

Teacher specific questions

Now we would like to ask you a few questions related to your role as an elementary or secondary teacher.

44. Are there any processes or procedures at your school to deal with concussions?

• Yes
• No
• I don’t know

45. When was the last time you received formal education/training about concussions from your school or board?

• Within the past year
• 1-2 years ago
• 3-5 years ago
• More than 5 years ago
• I have never received formal education/training about concussion from school or board
• Don’t know

46. In the past 4 years have any of your students ever been diagnosed by a health care provider with a concussion?

• Yes
• No
• Don’t know

HCP specific questions

47. Have you ever diagnosed a concussion?

• Yes
• No
• Don’t know

Programming instruction:  If yes to diagnosed a concussion (q47) ask q48

48. Thinking about your internal reporting procedures related to concussions, which International Classification of Diseases and related Health Condition (ICD – 9 or 10) do you use to identify concussion?

• ICD 9
• ICD 10
• Don’t know

Programming instruction:  If yes to diagnosed a concussion (q47) ask q49

49. Approximately how many concussions have you diagnosed in the past 3 years?

• Open
• Don’t know

50. Do you currently have processes or protocols in place to deal with concussions in your practice?

• Yes
• No
• I don’t know

Programming instruction:  If yes to diagnosed a concussion (q47) ask q51

52. How do you currently diagnose a concussion? Select all that apply.

• Neurological exam
• Cognitive testing
• Imaging tests such as X-ray, CT scan or MRI
• Observation
• Patient symptoms
• Patient history
• Other: Please specify

52. Which of the following concussion related tools or resources are you aware of? Select all that apply

• The Concussion Awareness Training Tool by BC Injury Research and Prevention Unit
• Concussion Management and Return to Learn by Dr. Mike Evans
• Parachute’s Return to Learn protocol
• Parachute’s Return to Sport protocol
• Concussion Baseline Testing
• Statement on Concussion Baseline Testing in Canada
• Canadian Guidelines on Concussion in Sport
• Sport Medical Assessment Letter
• Sport Medical Clearance Letter
• Ontario Neurotrauma Foundation Guidelines for Concussion/mild Traumatic Brain Injury & Persistent Symptoms
• Ontario Neurotrauma Guidelines for Diagnosing and Managing Pediatric Concussion
• Canadian Medical Association Head Injury Sport Policy
• Collaboration Canadienne sur les Commotions Cérébrales  - Les 5 principaux messages du 5ème consensus international sur les commotions cérébrales (CC) dans le sport (FRENCH ONLY)
• Ontario Neurotrauma Foundation Standards for Post-Concussion Care
• Canadian Concussion Collaborative – 5 Key Messages from the 5th International Consensus Statement on Concussion in Sport
• Concussion Recognition Tool 5 (CRT5)
• Sport Concussion Assessment Tool 5 (SCAT5)
• Child Sport Concussion Assessment Tool 5 (Child SCAT5)
• Canadian Harmonized Guidelines on Concussions
• Canadian Paediatric Society: Sport Related Concussion: Evaluation and Management Identification and Management of Children with Sport-Related Concussion
• None of the above

Programming instruction:  If yes to diagnosed a concussion (q47) ask q53

53. Which of the following do you currently use to diagnose and assess the severity of a concussion?

Programming instruction: Only show in list if aware of at previous question (q52)

• Concussion Recognition Tool 5 (CRT5)
• Sport Concussion Assessment Tool 5 (SCAT5)
• Child Sport Concussion Assessment Tool 5 (Child SCAT5)
• Canadian Harmonized Guidelines on Concussions
• Canadian Guidelines  on Concussion in Sport
• Other: specify

Only ask if used Canadian guidelines on concussion in sport

54. You indicated that you have used the new Canadian Guideline on Concussion in Sport.  Please indicated the extent to which you agree or disagree with the following statements about the guideline:

Scale:

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree

• The guideline is a useful tool for health care providers
• The guideline has made it easier to diagnose concussions
• The guideline has made it easier to manage concussions
• The guideline will improve concussion diagnosis in Canada
• The guideline will improve concussion management in Canada

Only ask if aware of sport medical assessment letter or medical clearance letter at q52

Programming instruction:  Insert sport medical assessment letter and/or clearance letter based on awareness at q52

55. You indicated that you are aware of the [Sport Medical Assessment Letter and/or Medical Clearance Letter].  Which of the following, if any, have you completed in the past three years: Select all that apply

• Sport Medical Assessment Letter
• Medical Clearance Letter
• Neither

Programming instruction: Only ask q56 if they have completed a letter (q55). Answer list based on those who have completed letter

56. How would you rate the usefulness of the letter(s) for managing concussions?

• Sport Medical Assessment Letter
• Medical Clearance Letter

Scale:

• 5 - Very useful
• 4
• 3
• 2
• 1 – Not at all useful

57. Are there any knowledge gaps or barriers that prevent you from addressing concussion prevention?

Open text

Demographic information (non HCP)

Now, we just have a few questions to help us classify your answers.  Your responses to these and all other questions will be kept completely confidential.

58. In the past 4 years have you, your child or anyone else in your immediate family ever been diagnosed by a health care provider with a concussion?

• Yes
• No
• Don’t know

59. What is the highest level of formal education that you have completed?

• Grade 8 or less
• Some high school
• High school diploma or equivalent
• Registered Apprenticeship or other trades certificate or diploma
• College, CEGEP or other non-university certificate or diploma
• University certificate or diploma below bachelor's level
• Bachelor's degree
• Post graduate degree above bachelor's level
• Prefer not to answer

60. Which of the following categories best describes your current employment status? Are you…

• Working full-time, that is, 35 or more hours per week
• Working part-time, that is, less than 35 hours per week
• Self-employed
• Unemployed, but looking for work
• A student attending school full-time
• Retired
• Not in the workforce [Full-time homemaker, unemployed, not looking for work]
• Other
• Prefer not to answer

61. Which of the following categories best describes your total household income? That is, the total income of all persons in your household combined, before taxes?

• Under $20,000
• $20,000 to just under $40,000
• $40,000 to just under $60,000
• $60,000 to just under $80,000
• $80,000 to just under $100,000
• $100,000 to just under $150,000
• $150,000 and above
• Prefer not to answer

62. What language do you speak most often at home? [Accept all that apply]

• English
• French
• Other
• Prefer not to answer

63. Do you consider yourself to be Indigenous, that is, First Nations (North American Indian), Métis or Inuk (Inuit)?

• Yes
• No
• Don’t know
• Prefer not to answer

64. We all live in this country, but many of us also identify with specific ethnic or cultural groups. To which, if any of the following ethnic or cultural group(s) do you MOST strongly associate with? Please only select one.

• American
• Canadian
• Caribbean or West Indian (e.g., Haitian, Cuban, Dominican)
• Central Asian / Middle Eastern (e.g., Palestinian, Israeli, Iraqi, Iranian)
• East Asian (e.g., Chinese, Japanese, Korean)
• European (e.g., German, Italian, Ukrainian, Dutch, Polish, Portuguese, Spanish, Russian, Scandinavian, Greek, French)
• French Canadian (e.g., Quebecois, Franco-Ontarian, Acadian)
• North African (e.g., Moroccan, Algerian, Libyan, Egyptian)
• South Asian (e.g., East Indian, Sri Lankan, Pakistani)
• Hispanic / Latin American (e.g., Mexican, Colombian, Brazilian, Argentinian, etc.)
• Southeast Asian (e.g., Vietnamese, Cambodian, Thai)
• Sub-Saharan African (e.g., Somali, Sudanese, Ethiopian)
• United Kingdom (e.g., English, Scottish, Welsh) or Irish
• Other
• Don’t know
• Prefer not to say

Thank you for taking the time to complete the survey.  Should you wish to learn more about concussions, please visit the following websites.

http://www.parachutecanada.org/
https://www.coach.ca/