Caregiver’s implicit views of symptom severity

By Dr Emma Sartin (@GoodmanSartin), October 19th, 2020 

Concussions obtained during childhood and adolescence have long-term, negative consequences because their brains are still developing. In recent years, there has been a multitude of concussion awareness, education, and prevention campaigns; however, a “culture of resistance” persists. Specifically, studies have found that a large number of concussed children are not medically evaluated, and of those that are, many do not follow concussion management plans (i.e., doctor recommendations following a concussion). 

With Dr. Jessica Mirman’s guidance, my co-authors and I investigated how caregivers unconsciously rank the severity of different concussion symptoms (e.g., blurry vision) based on whether or not they would seek medical care for their child if they were exhibiting that symptom after hitting their head. We categorized these unconscious or implicit beliefs using a data-driven technique, called community detection analysis. We also examined how these implicit beliefs vary across different child and caregiver risk factors, like age, sex, and previous concussion injuries.  

Seventy-five caregivers of children between the ages of 10-15 years old completed a phone survey. In the survey, we asked them to tell us the likelihood that they would bring their child to a doctor, nurse, or athletic trainer if their child had specific symptoms after hitting their head in different scenarios (while playing sports, during a physical fight, and because of a fall). 

We found symptoms that we describe as “non-specific” to concussions, or those that can be attributed to other causes (like headaches), are less likely to prompt caregivers to seek medical care for their child than other symptoms that are more commonly associated with concussions, like blurry vision or loss of consciousness. We also found that regardless of injury scenarios, caregivers based their decisions to seek medical care based on symptom type and their child’s injury history.  

We hope that our findings will inform the development of more effective education, awareness, and intervention efforts to combat the “culture of resistance” around seeking treatment for concussion symptoms. The majority of these efforts are designed without fully understanding the complex way that caregivers view and rank the severity of concussion symptoms. This emic (layperson, insider) vs. etic (expert, outsider) disconnect may create situations where professionals and caregivers are talking past one another. Therefore, if we can improve the alignment of these emic and etic perspectives, we may be able to more effectively communicate the seriousness of any concussion symptom during childhood and adolescence.  

This study is openly available here: https://www.mdpi.com/2313-576X/4/3/35  

Emma Sartin (she, her, hers), PhD, MPH, CPST is a Postdoctoral Research Fellow at the Center for Injury Research and Prevention at Children’s Hospital of Philadelphia.