How do coaches talk about tackling? using the theory of planned behavior to explore coach communication with youth football and soccer players about physical contact in sport

Abstract

Physical contact such as tackling is a part of youth sport, but associated with concussion risk. Coach communication with athletes about how to approach contact could be a strategy to reduce concussion risk. We interviewed n = 50 adult stakeholders (coaches, referees and administrators) in youth football and soccer to identify barriers and facilitators to coach communication about contact. We framed interviews using the Theory of Planned Behavior, discussing: knowledge/experience, attitudes/beliefs, norms/values and perceived behavioral control. Stakeholders could easily describe ‘good’ contact (knowledge/experience) like keeping your head up (football) and tackling shoulder-to-shoulder (soccer), and ‘bad’ contact like spearing (football) and retaliating against an opponent (soccer). They also talked about the importance of sportsmanship and playing by the rules. Most coaches believed ‘bad’ contact was associated with greater injury (attitudes/beliefs). Coaches felt responsible for managing contact (norms/values), but also described not receiving any information indicating that this was part of their role. Coaches worried about creating a fear of injury, and felt it was important for discussions to be framed positively (perceived behavioral control). In summary, youth football and soccer coaches believe ‘bad’ contact is associated with greater injury risk and feel it is their role to provide youth guidance about contact, but describe a lack of institutional guidance regarding this role. They also are concerned about barriers, including creating fear, and describe ways to address this barrier with language. Developing programs to support coach communication about contact with youth athletes presents a potential strategy for concussion prevention.

KEY MESSAGES

• Youth football and soccer coaches know that some contact (like head-to-head tackling) is associated with greater risk of injury, particularly concussion.

• Coaches feel responsible for teaching youth approaches to tackling and other sport contact that have a lower risk for injury, but most are not provided guidelines for how to do this.

• Coaches feel it is important to frame messaging positively, e.g. ‘lead with your shoulders’ rather than ‘keep your head down’.

• Instructing coaches regarding how to teach ‘good’ contact in sport is a potential strategy for injury prevention.

Keywords:

• Brain concussion
• health communication
• qualitative research
• youth sports
• theory of planned behavior

Reviewing Editor:

• Joe Homas
• Institute of Health and Management
• Australia

SUBJECT:

• sports coaching
• risk communication
• health communication
• health & society
• public health policy and practice

Acknowledgements

We would like to thank the youth coaches, referees and administrators in Washington and Georgia without whom this study would not have been possible.

Author contributions

Sara Chrisman applied for and received grant funding to carry out the study (MPI), developed and refined the structured interview, oversaw data collection and analysis including interpretation of results, and generated the final manuscript.

Emily Kroshus worked alongside Dr. Chrisman to apply for and received grant funding (MPI) to carry out the study, participated in the generation of the structured interview and data analysis, and reviewed and edited the final manuscript.

Rachel Hays supported development of the structured interview, coordinated all data collection and participated in analysis and interpretation, supporting several research coordinators to carry out data coding and synthesis, and reviewed and edited the final manuscript.

Erin Kinney helped refine the structured interview, conducted interviews of participants in Washington, engaged in data coding and synthesis, and reviewed and edited the final manuscript.

Kiana Hafferty helped refine the structured interview, conducted interviews of participants in Washington, engaged in data coding and synthesis, and reviewed and edited the final manuscript.

Beth Bollinger supported data analysis and interpretation, and reviewed and edited the final manuscript.

Tamerah Hunt oversaw data collection in Georgia including completing some of the interviews, participated in data analysis and interpretation, and reviewed and edited the final manuscript.

Nicole Walden conducted interviews of participants in Georgia, engaged in data coding and synthesis, and reviewed and edited the final manuscript.

Stephanie Fletcher conducted interviews of participants in Georgia, engaged in data coding and synthesis, and reviewed and edited the final manuscript.

George Chiampas assisted with development of the grant for funding, provided support and engagement for data collection, helped develop the structured interview, participated in data interpretation, and reviewed and edited the final manuscript.

Dane Ramshaw assisted with development of the grant for funding, provided educational resources for the study to assist with data collection, developed conceptual model materials, and reviewed and edited the final manuscript.

Kirsten Senturia oversaw all qualitative data collection including development of the structured interview, training and supervision of research coordinators to complete data coding and synthesis, and engagement with final data interpretation, including reviewing and editing the final manuscript.

Ann Glang supported development of the grant for funding, worked with MPIs Kroshus and Chrisman to engage coaches and other key stakeholders, participated in data analysis and interpretation and reviewed and edited the final manuscript.

Disclosure statement

Dr. Chiampas is chief medical officer for U.S. Soccer. The authors otherwise have no conflicts of interest to declare.

Data availability statement

The authors have agreed to make data and materials supporting the results or analyses presented in this paper available upon reasonable request.

Additional information

Funding

This work was made possible by a grant from the Centers for Disease Control and Prevention, U01CE002880

Notes on contributors

Sara P. D. Chrisman

Drs. Chrisman and Kroshus are researchers at Seattle Children’s Research Institute and have worked together for several years to develop a novel injury prevention program (Huddles), in partnership with US Soccer. Dr. Chrisman is a pediatrician, epidemiologist and physician scientist and Dr. Kroshus is a social scientist and implementation specialist.

Emily Kroshus

Drs. Chrisman and Kroshus are researchers at Seattle Children’s Research Institute and have worked together for several years to develop a novel injury prevention program (Huddles), in partnership with US Soccer. Dr. Chrisman is a pediatrician, epidemiologist and physician scientist and Dr. Kroshus is a social scientist and implementation specialist.