"Easy when everyone is on board": Implementing a framework for managing concussions in New Zealand secondary schools

Abstract

We implemented a FRAmework for maNaging Concussions in 12 New Zealand secondary Schools (FRANCS) in 2022 and 2023. The aims of this study were to describe the characteristics of students with concussion utilising the framework and to assess the implementation outcomes as reported by the school stakeholders. Assistant research fellows (ARFs) met weekly with students with concussion, assessing the mechanism of injury and concussion-related symptoms. An implementation survey was administered to school staff at the end of each year. Demographic data, concussion characteristics, and implementation outcomes were summarised. Open-ended survey questions were analysed using content analysis. Eighty-two students (23 girls) diagnosed with a concussion met with the ARFs. Most concussions were sports related (89%). The Mdn (range) Concussion Symptom Score at the first and last meetings were 22/75 (0, 53, n = 84) and 6/75 (0, 55, n = 31) respectively. Twenty-one of 24 school stakeholder ratings suggested that FRANCS was successfully implemented, and 22 would use FRANCS beyond project completion. Support provided by the ARFs and FRANCS’ processes were highly valued. Challenges included lack of time and inconsistent buy-in from some students, parents, staff, and coaches. FRANCS can be adapted to individual schools’ contexts and buy-in, and good communication processes are needed from all members of the school community to sustain the processes.