Micky Olutende, Anthony Muchiri Wangui, Maximilla Wanzala, Edwin Kadima Wamukoya


Objective: The objective of the study was to determine the level of concussion knowledge and attitudes among sub-elite rugby union players in Western Kenya. Design: The study was a descriptive cross-sectional study and Quantitative methods were adopted. Setting: The study was carried out in Western Kenya Sample: The respondents were Sub elite rugby players who were randomly sampled from various rugby clubs in the region (n = 209) Analysis: Data was analyzed through descriptive statistics, confirmatory factor analysis and one-way analysis of variance (ANOVA). Main outcome measures: Concussion knowledge and attitude Results: Results from the Confirmatory factor analysis yielded a 22-item two-factor structure. The results showed a non-significant chi-square result, therefore, indicating good fit, the goodness of fit index (GFI), comparative fit index (CFI), and incremental fit index (IFI) had valued above .90 hence indicating a good fit. Root mean square error of approximation (RMSEA) that normally exceeds .1 warrants rejecting the model, however, our value was  .05 indicating close fit. Cronbach’s alpha for the 14-items Knowledge scale and 8-items attitude scale were α = .702 and α = .728. Deleting construct items did not increase the alpha. The mean concussion knowledge score was 20.94 out of 27 (95% CI 20.7 to 21.2, ± 2.02), 90% (n=188) correctly said that there was a possible risk of death if a second concussion occurred before the first one had healed. 49.3% (n=103) correctly answered that people who have had one concussion were more likely to have another concussion. In addition, 71.3% (n=149) correctly answered that, in order to be diagnosed with a concussion, a person didn't have to be knocked out. However, only 30% (n=63) answered correctly that after a concussion occurs, brain imaging (e.g., CAT Scan, MRI, X-Ray, etc.) does not show visible physical damage (e.g., bruise, blood clot) to the brain. With regards to attitude, most players had a negative attitude (n=122, 58%), many rugby players (48.8%, n=102) strongly disagreed that they would continue playing the sport while also having a headache that resulted from a minor concussion. Many strongly agreed (58.9%, n=123) that coaches need to be extremely cautious when determining whether a rugby player should return to play. The majority strongly disagreed (75.1%, n=157) that concussions are less important than other injuries. The independent between-group ANOVA yielded a statistically significantly effect, F (3, 202) = 3.158, p = .026, ƞp2= .045. Thus, the null hypothesis of no significant differences in concussion knowledge among sub-elite rugby players of different National team caps was rejected, however, only 5% of the variance (small effect size) in knowledge was accounted for by group membership. Conclusion: Action should be taken to better educate athletes and to ensure a change in attitude, proper recognition and management of concussions.


Article visualizations:

Hit counter



head injuries, education, symptoms, traumatic brain injury rugby, concussion, sport injuries, Western Kenya, knowledge, attitude, confirmatory factor analysis, sub elite

Full Text:



Arbuckle, J. L. (2012). IBM SPSS Amos 21. Amos Development Corporation, Chicago, IL. Conceptualization and Measurement (ed. R. L. Schalock), American Association on Mental Retardation, Washington, DC, 105–119

Bailes, J. E. (2009). Sport-related concussion: What do we know in 2009 – A neurosurgeon’s perspective. J Int Neuropsych Soc, 15(4), 509-511. []

Browne, M. W., & Cudeck, R. (1989). Single sample cross-validation indices for covariance structures. Multivariate Behavioral Research, 24, 445–455

Buzzini, S. R., Guskiewicz, K. M. (2006). Sport-related concussion in the young athlete. Curr Opin Pediatr, 18(4), 376–382

Cusimano, M. D. (2009). Canadian minor hockey participants’ knowledge about concussion. Can. J. Neurol. Sci. J. Can. Sci. Neurol, 36, 315–320

Echemendia, R. J., Putukian, M., Mackin, R. S., Julian, L. J., & Shoss, N. (2001). Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clinical Journal of Sports Medicine, 11, 23–31

Erlanger, D., Feldman, D., Kutner, K., Kaushik, T., Kroger, H., Festa, J., et al. (2003). Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision making. Archives of Clinical Neuropsychology, 18,293–316

Harmon, K. G., Drezner, J. A., Gammons, M., et al. (2013). American Medical Society for Sports Medicine position statement: Concussion in sport. Br J Sports Med, 47(1),15-26. []

Haseler, C. M., Carmont, M. R., England, M. (2010). The epidemiology of injuries in English youth community rugby union. Br J Sports Med, 44(15), 1093-1099. []

Hecimovich, M., King, D., Marais, I. (2016). Player and parent concussion knowledge and awareness in youth Australian Rules Football. The Sport Journal. [Accessed 10 January 2019]

Hollis, S. J., Stevenson, M. R., McIntosh, A. S., et al. (2012). Compliance with return-to-play regulations following concussion in Australian schoolboy and community rugby union players. Br J Sports Med, 46(10),735-740. []

Jansen van Rensburg, M. (2013). Concussion knowledge and practice among role players in primary school rugby in the North West Province. Unpublished Master’s Dissertation. Bloemfontein: University of the Free State

Jessica, W., Tracey, C., Sally, N., Daniel, G., Jeffrey, K., (2017) Knowledge of Concussion and Reporting Behaviors in High School Athletes With or Without Access to an Athletic Trainer. Journal of Athletic Training, 52(3), 228–235. [doi: 10.4085/1062-6050-52.1.07]

Kaut, K. P., DePompei, R., Kerr, J., Congeni, J. (2003). Reports of head injury and symptom knowledge among college athletes: implication for assessment and educational intervention. Clin J Sport Med, 13(4), 213–221

Kirk, B., Jamie N. P., Rosanna, C., and Shaun, M. P. (2018). Concussion in University Level Sport: Knowledge and Awareness of Athletes and Coaches. Sports, 6, 102 [doi:10.3390/sports6040102]

Kraak, W. J., Bernardo, B. A., Gouws, H. A., Loubser, A., Vuuren, J. O., Coetzee, M. C., (2018). Concussion knowledge and attitudes amongst Stellenbosch University hostel rugby players. S Afr J Sports Med,30:1-5. [DOI: 10.17159/2078-516X/2018/v30i1a4404]

Kroshus, E., Daneshvar, D. H., Baugh, C. M., et al. (2014). NCAA concussion education in ice hockey: An ineffective mandate. Br J Sports Med, 48(2),135-140. []

Livingston, S. C., & Ingersoll, C. D. (2004). An investigation of collegiate athletes’ knowledge of concussions. Journal of Athletic Training, 39(Suppl. 2), S17–S18

McCrea, M., Hammeke, T., Olsen, G., Leo, P., Guskiewicz, K. (2004). Unreported concussion in high school football players: Implications for prevention. Clin. J. Sport Med. Off. J. Can. Acad. Sport Med. 2004, 14, 13–17

McCrory, P., Johnston, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., et al. (2005). Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Clinical Journal of Sports Medicine, 15, 48–55

McCrory, P., Meeuwisse, W., Johnston, K., et al. (2008). Consensus statement on concussion in sport the 3rd International Conference on concussion in sport, held in Zurich. J Clin Neurosci,16, 755-763

McCrory, P., Meeuwisse, W. H., Aubry, M., et al. (2012). Consensus statement on concussion in sport: The 4th International Conference on concussion in sport held in Zurich.Br J Sports Med, 47(5), 250-258. []

O’Connell, E., Molloy, M. G. (2016). Concussion in rugby: knowledge and attitudes of players. Ir J Med Sci,185(2), 521-528. [doi: 10.1007/s11845-015-1313-6]

Paolo, B., Michele, B., Cesare, G., Fabio, R., Riccardo, C., & Raimondo, P. (2011).Rugby Players’ Awareness of Concussion. J Craniofac Surg,22, 2053-2056

Pfister, T., Pfister, K., Hagel, B., Ghali, W. A. Ronksley, P.E.(2016). The incidence of concussion in youth sports: A systematic review and meta-analysis. Br. J. Sports Med, 50, 292–297

Register-Mihalik, J. K., Guskiewicz, K. M., Valovich, McLeod, T. C., Linnan, L. A., Mueller, F. O., Marshall, S. W. (2013). Knowledge, attitude, and concussion reporting behaviors among high school athletes: a preliminary study. J Athl Train, 48(5), 645–653

Rosenbaum, A. M., Arnett, P. A. (2010). The development of a survey to examine knowledge about and attitudes toward concussion in high-school students. J Clin Exp Neuropsychol,32, 44–55

Rosenbaum, A. M., Arnett, P. A. (2010). The development of a survey to examine knowledge about and attitudes toward concussion in high-school students. J Clin Exp Neuropsychology, 32(1), 44-55. [doi: 10.1080/13803390902806535]

Sefton, J. M. (2003). An examination of factors that influence knowledge of and reporting of head injuries in college football. Unpublished master’s thesis, Central Connecticut State University, New Britain, USA

Shuttleworth-Edwards, A. B., Noakes, T. D., Radloff, S. E., et al. (2008). The comparative incidence of reported concussions presenting for follow-up management in South African Rugby. Union. Clin J Sports Med, 18(5), 403-409. []

Simonds, C. B. (2004). Development of a Questionnaire to Assess Knowledge and Attitudes about Concussion and Return to Play Criteria in College Athletes. [PhD Dissertation]. Philadelphia, PA: La Salle University

Sye, G., Sullivan, S. J., & McCrory, P. (2006). High school rugby players’ understanding of concussion and return to play guidelines. British Journal of Sports Medicine, 40, 1003–1005

Sye, G., Sullivan, S. J., McCrory, P. (2006). High school rugby players’ understanding of concussion and return to play guidelines. Br J Sports Med, 40(12),1003-1005. []

Viljoen, C. T. M., Schoemman, C., Brandt, et al. (2017). Concussion knowledge and attitudes among amateur South African rugby players. S Afr J Sports Med, 29(1), 1-6. [doi: 10.17159/2413-3108/2015/v27i2a492]

Viljoen, W., Patricios, J., Boksmart. (2012). Implementing a National Rugby Safety Programme. Br J Sports Med, 46(10), 692-693. []

Walker, S. P. (2015). Concussion knowledge and return-to-play attitudes among sub elite rugby union players. S Afr J Sports Med, 27(2), 50–54. [doi: 10.7196/SAJSM.536]

Walker, S. P. (2015). Concussion knowledge and return-to-play attitudes among subelite rugby union players. S Afr J Sports Med, 27(2), 50-54. [DOI:10.7196/SAJSM.536]

Wang, L., Fan, X., & Willson, V. (1996). Effects of nonnormal data on parameter estimates and fit indices for a model with latent and manifest variables: An empirical study. Structural Equation Modeling, 3, 228–247

White, P. E., Newton, J. D., Makdissi, M., et al. (2014). Knowledge about sports-related concussion: Is the message getting through to coaches and trainers? Br J Sports Med,48(2),119-124. []


  • There are currently no refbacks.

Copyright (c) 2019 Micky Olutende, Anthony Muchiri Wangui, Maximilla Wanzala, Edwin Kadima Wamukoya

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2019 - 2023. European Journal of Public Health Studies (ISSN 2668-1056/ISSN-L 2668-1056) is a registered trademark of Open Access Publishing Group. All rights reserved.

This journal is a serial publication uniquely identified by an International Standard Serial Number (ISSN) serial number certificate issued by Romanian National Library. All the research works are uniquely identified by a CrossRef DOI digital object identifier supplied by indexing and repository platforms. All the research works published on this journal are meeting the Open Access Publishing requirements and standards formulated by Budapest Open Access Initiative (2002), the Bethesda Statement on Open Access Publishing (2003) and Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (2003) and can be freely accessed, shared, modified, distributed and used in educational, commercial and non-commercial purposes under a Creative Commons Attribution 4.0 International License. Copyrights of the published research works are retained by authors.