Parents can play an important role in evidence-based concussion management by (1) monitoring their child's activity and level of stimulation, (2) communicating with school personnel about potential need for short-term academic accommodations, and (3) ensuring their child does not return to contact or collision sport prematurely and risk greater injury. However, not all parents follow these evidence-based guidelines, in part due to health literacy deficits, and further compounded by the poor fit and inconsistent implementation of educational materials. The initial medical encounter following a concussion provides an important opportunity for evidence-based knowledge translation to parents. Families at risk of low health literacy most often seek initial post-concussion care in emergency departments (ED) and often do not follow-up with a primary care provider or concussion specialist. Knowledge translation to parents in the ED is often inconsistent in terms of content and delivery, and existing approaches often do not meet the needs of families with low health literacy. The Agency for Healthcare Research and Quality's (AHRQ) Re-Engineered Discharge (RED) Toolkit provides an evidence-based approach to supporting the implementation of parent education that has not as yet been adapted for use post-concussion in the ED setting.
Aim 1 : Develop toolkit to support evidence-based parent education post-concussion in the ED. Guided by the Consolidated Framework for Implementation Research, we will adapt the AHRQ RED Toolkit to facilitate post-concussion parent education in the ED. The evidence-based parent education to be shared will be the CDC Acute Concussion Care Plan, adapted to meet learning needs of parents with low health literacy and limited English proficiency. We will use parent and provider interviews to iteratively develop the implementation toolkit (provider training, checklists, EHR support, downloadable parent materials) in consultation with an advisory board comprised of providers and parents.
Aim 2 : Conduct a hybrid implementation-effectiveness evaluation of the educational intervention. Guided by the RE-AIM framework, our primary outcomes will be the reach, acceptability, and implementation of the post-concussion education intervention. We will also explore whether successful implementation is associated with (1) improved parent knowledge and self-efficacy related to helping their child adhere to CDC guidelines for returning to daily activities, school and sports, and (2) decreased disparity in knowledge and self- efficacy between high and low health literacy parents. Achieving these aims will result in a scalable approach to the implementation of the CDC's ACE Care Plan in the pediatric ED post-concussion. If parents are better able to follow evidence-based guidelines for concussion, they will better advocate and care for their children, and this should improve outcomes for all youth. More broadly, achieving these aims will provide a model for engaging low health literacy parents in adapting evidence-based educational practices for implementation in ED settings.

Public Health Relevance

Inconsistent implementation of concussion education for parents in Emergency Department settings contributes to inequities in post-concussion outcomes for youth. This project seeks to develop an implementation toolkit for evidence-based parent concussion education in the Emergency Department based on the Agency for Healthcare Research and Quality's Re-Engineered Discharge (RED) Toolkit. A pilot hybrid implementation effectiveness evaluation of the adapted intervention will subsequently be conducted.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Exploratory/Developmental Grants (R21)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Conwit, Robin
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Seattle Children's Hospital
United States
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