Sport, healthcare and educational organisations’ perceptions of a framework for managing concussion in New Zealand schools: a qualitative study

Marelise Badenhorst; Debbie Skilton; Anja Zoellner; Patricia Lucas; Danielle M. Salmon; Simon Walters; Kate Mossman; Sierra Keung; Kylie Thompson; Gisela Sole

doi:10.1071/HC24190

RESEARCH ARTICLE (Open Access)

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Sport, healthcare and educational organisations’ perceptions of a framework for managing concussion in New Zealand schools: a qualitative study

Marelise Badenhorst ¹ , Debbie Skilton

¹ , Anja Zoellner

¹ , Patricia Lucas

¹ , Danielle M. Salmon ² , Simon Walters

¹ , Kate Mossman ³ , Sierra Keung ¹ , Kylie Thompson ¹ , Gisela Sole

³ ^*

+ Author Affiliations

- Author Affiliations

¹ Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand.

² Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand.

³ Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.

^* Correspondence to: Gisela.sole@otago.ac.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 17(3) 251-258 https://doi.org/10.1071/HC24190

Submitted: 21 December 2024 Accepted: 16 June 2025 Published: 3 July 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Concussion guidelines exist for Aotearoa New Zealand schools for safe return-to-learn/sports, yet are infrequently implemented. We previously co-designed a framework for managing concussion in schools with school and sports stakeholders and students with concussion and their parents, and piloted the framework in 12 schools.

Aim

We explored perceptions of key national, regional, and local stakeholders regarding the value of a FRAmework for maNaging Concussion in Schools (FRANCS) and develop recommendations for wider-scale implementation.

Methods

Using Participatory Action Research, we invited representatives from national and regional healthcare, education, and sporting organisations to participate in semi-structured interviews and focus groups. Forty-five participants were included, and we used thematic analysis for the data.

Results

We defined three main themes. The first theme, ‘the school–sport–healthcare nexus’, describes the intersection of existing school, sport, and healthcare contexts for management of students with concussions. The second theme, ‘FRANCS opportunities and refinement’, centred on participants’ perceptions of factors of the framework that may influence its implementation. The third theme, ‘making it work on a larger scale’, related to the need for coordinated efforts and collaborations among various agencies and stakeholders to support a national roll-out.

Discussion

Participants believed there was high value in a national adoption of FRANCS to address significant challenges faced by schools in supporting students with concussion. Competing priorities, concussion knowledge and beliefs, resources, and existing policies were identified to potentially influence wider implementation.

Keywords: concussion, education, implementation, perceptions, return to learn, return to sports, secondary schools, sports organisations.

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