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Jeffrey Scott Delaney is an associate professor and research director at the department of emergency medicine at McGill University Health Centre

Health-care professionals and researchers who deal with patients on a day-to-day basis know that changing human behaviour can be a difficult task. You might expect, if you explain how dangerous behaviour can result in immediate, and possibly long-term, negative effects, most people would decide to stop such behaviour. Unfortunately, this is often not the case. Many Canadians still make the decision to drink and drive, or text and drive or consume a diet high in fat and calories. These are only a few examples of behaviour that continues despite the potential negative consequences. This type of behaviour is also seen in athletes with concussions.

On Tuesday, the Research Institute at the McGill University Health Centre published a study titled "Why Professional Football Players Chose Not to Reveal Their Concussion Symptoms during a Practice or Game." We examined 454 CFL players and planned and completed the study in conjunction with the CFL league office and the CFL Players Association (CFLPA).

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Our research revealed that around 25 per cent of the football players believed they had suffered a concussion while playing football during the 2015-16 season. Unfortunately, around 80 per cent of these athletes decided not to seek medical attention for a concussion at least once during the 2015-16 season.

Common reasons for deciding not to seek medical attention included fear of letting the team down by being removed from the game and not feeling the concussion was serious enough to be a danger to their health. Some players stated they normally would have sought medical attention, but the concussion occurred during an important game, so they did not seek care at the time.

This type of risky behaviour is not unique to professional football players. The results and reasons for hiding concussions among CFL players are almost identical to a recent study asking the same questions of male and female university athletes participating in a variety of sports.

This type of behaviour is occurring at a time when athletes have never been better educated about concussions. Fifteen to 20 years ago, our research showed that roughly four out of five of university and professional athletes would not have recognized the symptoms of a concussion if they had one. Players today are more knowledgeable about the signs, symptoms, dangers and treatment guidelines for concussions, but often seem to disregard this knowledge at the time of the injury. Only 20 per cent of players in our study always reported their concussion to the team medical staff and around 6 per cent of players who said they would get medical attention after the game actually did.

How can we change the behaviour of athletes if concussion education and presentation of the facts is not enough? What has to happen to effect change and get athletes to take concussions at least as seriously as they would a broken bone?

Should we look at adapting a new approach; one that is more visual and graphic? This approach has been used to educate about the dangers of smoking, with graphic warning labels and photos placed on cigarette packages. Would it be useful to place an image of a damaged brain on the back of protective headgear or on posters in the change rooms? Would it make a difference?

While fear can be effective in provoking a change in behaviour, it must be balanced to keep from scaring people from involvement in sport. Participation in sport should be encouraged, as it provides both physical and psychological benefits for an individual.

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The athletes, coaches and medical staff at McGill have taken initiative and steps to eradicate the stigma that surrounds concussion disclosure by signing a preseason concussion contract. Although there are no legal implications, we ask athletes and coaches to read an information package about the signs, symptoms and dangers of concussions.

Whether concussion contracts will result in a significant improvement in players' health will need to be studied. Even if these contracts result in a few more athletes each year being more forthcoming and honest about their concussions, they will be a success.

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