Athletic trainers need to understand the knowledge and perceptions of secondary-school administrators. This information is critical for future employment and the quality of health care that is available to student athletes at our nation’s secondary schools.
Concern about legal liability is an important issue for secondary-school administrators, but they have an inaccurate perception of the role and importance of athletic trainers in reducing liability.
The NATA Secondary School Athletic Trainers’ Committee should focus more efforts on secondary-school administrators and the positive impact that certified athletic trainers can have on students and health care in secondary schools. Key Words: survey, high school, liability
Key Points
Key Points
Secondary-School Administrators’
Knowledge and Perceptions of Athletic Training
TRENTON E. GOULD, MS, ATC, and RICHARD G. DEIVERT, PhD, ATC • Ohio University
T
he National Athletic Trainers’ Association(NATA) recently celebrated its 50-year anniver-sary as the national governing body of the U.S. athletic training profession. According to O’Shea, the NATA was established to “build and strengthen the profession of athletic training through the exchange of ideas, knowledge, and meth-ods of athletic training” (as cited in Delforge and Behnke1,p53) Many
events have occurred over those decades that have contributed to the maturation of the ath-letic training profes-sion. Development of the athletic training major and curriculum, development of the NATA Board of Certifi-cation exam, and ac-creditation require-ments for all entry-level athletic training pro-grams through the Commission on Ac-creditation of Allied Health Education Pro-grams have advanced the profession.1 As a
result, the athletic trainer’s job has evolved into that of a highly technical, well-educated, allied health-care pro-fessional, recognized by the American Medical Association in June of 1990.1-3
The Problem
The National Federation of State High School Associations (NFSHSA) issued a press release on September 14, 1999,4 stating that the
num-ber of students participating in athletics in our nation was at an all-time high. Currently, there are approximately 6.7 million student athletes participating in interscholastic athletics.5 It is
the position of the NATA that all secondary schools should provide the services of a full-time, on-site, certified athletic trainer (ATC) to student athletes.6 According to the December
2001 NATA membership statistics, there are ap-proximately 7,564 ATCs employed in either the high-school or the high-school/clinic setting.7
The disproportionately large number of sports participants in relation to these secondary-school employment statistics provides evidence of the need for ATCs at the secondary-school level. A thorough investigation should be con-ducted of the knowledge and perceptions of the secondary-school administrators who would hire athletic trainers at these institutions. These administrators include superintendents, prin-cipals, and athletic directors. Accurate knowl-edge and positive perceptions on their part could have a major impact on job growth in this market. Likewise, inaccurate knowledge coupled with poor perceptions of the athletic training profession could lead to lack of growth of employment in this setting. Therefore, the purpose of this study was to determine the ex-tent of knowledge and the nature of percep-tions about the athletic training profession among secondary-school superintendents, prin-cipals, and athletic directors in NATA District Four. The Ohio University Institutional Review Board approved this project.
Methods
Instrument
The instrument was designed to measure knowledge and perceptions of athletic training among secondary-school superintendents, principals, and athletic direc-tors. Ray8 and Pinciaro9 developed the questions
included on the survey used in this study. We updated some of the questions to more accurately depict the knowledge and perceptions held by the sample (e.g., the salary ranges were inconsistent with the NATA sal-ary survey). Two content-area specialists reviewed the survey to ensure content validity. The questionnaire was pilot tested for reliability on a group of 18 ATCs. The first five questions dealt with the knowledge base of the administrators: acknowledgment of the letic training profession, personal contact with an ath-letic trainer, familiarity with an athath-letic trainer’s job functions, awareness of the goals of the NATA, and the acknowledgment of professional recognition by the American Medical Association. The next 13 ques-tions dealt with the administrators’ percepques-tions of the job tasks, salary, liability, and the most accurate name for the profession. Answers to the last seven ques-tions provided demographic information about the administrators and their schools: age, gender, years of experience in the position, estimated number of athletes injured, sponsorship of football as an inter-scholastic sport, number of interinter-scholastic sports, and size classification of the school.
Sample
We enlisted the assistance of Clell-Wade Industries, a national publisher of all state high school athletic as-sociations’ handbooks for coaches. NATA District Four consists of six states: Illinois, Indiana, Michigan, Min-nesota, Ohio, and Wisconsin. We obtained handbooks from each state’s high school associations, selected a simple random sample of 10% of the public second-ary schools in each state, and mailed survey packets to the chosen schools.
Procedures
The survey instrument, consisting of 25 questions, was mailed to 1,095 administrators (10% of the pub-lic secondary-school administrators in each state in NATA District Four). A packet of three surveys was
mailed to each school, one each for the superinten-dent, the principal, and the athletic director. Each sur-vey included an attached explanation of the study and was given a letter designation for classification of administrative position (i.e., superintendents, S; principals, P; and athletic directors, A). The adminis-trators were instructed to return the surveys in the self-addressed, postage-paid envelope that was pro-vided. The state’s initials were coded on each return envelope so that the survey could be entered into the statistical software program by state and job descrip-tion.
Data Analysis
Statistical Package for Social Sciences (version 10, SPSS,
Inc., Chicago) software was used to generate descrip-tive statistics that formed background profiles of the respondents and to provide a summary of the ques-tionnaire responses. Multiple Kruskal–Wallis H tests, matching the category of administrative position with each question of the survey, were performed to test for significant differences. For each significant differ-ence, pairwise comparisons between group medians (Mann–Whitney U tests) were calculated to determine which administrative groups were different. We set alpha at .05 and performed a Bonferroni correction to control for overall error rate.
Results
Of the 1,095 surveys that were administered, 234 us-able surveys were returned (21% response rate). Cross-tabulation frequency reports (chi-square) were used to calculate percentages and to identify significant asso-ciations within the data (Table 1). Ohio provided the largest percentage of responses. The administrators most familiar with the functions of an ATC were the athletic directors (74%). There were 217 (93%) admin-istrators who reported personal contact with an ath-letic trainer. We asked what tasks were required of an ATC. The principals and athletic directors consistently responded with the greatest frequency of correct re-sponses for the most relevant tasks of athletic training. The Kruskal–Wallis ANOVA function revealed a signifi-cant difference (p < .05) between the job-description variable and the survey questions “Familiarity with job functions of an ATC” and “Perception that hiring an
Table 1. Cross-Tabulation Frequency Chart
of Job Description With Selected Questions
Superintendent Superintendent Superintendent Superintendent
Superintendent PrincipalPrincipalPrincipalPrincipalPrincipal Athletic DirectorAthletic DirectorAthletic DirectorAthletic DirectorAthletic Director TotalTotalTotalTotalTotal
State IL 14 18 15 47 IN 10 10 10 30 MI 9 17 18 44 MN 7 7 10 24 OH 16 18 17 51 WI 9 14 15 38 total 65 84 85 234
Most relevant tasks taping and bandaginga 56 81 81 218
ordering equipment 19 34 39 92
rehabilitation of injuries 64 83 80 227
fitting equipmenta 32 44 30 106
laundering uniforms 65 84 1 150
evaluating athletic injuries 63 81 82 226
field maintenance 65 1 1 67
Education level high school/some college 1 0 1 2
associate’s degree 17 20 21 58
bachelor’s degree 40 53 53 146
master’s degree 7 11 8 26
totalb 65 84 83 232
Salary required to employ ATCa <$20,000 3 6 17 26
$20,000–24,999 13 13 18 44
$25,000–29,999 15 27 24 66
$30,000–34,999 18 18 16 52
>$35,000 4 8 1 13
totalb 53 72 76 201
ax2 test of independence values was significant at p < .05. bValid n of less than 234.
ATC would reduce risk of liability” (Table 2). Pairwise comparisons demonstrated significant differences be-tween superintendents and athletic directors for both of these questions (Tables 3 and 4). A significant differ-ence was also found between principals and athletic directors for the survey question “Perception that hir-ing an ATC would reduce risk of liability” (Table 4).
We asked the respondents what level of education they thought was needed to be an ATC. Most thought that a baccalaureate degree was needed. According to individual total responses, both the principals and the athletic directors thought that a baccalaureate was
re-quired (Table 1). Superintendents thought that a higher salary would be required to hire an ATC than did prin-cipals and athletic directors. All administrators thought that an athletic trainer is the most qualified person to treat athletic injuries and chose the title “athletic trainer” as the name that best describes the profes-sion.
When asked how concerned they were about le-gal-liability issues in their schools, most administra-tors responded that they were very concerned. The administrators most concerned with these issues were the athletic directors (Table 1). Furthermore, we asked
Table 1. Cross-Tabulation Frequency Chart
of Job Description With Selected Questions
Superintendent SuperintendentSuperintendent
SuperintendentSuperintendent PrincipalPrincipalPrincipalPrincipalPrincipal Athletic DirectorAthletic DirectorAthletic DirectorAthletic DirectorAthletic Director TotalTotalTotalTotalTotal
Most qualified person athletic trainer 58 75 79 212
coach 0 3 2 5
health/physical educator 1 1 0 2
school nurse 2 1 0 3
other 2 2 2 6
totalb 63 82 83 228
Title best describing the profession athletic-injury specialist 7 10 11 28
athletic therapist 3 2 3 8 athletic trainer 47 59 65 171 massage therapist 0 1 1 2 physical trainer 2 4 2 8 sports therapist 4 5 1 10 trainer 0 1 1 2 totalb 63 82 84 229
Concern about liability very concerned 46 58 65 169
somewhat concerned 18 24 19 61
unconcerned 1 2 0 3
no response 0 0 1 1
total 65 84 85 234
Belief that hiring ATC reduces liabilitya high reduction 8 23 45 76
moderate reduction 36 45 31 112
low reduction 18 13 9 40
no reduction 3 3 0 6
total 65 84 85 234
School should hire ATC yes, full-time 9 14 18 41
yes, part-time 16 33 33 82
no 35 33 34 102
totalb 60 80 85 225
ax2 test of independence values was significant at p < .05. bValid n of less than 234.
the administrators whether they thought that hir-ing an athletic trainer would reduce the risk of liabil-ity in their schools. Almost half indicated that they thought it would moderately reduce their risk. The athletic directors thought that hiring an ATC would make a high reduction in risk. When asked whether they currently employed a full- or part-time athletic
trainer, 45.3% (n = 102) of the administrators an-swered no.
Discussion
Although we should not ignore the fact that the response rate was low, much information can be obtained from
these results for practical use. Two previous studies have examined the knowledge and attitudes of secondary-school administrators. Ray8
investigated the knowledge of superintendents in Michigan about ath-letic injuries, athath-letic trainers, and legal liability, and Pinciaro9
investi-gated the knowledge and attitudes of secondary-school athletic directors in Pennsylvania. Ray found that over 75% of superinten-dents perceived athletic trainers as the people most qualified to pre-vent and treat athletic injuries. In our study, over 92% (n = 57) of the superintendents in NATA District Four perceived athletic train-ers as most qualified. This suggests that NATA District Four, as a
Table 2. Kruskal–Wallis H-Test Results
Perception That Hiring an ATC Perception That Hiring an ATC Perception That Hiring an ATC Perception That Hiring an ATC
Perception That Hiring an ATC Familiarity WithFamiliarity WithFamiliarity WithFamiliarity WithFamiliarity With Would Reduce Risk of Liability
Would Reduce Risk of LiabilityWould Reduce Risk of Liability Would Reduce Risk of Liability
Would Reduce Risk of Liability Job Functions of an ATC Job Functions of an ATC Job Functions of an ATC Job Functions of an ATC Job Functions of an ATC
x2 30.066 21.094
df 2 2
p .000** .000**
**p < .01.
Table 3. Results of the Group Comparisons
for “Familiarity With Job Functions
of an ATC”
S–P S–PS–P S–P
S–P S–AS–AS–AS–AS–A P–AP–AP–AP–AP–A
Mann–Whitney U 2,317.50 1,724.00 2,803.50
Z –1.802 –4.596 –2.883
p .072 .000** .004**
Note. S–P = superintendents compared with principals; S–A = superintendents
compared with athletic directors; P–A = principals compared with athletic directors. **p < .01.
Table 4. Results of Group Comparisons
for “Perception That Hiring an ATC Would
Reduce Risk of Liability”
S–P S–PS–P S–P
S–P S–AS–AS–AS–AS–A P–AP–AP–AP–AP–A
Mann–Whitney U 2,141.50 5,711.50 2,598.50
Z –1.802 –4.596 –2.883
p .013* .000** .001**
Note. S–P = superintendents compared with principals; S–A = superintendents
compared with athletic directors; P–A = principals compared with athletic directors. *p < .05. **p < .01.
whole, has a better perception of ath-letic trainers than do superintendents in Michigan. Ray and Pinciaro found that most superintendents and athletic directors, respectively, in their studies were very concerned about legal-liabil-ity issues in their schools. Our study revealed that more than half the sur-veyed superintendents in NATA District Four (n = 46) were very concerned about legal-liability issues. It appears likely that secondary-school adminis-trators in District Four are as concerned about liability as administrators in Michigan and Pennsylvania are.
Pinciaro9 found that Pennsylvania
athletic directors had a reasonably ac-curate perception of the job functions of athletic trainers. According to our re-sults, athletic directors in District Four also have a reasonably accurate percep-tion of those job funcpercep-tions. Both Ray8
and Pinciaro9 found that few school
dis-tricts employ an athletic trainer (19.5% and 46%, respectively). More than half the administrators we surveyed in Dis-trict Four (54.7%, n = 102) answered that they currently employ either a full-or a part-time athletic trainer. In the decade that separates these studies, employment of athletic trainers appears to have increased. Administrators in Michigan and Pennsylvania, as well as those surveyed in NATA District Four, have an accurate perception of what ath-letic trainers do and how ATCs can re-duce their schools’ risk of liability (Table 1). Although 55% of the surveyed ad-ministrators represented school districts that employed an athletic trainer, there were still a large number (45%) that did not. The high number of responses in-dicating that schools do not employ ATCs suggests that administrators for those schools have not established student-athlete health care as a priority.
Employment in the secondary-school setting has always been an
important topic in the athletic training profession. The large number of secondary-school athletic programs in the nation that lack professional injury-prevention and -management services demonstrates the need for ATCs at the high school level. The number of stu-dents participating in high school athletics is now well over 6 million.10,11 A 1999 NFSHSA press release stated
that for the 10th consecutive year, participation in athletics had risen.4 Coincidentally, four of the six
states in NATA’s District Four are represented in the top 10 schools according to the NFSHSA participa-tion totals. These states are Ohio (4), Illinois (5), Michi-gan (6), and Minnesota (8). The large number of athletes participating in high school athletics, specifi-cally in NATA District Four, further establishes the need for ATCs at secondary schools. Injury is an inherent risk of participating in sports.11 With an increase in
participation in high school athletics, there would also be an associated increase in the number of athletic injuries.12,13 Because more than 6 million students
par-ticipate in athletics at nearly 20,000 schools each year, it has been estimated that these athletes account for more than 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations each year.12,14 Despite the
apparent need for student-athlete access to an ATC in the high school setting, many school administrators either do not recognize that need or do not consider it a high priority.
The NATA 1998 salary-survey results indicate that the average salary for a District Four athletic trainer (all clinical settings included) was $35,220. The aver-age salary for a high school athletic trainer (inclusive of all districts) was $30,533. Our survey revealed that $25,000–29,999 was the most often-reported salary range that the administrators thought would be ad-equate to employ a certified athletic trainer in Dis-trict Four. Unwillingness to provide a higher salary might be a contributing factor to the lack of ATC em-ployment in 45.3% of the surveyed schools.
Conclusions
The salary that administrators in District Four are willing to allocate for employing ATCs is insufficient. We are compelled to believe that this is a major fac-tor contributing to the low employment rate in this setting. We think that this study has shown that
ad-ministrators possess accurate knowledge of the ath-letic training profession, but we believe that they have an inaccurate perception of the value of athletic train-ing, as evidenced by inadequate compensation and low employment rates. Further research in this area is needed to characterize perceptions and opinions of administrators in other NATA districts as efforts con-tinue to expand the number of ATCs working in the high school setting ❚
References
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12. National Federation of State High School Associations. 1996 General
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Trent Gould is a doctoral candidate in curriculum and instruction at
Ohio University. His graduate assistantship allows him to work with the Ohio University Club Ice Hockey Team. He has been certified in the field for 5 years.
Rich Deivert is the coordinator of athletic therapy and the graduate
program director at Ohio University. He has been certified in the field for 20 years.
